Newsletters # 14,13,12
Mongolia FETP support in COVID-19 response operations
Mongolian Field Epidemiology Training Program (FETP) graduates are serving at the forefront of emergencies and outbreaks where their contribution is having a measurable impact. They have strengthened the country’s capacity to rapidly detect and respond not only to COVID-19, but to public health emergencies and outbreaks at all levels.
The FETP has been instrumental for the country’s COVID-19 response operations, with graduates placed at all levels of response operations. Mandated through Ministerial Orders, 15 COVID-19 surveillance and rapid response teams were established, comprising 98 members. Of these, 20% are FETP graduates, with eight teams led by graduates. These teams have primarily been responsible for contact tracing of suspected cases, interviewing repatriated individuals, confirming hospitalized cases using a standard questionnaire, and collecting samples for testing.
Training and Retention
In part supported by the Pandemic Influenza Preparedness (PIP) Partnership Contribution (PC), the Mongolia FETP produced 70 graduates across nine cohorts. Graduates hail from various sectors, professions, and levels including doctors, public health leaders, laboratory specialists, biologists, and veterinarians. Most importantly, the program features a high post-graduate retention rate, with 86% currently working for the Government, 75% working in the national epidemiology and surveillance system, 8% in the private sector, and 6% in non-governmental organizations. While initially the program was supported by development partners, the Mongolian government progressively took ownership of the program delivery – demonstrating long-term sustainability for their health workforce development.
On-the-ground research and analysis
The Mongolian FETP has played a vital role in improving scientific knowledge following outbreak investigations. Leaders have instilled a culture among graduates of publishing results from epidemiological investigations – most notably with seven scientific pieces on the COVID-19 response published by FETP graduates.
Of note are two studies conducted by cohort trainees. One focused on the clinical characteristics of initial COVID-19 confirmed cases, and showed that 21% of cases had no symptoms upon testing, and 33% had mild illness. The second study focused more on an analysis of risk communications and community engagement data – particularly around calls to hotlines, and prevention and care information shared through the Ministry of Health’s social media channels. This study found that when the first COVID-19 case was confirmed in Mongolia, there was a peak of inbound calls 2.9 times higher than the average number of daily calls, with the highest number of calls about medical services.
This on-the-ground data collection, research, and analysis is integral for operational decision-making, with risk communications and community engagement a key pillar of the Mongolian response to COVID-19. Over time, the continuous strengthening of Mongolia’s health workforce is better preparing the country for future outbreaks and pandemics.
Pandemic influenza planning pays off for COVID-19 in South East Asia
Across WHO’s South East Asia Region (SEAR), countries are reaping the rewards of long-term investment in influenza pandemic preparedness planning (IPPP) as they develop and implement their response to the COVID-19 pandemic.
WHO’s SEAR has invested heavily in preparing for pandemic influenza for nearly two decades. As early as 2003, countries began developing and exercising plans for responding to an influenza pandemic. Since 2018, the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution (PC) has supported six countries in the region to advance IPPP. As the region grapples with the fast evolving COVID-19 pandemic, its past investments and efforts are really bearing fruit as five out of six countries are leveraging their IPPP capacities and plans to support the pandemic response (see Box).
Harnessing influenza infrastructure
All PIP PC supported countries were actively updating, testing or finalizing their plans when COVID-19 struck. Some quickly adapted their pandemic influenza plans to COVID-19. Others harnessed influenza infrastructure and capacities for the pandemic. Individual countries drew on national disaster management structures and risk communication capacities to manage the COVID-19 response; used National Influenza Centres for COVID-19 testing; deployed influenza surveillance systems to monitor trends; and delivered pre-existing training modules to rapidly refresh staff in case management and outbreak response for severe acute respiratory infections.
