Published on Linkedin on April 5, 2026
A simple blood count is not a glamorous, high-tech, innovation-driven precision medicine, AI-powered solution. It is not the next shiny thing that makes investors and bureaucrats alike very excited. Yet every hospital in the Gulf runs hundreds, maybe thousands of them every day. Haematology panels, biochemistry screens, urine cultures, blood cultures, coagulation panels, the utterly unremarkable, essential machinery of clinical medicine. These tests inform clinical teams whether a patient is infected, anaemic, in renal failure, or bleeding internally, and allow them to act. These tests are so routine they are essentially invisible.
In the Gulf, the overwhelming majority of reagents used to run those tests are imported. And so is the machinery that runs them. And the algorithms that analyse them. And…
So while I am very focused on precision diagnostics and have stated repeatedly my conviction that the Arabian peninsula holds structural advantages for success and global leadership, the current geopolitical crisis made me reflect on the underlying supply and value chain. The Strait of Hormuz has come under heavy military and political pressure, with shipping severely restricted and contested; regional air routes have been disrupted; and the threat to Red Sea and Suez Canal traffic remains live. The Gulf states’ supply chains are under significant and sustained strain. In the news I hear discussions about oil, helium, LNG, urea – the flows that matter to the rest of the world. But what about the medical supply chain for the Gulf countries?
I argue here that building a Gulf-based diagnostics value chain is building sovereignty and competitiveness. The manufacturing infrastructure required to produce a haematology reagent kit is the same infrastructure required to produce a liquid biopsy assay. The ISO 13485-certified facility that fills PCR reagents can be scaled to fill next-generation sequencing consumables. The regulatory pathway for a routine biochemistry panel is, in its underlying logic, the pathway for a companion diagnostic. The difference between basic and advanced diagnostics is not a different supply chain, but a different position on the same supply chain. And the same technologies and reagents underlie food and environmental security value chains.
The Region Has Been Here Before
The Gulf’s vulnerability to external disruption is not new. It is a recurring condition with a long history.
As a Portuguese, I am taught how amazing and world-changing the discovery of a maritime route to India was. But in 1498, when Vasco da Gama rounded the Cape of Good Hope, he severed Arabia’s position as the world’s indispensable commercial intermediary. For a thousand years, most spices that reached a European table, most silk that crossed from Asia to the Mediterranean, had passed through Arab hands. The Incense Route, the Indian Ocean trade networks, the Abbasid knowledge economy — all of it rested on Arabia’s geographic centrality. Da Gama’s route didn’t destroy the region, but it marginalised it for four centuries by making it irrelevant to the economic flows that mattered at the time.
The parallel is not exact. But the structural logic is the same: a region that does not control the infrastructure of the flows it depends on is permanently exposed to disruption by actors with better options.
Fast forward five centuries and the disruptions have been coming faster.
In 2017, Qatar was blockaded by its immediate neighbours. Land borders closed overnight. Air routes severed. What arrived by land stopped arriving. It seems to me that Qatar drew a clear lesson, one that it has been building into its institutional architecture ever since, that regional interdependence only makes sense when paired with individual sovereign capability.
In 2020, COVID-19 exposed the diagnostic supply chain for what it was: a single point of failure. When demand for PCR reagents surged globally, the Gulf experienced the same shortage dynamics as other import-dependent regions, with local institutions forced to improvise. Manufacturing was concentrated in a handful of countries and allocation followed political relationships and domestic demand — countries that produced nothing received what was left. The consequences were immediate and clinical. In April 2020, Sidra Medicine in Doha — one of the most technically advanced clinical laboratories in the region — had to develop an alternative RNA extraction method from scratch because the global reagent supply had collapsed. Dr. Patrick Tang, Division Chief of Pathology, stated publicly that kit shortages were causing viral RNA degradation and false negatives, with the direct risk of releasing infectious individuals into the community [1]. In Saudi Arabia, researchers at Alfaisal University in Riyadh, facing the same import collapse, independently developed a rapid PCR test for COVID-19, noting explicitly that “test kits and many other vital medical resources are not manufactured in the region, forcing countries like Saudi Arabia to rely heavily on expensive imports” [2]. Two institutions in two countries arrived at the same conclusion by the same path: the supply chain had failed them, and they had to build their way out. But this seems to have been forgotten as supply chains normalised.
