Management and control of pandemics can be imperative for regional cooperation and solidarity. In the Middle East and North Africa (MENA) region, existing regional organisations mainly failed to deal effectively with Covid-19, although they differed in their performances. Instead, both the regional countries and extra-regional powers preferred to address the pandemic through bilateral health diplomacy. Thus, the pandemic has not been transformative in terms of regionalism and regional politics in the MENA region. There were, however, examples of regionalisation, namely cooperation at the societal level and among health officials, which points to the equal importance of bottom-up processes of regional solidarity.