Affected by outbreaks of avian influenza since 2003, South East Asian countries know better than most the importance of contingency planning and pandemic preparedness. By the time the 2009 influenza pandemic hit, all already had a plan for tackling a new influenza virus; and later, when the global emphasis turned to strengthening cross-cutting core capacities through National Action Plans for Health Security (NAPHS), the region remained committed to IPPP as the contingency plan for biological hazards.
Collateral benefits for core capacity strengthening
Today, in the midst of the COVID-19 pandemic, the region remains committed to strengthening IPPP, either through a standalone plan,as part of a NAPHS, or another national emergency plan. In the run-up to the annual WHO South East Asia Regional Committee Meeting, countries have emphasized the value of sustainably strengthening core capacities under the International Health Regulations (2005) and pandemic preparedness including through the lens of influenza. This is a major milestone in a diverse region that is home to nearly a fourth of the world’s population; one that promises to allow countries to continue capitalizing on the gains made from nearly two decades of national pandemic influenza investment.
Box. IPPP in six SEAR countries since the publication of WHO’s Pandemic Influenza Risk Management guidance in 2013
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SocialNet 2019: an invaluable rehearsal for COVID-19
Without knowing it, participants in a simulated public health emergency in December 2019 were rehearsing for a far bigger challenge: the COVID-19 pandemic, which began just few days later. The simulation training, called SocialNet 2019, placed fifty European health experts in a week-long bootcamp in Belgrade, Serbia, to sharpen their skills in risk communication, community engagement and social science.
SocialNet participants were hand-picked from public health authorities and WHO Country Offices in twenty countries across WHO’s European Region. They began the week by working together to explore core concepts and technical topics. Then they travelled to a Red Cross camp for a two-day simulated emergency. There they put their new-found knowledge into practice in the field, under the escalating pressure of a rapidly evolving crisis. “SocialNet is as close to a real emergency as it gets,” says Miljana Grbić, WHO Representative and Head of WHO Romania.
Real-world skills
In the months that followed, participants drew on their SocialNet experience to join and shape the COVID-19 response in their home countries. For example, Oskars Sneiders, Head of the Communication Division in Latvia’s Ministry of Health, used principles of transparency and early announcement emphasized during SocialNet to improve the ministry’s risk communications during the pandemic. “When COVID-19 emerged, we quickly committed to daily press conferences and answered each and every question. If we didn’t have the answer, we said so honestly,” says Sneiders. The result has been impressive: “people really listened and followed our recommendations, which has helped us to keep case numbers down.”
Zlatan Peršić, from the Ministry of Health of the Federation of Bosnia and Herzegovina, similarly attributes communications successes to SocialNet training in community engagement. “After returning home, my ministry opened a Facebook profile which grew to reach approximately one million people. Social listening, data collection and analysis from the page now allows us to continuously adjust our response strategy,” says Peršić.
A team effort
Like the pandemic itself, SocialNet 2019 was a test of character as much as skill, where cooperation and coordination succeed. Michail Okoliyski, public health officer in WHO Bulgaria, looks back on the long hours and unrelenting pressure of the field simulation, saying “you only make it through if your team focuses on the shared objective of serving your community, stopping the disease and saving lives”. He adds “During SocialNet, we learned how to manage stress as a team with inspiration, professionalism and responsibility. This teamwork was, and still is, what keeps me going through dark moments such as the current COVID-19 pandemic.”
The delivery of SocialNet 2019 was supported by the the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution (PC) . The exercise was delivered by a unique team of facilitators and trainers from WHO, UNICEF, the European Centre for Disease Prevention and Control, and US Centers for Disease Control and Prevention—a combination of partners and expertise not seen before during trainings in the WHO European Region.
Countries in WHO’s South East Asia Region resume regular reporting of influenza data
In WHO’s South East Asia Region (SEAR), the initial response to COVID-19 caused a significant drop in influenza data sharing through FluMart as key personnel were repurposed to tackle the crisis. With targeted support from WHO, almost all countries in the region have resumed regular reporting of influenza data; several are now also reporting COVID-19 data through the global platform.
