Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Annual report 2014
PUBLISHED: APRIL 2015
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Annual report 2014
© World Health Organization 2015.
WHO/HSE/PED/GIP/PIP/2015.2
All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_ form/en/index.html). The designations employed and the presentation of the material in this publication 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. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed by the WHO Document Production Services, Geneva, Switzerland.
Table of contents
List of Acronyms Foreword 1. Executive summary 2. Introduction 3. Implementation updates A. Identifying and prioritizing 2014 country recipients B. Laboratory and Surveillance Indicators: review and finalization C. Laboratory and Surveillance Capacity Building 1) African Region 2) Region of the Americas 3) Eastern Mediterranean Region 4) European Region 5) South-East Asia Region 6) Western Pacific Region 7) Laboratory and Surveillance (Headquarters) D. Burden of Disease E. Regulatory Capacity Building F. Planning for Deployment G. Risk Communications 4. PIP Secretariat 5. Financial implementation Preparedness Implementation Response PIP Secretariat Annex 1: Laboratory & Surveillance indicator definitions Annex 2: Laboratory & Surveillance indicator baselines by region Annex 3: Certified financial statements
02 03 04 08 10 11 12 13 13 16 19 22 25 28 32 35 37 40 43 46 49 50 53 57 58 61 66 72
List of Acronyms
AEFI AFRO AHI AMRO AOW CDC EBS ECN EID EQAP EMRO EURO EWARS GAP GISRS GOARN HQ IATA ICAO ICU IHR ILI IPC L&S MERS-CoV MS NIC NRA PHEIC PIP PC PPE RO RRT SARI SEARO SMTA WBDS WPRO
Adverse events following immunization WHO Regional Office for Africa Animal human interface WHO Regional Office for the Americas Area of work US Centers for Disease Control and Prevention Event-based surveillance Emergency communications network Emerging infectious disease External Quality Assessment Project WHO Regional Office for the Eastern Mediterranean WHO Regional Office for Europe Early Warning and Response System Global Action Plan for Influenza Vaccines Global Influenza Surveillance and Response System Global Outbreak and Response Network WHO Headquarters International Air Transport Association International Civil Aviation Organization Intensive care unit International Health Regulations (2005) Influenza-like illness Infection prevention and control Laboratory and surveillance Middle East respiratory syndrome - coronavirus Member State National Influenza Centre National Regulatory Authority Public Health Emergency of International Concern Pandemic Influenza Preparedness Partnership Contribution Personal protective equipment Regional office Rapid response training Severe acute respiratory infection WHO Regional Office for South-East Asia Standard material transfer agreement Web-based disease surveillance WHO Regional Office for the Western Pacific
2 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Foreword
This is the first report for the Pandemic Influenza Preparedness Framework Partnership Contribution. It covers the period from January through December 2014 and provides technical and financial information concerning progress to implement activities in the five Areas of Work (AOW) defined in the PIP Partnership Contribution Implementation Plan 2013-2016, approved by the Director-General in January 2014. Those AOWs are: 1) Laboratory and Surveillance Capacity Building; 2) Burden of Disease; 3) Regulatory Capacity Building; 4) Risk Communications; and 5) Planning for Deployment. Activities identified for support under each AOW are directly linked to the findings of Gap Analyses conducted in 2013. Likewise, they are consistent with the analyses found in the Critical Path Analysis – From Detection to Protection which provides a high level overview of the complex, multi-sectoral ‘path’ that starts at the time of the detection of a new influenza virus and culminates with the protection of the global community. Readers are therefore strongly encouraged to familiarize themselves with these three documents which may be found on the PIP webpage 1.