In 2021, a single container ship lodged sideways in the Suez Canal for six days disrupted an estimated $9.6 billion of trade per day [3]. Pharmaceutical and medical device shipments — moving along the primary route for European medical goods into the Gulf — stopped. Six days and one ship. No conflict, no pandemic, no politics.
In 2023 and 2024, Houthi attacks on Red Sea shipping forced major container lines to reroute around the Cape of Good Hope, adding ten to fourteen days and significant cost to every shipment. Diagnostic consumables, pharmaceutical intermediates, and medical devices were all affected. The Yad Sarah medical aid organisation documented 64 containers of critical medical supplies delayed three to five months, with sharply increased costs [4]. This was a very clear warning, if anyone had paid attention.
In 2026, the Strait of Hormuz itself came under pressure, and all the Arab states of the peninsula — states that had been driving agendas of prosperity, economic transformation, and societal modernisation — are now hostage to what I find, as an outsider, a deeply irrational and destructive conflict. The region that exports the world’s energy has discovered, again, that it imports almost everything else. And as I write this, I see no rational way forward when all sides are screaming for blood and destruction, no matter the cost.
Each of these disruptions was a different type. Natural accident. Pandemic. Political blockade. Military conflict. Regional war. Together they make a single argument: the Gulf’s supply chain exposure is not a scenario-specific risk. It is a structural condition. And diagnostic supply chains sit at its most vulnerable point, with high SKU count, cold chain requirements, short shelf life, specialist consumables. Harder to stockpile than food. More immediately lethal in shortage than almost anything except blood.
What the Region Imports
The abstraction of “supply chain dependency” obscures what is actually at stake. Let me be specific — and the picture of near-complete dependence, once mapped, is not reassuring. I have not seen it mapped in this way in the health policy literature.
The physical dependency is the most visible. Reagents and assay kits — the consumable backbone of every clinical laboratory, from haematology panels to immunoassay kits to microbiology culture media — are manufactured predominantly in Europe and the United States, shipped in temperature-controlled containers with shelf lives measured in months. When supply chains break, laboratory medicine stops within weeks. Sequencing consumables for the region’s growing genomic ambitions — the Qatar Genome Programme, the Saudi Human Genome Program, the Omani national genome initiative — are heavily dependent on a small number of foreign suppliers, predominantly US-based platforms, with no regional alternative at scale. Diagnostic devices are largely European and US OEM, manufactured elsewhere, validated elsewhere, and in many cases serviced by engineers flying in from elsewhere.
The instruments are world-class, but the supply chains beneath them are predominantly external.
In setting up diagnostic manufacturing operations in Qatar, I have encountered this dependency at first hand. Every item of equipment I have needed to source — analysers, consumable components, quality control materials — is externally manufactured, externally validated, and arrives with lead times and logistics costs that no European or American counterpart would accept as normal. There is no published aggregate study on the extent of Gulf diagnostic device import dependency that I could find, but a framework analysis by Efficio Consulting published in January 2026 on in-country value creation in the GCC identifies sectors with near-total import dependency as among the strongest cases for industrial localisation [5].
If crisis moments encourage reflection on system fragilities, everyday operational inefficiency compounds to reduced competitiveness and cost effectiveness of research and clinical operations. Let me give you a single example. I regularly order custom PCR primers — short, specific DNA sequences that are a basic commodity of molecular biology, used in everything from clinical diagnostics to research laboratories. In Portugal, itself a marginal European market, these arrive in two days at most. Major US suppliers — Thermo Fisher, IDT — ship standard oligos the same or next working day domestically, with international delivery quoted at two to three business days before customs [6, 7]. In Qatar, the same order from the same supplier takes weeks. The delay is not in the manufacturing; it is in the friction of a supply chain that was not built with this region in mind.
Beyond physical reagents, the region also imports something less tangible: the interpretive frameworks that make diagnostics meaningful. Genomic reference databases — the population-level datasets that determine whether a genetic variant is clinically significant or benign — are built predominantly from European and North American cohorts. A Gulf patient diagnosed against Northern European genomic norms is receiving structurally inferior care. This is not a minor technical limitation. Multiple academic studies have documented the systematic underrepresentation of non-European populations in major genomic databases. One that recently caught my attention — partly because it comes from institutions I have been spending time around in Barcelona — was published in Nature Communications in December 2025 by researchers from the Barcelona Supercomputing Centre and the Centre for Genomic Regulation. They found that human gene maps contain thousands of missing transcripts in African, Asian, and other non-European populations, affecting genes linked to conditions including lupus, rheumatoid arthritis, and asthma. The lead author stated: “Gene maps are used by scientists every day, but we’ve been leaving out huge sections of the world’s population” [8]. The Gulf’s distinct population genetics — elevated consanguinity, specific founder effects, different environmental exposomes — are among those missing sections.
