Newsletters April 2021

Preparing countries and champions for acute respiratory infections

Development of the course is being guided by a Steering Committee comprising technical and learning design specialists across all levels of WHO: country offices, regional offices and headquarters. 

Course content

When it launches, the course will offer strategic, policy and operational considerations for strengthening national ARI strategies. Participants will, for example, consider why ARI preparedness is so important, how data can be used to inform policy and action, and which measures can be used to prepare for and respond to ARIs.

As part of the course, participants will share experience and expertise with other country teams and join live talks to discuss case studies. Through the course, country teams will develop a comprehensive ARI preparedness and control strategy that can be used to advocate for and strengthen ARI capacity within their own country.

Twinned teams

WHO regions are nominating country teams to participate in this pilot course. Each country team will adopt a ‘twinned’ approach to learning by including technical specialists and senior decision-makers from both government ministries and WHO country offices. This will enable a more holistic development of ARI strategies, as well as laying the foundations for long-term advocacy for ARI preparedness, supported by a wider peer-support network for national and international knowledge exchange that can endure throughout participants’ careers.

We look forward to launching this new course in June 2021 as an example of a robust cross-cutting learning programme aimed at strengthening and sustaining ARI preparedness.

Influenza training and reporting gains in Uzbekistan

Over the past years, with support from WHO and partners, the Ministry of Health (MOH) of Uzbekistan has made significant gains in strengthening the country’s pandemic influenza preparedness by establishing a weekly national influenza bulletin and developing a new clinical training programme.  

Vital statistics

The COVID-19 pandemic has underlined the importance of data availability for health policy planning and prioritization and for supporting front-line responders. In recent years, Uzbekistan has improved influenza surveillance significantly with support from the PIP Framework Partnership Contribution, yet gaps were revealed with the emergence of the COVID-19 pandemic which led to further enhancement of surveillance for influenza and other respiratory infections. 

As a significant achievement the MOH and Sanitary and Epidemiological Wellbeing and Public Health Service have worked with partners to successfully establish a weekly national influenza bulletin that is publicly available in Russian and Uzbek. The bulletin, which has been consistently published since December 2020, was developed following recommendations from the Global Influenza Surveillance and Response System (GISRS), and with the support of the Pandemic Influenza Preparedness (PIP) Framework, USAID and WHO country and regional offices.

It is anticipated that the newly established regular data sharing will enhance understanding of the public health burden caused by influenza and SARS-CoV-2 in Uzbekistan, contributing to global surveillance of these viruses, broadening insight into their biology and supporting appropriate and timely responses.

Critical course

Alongside its efforts to improve influenza reporting, the MOH has also been working to improve treatment of Severe Acute Respiratory Infections (SARI) caused by influenza through training of frontline responders . For several years, Uzbekistan has applied WHO’s critical care training short course to sharpen the skills of senior doctors and build the country’s human resource capacity to manage patients with SARI. In 2018, with support from the PIP Framework, the MOH used the short course to develop and adopt its National Guidance on Management of Patients with SARI.

Two years later, in the face of a new global pandemic, the MOH and WHO leveraged the partnerships established under PIP to form a collaborative group of experts and develop a new training programme on managing critically ill SARS-CoV-2 patients. The programme was built in line with WHO recommendations on clinical management of patients with SARI, and was designed to enable post-graduates to better manage SARI patients, including influenza patients, in intensive care units. The new course, which can be delivered in just 36 hours, was created by professionals from the National Advanced Training Center for Medical Doctors in Tashkent in collaboration with WHO country and regional offices, with support from USAID.

The new training in critical care has since been formally approved by the MOH. It provides a systematic approach to case management, highlights the importance of infection prevention and control for health care practitioners, sets up new standards of care, emphasizes the importance of pandemic preparedness and ethics, and provides best practices for managing patients in ICUs. The course materials are being printed in three languages—English, Russian and Uzbek—before being launched for use across Uzbekistan.

