In 2014, the Global Health Security Agenda was launched to accelerate progress toward implementation of the International Health Regulations (IHR) 2005, so that all countries are able to rapidly detect, respond to, and control public health emergencies [1,2]. This emphasized the role of Field Epidemiology Training Programs (FETP) to ensure global health security [3]. FETP is originally a 2-year training program in applied epidemiology that is established to produce well-trained multidisciplinary public health professionals who are competent in health surveillance systems, outbreak detection and response to health threats, and management of emerging and re-emerging diseases [4,5]. In recent years, the Ministries of Health in some countries have recognized the importance of strengthening the capacity of the public health workforce at all levels of the public health system. In response, a three-tiered “pyramid” model of training (ie, advanced: 2 years, intermediate: 9 months, and basic: 3 months) was adopted. However, only few countries had achieved the Joint External Evaluation target of having 1 trained field epidemiologist (or equivalent) per 200,000 people [6].

The current coronavirus disease (COVID-19) and the previous outbreak of severe acute respiratory syndrome raised concerns about the continued global vulnerability to infectious disease threats and the poor preparedness to respond to such threats [2,7]. This vulnerability underscores the need for field epidemiology workforce and capacity in all countries of the world at all levels of the health care and public health system.

The Eastern Mediterranean Public Health Network (EMPHNET) has helped to launch, establish, and support several FETPs in many countries in the Eastern Mediterranean Region (EMR). As service-based training programs implementing competency-based training under the supervision of qualified mentors/supervisors, FETPs are focused on building workforce capacity in public health surveillance, outbreak investigations, epidemiological methods, laboratory and biosafety, risk communications, health-related surveys, and evaluation of the impact of prevention and control programs. The programs are established within the Ministries of Health and have access to technical assistance from the Centers for Disease Control and Prevention.

In the EMR, FETP residents and graduates have contributed significantly to improvements in surveillance systems, control of infectious diseases, and outbreak investigations [8] and have been instrumental in controlling many past epidemics including Middle East respiratory syndrome (MERS) [9,10] and dengue fever outbreak [11]. During the current emergency, the FETP graduates played a key role in actions responding to COVID-19 including developing preparedness plans, supporting and evaluating the surveillance system to identify the gaps and needs, assessing the needs in health facilities for isolation rooms, case investigations, points of entry/arrivals screening and follow-up, quarantine and isolation protocols, transferring cases, risk communication, and training on infection control. FETP graduates in many EMR countries are currently members of different technical, advisory, and coordination committees that manage the COVID-19 threats in the region. Moreover, they are involved in developing/adapting local guidelines, protocols, and case definitions for health professionals to implement various interventions. Considering their instrumental roles during the COVID-19 crisis, this study aimed to assess the awareness and preparedness of FETP graduates in three EMR countries to respond to the COVID-19 pandemic.

This survey provides insight on the preparedness of FETP graduates from three EMR countries and their level of awareness of COVID-19 epidemiology at the time of the COVID-19 pandemic. The three programs had different durations since their establishment. The FETP graduates in Jordan were more likely to be in the response team against COVID-19 than their counterparts in Sudan and Yemen. This might be explained by the fact that both Sudan and Yemen were not reporting cases at the time of data collection. However, the FETP graduates were involved in preparedness activities for COVID-19. Males were predominant in the sample, which can be explained by the higher percentages of males who were enrolled in these program.

To conduct and respond to an infectious disease outbreak such as COVID-19, the FETP graduates should be aware of the basics of infectious disease including agents and hosts, mode of transmission, signs and symptoms, and control measures [12].

Knowing the COVID-19 incubation period is crucial for FETP graduates to protect themselves from the subclinical infection [13]. All respondents identified the correct incubation period of 1-14 days [14]. Almost all respondents were able to identify cough and fever as the main symptoms of COVID-19 [15].

Although the majority of respondents perceived COVID-19 as a dangerous infection, all reported that they have no problem with handling patients with COVID-19. This reflects the positive attitudes of FETP graduates toward patients with COVID-19 and their willingness to control the pandemic. This is not surprising because FETP residents and graduates are trained to conduct outbreak investigation and respond to public health threats. Moreover, this reflects their high level of confidence in dealing with patients with COVID-19 because all were aware of how to use personal protective equipment and perform isolation procedures on patients to minimize chances for exposure.

This study showed that the majority of respondents receive information about COVID-19 from the Ministries of Health. Reliance on the Ministry of Health data and reports reflects that the information they gain is credible. Therefore, Ministries of Health need to make sure that all essential information and educational materials are posted on the ministries’ website during the outbreak.

Half of the respondents gained information on COVID-19 from television and radio, Epishares, and social media. It is worth mentioning the EpiShares was identified as a source of information by many of the FETP graduates. Epishares is a networking platform powered by Global Health Development/EMPHNET [16]. The Epishares platform offers a space for public health professionals from the region and beyond to exchange ideas, discuss issues, share experiences, and share documents of interest. It functions like other social media channels, thus offering the ability to create pages and groups as well as share posts videos, photos, polls, documents, and more. Throughout the COVID-19 pandemic, the platform was used as a hub for news and knowledge and to provide regular updates from credible news sources about the pandemic. These updates are shared via a page on this platform dedicated to this purpose and titled “COVID-19 Updates.” Furthermore, the platform holds a group dedicated to FETP. The group serves as a private space for FETP directors, advisors, and support teams to share guidelines, reports, practices, and exchange ideas in the fight against this pandemic.