Gap Analyses
PIP Framework Partnership Contribution Implementation Plan 2013-2016
Critical Path Analysis – From Detection to Protection
1
http://www.who.int/influenza/pip/en/
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1. Executive summary
Overview The PIP Framework is an innovative and ambitious arrangement, among the 194 Member States of the World Health Organization, that aims to improve global pandemic influenza preparedness and response. Adopted in 2011, the Framework brings together public and private partners in a new approach to increase pandemic preparedness and response capacities. The PIP Benefit Sharing System, established in the PIP Framework, includes an annual Partnership Contribution (PC) to WHO from influenza vaccine, diagnostic and pharmaceutical manufacturers that use the WHO Global Influenza Surveillance and Response System (GISRS). The Framework specifies that PC resources shall be used to improve pandemic preparedness and response and that the WHO Executive Board will decide on the proportion that should be allocated to each area. In May 2012, the Executive Board decided that for the period 2012-2016, 70% of resources should go to preparedness and 30% to response. The Framework also specifies that the contributions were to commence in 2012. Through the support of influenza product manufacturers, Partnership Contribution funds have been received every year by WHO since 2012. By January 2014, when work plans for preparedness activities were being developed, approximately US$ 25.3M were available to WHO for disbursement to support capacity building activities in 5 Areas of Work (AOW): laboratory and surveillance; burden of disease; regulatory capacity building; planning for deployment; and risk communications.
100+ NIC have SOPs for identification of unusual influenza virus or new subtype
93 93 NICs reported influenza specific surveillance in animals
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100+ 100+ NIC countries reported ILI surveillance
Antiviral medicines available in 100+ NIC countries
100+ NIC shipped isolates to WHO CCs
26 countries received PIP PC funds and technical support for capacity building
Map 1: 2014 PIP PC countries
26 ©WHO 2015. All rights reserved. The designations employed and the presentation of the material in this publication 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.
Laboratory & Surveillance (16 countries) Laboratory & Surveillance and Regulatory Capacity (3 countrIies) Laboratory & Surveillance and Risk Communications (6 countries) Laboratory & Surveillance, Regulatory Capacity and Risk Communications (1 country) Regulatory Capacity (3 countries) Risk Communications (12 countries)
2014 Progress During the first semester of 2014, many processes and procedures were developed to enable efficient, effective and transparent management of funds, and implementation of activities using standardized approaches to monitor and report on technical and financial progress. Staff were recruited as necessary. During this time, work plans were developed across the three levels of the Organization. Starting in April 2014, funds were distributed against approved work plans and by August 2014, US$ 17.36M had been distributed to work plans across Headquarters, Regional Offices and Country offices for implementation of activities in the 5 AOWs. These funds were immediately put to work. Highlights of activities undertaken or completed – and a map showing all countries where PIP Partnership Contribution funds were distributed – are below.
• Laboratory
and Surveillance Capacity Building (L&S) - Activities started in the following 26 countries: Afghanistan, Armenia, Bangladesh, Cambodia, Chile, Democratic People’s Republic of Korea, Djibouti, Egypt, Fiji, Ghana, Indonesia, Jordan, Lao People’s Democratic Republic, Lebanon, Mongolia, Morocco, Myanmar, Nepal, Nicaragua, Tajikistan, TimorLeste, Turkmenistan, United Republic of Tanzania, Uzbekistan, Viet Nam, Yemen. - Indicators were refined for each Output and baseline data were collected in the 43 countries prioritized for support in this area. Analysis of these data showed that, notwithstanding significant variations among Regions, capacities are weak to very weak and in urgent need of strengthening. - Each Region identified a minimum of 2 countries in which to begin work to strengthen capacities in one of more of the three L&S Outputs. This entailed working with counterparts at Ministries of Health to develop specific, measurable, attainable, relevant and time-bound activities.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 5
- Plans were developed and approved, funds distributed and activities started on the ground. These included various forms of training and hand-on workshops to hone laboratory skills; establishment of new sentinel sites; and development of guidelines.
