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Pandemic Infl uenza Preparedness Framework
Partnership Contribution
ANNUAL REPORT 2015
Pandemic Infl uenza Preparedness Framework
Partnership Contribution
ANNUAL REPORT 2015
© World Health Organization 2016.
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Table of contents
Executive summary
Overview of the PIP Framework
Laboratory and Surveillance Profi le
Regional Offi ce for Africa (AFRO)
Regional Offi ce for the Americas (AMRO/PAHO)
Regional Offi ce for the Eastern Mediterranean (EMRO)
Regional Offi ce for Europe (EURO)
Regional Offi ce for South-East Asia (SEARO)
Regional Offi ce for the Western Pacifi c (WPRO)
Laboratory and Surveillance Achievements
Burden of Disease Profi le
Regulatory Capacity Building Profi le
Planning for Deployment Profi le
Risk Communications Profi le
Preparing to respond to a pandemic
PIP Secretariat
PIP Advisory Group members
Looking to the future
Annex 1
PIP PC Priority Countries across each Area of Work
Training and workshops held with PIP PC funds
Country Laboratory & Surveillance indicators
Annex 2
03
06
12
15
18
21
24
27
30
33
36
39
44
46
49
50
51
52
53
53
55
58
63
List of Acronyms
AFRO
AHI
AMRO
AOW
BSF
CDC
CPA
EBS
ECBS
ECN
ECSPP
EID
EMP
EMRO
EQAP
ERC
EURO
GIP
GISRS
WHO HQ
IATA
ICAO
IDP
IHR
ILI
Regional Offi ce for Africa
Animal human interface
Regional Offi ce for the Americas
Area of Work
Band Selection Form
Centers for Disease Control and Prevention, Atlanta, Georgia (USA)
Critical Path Analysis
Event-based surveillance
WHO Expert Committee on Biological Standardization
Emergency Communications Network
Expert Committee on Specifi cations for Pharmaceutical Preparations
Emerging Infectious Disease
WHO’s Essential Medicines and Health Products Department
Regional Offi ce for the Eastern Mediterranean
External Quality Assessment Project
Emergency Risk Communication Systems
Regional Offi ce for Europe
WHO’s Global Infl uenza Programme
Global Infl uenza Surveillance and Response System
WHO headquarters
International Air Transport Association
International Civil Aviation Organization (ICAO)
Institutional Development Plans for regulatory capacity
International Health Regulations (2005)
Infl uenza-Like Illness
IPCIRR
ISST
IVTM
L&S
MERS-CoV
MOH
MS
NIC
NRA
OIE
OIR
PCR
PSC
PHEIC
PIP
BM
PIP PC
PQ
RO
RRT
RSS
SARI
SEARO
SMTA-2
WHO CC
WPRO
Infection Prevention and ControlInfl uenza Reagent Resource
Infectious Substance Shipping Training
Infl uenza Virus Tracking Mechanism
Laboratory and Surveillance
Middle East Respiratory Syndrome Corona Virus
Ministry of Health
WHO Member State
National Infl uenza Centre
National Regulatory Authority
World Organization for Animal Health
Outbreak Investigation and Response
Polymerase Chain Reaction
WHO Programme Support Costs
Public Health Emergency of International Concern
Pandemic Infl uenza Preparedness
Biological Material
Pandemic Infl uenza Preparedness Partnership Contribution
WHO Prequalifi cation
WHO Regional Offi ce
Rapid Response Training
Regulatory Systems Strengthening
Severe Acute Respiratory Infection
Regional Offi ce for South-East Asia
Standard Material Transfer Agreement-2
World Health Organization Collaborating Centre
Regional Offi ce for the Western Pacifi c
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 3
The Pandemic Infl uenza Preparedness (PIP) Framework
for the sharing of infl uenza viruses and access to
vaccines and other benefi ts is a broad-based partnership
adopted in May 2011 by the 194 Member States of the
World Health Organization (WHO) to improve global
pandemic infl uenza preparedness and response. The
Framework established a PIP Benefi t Sharing System
that includes an annual Partnership Contribution
(PC) to WHO from infl uenza vaccine, diagnostic and
pharmaceutical manufacturers using the WHO Global
Infl uenza Surveillance and Response System (GISRS). In
accordance with the high-level PC Implementation Plan
2013-2016 1, the PC is distributed across fi ve Areas of
Work (AOWs):
Executive summary
1. Laboratory and Surveillance
2. Burden of Disease
3. Regulatory Capacity Building
4. Planning for Deployment
5. Risk Communications
The capacities developed from these AOWs will
strengthen overall preparedness and capacity of
countries to respond to public health emergencies (see
fi gure below).
Vaccine virusdevelopment
AntiviralsDiagnostics
GISRS
Burdenof
Disease
Laboratory&
Surveillance
Vaccineproduction
Preparedness for pandemic interventions
RegulatoryCapacity Building
RiskCommuni-
cations
Planningfor
Deployment
INFORMATION
IMPLEMENTATIONof influenza specific interventions(e.g. vaccination, treatment, etc.)
PUBLIC HEALTH DECISIONS
& STRATEGY
INFLUENZAOUTBREAK
Community
Influenzavirus
REDUCTION OFMORTALITY
& MORBIDITY
Pandemic Infl uenza Preparedness Cycle
1 http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1
4 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
2 Refers to both seasonal and non-seasonal infl uenza viruses
3 Virus detection is the fi rst step towards vaccine composition, see Critical Path Analysis from detection to protection, World Health Organization 2015
By the end of 2015, approximately US$ 31 million
was distributed for activities to prepare countries for
pandemic infl uenza across the fi ve AOWs. Of these
funds, 70% supported Laboratory and Surveillance
capacity-building activities to detect, monitor and
share novel infl uenza viruses. The balance supported
capacity-building activities in the remaining AOWs. This
report summarizes the results of implementing the PC
in 2015, providing for the fi rst time Regional and Area of
Work profi les.
Progress in 2015Building upon processes and procedures for work
planning developed in 2014, all projects met key
milestones in 2015. Highlights are described in the
sections below.
Laboratory and Surveillance
This area of work aims to improve country capacity to
detect, monitor and share infl uenza viruses for risk
assessment and to inform vaccine composition during
an infl uenza pandemic. The focus is on expanding the
Global Infl uenza Surveillance and Response System
(GISRS) so that more laboratories improve the quality of
their laboratory testing to better detect novel infl uenza
viruses and share these viruses with their networks. In
the Regions, 43 priority countries reported data on 21
indicators measuring their capacity to detect, monitor
and share novel infl uenza viruses and to sustain these
activities over time. Measurements taken for all countries
in August 2014 (baseline) compared with subsequent
measures made in February 2015 and again in August
2015 showed increasing capacity in all three areas.
Many countries have defi ned country implementation
plans for infl uenza virus surveillance, demonstrating
a commitment to sustaining pandemic infl uenza
preparedness activities into the future. Others are
actively working to establish WHO-recognized National
Infl uenza Centres (NICs). WHO offi cially recognized
Zambia’s NIC in 2015, increasing the total number of
Centres to 143 across 113 countries.
At the global level, improvement in virus detection was
demonstrated by the results of the 174 laboratories
from 137 countries around the world that participated
in the WHO External Quality Assessment Programme
(EQAP). A total of 103 countries reported 100% correct
results on the assessment panels. Virus-sharing has been
facilitated by better infl uenza detection capacity at the
national level, coupled with training to ship infectious
substances. In fact, 128 countries shared viruses2 with
WHO Collaborating Centres (CCs) for characterization
in 2015. These national eff orts to detect and share
infl uenza viruses strengthen GISRS and provide concrete
evidence of improvements towards global pandemic
infl uenza preparedness.3
Burden of Disease
Preparation for the next pandemic will require increased
global vaccine production capacity. This can only be
achieved if global seasonal vaccine demand increases
in parts of the world where it is not widely used. The
introduction of seasonal vaccine in new countries will
require disease and economic burden data to allow
policy-makers to compare the burden of infl uenza with
other health priorities. WHO is convening the countries
that are doing Burden of Disease studies so that they
can share their results and increase the overall picture
of burden of infl uenza in diff erent country setting. Forty
countries, including the 19 PIP PC priority countries, are
currently engaged in estimating the burden of infl uenza
using WHO methodology and technical support. These
national estimates will be used to produce a robust
global estimate for the burden of infl uenza by the end
of 2016.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 5
4 http://www.who.int/risk-communication/pandemic-infl uenza-preparedness/en/
Regulatory Capacity-Building
Rigorous regulatory processes and practices are
essential to ensuring the approval and use of safe
and eff ective infl uenza vaccines and related products
in the event of a pandemic. 2015 saw regulatory
capacity assessments performed in 14 out of 16 PIP
priority countries. These assessments help countries
develop the standards necessary for eff ective
regulatory systems, market authorization processes
and pharmacovigilance. In 2015, 14 national regulatory
authorities (NRAs) adopted the Collaborative procedure
between WHO Prequalifi cation of Medicines Programme
and National Regulatory Authorities for the assessment
and accelerated national registration of WHO-prequalifi ed
pharmaceuticals and vaccines. This agreement between
WHO and national governments accelerates regulatory
approval of infl uenza vaccines and related products in a
public health emergency.
Planning for Deployment
Vaccines and anti-viral treatments need to be deployed
quickly to where they are needed from manufacturers,
global stockpiles or donating countries in order to save
lives during an infl uenza pandemic. The PIPDEPLOY
simulation tool was developed in 2015 to measure
and improve the time it takes to deploy vital infl uenza
products into countries during a pandemic. The fi rst
simulation will take place in 2016, paving the way for
improvement in response time by making sure that
national supply chain and regulatory systems together
work effi ciently and eff ectively during a pandemic.
Risk Communications
Risk communication during a crisis can prevent the
spread of rumours and false information that create
panic and hamper eff ective public health measures.
New guidelines, tools, resources, curricula and materials
were developed to disseminate pandemic infl uenza
skills and knowledge and build capacity in pandemic
infl uenza risk communication globally.4 Last year alone,
1500 people from 122 countries were trained in Risk
Communications.
Preparing for pandemic infl uenza has stimulated
the need for specialized training in emergency
communication and helped to develop the Emergency
Communication Network (ECN). The ECN now has
a roster of 150 trained communicators who can be
deployed to emergency situations to provide advice
and support for protecting populations at risk.
Next steps toward preparedness for pandemic
infl uenza
The Regions and AOW Programmes have defi ned
activities for 2016 that build upon the achievements
of 2015. A third round of data collection on the 21
indicators of laboratory and surveillance capacity for the
43 PIP priority countries was collected in the fi rst quarter
of 2016. This collection will help measure the impact
of the PIP PC funds over time and track improvements
in laboratories globally to detect, monitor and share
infl uenza viruses with human pandemic potential.
6 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Overview of the PIP Framework
BackgroundNovel infl uenza viruses with human pandemic potential
can emerge anywhere in the world at any time. All
countries, therefore, need the capacity to detect, monitor
and share these viruses so that response measures can
rapidly be developed and global populations protected
in the event of a pandemic. The PIP Framework, which
grew out of the re-emergence of A(H5N1) infl uenza
in 2004, is a broad-based partnership adopted by
the 194 Member States of WHO on 24 May 2011 to
improve global pandemic infl uenza preparedness and
response. The Framework brings together public and
private partners, recognizing that “Member States have
a commitment to share on an equal footing H5N1 and
other infl uenza viruses of human pandemic potential
and the benefi ts, considering these as equally important
parts of the collective action for global public health”
(PIP Framework, section 1, Principle 3).
For over 50 years, WHO has been at the forefront of
infl uenza virus monitoring and risk assessment through
the work of a global alert mechanism for the emergence
of infl uenza viruses with human pandemic potential
known as the Global Infl uenza Surveillance and
Response System (GISRS). This international network
of public health laboratories specialized in infl uenza,
coordinated by WHO, and provides year-round
surveillance of infl uenza through its 143 laboratories in
113 countries.
Under the PIP Framework, countries are expected
to share viruses with human pandemic potential in
a rapid, timely and systematic manner with GISRS.
Likewise, manufacturers are expected to provide funds
and real-time access to essential infl uenza products
at the time of a pandemic. This arrangement is called
the PIP Framework Benefi t Sharing System. It has two
operational tools that ensure that manufacturers which
use GISRS share the benefi ts that arise from such use.
These two tools are:
1. The annual Partnership Contribution (PC), and
2. Standard Material Transfer Agreements-2 (SMTA2)
which ensure that at the time of the next pandemic,
WHO will have real-time access to specifi c quantities
of response supplies, notably vaccines, antiviral
medicines and diagnostics, that will be deployed to
countries in need.
The objective of the Benefi t Sharing System is, on
the one hand, to increase global health security by
strengthening capacities where they are weakest, and
on the other, to ensure equity of access to pandemic
response products by all countries, regardless of income
level. PIP PC funds support the capacity-building eff orts
that are underway.
Key principles of the PIP FrameworkIn the PIP Framework, Members States affi rmed the
fundamental principle that virus-sharing and benefi t-
sharing are equally important parts of collective action
of global public health. Intrinsic to this are several other
principles which guide implementation of the PIP
Framework. They are transparency, equity, collaboration
and partnership.
Transparency guides all facets of the implementation of
the Framework. Thus, program and fi nancial information
is freely shared with collaborators and partners: the
internet-based PIP PC implementation portal and the
PIP webpage enable regular access to up-to-date facts,
fi gures and reports on the use of funds and indicators
measure progress towards meeting milestones and
targets.
Equity refers to the commitment that WHO Member
States make to ensure that at the time of the next
pandemic, all countries will have real-time access to
life-saving pandemic infl uenza vaccines, diagnostic
tests and anti-viral medicines. The conclusion of SMTA2s
embodies the work that is being carried out to achieve
greater equity.
Collaboration on preparedness activities brings
together the three levels of WHO (headquarters, regional
and country offi ces) that work closely with GISRS
laboratories, industry and civil society to implement
capacity-strengthening projects in priority countries.
PIP aims to build a partnership with its broad stakeholder
base to promote shared ownership and support of the
PIP objectives and coherence on the implementation of
its strategies.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 7
Overview of achievementsThe PIP PC funds are used to implement activities in the
fi ve AOWs defi ned in the PIP Partnership Contribution
Implementation Plan 2013-20165, approved by the
Director-General in January 2014 and updated in
January 2015.
These AOWs are:
1. Laboratory and Surveillance
2. Burden of Disease
3. Regulatory Capacity-Building
4. Planning for Deployment
5. Risk Communication
Activities identifi ed for support under each AOW are
directly linked to the fi ndings of the Gap Analyses
conducted in 20136.
Figure 1: The fi ve Areas of Work (AOWs) supported through PIP PC
5 http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1
6 http://www.who.int/infl uenza/pip/pip_pc_ga.pdf?ua=1
This report presents an overview of the achievements
and challenges in 2015. It provides technical descrip-
tions of the work undertaken as well as fi nancial
accounting of the funds for each AOW through Regional
and AOW profi les. Summaries of the achievements of
2014 are presented side-by-side with those of 2015 to
highlight that adequate preparation in 2014 led to the
improvements in preparedness in the WHO regions
reported here for 2015.
PREPAREDNESSRegulatory
Capacity Building
Burden ofDisease
Laboratory & Surveillance
RiskCommunications
Planning forDeployment
RESPONSE
8 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Summary of 2014 Achievements
During 2014, the PIP Secretariat developed key processes
and procedures to enable effi cient, eff ective and
transparent management of funds, and implementation
of activities using standard approaches to monitor
and report on technical and fi nancial progress. During
this time, 54 work plans were developed across the
three levels of WHO. Starting in April 2014, funds were
distributed against approved 2014 work plans and by
August 2014, US$ 17.4 million had been distributed
across headquarters, Regional Offi ces and Country
Offi ces to implement activities in the fi ve AOWs. These
actions provide a fi rm foundation for the results of 2015.
The highlights of 2014 are presented in the table below.
Table 1: Highlights from 20147
Laboratory and Surveillance capacity-building
Burden of Disease
Regulatory capacity-building
Planning for Deployment
Risk Communications
21 capacity indicators were defi ned to measure progress towards outputs and outcomes.
Baseline data were collected in the 43 countries prioritized for support in this area.
Seven countries participated in a training to learn how to develop national disease burden estimates using a new WHO manual.
Work started to revise the expedited review procedure to facilitate licensing of pre-qualifi ed antivirals and vaccines.
The new Collaborative procedure to address assessment and accelerated national registration of WHO-prequalifi ed pharmaceutical products and vaccines was developed and endorsed by the Expert Committee on Specifi cations for Pharmaceutical Preparations (ECSPP) in October 2014.
Model agreements between WHO and recipient countries of pandemic products were drafted.
Signifi cant training materials were developed, translated and published online.
AREA OF WORK ACTIONS
Table 2: Highlights from 2015 (See Regional and AOW profi les for complete results)
Laboratory and Surveillance capacity-building8,9
Burden of Disease
Regulatory capacity-building
Planning for Deployment
RiskCommuni-cations
Established and functioning event-based surveillance for infl uenza in 12 of the 43 PIP priority countries.
128 countries worldwide shared virus10 with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories.
66 countries consistently reported epidemiological data to regional or global platforms.
114 countries consistently reported virological data to a regional or global platform.
103 countries participated in EQAP and scored 100%.
40 countries, including 19 PIP PC priority countries, are estimating the burden of infl uenza using WHO methodology and technical support.
3 PIP priority countries completed robust national burden of infl uenza estimates.
6 countries are piloting the WHO economic burden tool.
WHO collaborative procedure for accelerated regulatory approval of infl uenza products adopted by 14 countries11.
14 of 16 priority countries assessed for regulatory capacity.
PIPDEPLOY tool to improve deployment of infl uenza products to countries was developed. The fi rst simulation will start mid-2016.
17 target countries12 had specifi c risk communication training and/or workshops.
The ECN has a roster of 150 people able to be deployed to health emergencies worldwide.
AREA OF WORK ACTIONS
7 See Pandemic Infl uenza Preparedness Framework Partnership Contribution 2013-2016: Annual Report 2014. World Health Organization 2015 for complete 2014 results.
8 Data from regional and global data bases (see Annex 1)
9 Achievements for L&S at WHO HQ level were made with funds from PIP PC and other donors
10 Refers to seasonal and pandemic potential infl uenza viruses
11 United Rep. of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique, Burkina Faso, Cameroon, Benin, Mali, Armenia, Sri Lanka, Bhutan, and Myanmar
12 Barbados, Cambodia, Dominica, Egypt, Kazakhstan, Kenya, Republic of Moldova, Mongolia, Nepal, Saint Lucia, Saint Vincent and the Grenadines, Senegal, Sudan, Turkey, Ukraine, Uzbekistan, Viet Nam
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 9
Summary of 2015 Achievements
While 2014 focused on developing foundational
processes and procedures for the PC implementation
across all AOWs, by 2015 work was well underway to
ramp up the implementation pace of preparedness
projects in PIP priority countries. In 2015, WHO had
available US$ 13.3 million for Preparedness work. The
activities supported with these funds are starting to
show concrete improvements in pandemic infl uenza
preparedness as shown in Table 2.
Partnership Contribution Collection ProcessPIP Framework Section 6.14.3 establishes an annual
Partnership Contribution (PC) to be paid to WHO by
infl uenza vaccine, diagnostic and pharmaceutical
manufacturers using the WHO GISRS. Section 6.14.3
specifi es that the sum of the annual PC is equivalent to
50% of the running costs of GISRS, which in 2010 were
estimated to be US$ 56.5 million, setting the annual
amount to be collected at US$ 28 million. The collection
process begins in January/February each calendar year
with the publication of the PC questionnaire. This starts
the process of collecting the contribution that funds the
work plans for the following calendar year. The process
is fully described in the following sections.
Questionnaire & Contributor identifi cation
Every year, WHO issues the Partnership Contribution
Questionnaire in order to identify potential Contributors.