The re-purposing of influenza resources to support a COVID-19 response reduced the reporting of both laboratory data (to FluNet) and epidemiological data (to FluID), among other surveillance activities (see Revitalizing influenza in South East Asia during COVID-19).
Regular reporting of influenza data to a global platform is critical to ensure regional and global monitoring of seasonal epidemics, including the circulating virus types and the impact of influenza illness, and to inform national health authorities’ planning and resource allocation activities. Acknowledging this need, WHO’s South East Asia Regional Office (SEARO) worked with country offices and officials from national programmes to characterize the declining status of influenza data reporting in the region, identify root causes and support workable solutions. They found that in many cases the drop in reporting was caused by a lack of dedicated staff for the job, information technology issues or delays in receiving laboratory results, among other things.
To address these issues, WHO:
- recruited a dedicated person to support data management in the Maldives;
- provided technical support to map additional variables to the FluMart reporting template and improve national programmes’ access to the platform;
- gave countries a short refresher course in FluMart reporting, including a virtual discussion and a practical demonstration of the platform; and
- supported six national influenza centres to combine COVID-19 and influenza reporting through FluMart.
By May 2020, 10 out of 11 Member States in the region had resumed reporting influenza data to FluMart. Between May and October, half of these had also begun submitting COVID-19 sentinel and non-sentinel test results, making the most of the fact that FluMart was configured early in the pandemic to collect these data and add them to FluNet and FluID. In addition to routine channels, WHO continues the dialogue on influenza surveillance in the context of COVID-19 pandemic with countries through its focal points in the Incident Management Supporting Team. And epidemiological and laboratory indicators continue to be shared with WHO Country Offices every month.
The region’s success in resuming influenza data reporting shows that even though ILI/SARI surveillance systems can be disrupted by nation-wide disease outbreaks, they can also bounce back and be leveraged to detect and monitor other respiratory diseases.
WHO continues to support all Member States to continue reporting aggregated influenza surveillance data, as well as COVID-19 data when feasible, on a weekly basis to regional and global levels.
Global influenza surveillance outputs from FluNet and FluID are available online.
Influenza labs open door to COVID-19 testing in Africa
The National Influenza Centres (NICs) that form the backbone of WHO’s Global Influenza Surveillance and Response System (GISRS), have proved instrumental in supporting the COVID-19 response and scaling up regional testing capacity from 4% to 100% in less than five months.
By the time COVID-19 was declared a Public Health Emergency of International Concern on 30 January 2020, NICs in Senegal and South Africa could already test for it. But there was a clear need to rapidly scale up testing capacity in more countries if the region hoped to keep track of the disease beyond initial hot spots.
A rapid review of regional laboratory capacities and capabilities by the WHO Regional Office for Africa (AFRO) showed that while many countries had the potential to introduce reliable molecular testing for COVID-19—using either Polymerase Chain Reaction (PCR) or GeneXpert technology—they were prevented from doing so by a lack of essential supplies, equipment or technical know-how.
This review revealed:
AFRO quickly devised and implemented a plan to overcome these obstacles, drawing on the expertise of NICs and partners across the region.
Scaling up capacities
Led by the Influenza Laboratory Focal Point (also functioning as the COVID-19 Laboratory Pillar Lead), the AFRO team placed emergency orders for PCR test kits and GeneXpert cartridges, as well as viral transport media for those countries that already had PCR or GeneXpert machines to test for influenza or other diseases. For those four countries with no machinery, the team procured a PCR machine and other relevant equipment, helping these countries achieve a major milestone in testing capacity that extends far beyond COVID-19.
PCR experts from NICs across the region—including Cameroon, Cote d’Ivoire, Ghana and Senegal—were mobilized to train laboratory staff in the COVID-19 testing protocol. Partner agencies, including African Centres for Disease Prevention and Control, hosted training workshops giving laboratory staff from 39 countries a refresh in diagnostic methods and good laboratory practices.