Strengthening advance supply contracts for pandemic influenza vaccines

With support from the Pandemic Influenza Preparedness Framework Partnership Contribution (PIP PC), Ghana has developed a well-functioning regulatory system for medical products that has proved critical in enabling the country’s response to COVID-19.

Vaccines are a key component of any pandemic influenza response. The PIP Framework helps to ensure timely and equitable access to pandemic vaccines through advance supply agreements with influenza product manufacturers. To date 14 vaccine manufacturers have signed a Standard Material Transfer Agreement 2 (SMTA2) with WHO, committing to supply an average of 10% real-time vaccine production in the event of an influenza pandemic. This means that WHO has already secured an estimated 400 million doses for the next influenza pandemic. Most of these will be donated to WHO while some will be provided at an affordable price.

Operational focus

It is essential that these vaccine supply commitments can be quickly and effectively operationalized when the next influenza pandemic strikes. To that end, WHO is working with PIP industry partners to review some of the SMTA2 deployment terms and related policy issues, to ensure clear and actionable roles and responsibilities for all stakeholders involved in the vaccine supply process. This includes, for example, examining the roles of manufacturers, WHO and regulatory agencies in approving the pandemic vaccine for use in recipient countries.

Manufacturers that have already signed an SMTA2 with WHO as well as industry associations such as IFPMA, DCVMN and BIO are involved in the review. A series of virtual meetings have been planned, and two have already been held (in November 2020 and March 2021). Once the series of meetings is concluded, a report will be drafted to highlight key discussion points, decisions and recommendations made.

Any resulting changes to SMTA2s will be incorporated on an individual basis with each manufacturer, coinciding with the contractual requirement for the parties to review the agreement every four years.

Robust response

Importantly, the SMTA2 review is also drawing on lessons learnt from the ongoing roll-out of COVID-19 vaccines across the globe, including country preparedness to authorize and receive vaccines and application of the Emergency Use Listing and prequalification processes for pandemic vaccine risk assessment.

Ultimately the goal of the SMTA2 review is to make sense of the many moving parts and players involved in pandemic vaccine deployment; and to ensure the process is as efficient as possible so that when the next influenza pandemic emerges, vital vaccines can be quickly and fairly distributed to those in need.

Ghana’s regulatory system achieves a critical milestone

With support from the Pandemic Influenza Preparedness Framework Partnership Contribution (PIP PC), Ghana has developed a well-functioning regulatory system for medical products that has proved critical in enabling the country’s response to COVID-19.

A regional milestone

In April 2020, after being assessed by WHO using the Global Benchmarking Tool, the Food and Drug Authority (FDA) of Ghana was found to meet all indicators that define a maturity level 3 (ML3) agency. In doing so, it became the second confirmed country in Africa to achieve a stable, well-functioning and integrated regulatory system for medical products.

The achievements of FDA Ghana and FDA Tanzania (the other ML3 agency in Africa) mark a milestone for the region and open the door for stakeholders across Africa to work collectively for timely access to quality assured medical products. Their success was enabled by years of system strengthening investment, action and support, including support from PIP PC to build staff capacity and develop regulatory tools in areas such as pharmacovigilance, market control, marketing authorization and clinical trials oversight. 

Securing supplies

In the face of COVID-19, FDA Ghana’s investment in regulatory system strengthening has been very beneficial. The agency has been a key enabler of the Ministry of Health’s pandemic response. For example, by providing timely support to local industry, FDA Ghana ensured the availability of affordable and quality-assured personal protective equipment during the pandemic, including the hand sanitizers and face masks that were at the heart of safety protocols for controlling COVID-19 infections. FDA Ghana’s capacity to quickly develop specifications and guidance, and to establish a fast-track for marketing authorization, enabled the country to secure vital supplies at a time of acute scarcity across the region.