• Risk Communications - Activities were undertaken in the following 19 countries: Bangladesh, Barbados, Bhutan, Dominica, Egypt, Indonesia, Kazakhstan, Nepal, Pakistan, Republic of Moldova, Saint Lucia, Saint Vincent and the Grenadines, Sudan, Suriname, TimorLeste, Turkey, Ukraine, Uzbekistan, Viet Nam - This area of work achieved the most progress, due in part to the Ebola crisis which rapidly boosted national authorities’ demand for risk communications training - Simulation exercises tested risk communication skills, including a scenario based on an emerging pandemic influenza virus - Significant training materials were developed, translated, and placed on-line
• Burden of Disease - A tool was developed to estimate the economic burden of influenza in a country - Seven countries participated in a training to learn how to develop national disease burden estimates using a new WHO manual - Collection of disease burden data started in several priority countries - The methodology to develop a global estimate of influenza disease burden was started
Impact of Ebola The Ebola crisis presented unexpected challenges that significantly affected implementation of activities under PIP PC work plans. The effects were due mostly to the transfer of human resources across all Regions and all Areas of Work, to one degree or another. The 2 Regions and AOWs by far the most affected were the African Region and Planning for Deployment. That said, even the most dire situations provide some opportunities. Thus, while the Ebola crisis hampered efforts across many countries and Areas of Work, it provided the most compelling evidence for strong risk communications and logistics capacities in countries and at WHO. The lessons being learned in real-time from Ebola will strengthen influenza preparedness approaches.
•
Regulatory Capacity Building - Activities were undertaken in the following 7 countries: Cambodia, Democratic Republic of the Congo, Georgia, Ghana, Kenya, Lao People’s Democratic Republic, Nepal - Five National Regulatory capacity assessments were completed for vaccines, medicines and in one case, diagnostic products. - Work started to revise the expedited review procedure to facilitate licensing of pre-qualified antivirals and vaccines - The new ‘Collaborative procedure’ to address assessment and accelerated national registration of WHO prequalified pharmaceutical products and vaccines was developed and endorsed by the Expert Committee on Specifications for Pharmaceutical Preparations (ECSPP) in October 2014
81% NIC countries having national pandemic plans has increased 81% since 2009
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Looking to 2015 and beyond Implementation of a global program of this magnitude requires strategic vision and leadership, technical excellence, trust and commitment of donors and recipients, and sound financial systems. WHO’s global team provides this, using a transparent approach that focuses on the quality, sustainability and potential scalability of each intervention. It is still too early to meaningfully measure impact of the PIP PC funds on pandemic preparedness. However, as described in detail in this report, there have been some notable achievements under each AOW and it is expected that the solid foundations developed by WHO in 2014 will allow a steady increase in the rate of implementation in 2015.
96% of NIC use RT-PCR for virus sub-typing
395 395 people from 45 countries received risk communications training
96% 85+ countries have a national influenza vaccination policy
85+ Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 7
2. Introduction
PIP Framework Background Pandemic viruses respect no borders. All countries, rich and poor, large and small, must work together to prepare for its onset and to respond effectively. Access to adequate quantities of life-saving interventions, notably vaccines and antiviral medicines, made available in a timely and equitable manner to all countries, is essential for response. In 2006, during the outbreaks of H5N1 influenza cases, it became clear to WHO Member States that a formal arrangement was needed to ensure access to vaccines during influenza pandemics, particularly for countries in need. At the same time, Member States recognized that ongoing, systematic virus sharing was critical to ensuring continuous global monitoring and risk assessment, as well as ensuring the development of safe and effective pandemic influenza vaccines. In 2007, and over the next four years, WHO Member States came together to start negotiating the PIP Framework. The process included many formal and informal interactions with industry, civil society organizations, and other stakeholders. When the PIP Framework was unanimously adopted by the 194 countries of the World Health Assembly on 24 May 2011, the result was a landmark step forward for public health.
The PIP Framework is a unique tool to promote global action to prepare for pandemic influenza. As such, it fits within the larger context of two other significant public health initiatives – the International Health Regulations (2005) and the Global Action Plan for Influenza Vaccine (“GAP”), with global preparedness as both the driver and the desired outcome. The PIP Framework establishes many responsibilities among countries, national laboratories, vaccine manufacturers, and WHO. Under the Framework, countries are expected to share their influenza viruses with pandemic potential on a regular and timely basis with GISRS, a WHO-coordinated network of public health laboratories. The viruses are used by the public health laboratories to assess the risk of pandemic influenza and develop candidate influenza vaccine viruses. The PIP Framework also establishes a PIP Benefit Sharing System, that operates to, inter alia, provide all countries with pandemic surveillance and risk assessment, and build capacity in countries where needs are identified. The Partnership Contribution is one of the benefitsharing mechanisms established by WHO Member States in the PIP Framework.