The purpose of this annual Questionnaire is to determine
if an entity is an infl uenza vaccine, diagnostic [or]
pharmaceutical manufacturer using the GISRS. The PIP
Framework considers a Contributor to be a company/
institution that meets the following criteria:
1. is an infl uenza vaccine, diagnostic and pharmaceutical
manufacturer (currently or in the past 15 years);
2. uses (or has used in the past 15 years) the WHO GISRS;
and
3. has developed or produced a human infl uenza
vaccine, antiviral, diagnostic or other product to
13 As of 02 March 2016
prevent, treat or diagnose infections from H5N1
or other infl uenza viruses with human pandemic
potential and such product has obtained provisional
or fi nal licensure, registration or market authorization.
“Use of GISRS” means a company/institution has used or
received:
• Materials (e.g. virus materials, such as candidate
vaccine viruses, wild-type viruses, cDNA, plasmids, or
reagents); and/or
• Services (e.g. antigenic and genetic characterization
of candidate vaccine viruses/seed material, antiviral
susceptibility assays); and/or
• Information (e.g. sequence information,
epidemiological data, antiviral susceptibility data,
pre and post-vaccine composition meeting reports);
developed and/or provided by or through GISRS.
Potential Contributors are identifi ed by the PIP
Secretariat using information from manufacturer
associations, internet searches and the Infl uenza Virus
Traceability Mechanism (IVTM) which identifi es non-
GISRS recipients of PIP Biological Materials (PIP BM).
A broad range of organizations including academic
institutions, government agencies, non-profi t
organizations and manufacturers of infl uenza products
are identifi ed. A link to the Questionnaire is sent by
email to all identifi ed entities.
Companies/institutions are identifi ed as Contributors
through their answers to the Questionnaire. Those so
identifi ed are sent a “Band Selection and Certifi cation
Form” (BSF) which requests them to calculate their year
average annual infl uenza product sales for 4 years and
to use that fi gure to place themselves into one of 23
“sales bands”. WHO enters each company’s sales band
into a weighted formula to determine how much each
contributor will pay. Once the formula is applied, each
contributor is sent an invoice which is payable within 30
days.
Table 3: PC Collection (2013-2016)
Entities contacted
Questionnaire Responses
Contributors identifi ed
Funds received13
194
89
32
$27,538,586
250
102
42
$26,964,062
256
90
39
$18,813,522
2013 2014 2015
10 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Results of the Partnership Collection in 2014Based on answers to 2014 Questionnaire, 42 contributors
were identifi ed and US$ 26,964,062 was collected to
support activities implemented in 2015.
Results of the Partnership Collection in 2015Funds from the 2015 PC Collection process will
support activities in work plans approved for 2016
implementation. Collection of 2015 funds is still
underway. Detailed results of the PC collection are
found in Annex 2.
Use of PC fundsPIP PC funds were used in 73 countries in 2015. (See
Figure 2)
Why fi ve Areas of Work?The infl uenza A(H1N1) pandemic of 2009 highlighted
weaknesses in preparedness at the global, regional and
country levels. Two systemic reviews14 were performed
in its immediate aftermath that identifi ed areas where
global action was needed to strengthen the world’s
capacity to eff ectively and effi ciently respond to a
pandemic event. Lessons learnt from these reviews and
the PIP Framework’s Gap Analyses15 led the PIP Advisory
Group to recommend that the PIP PC preparedness
funds be used to strengthen capacity in fi ve critical
areas: laboratory and surveillance capacity, knowledge
of disease burden, regulatory aff airs, planning for
deployment of pandemic response supplies and
risk communications. These recommendations were
Figure 2: Countries using funds from PIP PC, 2015
14 These reviews were 1) a review of the International Health Regulations (2005) (http://apps.who.int/gb/ebwha/pdf_fi les/WHA64/A64_10-en.pdf) and 2) a review of the deployment of A(H1N1) vaccine(http://www.who.int/infl uenza_vaccines_plan/resources/h1n1_vaccine_deployment_initiative_moll.pdf).
15 Pandemic Preparedness Partnership Contribution, 2013-2016: Gap Analyses (November 2013)
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 11
16 Critical Path Analysis: From detection to protection, World Health Organization 2015.
accepted by the Director-General. Each AOW developed
specifi c goals to improve pandemic infl uenza
preparedness. These are highlighted below in Table 4.
Expected Outcomes
Based on guidance from the Advisory Group, lessons
learned, the Gap Analyses and interactions with
stakeholders; the Secretariat developed a high-level
Partnership Contribution Implementation Plan 2013-
2016. The Plan specifi es that in a decade’s time the
allocation of the PC resources should result in the
following improvements in pandemic preparedness:
• All countries should have in place well established
core capacities for surveillance, risk assessment and
response at the local, intermediate and national level,
as required by the IHR.
Table 4: Pandemic infl uenza preparedness goals by
AOW
Laboratory and Surveillance capacity-building
Burden of Disease
Regulatory capacity-building
Planning for Deployment
Risk Communications
Improve national ability to detect, monitor and sharenovel infl uenza viruses
Provide training and support for burden of infl uenza estimates which will contribute to the development of a globalburden of infl uenza estimate
Build national regulatory capacity so that vaccines, diagnostic tests and antiviral medicines for infl uenza can be deployed quickly
Plan for effi cient and equitable deployment of vital suppliesfor pandemic infl uenza
Build national capacity to provide accurate publichealth information during emergencies
AREA OF WORK ACTIONS
• All countries should have access to a NIC laboratory -
the backbone of GISRS.
• A clearer picture of the health burden that infl uenza
imposes on diff erent populations should be
established.
• All countries should have access to pandemic infl uenza
vaccines and antiviral medicines to help reduce
pandemic-related morbidity and mortality.
• All countries should have improved capacities to carry
out eff ective risk communications at the time of a
pandemic.
An analysis of the full scope of preparedness work that
will be required from the time of detection of a novel
virus to the protection of the global population was
developed in the Critical Path Analysis (CPA)16. This
analysis showed that additional areas will require PC
resources to achieve the improvements in pandemic
preparedness foreseen by the PC Implementation Plan
2013-2016.
How are results measured across Areas of Work?
The PC Implementation Plan 2013-2016 sets out the
expected outcomes and outputs for the 5 AOWs
currently supported. Each AOW has a set of performance
indicators that measure progress towards delivery of
defi ned outputs (deliverables) and expected changes
(outcomes) in levels of preparedness for an infl uenza
pandemic. These outcomes and outputs are measured
biannually using defi ned indicators. Baselines and
targets are set and reviewed regularly for each indicator.
Analysis of progress towards these targets is performed
every six months in order to ensure activities are
appropriate or draw attention to specifi c areas that need
corrective action. In the following section, progress is
presented by outputs and outcome in each AOW profi le.
The profi les focus on the achievements of 2015 and
preview work underway for 2016.
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
12 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Laboratory and Surveillance Profi le
Following the 2009 A(H1N1) pandemic, strengthening
laboratory and surveillance (L&S) capacities were
identifi ed as key to improving national capacities to
conduct risk assessment and thereby increasing global
preparedness. Early in the process to distribute resources
among AOWs, it was recommended that L&S receive the
largest proportion of funds. Thus, 70% of preparedness
funds are allocated to strengthening L&S capacities in
countries.
All activities funded with the PC aim to achieve the
following outcome: “The capacity to detect and monitor
infl uenza epidemics is strengthened in developing
countries that have weak or no capacity.” The majority
of activities are under the responsibility of Regional
Offi ces that work through Country Offi ces to strengthen
capacities where they are most needed – in the
laboratories and at the fi eld level. Thus, at the regional
level, emphasis is placed on: 1) strengthening national
capacities to detect respiratory disease outbreaks due to
a novel virus (Output 1); and 2) strengthening national
capacities to monitor trends in circulating infl uenza
viruses (Output 2). Tying this together at the global
level is an emphasis on strengthening collaboration,
through the sharing of information and viruses, with
a view to improving the quality of the GISRS system
(Output 3). The focus is on strengthening data sharing,
enhancing laboratory capacities for infl uenza diagnosis
by polymerase chain reaction (PCR), improving quality
of viruses shared from countries, and strengthening
capacities to ship infectious substances (dangerous
goods).
This section will provide an overview of achievements
in each region (Regional Profi les) followed by the
achievements at the global level.
Improve national ability to detect, monitor and share novel infl uenza viruses
Target countries: Afghanistan, Algeria, Armenia, Bangladesh, Bolivia, Burundi, Cambodia, Cameroon, Chile, Congo
(Republic of ), Costa Rica, Djibouti, Dominican Republic, Ecuador, Egypt, Fiji, Ghana, Haiti, Indonesia, Jordan, Korea
DPR, Kyrgyzstan, Lao PDR, Lebanon, Madagascar, Mongolia, Morocco, Mozambique, Myanmar, Nepal, Nicaragua,
Sierra Leone, South Africa, Suriname, Tajikistan, The United Republic of Tanzania, Timor-Leste, Turkmenistan, Ukraine,
Uzbekistan, Viet Nam, Yemen, Zambia
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 13
Building Laboratory and Surveillance Capacity in 43
PIP priority countries
Since 2013, PIP PC funds have been directed to build
or strengthen laboratory and surveillance in countries
across all WHO regions to improve global pandemic
infl uenza preparedness.18 Gap assessments were
conducted and countries were prioritized19 according
to pre-defi ned criteria20 and taking into account the
following factors identifi ed by the PIP Advisory Group21:
• Fairness, equity and public health risk, particularly
vulnerability to infl uenza A(H5N1);
• Be evidenced-based and consider indicators such as
core capacities under the IHR, income, disease burden
and epidemiology;
• Consider the need for countries to have the critical
foundation of epidemiology and laboratory
surveillance;
• Take into account the modest amount of PC resources;
and
• Ensure the involvement of at least on country from
each region while maintaining the focus on countries
with the highest need.
The focus for the 43 PIP PC priority countries is on
improving laboratory and surveillance capacities so that
in a decade’s time, all countries are able to detect and
monitor infl uenza epidemics22. Twenty-one indicators
were developed to measure progress (See Table 5). The
indicators are grouped into four categories and data are
collected every six months against each indicator. These
indicators measure a country’s ability to detect, monitor
and share novel infl uenza viruses, as well as the ability to
sustain these practices into the future. Each indicator is
scored for each target country according to three levels
of capacity23 as provided by country representatives
and confi rmed through appropriate documentation. An
average of these scores across the indicator categories
is presented in the profi les for three data collection
periods:
• Baseline (August 2014),
• Period from September 2014 to February 2015,
• Period from March 2015 to August 2015.
17 31 August 2014
18 The African Regional Offi ce (AFRO), the Regional Offi ce for the Americas (AMRO/PAHO), The European Regional Offi ce (EURO), The Eastern Mediterranean Regional Offi ce (EMRO), The South-East Asia Regional Offi ce (SEARO), and The Western Pacifi c Regional Offi ce (WPRO).
19 See List of PIP PC Implementation target countries for Regional Offi ce in Annex 1.
20 See http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at pages 9-10.
21 See http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at page 8, Section 5 “Methodology”
22 See www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at page 12 “Outcome”
23 1= no capacity, 2= partial capacity, 3= full capacity
Detection capacity (43 PIP priority countries)
Number of countries with an established and functioning event-based surveillance system
Monitoring capacity (43 PIP priority countries)
Number of countries able to consistently report and analyse
virological data
Number of countries able to consistently report and analyse
epidemiological data
8 43 12
26
5
35
17
30
9
Output indicators
Support to WHO Regions and Countries
BASELINE 17 TARGET STATUS
14 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Measuring progress in 2015
Indicators of performance
Laboratory and Surveillance indicators have been
grouped across four categories (see Table 5 below)
to measure the capacity of target countries to detect,
monitor and share novel viruses with human pandemic
potential and to sustain these actions into the future.
The Regional Profi les presented here highlight pre-
PIP PC gaps in Laboratory and Surveillance. They
also integrate the ongoing work of the four other
AOWs into regional profi les to show how all areas are
working together through the WHO Regional Offi ces to
strengthen national pandemic infl uenza preparedness.
Tracking capacity development over time
Capacity-building needs continuous eff orts over a
signifi cant period of time, especially in light of changing
country political situations or laboratory staff turnover.
WHO will monitor these country-level indicators over
time to track the progress of priority countries towards
improved national ability to detect, monitor and share
novel infl uenza viruses.
This remainder of this section will provide an overview
of achievements by region (Outputs 1 and 2) followed
by the achievements at the global level (Output 3).
Table 5: Laboratory and Surveillance capacity indicators measured for each of the 43 PIP priority countries.
See Annex 1 for details of indicator rationale and scoring criteria
Algorithm for laboratory detection of unusual infl uenza viruses
Registration in IRR or receiving testing kits from WHO CCs
PCR Testing ability
PCR Quality for non-seasonal infl uenza viruses
PCR Quality for seasonal infl uenza viruses
Sequencing ability
National “Early Warning” systems or Event-Based Surveillance (EBS)
National surveillance for ILI
National surveillance for SARI
Integration of laboratory and epidemiological data
Regular infl uenza surveillance reports/bulletins
Coordination at the Human Animal Interface
Reporting lab surveillance data to WHO through FluNet and/or regional databases
Reporting epidemiologic surveillance data to WHO through FluID and/or regional databases
Shipping capacity for infectious substances
Sharing samples with WHO CCs
Sharing sequence data
Country Implementation Plan developed
Rapid Response Team Training
Evidence of sustainability (integration in national plan)
WHO-recognized National Infl uenza Centre
DETECTION MONITORING SHARING SUSTAINABILITY
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 15
Algeria
Burundi
CameroonGhana
MadagascarMozambique
Republic of Congo
Sierra Leone
South Africa
TanzaniaZambia
Regional Offi ce for Africa (AFRO)PIP PC Achievements 2015
In 2015, the region experienced several major infectious
disease outbreaks including Ebola, Cholera, and
Meningitis, making it diffi cult to manage competing
disease priorities, often with the same staff responsible
at the national levels for sentinel surveillance of all
infectious diseases. The Regional Offi ce for Africa
(AFRO) focused on supporting Ghana and the United
Republic of Tanzania with PIP PC implementation
funds. These funds allowed AFRO to provide training
and technical support to these PIP target countries to
improve submission of weekly surveillance information
to WHO’s Collaborating Centre (US CDC) and GISRS
laboratories via FluNet and weekly epidemiological
bulletins. Provisional data analysed shows the results
for all 11 countries that are the target of PIP PC funds
for Laboratory and Surveillance capacity-building, even
though only two countries (Ghana and the United
Republic of Tanzania) have achievements that can be
directly attributed to PIP funds in 2015.
Detection capacity
Number of countries with an established and functioning event-based surveillance system
Sharing Capacity
Number of countries sharing infl uenza virus with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories at least once a year in the past two years
Monitoring capacity
Number of countries able to consistently report and analyse virological data
Number of countries able to consistently report and analyse epidemiological data
1
NA28
11
NA29
325
830
8
1
11
11
826
027
Output indicators for priority countries: Algeria, Burundi, Cameroon, Congo, Ghana, Madagascar,
Mozambique, Sierra Leone, South Africa, The United Republic of Tanzania and Zambia
27 Lower capacity due to Ebola outbreak
28 No regional baseline, global baseline is 90
29 No regional target, global target is 108
30 Algeria, Cameroon, Ghana, Madagascar, Mozambique, South Africa, United Republic of Tanzania, Zambia
24 31 August 2014
25 Ghana, Mozambique, South Africa
26 Algeria, Cameroon, Ghana, Madagascar, Mozambique, South Africa, the United Republic of Tanzania, Zambia
2015 Laboratory & Surveillance programmatic results for PIP target countries
BASELINE 24 TARGET STATUS
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
16 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
AFRO Detection Capacity AFRO Sharing Capacity
AFRO Monitoring Capacity
AFRO Sustaining Capacity
All countries have demonstrated capacity in PCR testing.
Laboratory algorithms and reagents are in place in most
priority countries. Event-based surveillance for infl uenza
is still a gap in AFRO with only three countries having full
capacity for EBS.
Countries still need support for shipping viruses to WHO
Collaborating Centres. Nonetheless, Ghana benefi ted
from training at a WHO Collaborating Centre (United
Kingdom) and provided training to neighbouring
countries (Nigeria, Côte D’Ivoire) in infl uenza virus
isolation techniques, thereby improving ability in the
region to isolate infl uenza viruses for shipping to GISRS
laboratories.
Monitoring capacity continues to improve from the
baseline level (31 August 2014). One of the biggest
challenges in this region is assisting countries to develop
and update their plans for national infl uenza sentinel
surveillance. Guidelines, protocols for investigation
of respiratory illness outbreaks and training were
produced by the Regional Offi ce through PIP PC funds.
Ghana benefi tted from the guidance and began to
actively send samples to the National Infl uenza Centre
for testing during 2015. Weekly epidemiological
bulletins are regularly being produced in all but two
target countries in the region.
Countries are working to develop national plans for
infl uenza surveillance. In 2015, Zambia obtained WHO
certifi cation as a National Infl uenza Centre31, increasing
regional capacity to detect and monitor viruses with
human pandemic potential.
31 Tanzania obtained WHO certifi cation in 2014
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 17
0
0
0
0
0
0
2
6
6
NA38
18
NA39
032
Pendingtools
033, 34
3
035, 36
240
Burden of Disease
Regionally representative estimates
Number of countries supported by the Partnership Contribution
with infl uenza disease burden estimates by 2016
Planning for Deployment
Country readinessCountries and partners accessing web-based planning tools
Regulatory Capacity Building
Targeted training
Number of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic
Common approach for accelerated approvalNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency
Risk Communications
Training on risk communications
Number of trainings completed on IHR risk communications training website37
Support to priority countries
Targeted Member States will have benefi ted from IHR risk communications programme by end of 2016
Actions for 2016AFRO plans to provide PIP Partnership Contribution
funds to Burundi, Cameroon, Congo, Ghana, Madagascar,
Mozambique, Sierra Leone, the United Republic of
Tanzania and Zambia. AFRO will work to support
and maintain existing sentinel sites and laboratory
surveillance systems so that:
• Health care facilities/laboratories in the region have
equipment and reagent supplies;
• Detected infl uenza viruses can be transported from
districts to the national infl uenza laboratories and to
WHO Collaborating Centers;
• Laboratory technicians and data managers develop
and maintain their skill levels; and
• Existing surveillance sites are supervised for optimal
reporting of results locally and internationally.
32 Senegal and Madagascar are collecting data for burden of disease analysis
33 Marketing authorization is ongoing in Ghana and Nigeria
34 Pharmacovigilance training/meetings ongoing in Ghana, Ethiopia, Gambia, Kenya, the United Republic of Tanzania and DR Congo
35 Agreements signed in the United Republic of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique
36 Joint reviews of capacity in preparation to sign Burkina Faso, Cameroon, Benin and Mali
37 WHO iLearn platform was used in 2015
38 No regional target, global target is 200
39 No regional target, global target is 30
40 Kenya and Senegal
Results from other Areas of Work that help the region to prepare for pandemic infl uenza (2015)
BASELINE TARGET STATUS
18 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Bolivia (Plurinational State of)
Chile
Costa Rica
Dominican Republic
Ecuador
Haiti
Nicaragua
Suriname
Regional Offi ce for the Americas (AMRO/PAHO) PIP PC Achievements 2015
In 2015, the Region for the Americas (AMRO) supported
Chile, Costa Rica, Ecuador, Nicaragua and Suriname
with PIP PC implementation funds. These funds allowed
AMRO to provide training and technical support to
these PIP priority countries to improve epidemiology
and virology data collection. The Regional Offi ce worked
with countries to develop standard data reporting
formats that could be shared directly with the global
data reporting platform, WHO’s FluID. Funds were also
used to build human-animal interface surveillance in the
region. Provisional data analysed and presented below
shows that country capacity to monitor and detect
infl uenza viruses with pandemic potential is improving
in target countries and throughout the region as a result
of these eff orts.
