August 2021, Issue no. 18

PIP PC High-Level Implementation Plan: mid-term review  


A mid-term review of the High-Level Implementation Plan 2018-2023 for strengthening pandemic influenza preparedness has recommended three short-term adjustments to improve implementation and identified three opportunities to catalyse pandemic preparedness in light of COVID-19.

The High-Level Implementation Plan II 2018–2023 (HLIP II) guides the use of the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution (PC) for strengthening country, regional and global preparedness capacities. 

In 2021, a mid-term review evaluated progress under HLIP II from 2018–2020, and as recommended by the PIP Advisory Group, it focused on identifying obstacles to implementation and opportunities for improvement. 

Looking back 
The review found significant progress towards HLIP II objectives in the three-year period, including: 
  • 9 new National Influenza Centres; 
  • 9 countries reported virological data to WHO FluNet and 22 countries reported epidemiological data to FluID for the first time;
  • 43 published country influenza burden estimates; 
  • 7 countries with stronger regulatory capacities (including two in sub-Saharan Africa achieving maturity level 3 indicating stable and well-functioning regulatory systems); 
  • increased content and reach of OpenWHO; and 
  • accelerated support for countries to develop influenza pandemic preparedness plans. 

Looking forward 
The review made six recommendations for strengthening future implementation. Three of these focused on course corrections to improve implementation of the plan: 
  1. Review indicators and milestones that are no longer fit-for-purpose. 
  2. Better capture regional actions.
  3. Regularly inform stakeholders of how resources are allocated and implemented.
Three recommendations highlighted opportunities to catalyse pandemic preparedness in light of COVID-19: 
  1. Monitor the current pandemic landscape and capture lessons from COVID-19.
  2. Link to independent preparedness reviews to get an overview of country and regional preparedness.
  3. Consider how to map PC investments in the context of the broader preparedness landscape. 
WHO thanks all stakeholders for engaging in the review. We have started an ambitious plan to implement the recommendations.

Photo: Flickr / NIH Image Gallery (CC BY-NC 2.0)

 

GISAID launches EpiRSV™ sequence database  


The latest sequence database to join the GISAID Initiative, EpiRSV™ provides open access to genomic data for Respiratory Syncytial Virus (RSV) alongside bioinformatic tools to support therapeutic developments, outbreak investigations and virus evolution monitoring.

GISAID was first developed to enable free and rapid sharing of sequence data for influenza viruses. Since 2008, when it launched the EpiFlu™ database, it has collaborated with the Global Influenza Surveillance and Response System (GISRS) and other partners to share genomic data and support the development of seasonal and pandemic influenza vaccines and risk assessments of zoonotic influenza infections. 

In January 2020, the first SARS-CoV-2 sequence was shared through GISAID. This led to the rapid development of EpiCoV™, which supports genomic surveillance of the new coronavirus that causes COVID-19. EpiCoV™ also includes bioinformatic tools for monitoring the emergence of variant strains and mutations that may affect laboratory testing, diagnostics kits and External Quality Assessment panels. More than 2.3 million complete human SARS-CoV-2 sequences have already been uploaded to EpiCoV™. 

Most recently, in June 2021, GISAID launched EpiRSV™ for sharing genomic data on RSV, which affects an estimated three million children under 5 years of age each year. 

The new database, which is now publicly accessible to registered users, supports the WHO Global RSV Surveillance strategy. It aims to boost access to, and analysis of, genomic data around the world and will help close surveillance gaps to strengthen understanding of hRSV genomic diversity, support vaccine and therapeutic developments, and inform outbreak responses. 

EpiRSV™ already holds more than 23 500 sequences. It also provides access to a range of bioinformatics tools, such as reference sequences, BLAST, and PrimerChecker.

Photo: Flickr / Philippe Put (CC BY 2.0)

 

WHO Global RSV Surveillance project: progress despite pandemic disruptions   


A virtual meeting in June 2021 brought together 134 experts and partners from 25 countries to share experience and review progress in implementing Phase II of the Global Respiratory Syncytial Virus (RSV) Surveillance project, noting achievements and reviewing workplans in the context of the COVID-19 pandemic.

The first phase of the project was successfully implemented by the WHO Global Influenza Programme (GIP) from 2016 to 2019 in 14 countries across six WHO regions.