Overcoming operational barriers
Despite diverse operational challenges, including travel bans, competing demand for diagnostic supplies, and the collapse of international supply chains, the region rapidly increased its testing capacity:
Each gain marked a major step forward in enabling the COVID-19 response in the region. Supported by the PIP PC, existing influenza infrastructure laid the foundations for COVID-19 response capacities, highlighting the collateral benefits of establishing influenza laboratory and surveillance capacities and building a stronger global network of NICs.
Revitalizing influenza surveillance in South East Asia during COVID-19
In South East Asia, the initial response to COVID-19 severely affected influenza surveillance, as key personnel and infrastructure were diverted to cope with the crisis. But now a multi-pronged strategy, jointly developed and deployed by WHO and countries, has reinstated much needed influenza surveillance activities to ensure continued pandemic preparedness.
By the end of April 2020, 10 out of 11 countries in WHO’s South East Asia region (SEAR) had begun reporting COVID-19 cases in different phases of transmission and were already responding to the pandemic. A decade of pandemic influenza preparedness in the region meant countries were able to quickly scale up their COVID-19 responses: by repurposing the national influenza workforce, infrastructure and preparedness platforms, they managed to rapidly increase their COVID-19 detection and surveillance capacities. But this success came at a cost to influenza surveillance, which suffered significantly reduced levels of laboratory diagnosis, virus sharing and data reporting.
WHO’s regional office for SEAR (SEARO) soon recognized the need to re-prioritize influenza surveillance, even in the face of the COVID-19 crisis. Supported by WHO global and regional senior management, and guided by the Global Influenza Programme (GIP), SEARO developed country-specific plans to get the job done. Working with WHO country offices and Ministry of Health officials, it did SWOT (strengths, weaknesses, opportunities and threats) analyses of national surveillance frameworks, searched for possible solutions to key problems and gaps, identified potential WHO support, provided recommendations for action and carried out joint performance monitoring, in parallel to the ongoing COVID-19 responses. The GIP’s webinars on the interface between influenza and COVID-19, held in June and July 2020, were particularly useful in helping countries understand the need to maintain a high level of commitment to sustaining influenza preparedness in the region.
The result of this multi-pronged strategy is that all SEAR countries have now resumed influenza surveillance. In addition, three countries have started reporting both COVID-19 and influenza through Flu Mart, in line with the WHO operational considerations for COVID-19 surveillance using GISRS; and six more are working to do so too. The strategy also helped re-start the sharing of influenza viruses, which will provide vital information for the next vaccine composition meeting.
The success of SEARO’s revitalization strategy is due to a combination of strong leadership and advocacy from senior management, clear policy guidance from GIP, high levels of country engagement, joint action plans and specific support. All of this looks set to continue. Most recently, at the 73rd Regional Committee meeting, Ministers of Health agreed to strengthen regional pandemic responses by focusing on the committee’s sixth flagship priority, to scale up capacities in emergency risk management. To that end, support from the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution in conjunction with technical guidance from GIP will continue to be invaluable for Member States.
Influenza preparedness helps ready the Philippines for COVID-19
Joint influenza preparedness planning and swift inter-agency action enabled a quick response to COVID-19 in the Philippines, buying the country’s health system much-needed time to prepare for an inevitable surge in cases.
The first death from COVID-19 outside China was reported in the Philippines on 1 February 2020. The event quickly prompted an interagency contingency planning workshop to agree priorities for government interventions. The workshop, held on 27–28 February 2020, included participants from the departments of health, agriculture, natural resources, interior and local governance, education, social welfare and development, public works, trade, transport, foreign affairs and justice, as well as representatives from the Office of Civil Defense, the police, the armed forces, the Philippine Red Cross, UNICEF and WHO.
