Indonesia recognizes influenza as a priority hazard and is committed to strengthening and streamlining its pandemic preparedness process, including adherence to the International Health Regulations (IHR). Nevertheless, when COVID-19 swept across Indonesia, it became apparent that additional improvements in health resilience were necessary, prompting the Government of Indonesia (GoI) to request technical assistance from the World Health Organization (WHO). WHO responded by collaborating with the GoI to enhance the country’s capacity to prevent, detect and respond to potential pandemic influenza outbreaks. This included revising Indonesia’s National Influenza Pandemic Preparedness Plan (NIPP) and expanding Indonesia’s influenza-like illness (ILI) and severe acute respiratory infection (SARI) sentinel surveillance sites. These initiatives have better equipped the country to detect both influenza and COVID-19, and enabled a more effective and coordinated response effort to current and emerging health crises.

How did Indonesia, with the support of the WHO Secretariat, achieve this?

In 2017, WHO and the GoI conducted a full-scale epicentre pandemic simulation exercise to evaluate multisectoral capacities in responding to pandemics in Indonesia and to identify strengths and gaps for further improvement, guided by IHR core capacities. Based on this evaluation, the GoI joined forces with WHO in 2019 to create a pandemic influenza contingency plan that aimed to promote a comprehensive “whole-of-society” approach to preparedness. With financial support from WHO, a multisectoral team of representatives from the MoH, National Disaster Agency (NDA) and other key stakeholders participated in a series of workshops to develop the plan. During this collaboration, WHO guidance on pandemic influenza risk management was adapted to suit the local context. The national contingency plan covers critical technical areas such as surveillance and risk communication and underwent development and testing via tabletop exercises.

"Indonesia developed an influenza pandemic contingency plan based on lessons learned from COVID-19 as part of ongoing capacity-building and preparedness efforts. We hope it can address the COVID-19 pandemic while preparing us for future pandemic threats."

-          Minister of Health, Budi Gunadi Sadikin

When the COVID-19 pandemic hit Indonesia in March 2020, the GoI used the pandemic influenza contingency plan to create a COVID-19 response plan. In August 2020, an Intra-Action Review (IAR) was conducted to assess the initial response, followed by periodicperiodic IAR monitoring meetings. This review process identified lessons learned and proposed revisions to the NIPP to enhance pandemic preparedness and response strategies. Revisions included defining roles and responsibilities for key stakeholders, and mapping resources to ensure adequate preparedness levels. The review process also aimed to enhance stakeholder coordination in pandemic preparedness and response efforts.

WHO provided Indonesia’s MoH and NDA with financial and technical assistance to update the country’s existing NIPP, leveraging insights gained from the COVID-19 response. In May 2021, a scenario-based tabletop exercise evaluated the revised NIPP’s effectiveness. The updated plan prioritizes four critical areas of work: preparedness, emergency alert, emergency response and emergency transition. It aligns with WHO’s COVID-19 strategic preparedness and response plan and health cluster approach, aiming to ensure an efficient, effective, coordinated and integrated response to a pandemic influenza outbreak, from pre- through to post-pandemic stages. The updated plan will be essential to support Indonesia’s preparedness and response efforts to any future pandemic influenza virus or novel respiratory pathogen, enabling prompt and effective responses.

To improve influenza and COVID-19 monitoring, WHO Indonesia provided technical support, including refresher training about case definitions, data collection and analysis, sample collection and shipment, and field monitoring and evaluation. A comprehensive, two-stage ILI and SARI refresher trainings and review meetings were held. The first trainings on ILI targeted 120 health care professionals from 31 primary health care-based ILI sentinel sites plus district and provincial health officers in 26 provinces. A second meeting focused on SARI and involved 68 participants from 14 hospital-based SARI sentinels and district and provincial health officers in 10 provinces. During the meetings, participants from ILI and SARI sentinel sites identified gaps and challenges in implementing influenza surveillance and developed solutions to improve processes.

These efforts aim to enhance the function of sentinel sites as well as improve Indonesia’s capacity to monitor and respond to future outbreaks of influenza and other respiratory pathogens. Sentinel sites are crucial in Indonesia’s public health emergency management as they collect specimen samples, follow case definitions, and submit weekly reports to designated laboratories for testing and case recording. The MoH ensures that these reports are complete, conducts data analysis, and uploads data to the Global Influenza Surveillance and Response System (GISRS) platform.

“Sentinel surveillance for influenza and COVID-19 through the Global Influenza Surveillance and Response System (GISRS) is critical to acquire the epidemiological and virological information that is needed to formulate policy recommendations for improved pandemic preparedness.”

 -          Dr Imran Pambudi, Director of Communicable Disease Control, MoH

While these efforts are expected to strengthen Indonesia’s capacity to monitor and respond to future outbreaks, challenges to pandemic preparedness in Indonesia persist. These include variations in capacity across regions due to a decentralized system, high turnover at the subnational level requiring refresher training, and logistical and sample shipment issues in a large archipelagic country. To address these challenges and maintain the country’s readiness to respond to public health emergencies, regular NIPP reviews and exercises at both national and subnational levels will be essential.