Detection capacity
Number of countries with an established and functioning event-based surveillance system
Sharing Capacity
Number of countries sharing infl uenza virus with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories at least once a year in the past two years
Monitoring capacity
Number of countries able to consistently report and analyse virological data
Number of countries able to consistently report and analyse epidemiological data
0
NA44
8
NA45
0
646
7
0
8
8
742
443
Output indicators for priority countries: Bolivia (Plurinational State of), Chile, Costa Rica, Dominican
Republic, Ecuador, Haiti, Nicaragua and Suriname
2015 Laboratory & Surveillance programmatic results for PIP target countries
BASELINE 41 TARGET STATUS
44 No regional baseline, global baseline is 90
45 No regional target, global target is 108
46 Bolivia, (Plurinational State of), Chile, Costa Rica, Dominican Republic, Ecuador and Nicaragua
41 31 August 2014
42 Bolivia, (Plurinational State of), Chile, Costa Rica, Dominican Republic, Ecuador, Nicaragua, and Suriname
43 Bolivia, (Plurinational State of), Chile, Ecuador, Suriname
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 19
AMRO Detection Capacity AMRO Sharing Capacity
AMRO Monitoring Capacity
AMRO Sustaining Capacity
Prior to PIP PC funding, AMRO/PAHO identifi ed there was
a gap in event-based surveillance in priority countries in
the region. The average scores for detection refl ected
the need for support in this area. PIP PC funds supported
trainings in EBS for infl uenza and data management in
the region in 2015 and we expect to see an increase in
country capacity for detection in the next round of data
collection as a result of this investment.
AMRO/PAHO has worked to enhance reporting of
epidemiological and virological data on infl uenza
into PAHO FluID to allow real-time ability to monitor
infl uenza spread throughout the region. In 2015, Chile,
Ecuador and Suriname reported data for the fi rst time
using this platform. A total of 783 virus samples were
submitted to WHO Collaborating Centre (CDC) for viral
characterization. PIP funds have facilitated a training
course targeting sample conservation and timely
submission to WHO Collaborating Centres to improve
sample submission. Fifty laboratory technicians
participated in this course in 2015.
The interactive PAHO FluID website launched in 2015
allows transparent access to monitoring and surveillance
data across the region (www.paho.org/reportesinfl uenza).
Bolivia (Plurinational State of ), Chile, Costa Rica and
Ecuador report full capacity for surveillance of patients
hospitalized with severe acute respiratory illness (SARI)
with samples routinely tested for infl uenza. PIP PC funds
are also supporting a landscape analysis of regional
activities being done to improve human-animal
interface surveillance in the region to identify gaps and
provide guidance to Member States on what is working
in countries.
Chile, Costa Rica, Ecuador and Nicaragua all have
recognized NICs. Most countries have established
country plans for sustaining Laboratory and Surveillance
activities. March 2015 data collection saw new country
plans reported for Costa Rica, Ecuador and Suriname.
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
20 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Actions for 2016AMRO continues to develop capacity in Chile, Costa
Rica, Ecuador, Nicaragua, Suriname and to increase
support to the region by working in Bolivia (Plurinational
State of ), Dominican Republic and Haiti. Activities to
strengthen preparedness in the entire region are being
planned. There are plans for a severe acute respiratory
infections (SARI-net) meeting, upgrades to regional
reporting systems, and training for laboratory logistics
both regionally and for larger countries in the region
(Brazil and Mexico). Several activities target improving
coordination at the human-animal interface, including
development of respiratory outbreak training materials
and a simulation exercise.
47 Costa Rica and Chile have estimates pending publication in peer-reviewed journal.
48 Bolivia (Plurinational State of) has been assessed. Haiti will be assessed in 2016.
49 Bolivia (Plurinational State of), Haiti, Honduras, Nicaragua, Guyana, and Peru are in process of signing the Collaborative agreement.
50 WHO iLearn platform was used in 2015
51 No regional target, global target is 200
52 No regional target, global target is 30
53 Barbados, Dominica, Saint Lucia, Saint Vincent and the Grenadines.
0
0
0
0
0
0
2
6
2
NA51
6
NA52
247
Pendingtools
048
12
049
453
Burden of Disease
Regionally representative estimates
Number of countries supported by the Partnership Contribution
with infl uenza disease burden estimates by 2016
Planning for Deployment
Country readinessCountries and partners accessing web-based planning tools
Regulatory Capacity Building
Targeted training
Number of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic
Common approach for accelerated approvalNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency
Risk Communications
Training on risk communications
Number of trainings completed on IHR risk communications
training website50
Support to priority countries
Targeted Member States will have benefi ted from IHR risk communications programme by end of 2016
Results from other Areas of Work that help the region to prepare for pandemic infl uenza (2015)
BASELINE TARGET STATUS
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 21
Afghanistan
Djibouti
EgyptJordan
LebanonMorocco
Yemen
Regional Offi ce for the Eastern Mediterranean (EMRO)PIP PC Achievements 2015
During 2015, the Regional Offi ce for the Eastern
Mediterranean (EMRO) worked in seven countries
prioritized for PIP PC preparedness funds (Afghanistan,
Djibouti, Egypt, Jordan, Lebanon, Morocco and Yemen).
Complex emergencies are occurring in several of these
priority countries (Yemen, Afghanistan and Lebanon).
Nonetheless, infl uenza surveillance has gradually
started gaining visibility among public health priorities
at country level in the region. A regional database
(EMFLU) is being promoted as a key platform for
infl uenza surveillance information to link countries to
all levels of WHO. Provisional data analysed by indicator
type and shown in the charts below indicate that
capacity to detect, monitor and share infl uenza viruses
with pandemic potential varies widely, although there
is progress in countries where capacity has been the
weakest.
Detection capacity
Number of countries with an established and functioning event-based surveillance system
Sharing Capacity
Number of countries sharing infl uenza virus with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories at least once a year in the past two years
Monitoring capacity
Number of countries able to consistently report and analyse virological data
Number of countries able to consistently report and analyse epidemiological data
4
NA58
7
NA59
555
360
2
1
7
7
456
157
Output indicators for priority countries: Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Morocco and Yemen
54 31 August 2014
55 Afghanistan, Djibouti, Egypt, Morocco, Yemen
56 Afghanistan, Egypt, Jordan and Morocco
57 Morocco
58 No regional baseline, global baseline is 90
59 No regional target, global target is 108
60 Egypt, Jordan, Morocco
2015 Laboratory & Surveillance programmatic results for PIP target countries
BASELINE 54 TARGET STATUS
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
22 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
EMRO Detection Capacity EMRO Sharing Capacity
EMRO Monitoring Capacity
EMRO Sustaining Capacity
Almost all priority countries are regularly performing
PCR testing for infl uenza. Ability to do event-based
surveillance has also improved in the region with all
countries having either full or partial capacity for this
indicator.
Virus sharing is steadily increasing from priority
countries. The Regional Offi ce has worked with ministries
of health, and partner organizations to train cohorts of
health workers to package and ship infl uenza viruses. As
a result, Afghanistan and Egypt have both made timely
contributions of virus samples to GISRS.
SARI/ILI surveillance has improved in the region. In
2015, two countries (Djibouti and Lebanon) initiated
SARI surveillance and two countries (Afghanistan and
Yemen) revived dormant SARI/ILI surveillance. Three
additional countries (Egypt, Jordan and Morocco)
strengthened existing SARI/ILI surveillance. Linkages
between epidemiological and virological information
have been enhanced, resulting in timely sample sharing
with laboratories and timely feedback from laboratories
to sentinel sites.
National Infl uenza Centres and infl uenza laboratories
in Afghanistan, Djibouti, Egypt, Jordan, Lebanon and
Morocco have been strengthened through assessments,
provisions of reagents and equipment, training and
linkages with WHO Collaborating Centres for Infl uenza.
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 23
0
0
0
0
0
0
2
6
2
NA65
6
NA66
161
Pendingtools
062
12
063
267
Burden of Disease
Regionally representative estimates
Number of countries supported by the Partnership Contribution
with infl uenza disease burden estimates by 2016
Planning for Deployment
Country readinessCountries and partners accessing web-based planning tools
Regulatory Capacity Building
Targeted training
Number of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic
Common approach for accelerated approvalNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency
Risk Communications
Training on risk communications
Number of trainings completed on IHR risk communications
training website64
Support to priority countries
Targeted Member States will have benefi ted from IHR risk communications programme by end of 2016
Actions for 2016The focus in future activities is to:
• Strengthen data management systems both at country
and regional level;
• Revise national pandemic infl uenza preparedness
plans in priority countries based on lessons from H1N1
outbreaks;
• Apply sentinel surveillance tools in assessments
planned for PIP priority countries;
• Sustain quality PCR testing in all priority countries
through provision of reagents, aligning support from
other donors such as US CDC and continue building
capacity of NIC staff ; and
• Enhance virus sharing with WHO Collaborating Centers
and ensure refl ection of regional infl uenza viruses in
GISRS databases.
61 Egypt has estimates, publication in process
62 Pakistan and Sudan have been assessed
63 Pakistan, Sudan, Afghanistan, Yemen, Iraq, Morocco are in the process of signing agreement
64 WHO’s iLearn platform was used in 2015
65 No regional target, global target is 200
66 No regional target, global target is 30
67 Egypt and Sudan
Results from other Areas of Work that help the region to prepare for pandemic infl uenza (2015)
BASELINE TARGET STATUS
24 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Armenia KyrgyzstanTajikistan
Ukraine
Uzbekistan
Regional Offi ce for Europe (EURO) PIP PC Achievements 2015
During 2015, the Regional Offi ce for Europe (EURO)
worked in Armenia, Kyrgyzstan, Tajikistan, Turkmenistan
and Uzbekistan. Ukraine is also a priority country for
PIP PC funds but work was unable to be performed in
this country in 2015 due to regional unrest. The EURO
Regional Offi ce has developed a EURO PIP website
(http://bit.ly/1P2DdiN) (in English and Russian) to
display information about the PIP Framework and the
achievements of the PIP PC implementation in target
countries. For a second infl uenza season, the joint WHO/
ECDC Infl uenza Surveillance Bulletin was published
to report and share infl uenza surveillance information
throughout the region. One area that needs further
support in the target countries is sharing of viruses and
information on novel viruses with human pandemic
potential. Nonetheless, provisional data analysed
by indicator type and shown in the chart below
demonstrate that regional capacity to detect, monitor
and share infl uenza viruses with pandemic potential is
moving in a positive direction.
Detection capacity
Number of countries with an established and functioning event-based surveillance system
Sharing Capacity
Number of countries sharing infl uenza virus with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories at least once a year in the past two years
Monitoring capacity
Number of countries able to consistently report and analyse virological data
Number of countries able to consistently report and analyse epidemiological data
0
NA72
6
NA73
069
374
4
5
6
6
370
571
Output indicators for priority countries: Armenia, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan and Ukraine
2015 Laboratory & Surveillance programmatic results for PIP target countries
BASELINE 68 TARGET STATUS
68 31 August 2014
69 All six countries have established partial capacity
70 Ukraine, Uzbekistan and Kyrgyzstan
71 Armenia, Kyrgyzstan, Tajikistan, Ukraine, Uzbekistan
72 No regional baseline, global baseline is 90
73 No regional target, global target is 108
74 Armenia, Kyrgyzstan, Ukraine
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 25
EURO Detection Capacity EURO Sharing Capacity
EURO Monitoring Capacity
EURO Sustaining Capacity
All priority countries participated in EQAP in 2015
with Kyrgyzstan and Turkmenistan demonstrating
80% to 100% profi ciency in identifi cation of viral
samples. Armenia, Tajikistan and , Turkmenistan and
Uzbekistan have outbreak investigation and response
(OIR) guidelines and are working to institutionalize OIR
training curricula and to develop national case studies
to support monitoring and surveillance.
PIP PC funds are being used to develop capacity of
national infl uenza laboratories to ship infl uenza viruses
to WHO Collaborating Centres for viral characterization.
All fi ve target countries have benefi ted from Infectious
Substances Shipping Training and a total of 77 specialists
from these countries are now certifi ed shippers of
infectious substances.
Armenia, Kyrgyzstan, Tajikistan, Turkmenistan and
Uzbekistan have completed baseline assessments
of their infl uenza surveillance systems (including
laboratory surveillance) using the WHO/EURO sentinel
surveillance review tool and are currently applying
a new WHO/EURO tool to select sentinel sites for
improved surveillance systems. Armenia, Tajikistan
and Turkmenistan have revised their sentinel infl uenza
surveillance guidelines and national recommendations.
All target countries have strengthened their capacities
for infl uenza virological surveillance and are able to
detect and identify novel infl uenza viruses as part of
early warning and response.
Lack of fi nancial and human resources continue to
be challenges to sustaining the achievements of the
region. Five countries now have country plans agreed
with their ministries of health to strengthen capacity in
pandemic preparedness. National infl uenza laboratories
in Tajikistan, Turkmenistan and Uzbekistan are receiving
reagents and consumables through PIP PC funds to
ensure sustainability of their detection and monitoring
capabilities. These countries have received external
assessment of their capacities and mentoring support
to start the WHO NIC recognition process. Over 250
front-line clinicians working in the intensive care units
in all priority countries were trained to perform critical
care management of SARI using an evidence-based
approach.
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
26 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Actions for 2016
In their 2016 work plans, all fi ve PIP priority countries
requested for assistance in implementation of the
national OIR guidelines, in particular development of
training modules and curricula. To strengthen capacity
on SARI clinical management, countries need revision/
development of their national guidelines based on
the WHO SARI training materials and the International
Surviving Sepsis Campaign Guidelines. In 2016, all
priority countries will pilot the new sentinel surveillance
guidelines with further expansion of sentinel surveillance
sites where necessary. Infl uenza data management
systems will be improved for better data monitoring
and use. In addition, mentoring will continue to priority
countries to enable National infl uenza laboratories to
meet the requirements of WHO to become National
Infl uenza Centers. To facilitate progress in this domain,
procurement of reagents will continue so that the
75 Albania, Armenia, Croatia, Georgia, Kyrgyzstan, Republic of Moldova, Serbia and Ukraine have begun data collection
76 Armenia assessed; Georgia under assessment
77 Armenia has signed the Collaborative agreement; Five countries (Georgia, Republic of Moldova, Kazakhstan, Kyrgyzstan and Tajikistan) are in the process of signing
78 WHO’s ilearn system was used in 2015
79 No regional target, global target is 200
80 No regional target, global target is 30
81 Kazakhstan, Republic of Moldova, Turkey, Uzbekistan and Ukraine attended a risk communications capacity-building workshop.
0
0
0
0
0
0
8
6
2
NA79
6
NA80
075
Pendingtools
076
20
177
581
Burden of Disease
Regionally representative estimates
Number of countries supported by the Partnership Contribution
with infl uenza disease burden estimates by 2016
Planning for Deployment
Country readinessCountries and partners accessing web-based planning tools
Regulatory Capacity Building
Targeted training
Number of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic
Common approach for accelerated approvalNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency
Risk Communications
Training on risk communications
Number of trainings completed on IHR risk communications
training website78
Support to priority countries
Targeted Member States will have benefi ted from IHR risk communications programme by end of 2016
Results from other Areas of Work that help the region to prepare for pandemic infl uenza (2015)
BASELINE TARGET STATUS
National infl uenza laboratories have continuous
availability of reagents to facilitate detection and
monitoring of infl uenza viruses. Work will also continue
to make the mechanism for shipment of virus isolates/
specimens to the WHO CCs sustainable. Activities will
include identifying and addressing barriers to shipment
and advocacy for virus sharing at the decision making
level in target countries.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 27
Bangladesh
DPR Korea
Indonesia
Myanmar
Nepal
Timor-Leste
Regional Offi ce for South-East Asia (SEARO)PIP PC Achievements 2015
In 2015, the Regional Offi ce for South-East Asia (SEARO)
worked with the following PIP PC priority countries:
Bangladesh, DPR Korea, Myanmar, Nepal, Indonesia and
Timor-Leste. Prior to PIP PC funding, laboratories across
the region had limited resources for effi cient function,
including equipment and reagents. PIP PC funds helped
laboratories in all priority countries to procure essential
equipment and reagents, therefore ensuring the
continuation of testing of samples.
Detection capacity
Number of countries with an established and functioning event-based surveillance system
Sharing Capacity
Number of countries sharing infl uenza virus with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories at least once a year in the past two years
Monitoring capacity
Number of countries able to consistently report and analyse virological data
Number of countries able to consistently report and analyse epidemiological data
1
NA85
6
NA86
283
487
2
0
6
6
384
0
Output indicators for priority countries: Bangladesh, Democratic People’s Republic of Korea, Indonesia,
Myanmar, Nepal, Timor-Leste
82 31 August 2014
83 Indonesia, Timor-Leste
84 Bangladesh, Indonesia, Nepal
85 No regional baseline, global baseline is 90
86 No regional target, global target is 108
87 Bangladesh, Indonesia, Myanmar, Nepal
2015 Laboratory & Surveillance programmatic results for PIP target countries
BASELINE 82 TARGET STATUS
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
28 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
SEARO Detection Capacity SEARO Sharing Capacity
SEARO Monitoring Capacity SEARO Sustaining Capacity
Detection activities are strongly supported in the region
by laboratory algorithms and the ability of PIP priority
countries to perform PCR testing. PIP PC funds helped
laboratories in all priority countries to procure essential
equipment and reagents, ensuring continuity of sample
testing to enhance detection of novel infl uenza viruses.
Training on safe handling and transportation of sample
of infl uenza and emerging infectious disease agents
was conducted in all 11 countries of SEARO. This has
improved awareness about how to handle and transport
samples of infl uenza and other infectious agents.
Indonesia, with support from WHO, helped to train
colleagues in SARI in Timor-Leste. Timor-Leste now has
one SARI and ILI sentinel site functional and providing
data. Nepal expanded national infl uenza surveillance
sites from 10 to 20 by the end of 2015. Bangladesh used
PIP PC funds to identify infl uenza surveillance catchment
areas and strengthen representativeness of surveillance
baseline data.
All target countries in the region have National Infl uenza
Centers and all but one have country plans agreed with
ministries of health. Nonetheless, sustaining laboratory
activities is still diffi cult. Many countries still have a
shortage of staff and funding. Existing staff conduct
not only infl uenza surveillance and testing, but other
infectious disease outbreaks as well.
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 29
0
0
0
0
0
0
2
6
2
NA92
6
NA93
088
089
3
390
194
Burden of Disease
Regionally representative estimates
Number of countries supported by the Partnership Contribution
with infl uenza disease burden estimates by 2016
Planning for Deployment
Country readinessCountries and partners accessing web-based planning tools
Regulatory Capacity Building
Targeted training
Number of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic
Common approach for accelerated approvalNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency
Risk Communications
Training on risk communications
Number of trainings completed on IHR risk communications
training website91
Support to priority countries
Targeted Member States will have benefi ted from IHR risk communications programme by end of 2016
Actions for 2016The following actions will be targeted by SEARO in 2016:
• Expand ILI/SARI surveillance sites to cover entire
national populations;
• Train more health care workers on case management
for ILI/SARI;
• Advocate countries share virological and
epidemiological information between human and
animal health sectors;
• Support development of a NIC for Bangladesh; and
• Maintain laboratory reagent and equipment supplies
in laboratories across the region.
88 Indonesia and Nepal have started data collection to do estimates
89 Nepal was assessed for regulatory capacity
90 Sri Lanka, Bhutan, Myanmar have signed WHO Collaborative agreement
91 WHO’s iLearn platform was used in 2015
92 No regional target, global target is 200
93 No regional target, global target is 30
94 Nepal
Results from other Areas of Work that help the region to prepare for pandemic infl uenza (2015)
BASELINE TARGET STATUS
Pendingtools
30 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
CambodiaLao PDR
Mongolia
Viet Nam
Regional Offi ce for the Western Pacifi c (WPRO) PIP PC Achievements 2015
In 2015, PIP PC funds in the Western Pacifi c supported
laboratory and surveillance activities under the Asia
Pacifi c Strategy for Emerging Diseases. Cambodia,
Lao PDR, Mongolia, Pacifi c Island Countries and Viet
Nam were priority recipients of funds. PIP PC funding
supported the 9th bi-regional (SEAR & WPR) Meeting of
National Infl uenza Centres and Infl uenza Surveillance
held in Phnom Penh, Cambodia last year. This meeting
brought together Asia Pacifi c countries to set directions
and priorities for infl uenza surveillance work for the year
to come. It was an example of countries and regions
working together to share laboratory best practices,
as well as information on seasonal and avian infl uenza
activity and epidemiology in the broader region.