The same group of agencies had come together several months before, in November 2019, to test the country’s Pandemic Influenza Preparedness Plan through a tabletop exercise. The lessons learnt from that joint exercise, and the recommendations issued by participants to strengthen pandemic preparedness, were to be used to update the plan in 2020 but have since also proved invaluable in informing the Philippine government’s approach to COVID-19.
For example, the inter-agency connections forged in November enabled the Department of Health to identify and convene the right stakeholders quickly and effectively in February and cement working relationships. This greatly facilitated the activation of an Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID), led by the Secretary of Health, to coordinate the country’s COVID-19 response. Similarly, the awareness around responding to pandemic influenza that was built among government stakeholders in November enabled the quick identification of priority interventions and their rapid adoption in February and March. One of those interventions was a strict lockdown imposed from 13 March, which prevented significant morbidity and mortality by slowing the spread of disease during the early days of the COVID-19 crisis and allowing the country to prepare its health system for the inevitable surge in cases that came on easing restrictions in June.
Pandemic influenza preparedness has also provided the platform for laboratory capacities in the Philippines’ COVID-19 response. Thanks to capacity strengthening provided through the Pandemic Influenza Preparedness (PIP) Partnership Contribution, all five of the government’s dedicated influenza laboratories were able to quickly convert into COVID-19 laboratories; and testing capacity has been steadily growing since. The Philippines currently has 114 COVID-accredited laboratories that combined can test up to 45,000 samples per day.
Costa Rica leverages influenza advances to combat COVID-19
Long-term targeted support from the Pandemic Influenza Preparedness Partnership Contribution (PIP PC) has strengthened Costa Rica’s capacities for surveillance of influenza and other respiratory viruses, helping to establish a robust platform for the country’s frontline response to the COVID-19 pandemic.
Costa Rica has a long history of influenza surveillance guided by a multi-sectoral technical group comprising the Ministry of Health, the National Influenza Centre INCIENSA and the Costa Rican Social Security Fund (CCSS), which provides health care services through centers and hospitals accessible to all residents. Over the past seven months these technical experts have worked with PAHO regional and country teams to adapt the country’s influenza surveillance systems and protocols to support the COVID-19 response in several key areas, including virologic surveillance and data analysis.
Before the onset of COVID-19, Costa Rica had 18 sentinel sites to actively monitor severe acute respiratory infections (SARI) and influenza like illness (ILI); and all samples from patients at these sites were processed by INCIENSA. When COVID-19 hit, the national laboratory testing network was expanded to incorporate CCSS laboratories in the detection of respiratory pathogens. Both influenza and COVID-19 testing were decentralized to take advantage of these CCSS laboratories. The move significantly increased testing capacities, enabling influenza and COVID-19 screening in multiple at-risk locations in the country. This not only generated more surveillance data, but also facilitated the monitoring of epidemiologic trends and assessments of disease severity.
Since the second quarter of 2020, Costa Rica has also been using the expanded regional surveillance platform, PAHO Flu, to report and analyse clinical, epidemiological and laboratory data for influenza and COVID-19. These data are then fed into the global platforms FluNet and FluID, where they are used in critical data analyses. In this way, PAHO Flu has been supporting Costa Rica and other PIP PC countries to identify, investigate and monitor the virological and epidemiological trends of respiratory viruses in the country.
As a PIP PC priority country, Costa Rica is poised to maintain the capacities built so far. Plans are underway to update the National Protocol for the Surveillance of Influenza to incorporate COVID-19 guidelines. Further, with the decentralization of influenza detection, INCIENSA plans to establish a diagnostic confirmation process that will evaluate the laboratory network’s performance through an external third party. Finally, INCIENSA plans to evaluate the possibility of strengthening sequencing capacities for influenza, which will ensure more efficient detection of future influenza viruses with pandemic potential.
Surveillance in the Americas: 2019 data out now
In September 2020, PAHO published its latest surveillance landscape report, Influenza and other respiratory viruses: surveillance in the Americas, 2019. This is the third edition of the landscape report since 2014; and it marks a significant milestone in implementing PAHO’s surveillance strategy. We asked Dr Jorge Jara, Technical Officer of PAHO’s regional influenza team, what the new report tells us and how it can help strengthen surveillance in the region.
