In a first step to boost influenza surveillance, in September 2020 the NIC-NPHL initiated retrospective influenza testing on SARS-CoV-2-negative samples from Severe Acute Respiratory Infection (SARI) patients. Testing was conducted in alignment with WHO's Global Influenza Programme (GIP) recommendations and findings were reported via the RespiMart platform.[5][6]

Then, following a kick-off meeting in October 2021, Nepal began a multisectoral process, involving human and animal health authorities to harmonize surveillance networks for influenza and SARS-CoV-2. [7] To expand the existing influenza laboratory surveillance network to include the Provincial Public Health Laboratories (PPHLs), a consultative meeting and hands-on training were conducted. To facilitate implementation, WHO Nepal participated in pivotal discussions and provided resources including a sequencing machine, validation panels, diagnostic kits, and other essential laboratory consumables, as well as technical assistance for the validation and standardization of the multiplex kit intended for dual testing.

- Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal

WHO Nepal then provided targeted technical assistance to the NIC-NPHL for onsite assessments of testing sites and sentinel hospitals, including delivering practical training for National Influenza Surveillance Network (NISN) members. Assessments led to gap identification and rectification, strengthening the quality assurance system. The enhanced infrastructure, coupled with improved sequencing capabilities, played a key role in identifying Nepal's first case of the Omicron variant in January 2022.

To strengthen the national integrated respiratory virus surveillance, WHO Nepal provided technical guidance for the restructuring of the national influenza surveillance plan in line with GIP recommendations. Completed by end 2021 and endorsed by the Ministry of Health and Population (MoHP) in February 2022, it reflected the evolving surveillance and diagnostic demands of the pandemic while sustaining influenza surveillance with focus on monitoring seasonal and non-seasonal influenza viruses. Designed in harmony with Nepal's federal governance structure, it cast a wider net in sample collection by increasing provincial access to influenza and SARS-CoV-2 testing. 

A wave of nationwide implementation meetings was conducted and by June 2022, PPHLs began harnessing the multiplex-RT-PCR kit for reporting influenza and SARS-CoV-2 testing data. This step amplified the number of samples available for routine reporting on the Global Influenza Surveillance and Response System (GISRS) platform.[8][9][10][11] In November of the same year, the NIC incorporated testing for RSV into its arsenal, further strengthening its broad respiratory virus surveillance leveraging the NISN. 

^{In April 2023, the Director of the National Influenza Centre (NIC) at the National Public Health Laboratory (NPHL) emphasized the necessity for an integrated influenza and SARS-CoV-2 surveillance system in Nepal during a visit to Gandaki province..}
Photo credit: WHO Nepal

As the country transitioned into 2023, routine oversight of testing sites and sentinel hospitals, consistent participation in the External Quality Assurance Program (EQAP), and routine troubleshooting meetings among NISN members became engrained as standard practices. Further contributing to global influenza control efforts as outlined in the Global Influenza strategy (2019-30)[12] , ensuring adherence to the Terms of Reference of NICs, WHO Nepal played an active role in the transportation of influenza virus clinical samples from the NIC-NPHL to WHO's Collaborating Centre for Reference and Research on Influenza in Tokyo, Japan, which aids in the semi-annual recommendations for influenza vaccine composition and selection of candidate vaccine viruses (CVV). 

- Dr Runa Jha, Director, National Public Health Laboratory (NPHL), Nepal