So what does the region produce? Almost none of this. Some reagent filling and packaging. Some device servicing and distribution. Virtually no primary reagent manufacturing at scale, and minimal local equipment production. Early days on data and digital sovereignty in the medical domain.
The same Gulf countries spending billions on hospitals equipped with the most advanced diagnostics in the world cannot produce a PCR reagent kit at scale.
The Geopolitical Tug of War
I believe the Gulf’s diagnostic import dependency is a structural feature of the post-WWII global health architecture, in which manufacturing capacity concentrated in wealthy countries and everywhere else imported. The Gulf inherited this structure in times when it was dominated by less affluent societies, with smaller populations and limited industrial capacity, and has not yet found a way to exit it. This is true across many domains, and acutely so in diagnostics.
I perceive two external forces actively contesting the space that sovereign diagnostic infrastructure would occupy.
The Western incumbent position is entrenched: European and US diagnostic companies hold the supply relationships, the regulatory approvals, the reference databases, and the distribution infrastructure. Their collective commercial interest — even if emerging organically rather than through concerted action — is for the Gulf to remain an import market, not become a manufacturing competitor. Some Asian countries have found a place in this supply chain, notably South Korea and Japan, operating within market rules. They represent a diversification for the region, but a persistence of the dependency. On a personal note: as I build my own project in a Gulf state, I have been discussing with experienced industrialists internationally and learning from their experience. In a recent conversation with the head of an industrial association in medical products — one I do not wish to identify — I heard that establishing a manufacturing unit in the GCC would be very hard because there are so many distributors currently earning so much that any initiative would be fought against deliberately and ruthlessly. This is the opinion of people with first-hand experience of building manufacturing capabilities in different regions.
China’s emerging position is, I believe, more deliberate. Belt and Road Initiative health infrastructure investments, diagnostic kit exports at competitive prices, and — most strategically — genomic data collection through health partnerships are all elements of a strategy that builds dependency through financing, equipment supply, and data relationships that are difficult to exit once established. China already dominates global production of active pharmaceutical ingredients for antibiotics — a position documented in peer-reviewed analysis as a strategic vulnerability for global supply chains [9]. It is fair to assume that the diagnostic layer will follow the same logic.
The Gulf sits between these two forces, pulled toward dependency on whichever side offers better terms at any given moment. This is not a unique predicament. Speaking at the World Economic Forum in Davos in January 2026, Canadian Prime Minister Mark Carney put the condition of middle powers plainly: “If we’re not at the table, we’re on the menu.” He also said something more directly applicable here: “A country that cannot feed itself, fuel itself or defend itself has few options” [10]. He was speaking about Canada’s geopolitical position. He could have been describing the Gulf’s relationship with its own diagnostic supply chain. A region that cannot produce the reagents to run its own hospital laboratories has, in that domain, no seat at any table.
The true choice is not a false dichotomy between dependency on the West and dependency on China. It is between managed dependency on either, or sovereign capability that gives the region genuine negotiating position with both.
The Meaning of Diagnostic Sovereignty
I want to be precise about what I mean by diagnostic sovereignty, because it is easy to equate it with the more glamorous arguments about precision medicine and genomics that I have made repeatedly here on LinkedIn and in my book Precision Diagnostics: A Founder’s Journey.
Diagnostic Sovereignty is the capacity to diagnose your population accurately during a crisis — any crisis — without dependency on external supply chains. It begins with the tests that every patient in every emergency room needs every day: the full blood count that tells you a child has severe anaemia, the culture that tells you which antibiotic to use, the troponin that tells you whether a patient is having a heart attack. It can then extend to include genomic sequencing reagents, companion diagnostics, and the full apparatus of precision medicine. But it starts with the basics. And the region cannot produce the reagents to run them.