Tell us about this new report. What is it and why is it important for surveillance in the region?
The new landscape report details the main characteristics of surveillance systems for influenza and other respiratory viruses in the Americas. It includes a general section outlining the collective surveillance capacities in each subregion, and a country-specific section that profiles these capacities for each nation.
The information in this report is useful for health professionals and the general public. Each edition provides a snapshot of current surveillance systems in the region and as such can be used to document progress achieved over time. It can also be used to identify gaps in capacity and key areas for improvement to make surveillance more effective and efficient.
Have you noticed any improvements in national capacities since the last publication in 2017?
Yes. Among many advances, I would like to highlight three:
- The national laboratories of PIP countries Bolivia, Dominican Republic and Haiti have all been recognized as a WHO National Influenza Centre.
- Many more countries have automated information systems to generate real-time data and reports.
- More countries are estimating the economic and medical burden of influenza. Several national studies have recently been published, which will support public health policies aimed at filling the gaps between the prevention and control of influenza.
Compiling the landscape report is always very intense, as we collate data from multiple sources including country surveys, country bulletins, and presentations at the regional SARInet meeting. We have learned quite a bit through the process. In the next publication, we plan to enhance the survey structure, include updates on the seasonality of influenza and other respiratory viruses in the region and, most likely, incorporate COVID-19 in our analyses.
Suriname gains National Influenza Centre
The Central Laboratory of Suriname’s Bureau of Public Health (BOG-CL) has gained WHO recognition as a National Influenza Centre (NIC) and in so doing joins the network of laboratories that form the backbone of the WHO's Global Influenza Surveillance and Response System (GISRS). We asked Mr. Merril Wongsokarijo, Head of BOG-CL, how his laboratory achieved NIC status and what this achievement means for surveillance in Suriname.
How did BOG-CL get NIC status?
The BOG-CL has been recognized as a quality and competent medical laboratory by the International Organization for Standardization (ISO 15189 accredited) since 2016. The official process to also become an NIC began a year later, in July 2017, when the Pan American Health Organization (PAHO) nominated us at the request of our Ministry of Health. Since then, we have been through a rigorous programme of capacity building and skills strengthening, which included a combination of on- and off-site training by FIOCRUZ (a collaborating NIC in Brazil) and PAHO in key areas such as influenza molecular diagnostics, biosafety and biosecurity, sample shipping and rapid response. Our laboratory staff also attended the regional surveillance meeting, SARINet, and other laboratory training workshops. And using funds from the Pandemic Influenza Preparedness Framework Partnership Contribution (PIP PC), PAHO procured a real-time thermocycler for us. By February 2020, when PAHO did the final official NIC evaluation BOG-CL, we were ready and we passed with flying colours.
Why is this achievement important?
This achievement marks a major milestone in influenza surveillance for Suriname. It enables us to share critical virologic data and samples on a global scale through the GISRS network. Being part of the network will not only facilitate our participation in global influenza surveillance, it will also open the door for crucial collaborations to boost our own country’s laboratory network development. Achieving NIC status will enhance our national capacity for influenza diagnostics and may even enable us to expand molecular testing for other respiratory viruses such as COVID-19.
As a NIC, you’ll be reporting influenza data to the global platform. Will this help you to report COVID-19 data too?
Since 2017, we have been consistent and timely in reporting our influenza data through PAHO’s platform, PAHO Flu. It is much easier to expand an existing platform than build one from scratch, and having PAHO Flu on hand means it is much easier for us to incorporate COVID-19 data. We already know how to use the system so we can, and are, uploading data quickly and easily, with minimal delay.
What is the next step for BOG-CL?