Phase II comprises a three-year extension (to October 2021) that expands the project to 25 countries and includes objectives to: 
  • enhance the surveillance in infants and young children under two years of age,
  • focus on severe disease requiring hospitalization,
  • widen virologic monitoring to differentiate virus types and identify genetic groups, and
  • generate a robust understanding of the seasonality, risk groups and disease burden of RSV, especially in low- and middle-income countries (LMICs). 
The June meeting reviewed progress towards these goals over the past year in the context of COVID-19. Participants noted that while 68% of project countries have maintained some form of RSV surveillance during the pandemic, most have faced significant disruptions as sentinel sites and some laboratory staff were repurposed for COVID-19 control, and patients avoided seeking health care or were re-directed for COVID-19 evaluation.

Despite these challenges, considerable advances were made, notably in: developing and completing RSV External Quality Assessment panels, typing and sequencing protocols, standardizing RSV nomenclature and sharing specimens with RSV reference laboratories for genetic characterization. One particular achievement has been the launch of EpiRSV™, a genomic data-sharing platform available through GISAID that already hosts more than 23,000 RSV sequences.

The June meeting also discussed next steps for RSV surveillance. Participants reviewed workplans for 2021–2022; the feasibility of integrating surveillance for influenza, RSV and SARS-CoV-2; and the need for advocacy strategies to ensure country-ownership and sustainability.

Image: WHO / Countries with at least one investigation (by WHO Unity Studies (Jan 2020–30 Mar 2021)

  

From influenza to COVID-19, WHO Unity Studies enable early investigations


Rapidly adapted from early seroepidemiological (sero-epi) investigation protocols for influenza, MERS-CoV and Zika, the WHO COVID-19 Unity studies aim to enable standardized quality enhanced surveillance and operational research during the COVID-19 pandemic. 

Ever since the 2009 influenza pandemic, WHO and partners have supported Member States to implement standardized early sero-epi investigations, with an emphasis on building surveillance and research capacities in low- and middle-income countries (LMICs). 

Starting with the CONSISE initiative and while initially focused on influenza, these protocols have been adapted for emerging threats over the years, including MERS-CoV and Zika. Now they have also been adapted for COVID-19 in what are known as the WHO Unity Studies. There are 10 protocols available, including protocols for investigating household transmission, the first few cases, population seroprevalence, health facilities transmission, vaccine effectiveness, pregnancy outcomes and transmission, school transmission, and surface contamination. 

As of 30 March 2021, 143 investigations have been completed using the Unity Studies. These were implemented in 81 countries, including 58 (72%) low- and middle-income countries (LMICs). The most widely used protocols were those on population seroprevalence (implemented in 69 countries) as well as the first few cases and household transmission protocols (implemented in 37 countries).

The widespread adoption of the WHO Unity Studies, especially in LMICs, helps generate much-needed data to inform local public health actions. The studies give countries the tools they need to enhance national surveillance and strengthen research by providing a standardized framework that is appropriate to any resource setting. 

WHO is now planning a review of how the Unity Studies have been implemented to inform future efforts to strengthen preparedness for influenza and other pandemic threats.

For more information, please contact:  EarlyInvestigations-2019-nCoV@who.int

Photo:  Flickr / Aimee Rivers (CC BY-SA 2.0)

 

First report of human infection with avian influenza A(H10N3)   


On 31 May 2021, the People’s Republic of China reported the world’s first case of human infection with avian influenza A(H10N3) virus to WHO. 

The case—a 41-year-old male from Zhenjiang City in Jiangsu Province—had no clear history of exposure to poultry before becoming ill. His close contacts have not shown any symptoms; and no A(H10N3) virus has been found in the local surroundings or poultry. 

Based on local and national assessment the case is thought to be an incidental infection that is unlikely to spread further.

For more information on the public health response, and WHO risk assessment and advice, visit WHO Disease Outbreak News and the Global Influenza Programme’s risk assessment summary.

Image: WHO / Blink Media – Mustafa Saeed

  

Starting sentinel surveillance in Somalia


The Federal Ministry of Health (FMOH) of Somalia and WHO are partnering to establish sentinel surveillance for influenza in the country. 

Somalia’s standard Early Warning Alert and Response Network for epidemic-prone disease surveillance and response provides limited data on severe acute respiratory infection (SARI) and influenza-like illness (ILI), which poses a real challenge to monitoring influenza in the country. 

In April 2019, a technical team from the WHO Regional Office for the Eastern Mediterranean assessed three hospitals (in Mogadishu, Hargeisa and Garowe) and supporting reference laboratories for their potential as sentinel sites in SARI and ILI surveillance. 