Detection capacity
Number of countries with an established and functioning event-based surveillance system
Sharing Capacity
Number of countries sharing infl uenza virus with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories at least once a year in the past two years
Monitoring capacity
Number of countries able to consistently report and analyse virological data
Number of countries able to consistently report and analyse epidemiological data
1
NA98
5
NA99
296
5100
4
0
5
5
597
0
Output indicators for priority countries: Cambodia, Fiji, Lao People’s Democratic Republic, Mongolia, Viet Nam
2015 Laboratory & Surveillance programmatic results for PIP target countries
BASELINE 95 TARGET STATUS
95 31 August 2014
96 Lao PDR, Viet Nam
97 Cambodia, Lao PDR, Mongolia, Fiji and Viet Nam
98 No regional baseline, global baseline is 90
99 No regional target, global target is 108
100 Cambodia, Lao PDR, Mongolia, Fiji and Viet Nam
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 31
WPRO Detection Capacity WPRO Sharing Capacity
WPRO Monitoring Capacity
WPRO Sustaining Capacity
Detection activities are strongly supported in the region
through the use of established laboratory testing
algorithms, availability of reagents and PCR capacity. In
the Western Pacifi c Region, 26 laboratories (including
PIP priority countries) participated in the WHO EQAP
with 87% of the countries scoring all samples correctly.
Infectious Substances Shipping Training (ISST) was
attended by 29 participants (including PIP priority
countries) and all participating countries passed the
course. Laboratories in Mongolia, Cambodia and Viet
Nam are now regularly isolating viruses, increasing the
number of viruses isolated and specimens shipped to
WHO Collaborating Centres.
A “right-size” approach to infl uenza surveillance is
promoted in the region for effi cient resource allocation.
PIP PC funds supported surveillance at geographically
representative ILI and SARI sites as well as transport of
specimens from these sites to national laboratories.
To disseminate data collected through these systems,
WPRO produced a prototype for an online infl uenza
dashboard displaying epidemiological and virological
data for seasonal infl uenza and human infections with
avian infl uenza viruses.
Although all priority countries have WHO-recognized
National Infl uenza Centres and all but one has national
PIP plans agreed with ministries of health, sustaining
laboratory activities remains challenging. Many
countries still have a shortage of funding and staff who
must conduct surveillance and testing not only for
infl uenza, but also for other competing priority diseases.
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
Ave
rag
e s
core
Baseline March 2015 September 2015
Target3
2
1
0
32 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Actions for 2016WHO will hold a workshop in Viet Nam in May 2016
that will introduce public health professionals to the
methods of the WHO Manual for Estimating Disease
Burden Associated with Seasonal Infl uenza as well as
the WHO Manual for Estimating the Economic Burden of
Seasonal Infl uenza. To allow for more accurate estimates
of infl uenza disease burden, a protocol for hospital
admission surveys is being developed and piloted in
Cambodia in collaboration with US CDC.
Annual PanStop108 exercises will continue to test and
improve the functionality of regional and national
response capacities. Refresher trainings and “train-the-
trainer” courses for laboratory and surveillance staff will
increase capacity of sub-national staff .
101 Cambodia, Lao PDR and Mongolia are in the process of completing estimates
102 Cambodia and Lao PDR assessed for regulatory capacity for vaccines and antiviral medicines
103 The Philippines has signed; Lao PDR, Cambodia, Kiribati, Mongolia, Papua New Guinea are in the process of signing Collaborative agreement
104 WHO ilearn system used in 2015
105 No regional target, global target is 200
106 No regional target, global target is 30
107 Cambodia, Viet Nam, Mongolia
108 PanStop is a desktop simulation exercise for deployment of antivirals for pandemic infl uenza
0
0
0
0
0
0
3
6
2
NA105
6
NA106
0101
Pendingtools
0102
6
1103
3107
Burden of Disease
Regionally representative estimates
Number of countries supported by the Partnership Contribution
with infl uenza disease burden estimates by 2016
Planning for Deployment
Country readinessCountries and partners accessing web-based planning tools
Regulatory Capacity Building
Targeted training
Number of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic
Common approach for accelerated approvalNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency
Risk Communications
Training on risk communications
Number of trainings completed on IHR risk communications
training website104
Support to priority countries
Targeted Member States will have benefi ted from IHR risk communications programme by end of 2016
Results from other Areas of Work that help the region to prepare for pandemic infl uenza (2015)
BASELINE TARGET STATUS
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 33
109 31 August 2014
110 See Annex 1 for more information on these data sharing platforms
111 Results provided within 4 weeks of date of sample receipt
Information sharingWHO information sharing systems (FLUNET and FluID110)
have operated since 1997 and 2009 respectively to
receive surveillance data online from all Member States.
Both platforms were modifi ed in 2015 to ease data
transfer. The systems allow continuous analysis of data,
follow-up of inconsistencies and provision of assistance
in case of issues with data loading in order to encourage
countries to report regularly. Additional online graphs
have been added which show the country data in the
context of the global situation for a quick overview.
In 2015, both FluNet and FluID had more countries
reporting regularly to the system. The number of PIP
countries reporting to FluNet increased from 26 to 30.
Globally, this number has risen from 108 to 114. For
FluID, the number of PIP countries reporting increased
from fi ve to 11. Globally, the number of countries
reporting has risen from 55 to 66.
Infl uenza virus detectionPCR is the gold standard for identifying infl uenza virus
from specimens. WHO’s EQAP for infl uenza virus subtype
A by PCR was initiated in 2007 to monitor the quality
and comparability of the performance of participating
laboratories in routine molecular detection and
surveillance. The indicator, which measures number of
countries who participate in EQAP and score 100% on
Laboratory and Surveillance Achievements –Global Level (Output 3)
Sharing Capacity (global)
Number of countries that participate in
EQAP and score 100%
Number of countries sharing virus with WHO CCs, H5
Reference Laboratories and Essential Regulatory Laboratories
at least once a year in the past two years
Number of countries consistently reporting epidemiological
data to regional or global platforms
Number of countries which consistently report virological data
to a global platform
109
90
55
108
120
108
71
124
103
128
66
114
Output indicators
BASELINE 109 TARGET STATUS
all panels, has remained relatively constant from the
baseline measurement. Small decreases in number of
participating laboratories scoring 100% refl ect the need
to continuously train laboratory technicians, including
new technicians, to maintain high quality use of PCR
to detect infl uenza viruses. In 2015, 174 laboratories
from 137 countries participated and 153 laboratories
reported results111. A total of 125/153 labs (81.7%)
reported 100% correct results for all samples. For the
infl uenza A(H7N9) sample, the correct rate of detection
increased from 135/156 (86.5%) in panel 13 to 141/153
(92.2%) in panel 14, which is comparable to that for
seasonal infl uenza viruses. The number of participants
performing H7 testing also increased to 136/153
(88.9%) in panel 14 from 114/156 (73.1%) in panel 13.
These improvements refl ect better preparedness for the
detection of infl uenza A(H7) virus.
In addition to ensuring the quality of laboratories
through the EQAP, WHO also identifi es national
laboratories that meet the standards to be designated
a National Infl uenza Centre (NIC). In 2015, Zambia’s
national infl uenza centre was recognized as a NIC. This
achievement demonstrates progress towards the L&S
outcome articulated in the Partnership Contribution
Implementation Plan 2013-2016, that in the next
decade, every country should have access to a NIC.
34 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Infl uenza virus sharingThe infl uenza virus shipment fund was established
a number of years ago to improve sharing capacity
for infl uenza viruses and clinical specimens from
countries, in particular, resource poor ones, with WHO
Collaborating Centres (CCs). Viruses with pandemic
potential are classifi ed as dangerous goods when
transported. Consequently, Infl uenza Substance
Shipping Training (ISST) workshops are carried out
regularly to ensure that laboratory personnel obtain
the mandatory certifi cations for shipping infectious
substances (dangerous goods) under International
Civil Aviation Organization (ICAO) and International
Air Transport Association (IATA) regulations. These
certifi cates are valid for a period of two years. During
2015, 150 countries shared viruses with the WHO CCs
and eight ISST workshops were carried out.
Actions for 2016
Information sharing
Ongoing improvements to the data platform will
make it even more user-friendly and give automated
feedback to users and data managers. Regular data
accuracy checks and continuous feedback are essential
to encourage regular reporting.
Infl uenza virus detection
In 2016, an EQAP panel will be distributed to monitor
the quality and comparability of the performance of
participating laboratories in molecular detection and
surveillance of both seasonal viruses and those with
pandemic potential.
Infl uenza virus sharing
Continuous support for shipments will be provided
and more laboratories will be encouraged to share
specimens in a timely manner. More ISST workshops will
be provided to ensure that countries have laboratory
personnel who are certifi ed to ship the viruses
(dangerous goods).
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 35
Bri
ng
ing
it a
ll to
get
her
: Oth
er A
reas
of
Wor
k
36 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Burden of Disease Profi leProvide training and support for burden of infl uenza estimates which will contribute to the development of a global burden of infl uenza estimate
Target countries: Albania, Armenia, Cambodia, Chile, Costa Rica, Croatia, Egypt, Georgia, Indonesia, Kyrgyzstan, Lao
PDR, Madagascar, Moldova (Republic of ), Mongolia, Nepal, Oman, Senegal, Serbia, Ukraine
All 6 WHO regions develop regional representative burden of
disease data to guide developing countries’ policy-making
Output 1: Derive regionally representative infl uenza disease burden estimates from selected countries
Number of countries supported by the Partnership Contribution
with disease burden estimates by 2016
Output 2: Derive a global estimate of infl uenza disease burden estimates from selected countries
Global estimate of infl uenza disease burden derived from national
estimates published
NA
0
0
6
December2016
19
On track
On track
3112
Outcome: National policy-makers will have infl uenza disease burden data needed for informed decision-making and
prioritization of health resources
Burden of Disease
BASELINE TARGET STATUS
112 Costa Rica, Chile and Egypt have estimates pending publication in peer-reviewed journals. A further 12 countries are fi nalizing estimates.
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 37
BackgroundThe burden of disease related to infl uenza is unknown
in most of the world. The available burden information
and vaccine cost eff ectiveness data derives from a few
countries located in temperate climates, which are
not representative of the majority of countries in the
developing world. Lack of representative data makes it
diffi cult to prioritize infl uenza prevention and control
measures against other competing health issues in
countries where resources are most limited. Recent
developments in surveillance capacity now provide
an opportunity to better understand infl uenza disease
burden in previously underrepresented areas of the
world. An inclusive description of disease burden is
needed to address gaps in understanding infl uenza
mortality, morbidity, high-risk groups and economic
impact, especially at the national level.
Developing national burden of disease estimates
that are inclusive takes time largely due to the lack of
adequate country-level data with which to estimate
disease burden. The challenges relate to identifying and
using national data in the following areas:
• New techniques for mortality estimation using
available national data, which are often incomplete,
need to be developed.
• Infl uenza morbidity including hospitalization
burden is diffi cult to measure because of the lack of
specifi c symptoms and the need to use laboratory
confi rmation.
• Several populations have long been recognized to
be at risk for severe complication due to infl uenza.
Specifi c data and a better understanding of what
factors contribute to greater risk for these populations
is needed.
• Costs to the economy, health care systems and
individuals, also known as economic burden, are
important factors infl uencing adoption of intervention
strategies. However, direct medical costs and the
indirect costs of lost productivity are country-specifi c,
depending heavily on social support structures of
each country. Countries need to collect cost data that
refl ect their national systems.
WHO has developed tools to fi ll national data gaps and
help countries to produce valid estimates for infl uenza
disease burden and also the economic burden of
infl uenza. The PIP PC and funds from other donors113
supports WHO’s Global Infl uenza Programme (GIP) to
provide these tools and associated trainings to 19 priority
countries so that they can produce national burden of
infl uenza and economic burden of infl uenza estimates
to improve policy decision-making for vaccination and
other protective health measures for seasonal infl uenza.
Achievements 2015Forty countries, including the 19 PIP PC priority
countries, are currently engaged in estimating the
burden of infl uenza using WHO methodology and
technical support. Many countries face a challenge to
generate national data to produce both the infl uenza
disease and economic burden estimates and progress is
slow but steady. The results are as follows:
• PIP priority countries, Chile, Costa Rica and Egypt, have
completed their national burden of disease estimates
for infl uenza and are awaiting publication in peer-
reviewed journals.
• Twelve other PIP priority countries114 are collecting
data or analyzing them to fi nalize burden of disease
estimates.
• A further 25 countries are expected to have estimates
based on WHO methodology by the end of 2016.
• WHO’s economic burden tool is being piloted by four
PIP priority countries, Chile, Costa Rica, Lao PDR and
Indonesia; and two other countries, Colombia and
Romania.
To provide advice and support to countries undertaking
infl uenza burden estimation, a Burden of Disease Expert
Advisory Group for infl uenza was convened in 2014. This
group holds monthly conference calls and has had two
face-to-face meetings since December 2014.
113 US CDC and Bill and Melinda Gates Foundation
114 Albania, Armenia, Cambodia, Croatia , Georgia, Indonesia, Kyrgyzstan, Lao People’s Democratic Republic, Madagascar, Mongolia, Nepal, Croatia, Pakistan, Republic of Moldova, Senegal, Serbia, Ukraine
38 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Actions for 2016GIP’s Burden of Disease team will continue to support
countries in doing their national estimates using
WHO methods. A meeting is planned for July 2016 to
encourage researchers to share their estimates (pre-
publication), methodology and input data with others
in the global public health community.
Global and regional estimates of infl uenza burden will be
based on the most robust national estimates available in
2016. Work toward global and regional infl uenza burden
estimates is further enhanced by systematic reviews on
infl uenza risk factors, incidence and mortality which are
commissioned to external experts and make use of the
wide range of national data now available through the
eff orts of WHO and other researchers around the world.
By the end of the year, a draft estimate on the
hospitalized respiratory infl uenza disease burden and
mortality based on excess mortality from infl uenza will
be available.
The WHO economic burden tool, now being tested in six
countries (see above), will also be fi nalized in 2016.
Further work is needed to develop:
• tools to estimate cost-eff ectiveness of specifi c
interventions to treat and/or prevent infl uenza;
• tools/models to guide policy decisions on when and
where to use seasonal vaccine; and
• a global platform that holds global and regional burden
data, economic data, and risk factors information that
could be used to plan national infl uenza policies.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 39
Regulatory Capacity Building Profi leBuild national regulatory capacity so that vaccines, diagnostic tests and antiviral medicines for infl uenza can be deployed quickly
Target countries: Armenia, Bolivia, Cambodia, Congo (Democratic Republic of ), Ethiopia, Georgia, Ghana, Haiti, Kenya, Lao PDR, Nepal, Pakistan, Sri Lanka, Sudan, United Republic of Tanzania, Uganda
By 2016, at least 16 countries will have improved their regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics and to accelerate national approval registration of these commodities in case of an infl uenza pandemic
Output 1: Develop guidelines on regulatory preparedness for non-vaccine producing countries that enable them to expedite approval of infl uenza vaccines used in national immunization programsRegulatory preparedness guidelines endorsed by the WHO Expert Committee on Biologicals Standardization (ECBS)
Output 2: NRA capacity to regulate infl uenza products includingvaccines, antivirals and diagnostics is strengthenedNumber of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic as per the WHO NRA assessment and IDP elaboration and implementation
Output 3: Regulatory processes to accelerate approval of infl uenza vac-cines, antivirals and diagnostics during a public health emergency are incorporated into deployment plans for pandemic infl uenza productsNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency
NA
0
0
0
At least16
16115
48117
1
On track
1116
14118
awaitingECBS
endorse-ment
Outcome: Countries with weak or no regulatory capacity will be able to regulate infl uenza products including vaccines,
antivirals and diagnostics, and to accelerate national approval of these commodities in case of an infl uenza pandemic
Regulatory Capacity
BASELINE TARGET STATUS
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
40 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
BackgroundDuring the 2009 A(H1N1) pandemic, WHO
prequalifi cation (PQ) of a vaccine was not suffi cient to
obtain regulatory approval in over half of the countries
that received donated pandemic A(H1N1) vaccines.
There was no common regulatory process for countries
to use for product registration and many countries were
unable to follow the relevant WHO guidance documents
for product registration due to severely limited capacity
to respond to emergencies and/or weak or no regulatory
capacity to regulate infl uenza products. These realities
highlighted an urgent need for regulatory capacity
building to facilitate deployment and avoid bottlenecks
in regulatory processes, especially during public health
emergencies.
To prepare for a more rapid response to pandemic
infl uenza, the WHO Essential Medicines and Health
Products Department (EMP) is using PIP PC to conduct
activities that strengthen the capacity of regional/sub-
regional and/or national regulatory systems to:
• regulate infl uenza products (including vaccines,
antivirals and diagnostic tests) effi ciently and
eff ectively; and
• accelerate national approval of these commodities in
the event of an infl uenza pandemic.
115 Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, United Republic of Tanzania, Uganda, Bolivia, Haiti, Pakistan, Sudan, Armenia, Georgia, Nepal, Sri Lanka, Cambodia, Lao PDR
116 The NRA of 14 of 16 PIP priority countries were assessed. One country has acceptable capacity in the three areas of assessment: regulatory systems, marketing authorization and pharmacovigilance. Implementation of Institutional Development Plans (IDP) started in 14 of the 16 PIP countries. Enhancing regulatory capacity is a long-term investment and impact data is not yet available.
117 Democratic Republic of Congo, Ethiopia, Ghana, Kenya, United Republic of Tanzania, Uganda, Mozambique, Cote d’Ivoire, South Africa, Angola, Burkina Faso, Gambia, Cameroon, Benin, Central African Republic, Guinea, Malawi, Mali, Bolivia, Haiti, Honduras, Nicaragua, Guyana, Peru, Pakistan, Sudan, Afghanistan, Yemen, Iraq, Morocco, Armenia, Georgia, Rep. of Moldova, Kazakhstan, Kyrgyzstan, Tajikistan, Nepal, Sri Lanka, Bangladesh, Bhutan, Myanmar, Timor-Leste, Cambodia, Lao PDR, Kiribati, Mongolia, Philippines, Papua New Guinea
118 United rep. of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique, Burkina Faso, Cameroon, Benin, Mali, Armenia, Sri Lanka, Bhutan and Myanmar
119 http://www.who.int/immunization_standards/national_regulatory_authorities/role/en/
Achievements 2015
Guidelines on regulatory preparedness for non-
vaccine producing countries
PIP PC supported the development of draft guidelines
on regulatory preparedness for non-vaccine producing
countries. These guidelines are aimed at helping
countries expedite approval of infl uenza vaccines used
in national immunization programs and/or deployed
by United Nations agencies in response to a pandemic
emergency. In 2015, WHO:
• conducted a review and analysis of relevant guidance
and prepared a report that identifi ed gaps and
provided a foundation for the WHO guidelines;
• convened a stakeholder workshop (Tunis, Tunisia,
June 2015) to develop a framework for the new
guidelines. Participants included experts from WHO
and from national regulatory authorities (NRA), and
representatives from countries that do not produce
vaccines; and
• produced draft guidelines based on the report and the
framework developed during the workshop.
National Regulatory Authority capacity to regulate
infl uenza products
WHO is working with 16 target countries to identify
and address critical gaps with a focus on strengthening
regulatory systems and the two functions deemed
essential for countries that procure vaccines primarily
through United Nations agencies: marketing
authorization and pharmacovigilance.119
As of 31 December 2015, WHO had assessed the
National Regulatory Authorities (NRAs) of 14
countries, identifi ed gaps and developed institutional
development plans. The results of these assessments
(Figure 3) show that capacities in the three areas of
enquiry vary greatly within and across countries. The
majority of these countries do not meet critical criteria
in their regulatory systems, marketing authorization,
or pharmacovigilance functions and are, therefore,
unprepared for public health emergencies of any kind.