At the same time, FDA Ghana made use of strategies such as working from home, electronic submissions, online reviews and virtual meetings and inspections to continue performing its routine regulatory activities.

Deploying vaccines

FDA Ghana’s capacity as a ML3 agency is also proving its worth as the country prepares to deploy COVID-19 vaccines. Ghana is the first country outside India to receive vaccines through the COVAX facility; and FDA Ghana is using its full capabilities to ensure these can be rapidly and effectively approved, received, distributed and administered. The agency has, for example, already activated its Emergency Use Authorization Procedure to review submissions for the various candidate vaccines.

Ghana has long seen the value of strengthening its regulatory system. Building on its success during the COVID-19 pandemic, it remains committed to continuous improvement in preparation for the next influenza pandemic.

PIPDeploy: A simulation exercise to get countries ready for pandemic vaccines

A recent article in the peer-reviewed journal Vaccine, describes the development and appraisal of the PIPDeploy table-top simulation exercise as a facilitated learning tool for emergency preparedness.

Given the role effective deployment of vaccine plays in pandemic response, and the role of simulation exercises in identifying gaps in preparedness capacities, documenting this work is extremely valuable.

A strategic tool

Whether responding to a localized outbreak or a nation-wide pandemic, a successful emergency vaccination campaign relies on effective planning and vaccine deployment. PIPDeploy is an interactive, in-person table-top simulation exercise that was built to facilitate learning for just that. Developed with support from the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution (PC), this novel approach to simulation exercises offers a strategic tool for strengthening countries’ capacities to deploy pandemic influenza vaccines.

The Vaccine article describes how PIPDeploy was developed and implemented across five workshops in four WHO regions, which were attended by national-level managers responsible for vaccine deployment in non-vaccine-producing countries. These workshops were used to emphasize the strategic importance of pandemic influenza vaccines as an integral part of pandemic preparedness; and to underscore the need to regularly review National Deployment and Vaccination Plans (NDVPs) so that any weaknesses can be identified and addressed.

Enhanced experience

Because PIPDeploy marks a novel approach to testing preparedness capacities, the Vaccine article considers the added value for participants. It shows how various elements of game design are used within PIPDeploy to enhance user experience, including game boards, time pressure, leader boards and teams. The game’s systematic and linear design of a vaccine deployment scenario is found to be particularly useful for countries that have not fully developed their NDVPS, not least because it gives them an opportunity to identify gaps in their own systems and plan how to address them.

The Vaccine article also sets out the activities and next steps for using PIPDeploy to extend and enhance emergency preparedness in participating countries. This includes, for example, potentially adapting PIPDeploy to sub-national contexts and to other epidemic-prone diseases.

Find out more:

Reprioritizing preparedness for the “new normal” of life with COVID-19

A performance review of pandemic influenza preparedness (PIP) activities in the South East Asia Region reflects on lessons learnt during the COVID-19 pandemic and emphasizes the need to strengthen risk communications and update national preparedness and response plans.

Seven countries in WHO’s South East Asia region (SEAR) received support under the PIP Framework Partnership Contribution (PC) to strengthen their pandemic preparedness capacities. All seven have received PIP PC funds this year. But the ongoing COVID-19 pandemic threatens to stymie their use through, for example, travel restrictions, staff shortages and technological gaps.

To discuss the challenges, and ensure progress despite the pandemic, WHO’s South East Asia Regional Office held a virtual meeting with all PIP-PC recipient countries and WHO country office focal points in December 2020. The meeting had a twin objective: to evaluate progress achieved during 2020; and to agree on workplans for 2021. Over two days, meeting participants considered lessons learnt over the past twelve months and noted areas where PIP PC activities might need reprogramming to adjust to the “new normal” of a world living with COVID-19.

Looking back

Looking back, meeting participants emphasized the importance of PIP PC funds to supplementing and accelerating national pandemic influenza preparedness and response across SEAR. In the face of challenges posed by COVID-19, many countries in the region found innovative ways of using PIP PC funds that could help tackle the threats of pandemic influenza and COVID-19 at the same time. This includes for example, updating and adapting national influenza preparedness plans.

