Pandemic influenza preparedness framework: annual progress report, 1 January - 31 December 2020

6-MONTH REPORT 12-MONTH REPORT 18-MONTH REPORT 24-MONTH REPORT 2020 2021 PANDEMIC INFLUENZA PREPAREDNESS FRAMEWORK ANNUAL PROGRESS REPORT 1 January – 31 December 2020 Pandemic Influenza Preparedness Framework: annual progress report, 1 January - 31 December 2020. ISBN 978-92-4-002420-5 (electronic version) ISBN 978-92-4-002421-2 (print version) © World Health Organization 2021. Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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Cover Page Image Credit: © WHO / Gregor Donaldson AFRO AMR BM BOD CC CPRP CVV DEP DG EMR EMRO EQAP EUR FDA FoRCCE GBT GHRP GISRS HAI HLIP ICFS IDP IPPP ISST IVPP IVTM LMIC L&S MOH WHO Regional Office for Africa WHO Region of the Americas Biological Material Burden of Disease Collaborating Centre Country Preparedness and Response Plan Candidate Vaccine Virus Planning for Deployment Director-General WHO Eastern Mediterranean Region WHO Regional Office for the Eastern Mediterranean External Quality Assessment Programme WHO European Region Food and Drug Authority Foundations of Risk Communications and Community Engagement Global Benchmarking Tool Global Humanitarian Response Plan Global Influenza Surveillance and Response System Human Animal Interface High-Level Implementation Plan Interim Financial Statement Institutional Development Plan Influenza Pandemic Preparedness Planning Infectious Substances Shipping Training Influenza Virus with Pandemic Potential Influenza Virus Traceability Mechanism Low and Middle Income Country Laboratory and Surveillance Capacity Building Ministry of Health Maturity Level Member State Non-Governmental Organization National Influenza Center National Immunization Technical Advisory Groups National Regulatory Authority National Deployment and Vaccination Plan Pan American Health Organization Partnership Contribution Polymerase Chain Reaction Public Health Emergency with International Concern Pandemic Influenza Preparedness Pandemic Influenza Severity Assessment Programme Support Costs Pandemic Special Studies Risk Communications and Community Engagement Regulatory Capacity Building Regional Office WHO South-East Asia Region Shipping Fund Project Standard Material Transfer Agreement 2 Strategic Preparedness and Response Plan United States Centers for Disease Control and Prevention United States Department of Health and Human Services Vaccine Composition Meeting Weekly Epidemiological Record World Health Assembly World Health Organization ML MS NGO NIC NITAG NRA NDVP PAHO PC PCR PHEIC PIP PISA PSC PSS RCCE REG RO SEAR SFP SMTA2 SPRP US CDC US DHHS VCM WER WHA WHO ACRONYMS & ABBREVIATIONS The Pandemic Influenza Preparedness (PIP) Framework is an innovative public health instrument that brings together Member States, industry, other stakeholders and WHO to implement a global approach to pandemic influenza preparedness and response. The key goals include: to improve and strengthen the sharing of influenza viruses with human pandemic potential through the WHO Global Influenza Surveillance and Response System (GISRS), and to increase the access of developing countries to vaccines and other pandemic response supplies. The Framework includes a benefit-sharing mechanism called the Partnership Contribution (PC). The PC is collected as an annual cash contribution from influenza vaccine, diagnostic, and pharmaceutical manufacturers that use GISRS. Funds are allocated for: (a) pandemic preparedness capacity building; (b) response activities during the time of an influenza pandemic; and (c) PIP Secretariat for the management and implementation of the Framework. For pandemic preparedness capacity building, activities are implemented according to six outputs under one outcome in the High Level Implementation Plan (HLIP) II 2018-2023. The technical and financial investments of countries and other partners, including GISRS, play a critical role in advancing pandemic preparedness alongside PC investments. Collectively, resources are used to strengthen pandemic preparedness systems, knowledge and capacities. We thank countries and partners for their important role and contribution. The progress made and successes achieved are a result of joint collaboration on common objectives. The PIP PC funding model is described in HLIP II, Section 6. This reporting format addresses the recommendation from the 2016 PIP Review that WHO develop progress reports that present overall success metrics and infographics to illustrate progress in PIP Framework implementation. A progress report is published four times a biennium, and covers technical and financial implementation for HLIP II, as well as the PIP Secretariat. Milestones are reported every six months and indicators are reported yearly. All data are presented cumulatively from the beginning of each biennium, in this case, 1 January 2020. For financial implementation, progress is reported against biennial workplan allocations. Figures presented exclude WHO Programme Support Costs (PSC) unless otherwise stated. For the mid-year reports, income, expenditures and encumbrances are presented, and are based on WHO’s financial tracking system (GSM). For annual and biennial reports, income and expenditures are presented, in line with the yearly WHO Interim Certified Financial Statement. Response to COVID-19 overshadowed implementation of all activities covered in this report. A central, recurring theme throughout the year, has been the invaluable global asset that GISRS represents for the global response. The targeted capacity-strengthening activities supported by PIP have also been recognized, and despite slow-downs, some notable results and impact have been achieved, as reflected in this report. Care was exercised at all times to ensure that PIP PC funds were used to implement influenza specific capacity-strengthening activities, and periodic risk assessments were done to manage and, to the extent possible, minimize the impact of COVID-19 on PIP PC implementation. Many staff across WHO Clusters and Departments in all Major Offices support the implementation of the PIP Framework. Without their work, dedication and collaboration, there would be no progress to report on. We extend our sincere thanks to these staff for their invaluable work. The report is structured as a series of infographics as follows: PIP Framework implementation overview pages 5 - 7 Technical and financial implementation progress pages 8 - 18 Stories from the field pages 19 - 26 Financial report including ICFS - Annex A (reported annually and biennially) pages 27 - 33 For previous reports, see https://www.who.int/influenza/pip/partnership_contribution/en/ INTRODUCTION IMPLEMENTATION OVERVIEW 6 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 PIP PC collection (As of 31 December 2020) PERCENTAGE OF TOTAL PC RECEIVED FROM CONTRIBUTORS $223.7M CONTRIBUTED BY INDUSTRY b M IL LI O N U S$ 2012 a 30 25 20 15 10 5 0 TARGET 28M /YEAR 2013 2014 2015 2016 2017 2018 2019 2020 99% 97% 98% 97% 97% 97% 97% 52% a In 2012, contributions were made voluntarily. b Figure includes PSC. PC collection for previous unpaid contributions and 2020 invoices is in process. Invoices for 2020 were issued on 25 June 2020. The figure does not include interest earned on Response Funds. PIP PC financial implementation (As of 31 December 2020) PREPAREDNESS PIP SECRETARIAT RESPONSE 2020-2021 BIENNIAL BUDGET: $31.4M FUNDED: $16.7M BIENNIAL BUDGET: $5.8M FUNDED: $3.3M IMPLEMENTED: $1.6M TOTAL IN RESERVE (WITH PSC & INTEREST ACCRUED FOR 2018-20)): $63.9M IMPLEMENTED: $6.6M Biennial budget Funded Implemented LEGEND 20,000 15,000 10,000 5,000 - L&S REG BOD RCCE IPPP DEP 3,000 2,000 1,000 - 3,000 2,000 1,000 - 3,000 2,000 1,000 - 3,000 2,000 1,000 - 3,000 2,000 1,000 - PIP Framework outcome indicators OUTCOME Improved global pandemic influenza preparedness and response through the implementation of the PIP Framework Indicator 2019 Baseline 2020 Status 2021 Target % of Member States with zoonotic influenza cases sharing IVPPs with GISRS (N=4) 71%a 75% N/A % of PC recipient Member States reporting to FluNet (sustainability indicator, N=41) 97% 88% ≥85% % of PC recipient Member States reporting to FluID (N=41) 81% 73% 70% % of Member States with BOD estimates considered by NITAG or other decision-making bodies (N=11) 11% 0% 40% No. of PC recipient Member States that have implemented regulatory approach (N=48) 22 27 23 % of PC recipient Member States that developed or updated a pandemic influenza preparedness plan (N=63) 52% 56% 75% % of influenza vaccine & antiviral manufacturers that concluded an SMTA2 (N=32) 41% 44% 50% % of Partnership Contributions received in the year of invoice (N=$28M) 58% 52% 100% a 2019 indicator's result was reported to be 57% in the 2018-2019 PIP Biennial Progress Report. This result has since been corrected upon reviewing the data retrospectively. 7ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 PIP Framework governance SMTA2: SECURING PRODUCTS FOR PANDEMIC RESPONSE PIP Biological Materialsa shared The COVID-19 pandemic has continued to impact all aspects of WHO's work, including implementation of the PIP Framework. As a result of travel restrictions and public health advice, the PIP Framework Advisory Group held its first virtual meeting from 12-16 October 2020, preceded by three technical briefings on: (1) strengthening engagement with the diagnostics sector and outcomes of the World Health Assembly, (2) COVID-19 and influenza virus sharing and (3) the ACT-Accelerator. At the resumed session of the Seventy-Third World Health Assembly, the Director-General informed Member States of WHO's new, harmonized approach to reporting on PIP Framework Implementation, as recommended by the 2016 PIP Framework Review Group. Finally, the PIP Framework Secretariat is contributing to various WHO initiatives undertaken to improve response to the pandemic and better prepare the world for future health emergencies. PIP BMs RECORDED IN IVTM FROM 1 JANUARY TO 31 DECEMBER 2020: TOTAL SINCE 1 DECEMBER 2012: SMTA2 WITH VACCINE MANUFACTURERS SINCE 2013 SMTA2 WITH ANTIVIRAL AND DIAGNOSTIC MANUFACTURERS & ACADEMIC AND RESEARCH INSTITUTIONS 1273 25M 73 >75M >5M and <75M <5M pandemic production pandemic production pandemic production 29 250,00010M 67 DIAGNOSTIC KITS SYRINGES BENEFIT-SHARING OFFERS FROM ACADEMIC & RESEARCH INSTITUTIONS SMTA2 WITH ACADEMIC & RESEARCH INSTITUTIONS TREATMENT COURSES OF ANTIVIRALS Large / multi-national manufacturers Medium-sized manufacturers Small manufacturers VIRUS SUBTYPES RECORDED: A(H5N1), A(H9N2), A(H3N2)v, A(H1N1)v, A(H1N2)v, A(H5N6), A(H7N9) PIP BMs RECORDED a For definition of ‘PIP Biological Materials’, see PIP Framework Section 4.1 >400M DOSES SECURED FOR PANDEMIC RESPONSE NEW: 1 additional SMTA2 signed in 2020 NEW: 3 additional SMTA2 signed in 2020 6 7 16 10 16of of ofconcluded concluded concluded 8 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 IMPLEMENTATION PROGRESS 9ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 IMPLEMENTATION PROGRESS OUTPUT READING GUIDE NOTE TO READERS Please read this Output Reading Guide which provides clarity on the data reported in this section. Output name & statement Funds implemented cumulatively at deliverable level (excluding PSC) Indicators: progress updated annually. Results are presented against biennial targets (Baselines are as of 31 December 2019)Proportion of funds implemented from the biennial budget (gray denotes proportion of funds not implemented) Deliverable name Biennial budget & funds implemented cumulatively at Output level (excluding PSC) Highlights from January to December 2020 (as of 31 December 2020) Milestones: cumulative progress updated every six months since beginning of 2020 Laboratory & surveillance BIENNIAL BUDGET: OUTPUT: National influenza L&S systems contribute to GISRS for timely risk assessment & response measures IMPLEMENTED:$XM $XM DELIVERABLE A IMPLEMENTED $XM HIGHLIGHTS Risk and severity of influenza, including at the human- animal interface, are routinely assessed • Risk and severity assessments are critical to inform national and global preparedness, response and recovery measures during an epidemic or a pandemic. X WHO risk assessments of human infections with non- seasonal or animal influenza viruses were published. • X countries including X PC recipient countries from X regions reported their yearly influenza epidemic severity assessments to WHO. X% of these countries were trained by WHO in 2018-19. The number of countries reporting severity assessments decreased compared to 2019. This is likely due to the disruption to influenza surveillance caused by the COVID-19 pandemic and the sharp decline in influenza activity in 2020. • X% of countries globally conducted outbreak detection and response trainings in 2020. These trainings are critical for influenza readiness and have been integral in the national and sub-national response to COVID-19. X% X% MILESTONES PISA trainings completed Outbreak detection & response trainings Meetings, workshops, joint investigation & risk assessments X X X countries from regions X X countries from regions X X countries from regions X X INDICATORS X BASELINE X BASELINE X TARGET X TARGET X X Number of risk assessments published Number of MS reporting PISA to WHO ≥ twice in a season 10 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Laboratory & surveillance BIENNIAL BUDGET: OUTPUT: National influenza L&S systems contribute to GISRS for timely risk assessment & response measures IMPLEMENTED:$20M $4.9M DELIVERABLE A DELIVERABLE B DELIVERABLE C MILESTONES MILESTONES MILESTONES IMPLEMENTED $1.7M IMPLEMENTED $1.7M IMPLEMENTED $689K HIGHLIGHTS HIGHLIGHTS HIGHLIGHTS Risk and severity of influenza, including at the human- animal interface, are routinely assessed Quality influenza virus detection capacity is sustained Countries are supported to consistently report influenza data to global platforms • Risk and severity assessments are critical to inform national and global preparedness, 6 WHO risk assessments of human infections with non-seasonal or animal influenza viruses were published.1 • The overall public health risk from reported influenza viruses' events at the HAI is considered low, with no reported sustained human-to-human transmission of these viruses. • 14 countries including 2 PC recipient countries from 2 regions reported their yearly influenza epidemic severity assessments to WHO. 79% (11/14) of these countries were trained by WHO in 2018-19. The number of countries reporting severity assessments decreased compared to 2019. This is likely due to the disruption to influenza surveillance caused by the COVID-19 pandemic and the sharp decline in influenza activity in 2020. • 28% of countries globally conducted outbreak detection and response trainings in 2020. These trainings are critical for influenza readiness and have been integral in the national and sub-national response to COVID-19. • The NIC in Suriname (a PC recipient country) was newly recognized by WHO bringing the total number of NICs globally to 147 in 123 countries. NICs are playing a critical role in the COVID-19 pandemic with most serving as national reference laboratories. • In 2020, 47 countries from 6 regions benefited from laboratory trainings activities. These activities along with the yearly participation in an EQAP help improve and sustain quality national influenza virus detection capacity. • Of the 110 countries that participated in influenza EQAP, 91 (83%) correctly identified all non-seasonal viruses and 105 (95%) correctly identified all seasonal viruses. Variation of results every year is partially due to new laboratories joining the EQAP. WHO ROs continue to follow up with low performing laboratories through implementation of laboratory quality management systems to ensure consistent quality results of influenza detection. 26 fewer countries participated in EQAP in 2020 compared to 2019 likely due to COVID-19 disruptions. • All 147 NICs participated in the COVID-19 EQAP highlighting the commitment to assuring laboratory services during a public health emergency. • Consistent and timely data reporting facilitates influenza activity monitoring and risk assessment. Globally, 150 (77%) countries reported virological data to FluNet and 131 (68%) epidemiological data to FluID (data not shown). Most of these (respectively 83% and 81%) reported consistently during the influenza season. • In 2020, 2 countries started reporting for the first time to FluNet. WHO encourages country participation to improve geographic representativeness of global influenza surveillance. • Of the 41 PC L&S recipient countries, the proportion reporting to FluNet (88%) and FluID (73%) exceeded the annual indicator targets despite the COVID-19 pandemic. • In addition, WHO integrated the reporting of COVID-19 community transmission surveillance data into influenza platforms to increase efficiency and facilitate monitoring of respiratory disease activity holistically. PISA trainings completed Regional meetings held to improve global surveillance systems Laboratory trainings, missions and visits completed Outbreak detection & response trainings Meetings, workshops, joint investigation & risk assessments 9 5 81 312 22 countries from countries from regions regions 8 47 4 6 countries from regions 54 6 countries from countries from regions regions 11 45 6 3 Trainings, missions & other types of support for surveillance provided 117 countries from regions 72 6 Regional bulletins published131 regions involved4 2020 EQAP status Contract signed EQAP sent out Results received Results shared with participating laboratories Results published in WER 74% 26% 72% 28% 80% 20% INDICATORS INDICATORS INDICATORS 24 BASELINE ANNUAL TARGET = 90% ANNUAL TARGET = 95% 27 BASELINE 50 TARGET 51 TARGET 30 83% 14 95% Number of WHO HAI risk assessments published Proportion of participating MS that were 100% correct for non-seasonal virus identification (N=110) Number of MS reporting PISA to WHO ≥ twice in a season Proportion of participating MS that were 100% correct for seasonal virus identification (N=110) TARGET ≥ 85% TARGET = 70% 88% 73% Proportion of PC recipient MS reporting to FluNet (N=41) Proportion of PC recipient MS reporting to FluID (N=41) 11ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Laboratory & surveillance DELIVERABLE D DELIVERABLE E MILESTONES MILESTONES IMPLEMENTED $680K IMPLEMENTED $76K HIGHLIGHTS HIGHLIGHTS Countries are supported to share timely representative influenza samples with WHO CCs Influenza CVVs, virus detection protocols and reagents, and reference materials are routinely updated • 1105 zoonotic influenza viruses and other influenza viruses with pandemic potential were characterized by GISRS in 2020. The viruses were of 10 influenza A subtypes and originated from 13 countries. Through the two 2020 VCM consultations, characterization led to the development of 3 new CVVs (H1N1v, H9N2, H5N1) for pandemic influenza preparedness. • In early 2020, WHO updated 4 molecular detection protocols2 and published a guidance for NICs and other influenza laboratories performing virological