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The COVID-19 transmission in the Eastern Mediterranean Region (EMR) was influenced by various factors such as conflict, demographics, travel and social restrictions, migrant workers, weak health systems, and mass gatherings. The countries that responded well to COVID-19 had high-level political commitment, multisectoral coordination, and existing infrastructures that could quickly mobilize. However, some EMR countries faced challenges due to political instability and fragile health systems, which hindered their response strategies. The pandemic highlighted the region’s weak health systems and preparedness, fragmented surveillance systems, and lack of trust in information sharing. COVID-19 exposed the disruption of access and delivery of essential health services as a major health system fragility. In 2020, the World Health Organization (WHO) conducted a global pulse survey, which demonstrated that the EMR experienced the highest disruption in health services compared to other WHO regions. However, thanks to prioritization by the WHO and its member states, significant improvement was observed in 2021 during the second round of the WHO’s National Pulse Survey. The pandemic underscored the importance of political leadership, community engagement, and trust and emphasized that investing in health security benefits everyone. Increasing vaccine coverage, building regional capacities, strengthening health systems, and working toward universal health coverage and health security are all priorities in the EMR. Emergency public health plays a key role in preparing for and responding to pandemics and biological threats. Integrating public health into primary care and investing in public health workforce capacity building is essential to reshaping public health and health emergency preparedness.

We develop a novel statistical approach to estimate topological information from large, noisy images. Our main motivation is to measure pore microstructure in 2-dimensional X-ray micro-computed tomography (micro-CT) images of ice cores at different depths. The pore space in these samples is where gas can move and get trapped within the ice column and is of interest to climate scientists. While the field of topological data analysis offers tools (e.g. lifespan cutoff and PD Thresholding) for estimating topological information in noisy images, direct application of these techniques to large images often leads to inaccuracies and proves infeasible as image size and noise levels grow. Our approach uses image subsampling to estimate the number of holes of a prescribed size range in a computationally feasible manner. In applications where holes naturally have a known size range on a smaller scale than the full image, this approach offers a means of estimating Betti numbers, or global counts of holes of various dimensions, via subsampling of the image.