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Overview of the Partnership Contribution As an innovative sustainable financing mechanism, the Partnership Contribution recognizes the desirability of having all users of the WHO Global Influenza Surveillance and Response System (GISRS) contribute to the PIP Benefit Sharing System, according to their nature and capacity. As such, the PC is an annual payment to WHO from influenza vaccine, diagnostic and pharmaceutical manufacturers that use the GISRS. The Framework specifies:
Partnership Contribution Collection Contributors are identified on a yearly basis through a Questionnaire. Amounts owed by individual contributors are calculated using a formula developed in collaboration with industry and invoices are generally sent in the last quarter of a calendar year.
PC contributor indentification 249
• The Partnership Contribution will be used to improve pandemic preparedness and response, inter alia, for conducting disease burden studies, strengthening laboratory and surveillance capacity, access and effective deployment of pandemic vaccines and antiviral medicines.1 The Director-General will propose to the Executive Board which proportion of contributions should be used for inter-pandemic preparedness measures, and which proportion should be reserved for response activities in the event of a pandemic.2 The sum of the annual contributions shall be equivalent to 50% of the running costs of the WHO GISRS.3
250
200 163
193
•
150
101
100
84 54
•
50 24
43
36
In May 2012, the Executive Board decided that for the period 2012-2016, 70% of resources should go to preparedness and 30% to response.4 In addition, 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, 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 made possible so as to meet the objectives of the PIP Framework.5
0 2012 2013 2014
Contributors identified Questionnaire responses Entities contacted
1 2 3
See PIP Framework Section 6.14.4 See PIP Framework Section 6.14.5 See PIP Framework Section 6.14.3, footnote 1. GISRS running costs for 2010 were approximately US$ 56.5M. See: http://apps.who.int/gb/ebwha/pdf_files/EB131/B131_4-en.pdf?ua=1 and http:// apps.who.int/gb/ebwha/pdf_files/EB131-REC1/B131_REC1-en.pdf#page=18 See http://www.who.int/influenza/pip/pip_pcimpplan_17jan2014.pdf?ua=1 at page 6.
4
5
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3. Implementation updates
The activities undertaken by WHO under the PIP Partnership Contribution Implementation Plan 2013-2016 aim to successfully achieve the goals set out by the Advisory Group in 2012, that, in a decade’s time:
focuses on the review and finalisation of indicators; and thereafter each sub-part covers one technical area of work (AOW). For each of those 5 technical AOWs, the report is structured as follows:
• 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. All countries should have access to a National Influenza Centre (NIC) laboratory – the backbone of the GISRS. A clearer picture of the health burden that influenza imposes on different populations should be established. All countries should have access to pandemic influenza vaccines and antiviral medicines to help reduce pandemic-related morbidity and mortality. All countries should have improved capacities to carry out effective risk communications at the time of a pandemic.
• Priority countries • Overview of financial implementation • Overview of technical progress • Challenges
This section reports on the many activities undertaken towards these ends. The section is divided into seven sub-parts: the first recalls the work carried out to identify and prioritize PC country recipients for 2014; the second
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A. Identifying and prioritizing 2014 country recipients At the end of 2013, countries were prioritized by Region using the results of the Gap Analyses that reviewed risks and needs in each area of work.6 From this list, a smaller set of countries was identified to receive support for capacity building during 2014. This selection was made on the basis of: discussions among headquarters, regional and country offices; readiness and capacity of countries to absorb support; and the capacity of WHO to provide support. Table 1 lists the countries that received PIP PC support during 2014; no countries received support for Burden of Disease or Planning for Deployment. Map 1, shows the geographical distribution of 2014 recipient countries, by area of work.