surveillance focusing on the use of next-generation sequencing for genetic characterization of influenza viruses for virological surveillance, research or outbreak investigations. • WHO also published guidance to support countries in using GISRS for COVID-19 surveillance and response, including how to conduct COVID-19 sentinel surveillance using GISRS, how to interpret influenza surveillance data in the context of the pandemic and how to prepare for upcoming influenza seasons. An e-consultation was conducted in October 2020 to review lessons learnt and assess further opportunities to use GISRS to support countries in their COVID-19 pandemic response and beyond. • 75% (3/4) of the countries that reported zoonotic influenza cases to WHO timely shared IVPPs with GISRS, according to WHO guidance. WHO continuously encourages countries to share IVPPs with GISRS. • 124 (64%) countries shared influenza viruses/ clinical specimens at least once with WHO CCs. The proportion of countries sharing two timely shipments with WHO CCs (in line with WHO guidance) decreased in 2020 (31%) compared to the 2019 baseline (44%). • Using the SFP, 88 countries from all 6 WHO regions made 154 shipments to WHO CCs in 2020. This is compared to 252 shipments made in 2019. • The disruptions caused by COVID-19 pandemic and the sharp drop in influenza activity in 2020 resulted in reduced influenza sample sharing. WHO undertook a series of measures including mission briefings, meetings with GISRS institutions, circulars to MS, and advocacy through all relevant WHO offices to mitigate the risk of the COVID-19 pandemic on influenza preparedness. • As a platform, the SFP was rapidly adapted to support the COVID-19 response so that countries could share their specimens with COVID-19 reference laboratories for further characterization and to validate their results. • A new version of the IVTM (IVTM 2.0) was launched in June 2020. Positive feedback was received from users about the performance of the new version. Training on infectious substance shipping completed Shipments made using the SFP Protocols and guidance reviewed, including translations VCM consultations completed new CVVs proposed 1 5 2 3 154 country from countries from region regions 1 88 1 6 80% 20% 78% 22% INDICATORS INDICATOR 71% BASELINE 44% BASELINE N/A TARGET 46% TARGET 75% 31% Proportion of MS with zoonotic influenza cases sharing IVPPs with GISRS (N=4) Proportion of MS with two timely shipments of virus isolates/clinical specimens with CCs (N=194) N/A BASELINE N/A TARGET 1105 Number of zoonotic viruses & other viruses of pandemic potential characterized by GISRS 12 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Burden of Disease BIENNIAL BUDGET: OUTPUT: DELIVERABLE A DELIVERABLE B MILESTONE MILESTONE IMPLEMENTED $61K IMPLEMENTED $215K HIGHLIGHTS HIGHLIGHTS Number of countries in each burden of disease estimate development stage (N=194) Representative national, regional and global disease burden estimates are available Disease burden findings are communicated to national and international expert bodies in a format that promotes evidence- based decision making Influenza disease burden estimates are used for public health decisions IMPLEMENTED:$2M $276K • In 2020, 4 additional countries published their BOD estimates and 4 updated their previous findings bringing the total to 43 countries with BOD estimates globally. Of the 43 countries, 67% (29) are LMICs. The progress made has already exceeded the 2021 biennial indicator target. In addition, 57 countries have either already calculated or established a plan to calculate their national BOD estimates. • To date, 69 countries including 23 LMICs have shared their data for use in regional or global BOD estimates. Regional and global estimates support national and international decision- making bodies in developing and updating prevention and control measures such as vaccination and clinical management strategies. • WHO is developing an influenza disease burden pyramid tool to help countries with limited data to comprehensively estimate their burden of disease. The tool was used to inform the COVID-19 disease burden pyramid tool and will be adjusted based on experience gained. • Chile completed a case study to understand how influenza burden of disease estimates have been utilized by policy makers to strengthen seasonal influenza programs. The study highlighted the importance of timely sharing of epidemiological data and the dissemination of analyses to relevant stakeholders.3 • In 2020, no specific progress was made on this Deliverable mainly due to (1) shifted attention of policy-makers to respond to the COVID-19 pandemic and change of priorities, and (2) challenges to retrieve data on the utilization of BOD findings by policy-makers. WHO together with the BOD working group is trying to find a standardized way to remedy the lack of data. • In a complementary activity, WHO is conducting analyses on the relationship between seasonal influenza vaccination of health workers and pandemic preparedness. This work is being funded by Gavi. The findings will support Gavi and Member States in evidence-based decision making on the value of influenza vaccine introduction for health workers. Implementation plan established in countries 35 BOD calculated in countries 22 BOD findings published in countries 43 93% 7% 81% 19% INDICATOR INDICATOR 39 BASELINE 11% BASELINE 36 TARGET 40% TARGET 43 0% Number of MS with published disease burden estimates based on data collected since 2011 (N=194) Proportion of MS with burden of disease estimates that have been considered by NITAG or other decision-making bodies (N=11) 1 country Shared/communicated BOD estimates to decision-making bodies 13ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Regulatory capacity building BIENNIAL BUDGET: OUTPUT: DELIVERABLE A DELIVERABLE B MILESTONES MILESTONES IMPLEMENTED $314K IMPLEMENTED $295K HIGHLIGHTS HIGHLIGHTS Refinements made to WHO GBT Country WHO-benchmarked Countries self-benchmarked IDP follow-up visits National regulatory capacity for pandemic influenza products is strengthened Adoption of regulatory pathways that accelerate approval for use of pandemic influenza products is promoted Timely access to quality-assured influenza pandemic products is supported IMPLEMENTED:$2.9M $609K • In 2020, Ghana became the second country in Africa to attain WHO Maturity Level 3 (ML3) for their regulatory system, which is a major achievement supported by PIP. ML3 indicates the presence of a stable, well-functioning, and integrated system of oversight for medical products.4 • Based on WHO benchmarking assessments, one other PC recipient country increased its regulatory capacities which will facilitate product oversight at the time of the next influenza pandemic. • The progress achieved through WHO support enabled 21 countries in five regions, together with over 150 regulators, to implement various components of their IDPs. This included marketing authorization, quality management systems, storage and distribution practices, pharmacovigilance, and legal frameworks - all aimed at strengthening country regulatory readiness for public health emergencies. • Due to the COVID-19 pandemic, most activities were implemented virtually including WHO's technical support for self-benchmarking regulatory capacities and implementing IDPs in countries. This agility in implementation ensured a continuation of capacity strengthening efforts for PIP priority countries. • Updates to the GBT manual were made and the tool was translated into three UN languages to facilitate country uptake. • In 2020, WHO continued to support countries to implement their defined regulatory pathways based on WHO guidelines. Exceeding the biennial target of 23 countries, 27 countries developed country roadmaps and follow-up plans for the implementation of pathways required for timely approval of products. As part of these activities, WHO promoted adequate and effective coordination and communication mechanisms among stakeholders to address health emergencies. Work was implemented regionally to promote coherence and consistency. For example, 7 SEAR countries - 5 of which are PC recipient countries - attended a workshop on implementing WHO guidelines on regulatory preparedness for the provision of marketing authorization of pandemic influenza vaccines in non-vaccine producing countries. • Using the framework of support established for PIP, webinars were organized with regulators in collaboration with regional offices to share the latest updates on regulatory preparedness and country readiness for the expedited approval of COVID-19 vaccines. This is expected to improve the timeliness and quality of vaccine roll-out. • Building on PIP, a section on regulatory preparedness for the expedited approval of COVID-19 vaccines was developed under the NDVP guidance published in November 2020. WHO regulatory preparedness guidelines translated to all languages5 Workshop/training conducted to implement the PIP regulatory guidelines linking national IPPP & NDVP for pandemic influenza vaccines 1 2 countries region 7 1 0 4 3 countriesregions32 IDP implementation & technical support activities 9 countries regions 21 5 78% 22% 79% 21% INDICATOR INDICATOR 6 BASELINE 22 BASELINE 8 TARGET 23 TARGET 7 27 Number of PC recipient MS which strengthened national regulatory capacity to oversee pandemic influenza products (N=16) Number of PC recipient MS that have implemented a defined regulatory approach that enables timely approval for use of pandemic influenza products (N=48) 14 