As a fi rst step, regulatory capacity-building activities
should aim at helping countries move out of critical and
into acceptable capacity, with particular emphasis on
pharmacovigilance.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 41
A diverse range of activities was carried out in 2015 to
strengthen capacities across the three regulatory areas
of work (Table 6).
Figure 3: Snapshot of regulatory capacity status in 14 PIP Countries - The dots represent each country and show their current status in each area of regulatory capacity development.
Table 6: Sample of regulatory capacity-building activities supported by PIP PC in 2015
• WHO meeting to develop Guidelines on regulatory preparedness for vaccine non-producing countries in response to pandemic infl uenza emergency, regulators from 10 PIP target countries participated, June 2015, Tunis, Tunisia
• PQ product summary fi le (SPF) review of seasonal infl uenza vaccine, one participant from Ghana NRA participated, June 2015, Geneva, Switzerland
• One regulator from Nigeria NRA completed a rotational fellowship with the WHO PQ team, July-October 2015, Geneva, Switzerland
• Vaccine pharmacovigilance fellowship, WHO Collaborating Centre for Advocacy and Training in Pharmacovigilance, four participants from Democratic Republic of Congo and Ethiopia, September 2015, Accra, Ghana
• 38th International pharmacovigilance centers’ meeting, three participants from Ethiopia and Gambia, November 2015, New Delhi, India
• Inter-regional pharmacovigilance training, WHO-Uppsala Monitoring Centre, Health Sciences Authority of Singapore, eight participants from Cambodia, Lao PDR, Myanmar, and Philippines, September-October 2015, Singapore
• First Asia Pacifi c training course in pharmacovigilance, organized by WHO, JSS University in Mysore, India, and Uppsala Monitoring Centre, four participants from Cambodia, Lao PDR, February 2015, Mysore, India
• In-country training on Quality Management Systems for regulators, 40 participants, October 2015, Phnom Penh, Cambodia
• In-country training on Quality Management Systems for regulators, 27 participants, November 2015, Vientiane, Lao PDR
• WHO Workshop on sensitization towards Quality Management Systems for NRAs: 13 countries from the Eastern Mediterranean and European Regions, 31 participants, December 2015, Antalya, Turkey
Marketing authorization
Pharmacovigilance
Regulatorysystems
REGULATORY FUNCTION ACTIVITY
Regulatory SystemsPharmacovigilance
Marketing Authorization
Below critical capacity
Acceptable capacity
Desired capacity
42 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Common approach for accelerated regulatory approval of infl uenza products in a public health emergency
The Collaborative procedure developed by WHO
Prequalifi cation of Medicines Programme and national
medicines regulatory authorities to assess and
accelerate national registration of WHO-prequalifi ed
pharmaceutical products and vaccines has been
adopted by 14 countries120. This agreement facilitates
the deployment of pharmaceutical products during a
public health emergency. To encourage more countries
to adopt the collaborative procedure, WHO:
• conducted an advocacy workshop in the South-
East Asia Region on the collaborative procedure for
registration of infl uenza vaccines as part of pandemic
infl uenza preparedness (Bangkok, Thailand, November
2015); and
• initiated the development of an addendum to
the collaborative procedure to cover vaccines for
emergency use.
Actions for 2016
Guidelines on regulatory preparedness for non-vaccine producing countries
A stakeholders consultation was held April 2016, Geneva,
Switzerland, to review the draft guidelines and provide
comments to the drafting group. The fi nalized guidelines
will be submitted to the WHO Expert Committee on
Biological Standardization for endorsement in October
2016.
NRA capacity to regulate infl uenza products
The NRA of the two remaining PIP target countries,
Sudan and Haiti, will be assessed in 2016 so that gaps
can be identifi ed and institutional development plans
prepared. Trainings and workshops will continue in
priority countries to address regulatory gaps, and WHO
will monitor progress on each of the three critical areas
for national regulatory capacity.
120 United Rep. of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique, Burkina Faso, Cameroon, Benin, Mali, Armenia, Sri Lanka, Bhutan, Myanmar
Common approach for accelerated regulatory approval of infl uenza products in a public health emergency
WHO will continue to raise the profi le of the collaborative
procedure for pharmaceutical products and vaccines
by conducting a regional advocacy workshop in the
Western Pacifi c Region.
WHO will continue to develop the addendum to the
collaborative procedure to cover vaccines for emergency
use.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 43
WHO`s fi ve-step regulatory capacity-building model
Guidelines on regulatory preparedness for non-vaccine producing countries
Since the 1990’s, the WHO programme on regulatory systems strengthening (RSS) has implemented a fi ve-
step capacity building model with the goal of helping countries meet and sustain regulatory functionality for
medicines and other health products as per established WHO indicators. To date, WHO has assessed more than
100 NRA around the world using tools developed in-house. WHO complements these assessments with the
use of newly developed tools that specifi cally assess regulatory capacity for infl uenza vaccines, and pandemic
infl uenza preparedness.
The fi ve-step approach includes developing and maintaining a benchmark tool for assessing NRAs using a set
of indicators to measure performance for the recommended regulatory functions. It may entail either a self-
assessment of functions by the NRA or a WHO assessment of the functions by an international team of experts. This
assessment leads to the identifi cation of strengths and gaps which are refl ected in an Institutional Development
Plan (IDP), or in special cases, in a road map as well. After endorsement of the IDP by the government (NRA
and/or Minister of Health) it can be used to tailor the technical support to the specifi c needs of that particular
authority and country. Once the proposed activities are implemented (including training and technical support),
a re-assessment, or other monitoring mechanisms, allow verifi cation of the progress achieved. Based on the
progress made and the remaining gaps a new plan for technical support is developed and implemented.
Revision of indicators
and assessment
process every
2-3 years
Re-assessment
every 2-5 years or
7 years
With or without a
road map for
prequalification of
products
WHO support through
technical assistance,
in-country training
and Global Learning
Opportunities (GLO)
WHO electronic
platform to monitor
NRA information and
assessment reports,
IDP, training, etc.
1 2 3 4 5
Benchmarking development of NRA assessment
tool
Assessment of NRA
Developmentof Institutional
Development Plan (IDP)
Providingtechnical support, training / learning
and networking
Monitoringprogress & impact
44 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Planning for Deployment Profi lePlan for effi cient and equitable deployment of vital supplies for pandemic infl uenza
Target countries: Armenia, Bolivia, Cambodia, Congo (Democratic Republic of ), Ethiopia, Georgia, Ghana, Haiti,
Kenya, Lao PDR, Nepal, Pakistan, Sri Lanka, Sudan, United Rep. of Tanzania, Uganda
Output 1: A common approach to manage deployment operations is developed and shared with stakeholders and deployment partners
A common deployment approach is developedwith multiple deployment stakeholderendorsement
Number of training and simulation exercises with deployment
stakeholders
Output 2: Country deployment readiness systems are simplifi ed and updated
Model country recipient agreement is revised and updated
Countries and partners accessing web-basedplanning tools
0
0
0
0
1
16
1
8
In process
Pendingtools
Draftavailable
Simulation exercise set for
mid-2016
Outcome: Plans for deployment of pandemic supplies including vaccines, antivirals and diagnostics, will be developed
and regularly updated
Planning for Deployment
BASELINE TARGET STATUS
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 45
BackgroundAn analysis of vaccine deployment activities in the
A(H1N1) pandemic in 2009121 identifi ed slow country
readiness and a high number of deployment systems as
bottlenecks in the eff ectiveness of delivering donated
vaccines. Multiple agencies acted as responders,
including UN agencies, government agencies, industry
and civil society. Each responder had diff erent
operational platforms, few of which had been used in
emergencies. The large number of competing systems
led to two key bottlenecks:
1. Respondents were not suffi ciently aware of the
actions of others and the reciprocal impact of each
other’s activities, especially the impact on recipient
countries; and
2. Multiple responder systems experienced operational
failures in attempts to fi t domestic and other systems
into an emergency mode.
In addition, countries were overwhelmed by competing
health priorities and had diffi culties in developing a
“ready” status, which was a requirement to receiving
and making immediate use of the initially limited supply
of vaccines.
PIP PC funds are being used to provide solutions to
these challenges. The fi rst is to develop and participate
in simulation activities to avoid losing institutional
knowledge gained and to continually test operational
systems. While each responder will likely continue
to operate a unique system, simulating a combined
response provides an opportunity to adapt towards a
single system.
The second is to assess existing country deployment
plans to identify common gaps across countries,
weaknesses in the approaches for readiness, and develop
a quantifi cation of the needs for technical support that
could facilitate rapid deployment. Filling these gaps with
immediate technical support will prevent a situation
where a country needs vaccines or supplies but is not
ready to deploy them without assistance.
Achievements 2015The simulation tool designed to identify and correct
bottlenecks in vaccine delivery to countries in public
health emergencies, PIPDEPLOY, was pilot tested in early
2015. The tool captures the time it takes to perform key
interactions in the supply chain. It also measures which
actions fail the most frequently so that improvements can
be made to effi ciently handle these actions. Responders
use this information to evaluate and prepare their
internal systems for pandemic infl uenza. WHO solicited
external IT companies to develop the simulation tool
through a rigorous, competitive bidding process. A fi rm
was selected and began work to fully develop the tool
in late 2015. Unlike commercially available supply chain
simulators, the complexity in an emergency response is
capturing the number of complex interactions and any
related bottlenecks. The product is undergoing fi nal
quality testing and is expected to be available in a live
version in 2016.
Evaluation of country deployment plans, including
quantifi cation of technical assistance needed and gaps
in methodologies has been completed. The subsequent
draft report considers the development of a roster
of individuals to respond to a core set of capacities
to facilitate deployment in the event of a national
emergency. However, the fi nal report will describe a
model whereby national and/or international agencies
agree to release staff to an emergency response team.
This model, if agreed, could reduce administrative delays
and the concurrent risks of managing large numbers of
individual consultants.
Actions for 2016The simulation tool will go live in 2016, to be preceded
by brief web-based trainings on the concept and use
of the system. National deployment plans will move to
another phase of development in 2016. This phase will
include an assessment of current plans against those of
2009 with subsequent updating to fi ll identifi ed gaps.
121 A review of the deployment of A(H1N1) vaccine (http://www.who.int/infl uenza_vaccines_plan/resources/h1n1_vaccine_deployment_initiative_moll.pdf)
46 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Risk Communications Profi leBuild national capacity to provide accurate public health information during emergencies
Target countries: Afghanistan, Barbados, Bangladesh, Bhutan, Burkina Faso, Cambodia, Dominica, Ecuador, Egypt, Honduras, Fiji, Gabon, Indonesia, Kazakhstan, Kenya, Lao PDR, Lebanon, Mauritania, Mexico, Moldova (Republic of ), Mongolia, Mozambique, Nepal, Pakistan, Panama, Saint Lucia, Saint Vincent and the Grenadines, Senegal, Seychelles, Sudan, Suriname, Timor-Leste, Turkey, Ukraine, Uzbekistan, Viet Nam, Yemen, Zimbabwe
Output 1: Access to risk communications training and platformsis increased enabling all countries to respond more eff ectivelyto a potential infl uenza pandemic Tools and web-based risk communications training material access-ible to Member States in all language versions by December 2015
Number of registered users of online material
Number of trainings completed on IHR risk communications training website122
Output 2: Risk communications capacity is established in priority countries with little or no capacityTargeted Member States will have benefi ted from IHR risk communications programme by end of 2016
Output 3: Global Emergency Communications Network (ECN) operationalized to provide support to countries before, during and after public health emergenciesProportion of requests for risk communications surge support responded to within 72 hours by WHO in 2015/16
0
0
0
0
0
30
80%
194
500
200
513
96
17
100%
Available in English
Outcome: Global risk communications capacities are strengthened with a special focus on pandemic infl uenza communications
Risk Communications
BASELINE TARGET STATUS
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 47
122 WHO iLearn platform was used in 2015
123 http://www.who.int/risk-communication/pandemic-infl uenza-preparedness/en/
BackgroundOver the last two years, risk communication has rapidly
moved up political agendas and transformed from an
ill-defi ned, underfunded public health technical fi eld to
a core, crosscutting element of health emergency and
outbreak preparedness and response. In 2012, when
the PIP PC funding began, there was little support for
risk communication. It was treated as an afterthought
in both emergency preparedness and response. In 2014
and 2015, challenges faced and lessons learnt in the
international response to the Ebola outbreak in West
Africa highlighted the importance of building national
and international capacity for risk communication.
The PIP PC funded risk communication project aims to
strengthen global resources and tools available to all
countries and stakeholders for eff ective pandemic risk
communication. The project provides targeted support
for national risk communication capacity building
in 30 priority countries by supporting governments
and national/local journalists. In addition, a global
Emergency Communications Network (ECN) has been
established so that experts can be deployed quickly to
support risk communication emergencies.
Achievements 2015Through PIP PC funds, WHO developed new guidelines,
tools, resources, curricula and materials to disseminate
pandemic infl uenza skills and knowledge and build
capacity in pandemic infl uenza risk communication
globally.123 Highlights of these tools and resources
include:
• Standard risk communication curricula for workshops
and trainings with modules on pandemic risk
communication, and vaccine hesitancy;
• Online PIP risk communication training platform with
a contact database of over 1,000 training participants;
• Simulation and tabletop exercises designed around
testing risk communication capacity in response to a
pandemic infl uenza outbreak or other proxy diseases
with pandemic potential in Turkey, Republic of
Moldova, Kingdom of Saudi Arabia, Kenya, Cambodia,
Kazakhstan, Switzerland and Jordan;
• Vaccine safety communication training course
developed and tested;
• Multiple regional and sub-regional workshops across
WHO’s African, European, Eastern Mediterranean and
Americas regions to engage senior decision-makers in
investing in risk communication preparedness; and
• Training package developed and sub-regional media
workshops to provide technical trainings for around 50
journalists and support responsible reporting during
pandemic infl uenza.
WHO has worked closely with decision-makers to
provide expertise and sustained support for national
pandemic infl uenza risk communication capacity
building in priority countries. Important meetings and
risk communication plans completed include:
• Country-level engagement and support in priority
countries including Egypt, Sudan, Kazakhstan,
Republic of Moldova, Turkey, Ukraine, Uzbekistan,
Cambodia, Mongolia and Viet Nam124;
• On-request risk communication capacity-building/
emergency support to countries experiencing
infl uenza outbreaks;
• Providing risk communication capacity-building
sensitization and engagement following outbreaks of
respiratory illnesses such as Middle East Respiratory
Syndrome Coronavirus (MERsCoV); and
• Rapid national risk communication capacity
assessment in 20 EMRO countries.
WHO’s ECN has been expanded in numbers and areas
of expertise to include media communication, vaccine
communication, community engagement, social
mobilization and partner communication among
others. Three ECN pre-deployment trainings took place
during the period under review and the curriculum and
the simulation exercise contained content on pandemic
infl uenza and vaccine-related communication issues.
There is currently a roster of 150 staff , consultants,
partners, and government experts and offi cials trained in
emergency risk communication able to be deployed for
pandemic communications. The ECN roster deployment
rate is around 80%.
124 Hands-on support with development of National risk communication plans in Viet Nam and Sudan
48 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Actions for 2016Work will continue in 2016 to expand the Online PIP
Risk Communications training platform to train more
people around the world in risk communications. In
addition, through PIP funding in 2015, a new national
risk communication assessment tool was developed
under IHR and is being piloted and used in 2016. Other
ongoing activities in 2016 include:
• Risk communication outcome monitoring tool
developed with the Harvard School of Public Health;
and
• A partnership with the World Organization for
Animal Health (OIE) with joint training of animal and
human health professionals for pandemic infl uenza
preparedness.
Risk communication capacity-building: PIP’s ‘hands-on’ approachA new hands-on approach is helping build
global and national capacity in pandemic
infl uenza risk communication. Simulation and
table-top exercises provide participants with the
opportunity to fi nd out how prepared they are for
an outbreak with pandemic potential. Participants
are given details of a fi ctive setting including
economic, cultural and political characteristics.
Through a series of increasingly challenging
“injects”, they learn about an evolving public
health situation and are given a series of tasks
they must execute in small groups within tight
deadlines.
Exercises can take place in a classroom, a simulated
fi eld environment or in the workplace, and may
unfold over many days. Through PIP, around
300 participants have taken part in simulation
and table-top exercises to practice pandemic
infl uenza risk communication in Turkey, Republic
of Moldova, Kingdom of Saudi Arabia, Kenya,
Cambodia, Kazakhstan, Switzerland and Jordan.
Regional risk communication workforce in the Eastern Mediterranean RegionIn December 2015, PIP’s fi rst regionally-focused
Emergency Communications Network (ECN)
training took place in Amman, Jordan. Public
health offi cials from 13 countries in the Eastern
Mediterranean attended including Afghanistan,
Egypt, Iraq, Islamic Republic Of Iran, Jordan,
Oman, Lebanon, Libya, Morocco, Pakistan, Saudi
Arabia, Sudan and Tunisia. Participants spent six
days in a classroom environment undertaking
intensive morning-to-night training and drills in
emergency risk communication. Over the fi nal
three days and two nights, participants took part
in an around-the-clock simulation exercise to
practice their new skills and knowledge. Within a
scenario of a rapidly escalating outbreak of novel
infl uenza, participants were deployed to a “fi eld-
like” environment as risk communication experts
working in a race against time to limit disease
spread and help prevent a pandemic. Graduates
of the program joined the ECN – a global roster
of trained communication specialists who can be
deployed in public health emergencies.
Prioritizing pandemic communication in WHO’s African RegionCapacity-building work in AFRO was delayed
due to the Ebola outbreak. But on the fl ip side,
the project team was able to leverage the Ebola
experience into high-level political commitment
for epidemic and pandemic risk communication.
In 2015, in two high-level meetings in Nairobi
and Dakar, senior government health emergency
decision-makers from 44 countries in the
region convened to learn about and plan for
strengthening their national emergency risk
communication (ERC) systems. As part of a
table-top exercise, participants developed risk
communication plans in response to a simulated
novel infl uenza outbreak with pandemic potential
outputs. The meetings focused on guiding
principles, national priorities and concrete actions
for national risk communication capacity building
in the African Region.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 49
Preparing to respond to a pandemic
Figure 4: Response funds, 2012-2015
25
20
15
10
5
0
Mil
lio
ns
Response fund
Total available:
$22,723,424
2014: $7,280,297
2015: $3,115,038
2012: $4,892,671
2013: $7,435,418
Guiding principles governing the use of PIP PC response fundsThirty per cent of PIP PC funds are held in reserve for
use when the next infl uenza pandemic is declared
by WHO (Figure 4). In October 2014, the Advisory
Group developed Guiding Principles for the use of PIP
Partnership Contribution ‘Response’ Funds125, recognizing
that “at the time of a pandemic, time will be of the
essence and there will be limited or no opportunities
to convene the Advisory Group or hold interactions
with industry and other stakeholders to discuss the
use of ‘Response’ resources.”126 The Guiding Principles,
developed by the Advisory Group in consultation with
industry and other stakeholders, will provide the basis
for the Director-General to decide on the use of the PC
for response purposes without further advice from the
Advisory Group, or interaction with industry and other
stakeholders.127
It is anticipated that these funds will be needed to
access and transport some of the pandemic infl uenza
vaccine that has been secured through the Standard
Material Transfer Agreements (SMTA2s).128 Additionally,
antiviral medicines, diagnostic tests and other related
products will be needed for an eff ective response. Rapid
and eff ective deployment of these supplies to countries
in need will require these reserved funds as well as
additional fi nancial resources.129
125 http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1
126 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section I, paragraph 8
127 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section I, paragraph 9
128 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section II, paragraph 3
129 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section II, paragraphs 4 and 7
50 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
PIP Secretariat
General functionsThe PIP Secretariat is the unit within WHO that manages,
administers and coordinates the implementation of
the PIP Framework as a whole and the Partnership
Contribution (PC) in particular. The PIP Secretariat is
funded in part through PC resources130. The Secretariat
also seeks additional support through extra-budgetary
grants for specifi c components, such as the conclusion
of SMTA2s.