Suriname is committed to implementing the International Health Regulations (IHR), and BOG-CL, in its NIC capacity, will support this endeavour by reporting unusual events to WHO though IHR official channels, as required. We are also looking to expand the scope of our ISO 15189 accreditation in 2020 to include influenza, which means that our influenza testing going forward will also be ISO 15189 accredited.
Leveraging rapid response teams to tackle COVID-19 in the Eastern Mediterranean
Targeted efforts over the past four years have ensured the availability of at least one rapid response team (RRT) in every country of the WHO Eastern Mediterranean Region. These teams have proven invaluable in providing frontline support to detect, monitor and control the COVID-19 pandemic.
The EMR has long faced outbreaks of infectious disease as well as other public health emergencies resulting from armed conflict. In 2014, the region’s governments identified the lack of multidisciplinary RRTs as a major obstacle to tackling such threats effectively. This sparked a targeted effort to develop RRTs throughout the region and equip them with the knowledge, tools and techniques they need to improve outbreak investigation and response.
Supported by the WHO Regional Office for the Eastern Mediterranean (EMRO) and the US Centers for Disease Control and Prevention (CDC), an innovative training programme was developed and delivered across 22 countries. Initially focused on Ebola, the programme quickly evolved to cover other epidemic and pandemic threats, including emerging respiratory and zoonotic infections such as MERS and avian influenza A(H5N1).
From 2016 and 2019, the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution, CDC and other partners funded tens of training workshops to establish and enhance RRTs and build capacity to tackle emerging respiratory infections when the source of the outbreak is either unknown or ill-defined. Those workshops paved the way for cascade training at the national level; and by the end of 2019 these had reached more than 875 RRT members. Fortunately, the effort to build RRT capacity has not been thwarted by COVID-19. In the face of travel restrictions that prevented experts from travelling to affected countries, EMRO used webinars to continue supporting and training RRT members. By the end of June 2020, 130 rapid responders across Libya, Pakistan, Somalia, Sudan and northern Syria had participated in one of these webinars.
In 2014, just three countries had an RRT; today all 22 countries of the region have a national RRT, with 21 countries also home to RRTs at the sub-national level. These RRTs have proved an invaluable resource against the ongoing COVID-19 pandemic in the Eastern Mediterranean. In the region’s more stable countries, they have enabled a frontline response, with RRT members providing timely and effective case detection, contact tracing and risk communication as well as implementing various control measures. In conflict-stricken countries like Syria and Yemen, RRTs have been the main—and sometimes the only—resource available for implementing any kind of COVID-19 response at all.
Building on pandemic influenza preparedness to respond to COVID-19 in Europe
Six years of pandemic influenza preparedness efforts in the WHO European region have established a basis for the ongoing response to COVID-19.
Since 2014, the WHO Regional Office for Europe has
worked with select Member States to enhance pandemic influenza preparedness under the auspices of the Pandemic Influenza Preparedness Framework (PIP) through
a range of activities designed to, for example, strengthen laboratory and surveillance capacities, build national outbreak investigation and response mechanisms, and develop national influenza pandemic preparedness plans (NIPPPs). This work has been
done in concert with efforts to accelerate implementation of the International Health Regulations (2005) core capacities in the Region.
These new and improved capacities, systems and protocols have become particularly relevant with
the emergence of COVID-19. For example, the NIPPPs provided the foundation for developing COVID-19 Country Preparedness and Response Plans (CPRPs), which were further tailored through guidance provided in WHO’s global Strategic Preparedness
and Response Plan for COVID-19 (SPRP).
Armenia in action
In Armenia, several components of the COVID-19 CPRP were developed early in the pandemic, largely based on national guidelines and protocols that had been
previously established with PIP PC support. In particular, four streams of pandemic influenza preparedness work provided a basis for Armenia’s response to COVID-19:
- Surveillance strengthening: An improved surveillance system for acute respiratory infections and influenza-like illness facilitated the identification of the first COVID-19 cases.