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Risk Communications & Community Engagement BIENNIAL BUDGET: OUTPUT: Tools and guidance are available for countries to enhance influenza risk communication and community engagement IMPLEMENTED:$2.3M $165K DELIVERABLE A Countries and frontline responders have access to resources for influenza risk communication, community engagement and social science-based interventions Technical assistance is provided to countries to plan and exercise influenza risk communication and community engagement IMPLEMENTED $68K IMPLEMENTED $97K DELIVERABLE B MILESTONE MILESTONES INDICATOR INDICATOR HIGHLIGHTS HIGHLIGHTS • Over 1,700 participants from all six WHO regions participated in global webinars to strengthen national RCCE capacities relevant to COVID-19 and pandemic influenza. On average more than 90 countries participated with representatives ranging from RCCE practitioners, national government agency directors, and public health and emergency responders. • The FoRCCE network was developed with PIP PC support in 2019, and proved to be instrumental during the COVID-19 response. This network enabled RCCE leads from all six WHO regions and headquarters to quickly track and share social listening data, sentiment analysis, tailored risk communication materials, rumor monitoring strategies, behavioral insights survey tools, and country and community focused capacity building products. This ensured consistency in the response while avoiding duplication - a critical time-saver during pandemic response. Additionally, the network responded effectively to the challenges of pandemic fatigue, social cohesion, and the translation of evolving science. These experiences have presented an invaluable learning opportunity for community level capacity building for pandemic influenza preparedness led by the FoRCCE network. • Despite shifting attention from influenza-specific activities, RCCE capacities and response plans were bolstered for the COVID-19 pandemic. This is evident through response actions, where 188 (97%) countries developed COVID-19 RCCE plans in 2020. The experience and lessons learnt will help countries and stakeholders prepare for future public health emergencies including pandemic influenza. • OpenWHO continues to grow as a forum for knowledge exchange. In 2020, over 152,000 users completed influenza-related RCCE trainings, with over 192,000 users since the inception of OpenWHO. This was over seven times the biennial target. • As an RCCE tool initially developed through PIP, OpenWHO has become a valuable platform used by WHO for various public health initiatives. The momentum and gains achieved have enabled the more efficient and reliable transfer of information and knowledge for preparedness and response. • Previous PIP investments in RCCE highlighted the importance of community engagement. In 2020, WHO established infodemic management to ensure that countries and front-line responders have timely access to quality resources by developing materials, hosting mass online events to share information, and use the insights gained from feedback mechanisms to continuously address needs. Lessons learnt will support RCCE implementation for future pandemic influenza preparedness. Trainings, missions and other types of technical support provided involving Influenza guidance/courses available on OpenWHO OpenWHO advocacy & marketing event RCCE factor mapped in priority country Global partnership & network for effective RCCE capacity 10 22 0 0 0 1 regions6 partners plans of action available 2 5 95% 5% 90% 10% 39 734 BASELINE 51 BASELINE 25 000 TARGET 130 TARGET 192 111 Number of users who completed Open- WHO influenza modules Number of MS that utilized RCCE support for influenza preparedness or response 51 15ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Planning for Deployment BIENNIAL BUDGET: OUTPUT: Plans for effective & efficient deployment of pandemic supplies are optimized IMPLEMENTED:$1.3M $143K DELIVERABLE A DELIVERABLE B DELIVERABLE C IMPLEMENTED $36K IMPLEMENTED $19K IMPLEMENTED $88K A common approach to manage global deployment operations is developed and regularly tested with stakeholders and deployment partners National deployment planning process is revised and updated Technical assistance to develop policies for sustainable influenza vaccine procurement and production is provided to countries 87% 13% 60% 40% 96% 4% HIGHLIGHTS HIGHLIGHTS HIGHLIGHTS • An article was published in the peer-reviewed journal Vaccine highlighting the development and evaluation of the PIP Deploy gamified tabletop simulation exercise. This publication5 detailed the features and applications of the PIP Deploy exercise and the national level managers' experiences in these exercises. It found the exercise to have utility for identifying gaps in national vaccine deployment plans and regulatory frameworks for the importation of vaccine products. • A policy brief6 was published highlighting the ethical considerations governments should factor in for the allocation of scarce resources including pandemic influenza and COVID-19 vaccines, medical equipment, and personal protective equipment. The brief provided a high-level framework to guide decision-making focusing on the importance for governments to set priorities for equal and equitable allocation. • Accomplishments under the PIP Framework were leveraged to facilitate country planning for COVID-19 vaccine roll-out. Pandemic influenza guidance and tools were used to rapidly develop the Guidance on Developing a National Deployment and Vaccination Plan for COVID-19 Vaccines and the NDVP review form, as well as the Vaccine Request Form and Vaccine Information Form used in the context of the COVAX Facility. Without the PIP Framework progress on planning for pandemic product deployment, COVID-19 documents and tools would have taken much longer to develop and publish. • Countries are identifying opportunities and challenges to sustaining local production of influenza vaccines as a component of pandemic preparedness. Serbia being one of these countries that have started this process, held a multi-stakeholder workshop to assess the feasibility and sustainability of their own domestic capacities. They have since submitted a report to the MOH. This highlights the role of local manufacturing in pandemic preparedness, and the importance of securing public financing for influenza vaccination. • In September 2020, an influenza vaccination toolbox was launched. This included tools and guidance related to influenza vaccine programme development and strengthening for MOH Officials, WHO staff, vaccinators, health workers, researchers, and other key stakeholders. • An article was published in the peer-reviewed journal Vaccine7 comparing the global capacity for seasonal influenza vaccine production in 2019 with estimates from previous surveys. It found that while there has been little change to production capacity, greater effort is needed to ensure sustainable production, and that additional research is needed into vaccines that can be produced quicker and are more broadly protective. MILESTONES MILESTONES MILESTONES INDICATOR INDICATOR Training, mission, visit & other type of technical support provided 1 country country country region region region 1 1 0 1 1 0 Training, mission, visit & other type of technical support provided to update NDVP Global guidance tool revised PIP Deploy tool refinement to facilitate planning, allocation and coordination Advocacy meeting for a common approach completed 1 1 0 0 Country engagement & concurrence Kick-off meeting completed Draft report completed Stakeholders workshop held (1 country) Final sustainability assessment report available (2 countries) 6 BASELINE 5 TARGET Number of simulation exercises conducted to test global deployment of pandemic influenza vaccines and other products 6 8 BASELINE 10 TARGET Number of MS that have undergone a national analysis of influenza vaccine procurement or production sustainability 8 16 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 DELIVERABLE A Countries are supported to develop, test and update their pandemic influenza preparedness plan Influenza Pandemic Preparedness Planning BIENNIAL BUDGET: OUTPUT: National pandemic influenza preparedness & response plans are updated in the context of all-hazards preparedness and global health security IMPLEMENTED:$2.9M $507K MILESTONE HIGHLIGHTS • WHO recommends that all countries revise their national pandemic plans to prepare for future influenza pandemics. Of the 63 IPPP PC recipient countries in the 2020-21 biennium, 35 (56%) now have a plan based on WHO's Pandemic Influenza Risk Management guidance. This is an increase of 2 PC recipient countries with an up-to-date plan since 2019. • In addition, 16 PC recipient countries are in the process of developing/updating their plans. Progress made in 2020 means that more countries are getting operationally ready for pandemic influenza. • Of note, all 40 2018-19 PC recipient countries developed a COVID-19 response plan in 2020, where most developed their plans based on their IPPP8 and within 4 months after the declaration of the PHEIC (n=36, 90%). PIP investments facilitated countries to develop their COVID-19 response plans. • Two countries exercised their pandemic influenza plans in 2020 focusing on laboratory readiness and outbreak response coordination. Additionally, 15 2018-19 PC recipient countries conducted COVID-19 Intra-Action Reviews and Simulation exercises. These exercises will support the iterative improvements and updates of emergency preparedness and response. • In 