6
See http://www.who.int/influenza/pip/pip_pc_ga.pdf?ua=1
Table 1: 2014 Recipient Countries AREA OF WORK MAJOR OFFICE COUNTRIES RECEIVING SUPPORT IN 2014
Laboratory & surveillance
AFRO AMRO EMRO EURO SEARO WPRO
Ghana, United Republic of Tanzania Chile, Nicaragua Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Morocco, Yemen Armenia, Tajikistan, Turkmenistan, Uzbekistan Bangladesh, Democratic People’s Republic of Korea, Indonesia, Myanmar, Nepal, Timor-Leste Cambodia, Fiji, Lao People’s Democratic Republic, Mongolia, Viet Nam Cambodia, Democratic Republic of the Congo, Kenya, Lao People’s Democratic Republic, Ghana, Georgia, Nepal Bangladesh, Barbados, Bhutan, Dominica, Egypt, Indonesia, Kazakhstan, Nepal, Pakistan, Republic of Moldova, Saint Lucia, Saint Vincent and the Grenadines, Sudan, Suriname, Timor-Leste, Turkey, Ukraine, Uzbekistan, Viet Nam
Regulatory capacity building Risk communications
Headquarters Headquarters
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B. Laboratory and Surveillance Indicators: review and finalization The Partnership Contribution Implementation Plan 20132016 approved by the WHO Director General in January 2014 included performance measures as follows: Graph 1: Baseline capacities - Detection (Output 1) by Region Level of Output 1 capacity ( % of countries per region ) N = 43 Data as of 31 Aug 2014 N = 11 N=8 N=7 N=6 N=6 N=5
• Outcome measurements of success • Output indicators with baselines and targets These performance measures were based on the criteria, definitions and findings of the Gap Analyses. In the course of developing implementation plans, two actions were taken in relation to the indicators in the Plan: 1) Review and refinement following detailed field evaluations. Revised indicators were published in February 2015.7 Progress against Outcome and Output indicators will be measured and reported annually starting in December 2015. 2) Development of capacity indicators: In order to facilitate a regular and meaningful demonstration of progress toward achieving Outputs and Outcomes, 21 capacity indicators were developed for L&S and ordered according to Output. Thus, for Output 1, eight capacity indicators were developed; for Output 2, eight capacity indicators were developed; and for Output 3, five capacity indicators. Once the indicators and capacity indicators were defined, baseline data for them were collected for the 43 L&S priority countries. Data were entered into a global database and colour-coded according to the strength of the capacity in the country. Data were then aggregated by Output per Region. The results appear in Graphs 1, 2 and 3 below. Progress against the capacity indicators will be measured semi-annually.
100 90 80 70 60 50 40 30 20 10 0
AFRO No data
AMRO No capacity
EMRO
EURO
SEARO
WPRO
Partial capacity
Capacity established
Graph 2: Baseline capacities - Monitoring (Output 2) by Region Level of Output 2 capacity ( % of countries per region ) N = 43 Data as of 31 Aug 2014 N = 11 N=8 N=7 N=6 N=6 N=5
100 90 80 70 60 50 40 30 20 10 0
AFRO No data
AMRO No capacity
EMRO
EURO
SEARO
WPRO
Partial capacity
Capacity established
Graph 3: Baseline capacities - Information and virus sharing (Output 3) by Region Level of Output 3 capacity ( % of countries per region ) N = 43 N = 11 N=8 N=7 N=6 Data as of 31 Aug 2014 N=6 N=5
100 80 60 40 20 0 AFRO No data
AMRO No capacity
EMRO
EURO
SEARO
WPRO
Partial capacity
Capacity established
7
http://www.who.int/influenza/pip/pip_pcimpplan_update_31jan2015.pdf?ua=1
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C. Laboratory and Surveillance Capacity Building L&S Outcome & Outputs8 Outcome Capacity to detect and monitor influenza epidemics is strengthened in developing countries that have weak or no capacity.
