The Pandemic Influenza Preparedness (PIP) Framework is an innovative public health instrument that brings together WHO, Member States and stakeholders to implement a global approach to PIP and response. It was formulated to strengthen protection against influenza pandemics by improving the WHO coordinated Global Influenza Surveillance and Response System (WHO GISRS). Its goal was to have a fair, transparent, and equitable system that enabled sharing of H5N1 and other influenza viruses with human pandemic potential and the sharing of benefits. The Framework operationalizes the concept borne out of lessons learnt and experiences of the 2009 influenza pandemic. The year 2021 marked a decade since adoption of the PIP Framework by all 194 Member States of WHO through the World Health Assembly.
Operationalizing the PIP Framework
The PIP Framework includes a benefit-sharing mechanism called the Partnership Contribution (PC) which is collected as an annual cash contribution from manufacturers of influenza vaccines, diagnostics and pharmaceuticals that use GISRS. Funds are allocated for country capacity-building in pandemic preparedness and response.
Based on lessons learnt from COVID-19, all Member States in the WHO SEA Region have been making their influenza systems more resilient and “building back better” ahead of future pandemics from influenza and other respiratory-borne infectious agents. Towards this end, the deliverables of the High-Level Implementation Plan (HLIP)- II for 2018–2023 are critical.
Status of PIP implementation in the Region
In the context of specific countries, Indonesia established thresholds for pandemic influenza severity assessment (PISA). Nepal and Myanmar set up national systems to conduct syndromic investigation of acute respiratory infections (ARI) and feed them into the process for conducting national risk assessments through the early warning, alert and response system (EWARS).
Although considerable improvements are still needed, Member States are focusing on systems establishment for influenza risk assessment at the human–animal interface. A notable achievement by Member States was the improvement in laboratory diagnostics, with all of them achieving a 100% score on WHO’s External Quality Assurance Programme (EQAP) for polymerase chain reaction (PCR) during its 2019 cycle. Additionally, countries were engaged in improving influenza data management, data reporting to the global data-sharing platform and using data through national EWARS for risk assessments and data-driven influenza outbreak responses.
Currently, all seven PIP-PC recipient countries are reporting laboratory data to FluNET and four report epidemiological data to FluID, the two components of the global influenza data-sharing platform. Notwithstanding these successes, the PIP-PC fund implementation for strengthening these major areas of PIP has faced formidable challenges since the beginning of the COVID-19 pandemic.
Consultation and review meeting
Considering the dynamics of the pandemic, to collectively decide the course of action, a regional consultation and annual review meeting of PIP-PC implementation in WHO’s Southeast Asia Region (SEAR) was organized in 2021. Following these regional meetings, PIP-PC recipient countries began to re-programme and find innovative and effective mechanisms for implementing PIP-PC-supported workplans.
Given that all Member Countries were overwhelmed with the pandemic response, the PIP Secretariat allowed flexibility in adopting an approach that could integrate PIP activities with the COVID-19 response. It helped strengthen health emergency preparedness by bolstering some aspects of country core capacities outlined in IHR (2005). Against this backdrop, the Partnership Contribution Independent Technical Expert Mechanism (PCITEM) at its virtual meeting on 31 August–3 September 2021 made important recommendations to PIP-PC recipient countries:
- Monitor implementation and maintain agility in financing areas of need
- Consider adjusting HLIP-II progress measures, including indicators based on findings of mid-term review, COVID-19 lessons learnt and the new landscape
- Encourage and identify opportunities for collaboration across HLIP-II projects, especially cross-cutting collaborative opportunities such as role of risk communication and community engagement (RCCE).
Member States were also requested to consider the following:
- Find lessons from the pandemic, to engage in broader initiatives, frameworks and processes that help advocate for and assure availability of vaccines/ products at the time of a pandemic for vulnerable countries or those not producing influenza countermeasures (such as vaccines, antiviral medicines and diagnostics).
- Explore options to maximize commitment and compliance of all parties
- Continually strengthen influenza disease prevention, control and preparedness while maximizing synergy between programmes so that there is coherent longer-term management of all acute respiratory infections
- Continue to advocate for country ownership of projects, including ways to maximize equitable and ethical principles in influenza preparedness and response capacities and capabilities as promoted by the PIP Framework.
- Conduct qualitative assessments and field-based reviews at country level to understand gains and challenges faced by countries.
Way forward and support from the Regional Office
In line with these recommendations, the PIP Advisory Group (AG) during the HLIP-II mid-term review recommended an analysis of the indicators or milestones that were no longer fit for purpose in the monitoring and evaluation framework of HLIP-II during 2021. As far as implementation of HLIP-II in the SEAR was concerned, the WHO’s Southeast Asia Regional Office (SEARO) continued working with all PIP-PC fund-recipient Member States to improve laboratory and surveillance outputs, especially with intensified focus on boosting laboratory diagnostic and genomic sequencing capacities for influenza in integration with COVID -19 and future priority respiratory pathogens.
All PIP PC-recipient countries in the SEAR completed and submitted their workplans for the 2022–2023 biennium. These were reviewed by the PIP Secretariat and countries made changes suggested. Following revisions, the PIP Framework Partnership Contribution Independent Technical Expert Mechanism (PCITEM) approved all PIP workplans of the PIP-PC recipient Member States in SEAR.
Going forward, countries will leverage the experience gained during the pandemic to support integration of influenza surveillance and monitoring of SARS-CoV-2, while noting the potential of adding other relevant respiratory pathogens. While PIP-PC funds will continue to be a predictable source of funding for PIP-PC recipient countries, the Regional Office will support other non-PIP-PC recipient countries to implement the Global Influenza Strategy 2019–2030 through the PIP PC work plan of SEARO and alternative funding sources such as SEARO’s bilateral cooperative agreement with US-CDC.