Influenza and other respiratory diseases pose a real threat to individuals and communities everywhere. Even in their comparatively mild seasonal form, respiratory diseases such as influenza (also known as the flu) kill hundreds of thousands each year. When such diseases occur as pandemics, they inflict large scale societal and economic disruption, and cost lives. The COVID-19 pandemic has shown that they can set back many of the hard-won health gains of the Sustainable Development Goals and other aspirations of the World Health Organization and the international community to bring about the highest possible level of health for all.
Today, seasonal epidemic outbreaks of influenza affect up to 1 billion people each year, causing 3 to 5 million severe cases and up to 650 000 deaths annually due to respiratory diseases. The number of influenza-related deaths is likely to be greater as more is learned about deaths related to influenza – for example, influenza-triggered deaths due to cardiovascular causes.
"Influenza is not a national issue; it’s not a national phenomenon – it’s a global phenomenon and you can’t work on it isolated in the country."- Dr Olav Hungnes, Director of National Influenza Centre, Norwegian Institute of Public Health |
The birth of the Global Influenza Surveillance & Response System
Global health threats require a global response. In July 1948 – only 3 months after the adoption of the WHO Constitution and exactly 30 years after the devastating H1N1 influenza pandemic of 1918 – the World Influenza Centre at Mill Hill in London was established. The subsequently formed WHO Expert Committee on Influenza met for the first time in 1952 at an event now widely regarded as the birth of global influenza surveillance by the World Health Organization. The resulting early network consisted of the World Influenza Centre and 21 collaborating laboratories in 25 countries, primarily located in Europe and North America. Within a year, this network doubled in size and expanded into every region of the world. Today, 127 countries, areas and territories are able to detect, report and share data on circulating influenza viruses. |
Hill, London home to the World Influenza Centre |
The Global Influenza Surveillance & Response System (GISRS) conducts the laboratory testing that is the foundation of disease surveillance for influenza and other respiratory viruses. Through GISRS, countries share clinical specimens and virus samples for genetic analysis throughout the year to understand patterns of respiratory virus circulation, to identify new and characterize novel influenza viruses as well as other emerging respiratory viruses, and to form the basis for seasonal influenza vaccine compositions.
"I am proud to say that WHO, through its Global Influenza Programme, has been at the very heart of the Global Influenza Surveillance and Response System since its creation in 1952."- Dr Tedros Adhanom Ghebreyesus, Director-General of World Health Organization |
The importance of GISRS in global health crises
| In 2022, GISRS marks 70 years of countries working together to protect against influenza and other respiratory disease threats, in a model of global collaboration and cooperation. From the start, the GISRS network has been instrumental in detecting and controlling new influenza viruses with pandemic potential. |  |
In 1957, the GISRS network detected the emergence of a new influenza virus in Singapore – distinct from those previously circulating. The network worked swiftly to identify the previously unknown virus subtype – influenza A(H2N2) – and offered materials and knowledge to influenza laboratories around the world to test for the virus and inform vaccine development. The virus spread across countries through trade and transportation routes, and caused the deaths of over a million people worldwide. The 1957-58 pandemic also forged the key role of GISRS in global health crises through the establishment of global disease surveillance, virus identification, and strengthening of and collaboration among national laboratories and sharing critical information for pandemic response.
Although originally conceived to address influenza, GISRS has served as a vital support for countries facing non-influenza respiratory disease emergencies. In addition to the influenza pandemics of 1957, 1968 and 2009, GISRS has coordinated the world’s response to episodic human cases of infection with the avian influenza A(H5N1) virus since 1997, the first outbreaks of severe acute respiratory syndrome (SARS) in 2002, and the Middle East respiratory syndrome (MERS) in 2012 in some countries.
Most recently, GISRS proved to be a pivotal global resource during the COVID-19 pandemic. National Influenza Centres – which collect influenza virus specimens and conduct preliminary analysis – became the primary hubs for testing and analysing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19.
Countries leveraged the expertise and infrastructure of their National Influenza Centres to launch an immediate response to the COVID-19 pandemic and engage influenza surveillance systems to detect evolving SARS-CoV-2 viruses. For instance, in January 2020, the National Influenza Centre in Nepal became the first reference laboratory in the country for SARS-CoV-2 testing, making it possible for quick detection, testing and genetic sequencing of SARS-CoV-2. In addition to expanding the capacities of its laboratory network, the country also integrated the respiratory disease surveillance system to monitor for both influenza and SARS-CoV-2 viruses concurrently. Even crisis-affected nations were able to adopt existing respiratory disease surveillance and laboratory infrastructure for COVID-19 response. The first COVID-19 sample collected in Afghanistan was at an influenza sentinel site, from where it was shipped to the National Influenza Centre for confirmation by polymerase chain reaction (PCR) test. |
Laboratory technicians prepare respiratory samples for PCR testing for respiratory viruses at the National Influenza Centre, Rafik Hariri University Hospital in Beirut, Lebanon. July 2022. |
SARS-CoV-2 is just the latest example of respiratory viruses that have demonstrated beyond doubt their ability to infect humans and cause widespread outbreaks, and are a reminder of the looming threat of the next potential pandemic. As we celebrate the first 70 years of this international collaboration on global health, the world needs GISRS more than ever.