• Output 1
AFR 8
• •
National capacity to detect respiratory disease outbreaks, due to a novel virus, is strengthened Output 2 National capacities to monitor trends in circulating influenza viruses is strengthened Output 3 Global collaboration, through the sharing of information and viruses, is strengthened and the quality of the system is improved (PCR detection quality assurance)
1) African Region Priority countries In 2014, the following countries received support under the PIP PC: Ghana and the United Republic of Tanzania. However, before implementation could begin, the Ebola outbreak developed in West Africa. Significant human resources were diverted to fight this unprecedented epidemic and for the latter half of 2014, the Ebola crisis consumed not only the health resources of the three most affected countries but also significant resources from the Regional Office, other countries in the Region and even from other WHO Regional Offices and Headquarters. Implementation of PIP PC funds in the African region was thus considerably delayed. The crisis also had a considerable impact on implementation of the PIP PC planned activities in other WHO regions.
Excerpt from PIP PC Implementation Plan 2013-2016: http://www.who.int/influenza/ pip/pip_pcimpplan_17jan2014.pdf?ua=1
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Graph 4: African Region 2014 Budget and Expenditure by country $0
Ghana Output 2 $33,321
$277,500
United Republic of Tanzania Output 1 United Republic of Tanzania Output 2 Regional Office Output 3
$158,000 Expenditure $0 $197,500 $136,234 $668,253 $169,554 Budget
TOTAL $0 $500,000 $1,000,000
$1,301,253 $1,500,000
Graph 5: African Region L&S capacity by Output Data as of 31 Aug 2014
Output 3
Output 2
No data No capacity Partial capacity Capacity established
Output 1
0
1
2
3
4
5
6
7
8
9
10
11
Number of countries
14 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Table 2: African Region 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
Output 2 In Ghana a meeting was held with the MoH to discuss PIP roll out.
• •
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
158,000 475,000 668,253 1,301,253 33,321 0 136,234 169,555 13%
Output 1 Output 2 Output 3 Total expenditure OVERALL REGIONAL IMPLEMENTATION RATE
Output 3 At the Regional level activities included developing a standardised data management tool and procuring of some essential laboratory supplies and virus transportation media for a number of PIP eligible countries. A full-time Project Manager was recruited at regional level and the team was further strengthened by the recruitment of US CDC funded technical officer, also at regional level.
Challenges Overview of financial implementation As of 31 December 2014, the overall implementation rate for the African Region was 13%, broken down as follows: 0% in Ghana, 9% in the United Republic of Tanzania and 20% at the African Regional Office. As explained, this low level of implementation is a result of resources and attention being drawn away from PIP and focused on the Ebola crisis. Ghana, for example, became the headquarters for UNMEER (UN Mission for Ebola Emergency Response). Collection of baseline L&S data was challenging. Additionally, in light of the significant and multiple health challenges faced by many of the PIP priority countries in the Region, advocacy work is required to ensure that pandemic preparedness receives sufficient support. In December 2014, the activities that had been planned for 2014 were reformulated and re-scheduled for implementation in 2015. In addition, two new staff were recruited at AFRO for PIP implementation support. For 2015, a plan to expand implementation of activities across the Region is being developed. As the Ebola crisis subsides, this expansion plan will be phased in as countries become available for PIP related work. As a result, PIP implementation at regional and country level is expected to accelerate in 2015.
Overview of technical progress Despite the significant impact of the Ebola crisis, some progress was made. Detailed work plans were developed in cooperation with the respective MoH for the two priority countries (Ghana and United Republic of Tanzania) before the Ebola outbreak, and the following was accomplished: Output 1 The United Republic of Tanzania provided training on specimen collection and shipment, and procured IT equipment for laboratory and epidemiological surveillance.
