"The birds and viruses that could cause this flu are not political. They don’t observe national boundaries," he states matter-of-factly at the outset of the interview. "So we, the professionals who are responsible for the health of our peoples, cannot think in those terms, either."
Under Ramlawi’s supervision, the Palestinian Authority has established a national committee, composed of representatives of all of the relevant ministries and United Nations agencies, to determine which policies will be implemented at the various stages, phases and levels of threat.
"We are developing a comprehensive preparedness plan based on the guidelines issued by the World Health Organization (WHO)," he explains.
Ramlawi attaches particular importance to this "awareness committee."
"The Awareness Committee will present information, provide health education and promote health awareness, which will be supervised by high-level officials," he says. "Like every other country, we must find the balance between providing adequate information and retaining a proper perspective without causing panic."
While repeating several times that the threat, at this point, is still minimal and that there is no need for concern, Ramlawi does note that from the point of view of the Palestinian Authority, the areas that require particular surveillance are Jericho, the Gaza beach, and the Jordan Valley.
In addition, the Palestinian Ministry of Agriculture is particularly pro-active with regard to monitoring and inhibiting the importation of hazardous projects from high-risk areas.
At some stage, Ramlawi acknowledges, Palestinian officials were concerned about the availability of vaccinations for the general public. Initial World Health Organization guidelines called for an inoculation of 25 percent of the population.
"There is no way that we could have met this level of coverage," Ramlawi states. "And the Palestinian Authority would not have been the only country to have failed to meet this standard – drug companies could not possibly meet this demand.
"Furthermore, it’s not practical. And finally, medically, we really don’t have enough information on the implications of wide-spread inoculation, possible side-effects, and so forth," he says.
Current guidelines call for much lower rates of inoculation. Ramlawi believes his ministry could inoculate three percent of the population and has submitted a request to the Palestinian Authority to fund this project. The request has not yet been approved, but he says he is "very hopeful," and assures that the Palestinian Authority recognizes the severity of the situation.
Preparing for the Hajj
The Palestinian Authority is a member of a number of regional organizations that deal with the threat of avian flu and is a full-fledged member of a regional committee that includes some 23 countries in the region, including Saudi Arabia, Libya, Syria, Jordan, the Gulf States and others.
Interestingly, Ramlawi notes, while all of these countries intend to follow WHO guidelines, some of them do face particular challenges. Saudi Arabian officials, for example, are concerned about the upcoming Hajj, during which millions of pilgrims will descend on Mecca, thus creating greater risk for both the country and the pilgrims themselves.
The Palestinian Authority has encouraged residents who intend to travel to Saudi Arabia to inoculate themselves at their own expense, and says that injections are readily available.
Israel is not a member of this regional committee. Both the PA and Israel are, however, members of the Middle East Consortium for Infectious Disease Surveillance (MECFIDS), a group that also includes Egypt and Jordan and that has already convened several times, and is scheduled to meet again in Istanbul later this month.
According to Ramlawi, MECFIDS is composed of high-level professionals and officials, who discuss and try to reach agreements regarding the handling of shared issues, including travel, border control, transportation, tourism, and airport control.
The atmosphere in MECFIDS is completely collaborative and cooperative, Ramlawi says.
"We deal with prevention and control in an atmosphere of mutual concern for the welfare of the public and mutual respect for each other. There are no political overtones here, because we all realize that we need a real plan that takes everyone into account."
Such cooperation is especially necessary, for example, for residents of East Jerusalem, who have daily, sometimes simultaneous, contact with the Palestinian Authority and the Israeli authorities and frequent contact with the Jordanians.
"If we do not cooperate, or if we establish different standards, the public will simply not know how to respond and it will be a very dangerous situation," he observes.
For these reasons, MECFIDS has agreed on a unified health education campaign, focusing heavily on prevention. They have adopted a British educational program, which is currently being translated into Hebrew and Arabic. The program, he insists, is being translated almost literally.
"The British did a very good job, and there was no need to adapt the program to any particular cultural needs," he says. "We are able to simply translate the materials."
They have also agreed on the usage of primary preventative equipment, including masks, gloves and eyeglasses for staff and, if necessary, for the public and identical kits for lab technique, which will enable joint analysis and diagnosis for both humans and animals.
In the Palestinian Authority, the cost of these measures is being covered by a grant from USAID. In fact, Ramlawi says the only significant difference between the Palestinian and Israeli plans is funding.
"Israel has enough money to to provide wider coverage for its population in the event of a pandemic," he says.
Later this month, Palestinian and Israeli teams will be training together at Tel Hashomer hospital, which has been designated as a regional lab and accredited by the WHO as a referral lab.
"In the past, of course, there have been difficulties arranging training or joint efforts. But not now," Ramlawi says. "All of the permits, everything that the teams need to work together was arranged smoothly."
And so, both literally and figuratively, Palestinians and Israelis will be speaking the same professional language when it comes to preparation of and treatment for avian flu.
Ramlawi notes that as he attends regional and world meetings, he is confident the Palestinian Authority is properly and professionally prepared for any eventuality, but adds "now that the authorities have worked through the technical and organizational aspects of the issue, it is time to deal with the social aspects.
"We face many social questions and they are more interesting. We must begin to ask ourselves, what we should be recommending for schools? For supermarkets? How about public places? If there really is an epidemic – how could I prevent a mother from being with her child?"
These issues, he contends, have not received adequate attention and experts are now asking the WHO to develop guidelines for what he refers to as "social distancing, which have more social and political aspects and serious medical implications."
"This is where we will have to take culture into account," he concludes.
Article reprinted with permission from bridges' Israeli-Palestinian public health magazine sponsored by World Health Organization. Bridges is produced by Palestinian and Israeli academics and health professionals (www.bridgesmagazine.org )