The assessment team identified several gaps in infrastructure, capacities and networking across the hospitals and laboratories. Since the assessment, WHO has worked with FMOH to fill the gaps. This support includes: training frontline health workers on SARI/ILI surveillance; prepositioning sentinel sites and laboratories with equipment, reagents and supplies; and training staff to collect, analyse and share epidemiological data through the regional platform, Eastern Mediterranean Flu Network (EMFLU)

The COVID-19 pandemic means no data have yet been collected from sentinel sites. But each of the activities listed above will allow the sentinel surveillance system to function efficiently once data collection does begin.

Starting with the three sentinel sites in Mogadishu, Puntland and Somaliland, WHO aims to support the FMOH to further strengthen Somalia’s laboratory capacity to identify and analyse influenza pathogens, share epidemiological and virological information through the Global Influenza surveillance and Respiratory System (GISRS) and participate in the WHO External Quality Assessment Project (EQAP). 

To gradually strengthen pandemic preparedness, FMOH is also working with WHO to develop a national plan for coordinating and implementing influenza surveillance and response. Progress on this plan has been delayed due to the ongoing COVID-19 response.

In conflict-affected countries like Somalia, health systems are underfunded and often rely on international development assistance to operate. The FMOH initiative on sentinel surveillance for influenza marks a significant commitment to prioritizing influenza preparedness and response, and also paves the way for better detection, preparedness and response to other emerging respiratory disease threats.

Photo:  WHO / Nursila Dewi

 

Trainers of trainers scale up SARI clinical management in South-East Asia    


A train-the-trainer approach in the WHO South-East Asia Region (SEAR) is boosting country capacities to clinically manage severe acute respiratory infections (SARI) and reduce the deaths and disability associated with influenza, SARS-CoV-2, and other respiratory pathogens.

The global influenza strategy (2019–2030) focuses on building better tools to prevent, detect and control influenza; and on strengthening country capacities for preparedness and response against the disease. In 2020, as part of its efforts to help countries implement the global strategy, WHO’s Regional Office for SEAR (SEARO) and the IMCI-IMAI Alliance began developing a regional training course on the clinical management of SARI from influenza. But when COVID-19 emerged later that year, the training materials were quickly modified to focus on managing SARI patients of COVID-19 aetiology instead. 

The training comprises six modules aimed at clinicians working in resource-limited non ICU settings; and are all adaptable to country contexts. Following a pilot test, it was made available on request; and delivered in three countries: Bangladesh (in Cox’s Bazar), Myanmar and Timor-Leste. Then an overwhelming demand for surge support in the face of fast-rising COVID-19 cases and deaths meant a new approach had to be found for rapid regional capacity development. 

Core clinicians
SEARO has established a regional group of core clinicians from seven SEAR countries who are receiving the new training in SARI clinical management online, with a view to becoming trainers in their own right. They can then roll out country-based support and enable a stronger regional response to the ongoing, and any future, pandemics. 

The online training is being delivered over 16 weeks by facilitators from Nepal, Timor-Leste and the IMAI-IMCI Alliance. The new group of “trainers of trainers” includes 38 practicing physicians who frequently handle SARI cases, mostly within district hospitals; and eight doctors from four WHO country offices. 

SEARO intends to evaluate the group’s in-country training at the end of this year; and will re-validate the trainers in two years’ time after a refresher course.

Photo:  WHO / Tom Pietrasik

 

Integrating strategies to tackle influenza and COVID-19 in South-East Asia   


In WHO’s South-East Asia Region (SEAR), countries are combining funds and activities for COVID-19 and influenza to strengthen pandemic preparedness for the short and long term.

The recent surge in COVID-19 cases across SEAR not only challenges countries to respond to a mounting crisis but also makes it very difficult to prioritize other pandemic threats. As a result, many countries have struggled to implement influenza preparedness activities planned under the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution (PC)

An emerging solution to the twin challenge has been to adopt an integrated approach, combining on-site and online activities to simultaneously strengthen the response to COVID-19 in the short term while continuing to build capacities for responding to future pandemics of respiratory viruses, including influenza. 

In Indonesia, for example, a combination of on-site and online activities is being used to build capacities in five new sites for sentinel surveillance of influenza-like illness. In addition, experts previously trained through PIP-PC are helping strengthen preparedness for a range of epidemic and pandemic threats. For example, some supported the Ministry of Health to deliver a pandemic influenza table-top exercise; while others are working with OIE, FAO and WHO to strengthen capacities for detecting and responding to zoonotic events, including zoonotic influenza.  

Nepal meanwhile has harnessed on-site and online opportunities for training, logistics and technical support to expand its network of laboratory-assisted surveillance of respiratory pathogens to subnational levels. By combining PIP-PC and COVID-19 funds, the National Influenza Centre has also been able to establish and implement a regular quality control programme for all laboratories in the network.