The ability to diagnose your population during a conflict, pandemic, or supply chain disruption is as foundational as the ability to feed or defend them. Sovereign food supply is an established concept. Sovereign pharmaceutical supply is increasingly recognised. Sovereign diagnostic supply is the least developed of the three, and the most immediately vulnerable. I am convinced this makes it a national security argument: a defence and economic resilience argument in its own right. And a competitiveness argument at the same time.
Building diagnostic sovereignty means reagent manufacturing, device servicing capability, cold chain infrastructure, and stockpiling protocols. It is industrial policy, not health policy.
The Same Supply Chain Unlocks Everything Above It
The argument for starting with basic diagnostics is not defensive. The manufacturing infrastructure required to produce a haematology reagent kit is the same infrastructure required, at scale, to produce an advanced liquid biopsy assay. The ISO 13485-certified facility that fills PCR reagents can be extended to fill next-generation sequencing consumables. The regulatory pathway for a routine biochemistry panel is, in its underlying logic, the same pathway as the one for a companion diagnostic or a genomic test kit. The same quality systems, the same cold chain, the same regulatory frameworks. Just a different position on the same supply chain.
By building this chain, the Gulf would also be building the infrastructure that converts its massive investment in world-class biomedical science and clinical research into something durable: into products, into industrial capability, into the innovation economy the Vision programmes are trying to create. The precision medicine ambition is strategically coherent. It is also structurally fragile if it rests on total import dependency for its most basic consumables. Sovereign diagnostic infrastructure is the condition that makes it viable.
And the value of the chain extends further still. Consider three applications that share the same PCR-based diagnostic infrastructure as clinical medicine, and are equally dependent on imported reagents:
Food security through aquaculture. Saudi Arabia’s National Aquaculture Group (NAQUA), the largest shrimp producer in the Middle East, once faced a severe epidemic of White Spot Syndrome Virus that devastated its shrimp industry. Through a public-private partnership with the Saudi Ministry of Agriculture, Water and Environment (ADMEWA), NAQUA deployed PCR-based diagnostic surveillance to detect and eliminate the virus across its farms. The result: Saudi Arabia became the only country in the world to achieve specific pathogen-free status for WSSV — a globally recognised food security achievement [11, 12]. The diagnostic tools that enabled this are the same molecular biology that runs a hospital laboratory, the exact same reagents, which means exactly the same supply chain dependency.
Halal food integrity. In 2019, Sharjah Municipality in the UAE banned the import of four meat and poultry products after food safety testing detected pork fat contamination in products labelled as halal, including items labelled as originating from Saudi Arabia and Argentina. The General Secretariat of UAE Municipalities ordered all four products withdrawn from shelves across Abu Dhabi, Sharjah, and Fujairah [13]. At larger scale, Malaysia’s 2020 fake halal meat scandal revealed a 40-year cartel relabelling non-halal meat — including pork — as halal; the fraud was ultimately exposed through DNA-based food authentication, triggering outrage across the Muslim-majority country [14]. The detection method in both cases relies on the same PCR technology as clinical diagnostics. A region that cannot manufacture these reagents cannot certify the integrity of its own food supply — and in a region where halal certification is a matter of individual and national identity, as well as public health significance, this is not an abstract risk.
Environmental health monitoring. In 2017, the first peer-reviewed study to investigate Legionella in Qatar’s cooling towers — published in the Eastern Mediterranean Health Journal (WHO EMRO) — found Legionella DNA in 100% of the ten cooling towers sampled at Qatar University. Critical concentrations exceeding safety thresholds were found in 56.7% of samples, with peak counts in May and June, the hottest months. The authors concluded this represented “a potential health risk to the local population” [15]. Cooling towers in the Gulf operate year-round at temperatures between 20 and 45°C — conditions ideal for Legionella growth. The diagnostic test required is PCR-based. Imported reagents.
The manufacturing line that could fill a haematology reagent kit could also supply the PCR kits that monitor a hospital’s cooling towers for a lethal pathogen, verify the halal status of imported meat, and protect a shrimp farm from a devastating virus. So diagnostics sovereignty is more than a narrow clinical argument, it is general infrastructure for resilience.
The applicability extends further still — to plant disease detection in the region’s agricultural systems, to livestock health monitoring, to environmental monitoring in the region’s industrial zones. But the three examples above are sufficient to make the point. One supply chain, multiple sovereign dependencies, and all currently unmet by local manufacturing.