Implementation of PC fundsThe PIP Secretariat benefi ts from three years of
experience in collecting and implementing the PC
funds. In 2015, the Secretariat had the strong support
and collaboration of six project managers, one in
each WHO Regional Offi ce. Additionally, each of the
fi ve headquarters-based Areas of Work (AOWs) had a
designated focal point for their PIP-funded projects.
Monthly video-teleconferences with the Regional Offi ce
project managers and regular meetings with the AOW
focal points helped coordinate the projects and ensure
synergies were captured. Solutions were found to
challenges in implementation as they arose. Biannual
planning meetings held in July and December 2015
helped standardize operating procedures and formulate
specifi c 2016 work plans, targeting gaps in capacity in
countries in each region.
Achievements 2015
Project management processes and procedures
Standardized templates and procedures, with associated
guidance notes, were developed for use by regions and
departments receiving PIP PC preparedness funds. The
documents establish standard approaches to technical
and fi nancial project planning, monitoring, review and
reporting. Work plans for 2016 were developed using
these tools and changes are being made to simplify
processes based on feedback from Regional and
Country Offi ces, and AOW focal points.
130 http://apps.who.int/gb/ebwha/pdf_fi les/WHA66/A66_17Add1-en.pdf?ua=1 at paragraph 29.
Work plans and funds distribution
Between August and December 2015, 53 work plans for
2016 were developed and approved, and a fi rst tranche
of US$ 9.8 million was distributed. These funds covered
both staff and activity costs.
Synergies
Building on the PIP global team established in 2014,
there was further integration of PIP PC-funded
activities to complement preparedness capacity-
building eff orts in other programmes and initiatives.
This included the programme for International Health
Regulations 2005 (IHR) at headquarters, US CDC-funded
infl uenza programmes and other disease surveillance
programmes in WHO Regional Offi ces.
Stakeholder Communications
Signifi cant eff orts were made to continue to increase
the frequency and quality of the existing high-level
communication with stakeholders. The following
communication eff orts were notable in 2015:
• PIP PC Implementation Portal: Quarterly updates
were made to this web-based system that is designed
to increase transparency and information about the
use of funds received from manufacturers under the
annual PC and detailed in the PIP PC Implementation
Plan (2013-2016).
• PIP Framework e-Newsletter: Six issues of the bi-
monthly news brief on implementation of the PIP
Framework were distributed to a mailing list of over
2,000 recipients.
• Outreach: The Secretariat held bi-monthly
teleconferences with industry and civil society
representatives throughout 2015 to discuss issues
arising from the implementation of the PIP Framework.
• Poster: A large portable poster for use at exhibitions
and conferences was developed to better explain
how the PIP Framework works to improve pandemic
preparedness.
• Critical Path Analysis (CPA): The fi nal version of
the CPA, which outlines the full scope of the process
from virus detection to population protection, was
published.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 51
PIP Advisory Group members
Role of the Advisory GroupThe oversight mechanism of the PIP Framework includes
the World Health Assembly, the Director-General and
the independent Advisory Group. The Advisory Group
monitors and provides guidance to strengthen the
functioning of the WHO GISRS and undertake necessary
assessments of the trust-based system needed to protect
public health and to help ensure implementation of
the Framework131. The Group has 18 members drawn
from three Member States in each WHO region, with a
skill mix of internationally-recognized policy-makers,
public health experts and technical experts in the fi eld
of infl uenza.
Advisory Group Members in 2015The PIP Secretariat acknowledges the exemplary
dedication and commitment to excellence that the
Advisory Group has shown since its very fi rst meeting. The
quality of the guidance and recommendations provided
to the Director-General have signifi cantly supported
and improved the Secretariat’s implementation. The
Secretariat extends its sincere thanks to the Advisory
Group. Its members in 2015 are listed in Table 7 below.
131 Taken from article 7.2.1 of the Pandemic Infl uenza Preparedness Framework for the sharing of infl uenza viruses and access to vaccines and other benefi ts
Table 7: Advisory Group Members in 2015
Professor Tjandra Y AditamaChairman, National Institute of Health Research and Development, Ministry of Health, Indonesia
Dr William Kwabena AmpofoSenior Research Fellow & Head of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana
Professor Chris BaggoleyChief Medical Offi cer Australia
Dr Jarbas Barbosa da Silva, Jr.Secretary (Vice Minister) of Health Surveillance, Ministry of Health, Brazil
Dr Rainer EngelhardtAssistant Deputy Minister of the Infectious Disease Prevention and Control Branch, Public Health Agency, Canada
Professor Didier HoussinPresident, French Agency for Food, Environmental, Occupational Health and Safety (ANSES), France
Dr Olav HungnesDirector, Norwegian National Infl uenza Centre, Norwegian Institute of Public Health, Norway
Dr Amr Mohamed KandeelChief Preventive Aff airs and Endemic Diseases Sector, First Undersecretary, Ministry of Health and Population, Egypt
Professor Oleg Ivanovich KiselevDirector, Research Institute of Infl uenza, Ministry of Public Health and Social Development, National Infl uenza Centre, Russian Federation
Dr Cuauhtémoc ManchaDeputy Director General of Preventive Programs, National Centre for Preventive Programs
Dr Frances McGrathDeputy Director of Public Health, Clinical Leadership, Protection and Regulation, Ministry of Health, New Zealand
Professor Ziad MemishAssistant Deputy Minister of Health for Preventive Medicine, Saudi Arabia
Dr Janneth MghambaAssistant Director for Epidemiology and Disease Control, Ministry of Health & Social Welfare, United Republic of Tanzania
Dr Hama Issa MoussaNational Technical Assistant, Institutional Support Unit, Ministry of Public Health, Niger
Dr Huma QureshiExecutive Director, Pakistan Medical Research Council, Pakistan
Professor Mahmudur RahmanDirector, Institute of Epidemiology, Disease Control and Research, Bangladesh
Dr P V VenugopalFormer Director of International Operations, Medicines for Malaria Venture, Public Health Specialist, India
Professor Yu WangDirector-General, Chinese Center for Disease Control and Prevention, China
ADVISORY GROUP MEMBER
52 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Looking to the future
Lessons learnt from PIP PC implementationUsing the current invoice cycle of the PC, funds
are generally received during the 4th quarter of an
implementation year and into the 1st and 2nd quarters
of the following year (see Figure 5). The relatively
long period of time to receive funds means that there
is uncertainty over how much WHO will receive and
when. Work plans are developed and approved but
there are delays in implementation across all AOWs
because of when funds are received by WHO. Several
disbursements were made in September 2015 as work
plans were approved.
Alignment of the PC collection and implementation
process, facilitated by a simplifi ed PC collection
process that is transparent and fair for all, will help
AOWs, Regional and Country Offi ces better plan critical
activities.
Next steps toward improving preparation and response to a pandemic infl uenza eventAll recipients of the PIP PC will continue to implement
activities in their approved work plans in 2016 to
meet the targets set for the projects, according to the
agreed indicators of outcomes and outputs in the PC
Implementation Plan 2013-2016. However, it is clear
that in order to meet the expectations for pandemic
preparedness in the Plan, additional AOWs and more
low and middle-income countries will need the support
of the PIP PC in the future.
Figure 5: Collection and implementation cycle for the PIP Partnership Contribution 2014-2015
* As of 17 August 2015
** L&S request for money was made later
March – November 2014November 2014 – August 2015
October 2014 – August 2015
March – September 2015
March – September 2015
Collection
Collection process(questionnaire, band selection form, invoicing)
Payments coming in
Project plans development**
Project plans approval by ADGO
Disbursement
Jan May Jul Sep Nov 2015 March May Jul Sep
Project plans development
USD 27,138,843received *
Mar
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 53
Annex 1PIP PC Priority Countries across each Area of Work
Table 8: Laboratory & Surveillance - 43 PIP Priority Countries
Table 9: Burden of Disease - 19 PIP Priority Countries
COUNTRY WHO REGION
Afghanistan
Algeria
Armenia
Bangladesh
Bolivia (Plurinational State of)
Burundi
Cambodia
Cameroon
Chile
Costa Rica
Djibouti
Dominican Republic
DPR Korea
Ecuador
Egypt
Fiji
Ghana
Haiti
Indonesia
Jordan
Kyrgyzstan
Lao PDR
Lebanon
Madagascar
Mongolia
Morocco
Mozambique
Myanmar
Nepal
Nicaragua
Republic of Congo
Sierra Leone
South Africa
Suriname
Tajikistan
United Republic of Tanzania
Timor-Leste
Turkmenistan
Ukraine
Uzbekistan
Viet Nam
Yemen
Zambia
EMRO
AFRO
EURO
SEARO
AMRO
AFRO
WPRO
AFRO
AMRO
AMRO
EMRO
AMRO
SEARO
AMRO
EMRO
WPRO
AFRO
AMRO
SEARO
EMRO
EURO
WPRO
EMRO
AFRO
WPRO
EMRO
AFRO
SEARO
SEARO
AMRO
AFRO
AFRO
AFRO
AMRO
EURO
AFRO
SEARO
EURO
EURO
EURO
WPRO
EMRO
AFRO
COUNTRY WHO REGION
Albania
Armenia
Cambodia
Chile
Costa Rica
Croatia
Egypt
Georgia
Indonesia
Kyrgyzstan
Lao PDR
Madagascar
Moldova, Republic of
Mongolia
Nepal
Oman
Senegal
Serbia
Ukraine
EURO
EURO
WPRO
AMRO
AMRO
EURO
EMRO
EURO
SEARO
EURO
WPRO
AFRO
EURO
WPRO
SEARO
EMRO
AFRO
EURO
EURO
Table 10: Regulatory Capacity Building - 16 PIP Priority Countries
COUNTRY WHO REGION
Armenia
Bolivia, (Plurinational State of)
Cambodia
Democratic Republic of the Congo
Ethiopia
Georgia
Ghana
Haiti
Kenya
Lao PDR
Nepal
Pakistan
Sri Lanka
Sudan
United Republic of Tanzania
Uganda
EURO
AMRO
WPRO
AFRO
AFRO
EURO
AFRO
AMRO
AFRO
WPRO
SEARO
EMRO
SEARO
EMRO
AFRO
AFRO
54 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Table 11: Planning for Deployment - 16 PIP Priority Countries
COUNTRY WHO REGION
Armenia
Bolivia, (Plurinational State of)
Cambodia
Democratic Republic of the Congo
Ethiopia
Georgia
Ghana
Haiti
Kenya
Lao PDR
Nepal
Pakistan
Sri Lanka
Sudan
United Republic of Tanzania
Uganda
EURO
AMRO
WPRO
AFRO
AFRO
EURO
AFRO
AMRO
AFRO
WPRO
SEARO
EMRO
SEARO
EMRO
AFRO
AFRO
Table 12: Risk Communications - 38 PIP Priority Countries
COUNTRY WHO REGION
Afghanistan
Bangladesh
Barbados
Bhutan
Burkina Faso
Cambodia
Dominica
Ecuador
Egypt
Fiji
Gabon
Honduras
Indonesia
Kazakhstan
Kenya
Lao PDR
Lebanon
Mauritania
Mexico
Moldova, Republic of
Mongolia
Mozambique
Nepal
Pakistan
Panama
Saint Lucia
Saint Vincent and theGrenadines
Senegal
Seychelles
Sudan
Suriname
Timor-Leste
Turkey
Ukraine
Uzbekistan
Viet Nam
Yemen
Zimbabwe
EMRO
SEARO
AMRO
SEARO
AFRO
WPRO
AMRO
AMRO
EMRO
WPRO
AFRO
AMRO
SEARO
EURO
AFRO
WPRO
EMRO
AFRO
AMRO
EURO
WPRO
AFRO
SEARO
EMRO
AMRO
AMRO
AMRO
AFRO
AFRO
EMRO
AMRO
SEARO
EURO
EURO
EURO
WPRO
EMRO
AFRO
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 55
Trainings and workshops held with PIP PC funds
Table 13: Summary of information sharing platforms globally and in the regions (2015)
Table 14: Summary of L&S capacity-building trainings and by region
PLATFORM NAME
AMRO
DATA TYPE URL
Ecuador
Panama
Jamaica
Trinidad & Tobago
Bolivia
Colombia
Costa Rica
Honduras
Nicaragua
Mexico
Brazil
Argentina
Regional Offi ce
Epidemiology data management (Ecuador, Colombia, Peru, Bolivia, Paraguay)
Viral isolation (Panama, Colombia, Costa Rica, Honduras, Nicaragua, El Salvador)
Epidemiology data management (Jamaica, Dominica, Haiti, Belize, Saint Lucia, Puerto Rico)
Laboratory training including viral isolation and real time PCR
Unusual Respiratory Events training
Unusual Respiratory Events training
Unusual Respiratory Events training
Unusual Respiratory Events training
Unusual Respiratory Events training
Burden of Disease Workshop (Argentina, Barbados, Brazil, Canada, Caribbean Public Health Agency (CARPHA), Chile, Colombia, Costa Rica, Cuba, Dominica, Ecuador, El Salvador, Honduras, Mexico)
Laboratory logistics (Argentina, Barbados, Brazil, Canada, CARPHA, Chile, Colombia, Costa Rica, Cuba, Dominica, Ecuador, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, Saint Vincent and the Grenadines, Uruguay)
Pyrosequencing (Ecuador)
Laboratory logistics
Economic Burden of Disease
Laboratory algorithms
July 2015
July 2015
December 2015
August 2015
October 2015
April 2015
August 2015
May 2015
June 2015
April 2015
April 2015
December 2015
November 2015
September 2015
November 2015
FluNet
FluID
SARInet
PAHO FluID
WHO/ECDCBulletins
Infl uenza virological data
Infl uenza epidemiological data
Infl uenza and other respiratory viruses epidemiological data
Infl uenza and other respiratory viruses epidemiological data
Infl uenza virological & epidemiological data
Global
Global
Regional(AMRO)
Regional(AMRO)
Regional(EURO)
http://www.who.int/infl uenza/gisrs_laboratory/fl unet/en/
http://www.who.int/infl uenza/surveillance_monitoring/fl uid/en/
http://www.sarinet.org/
http://ais.paho.org/phip/viz/fl umart2015.asp
https://fl unewseurope.org/
56 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Table 14, continued: Summary of L&S capacity-building trainings and by region
EURO
Armenia
Kyrgyzstan
Tajikistan
Turkmenistan
Uzbekistan
Intercountry
Outbreak Investigation and Response Guideline Development Workshop
Critical Care training
Infectious Substances Shipping Trainings
National annual fl u surveillance meeting
Infectious Substances Shippers Training (ISST) and Biorisk Management Advanced Training Programme (BRM ATP)
Training molecular identifi cation of circulation human infl uenza viruses for KGZ NIC
Practical Laboratory Training Course on Molecular Identifi cation of Infl uenza in the Russia NIC
1st workshops to initiate development of National operational OIR guideline
2nd workshops to fi nalize National operational OIR guideline
Training molecular identifi cation of circulation human infl uenza viruses for TJK NIC
Practical Laboratory Training Course on Molecular Identifi cation of Infl uenza in the Russia NIC
1st workshops to initiate development of National operational OIR guideline
2nd workshops to fi nalize National operational OIR guideline
Two workshops on sentinel surveillance for SARI and ILI for health personnel of sentinel sites
Training molecular identifi cation of circulation human infl uenza viruses for TKM NIC
Practical Laboratory Training Course on Molecular Identifi cation of Infl uenza in the Russia NIC
National meeting on infl uenza surveillance
Workshop on the development of “National Guidance on the Critical Care of Patients with SARI”
1st workshops to initiate development of National operational OIR guideline
Training molecular identifi cation of circulation human infl uenza viruses for UZB NIC
Practical Laboratory Training Course on Molecular Identifi cation of Infl uenza in the Russia NIC
National Infl uenza Surveillance Meeting
Annual Infl uenza meeting for NIS countries (Saint Petersburg)
OIR Guideline implementation (Berlin)
WHO group course on Infl uenza Bioinformatics Basics for Lab experts from 16 countries (NIC Saint Petersburg)
Principles of PCR assays’ development and validation (NIC Saint Petersburg)
LQSI training for Lab experts (Sochi, Russian Federation)
February 2015
September 2015
November 2015
December 2015
December 2015
September 2015
November 2015
May 2015
October 2015
October 2015
November 2015
April 2015
November 2015
November 2015
October 2015
March 2015
November 2015
June 2015
August 2015
November 2015
December 2015
November 2015
November 2015
December 2015
September 2015
May 2015
April 2015
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 57
Table 14, continued: Summary of L&S capacity-building trainings and by region
EMRO
SEARO
WPRO
Regional Offi ce
Regional
Expert consultation on gaps in research and policy on infl uenza surveillance and health systems to monitor and assess infl uenza events of international concern
Group Work on PIP Implementation with Country Focal
Expert consultation on fi nalization of available tools to assess SARI/ILI sentinel surveillance
Intercountry training on data analysis, scientifi c writing and publishing for epidemiologists and virologists
Intercountry training/certifi cation workshop on laboratory specimen collection, transportation, shipment of infl uenza and other pandemic prone respiratory viruses as per IATA regulations
Intercountry workshop on advanced epidemiological data analysis
Intercountry laboratory training workshop on infl uenza virus genotyping by Sanger sequencing
9th bi-regional meeting of the National Infl uenza Centres and Infl uenza Surveillance. Cambodia, joint meeting with WPRO
Regional meeting on PIP Jakarta
Training of trainers of sequencing and phylogenetic analysis of viruses, at Centers for Disease Control & Prevention in Atlanta
Training of trainers of screening antiviral susceptibility of infl uenza viruses by sequencing and antiviral resistance testing WHO CC for Reference & Research on Infl uenza, Victorian Infectious Diseases Reference Laboratory in Melbourne, Australia
IATA certifi cation training, Manila
9th bi-regional meeting of the National Infl uenza Centres and Infl uenza Surveillance. Cambodia, joint meeting with SEARO
Informal Consultation to Strengthen/Upgrade Surveillance for Early Detection of Public Health Events in the WPR, Manila
Enhanced training workshop on infl uenza laboratory diagnosis, China
Workshop on Strengthening ILI surveillance and laboratory testing, Cambodia
Meeting of human and animal health sectors to improve information-sharing, risk assessment and response to emerging zoonoses, including infl uenza, Mongolia
Meeting on setting priorities communicable diseases and events, Mongolia
May 2015
June 2015
August 2015
October 2015
October 2015
November 2015
December 2015
August 2015
April 2015
October 2015
July 2015
November 2015
August 2015
September 2015
November 2015
November 2015
November 2015
November 2015
58 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Country Laboratory & Surveillance indicators
Laboratory and Surveillance Capacity indicators measured by the WHO Regional Offi cesThe high-level PC Implementation Plan 2013-2016
has clear outcome and output indicators listed for
L&S. However, it was determined early on in the
implementation process that these were not sensitive
enough to capture the full extent of the capacity in the
countries and thus to identify the key areas for support
in the PIP PC target countries.
The PIP Secretariat worked together with the regional
and headquarters infl uenza programs to agree on a set
of 21 indicators that measured ability to detect monitor
and share novel infl uenza viruses and actions that would
sustain those abilities into the future. The detailed
indicator rationale and scoring criteria are presented in
Table 15.
The baseline data for these indicators were collected in
31 August 2014. Two further rounds of data collection
were undertaken in February 2014 and August 2015.
A third round was conducted in March 2016. The data
in this report have been thoroughly reviewed and
validated.
For 2016, to minimize the potential for variations in
interpretation of the criteria at the country level, WHO
Country Offi ces will answer a series of questions and the
scores will be automatically calculated based on their
responses. WHO headquarters will continue to report its
data using the global databases.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 59
Info
rma
l la
bo
rato
ry g
uid
an
ce
or
alg
ori
thm
exi
stin
g, b
ut
no
t fo
rma
lly d
ocu
me
nte
d a
nd
/or
no
t st
rict
ly p
ut
in u
se.
Re
gis
tere
d in
IRR
or
ag
ree
me
nt
wit
h W
HO
CC
s b
ut
no
re
ag
en
ts
rece
ive
d in
th
e p
ast
18
mo
nth
s,
an
d n
o o
the
r so
urc
es
ava
ilab
le
for
pri
me
rs a
nd
oth
er
rea
ge
nts
in
th
e p
ast
18
mo
nth
s.
