2.2.3 Mitigate the risk of the emergence and re-emergence of high-threat pathogens

Scorecard

The high scores across all five dimensions of output 2.2.3 demonstrate how WHO provided strong technical and strategic leadership to mitigate the risk and impact of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). WHO also worked to anticipate and provide direction for other high-threat pathogen issues, including improving pandemic preparedness. In 2020, WHO effectively delivered technical support at the country level, asserted its leadership role, delivered high-quality global public health goods and was considered to provide good value-for-money. Throughout the reporting period, and thanks to its previous global prevention, control and preparedness work, WHO has provided reliable, rapid and evidence-based advice by leveraging its networks to respond to urgent global needs. Comprehensive technical support has been provided to countries, ensuring that no one was left behind, not only in responding to COVID-19 but also through implementing the Pandemic Influenza Preparedness (PIP) Framework. WHO has worked to ensure equitable access to COVID-19 tools worldwide including vaccines, therapeutics and diagnostics in accordance with its humanitarian and scientific principles. WHO will focus on improving the integration of gender, equity and human rights across all levels of the Organization in the context of risk mitigation for high-threat pathogens.

Achievements and challenges

Epidemic and pandemic prevention applies to two broad categories of diseases. The first are known and established threats such as cholera and yellow fever for which the world has safe and effective strategies and countermeasures for prevention and rapid response. The second group are high-threat pathogens for which the world has no countermeasures. This group includes known and hypothetical (“disease X”) infectious pathogens that might emerge via zoonotic spill-over events such as COVID-19 or owing to accidental or deliberate release. Mitigating the risk of high-threat pathogens requires specific strategies and approaches distinct from disease-control strategies for known threats.

WHO’s response to COVID-19 has drawn extensively on the preparatory work undertaken under output 2.2.3 previously to establish, strengthen, lead and manage technical networks and global partnerships for research into and rapid development of countermeasures to prevent, control and mitigate novel, high-threat infectious hazards.

When SARS-CoV-2 emerged, WHO leveraged many of the pandemic influenza capacities that had been developed and strengthened over the past decade, including laboratory detection capacity at national influenza centres; sentinel surveillance via WHO’s Global Influenza Surveillance and Response System (GISRS) and associated influenza surveillance systems; reporting of sentinel surveillance data on influenza and COVID-19 through global and regional influenza platforms; adaptation of WHO’s external laboratory quality assurance mechanisms to COVID-19; and shipping of SARS-CoV-2 samples through existing influenza logistics mechanisms.

In addition, at the start of the COVID-19 outbreak, the GISRS mechanism for sharing genetic sequence data proved to be a valuable platform for sharing such data on SARS-CoV-2. In March 2020, however, global disruptions to routine influenza surveillance and a decline in shared global influenza viruses and data were observed: these had the potential to disrupt the functioning of global influenza systems and capacities. WHO therefore increased its technical assistance and advocacy efforts to encourage Member States:

1.  to remain vigilant for influenza, including seasonal influenza virus variants and influenza viruses with pandemic potential;

2.  to resume or maintain routine influenza sentinel surveillance to monitor the trends and co-circulation of influenza and other respiratory viruses, including SARS-CoV-2;

3.  to resume or maintain timely and routine reporting of influenza virological and epidemiological surveillance data to WHO through global or regional platforms; and

4.  to maintain routine influenza vaccination programmes.

WHO recognized one new national influenza centre in 2020, in Suriname, taking the total number of national influenza centres to 147 in 123 Member States. By implementing the Pandemic Influenza Preparedness Framework, WHO has secured 10% of future pandemic influenza vaccine production through legally binding agreements. Using current production technologies, this represents more than 400 million doses of pandemic vaccine, or four times the amount available during the 2009 pandemic. Since 2012, WHO has raised more than US$ 200 million from the Pandemic Influenza Preparedness Partnership to strengthen national preparedness capacities in more than 80 countries, of which 63 are being supported to develop influenza pandemic preparedness plans linked with their national action plans for health security.

Most recently, the emergence of SARS-CoV-2 variants of interest and concern during 2020 necessitated a coordinated approach to research on the potential impact of known and possible future variants on transmission dynamics, clinical severity, diagnostic accuracy and vaccine efficacy within a risk-monitoring framework for SARS-CoV-2 variants. Monitoring and analysis of SARS-CoV-2 variants will necessitate a strengthening of national genomic surveillance capacities within existing influenza surveillance systems.

Broader research and development efforts during 2020 were catalysed by the Global research roadmap published under the aegis of the WHO R&D Blueprint for Research in Epidemics. In record time this roadmap led to the development of safe and effective vaccines and diagnostics, and confirmed that one existing treatment (dexamethasone) is effective in hospitalized patients with severe disease.

Throughout 2020, WHO has given comprehensive support to countries to coordinate research, to develop evidence and initiate stakeholder-engagement processes to understand and shape policy and practice as well as political and systemic dynamics, and to create and/or implement national research ethics policies in the COVID-19 pandemic situation. Building on previous preparatory work and efforts to strengthen national capacities for research and regulatory governance during outbreaks and epidemics, WHO has supported countries to conduct rapid yet rigorous ethics reviews and supervise COVID-19-related research, to ethically scale up experimental interventions for COVID-19 outside research, and to maintain adequate ethics oversight of COVID-19 research.

Through the Access to COVID-19 Tools (ACT) Accelerator, which WHO launched with partners in April 2020, WHO has worked to ensure equitable access worldwide to COVID-19 tools including vaccines, therapeutics and diagnostics. WHO plays a vital role in coordinating the overall work of ACT-A, running the ACT-A Hub and leading the access and allocation workstream. Across the product pillars WHO supports research and development, generates essential norms and standard, develops critical policy and technical guidance, ensures regulatory capacity building and pre-qualification services, and provides deep technical assistance for national readiness. WHO also co-convenes the health systems connector within ACT-A, which focuses on cross-cutting aspects of health systems and capacities to enable the rapid uptake and delivery of COVID-19 tools as they become available. Ensuring that the capacities built up through the health systems connector are integrated within existing health systems and thereby contribute to the long-term strengthening of those systems is a vital strategic opportunity going forwards.

COVID-19 has also shown that are clear benefits to be gained from integrating influenza and other high-threat respiratory pathogens such as coronaviruses (including SARS, MERS, COVID-19) into a single platform in order to maximize investments in critical capacities. Such investments must, in future, give more weight to human resources and capacities. Training technicians and sustaining the acquired capacity are just as important as access to sequencing and data management platforms. This is equally true of low-resource and humanitarian contexts, where pandemic preparedness as part of broader health systems strengthening is dogged by chronic underinvestment.