Looking forward

Looking forward, all PIP PC recipient countries intend to carry out pandemic influenza preparedness activities, while continuing to respond to the COVID-19 pandemic. Participants at the December meeting pointed to two priorities for 2021:

• Update influenza preparedness plans. Participants stressed the potential value of drawing on their experiences of responding to COVID-19 to test and update their influenza preparedness plans. This includes updating the National Action Plan for Health Security (NAPHS) where this exists, or the equivalent standalone plan where it does not.
• Strengthen risk communication. The infodemic surrounding COVID-19 has underscored the importance of risk communication like never before. All PIP PC recipient countries are eager to strengthen their risk communication and community engagement capacities with targeted activities in 2021.

Delivering on these priorities will require looking at PIP PC workplans with a different lens – and how WHO can best collaborate and provide technical support will need to be evaluated.

Preparedness gains through the PIP PC: 2020 in review

The of the Pandemic Influenza Preparedness (PIP) Framework showcases public health gains made collaboratively with other investments.

The report, which covers the third year of the PIP PC’s High-Level Implementation Plan II (2018-2023), describes how industry partner contributions were allocated to strengthen preparedness globally, regionally and nationally in 80 targeted countries.

Since the PIP PC was established in 2012, it has received more than US$ 223 million from industry partners to support activities in six areas of work: laboratory and surveillance, burden of disease, regulatory capacity building, risk communications and community engagement, planning for pandemic product deployment, and influenza pandemic preparedness planning. WHO sincerely thanks industry partners for their contributions.

2020 achievements

Despite the challenges posed by the COVID-19 pandemic, much was achieved in 2020.

• New National Influenza Centre (NIC). After strengthening diagnostic testing and laboratory quality management systems, Suriname’s influenza laboratory was recognized as an NIC and joined the Global Influenza Surveillance and Response System (GISRS). 
• Global reporting gains. In 2020, 131 countriesreported epidemiological data to FluID. Two countries reported virological data to FluNet for the first time, bringing the total number of countries reporting on this global platform to 150. 
• Specimen shipping. Through the Shipping Fund Project, 88 countriesmade 154 shipments of influenza viruses and specimens to WHO Collaborating Centres despite severe disruptions caused by pandemic.
• Burden estimates. Four countriespublished influenza burden of disease estimates; another four updated their existing ones. 
• Regulatory system strengthening. Ghana became the second country in Africa to attain WHO Maturity Level 3 for its regulatory system, indicating a stable, well-functioning and integrated system of oversight for medical products
• New guidance. New guidance was published on developing a national deployment and vaccination plan for COVID-19 vaccine.
• Collective service. A collaborative partnership between WHO, UNICEF and IFRC was established as a global support mechanism for risk communication and community engagement (RCCE); and used to develop national COVID-19 action plans.
• RCCE learning. The OpenWHO online learning platform for frontline responders was launched in 2017 using PIP investments. By December 2020, 192 111 users had completed RCCE courses related to influenza in multiple languages.
• Preparedness plans. A total of 51 (out of 63) countries have written, exercised or are developing national pandemic influenza preparedness plans.
• Overall pandemic influenza capacity strengthening: The COVID-19 pandemic delivered a collateral benefit for influenza preparedness. With no COVID-19-specific infrastructure available, many countries are leveraging their influenza systems as a platform for pandemic response—to detect, test and keep track of the new virus. In doing so, they are simultaneously using, exercising and continuously strengthening their influenza systems.

Find out more: PIP PC Stories from the field: PIP Framework Partnership Contribution

A FORCCE for risk communication

The Formidable Officers of Risk Communication and Community Engagement (FORCCE) network, created under the Pandemic Influenza Preparedness (PIP) Framework in 2019, is an innovative network bringing WHO regions together to strengthen the global COVID-19 response. It has proved instrumental in enabling the use of a range of tools and tactics to improve risk communications and community engagement across the world.