- Outbreak investigation and response training: Trained rapid response teams are heavily involved in contact tracing for COVID-19.
- Laboratory capacity building: The National Virology Reference Laboratory, which achieved WHO National Influenza Centre status in 2017 following PIP PC-supported capacity building efforts, was the first to perform COVID-19 testing in Armenia and continues to do the bulk of COVID-19 tests in the country.
- Critical care training:Intensive care doctors trained in caring for patients presenting with severe acute respiratory infections have provided the backbone of frontline management of COVID-19 cases.
IVTM 2.0: Tracking the sharing of PIP Biological Materials
The WHO Influenza Virus Traceability Mechanism (IVTM) is an online tool for tracking the movement of influenza viruses with pandemic potential (and virus materials derived from these) into, within and out of the Global Influenza Surveillance and Response System (GISRS). After a decade of use, a recent upgrade of the tool (IVTM 2.0) has enhanced security and improved user experience.
Under the Pandemic Influenza Preparedness Framework (PIP), sharing PIP Biological Materials (PIP BM), which includes influenza viruses with pandemic potential and their candidate vaccine viruses, is integral to strengthening preparedness for the next pandemic and promoting access to vaccines and other benefits. The IVTM increases the transparency of this sharing by allowing users to track transfers of PIP BM. The new version, IVTM 2.0, allows users to select any specific PIP BM, visualize its movement throughout the GISRS and to non-GISRS laboratories, and export data to Excel. Funded by the PIP Partnership Contribution, not only is the tool more user-friendly than before, it also has a user authentication system to comply with new WHO cybersecurity requirements and new data quality rules to ensure more robust reports.
In April 2020, registered users were given orientation sessions for the new tool and their feedback was used to further refine individual features. You can find IVTM 2.0 at https://extranet.who.int/ivtm2, where there is also a suite of training materials to facilitate user experience in the new version. The Global Global Influenza Programme Programme will continue to monitor and enhance the IVTM through user feedback and ensure it remains a useful platform for robust and high quality data sharing.
Influenza preparedness underpins COVID-19 lab capacities in South East Asia
Every country in the WHO South-East Asia region (SEAR) has successfully established diagnostic capacity for COVID-19 and ensured a robust laboratory response to the pandemic. Their success was enabled in large part by a decade of preparedness activities in the region to build laboratory capacities for pandemic influenza.
The long-standing laboratory capacity building for influenza in SEAR has been made possible through a combination of national contributions coupled with funds from the Pandemic Influenza Preparedness Framework Partnership Contribution (PIP PC) and a range of other donors. Three areas of this support have proved particularly fruitful in enabling SEAR’s laboratory response to COVID-19:
- PCR diagnostic capacity building. By 2019, all 11 SEAR countries had built the capacity to accurately and reliably detect influenza viruses through real-time PCR, as recognized by the 2019 WHO External Quality Assessment Project (EQAP). This achievement was instrumental in providing the basis for COVID-19 PCR testing in the region. All SEAR countries are able to detect COVID-19 through real-time PCR. Six of these have already completed the 2020 COVID-19 EQAP test and achieved 100%; the rest are still waiting to receive or report on the EQAP panels.
- Online knowledge exchange. Since September 2019, WHO has hosted a series of regional webinars to share laboratory expertise and support online training within National Influenza Centres and public health laboratories involved in the diagnosis and surveillance of influenza. These laboratories now find themselves on the front line of COVID-19 detection and the webinars have been rapidly adapted to support this new role by focusing on COVID-19-specific laboratory topics, such as biosafety, specimen collection and transport, and data management.
- Laboratory assessment. During 2019, at least five South-East Asian countries assessed their national laboratory systems using WHO’s Laboratory Assessment Tool. They used the results to identify strengths and gaps in their laboratory capacities for influenza and to work towards addressing these. There is little doubt that this capacity building groundwork was critical in enabling laboratories to handle the surge in demand for laboratory services prompted by the COVID-19 response.