"GISRS played a critical role in the COVID-19 pandemic and, as such, further concretized its important position in the global surveillance architecture."- Dr Sylvie Briand, Director of Epidemic and Pandemic Preparedness and Prevention, World Health Organization |
There are several ways that the GISRS network supports countries and communities to tackle known and unknown respiratory disease outbreaks.
1. GISRS helps countries to share respiratory viruses
Influenza virus sharing is an essential cornerstone of preparing the world against pandemics. Virus sharing allows for pandemic risk assessment, the development of candidate vaccine viruses, revising diagnostic reagents and test kits, and surveillance
for resistance to antiviral medicines.
GISRS laboratories currently share around 20 000 influenza virus samples every year with WHO Collaborating Centres. The WHO provides financial and logistic support, especially to low- and lower-middle income countries, to enable such sharing through the WHO Shipping Fund Project – a GISRS resource that was created to ensure active and timely sharing of seasonal and potentially
pandemic avian influenza viruses within the global network.
The detailed characterization of these viruses is essential for assessing which viruses are expected to dominate in upcoming influenza seasons or carry the threat of the next pandemic.
2. GISRS provides vital information-sharing and analysis platforms
The GISRS network provides regular updates on the influenza situation through the analysis of laboratory and disease surveillance results reported to the WHO FluNet and FluID systems, respectively. FluNet is a web-based tool that allows National Influenza Centres and reference laboratories to share virological data for tracking the movement and spread of viruses globally. The database links with the FluID platform to offer regional influenza epidemiological data to chart global influenza trends.
In 1997, the first year of its operation, WHO FluNet was notified of 12 000 influenza-positive specimens. By 2016, this figure had reached almost half a million. Between 2014 and 2019, the network tested an average of 3.4 million clinical specimens annually. This figure surged to 6.7 million tests for influenza and 44.2 million tests for SARS-CoV-2 performed by National Influenza Centres in 2020 and 2021.
Laboratory testing on this enormous scale allows the WHO to conduct risk assessments on the influenza situation and alert countries to the emergence of unusual virus strains. Data from these global platforms are made publicly available to health policymakers to make informed decisions on managing influenza and other respiratory illnesses.
Another publicly shared database is the GISAID Initiative, first launched in May 2008 as a tool for scientists to safely share influenza genetic sequence data after recognizing the threat of avian influenza viruses to humans. GISAID’s major role in the COVID-19 pandemic was providing a platform for sharing the genetic sequence data for SARS-CoV-2, including the first complete genome of the SARS-CoV-2 virus within 48 hours of its completion through the EpiCoV database.
3. GISRS provides the viruses for seasonal and pandemic vaccine production
Influenza viruses evolve and circulate regularly. Members of the GISRS network play a unique and important role in tracking the global circulation and new strains of influenza viruses and all directly contribute to the development of appropriate vaccines against seasonal influenza.
Throughout the year, National Influenza Centres share a subset of the viruses they isolate with the WHO Collaborating Centres. These centres perform detailed characterization of the viruses received. The resulting information shared with the WHO and the GISRS network, informs the selection, development, and production of safe and effective seasonal influenza vaccines as well as the key reference reagents that are required for the regulatory approval for their use. Twice a year, the WHO makes recommendations on virus strains for inclusion in influenza vaccines per hemisphere (North and South) and flu season. Various vaccines are developed, targeting 3 or 4 strains of the virus predicted to be most commonly circulating in the coming flu season. |
Health worker administering influenza vaccine at a medical centre in Bishkek, Kyrgyzstan |
In addition, the GISRS infrastructure allows for the rapid detection of influenza or other respiratory viruses of pandemic potential, allowing experts to quickly develop and deploy vaccines against them. Learn more about the history of the influenza vaccine here.
4. GISRS promotes fair and equitable access through the Pandemic Influenza Preparedness (PIP) Framework
The Pandemic Influenza Preparedness (PIP) Framework is a World Health Assembly resolution adopted by Member States in 2011 for a global and unified approach to pandemic influenza preparedness and response. The WHO, through the PIP Framework, brings together industry and other stakeholders and Member States to improve and strengthen the sharing of influenza viruses with human pandemic potential through the GISRS network, and to increase access to vaccines, antivirals, and other pandemic-related supplies in developing countries.
