A University of the Hajj?

Every year, as many as 2·5 million Muslims from more than 160 countries gather for the 5-day Hajj in Mecca, Saudi Arabia, where population density can reach seven people per square metre. Protecting pilgrims from health risks in such a huge gathering is a great challenge, especially for the Saudi Ministry of Health (MOH). In 2011, the Hajj health system consisted of 141 primary care centres, 24 hospitals with 4964 beds, and more than 30 000 health-care professionals. Public health practices in the Hajj, including infectious disease surveillance, outbreak investigations, and mass vaccinations, require vigilance in addressing threats of emerging infectious diseases such as influenza H1N1, and MERS-CoV. The Saudi MOH starts preparation for the next Hajj immediately after the pilgrims' departure, using feedback from local and international health organisations that provided health services during the Hajj. Technical consultations are continuously sought with global public health agencies such as WHO and the US Centers for Disease Control and Prevention.

Infectious disease outbreaks that might spread globally when pilgrims return to their countries are the most worrying threats, and examples include the 1989 meningitis type A, and 2001 meningitis type W135 outbreaks. To prevent infectious disease epidemics, every pilgrim must present a vaccination certificate to get a Hajj visa. Yet the Saudi MOH has to depend on health authorities in other countries to implement public health regulations reliably. This might not be a problem for high-income countries with established health systems, but low-income and middle-income countries, where most Muslim pilgrims come from, could need assistance to implement the strict regulations. Assistance can take many forms, including provision of training to strengthen public health systems in pilgrims' host countries.

The need for Saudi Arabia to share experience of international health system strengthening is recognised, and global health diplomacy was suggested as a powerful tool to facilitate such a mission.1, 4 In global health diplomacy, public health professionals and diplomats work together as a team in decision making on global public health issues. To facilitate teamwork, diplomats and public health professionals need to be educated in an interdisciplinary environment that promotes shared learning and joint training to improve communication, collaboration, and cooperation. The Hajj is an exceptional environment for such a model, and Mecca Governor Prince Khalid Al-Faisal recently proposed to establish a Hajj University to serve as a focal point. The University, to be in Mecca, will provide education, training, and research to improve Hajj services. The University could benefit from the experience of the Graduate Institute of International Studies, Geneva, in global health diplomacy training, and other international and local public health institutes such as the Hajj research centre, the Saudi centre for disease control and prevention, and local universities. The proposed new University can be seen as an example of Saudi Arabian global health diplomacy, which could be beneficial in sharing experience of international health system strengthening to control potential global public health hazards, such as poliovirus in Pakistan.