Po
ten
tia
l in
fl u
en
za P
CR
te
stin
g
ab
ility
, e.g
. hav
ing
PC
R m
ach
ine
a
nd
re
ag
en
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ut
no
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ide
nce
o
f fu
nct
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ing
.
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lea
st o
ne
na
tio
na
l la
bo
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ry
pa
rtic
ipa
ted
bu
t n
on
e a
chie
ved
a
10
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sco
re o
n n
on
-se
aso
na
l v
iru
ses
in t
he
last
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infl
ue
nza
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R E
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lea
st o
ne
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na
l la
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ry
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rtic
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t n
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e a
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ved
a
10
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sco
re o
n s
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son
al
vir
use
s in
th
e la
st W
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in
fl u
en
za P
CR
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AP.
Se
qu
en
cin
g e
qu
ipm
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t a
nd
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nti
al c
ap
aci
ty a
vaila
ble
, b
ut
no
t fu
nct
ion
ing
in t
he
pa
st
12
mo
nth
s.
Pla
nn
ing
to
est
ab
lish
a n
ati
on
al
Ea
rly
Wa
rnin
g S
yste
m e
.g.
rele
va
nt
de
fi n
itio
ns,
pro
toco
ls,
pro
ced
ure
s a
nd
ta
rge
ted
tr
ain
ing
ma
teri
als
etc
. un
de
r d
eve
lop
me
nt.
Alg
ori
thm
est
ab
lish
ed
, fo
rma
lly d
ocu
me
nte
d a
nd
st
rict
ly p
ut
in u
se.
Re
gis
tere
d u
ser
of
IRR
or
ag
ree
me
nt
wit
h W
HO
CC
s w
ith
re
ag
en
ts r
ece
ive
d in
th
e
pa
st 1
8 m
on
ths;
or
rea
ge
nts
re
ceiv
ed
fro
m o
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r so
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es
in t
he
pa
st 1
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on
ths.
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ue
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ive
ly
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ing
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rme
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ith
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At
lea
st o
ne
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l la
bo
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art
icip
ate
d a
nd
a
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a s
core
of
10
0%
on
n
on
-se
aso
na
l vir
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s in
th
e
last
WH
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en
za P
CR
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AP.
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lea
st o
ne
na
tio
na
l la
bo
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ry p
art
icip
ate
d a
nd
a
chie
ved
a s
core
of
10
0%
on
se
aso
na
l vir
use
s in
th
e la
st
WH
O in
fl u
en
za P
CR
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AP.
Infl
ue
nza
vir
us
ge
ne
s se
qu
en
ced
in t
he
pa
st 1
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mo
nth
s.
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ctio
na
l na
tio
na
l Ea
rly
Wa
rnin
g S
yste
m w
ith
re
lev
an
t d
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nit
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s, p
roto
cols
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d
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ure
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tc. i
n p
lace
.
SCO
RE
TWO
(Par
tial
cap
acit
y)
Th
is in
dic
ato
r m
eas
ure
s la
bo
rato
ry
pre
par
ed
ne
ss fo
r d
ete
ctio
n o
f in
fl u
en
za
viru
ses
wit
h p
and
em
ic p
ote
nti
al.
Th
is in
dic
ato
r m
eas
ure
s a
cou
ntr
y’s
acc
ess
to
re
age
nts
th
rou
gh
re
gis
trat
ion
in t
he
IRR
or
by
agre
em
en
t w
ith
a W
HO
CC
, or
thro
ug
h u
sin
g
WH
OC
C e
stab
lish
ed
SO
Ps
wit
h in
-co
un
try
cap
acit
y to
syn
the
size
/ord
er/
imp
ort
pri
me
rs
etc
.
Th
is in
dic
ato
r m
eas
ure
s th
e c
ou
ntr
y’s
st
atu
s w
ith
re
gar
ds
to t
he
ab
ility
to
pe
rfo
rm
infl
ue
nza
PC
R t
est
ing
.
Th
is in
dic
ato
r m
eas
ure
s th
e q
ual
ity
of
the
P
CR
te
stin
g t
o d
ete
ct n
on
-se
aso
nal
infl
ue
nza
vi
ruse
s w
ith
pan
de
mic
po
ten
tial
bas
ed
on
th
e p
erf
orm
ance
in t
he
last
pan
el o
f th
e W
HO
In
fl u
en
za P
CR
EQ
AP.
Th
is in
dic
ato
r m
eas
ure
s th
e q
ual
ity
of
the
PC
R
test
ing
to
de
tect
se
aso
nal
cir
cula
tin
g v
iru
ses
bas
ed
on
th
e p
erf
orm
ance
in t
he
last
pan
el o
f th
e W
HO
Infl
ue
nza
PC
R E
QA
P.
Th
is in
dic
ato
r m
eas
ure
s se
qu
en
cin
g
cap
abili
tie
s fo
r in
fl u
en
za v
iru
ses.
Th
is in
dic
ato
r m
eas
ure
s th
e s
tatu
s o
f a
n
atio
nal
sys
tem
to
ide
nti
fy u
nu
sual
or
un
exp
ect
ed
illn
ess
eve
nts
. Th
ese
sys
tem
s ar
e
oft
en
cal
led
Eve
nt
Bas
ed
Su
rve
illan
ce (E
BS
) o
r “e
arly
war
nin
g” s
yste
ms
and
use
mu
ltip
le
sou
rce
s o
f o
ffi c
ial a
nd
un
offi
cia
l re
po
rts,
in
clu
din
g m
ed
ia r
ep
ort
s.
pre
v6
mth
s
pre
v1
8 m
ths
pre
v6
mth
s
pre
v6
mth
s
pre
v6
mth
s
pre
v1
2 m
ths
pre
v6
mth
s
Alg
ori
thm
fo
r la
bo
rato
ry d
ete
ctio
n
of
un
usu
al i
nfl
ue
nza
v
iru
ses
Re
gis
tra
tio
n in
IRR
or
rece
ivin
g k
its
fro
m
WH
OC
Cs
PC
R T
est
ing
PC
R q
ua
lity
fo
r n
on
-se
aso
na
l in
fl u
en
za
vir
use
s
PC
R q
ua
lity
fo
r se
aso
na
l in
fl u
en
za
vir
use
s
Se
qu
en
cin
g
Na
tio
na
l “E
arl
y
Wa
rnin
g”
syst
em
s o
r E
ve
nt
Ba
sed
S
urv
eil
lan
ce (
EB
S)
No
lab
ora
tory
a
lgo
rith
m e
sta
blis
he
d.
No
t re
gis
tere
d in
IRR
, a
nd
no
ag
ree
me
nt
wit
h W
HO
CC
s, a
nd
no
o
the
r so
urc
es
ava
ilab
le
for
pri
me
rs a
nd
oth
er
rea
ge
nts
.
No
infl
ue
nza
PC
R
test
ing
ab
ility
.
No
lab
ora
tory
p
art
icip
ate
d in
th
e la
st
WH
O In
fl u
en
za P
CR
E
QA
P.
No
lab
ora
tory
p
art
icip
ate
d in
th
e la
st
WH
O In
fl u
en
za P
CR
E
QA
P.
No
eq
uip
me
nt
an
d n
o
seq
ue
nci
ng
ca
pa
city
av
aila
ble
.
No
na
tio
na
l Ea
rly
Wa
rnin
g S
yste
m
such
as
Eve
nt
Ba
sed
S
urv
eill
an
ce.
SCO
RE
ON
E(M
inim
al c
apac
ity)
SCO
RE
THR
EE(C
apac
ity
esta
blis
hed
)TI
ME
-FR
AM
EIN
DIC
ATO
R R
ATIO
NA
LEIN
DIC
ATO
R
Ta
ble
15
: De
tail
ed
in
dic
ato
r ra
tio
na
le a
nd
sco
rin
g c
rite
ria
fo
r 4
ca
teg
ori
es
of
La
bo
rato
ry a
nd
Su
rve
illa
nce
in
dic
ato
rs
DE
TE
CT
ION
60 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
ILI s
urv
eill
ance
exi
stin
g b
ut
wit
h g
aps
in
colle
ctin
g d
ata
rou
tin
ely
* an
d s
ub
mit
tin
g
sam
ple
s re
gu
larl
y**
to a
lab
ora
tory
in t
he
p
ast
12
mo
nth
s.
*19
or
mo
re w
ee
ks d
uri
ng
th
e N
ort
he
rn
He
mis
ph
ere
infl
ue
nza
se
aso
n (w
ee
k 4
0 –
w
ee
k 2
0) o
r 1
3 o
r m
ore
we
eks
du
rin
g t
he
S
ou
the
rn H
em
isp
he
re s
eas
on
(we
ek
18
–
we
ek
40
), o
r 3
2 w
ee
ks o
r m
ore
du
rin
g t
he
w
ho
le y
ear
for
cou
ntr
ies
wit
h y
ear
-ro
un
d
surv
eill
ance
.
**id
eal
ly o
n a
we
ekl
y b
asis
, ho
we
ver
no
la
ter
than
1 m
on
th a
fte
r co
llect
ion
of
sam
ple
s.
SA
RI s
urv
eill
ance
exi
stin
g b
ut
wit
h g
aps
in
colle
ctin
g d
ata
rou
tin
ely
* an
d s
ub
mit
tin
g
sam
ple
s re
gu
larl
y**
to a
lab
ora
tory
in t
he
p
ast
12
mo
nth
s.
* 3
2 w
ee
ks o
r m
ore
in a
ye
ar.
**id
eal
ly o
n a
we
ekl
y b
asis
, ho
we
ver
no
m
ore
th
an 1
mo
nth
aft
er
colle
ctio
n o
f sa
mp
les.
Lab
ora
tory
an
d e
pid
em
iolo
gic
dat
a sh
are
d
info
rmal
ly b
ut
no
re
po
rts
of
inte
gra
ted
la
bo
rato
ry a
nd
ep
ide
mio
log
ic d
ata.
In t
he
pas
t 1
2 m
on
ths
bu
lleti
ns/
rep
ort
s p
ub
lish
ed in
th
e p
ub
lic d
om
ain
du
rin
g
the
infl
uen
za s
easo
n b
ut
less
th
an o
nce
a
mo
nth
.
Ad
-ho
c co
ord
inat
ion
i.e.
join
t m
ee
tin
gs,
sh
arin
g o
f in
form
atio
n a
nd
join
t in
vest
i-g
atio
n, b
ut
no
do
cum
en
ted
fu
nct
ion
al
coo
rdin
atio
n m
ech
anis
m in
pla
ce.
ILI s
urv
eill
ance
be
ing
car
rie
d o
ut,
sa
mp
les
be
ing
co
llect
ed
ro
uti
ne
ly*
and
se
nt
to a
lab
ora
tory
re
gu
larl
y**
in
the
pas
t 1
2 m
on
ths.
*19
or
mo
re w
ee
ks d
uri
ng
th
e N
ort
h-
ern
He
mis
ph
ere
infl
ue
nza
se
aso
n
(we
ek
40
– w
ee
k 2
0) o
r 1
3 o
r m
ore
w
ee
ks d
uri
ng
th
e S
ou
the
rn H
em
i-sp
he
re s
eas
on
(we
ek
18
– w
ee
k 4
0),
or
32
we
eks
or
mo
re d
uri
ng
th
e w
ho
le
year
for
cou
ntr
ies
wit
h y
ear
-ro
un
d
surv
eill
ance
.
**id
eal
ly o
n a
we
ekl
y b
asis
, ho
we
ver
no
late
r th
an 1
mo
nth
aft
er
colle
ctio
n
of
sam
ple
s.”
SA
RI s
urv
eill
ance
be
ing
car
rie
d o
ut,
sa
mp
les
be
ing
co
llect
ed
ro
uti
ne
ly*
and
se
nt
to a
lab
ora
tory
re
gu
larl
y**
for
dia
gn
osi
s o
f in
fl u
en
za in
th
e p
ast
12
mo
nth
s.
* 3
2 w
ee
ks o
r m
ore
in a
ye
ar.
**id
eal
ly o
n a
we
ekl
y b
asis
, ho
we
ver
no
mo
re t
han
1 m
on
th a
fte
r co
llect
ion
o
f sa
mp
les.
Su
rve
illan
ce r
ep
ort
s w
ith
inte
gra
ted
la
bo
rato
ry a
nd
ep
ide
mio
log
ical
dat
a
pu
blis
he
d.
In t
he
pas
t 1
2 m
on
ths
bu
lleti
ns/
re-
po
rts
pu
blis
he
d in
th
e p
ub
lic d
om
ain
at
leas
t m
on
thly
du
rin
g t
he
infl
ue
nza
se
aso
n.
Do
cum
en
ted
fu
nct
ion
al c
oo
rdin
atio
n
me
chan
ism
in p
lace
.
SCO
RE
TWO
(Par
tial
cap
acit
y)
Th
is in
dic
ato
r m
eas
ure
s th
e c
ou
ntr
y’s
sta
tus
wit
h r
eg
ard
to
th
e e
xist
en
ce o
f a
nat
ion
al
surv
eill
ance
sys
tem
wh
ere
pat
ien
ts w
ith
no
n-
seve
re r
esp
irat
ory
dis
eas
es
such
as
ILI o
r si
mila
r ar
e m
ed
ical
ly a
tte
nd
ed
at
an o
utp
atie
nt
or
pro
-vi
de
r se
ttin
g. A
s a
rou
tin
e d
uri
ng
th
e fl
u s
eas
on
, sa
mp
les
sho
uld
be
co
llect
ed
fro
m a
su
bse
t o
f p
atie
nts
an
d s
en
t to
a la
bo
rato
ry fo
r d
iag
no
sis
of
infl
ue
nza
. Th
is s
ho
uld
be
do
ne
as
de
fi n
ed
in
the
WH
O G
lob
al E
pid
em
iolo
gic
al S
urv
eill
ance
S
tan
dar
ds
for
Infl
ue
nza
.
Th
is in
dic
ato
r m
eas
ure
s th
e c
ou
ntr
y’s
sta
tus
wit
h r
eg
ard
to
th
e e
xist
en
ce o
f a
nat
ion
al
surv
eill
ance
sys
tem
wh
ere
ho
spit
aliz
ed
pat
ien
ts
wit
h s
eve
re r
esp
irat
ory
dis
eas
e s
uch
as
SA
RI
are
me
dic
ally
att
en
de
d. A
s a
rou
tin
e, s
amp
les
sho
uld
be
co
llect
ed
ide
ally
fro
m a
ll o
r a
sub
set
of
pat
ien
ts a
nd
se
nt
to a
lab
ora
tory
for
dia
gn
o-
sis
of
infl
ue
nza
. Th
is s
ho
uld
be
do
ne
as
de
fi n
ed
in
th
e W
HO
Glo
bal
Ep
ide
mio
log
ical
Su
rve
illan
ce
Sta
nd
ard
s fo
r In
fl u
en
za.
Th
is in
dic
ato
r m
eas
ure
s w
he
the
r la
bo
rato
ry a
nd
e
pid
em
iolo
gic
su
rve
illan
ce d
ata
are
lin
ked
an
d
inte
gra
ted
to
pro
du
ce s
urv
eill
ance
up
dat
es.
Th
is in
dic
ato
r m
eas
ure
s th
e e
xte
nt
to w
hic
h t
he
d
ata
colle
cte
d t
hro
ug
h in
fl u
en
za s
urv
eill
ance
is
colla
ted
into
ro
uti
ne
bu
lleti
ns
and
sh
are
d in
th
e
pu
blic
do
mai
n.
Th
is in
dic
ato
r m
eas
ure
s th
e e
xte
nt
to w
hic
h a
ni-
mal
an
d h
um
an h
eal
th a
uth
ori
tie
s co
ord
inat
e
acti
viti
es
in r
esp
on
se t
o in
fl u
en
za-r
ela
ted
eve
nts
o
f p
ote
nti
al p
ub
lic h
eal
th s
ign
ifi ca
nce
.
pre
v1
2m
ths
pre
v1
2m
ths
pre
v6
mth
s
pre
v1
2m
ths
pre
v6
mth
s
ILI N
ati
on
al
surv
eil
lan
ce
SA
RI N
ati
on
al
surv
eil
lan
ce
Inte
gra
tio
n o
f la
bo
rato
ry a
nd
e
pid
em
iolo
gic
da
ta
Bu
lle
tin
s -
Re
gu
lar
Infl
ue
nza
su
rve
illa
nce
rep
ort
s
Hu
ma
n A
nim
al
inte
rfa
ceco
ord
ina
tio
n
No
ILI s
urv
eil-
lan
ce (n
o a
ctiv
e
site
s p
rovi
din
g
dat
a o
r sa
mp
les
in t
he
pas
t 1
2
mo
nth
s)
No
SA
RI s
urv
eil-
lan
ce (n
o a
ctiv
e
site
s p
rovi
din
g
dat
a o
r sa
mp
les
in t
he
pas
t 1
2
mo
nth
s)
No
lin
kag
e o
f la
bo
rato
ry w
ith
e
pid
em
iolo
gic
d
ata.
In t
he
pas
t 1
2
mo
nth
s n
o
bu
lleti
n/r
ep
ort
p
ub
lish
ed
in t
he
p
ub
lic d
om
ain
.
No
evi
de
nce
of
coo
rdin
atio
n.
SCO
RE
ON
E(M
inim
al c
apac
ity)
SCO
RE
THR
EE(C
apac
ity
esta
blis
hed
)TI
ME
-FR
AM
EIN
DIC
ATO
R R
ATIO
NA
LEIN
DIC
ATO
R
Ta
ble
15
, co
nti
nu
ed
: De
tail
ed
in
dic
ato
r ra
tio
na
le a
nd
sco
rin
g c
rite
ria
fo
r 4
ca
teg
ori
es
of
La
bo
rato
ry a
nd
Su
rve
illa
nce
in
dic
ato
rs
MO
NIT
OR
ING
Re
po
rts
sub
mit
ted
for
< 2
0 w
ee
ks in
th
e
No
rth
ern
He
mis
ph
ere
se
aso
n (w
ee
k 4
0
-we
ek
20
), o
r fo
r <
13
we
eks
in t
he
So
uth
-e
rn H
em
isp
he
re s
eas
on
(we
ek
18
-w
ee
k 4
0),
or
for
< 3
2 w
ee
ks d
uri
ng
th
e w
ho
le
year
for
cou
ntr
ies
wit
h y
ear
-ro
un
d s
urv
eil-
lan
ce in
th
e p
ast
12
mo
nth
s.
Re
po
rts
sub
mit
ted
for
< 2
0 w
ee
ks in
th
e
No
rth
ern
He
mis
ph
ere
se
aso
n (w
ee
k 4
0
-we
ek
20
), o
r fo
r <
13
we
eks
in t
he
So
uth
-e
rn H
em
isp
he
re s
eas
on
(we
ek
18
-w
ee
k 4
0),
or
for
< 3
2 w
ee
ks d
uri
ng
th
e w
ho
le
year
for
cou
ntr
ies
wit
h y
ear
-ro
un
d s
urv
eil-
lan
ce in
th
e p
ast
12
mo
nth
s.
ISS
T r
ece
ive
d in
th
e p
ast
2 y
ear
s o
r va
lid
exp
ort
pe
rmit
in p
lace
, bu
t n
ot
bo
th.
On
e s
hip
me
nt
in t
he
pas
t 1
2 m
on
ths.
Co
un
try
’s s
eq
ue
nce
s b
ein
g u
plo
ade
d b
y a
W
HO
CC
to
a p
ub
licly
acc
ess
ible
dat
abas
e
in t
he
pas
t 1
2 m
on
ths.
Re
po
rts
sub
mit
ted
for
20
or
mo
re
we
eks
du
rin
g t
he
No
rth
ern
He
mi-
sph
ere
se
aso
n (w
ee
k 4
0 -
we
ek
20
),
or
for
13
or
mo
re w
ee
ks d
uri
ng
th
e
So
uth
ern
He
mis
ph
ere
se
aso
n (w
ee
k 1
8 -
we
ek
40
), o
r fo
r 3
2 o
r m
ore
we
eks
d
uri
ng
th
e w
ho
le y
ear
for
cou
ntr
ies
wit
h y
ear
-ro
un
d s
urv
eill
ance
in t
he
p
ast
12
mo
nth
s.