The objective of the PIP Framework is to improve pandemic influenza preparedness, response and protection by improving and strengthening GISRS as a fair, transparent, equitable, and effective system that allows all nations to share H5N1 and other influenza viruses with human pandemic potential; and have access to vaccines and other benefits.
This support has helped countries to improve laboratory capacities such as in Togo, where the influenza laboratory at the Institut National d’Hygiene (INH) in Lomo was recognized as a National Influenza Centre in 2021, thanks to the support from GISRS, the PIP Framework and through PIP Partnership Contributions. Hence, even as the nation prioritized responding to the COVID-19 pandemic with added demand on laboratory diagnostics, Togo’s influenza surveillance and pandemic preparedness capacities were strengthened for the future.
During the 2020-2021 biennium,15 out of the 17 [1] countries (88%) that reported zoonotic influenza cases to the WHO shared influenza viruses of pandemic potential with GISRS. In addition, many PIP-supported countries were able to authorize COVID-19 vaccines within 15 days of the WHO issuing an emergency use listing. Through its work in facilitating the global sharing of viruses and ensuring their detailed characterization, including for vaccine production, GISRS acts as a cornerstone of this landmark international endeavour.
5. GISRS fosters key partnerships
Partnership is the driving force of GISRS as it continues to galvanize collaborations with stakeholders in both the human and animal health sectors. By working closely with networks and agencies across the public and private sectors including vaccine, pharmaceutical and diagnostics manufacturers, and the academia, the contributions of the GISRS network have proven invaluable to global health security.
GISRS works with the Food and Agriculture Organization (FAO), the World Organization for Animal Health (WOAH) and national animal health experts to detect and respond to spill-overs of zoonotic influenza viruses from animal to humans. The WHO-FAO-WOAH Tripartite Alliance, which was announced in 2010, aims to prevent and control the health risks at the human–animal–ecosystems interface by providing multi-sectoral leadership and championing the One Health approach, recognizing that human health, animal health and the environment are strongly interconnected.
GISRS works with vaccine manufacturers and regulatory agencies every year to ensure that influenza vaccines and the necessary vaccine reagents are updated and available well before the start of each influenza season in a multi-faceted and time-sensitive process.
WHO Collaborating Centres and specialized laboratories develop the high-growth candidate viruses needed for vaccine development and production. The WHO Essential Regulatory Laboratories produce, calibrate and distribute diagnostic reagents based on antigens (for developing antibodies) that are provided by vaccine manufacturers. Through this long-standing public-private partnership, GISRS ensures the timely development and release of vaccines to protect against influenza.
GISRS today: a public health resource for the world
Since its establishment in 1952, the GISRS network has expanded to 127 countries, areas and territories. The network now includes 158 institutions, including 148 National Influenza Centres recognized by the WHO in 124 Member States, seven WHO Collaborating Centres, four Essential Regulatory Laboratories, and 13 H5 Reference Laboratories.
By monitoring and responding to influenza and other respiratory viruses that can cause seasonal epidemics, zoonotic outbreaks, and potential pandemics, GISRS has become an invaluable global public health resource. The GISRS network makes it possible to track the global spread of potentially highly dangerous influenza or other respiratory viruses, and of mounting a meaningful response when the first signals of an impending epidemic or pandemic are detected.
GISRS will continue to be at the heart of the WHO’s global influenza strategy which aims to reduce the burden of seasonal influenza, minimize the risk of zoonotic influenza and mitigate the impact of pandemic influenza. This will be achieved through a range of research, capacity-strengthening, and policy-development activities. In all these areas, the activities and support of the GISRS network will be a crucial asset for the WHO and all key partners.
"GISRS is the frontline in the fight against influenza. It is one of the oldest and most significant examples of international cooperation for public health."- Dr Wenqing Zhang, Head of Global Influenza Programme, World Health Organization |
Moving beyond influenza: expanding GISRS (GISRS Plus)
As GISRS celebrates 70 years of milestones and achievements, it also looks to the future and to the exciting prospects ahead. In particular, the vision of an enhanced and expanded network – the GISRS Plus – is now coming into view.
The WHO is working with GISRS and countries to develop a strategic action plan, building upon existing influenza infrastructure, workforce, experience, trust and confidence that would be capable of detecting, monitoring and responding to priority
respiratory virus with epidemic or pandemic potential.
An integrated global defence against respiratory diseases that harnesses technological innovations and progresses the knowledge of respiratory pathogens would revolutionize the tools and approaches to pandemic response. Entering its eighth decade, the Global Influenza Surveillance & Response System will continue to build upon the vision of its founders – to strengthen the world in the common fight against the threat of respiratory viruses.
[1] The remaining countries did not have virus material left for sharing.