•
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AMR
2) Region of the Americas 2014 priority countries In 2014, the following countries received support under the PIP PC: Chile and Nicaragua. Table 3: Region of the Americas 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
365,600 291,400 1,464,300 2,121,300 66,480 134,023 459,839 660,342 31%
Output 1 Output 2 Output 3 Total expenditure OVERALL REGIONAL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in mid-2014 across all three L&S Outputs. Although there were two countries identified to receive support in 2014, some activities were also carried out in Colombia, El Salvador and Suriname. As shown in Table 3, the 2014 financial implementation rate for the Region was 31%. Implementation rates were 18% for Nicaragua and 46% in Chile. Implementation overall was slower than planned. At the country level this was due to delays in securing country engagement to co-develop the work plans. At the regional level, implementation slowed starting in September due to the call for regional office staff to support the Ebola crisis.
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Graph 6: Region of the Americas 2014 Budget and Expenditure by country $134,023
Chile Output 2
$291,400 $66,480
Nicaragua Output 1 $459,839
$365,600
Expenditure Budget
Regional Office Output 3 $660,342
$1,464,300
TOTAL $0 $1,000,000 $2,000,000
$2,121,300 $3,000,000
Graph 7: Region of the Americas L&S capacity by Output Data as of 31 Aug 2014
Output 3
Output 2
No data No capacity Partial capacity Capacity established
Output 1
0
1
2
3
4
5
6
7
8
Number of countries
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Overview of technical progress Graph 7 illustrates the baseline capacities across the three Outputs in the 8 priority countries. Once plans were agreed with national counterparts and implementation began, good progress was made. Output 1 In Nicaragua the national influenza surveillance system and key laboratories were assessed. As a result of weaknesses detected, surveillance infrastructure is being re-organized to improve coordination, monitoring and reporting. This includes the first steps towards creating a unified informatics system, which is currently fragmented. In addition, national guidelines are under revision; a format for regular and integrated reporting of laboratory and epidemiological data has been developed and is ready for introduction.
Challenges Challenges for 2015 include the need to advocate government action on influenza preparedness in the face of competing health priorities. For example, many countries in the Region have been focused on evaluating preparedness for potential Ebola cases, and other outbreaks, rather than for influenza. In addition, dedicated human resources in both target countries are limited and threaten the sustainability and continuity of systems for detection, monitoring and surveillance for pandemic influenza. It is hoped that by engaging countries in developing national preparedness plans, some of these issues will be addressed. The lack of effective laboratory quality assurance systems is a barrier to the sustainable development of effective detection, monitoring and surveillance of influenza. PIP PC funds will provide support in this area. Extensive support will be given to laboratories to strengthen technical capacities as well as to improve quality assurance, and where appropriate, begin the process of becoming a NIC. At the regional level, there will be further development of regional reporting systems and increased support for training to enable countries to select the best viruses to share with WHO CCs. Work plans and budgets have been developed for 2015. Support for additional countries is planned and the implementation rate is expected to increase.
•
Output 2 In Chile, six laboratories (including the NIC) participated in external quality assurance programs and were verified as competent to carry out influenza detection through real time PCR and influenza subtyping. SARI and ILI surveillance were strengthened through the participation of several sentinel sites in a regional vaccine effectiveness study, which included a monitoring and evaluation component. The MoH has also started to integrate the four surveillance systems currently used to track laboratory and epidemiological influenza data. The new system will provide data, data analysis and automated reporting to improve public health decision making. A WHO influenza FluID platform compatible format to report epidemiological indicators is being developed with the national counterpart.
•
• At the regional level, two meetings were held to review and define regional network procedures for improved surveillance and early detection of highly pathogenic viruses. Regional guidelines for biosafety procedures for highly pathogenic viral pathogens were also produced.
Output 3
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EMR
3) Eastern Mediterranean Region 2014 priority countries In 2014, seven countries received support under the PIP PC: Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Morocco, Yemen. Table 4: Eastern Mediterranean Region 2014 budget and expenditure by Output (US$) 2014 BUDGET
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
977,500 780,500 498,500 2,256,500 104,637 174,946 174,645 454,228 20%
Output 1 Output 2 Output 3 Total expenditure OVERALL REGIONAL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in mid-2014 in the seven countries that received support, and across all three L&S Outputs. As shown in Graph 8, implementation rates per varied by country with Afghanistan at 76%, Morocco at 20% and the remaining 5 target countries below 15%. However, the financial implementation rate for the Region as a whole at the end of 2014 was low, recorded at 20%. Again, this is partly due to the Ebola crisis, as during the last quarter of 2014 considerable WHO and country human resources were diverted to assessing national level communicable disease preparedness in all EMRO countries. Some regional resources were diverted to support countries for the MERS-CoV outbreak. In addition, several of the countries that received support in 2014 are dealing with conflict and/or humanitarian crises, which present challenges to rapid and effective implementation.