Re
po
rts
sub
mit
ted
for
20
or
mo
re
we
eks
du
rin
g t
he
No
rth
ern
He
mi-
sph
ere
se
aso
n (w
ee
k 4
0 -
we
ek
20
),
or
for
13
or
mo
re w
ee
ks d
uri
ng
th
e
So
uth
ern
He
mis
ph
ere
se
aso
n (w
ee
k 1
8 -
we
ek
40
), o
r fo
r 3
2 o
r m
ore
we
eks
d
uri
ng
th
e w
ho
le y
ear
for
cou
ntr
ies
wit
h y
ear
-ro
un
d s
urv
eill
ance
in t
he
p
ast
12
mo
nth
s.
ISS
T r
ece
ive
d in
th
e p
ast
2 y
ear
s an
d
valid
exp
ort
pe
rmit
in p
lace
.
At
leas
t 2
sh
ipm
en
ts in
th
e p
ast
12
m
on
ths.
Co
un
try
up
load
ing
se
qu
en
ces
to a
p
ub
licly
acc
ess
ible
dat
abas
e in
th
e
pas
t 1
2 m
on
ths.
SCO
RE
TWO
(Par
tial
cap
acit
y)
Th
is in
dic
ato
r m
eas
ure
s th
e r
eg
ula
rity
o
f re
po
rtin
g v
iro
log
ical
dat
a to
WH
O
thro
ug
h F
luN
et
and
/o
r R
eg
ion
al O
ffi c
e
Dat
abas
es.
Th
is in
dic
ato
r m
eas
ure
s th
e r
eg
ula
r-it
y o
f re
po
rtin
g e
pid
em
iolo
gic
dat
a to
W
HO
th
rou
gh
Flu
ID a
nd
/ o
r R
eg
ion
al
Offi
ce
Dat
abas
es.
Th
is in
dic
ato
r m
eas
ure
s a
cou
ntr
y’s
ab
ility
to
sh
ip in
fl u
en
za c
linic
al s
pe
ci-
me
ns/
viru
s is
ola
tes
wit
h p
and
em
ic
po
ten
tial
ou
t o
f th
e c
ou
ntr
y to
a G
ISR
S-
asso
ciat
ed
WH
OC
C w
ith
ap
pro
pri
ate
IS
ST
(In
fect
iou
s S
ub
stan
ce S
hip
pe
rs
Trai
nin
g) a
nd
exp
ort
pe
rmit
for
such
m
ate
rial
s.
Th
is in
dic
ato
r m
eas
ure
s a
cou
ntr
y’s
sh
arin
g v
iru
s is
ola
tes
and
/or
clin
ical
sp
eci
me
ns
wit
h W
HO
CC
s.
Th
is in
dic
ato
r m
eas
ure
s sh
arin
g o
f in
fl u
en
za v
iru
s g
en
eti
c se
qu
en
ces
for
use
glo
bal
ly.
pre
v
12
m
ths
pre
v
12
m
ths
pre
v
24
m
ths
pre
v
12
m
ths
pre
v
12
m
ths
Re
po
rtin
g la
bo
rato
ry
surv
eil
lan
ce d
ata
to
W
HO
th
rou
gh
Flu
Ne
t a
nd
/or
Re
gio
na
l d
ata
ba
ses
(Vir
olo
gic
al D
ata
)
Re
po
rtin
g
ep
ide
mio
log
ic
surv
eil
lan
ce d
ata
to
W
HO
th
rou
gh
Flu
ID
an
d/o
r R
eg
ion
al
da
tab
ase
s (E
pid
emio
log
ica
l Da
ta)
Sh
ipp
ing
ca
pa
city
Sh
ari
ng
sa
mp
les
wit
h
WH
OC
Cs
Sh
ari
ng
/usi
ng
seq
ue
nce
da
ta
No
re
po
rt in
th
e
pas
t 1
2 m
on
ths.
No
re
po
rt in
th
e
pas
t 1
2 m
on
ths.
No
ISS
T in
th
e
pas
t 2
ye
ars
and
n
o v
alid
exp
ort
p
erm
it.
No
sh
ipm
en
t in
th
e p
ast
12
m
on
ths.
No
se
qu
en
ces
shar
ed
.
SCO
RE
ON
E(M
inim
al c
apac
ity)
SCO
RE
THR
EE(C
apac
ity
esta
blis
hed
)TI
ME
-FR
AM
EIN
DIC
ATO
R R
ATIO
NA
LEIN
DIC
ATO
R
Ta
ble
15
, co
nti
nu
ed
: De
tail
ed
in
dic
ato
r ra
tio
na
le a
nd
sco
rin
g c
rite
ria
fo
r 4
ca
teg
ori
es
of
La
bo
rato
ry a
nd
Su
rve
illa
nce
in
dic
ato
rs
SH
AR
ING
62 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Th
e p
lan
be
ing
dis
cuss
ed
b
etw
ee
n W
HO
CO
/RO
an
d M
OH
an
d is
un
de
r re
vie
w.
RR
T e
stab
lish
ed
, bu
t n
o t
rain
ing
in
the
pas
t 1
2 m
on
ths.
Ag
ree
d t
o b
e p
art
of
a n
atio
nal
p
lan
/nat
ion
al p
lan
s w
ith
in
teg
rati
on
un
de
r d
eve
lop
me
nt.
NIC
de
sig
nat
ed
by
cou
ntr
y,
pe
nd
ing
WH
O r
eco
gn
itio
n.
An
imp
lem
en
tati
on
pla
n a
gre
ed
b
etw
ee
n M
oH
an
d W
HO
CO
/RO
in
pla
ce.
RR
T e
stab
lish
ed
an
d t
rain
ed
in t
he
p
ast
12
mo
nth
s.
Inte
gra
ted
wit
h a
nat
ion
al p
lan
/n
atio
nal
pla
ns.
NIC
re
cog
niz
ed
by
WH
O.
SCO
RE
TWO
(Par
tial
cap
acit
y)
Th
is in
dic
ato
r m
eas
ure
s th
e d
eg
ree
to
wh
ich
th
e c
ou
ntr
y is
act
ive
ly p
arti
cip
atin
g in
th
e
pla
nn
ing
for
the
wo
rk t
o b
e a
cco
mp
lish
ed
. Id
eal
ly t
his
pla
n w
ou
ld b
e a
MO
H P
lan
or
it
cou
ld b
e d
eve
lop
ed
by
the
Co
un
try
Offi
ce
an
d a
gre
ed
to
by
the
MO
H. I
t ca
n b
e s
imp
le
bu
t sh
ou
ld c
on
tain
act
ivit
ies
for
targ
ete
d
imp
rove
me
nts
, tim
elin
es
and
bu
dg
ets
.
Th
is in
dic
ato
r m
eas
ure
s R
apid
Re
spo
nse
Te
am (R
RT
) tra
inin
g d
eliv
ere
d t
hro
ug
h
this
pro
ject
. Th
e p
urp
ose
of
the
tra
inin
g is
to
en
sure
th
at R
RTs
are
tra
ine
d a
nd
re
ady
to r
esp
on
d t
o u
nu
sual
eve
nts
incl
ud
ing
h
um
an c
ase
s/cl
ust
ers
of
infe
ctio
n w
ith
no
vel
infl
ue
nza
vir
use
s an
d o
utb
reak
s o
f se
vere
re
spir
ato
ry d
ise
ase
s.
Th
is in
dic
ato
r m
eas
ure
s th
e in
teg
rati
on
o
f th
is p
roje
ct in
to a
n o
vera
ll n
atio
nal
p
lan
to
incr
eas
e t
he
ch
ance
for
lon
g t
erm
su
stai
nab
ility
of
the
cap
acit
y b
uild
ing
e
ff o
rts.
Th
e h
igh
leve
l act
ivit
ies
of
this
p
roje
ct c
an b
e p
art
of
a n
atio
nal
pla
n fo
r su
rve
illan
ce, p
rep
are
dn
ess
an
d r
esp
on
se,
etc
.
Th
is in
dic
ato
r m
eas
ure
s p
rog
ress
to
war
ds
a
cou
ntr
y-d
esi
gn
ate
d a
nd
WH
O-r
eco
gn
ize
d
NIC
(Nat
ion
al In
fl u
en
za C
en
tre
).
pre
v6
mth
s
pre
v1
2 m
ths
pre
v6
mth
s
pre
v6
mth
s
Co
un
try
Im
ple
me
nta
tio
n P
lan
Ra
pid
Re
spo
nse
Tr
ain
ing
Su
sta
ina
bil
ity
(ev
ide
nce
of)
NIC
Sta
tus
Dis
cuss
ion
wit
h
Mo
H n
ot
yet
star
ted
.
No
RR
T
est
ablis
he
d.
No
inte
gra
tio
n
in a
nat
ion
al
pla
n/n
atio
nal
p
lan
s.
No
NIC
d
esi
gn
ate
d b
y M
OH
.
SCO
RE
ON
E(M
inim
al c
apac
ity)
SCO
RE
THR
EE(C
apac
ity
esta
blis
hed
)TI
ME
-FR
AM
EIN
DIC
ATO
R R
ATIO
NA
LEIN
DIC
ATO
R
Ta
ble
15
, co
nti
nu
ed
: De
tail
ed
in
dic
ato
r ra
tio
na
le a
nd
sco
rin
g c
rite
ria
fo
r 4
ca
teg
ori
es
of
La
bo
rato
ry a
nd
Su
rve
illa
nce
in
dic
ato
rs
SU
STA
INA
BIL
ITY
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 63
Annex 2
PIP PC Implementation work planning scheduleThe Partnership Contribution (PC) is allocated to
specifi c Areas of Work (AOWs) according to defi ned
work plans from WHO headquarters, Regional and
Country Offi ces. The work planning is done according
to WHO’s biennial fi nancial cycle. To facilitate this,
work plans were created for the 2014-2015 biennium
but disaggregated for each individual year. Work plan
development for all AOWs began with a meeting in
October 2014 that brought together Regional Offi ce
programme offi cers and headquarter AOW programme
offi cers to share achievements and challenges from the
past year. Recommendations for funding are made by
the Secretariat to the Director, Pandemic and Epidemic
Diseases, who also reviews the plans and makes
recommendations to the Assistant Director General for
approval.
All funds received by WHO are managed through
Awards. Awards are assigned to work plans and the
Award numbers allow funds to be tracked and reported
on across WHO. The PIP Secretariat keeps track of the
fi nancial implementation rate for each Regional Offi ce
and AOW, intervening when necessary to meet any
implementation challenges where and when they occur.
Figure 6 shows that the fi nancial implementation rate of
the budget overall for the 2014-2015 biennium was over
75%, indicating that much of the work planned for this
time period was performed according to the schedule
set out in the work plans for the biennium.
2015 PIP PC Financial Expenditure
Introduction
Reported below is the summary fi nancial data for 2015,
which is the second year of the WHO biennial fi nancial
cycle of 2014-15.
Collection of Funds (Partnership Contribution)
As specifi ed in the PIP Framework, Partnership
Contributions (PC) are paid annually and began in 2012.
In 2015, activities were funded by the contributions
collected in 2014. The 2014 Collection process started
with the publication of the 2014 PC Questionnaire,
used by WHO to identify infl uenza vaccine, diagnostic
and pharmaceutical manufacturers using GISRS. Based
on answers to the Questionnaire, 42 contributors were
identifi ed. As of 31 December 2014, WHO received
US$ 15,059,381 and by 15 March 2015 US$ 25,922,891.
As seen in Figure 7, as of March 2016 the Secretariat has
collected 96% of the 2014 PC Collection funds, with a
total of US$ 26,964,062.
Figure 6: Implementation rate of PIP PC for 2014-2015
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
% OverallImplementation
Total work plan distribution (2014-15): $30,690,703
77%
64 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Experiences in collecting the 2014 PC have highlighted
some challenges including non-response to the PC
Questionnaire and the Band Selection Form (BSF). The
latter is used by the Secretariat to calculate the individual
amount due by each contributor. Additionally, some
companies have been unable to make payments in full.
In accordance with guidance provided by the Advisory
Group, industry and other stakeholders, the Secretariat
used the most recent Questionnaire answers and
BSF information submitted by entities in previous PC
Collection years in order to move forward with the
2014 Collection process. This ensured that all entities
identifi ed as a Contributor were factored into the
formula, ensuring that entities that did submit their
forms were not adversely impacted. The Secretariat also
gave companies facing payment issues the possibility
of paying their contribution in installments. Table 16
below details individual payments by entity for 2014.
Figure 7: 2014 contributions expected vs received, as of March 2016
Table 16: PC by entity for 2014, as of March 2016
Alere Inc.
Becton, Dickinson & Company
BIKEN
BioCSL Pty Ltd.
Cepheid
CNBG - Beijing Tiantan Institute of Biological Products Co., Ltd.
CNBG - Changchun Institute ofBiological Products Co., Ltd.
CNBG - Shanghai Institute of Biological Products Co., Ltd.
Denka-Seiken Co., Ltd.
F. Hoff mann-La Roche Ltd.
Fluart Innovative Vaccines Ltd.
Focus Diagnostic
GlaxoSmithKline
Green Cross Corp.
InDevr
Institute of Vaccine and Medical Biologicals IVAC
Kitasato Daiichi Sankyo Vaccine Co. Ltd.
Medicago
MedImmune (AstraZeneca)
Nanosphere, Inc.
Novartis
Princeton BioMeditech Corporation
Protein Sciences
PT BioFarma
Qiagen
Quidel
Response Biomedical Corp
Saint-Petersburg Scientifi c Research Institute of Vaccines and Sera
Sanofi Pasteur
Serum Institute of India
Sinovac Biotech Co. Ltd.
Takeda Pharmaceuticals Int.
The Chemo-Sero-Therapeutic Research Institute (Kaketsuken)
The Government Pharmaceutical Organization (GPO)
UMN Pharma
Vabiotech
Zydus Cadila Healthcare Ltd.
TOTAL (US$)
39,071
83,975
699,790
979,706
2,799
83,975
83,975
139,958
475,857
6,158,153
83,925
30,791
6,158,153
335,879
2,799
2,799
335,899
2,799
1,399,580
2,799
2,799,160
2,799
2,779
2,799
2,799
2,799
2,789
30,791
6,158,153
2,799
139,958
2,799
699,790
2,799
2,799
2,799
2,769
26,964,062
ENTITY 2014
26.9M
2014
28M
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 65
Distribution of FundsIn May 2012, the Executive Board decided that for the
period 2012-2016, 70% of resources should be assigned
to preparedness and 30% to response.132 All of the funds
assigned to response remain in reserve for use when a
pandemic occurs.
Additionally, in March 2013, the Director-General
accepted a recommendation from the Advisory Group
that a portion of PC funds, not exceeding 10%, averaged
over the years 2013-2016, should be used by the PIP
Secretariat to enable work, either on-going but at risk, or
not yet undertaken because of lack of funds, to be done
in order to meet the objectives of the PIP Framework.133
Furthermore, a percentage of PC funds is taken by WHO
as part of its standard budget processes for Program
Support Costs (PSC).134
Figures 8 and 9 below summarize the further
distribution of funds assigned for preparedness in the
2014-15 biennium across each AOW and across the
WHO regions and headquarters. Figure 4 (page 49)
shows the amount set aside for Response.
Figure 8: Distribution of preparedness funds in 2014-15 by Area of Work
Figure 9: Distribution of preparedness funds in 2014-15 by WHO region and HQ
132 See: http://apps.who.int/gb/ebwha/pdf_fi les/EB131/B131_4-en.pdf?ua=1 and http://apps.who.int/gb/ebwha/pdf_fi les/EB131-REC1/B131_REC1-en.pdf#page=18
133 See: http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at page 6
134 WHO Program Support Cost (PSC) is calculated at 13% of direct costs for the Preparedness and Secretariat components, and 7% of direct costs for the Response component.
Funds for both AOWs and for major Offi ces are
distributed according to approved work plans that have
been developed to meet the outcomes and objectives,
and according to the budget, defi ned in the PIP PC
Implementation Plan 2013-2016.
Implementation Expenditures2015 work plans were developed in Quarter 4 of 2014
with the expectation that the majority of funds would
be received and in line with the distribution outlined in
the PIP PC Implementation Plan, 2013-2016.
Expenditure of FundsThe overall expenditure rate for activities during 2014-
2015 was 77%. Across the biennium and all offi ces/
AOWs, staff costs represented 23% of this total
expenditure with staff costs in 2015 being 24%. Figures
10 and 11 present the expenditure of funds in 2014-
2015 by AOW and region. Table 17 presents the overall
summary of expenditure for the biennium.
$22,370,997
$1,540,800
$3,955,406
$1,995,500
$828,000
Laboratory& Surveillance
RiskCommunications
RegulatoryCapacityBuilding
Planning for Deploy- ment
Burden ofDisease
$30,690,703
HQ
AF
AMEM
EU
SE
WP
$9,763,356
$1,301,253
$3,010,382$4,753,872
$3,317,603
$3,765,528
$4,778,709
66 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
18
16
14
12
10
8
6
4
2
0
Mil
lio
ns
L&S BoD Reg
2015
2014
RC Dep
$17,879,247
$633,107$1,117,428
$3,349,970
$675,517
5
4
3
2
1
0
Mil
lio
ns
HQ AFRO AMRO EMRO EURO SEARO WPRO
2015
2014
$978,614
$769,033
$2,494,292
$3,163,370$2,902,247
$3,015,493
$4,556,199
Figure 10: Expenditure in 2014-2015 by area of work
The majority of funds in 2015 were spent for L&S,
although there was also signifi cant spending on risk
communications.
For L&S, just under US$ 1M was spent at headquarters
on normative work and support for the shipping of
virus samples. In the regional offi ces spending was in
the range of US$ 2-3M for AMRO, EMRO, EURO, SEARO
and WPRO. Expenditure in AFRO was lower in 2015 as
activities were funded in only two countries.
Figure 11: Expenditure in 2014-2015 by WHO region and HQ on L&S
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 67
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tect
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Ta
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17
: Ov
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f 2
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xp
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dit
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s (3
1 D
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mb
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20
15
, US
$)
PR
EPA
RED
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2013
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BU
DG
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ALL
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TED
IN
2014
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SPEN
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2014
SPEN
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2015
%IM
PLE
MEN
TATI
ON
1 Th
is is
th
e b
ud
get
ou
tlin
ed in
th
e Pa
rtn
ersh
ip C
on
trib
uti
on
Imp
lem
enta
tio
n P
lan
(201
3-20
16),
htt
p:/
/ww
w.w
ho.
int/
infl u
enza
/pip
/pip
_pci
mp
pla
n_u
pd
ate
_31j
an
2015
.pd
f?u
a=
1 o
n p
ag
e 34
2 Th
e P
lan
nin
g C
on
tin
gen
cy w
ill b
e as
sig
ned
to
Pre
par
edn
ess
or
Res
po
nse
co
mp
on
ents
, as
war
ran
ted
by
ach
ieve
men
t o
f del
iver
able
s an
d c
ircu
mst
ance
s. T
he
amo
un
t co
rres
po
nd
s to
fun
ds
no
t ye
t al
loca
ted
to
sp
ecifi
c P
rep
ared
nes
s ac
tivi
ties
3 W
HO
Pro
gra
m S
up
po
rt C
ost
(PSC
) is
calc
ula
ted
at
13
% o
f dir
ect
cost
s fo
r th
e P
rep
ared
nes
s an
d S
ecre
tari
at c
om
po
nen
ts, a
nd
7%
of d
irec
t co
sts
for
the
Res
po
nse
co
mp
on
ent.
World Health Organization20 Avenue Appia1211 Geneva 27
Switzerland
PIP Framework SecretariatPandemic and Epidemic Diseases
Outbreaks and Health Emergenciesemail pipframework@who.int
http://www.who.int/infl uenza/pip/en/
WH
O/O
HE
/PE
D/2
01
6.0
1