Syria boosts influenza preparedness despite multiple crises

The influenza programme in Syria was established in 2009 in response to the H1N1 pandemic. At the time, the Ministry of Health did not have a comprehensive preparedness plan covering all relevant sectors. Only instructions about preventive and preparedness measures had been circulated across health directorates. In addition, influenza surveillance was not systematic, and reporting was universal and ad-hoc. Laboratory capacity was very limited, with an average of only 200 samples annually, and surveillance data was not representative of the entire population.

In 2011, after the outset of the Syrian crisis, the health system was severely affected, increasing the risk of potential outbreaks of infectious diseases. The country suffered from deteriorated living and environmental conditions, health system collapse, decreased health workforce capacity, and inadequate surveillance capacity. Concerns about the spread of infectious diseases, especially emerging influenza viruses with pandemic potential, have emphasized the need to strengthen preparedness for influenza and other respiratory viruses.

In 2021, despite the compounded complications resulting from the crisis as well as the ongoing COVID-19 pandemic, Syria’s Ministry of Health successfully launched its first comprehensive National Pandemic Influenza Preparedness Plan (NPIPP). Development of the new plan was overseen by the Syrian National Influenza Committee (SNIC), a new entity established by the Ministry of Health to ensure a whole-of-government and whole-of-society approach to influenza preparedness and response that coordinates action across all sectors and stakeholders.

How did Syria do it, and how did the WHO Secretariat support Syria?

A multisectoral venture

The SNIC includes representatives from a range of government ministries and directorates, including health, communicable diseases, agriculture, education, interior, and military medical services, as well as representatives from WHO country and regional offices. Together, the multisectoral committee is responsible for developing, maintaining, testing, evaluating and revising the NPIPP. Its work is supported by multiple partners, including WHO, with support from the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution.

Within PIP Partnership Contribution activities, WHO contracted an international expert to help Syria develop the plan and support joint meetings with SNIC. In addition, WHO technical staff and experts, together with the Ministry of Health influenza programme, conducted field visits, held technical consultations (both virtual and in-person) and considered lessons learned from the 2009 (H1N1) pandemic and ongoing COVID-19 pandemic.

The Ministry aligned its plan with WHO guidance on pandemic preparedness and response, particularly with regard to integrating surveillance for multiple pathogens. To that end, in parallel with the SNIC’s work on the NPIPP, Syria has successfully established an integrated laboratory and sentinel surveillance system that has enhanced detection and monitoring capacities for both influenza viruses and SARS-CoV-2.

In November 2021, a final draft of the NPIPP was agreed upon by all members of the SNIC and endorsed by the Syrian government. The final plan includes a detailed operational component identifying timeframes and responsibilities to guide preparedness and response capacity building for influenza outbreaks in humans and animals.

Next steps

Throughout 2021, despite huge operational restrictions and economic difficulties caused by the ongoing humanitarian emergency and COVID-19 pandemic, unavailability of data on influenza burden, unavailability of information needed to develop the plan (for example, number of health workers, people with chronic diseases, the elderly, etc.), the SNIC successfully developed the NPIPP. The process increased both the Ministry of Health and the broader Syrian government’s commitment to influenza preparedness and response. Through the PIP Partnership Contribution, WHO will continue to support the country to test, evaluate and refine the plan over the next two years. Planned activities include a simulation exercise in 2022 to test the plan and identify areas for further strengthening. In addition, the government is planning to use the NPIPP as a blueprint for enhancing preparedness, readiness and response to other priority health threats, including COVID-19 and other respiratory pathogens.

Photo Credit: © WHO Country Office, Syria

Photo Caption: Influenza and SARS-CoV-2 lab testing through the integrated surveillance approach at the new peripheral laboratory in Aleppo.