Middle East Respiratory Syndrome (MERS) was one of three high-impact zoonotic coronavirus diseases with pandemic potential to have emerged in recent decades, alongside Severe Acute Respiratory Syndrome (SARS) in 2002 and COVID 19 in 2019, according to the World Health Organisation. Coronaviruses can cause illnesses ranging from the common cold to severe respiratory disease and even death.
Middle East Respiratory Coronavirus (MERS-CoV) was first identified in Saudi Arabia and Jordan in 2012. While formally identified in September that year, retrospective investigations showed the first cases occurred in Jordan in April 2012, while in Saudi Arabia, the first cases were reported two months later in June. According to WHO, the virus is zoonotic, with dromedary camels serving as the primary reservoir. Infected camels typically show no symptoms, so detection depends on laboratory testing.
By the time the MERS outbreak ebbed, 27 WHO member states had reported cases, with about 84% of all human infections recorded in Saudi Arabia. The most affected region was the Middle East where, aside from Saudi Arabia, the countries affected were Algeria, Bahrain, Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Tunisia, Türkiye, the UAE and Yemen.
Elsewhere, other WHO member states that reported MERS cases were Austria, China, France, Germany, Greece, Italy, Malaysia, the Netherlands, the Philippines, South Korea, Thailand, the UK, and the US.
Since 2015, reported cases have been sporadic and largely concentrated in the Arabian Peninsula, particularly in Saudi Arabia. Improved surveillance, patient triage, and infection-prevention and control measures have significantly reduced person-to-person transmission.
Since April 2012, and as of 2 March 2026, a total of 2,647 MERS cases, including 959 deaths, have been reported by health authorities worldwide, according to the European Centre for Disease Prevention and Control.
SARS déjà vu??
Before MERS made the headlines in Middle Eastern news outlets, a decade earlier the world had come to a grinding halt due to SARS. The disease infected 8,237 people in 37 countries between November 2002 and July 2003, with the majority of cases in Hong Kong. Unlike SARS, MERS does not appear to spread as quickly between people, but it does seem more deadly. Compared to SARS’ 9% fatality rate, the death rate for MERS was over 30%.
MERS raised serious public health concerns amid the approach of Ramadan in 2012 as millions of pilgrims were expected to travel to Saudi Arabia for Umrah. The outbreak triggered heightened claims scrutiny, renewed focus on pandemic exclusions, and a reassessment of health, travel and business interruption cover across the region.
Impact of MERS
MERS significantly affected the healthcare and insurance sectors in the Middle East, with the impact continuing to be felt today through healthcare and health insurance reform. The outbreak underscored the high costs of infectious diseases, highlighting the need for improved infection control in hospitals and shifting the focus towards managed care, business continuity planning, and increased preparedness among insurers and providers.
The impact can be categorised as follows:
- Life and health claims
The high case-fatality rate of MERS—estimated at approximately 35-40%—led to a noticeable spike in life insurance and critical illness claims, though the total volume remained manageable for the industry at large.
- Medical costs: Insurers faced increased payouts for intensive care unit (ICU) stays and mechanical ventilation, as MERS patients often required prolonged, high-cost hospitalisations.
- Targeted demographics: Claims were disproportionately tied to older males with underlying comorbidities (such as diabetes or renal disease), which prompted actuaries to refine risk profiles for these segments.
- Shift in underwriting and policy terms
The outbreak exposed gaps in how “infectious diseases” were treated in standard policies.
- Exclusion clauses: Many insurers began reviewing and tightening “Pandemic and Epidemic” exclusion clauses in Business Interruption (BI) and travel insurance policies to protect against future, larger-scale outbreaks.
- Health screenings: There was a temporary tightening of underwriting for applicants with pre-existing respiratory conditions or those working in high-risk sectors, such as healthcare and animal husbandry (specifically camel farming).
- Operational and strategic preparedness
Perhaps the most lasting impact was the strengthening of the insurance infrastructure in the region, particularly, health insurance.
- Digitalisation: The fear of contagion in healthcare settings (where most human-to-human transmission occurred) accelerated early interest in telemedicine and digital illness and healthcare databases.
- Regulatory focus: Regulators in the GCC began emphasising more robust solvency requirements and catastrophe modeling that included biological risks alongside traditional natural disasters.
- Healthcare partnerships: Insurers deepened their collaboration with healthcare providers to ensure strict infection control protocols were in place, as hospital-acquired transmission was a major driver of claims.
Saudi Arabia
MERS served as a significant stress test for the Middle East insurance market, particularly, Saudi Arabia. The authorities began a multi-year overhaul of the health insurance framework, focused on three strategic pillars:
- Definitions
Prior to MERS, there was significant ambiguity regarding coverage for “novel” infectious diseases. Regulators worked to standardise the language around “epidemics” to remove ambiguity.
- Stress tests
MERS served as a catalyst for the Saudi Central Bank, then known as Saudi Arabian Monetary Authority (SAMA), to require stress tests in the insurance sector.
In the refined solvency exercises (which have since become a permanent fixture), SAMA began requiring insurers to model “health pandemic” scenarios. This ensures that insurers hold enough technical reserves to stay solvent during an outbreak.
- Integrated surveillance
The MERS outbreak highlighted a breakdown in communication between private insurers and public health authorities. Regulators revamped the framework to include:
- Digital integration (NPHIES): The launch of the National Platform for Health and Insurance Exchange Services (NPHIES) is seen as accelerated by the lessons of MERS. This platform allows for real-time tracking of claims and diagnostic data, giving regulators an early-warning system for spikes in specific ICD-10 codes related to respiratory infections.
- Mandatory reporting: Insurance companies were brought into the national “One Health” surveillance loop, requiring them to share data on claims patterns that might indicate an emerging zoonotic threat (like MERS).
The prior experience with MERS in the Middle East, particularly in Saudi Arabia, provided a significant advantage in managing COVID-19, offering established surveillance systems and experience with coronavirus pandemic threats.
Like Saudi Arabia, other countries in the region strengthened their public health infrastructure, diagnostic capacity, and healthcare worker training to deal with MERS outbreaks, which allowed for a faster initial response to COVID-19.
Overall, Saudi Arabia showed that in a region prone to zoonotic threats, health insurance and health intelligence are a critical part of national biosecurity. M