As the BA.5 variant rapidly infects populations worldwide, Tunisia is facing its fourth wave of the COVID-19 pandemic, averaging nearly 5,000 new cases weekly and faring worse than neighboring Morocco, Algeria, and Egypt. Nevertheless, compared to the delta-variant peak in August 2021 (PDF), vaccination rates have increased, and COVID-related mortality is dropping.
Similar to other countries in the region, Tunisia has struggled to maintain social distancing without placing additional pressure on its already struggling economy (PDF). Although obligatory mask wearing in enclosed public spaces was mandated in August 2020, enforcement was minimal and the requirement was largely ignored by the public and those in leadership positions. After lifting curfews and easing initial restrictions on people's movements, the government strictly banned all public gatherings in January 2022.
Although Tunisia's health care system has been ranked among the strongest in the region, investments in the public health system (PDF)—that covers two-thirds of ambulatory care encounters and 90 percent of hospital encounters—have declined in the past 20 years and been directed instead toward private sector specialty outpatient care and medical tourism. Before the pandemic, Tunisia attracted approximately 15,000 medical tourists annually (PDF), mainly for dermatological treatments. The emphasis on financing the private health care system weakened the ability of the public system to manage the pandemic. For example, in Tunisia, ICU beds are unevenly distributed across the country, with the majority located in coastal regions. Moreover, only 410 intensive care physicians (PDF) work across the public and private hospital systems.
Nevertheless, the National Coronavirus Response Authority coordinated activities among the 24 governorates in Tunisia, coordinating with the Tunisian Observatory of New and Emerging Diseases (ONME), the Response and Relief Organization, and the Regional National Committees for Disaster Prevention. Municipal councils also established local crisis committees that could work with civil society organizations and local governments. Production of hand sanitizer was accelerated from 4 months to 15 days, La Rabta teaching hospital experimented with telemedicine to expand access to specialty care, and free transportation motivated Tunisians to donate blood. When access to PPE was limited early in the pandemic, private organizations banded together to donate equipment and raise funds from the estimated 6.9% of Tunisians who live abroad.
Unfortunately, political upheaval has overshadowed all public health responses and despite goals to vaccinate 50% of the public, donations lagged and distribution was uneven among the population. Observers warn that ongoing pressure from the pandemic and spikes in food and fuel prices may lead to a fiscal crisis by year's end.
Tunisia's response to the COVID pandemic, like those of other countries in the region, has been spotty, though vaccination rates have improved and mortality rates have dropped. When the political instability is factored in, Tunisia's emergence from the pandemic may not be quick.
Emily Hoch is a policy analyst at the nonprofit, nonpartisan RAND Corporation and Mahshid Abir is a senior physician policy researcher at RAND.
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