2018-19, PIP supported the development of the Pandemic Special Studies to outline the key questions, protocols and tools needed at the time of a pandemic to rapidly characterize the seroepidemiological characteristics of a new virus. For COVID-19, the PSS were rapidly adapted and became the “Unity Studies”. By December 2020, 71 (37%) countries, including 48 LMICs, had started implementing at least one Unity Study protocol. Of these 48 LMICs, 17 (38%) were 2018-19 IPPP PC recipient countries. This showcases the adaptability of protocols and tools developed through PIP to assist all countries - including those with limited resources - to contribute and advance global knowledge about an emerging disease. IMPLEMENTED $507K Planning meeting held/workshop completed IPPP written or revised IPPP endorsed 16 21 3 IPPP exercises completed in 2 countries region 2 1 83% 17% Number of PC recipient MS developing/ revising their IPPP since 2017 INDICATORS 52% BASELINE 14% BASELINE 75% TARGET 50% TARGET 56% 3% Proportion of PC recipient MS that developed or updated a pandemic influenza preparedness plan since 2014 (N=63) Proportion of PC recipient MS that exercised their pandemic influenza preparedness plan in 2020 (N=63) 17ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 PIP Framework Secretariat BIENNIAL BUDGET: OUTPUT: The PIP Secretariat leads, manages and supports implementation of the PIP Framework IMPLEMENTED:$5.8M $1.6M DELIVERABLE A DELIVERABLE B DELIVERABLE C IMPLEMENTED $571K IMPLEMENTED $422K IMPLEMENTED $567K Promote the effective implementation of the PIP Framework in a changing environment Collect, implement, monitor, and report on the Partnership Contribution Negotiate and plan to operationalize the Standard Material Transfer Agreements 2 (SMTA2) MILESTONES MILESTONES MILESTONES HIGHLIGHTS HIGHLIGHTS HIGHLIGHTS Meetings held and reports submitted to WHO DG or governing bodies to support implementation of section 7 of the PIP Framework Advocacy materials/events completed to promote the PIP Framework to stakeholders Number and status of documents/reports developed for the World Health Assembly Status in annual project management cycle Number of SMTA2s in negotiation 11 19 • The PIP Advisory Group held its first virtual meeting from 12-16 October 2020.9 Three technical briefings were held in advance of the meeting on: (1) strengthening engagement with the diagnostics sector and outcomes of the World Health Assembly, (2) COVID-19 and influenza virus sharing and (3) the ACT-Accelerator. • The three reports requested under Decision WHA72(12)10 were concluded and uploaded to the PIP Framework webpage, along with comments received from stakeholders. In addition, the Director-General provided two reports to WHA73 on: (1) influenza preparedness and (2) harmonizing the approach to reporting on PIP Framework implementation. • The COVID-19 pandemic continues to challenge the PIP Framework's advocacy efforts. However, the Secretariat was still able to engage with GISRS, industry, civil society, databases and initiatives, and academia. • PC invoices were issued to 39 manufacturers in June 2020 and US$14.5 million (52%) were received by 31 December 2020. • 4 monitoring visits (including 3 virtually) were conducted, with discussions focusing on sustaining HLIP II implementation and using capacities strengthened collaterally for COVID-19. • The risk of COVID-19 hindering HLIP II implementation was monitored throughout 2020, and mitigation measures including advocacy to countries and WHO implementing teams were applied. For 11 indicators considered at risk of not progressing due to the pandemic, 4 nevertheless made gains. The HLIP II mid-term review in 2021 is expected to highlight the shifts in programmatic implementation needed to strengthen pandemic influenza preparedness in light of the COVID-19 context. • The PIP Secretariat is raising awareness among stakeholders about the contribution of PIP investments to the COVID-19 response. The Secretariat is also monitoring the approaches and tools used in the COVID-19 response to identify opportunities for application during a future influenza pandemic. • In 2020, 4 SMTA2s were concluded: 1 with a manufacturer of influenza vaccines and 3 with academic and research institutions. • To implement the WHA's 2019 amendment to the PIP Framework (Decision WHA72(12) OP2), a process has been developed and is being implemented to amend 84 SMTA2s signed prior to the Decision to add the new reporting obligations for indirect use of PIP BM. • Initiated in November 2020, a series of meetings were held to discuss pandemic vaccine deployment activities with a view towards operationalizing the SMTA2 supply commitments. Early scoping/ Under discussion In process (draft reports) Final & published 0 0 With manufacturers of vaccines and/or antivirals With manufacturers of other pandemic related products With academic & research institutions 5 78% 22% 74% 26% 61% 39% Reporting Implementation PC implementation updates published in newsletter Site monitoring visits 25 4 Planning Monitoring Invoices sent by 30 June Work plan compliance checks: PC funds distributed by 31 December Jan - June July - Dec INDICATOR INDICATOR 3 0 1 0 BASELINE 41% BASELINE 100% ($28 M) TARGET 50% TARGET 52% 44% Proportion of Partnership Contributions received in year of invoice Proportion of influenza vaccine and antiviral manufacturers that concluded an SMTA2 (N=32) Photo credit: WHO / Blink Media - Nana Kofi Acquah 19ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 STORIES FROM THE FIELD 20 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Ghana’s regulatory system achieves a critical milestone With support from the PIP PC, Ghana has developed a well-functioning regulatory system for medical products that has proved critical in enabling the country’s response to COVID-19. A regional milestone In April 2020, after being assessed by WHO using the GBT, the FDA of Ghana was found to meet all indicators that define a maturity level 3 agency. In doing so, it became the second confirmed country in Africa to achieve a stable, well-functioning and integrated regulatory system for medical products. The achievements of FDA Ghana and FDA Tanzania (the other ML3 agency in Africa) mark a milestone for the region and open the door for stakeholders across Africa to work collectively for timely access to quality assured medical products. Their success was enabled by years of system strengthening investment, action and support, including support from PIP PC to build staff capacity and develop regulatory tools in areas such as pharmacovigilance, market control, marketing authorization and clinical trials oversight. Securing supplies In the face of COVID-19, FDA Ghana’s investment in regulatory system strengthening has been very beneficial. The agency has been a key enabler of the Ministry of Health’s pandemic response. For example, by providing timely support to local industry, FDA Ghana ensured the availability of affordable and quality-assured personal protective equipment during the pandemic, including the hand sanitizers and face masks that were at the heart of safety protocols for controlling COVID-19 infections. FDA Ghana’s capacity to quickly develop specifications and guidance, and to establish a fast-track for marketing authorization, enabled the country to secure vital supplies at a time of acute scarcity across the region. At the same time, FDA Ghana made use of strategies such as working from home, electronic submissions, online reviews and virtual meetings and inspections to continue performing its routine regulatory activities. Deploying vaccines FDA Ghana’s capacity as a ML3 agency is also proving its worth as the country prepares to deploy COVID-19 vaccines. Ghana is the first country outside India to receive vaccines through the COVAX facility; and FDA Ghana is using its full capabilities to ensure these can be rapidly and effectively approved, received, distributed and administered. The agency has, for example, already activated its Emergency Use Authorization Procedure to review submissions for the various candidate vaccines. Ghana has long seen the value of strengthening its regulatory system. Building on the its success during the COVID-19 pandemic, it remains committed to continuous improvement in preparation for the next influenza pandemic. FDA Ghana has secured vital supplies of hand-sanitizers and other personal protective equipment during the COVID-19 pandemic. Image credit: WHO/Blink Media - Nana Kofi Acquah 21ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Enabling evidence-based influenza policy in Chile The timely sharing of epidemiological data and burden of disease analyses to stakeholders in Chile has been key to developing the country’s seasonal influenza control policies and programmes. Stakeholder survey In 2019, supported by the PAHO, Chile’s Ministry of Health (MOH) completed a series of studies on the disease and economic burden of influenza, and used the findings to shape national public health action for influenza control. The MOH and PAHO are working to examine the process followed in Chile to identify and understand the key enablers to implementing evidence-based influenza control policies and programmes so that other countries can benefit from their programmatic learning. The Influenza Surveillance Team at the MOH surveyed a selection a selection of key national and subnational decision-makers from the Metropolitan and Biobío Regions of Chile to evaluate how the influenza burden disease estimates —and the surveillance data that underpins