The African (AFR) and Eastern Mediterranean (EMR) regions suffer a large burden of humanitarian vulnerabilities. Nine out of the 10 United Nations system-wide scale ups in response to emergencies occurred in these two regions since 2014. The two regions also have 21 out of the 28 (75%) countries with active health clusters highlighting the considerable challenges for addressing population health needs.
Since the beginning of PC implementation in 2014, investments were made in laboratory and surveillance capacities for strengthening pandemic influenza preparedness including in AFR and EMR. Despite the multiple emergencies experienced in these two regions, significant gains were made as shown below. The gains represent global solidarity to ensure that populations everywhere, regardless of context, are supported to strengthen their preparedness for a future influenza pandemic. The work operationalizes equity, which is at the heart of the PIP Framework, and WHO's mandate to serve the vulnerable.
Increasing the number of National Influenza Centres (NICs) to facilitate global influenza monitoring and public health risk management
Four NICs were newly recognized by WHO in 3 African countries and 1 Eastern Mediterranean country, bringing the total number to 33 NICs in 31 countries in these two regions. Increasing the number of NICs was recognized, by the PIP Advisory Group in 2013, as the first objective for use of PC funds. Increasing the participation of countries in GISRS means that data and viruses shared are more representative for risk assessment and public health action. It will also facilitate a timely and effective response to an influenza pandemic as more countries will be able to rapidly detect a novel influenza virus.
Sharing influenza viruses to contribute to global surveillance and vaccine development
Fifteen countries started sharing influenza viruses or clinical specimens with WHO CCs since 2014 in AFR and EMR (respectively 12 and 3 countries). By sharing seasonal influenza viruses, countries increase the geographic representativeness of viruses available to inform the yearly composition of influenza vaccines. Through the sharing of seasonal influenza viruses, countries also show their capability to share influenza viruses with pandemic potential when the need arises.
Participating in WHO yearly EQAP to accurately detect emerging influenza viruses
Due to the continuous threat of pandemic influenza, quality laboratory diagnostics are essential. EQAP helps laboratories monitor, sustain and improve influenza virus detection capacity and performance standards. Since 2014, 5 African and 3 Eastern Mediterranean countries started participating in the WHO EQAP. EQAP helps WHO and GISRS institutions to focus capacity-strengthening initiatives to where they are most needed, and to ensure confidence in the underlying systems providing critical data for decision-making.
Sharing data to monitor influenza activity and inform risk assessments
Fifteen countries from AFR and EMR started reporting epidemiological data to WHO's influenza surveillance platform "FluID", 6 started reporting virological data to "FluNet", and 6 started reporting data to both platforms. The participation of more countries increases the geographical representativeness of the data in these two global systems. Routine data availability also means that situational analyses and risk assessments are up to date. These are critical for national and global preparedness.
Reporting influenza severity indicators to enable timely severity assessments and associated response recommendations
WHO's pandemic influenza severity assessment (PISA) platform was developed to monitor and assess the severity of yearly influenza epidemics, so that when the time comes, it can also be used for pandemic influenza monitoring. Since its launch in 2017, 13 countries from AFR and EMR (respectively 10 and 3) have started reporting to the PISA platform. Country participation will streamline monitoring during the next pandemic, and the historical data will assist countries to determine the timing, scale, emphasis, intensity and urgency of the pandemic response actions needed.
Building resilient systems
WHO congratulates countries for these gains. However, the work is not done. Due to the humanitarian and fragile contexts in many countries, time is needed to stabilize participation in influenza preparedness systems. The COVID-19 pandemic also shed light on existing gaps in preparedness and the need to revisit surveillance platforms and approaches to be resilient within a broader acute respiratory disease context.