When it was first established, the FORCCE network focused on capacity building and influenza preparedness to develop and strengthen countries’ capacities for emergency risk communication, which is one of the eight core capacities under the International Health Regulations (IHR) (2005).

During the COVID-19 pandemic, the network has evolved to help shape and support the ongoing global response. It meets every week to strategize and discuss content. By regularly exchanging experience and expertise about their shared challenges, the FORCCE network is able to identify and share diverse solutions.

Through the network, the Regional and HQ leads for Risk Communication and Community Engagement (RCCE) have shared key materials, messages and strategies related to COVID-19 over the past 12 months. This has enabled them to identify issues, ensure consistency in countries’ response plans and avoid duplication—a critical time-saver during pandemic response.

The network has, for example, effectively responded to the challenges of pandemic fatigue, social cohesion, and the translation of evolving science. It has also developed and shared social listening data, sentiment analyses, tailored risk communication materials, rumour monitoring strategies, behavioural insights survey tools, and country- and community-focused capacity building products.

Tools and tactics developed in one region are being shared and used by others, including for example:

• Community engagement technical assistance (AFRO)
• WHO tool for behavioural insights on COVID-19 (EURO)
• Home care for suspected and mild cases of COVID-19 (EMRO)
• An informative guide. Advice for journalists (PAHO)
• Protocol for Infodemics, misinformation and rumor management (SEARO)
• The COVID-19 risk communication package for healthcare facilities (WPRO)

As the FORCCE network continues to evolve, it will continue to provide invaluable learning opportunities for community level capacity building for pandemic influenza preparedness. To this end, a recent mid-course assessment highlighted four challenging areas that need to be addressed: behavioural insights capacity building, message testing, infodemics response, and monitoring and evaluation.

Enabling evidence-based influenza policy in Chile

The timely sharing of epidemiological data and burden of disease analyses to stakeholders in Chile has been key to developing the country’s seasonal influenza control policies and programmes.

Stakeholder survey

In 2019, supported by the Pan-American Health Organization (PAHO), Chile’s Ministry of Health (MOH) completed a series of studies on the disease and economic burden of influenza, and used the findings to shape national public health action for influenza control. The MOH and PAHO are working to examine the process followed in Chile to identify and understand the key enablers to implementing evidence-based influenza control policies and programmes so that other countries can benefit from their programmatic learning.  

The Influenza Surveillance Team at the MOH surveyed a selection of key national and subnational decision-makers from the Metropolitan and Biobío Regions of Chile to evaluate how the influenza burden disease estimates —and the surveillance data that underpins them— were used to develop the country’s policies on seasonal and pandemic influenza. The decision-makers were asked about factors that influenced their use of the burden estimates, including presentation of results, limitations in understanding, and competing priorities and political concerns, among other things.

Essential enablers

The survey results identify two critical enablers of influenza policy development in Chile:

1. Timely reporting of surveillance and burden data. Chile’s integrated epidemiological surveillance at all levels ensures the availability of up-to-date information, which means health service offerings can be continually adjusted, as can the availability of treatments and vaccines for future seasons. Most recently, national disease burden estimates were used in impact and cost-effectiveness studies of vaccine intervention to inform a decision to allocate additional financial resources for primary and hospital care.
   
2. Wide communication to all stakeholders. A national communications strategy ensures that the MOH can communicate information about seasonal influenza burden and define actions for all relevant stakeholders. Burden estimates and the corresponding action plan are always disseminated to expert stakeholders through technical meetings and scientific societies. Since 2015, key messages have also been adapted for the general population and featured in key press releases at the beginning of the annual seasonal influenza vaccination season. Informing and engaging the public in this way helps create demand for influenza vaccines, which has strengthened roll-out and sustained policy development.