them— were used to develop the country’s policies on seasonal and pandemic influenza. The decision-makers were asked about factors that influenced their use of the burden estimates, including presentation of results, limitations in understanding, and competing priorities and political concerns, among other things. Essential enablers The survey results identified two critical enablers of influenza policy development in Chile: 1. Timely reporting of surveillance and burden data. Chile’s integrated epidemiological surveillance at all levels ensures the availability of up-to-date information, which means health service offerings can be continually adjusted, as can the availability of treatments and vaccines for future seasons. Most recently, national disease burden estimates were used in impact and cost-effectiveness studies of vaccine intervention to inform a decision to allocate additional financial resources for primary and hospital care. 2. Wide communication to all stakeholders. A national communications strategy ensures that the MOH can communicate information about seasonal influenza burden and define actions for all relevant stakeholders. Burden estimates and the corresponding action plan are always disseminated to expert stakeholders through technical meetings and scientific societies. Since 2015, key messages were also adapted for the general population and featured in key press releases at the beginning of the annual seasonal influenza vaccination season. Informing and engaging the public in this way helped create demand for influenza vaccines, which strengthened roll-out and sustained policy development. Seasonal influenza vaccination drive in Chile. Image credit: Flickr/Gobierno de Chile (CC BY 2.0) 22 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 IVTM 2.0: Tracking the sharing of PIP Biological Materials The WHO Influenza Virus Traceability Mechanism is an online tool for tracking the movement of influenza viruses with pandemic potential (and virus materials derived from these) into, within and out of the GISRS. After a decade of use, a recent upgrade of the tool (IVTM 2.0) has enhanced security and improved user experience. Under the PIP Framework, sharing PIP BM, which includes influenza viruses with pandemic potential and their candidate vaccine viruses, is integral to strengthening preparedness for the next pandemic and promoting access to vaccines and other benefits. The IVTM increases the transparency of this sharing by allowing users to track transfers of PIP BM. The new version, IVTM 2.0, allows users to select any specific PIP BM, visualize its movement throughout the GISRS and to non-GISRS laboratories, and export data to Excel. Funded by the PIP PC, not only is the tool more user-friendly than before, it also has a user authentication system to comply with new WHO cybersecurity requirements and new data quality rules to ensure more robust reports. In April 2020, registered users were given orientation sessions for the new tool and their feedback was used to further refine individual features. You can find IVTM 2.0 at https://extranet.who.int/ivtm2, where there is also a suite of training materials to facilitate user experience in the new version. The Global Influenza Programme will continue to monitor and enhance the IVTM through user feedback and ensure it remains a useful platform for robust and high quality data sharing. 23ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Strengthening advance supply contracts for pandemic influenza vaccines WHO and industry partners are reviewing the deployment terms of advance supply contracts signed according to the PIP Framework, to ensure that when the next influenza pandemic strikes vital vaccine supplies will be quickly and fairly accessible to those who need them most. Vaccines are a key component of any pandemic influenza response. The PIP Framework helps to ensure timely and equitable access to pandemic vaccines by securing advance supply agreements with influenza product manufacturers. To date 14 vaccine manufacturers have signed a SMTA2 with WHO, committing to supply, an average of 10% real-time vaccine production in the event of an influenza pandemic. This means that WHO has already secured an estimated 400 million doses for the next influenza pandemic. Most of these vaccine will be donated to WHO while some will be provided at an affordable price. Operational focus It is essential that these vaccine supply commitments can be quickly and effectively operationalized when the next influenza pandemic strikes. To that end, WHO is working with PIP industry partners to review some of the SMTA2 deployment terms and related policy issues, to ensure clear and actionable roles and responsibilities for all stakeholders involved in the vaccine supply process. This includes, for example, examining the roles involved in helping recipient countries quickly approve the pandemic vaccine. Manufacturers that have already signed an SMTA2 with WHO as well as industry associations such as IFPMA, DCVMN and BIO are involved in the review. A series of virtual meetings have been planned, and two have already been held (in November 2020 and March 2021). Once the series of meetings have concluded, a report will be drafted to highlight key discussion points, decisions and recommendations made. Any resulting changes to SMTA2s will be incorporated on an individual basis with each manufacturer, coinciding with the contractual requirement for the parties to review the agreement every four years. Robust response Importantly, the SMTA2 review is also drawing on lessons learnt from the ongoing roll-out of COVID-19 vaccines across the globe. Ultimately the goal of the SMTA2 review is to make sense of the many moving parts and players involved in pandemic vaccine deployment; and to ensure the process is as efficient as possible so that when the next influenza pandemic emerges, vital vaccines can be quickly and fairly distributed to those in need. The SMTA2 deployment review is drawing on lessons learnt from the ongoing global roll-out of COVID-19 vaccines. Image credit: WHO/ Blink Media - Chiara Luxardo 24 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Building on pandemic influenza preparedness to respond to COVID-19 in Europe Six years of pandemic influenza preparedness efforts in the WHO European region have established a basis for the ongoing response to COVID-19. Since 2014, the WHO Regional Office for Europe has worked with select Member States to enhance pandemic influenza preparedness under the auspices of the PIP Framework through a range of activities designed to, for example, strengthen laboratory and surveillance capacities, build national outbreak investigation and response mechanisms, and develop national influenza pandemic preparedness plans. This work has been done in concert with efforts to accelerate implementation of the International Health Regulations (2005) core capacities in the Region. These new and improved capacities, systems and protocols have become particularly relevant with the emergence of COVID-19. For example, the NIPPPs provided the foundation for developing COVID-19 Country Preparedness and Response Plans (CPRPs), which were further tailored through guidance provided in WHO’s global Strategic Preparedness and Response Plan for COVID-19 (SPRP). Armenia in action In Armenia, several components of the COVID-19 CPRP were developed early in the pandemic, largely based on national guidelines and protocols that had been previously established with PIP PC support. In particular, four streams of pandemic influenza preparedness work provided a basis for Armenia’s response to COVID-19: 1. Surveillance strengthening: An improved surveillance system for acute respiratory infections and influenza-like illness facilitated the identification of the first COVID-19 cases. 2. Outbreak investigation and response training: Trained rapid response teams are heavily involved in contact tracing for COVID-19. 3. Laboratory capacity building: The National Virology Reference Laboratory, which achieved WHO National Influenza Centre status in 2017 following PIP PC- supported capacity building efforts, was the first to perform COVID-19 testing in Armenia and continues to do the bulk of COVID-19 tests in the country. 4. Critical care training: Intensive care doctors trained in caring for patients presenting with severe acute respiratory infections have provided the backbone of frontline management of COVID-19 cases. PIP priority countries share experience on sentinel flu surveillance procedures at a sentinel site in Armenia in 2019. Image credit: WHO EURO 25ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Influenza preparedness underpins COVID-19 lab capacities in South East Asia Every country in the WHO South-East Asia region has successfully established diagnostic capacity for COVID-19 and ensured a robust laboratory response to the pandemic. Their success was enabled in large part by a decade of preparedness activities in the region to build laboratory capacities for pandemic influenza. The long-standing laboratory capacity building for influenza in SEAR has been made possible through a combination of national contributions coupled with funds from the PIP PC and a range of other donors. Three areas of this support have proved particularly fruitful in enabling SEAR’s laboratory response to COVID-19: 1. PCR diagnostic capacity building. By 2019, all 11 SEAR countries had built the capacity to accurately and reliably detect influenza viruses through real-time PCR, as recognized by the 2019 WHO EQAP. This achievement was instrumental in providing the basis for COVID-19 PCR testing in the region. All SEAR countries are able to detect COVID-19 through real-time PCR. Six of these have already completed the 2020 COVID-19 EQAP test and achieved 100%; the rest are still waiting to receive or report on the EQAP panels. 