When the missiles and drones are destroying the lifelines of the countries in the Arabian peninsula, it is time to focus on the basics and build a resilient diagnostics value chain.
This article is adapted from a chapter in a book in progress on diagnostics, sovereignty, and the Gulf.
References
[1] Sidra Medicine develops new method for COVID-19 testing. The Peninsula Qatar, April 22, 2020. https://thepeninsulaqatar.com/article/22/04/2020/Sidra-Medicine-develops-new-method-for-COVID-19-testing. See also: Sidra Medicine press release, June 2020. https://www.sidra.org/media/news/2020/sidra-medicine-develops-second-covid-19-rapid-te/
[2] Aljada A. Developing affordable testing for Covid-19 in the Arab region. Times Higher Education, August 9, 2022. https://www.timeshighereducation.com/research/alfaisal-university/developing-affordable-testing-covid-19-arab-region
[3] $9.6 billion/day figure originates from Lloyd’s List westbound + eastbound throughput calculation, March 25, 2021; widely reported by BBC News, The Independent, International Trade Council. See also: Suez Canal blockage and its global impact on healthcare supply chains. International Maritime Health, 2021. https://journals.viamedica.pl/international_maritime_health/article/viewFile/76057/63268
[4] Houthi attacks in Red Sea delay arrival of critical Yad Sarah medical equipment. Times of Israel, January 20, 2024. https://www.timesofisrael.com/houthi-attacks-in-red-sea-delay-arrival-of-critical-yad-sarah-medical-equipment/
[5] Efficio Consulting. Catalyzing national transformation: How the GCC can accelerate In-Country Value through value chain development. January 2026. https://www.efficioconsulting.com/en-gb/resources/reports/how-the-gcc-can-accelerate-in-country-value-through-value-chain-led-localization/
[6] Thermo Fisher Scientific. Oligonucleotide ordering and delivery. https://www.thermofisher.com/us/en/home/life-science/oligonucleotides-primers-probes-genes/custom-dna-oligos/oligo-ordering-delivery.html
[7] Integrated DNA Technologies (IDT). International oligo shipping policy. https://www.idtdna.com/pages/support/faqs/how-long-does-it-take-to-ship-oligos-internationally
[8] Clavell-Revelles P et al. Long-read transcriptomics of a diverse human cohort reveals ancestry-biased gene models. Nature Communications, December 2, 2025. DOI: 10.1038/s41467-025-66096-x. CRG press release: https://www.crg.eu/en/news/human-gene-maps-are-biased-towards-european-ancestries
[9] Yang Y, Husain L, Huang Y. China’s position and competitiveness in the global antibiotic value chain: implications for global health. Globalization and Health 2024;20:87. DOI: 10.1186/s12992-024-01089-x. PMC11656612. See also: Socal MP et al. US antibiotic importation and supply chain vulnerabilities. JAMA Health Forum, 2025. PMC12495497.
[10] Carney M. Special Address, World Economic Forum Annual Meeting, Davos, January 20, 2026. Full transcript: https://www.weforum.org/stories/2026/01/davos-2026-special-address-by-mark-carney-prime-minister-of-canada/
[11] NAQUA White Spot Syndrome Virus eradication programme. Asian Fisheries Science 31S (2018): 194–209.
[12] World Aquaculture Society. Eradicating White Spot Syndrome Virus: The SPF and SPR Programme. https://www.was.org/meetings/Mobile/Paper.aspx?id=136330&src=P
[13] Four products banned for pork content. Gulf News, July 24, 2019. https://gulfnews.com/uae/four-products-banned-for-pork-content-1.438605
[14] Fake halal meat scandal — Malaysia. Bloomberg, December 30, 2020. https://www.bloomberg.com/news/articles/2020-12-30/fake-halal-meat-scandal-in-muslim-majority-malaysia-fuels-anger. See also: Malaysia reels from fake halal meat scandal. Arab News, February 15, 2021. https://www.arabnews.com/node/1808651/world
[15] AbuOdeh RO et al. First study in Qatar to reveal high Legionella counts in cooling towers. Eastern Mediterranean Health Journal (WHO EMRO) 2017;23(10):703–707. DOI: 10.26719/2017.23.10.703. PubMed PMID: 29270971. https://pubmed.ncbi.nlm.nih.gov/29270971/ Full PDF: https://applications.emro.who.int/emhj/v23/10/EMHJ_2017_23_10_703_707.pdf