Modeling the Potential Spread of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Evaluating Strategic Preparedness Measures in Thailand

Middle East respiratory syndrome (MERS) remains a public health threat due to its severity and potential for nosocomial and international transmission. Thailand remains at risk of a MERS outbreak due to ongoing travel, pilgrimage, and trade with the Middle East, despite having no confirmed case since 2016. This study aimed to assess the potential spread of MERS-CoV and evaluate national preparedness for MERS outbreaks by using a mixed-methods study. A quantitative study employed Susceptible-Exposed-Infectious-Recovered models to simulate the dynamics of MERS outbreaks under various scenarios in Yala, Pattani, and Narathiwat provinces. The qualitative component included documentary reviews and in-depth interviews with 21 key policymakers, experts, and relevant officers from provincial, sub-national, national, and international levels. The modeling revealed a low likelihood of widespread outbreaks, and combined interventions and early detection resulted in decreased peak and cumulative outcomes across various basic reproductive number values. Documentary reviews revealed that in Thailand, MERS surveillance was integrated into the national communicable disease surveillance, and its priority has diminished since 2016. In-depth interviews showed strengths in strategic plans, human resources, and cross-sector coordination, although gaps were identified in MERS-specific surveillance systems, laboratory surge capacity, insufficient community-level preparedness, and fragmented data systems. The results showed that Thailand has foundational capacity for MERS, supported by enhanced public health infrastructure following the COVID-19 pandemic. Recommendations include strengthening combined intervention and early detection measures, MERS-specific surveillance protocols, laboratory capacities, health literacy among high-risk groups such as pilgrims and caregivers, preparing sufficient resources, and enhancing digital health systems.