2. Online knowledge exchange. Since September 2019, WHO has hosted a series of regional webinars to share laboratory expertise and support online training within NICs and public health laboratories involved in the diagnosis and surveillance of influenza. These laboratories now find themselves on the front line of COVID-19 detection and the webinars have been rapidly adapted to support this new role by focusing on COVID-19-specific laboratory topics, such as biosafety, specimen collection and transport, and data management. 3. Laboratory assessment. During 2019, at least five South-East Asian countries assessed their national laboratory systems using WHO’s Laboratory Assessment Tool. They used the results to identify strengths and gaps in their laboratory capacities for influenza and to work towards addressing these. There is little doubt that this capacity building groundwork was critical in enabling laboratories to handle the surge in demand for laboratory services prompted by the COVID-19 response. Health professionals receive tailored COVID-19 case management training designed by WHO and partners. Image credit: WHO/SHOBHAN 26 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Influenza preparedness helps ready the Philippines for COVID-19 Joint influenza preparedness planning and swift inter-agency action enabled a quick response to COVID-19 in the Philippines, buying the country’s health system much-needed time to prepare for an inevitable surge in cases. The first death from COVID-19 outside China was reported in the Philippines on 1 February 2020. The event quickly prompted an interagency contingency planning workshop to agree priorities for government interventions. The workshop, held on 27–28 February 2020, included participants from the departments of health, agriculture, natural resources, interior and local governance, education, social welfare and development, public works, trade, transport, foreign affairs and justice, as well as representatives from the Office of Civil Defense, the police, the armed forces, the Philippine Red Cross, UNICEF and WHO. The same group of agencies had come together several months before, in November 2019, to test the country’s Pandemic Influenza Preparedness Plan through a tabletop exercise. The lessons learnt from that joint exercise, and the recommendations issued by participants to strengthen pandemic preparedness, were to be used to update the plan in 2020 but have since also proved invaluable in informing the Philippine government’s approach to COVID-19. For example, the inter-agency connections forged in November enabled the Department of Health to identify and convene the right stakeholders quickly and effectively in February and cement working relationships. This greatly facilitated the activation of an Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF- EID), led by the Secretary of Health, to coordinate the country’s COVID-19 response. Similarly, the awareness around responding to pandemic influenza that was built among government stakeholders in November enabled the quick identification of priority interventions and their rapid adoption in February and March. One of those interventions was a strict lockdown imposed from 13 March, which prevented significant morbidity and mortality by slowing the spread of disease during the early days of the COVID-19 crisis and allowing the country to prepare its health system for the inevitable surge in cases that came on easing restrictions in June. Pandemic influenza preparedness has also provided the platform for laboratory capacities in the Philippines’ COVID-19 response. Thanks to capacity strengthening provided through the PIP PC, all five of the government’s dedicated influenza laboratories were able to quickly convert into COVID-19 laboratories; and testing capacity has been steadily growing since. The Philippines currently has 114 COVID-accredited laboratories that combined can test up to 45,000 samples per day. Participants at the interagency contingency planning workshop in February 2020. Image credit: WHO 27ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 ANNEX A: FINANCIAL REPORT 28 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Table A.1: PIP Partnership Contribution received from each manufacturer (2012 - 2020) Status as of 31 December 2020 CONTRIBUTORS TOTAL CONTRIBUTIONS (US$) Sanofi Pasteur 55,252,737 Glaxosmithkline (GSK) 53,132,053 Hoffmann - La Roche and Co. Ltd. 51,073,654 Novartis 15,292,743 Seqirus 13,882,468 Medimmune 8,378,686 Kaketsuken (K M Biologics) 4,742,849 Research Foundation for Microbial Disease of Osaka University (BIKEN) 4,728,176 Denka Seiken Co. Ltd. 3,358,682 CSL Limted 2,667,745 Kitasato Daiichi Sankyo Vaccine Co. Ltd.( Daiichi Sankyo Vaccine CO.Ltd.) 2,706,242 G C Pharma (Ex-Green Cross Corporation) 2,480,027 Instituto Butatan 1,121,757 Shanghai Institute of Biological Products Co., Ltd. 650,231 Sinovac Biotech Ltd. 648,528 Hualan Biological Bacterin Co., Ltd. 592,708 Fluart Innovative Vaccines LTD 443,190 S K Bioscience 349,029 Becton Dickinson and Company (BD) 341,432 Beijing Tiantan Biological Procucts Co. Ltd. 235,234 Baxter International Inc. 209,238 Changchun Institute of Biological Products Co., Ltd. CNBG 208,231 Adimmune Corporation 201,354 Saint-Petersburg Scientific Research Institute of Vaccines & Sera 168,888 Omninvest Vaccine Manufacturing, Researching & Trading Ltd. 149,518 Alere Inc. 117,159 Takeda Pharmaceuticals Internatioanl GmbH 87,378 Focus Diagnostics, Inc. 83,844 Qiagen 61,512 Beijing Bio-Institute biological Products Co. Ltd (BBIBP) 76,787 Serum Institute of India Ltd. 42,604 DiaSorin Molecular LLC 29,692 China National Biotec Group 20,000 Princeton Biomeditech Corporation 17,572 Quidel Corporation 17,572 Cepheid 15,353 Government Pharmaceutical Organization (GPO) 15,353 Vabiotech 15,230 Cadila Healthcare Ltd. (R&D Center) 15,006 Fast Track Diagnostics 13,045 Institute of Vaccines and Medical Biologicals (IVAC) 10,591 NPO Petrovax Pharm 10,246 Indevr, Inc. 7,439 Medicago Inc. 7,439 Response Biomedical Corporation 5,417 Nanotherapeutics 5,337 Nanosphere Inc. 4,984 PT Bio Farma (Persero) 4,984 Protein Sciences Corporation 4,984 UMN Pharma Inc. 2,799 Lanzhou Institute of Biological Products 2,174 $223,709,901* ($200,970,717 NET OF PSC) *The figure does not include interest earned on Response Funds of $3,588,033 from 2018-2020. 29ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 O ut pu t D el iv er ab le 20 20 -2 1 A pp ro ve d bu dg et Fu nd s di st rib ut ed fo r 2 02 0a Ex pe nd itu re 20 20 Im pl em en ta tio n on 20 20 -2 1 ap pr ov ed bu dg et (% ) Ba la nc e fu nd s La bo ra to ry & Su rv ei lla nc e (L &S ) R is k an d se ve rit y of in flu en za a re ro ut in el y as se ss ed 6 ,5 63 ,4 97 3 ,5 83 ,9 90 1 ,6 75 ,9 75 26 % 1 ,9 08 ,0 15 Q ua lit y in flu en za v iru s de te ct io n ca pa ci ty is s us ta in ed 6 ,2 00 ,3 57 3 ,2 67 ,1 79 1 ,7 55 ,8 32 28 % 1 ,5 11 ,3 47 C ou nt rie s ar e su pp or te d to c on si st en tly re po rt in flu en za da ta to g lo ba l p la tf or m s 3 ,4 68 ,1 41 1 ,7 90 ,1 46 6 89 ,4 65 20 % 1 ,1 00 ,6 81 C ou nt rie s ar e su pp or te d to s ha re ti m el y re pr es en ta tiv e in flu en za s am pl es w ith W H O C C s 3 ,3 71 ,2 97 1 ,6 78 ,1 49 6 79 ,7 30 20 % 9 98 ,4 19 In flu en za C V Vs , v iru s de te ct io n pr ot oc ol s an d re fe re nc e m at er ia ls a re ro ut in el y up da te d 3 50 ,6 60 1 75 ,3 30 75 ,9 79 22 % 99 ,3 51 To ta l f or L &S 1 9, 95 3, 95 2 1 0, 49 4, 79 4 4, 87 6, 98 1 24 % 5, 61 7, 81 3 Bu rd en o f D is ea se (B O D ) R ep re se nt at iv e na tio na l, re gi on al a nd g lo ba l d is ea se bu rd en e st im at es a re a va ila bl e 8 64 ,6 00 4 42 ,3 00 6 0, 57 3 7% 3 81 ,7 27 D is ea se b ur de n fin di ng s ar e co m m un ic at ed to n at io na l an d in te rn at io na l e xp er t b od ie s in a fo rm at th at p ro m ot es ev id en ce -b as ed d ec is io n m ak in g 1 ,1 18 ,6 00 5 49 ,3 00 2 15 ,3 71 19 % 3 33 ,9 29 To ta l f or B O D 1 ,9 83 ,2 00 9 91 ,6 00 2 75 ,9 44 14 % 7 15 ,6 56 Re gu la to ry C ap ac ity Bu ild in g (R EG ) N at io na l r eg ul at or y ca pa ci ty fo r p an de m ic in flu en za pr od uc ts is s tr en gt he ne d 1 ,4 93 ,6 25 7 99 ,8 13 3 14 ,4 14 21 % 4 85 ,3 99 A do pt io n of re gu la to ry p at hw ay s th at a cc el er at e ap pr ov al fo r u se o f p an de m ic in flu en za p ro du ct s is p ro m ot ed 1 ,3 61 ,6 25 7 92 ,8 13 2 94 ,7 56 22 % 4 98 ,0 57 To ta l f or R EG 2 ,8 55 ,2 50 1 ,5 92 ,6 26 6 09 ,1 70 21 % 9 83 ,4 56 Ri sk C om m un ic at io n & Co m m un ic ty En ga ge m en t ( RC CE ) C ou nt rie s an d fr on t- lin e re sp on de rs h av e ac ce ss to g ui da nc e, to ol s an d in te ra ct iv e re so ur ce s fo r r is k co m m un ic at io n, c om m un ity e ng ag em en t, an d so ci al sc ie nc e- ba se d in te rv en tio ns fo r i nfl ue nz a 9 96 ,0 00 4 93 ,0 00 9 6, 96 7 10 % 3 96 ,0 33 Te ch ni ca l a ss is ta nc e fo r r is k co m m un ic at io n, c om m un ity en ga ge m en t a nd s oc ia l s ci en ce -b as ed in te rv en tio ns is pr ov id ed to c ou nt rie s to fa ci lit at e in flu en za in te rv en tio ns an d ad dr es s va cc in e he si ta nc y 1 ,3 49 ,0 00 7 07 ,0 00 6 8, 26 2 5% 6 38 ,7 38 To ta l f or R CC E 2 ,3 45 ,0 00 1 ,2 00 ,0 00 1 65 ,2 29 7% 1 ,0 34 ,7 71 Table A.2: Fund