Nepal has also assessed the preparedness of 20 laboratories, using the second wave of the pandemic to plan ahead for stronger laboratory capacities, not only for COVID-19 but for other public health threats, including influenza and Respiratory Syncytial Virus (RSV). 

Indonesia and Nepal are examples of the approach that is being adopted across the region to creatively use PIP PC funds to integrate activities that can help simultaneously tackle the twin challenges of influenza and COVID-19.

Ukraine ramps up mortality 
monitoring during the COVID-19 pandemic    


In April 2021, Ukraine became the first non-EU/EEA country in WHO’s European Region to share weekly mortality data through the European Mortality Monitoring project (EuroMOMO).

EuroMOMO aims to detect and measure excess deaths related to seasonal influenza, pandemics and other public health threats. It compiles data from 29 European countries or subnational regions to provide real-time monitoring of deaths in Europe. EuroMOMO increases the European capacity to assess the impact of disease outbreaks and other events with an impact on public health and it has been instrumental in monitoring excess mortality through the COVID-19 pandemic.

Supported by the Pandemic Influenza Preparedness Framework (PIP) Partnership Contribution (PC), Ukraine joined EuroMOMO in 2016. Since then, the Public Health Center of the Ministry of Health of Ukraine (PHC) has been working with the State Statistics Service of Ukraine (Ukrstat) to put the project into practice by developing an implementation plan for collecting and sharing mortality data across the country.

In 2019, following a WHO/Europe and EuroMOMO mission to Ukraine and a series of high-level meetings with PHC and Ukrstat, an agreement was reached for Ukrstat to share all-cause mortality data with PHC each month. 

This year, in the midst of the COVID-19 pandemic, further negotiation with the Ministry of Justice enabled a significant step up in this mortality data sharing from once a month to once a week. Since April 2021, Ukraine has shared weekly mortality data with EuroMOMO. The data include deaths by age group, both at country level and disaggregated per region. The data are published online every week, through the PHC newsletter and the EuroMOMO Bulletin. They are also provided to the Ministry of Health to prioritize health service response and to inform policy decisions around which interventions to use and which vulnerable groups to target first. 

Ukraine’s participation in EuroMOMO marks a major milestone in mortality monitoring for the country which was made possible through the coordinated actions and efforts of the PHC, the Ministry of Health, EuroMOMO, and the PIP PC. 

Find out more
Covid-19 deaths in Europe top one million. Wall Street Journal. 16 April 2021. https://www.wsj.com/livecoverage/covid-2021-04-16/card/wjbz5qVi6tZ9dIVQcHmC.

EuroMOMO: https://www.euromomo.eu

Pharmacovigilance for COVID-19 vaccines dashboard
 

The Americas strengthen safety surveillance of pandemic vaccines  


Sustained technical collaboration between PAHO and regulatory stakeholders has built a foundation for pharmacovigilance of pandemic supplies in WHO’s Region of the Americas that is supporting the roll out of COVID-19 vaccines.

Supported by the Pandemic Influenza Preparedness (PIP) Framework, PAHO has worked with regulatory authorities, manufacturers, health professionals and other national stakeholders for 10 years to strengthen post-authorization safety surveillance of pandemic supplies. Most recently, they have established regional initiatives for safety surveillance of the COVID-19 vaccines. 

In particular, PAHO and Member States are strengthening the regional system for surveillance of adverse events following immunization (AEFI). This includes collaborating on five lines of action for pandemic readiness: regulatory mapping and proposals for improving vaccine introduction; procedures for AEFI surveillance, including the regional information system; training; active pharmacovigilance; and strategy and communication.  

To support this work PAHO has delivered: 
  • Practical tools, including: guidance on post-authorization surveillance and reliance for emergency use authorization during a pandemic and on how to manage serious adverse events and suspected unexpected serious adverse reactions during clinical trials; and definitions and case identification of AEFIs and adverse events of special interest.
  • Regional knowledge exchange through 22 Regulatory Update meetings in the context of COVID-19, with the aim to build regional capacities for pandemic products, including promoting the use of regulatory pathways to accelerated approvals.  
  • New protocols for sentinel surveillance and cohort event monitoring of COVID-19 vaccines in selected centres across the region.  
  • New online data-sharing tools, including a weekly bulletin on safety data, and a real-time dashboard on efficacy and safety. 
These achievements have proven particularly timely and useful for countries as they roll out the new COVID-19 vaccines. Together, they have built capacities in pharmacovigilance and established a robust platform for vaccine safety monitoring that countries can draw on and adapt for future pandemics, including of influenza.

