Inborn Errors of Immunity in Arab Countries, Access to Care: Arab Society for Primary Immunodeficiency Disorders (ARAPID) Project

Introduction Inborn errors of immunity (IEI) comprise more than 580 genetically defined disorders with heterogeneous clinical manifestations, including recurrent infections, immune dysregulation, autoinflammation, allergy, lymphoproliferation, and malignancy. Despite major diagnostic advances, timely recognition remains challenging because of limited provider awareness and overlapping or subtle presentations. In addition, access to specialized diagnostic tools and effective therapies varies globally, contributing to delayed diagnosis and suboptimal outcomes. These challenges are particularly relevant in the Arab region, where IEI prevalence is higher, partly due to high consanguinity rates. Objectives To evaluate access to IEI care across Arab countries using the Arab Society for Primary Immunodeficiency Disorders (ARAPID) survey, focusing on immunology workforce availability, diagnostic and genetic testing capacity, treatment options, and funding mechanisms. A structured survey was reviewed and approved by the ARAPID board members and was conducted by ARAPID country members. Results Eight countries participated: Kuwait, Saudi Arabia, Morocco, Tunisia, Jordan, Egypt, Libya, and the United Arab Emirates. Among the surveyed centers, 62.5% provided care for both pediatric and adult patients, while 37.5% treated pediatric patients exclusively. Basic immunologic testing was universally available, and 88% reported access to advanced cellular and functional assays. In-country genetic testing was available in 37.5% of canters, whereas 62.5% relied on overseas laboratories and 12.5% reported no access. Intravenous immunoglobulin was universally available, although only 37.5% reported a stable supply. Hematopoietic stem cell transplantation was available in 75% of countries, often requiring referral abroad, and in-country gene therapy was unavailable. Major funding gaps were identified, disproportionately affecting non-citizen patients. Conclusions Although the Arab region demonstrates strong foundational diagnostic capacity and broad access to core IEI therapies, critical gaps persist in adult immunology services, genetic testing, funding, and advanced curative therapies. Strengthening regional genomic services, fostering pan-Arab collaboration, and revising funding policies are essential to improving IEI care and patient outcomes.