allocation and expenditure for staff and activities 1 January - 31 December 2020 30 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 O ut pu t D el iv er ab le 20 20 -2 1 A pp ro ve d bu dg et Fu nd s di st rib ut ed fo r 2 02 0a Ex pe nd itu re 20 20 Im pl em en ta tio n on 20 20 -2 1 ap pr ov ed bu dg et (% ) Ba la nc e fu nd s Pl an ni ng fo r D ep lo ym en t ( D EP ) A c om m on a pp ro ac h to m an ag e gl ob al d ep lo ym en t op er at io ns is d ev el op ed a nd re gu la rly te st ed w ith st ak eh ol de rs a nd d ep lo ym en t p ar tn er s 6 08 ,7 00 3 14 ,3 50 8 8, 29 1 15 % 2 26 ,0 59 Te ch ni ca l a ss is ta nc e to d ev el op p ol ic ie s fo r s us ta in ab le in flu en za v ac ci ne p ro cu re m en t a nd p ro du ct io n is p ro vi de d to c ou nt rie s 1 06 ,8 00 5 3, 40 0 1 8, 64 2 17 % 3 4, 75 8 N at io na l d ep lo ym en t p la nn in g pr oc es s is re vi se d an d up da te d 5 48 ,7 00 3 24 ,3 50 3 6, 17 0 7% 2 88 ,1 80 To ta l f or D EP 1 ,2 64 ,2 00 6 92 ,1 00 1 43 ,1 03 11 % 5 48 ,9 97 In flu en za P an de m ic Pr ep ar ed ne ss Pl an ni ng (I PP P) C ou nt rie s ar e su pp or te d to d ev el op , t es t a nd u pd at e th ei r pa nd em ic in flu en za p re pa re dn es s an d re sp on se p la n 2 ,9 74 ,9 93 1 ,7 84 ,8 20 5 06 ,7 84 17 % 1 ,2 78 ,0 36 To ta l f or IP PP 2 ,9 74 ,9 93 1 ,7 84 ,8 20 5 06 ,7 84 17 % 1 ,2 78 ,0 36 To ta l f or P re pa re dn es s O ut pu ts 3 1, 37 6, 59 5 1 6, 75 5, 94 0 6, 57 7, 21 1 21 % 10 ,1 78 ,7 29 U nd is tr ib ut ed fu nd sb 17 ,0 99 ,3 71 In p ro ce ss fo r 2 02 1 di st rib ut io nc 6 ,2 88 ,6 59 P SC (1 3% ) o n Pr ep ar ed ne ss F un ds 5, 57 8, 45 5 85 5, 03 7 4, 72 3, 41 8 G ra nd T ot al fo r P re pa re dn es s 3 1, 37 6, 59 5 22 ,3 34 ,3 95 7, 43 2, 24 8 24 % 38 ,2 90 ,1 77 PI P Se cr et ar ia t Pr om ot e th e ef fe ct iv e im pl em en ta tio n of th e P IP Fr am ew or k in a c ha ng in g en vi ro nm en t 2 ,5 56 ,8 75 1 ,5 17 ,2 50 5 67 ,1 51 22 % 9 50 ,0 99 C ol le ct , i m pl em en t, m on ito r a nd re po rt o n th e Pa rt ne rs hi p C on tr ib ut io n 2 ,2 04 ,7 50 1 ,2 04 ,6 56 5 70 ,9 66 26 % 6 33 ,6 90 N eg ot ia te a nd p la n to o pe ra tio na liz e th e St an da rd M at er ia l T ra ns fe r A gr ee m en ts 2 (S M TA 2) 1 ,0 90 ,6 67 6 10 ,3 56 4 21 ,7 30 39 % 1 88 ,6 26 To ta l f or P IP S ec re ta ria t O ut pu t 5 ,8 52 ,2 92 3 ,3 32 ,2 62 1 ,5 59 ,8 47 27 % 1 ,7 72 ,4 15 U nd is tr ib ut ed fu nd sb 1 ,2 79 ,1 20 In p ro ce ss fo r 2 02 1 di st rib ut io nc 9 78 ,4 51 P SC (1 3% ) o n P IP S ec re ta ria t F un ds 75 3, 80 6 2 02 ,7 80 55 1, 02 6 G ra nd T ot al fo r P IP S ec re ta ria t 5 ,8 52 ,2 92 4, 08 6, 06 8 1 ,7 62 ,6 27 30 % 4, 58 1, 01 2 R es po ns e fu nd s (in cl ud in g 7% P SC ) 60 ,4 01 ,6 74 A nn ua l I nt er es t e ar ne d on re sp on se fu nd s fo r 2 01 8- 20 20 3, 58 8, 03 3 To ta l f or R es po ns e Fu nd s - - - - 63 ,9 89 ,7 07 G ra nd T ot al fo r P IP 3 7, 22 8, 88 7 26 ,4 20 ,4 63 9, 19 4, 87 5 25 % 10 6, 86 0, 89 6d a F un ds d is tr ib ut ed re fe rs to fu nd s av ai la bl e fo r 2 02 0 im pl em en ta tio n in g lo ba l, re gi on al a nd c ou nt ry -l ev el w or k pl an s. b U nd is tr ib ut ed fu nd s in cl ud e Pa rt ne rs hi p C on tr ib ut io ns re ce iv ed a ft er fu nd s fo r 2 02 0 w or k pl an s w er e di st rib ut ed . c F un ds a re b ei ng d is tr ib ut ed fo r 2 02 1 w or k pl an im pl em en ta tio n. d I nc lu de s R es po ns e Fu nd s (U S$ 6 3, 98 9, 70 7) w hi ch w ill o nl y be u se d at th e tim e of a p an de m ic . 31ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Fig. A.1: Interim certified financial statement as of 31 December 2020 AN – 60478, 61722 and 60856 – 31.12.2020 – Interim.doc . Pandemic Influenza Preparedness (PIP) – Secretariat, Preparedness and Response Interim Financial Statement as at 31 December 2020 (expressed in US dollars) Secretariat - 10% Response - 30% Preparedness - 70% Total Opening Balance - 1 January 2020 3,794,557 55,995,730 29,663,235 89,453,522 Revenue Receipts from: Adimmune Corporation 6,656 17,972 41,933 66,561 Beijing T iantan Biological Products Co., Ltd 2,441 6,589 15,376 24,406 Denka Seiken Co., Ltd 37,718 101,838 237,623 377,179 Fluart Innovative Vaccines Ltd. 6,656 17,972 41,933 66,561 GlaxoSmithKline (GSK) 599,049 1,617,432 3,774,009 5,990,490 Green Cross Corporation 26,624 71,886 167,734 266,244 Hoffmann-La Roche and Co., Ltd 488,114 1,317,908 3,075,118 4,881,140 Hualan Biological Bacterin Co. Ltd. 6,656 17,971 41,934 66,561 Inst ituto Butantan, Brazil 54,468 147,062 343,145 544,675 Kaketsuken 55,468 149,762 349,445 554,675 Kitasato Daiichi Sankyo Vaccine Co. Ltd. 37,718 101,838 237,623 377,179 Medimmune 55,468 149,762 349,445 554,675 Princeton Biomeditech Corporation 222 599 1,398 2,219 Quidel Corporation 944 2,547 5,945 9,436 Research Foundation for Microbial Diseases of Osaka University 55,468 149,762 349,445 554,675 Saint Petersburg Scientific Research Institute of Vaccines and Sera 8,207 22,160 51,706 82,073 Sanofi Pasteur 758,648 2,048,349 4,779,481 7,586,478 Seqirus 323,166 872,547 2,035,945 3,231,658 Serum Institute of India Ltd. 222 599 1,398 2,219 Shanghai Institute Of Biological Products Co., Ltd. 2,441 6,589 15,376 24,406 Sinovac Biotech Ltd. 9,193 24,820 57,913 91,926 SK Bioscience 11,094 29,952 69,889 110,935 Takeda Pharmaceuticals International GmbH 2,441 6,589 15,376 24,406 Total received 2,549,082 6,882,505 16,059,190 25,490,777 Interest - 1,111,472 - 1,111,472 - Total Revenue 2,549,082 7,993,977 16,059,190 26,602,249 Expenditure 2020 1,762,627 - 7,432,248 9,194,875 - Balance as at 31 December 2020 4,581,012 63,989,707 38,290,177 106,860,896 I certify that the above statement reflects correctly the revenue and expenditure recorded in the WHO Global Accounting System. Jane Stewart Director Accounts 03 March 2021 32 ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 AN – 60478, 61722 and 60856 – 31.12.2020 – Interim.doc Page 2 Sum of Expense Expense Type Total (USD) Staff Costs 1,396,752 Equipment, Vehicles and Furniture 5,293 Contractual Services 139,242 Travel 11,530 General Operating Costs 7,030 Programme Support Costs (PSC) 202,780 Total 1,762,627 Statement of Financial Performance-by Donor/Award Entity : 'WHO' , From date : '01- JAN-2020 , To date : '31-DEC-2020' , Award Number : '60478' Sum of Expense Expense Type Total (USD) Staff Costs 3,032,152 Medical Supplies and Materials 648,339 Equipment, Vehicles and Furniture 20,173 Contractual Services 1,711,467 Travel 191,637 Transfers and Grants 846,416 General Operating Costs 127,027 Programme Support Costs (PSC) 855,037 Total 7,432,248 Statement of Financial Performance-by Donor/Award Entity : 'WHO' , From date : '01-JAN- 2020' , To date : '31-DEC-2020' , Award Number : '61722' 33ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 Endnotes 1. The risk of influenza at the human-animal interface is routinely assessed and findings are published as needed. An indicator target of 10 published risk assessments per calendar year was established based on the average of previous years. However, the frequency depends on the detection and reporting of new human cases, or changes in the public health risk from circulating viruses. 2. WHO information for molecular diagnosis of influenza virus - update. Geneva: World Health Organization; 2020 (https://www.who.int/influenza/gisrs_laboratory/molecular_diagnosis/en/, accessed 22 February 2021) Protocols revised in January 2020: • Annex 1. A. Protocol 2 updated: Conventional one step RT-PCR for A(H1N1)pdm09 HA gene (page 10) • Annex 1. B. Protocol 1 updated: Conventional one step RT-PCR for (H5N1) HA gene (page 12) • Annex 1. D. Protocol 1 updated: Conventional RT-PCR assays for the detection of seasonal influenza A(H1N1), A(H3N2) and influenza B viruses (page 19) • Annex 2. D. Protocol 1 updated: Real-time RT-PCR assays for the detection of seasonal influenza viruses and H5N1 influenza viruses (page 33) 3. See page 21 to learn more about Chile's case study on the use of influenza burden by policy-makers. 4. See page 20 to learn more about Ghana achieving maturity levels 3 and 4 in national regulatory capacities. 5. I. Ghiga, S. Richardson, A.M. Ropero Álvarez, M. Kato, D. Naidoo, S. Otsu, P.T. Nguyen, P.N. Nguyen, T. Nguyen PIPDeploy: Development and implementation of a gamified table top simulation exercise to strengthen national pandemic vaccine preparedness and readiness Vaccine, 39 (2) (2021), pp. 364-371, 10.1016/j.vaccine.2020.11.047 6. Ethics and COVID-19: resource allocation and priority-setting (https://www.who.int/ethics/publications/ethics-covid-19-resource-allocation.pdf?ua=1, accessed 22 February 2021) 7. E. Sparrow, J.G. Wood, C. Chadwick, A.T. Newall, S.Torvaldsen, A. Moen, G. Torelli. Global production capacity of seasonal and pandemic influenza vaccines in 2019. Vaccine, 39 (3) (2021), pp. 512-520, 10.1016/j.vaccine.2020.12.018 8. See Pandemic Influenza Preparedness Framework: progress report, 1 January - 30 June 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/bitstream/handle/10665/335937/9789240012653-eng.pdf?ua=1, accessed 19 February 2021). 9. https://www.who.int/docs/default-source/pip-framework/pip-framework-advisory-group/pipagmr-oct2020. pdf?Status=Master&sfvrsn=7fa544a7_1/PIPAGMR-Oct2020.pdf 10. https://www.who.int/initiatives/pandemic-influenza-preparedness-framework/governance/implementation-of-decision-wha72(12)

35ANNUAL PROGRESS REPORTPandemic Influenza Preparedness Framework 1 January - 31 December 2020 World Health Organization 20 Avenue Appia 1211 Geneva 27 Switzerland PIP Framework Secretariat pipframework@who.int www.who.int/influenza/pip/en