Photo:  Sandra Mallo, PAHO communicator Bolivia 

 

Bolivia leverages influenza capacities for COVID-19   


Bolivia has received capacity-building support through the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution (PC) since 2013. Now the country is reaping the rewards as it leverages strengthened capacities in surveillance, epidemiological analysis, risk communication and clinical care to deliver its COVID-19 pandemic response. 

Key areas where pre-pandemic PIP support is really paying off include:
  • Early response. Previous training and simulations on timely intervention for unusual respiratory events helped shape the country’s early response to the pandemic, informing the identification, clinical care, isolation and risk communication of the first recorded cases of COVID-19. 
  • Clinical care. Existing capacity to care for severe cases of influenza in sentinel hospitals combined with pre-pandemic training in intensive care helped direct the clinical care of severe cases of COVID-19.
  • Biosafety. Biosafety training held months before the pandemic built widespread skills, quantified the national need for personal protective equipment, and enabled the development of biosafety manuals for hospitals, laboratories and isolation centers, which are now being used for COVID-19. 
  • Laboratory diagnosis. Before the pandemic, Bolivia had three laboratories, including a WHO-recognized National Influenza Centre, with molecular capacity to diagnose respiratory viruses. When COVID-19 hit, these laboratories provided a vital platform for expansion through training and supervision. Over the past year, the country’s network of molecular biology laboratories capable of diagnosing respiratory viruses, including SARS-CoV-2, has grown to 12. The NIC provides a central link that also ensures quality control for the network as a whole. 
  • Epidemiological analysis. The SARI case form and PAHO Flu sentinel information system that Bolivia routinely uses for influenza served as models for developing a national COVID-19 case information system.
Bolivia looks forward to continued collaboration under PIP. Priorities include using the expanded laboratory network to keep up its surveillance of novel respiratory viruses including influenza, and to strengthen its capacity for genetic sequencing.

Photo:  WHO / Blink Media – Nana Kofi Acquah

 

Enabling vaccine effectiveness studies in Africa   


How well are COVID-19 vaccines working in Africa? A new network for vaccine effectiveness aims to support countries to collect the data they need to find an answer. 

Across the world, including in WHO’s African region, COVID-19 vaccines are being rolled out in response to the pandemic. Understanding their performance in real-world conditions is essential for countries to plan and prepare vaccination programmes and other public health measures. 

In March 2021, WHO’s Regional Office for Africa (AFRO) launched AFRO-MoVE, a COVID-19 African Vaccine Effectiveness Network, to support countries to conduct vaccine effectiveness studies that assess how well new COVID-19 vaccines protect from disease and infection in the real world. The network includes partners from ministries of health, national institutes of public health, research institutes, academia and humanitarian organizations who will work together to share experience and expertise and help standardize practice so that results can be compared and combined to understand true variations between communities and vaccines.

Activities of the network will engage new competencies while building on long-term collaborations in vaccinology and infection sciences across the region and leveraging the skills and infrastructure of existing influenza surveillance and monitoring systems and networks, including 15 National Influenza Centres. Among other things, the network aims to deliver: 
  • Two generic study protocols for use in the region.
  • Technical orientation workshops for each study design.
  • Support to study groups with design, planning and funding of studies.
  • Landscaping activities and partners across the region.  
So far, 17 countries have joined the network. As vaccines continue to be rolled out in the region, the network will continue to develop, working together to strengthen African countries’ contribution to the global knowledge base on the effectiveness of COVID-19 vaccines. Our efforts today are helping build capacities for epidemic and pandemic response tomorrow, not only for COVID-19 but for other respiratory pathogens, including influenza.

Upcoming events

 

Annual Consultative meeting with the representatives of the South-East Asia Regional (SEAR) informal laboratory network for preparedness and response to public health emergencies (SEARO Meeting)
16 August 2021

14th Bi-Regional Meeting of National Influenza Centres and influenza surveillance in the Western Pacific and South-East Asia Regions
17–19 August 2021

Implementation of PIP activities in current biennium and direction for planning 2022–2023 in the Western Pacific and South-East Asia Regions
20 August 2021

PCITEM meeting
31 August–3 September 2021

WHO Consultation on the Composition of Influenza Virus Vaccines for the Southern Hemisphere 2022
13–30 September 2021

Latest publications

 

Monthly risk assessment on influenza at the human-animal interface
Download

Risk Management Plans and Periodic Safety Reports for COVID-19 Vaccines: Recommendations for Their Request, Preparation, Management and Assessment
Download

Consultation Document for Case Definitions: Adverse Events of Special Interest and Adverse Events Following Immunization during COVID-19 Vaccine Introduction
Download

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