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Graph 8: Eastern Mediterranean Region 2014 Budget and Expenditure by country Afghanistan Output 2 Djibouti Output 2 Egypt Output 1 $6,436 $99,179 $131,000 $4,079 $75,000 $54,112 $401,000 $253,500 $13,916 $238,500 $57,772 $296,000 $44,089 $323,000 $0 $40,000 $174,645 $498,500 $454,228 $2,256,500 $0 $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 Expenditure Budget
Jordan Output 1 Lebanon Output 2 Morocco Output 2 Yemen Output 1 Yemen Output 2 Regional Office Output 3 TOTAL
Graph 9: Eastern Mediterranean Region L&S capacity by Output Data as of 31 Aug 2014
Output 3
Output 2
No data No capacity Partial capacity Capacity established
Output 1
0
1
2
3
4
5
6
7
Number of countries
20 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Overview of technical progress Graph 9 below illustrates the baseline capacities across the three Outputs in the 7 priority countries. By the end of 2014, four of the seven priority countries had carried out assessments of laboratory and epidemiological surveillance systems with national plans subsequently developed. This established a solid baseline from which targeted improvements have begun. These improvements will be expanded in 2015. Output 1 Assessments of national capacity to detect influenza and respiratory disease outbreaks were conducted in Afghanistan, Djibouti, Lebanon and Yemen and national plans were developed. National stakeholder meetings were held in Afghanistan, Lebanon and Egypt to determine ways to strengthen SARI surveillance and improve coordination between laboratory and epidemiological aspects of surveillance systems. There have been several trainings conducted, such as genetic characterization of respiratory viruses (Jordan and Morocco). Needs assessments were completed and basic laboratory equipment and supplies for routine influenza detection were procured for several countries.
•
Output 3 Through a regional meeting with epidemiologists and virologists, the seven priority countries were introduced to PIP and trained in epidemiological and virological best practices for influenza surveillance, including data management. Extended training on Good Laboratory Practice for laboratory personnel from Djibouti (training held in Morocco) and Yemen (training held in Jordan) was provided. Similarly trainings were held for epidemiologists on data collection and management. Twenty technical staff from seven priority countries were trained in virus shipping processes and procedures.
•
Challenges Health challenges in the Region have been greatly exacerbated by the number of conflicts and humanitarian emergencies in many PIP PC eligible countries. However, as a result of the Ebola crisis (as well as MERS-CoV and an H5N1 outbreak in Egypt) countries have a renewed focus on disease preparedness, and it is expected that 2015 will present opportunities for advancement. Synergies with other programs (e.g. IHR) and key partners in the Region are also being developed to try to maximise leverage to ensure a greater impact on influenza preparedness. Building sustainable capacity in a structured and systematic but relatively quick way is also a challenge. Standardised planning and strategic tools are being developed and will support a step-wise approach to capacity building that is tailored to country specifics. Country specific work plans and budgets have been written for 2015 and the rate of implementation is expected to increase.
•
Output 2 SARI/ILI surveillance system capacities were assessed in Afghanistan, Djibouti, Lebanon and Yemen, and new SARI/ILI sentinel sites were established in Afghanistan and Yemen with reactivation of several previously active SARI/ILI sentinel sites. Training on influenza surveillance through SARI/ILI surveillance was provided in Yemen. Periodic collection and publication of information on influenza surveillance has been established in Afghanistan, Egypt, Jordan, Morocco and Yemen. Health workers in Afghanistan were trained in epidemic preparedness and response including outbreak investigations and infectious sample handling and shipment
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 21
EUR
4) European Region 2014 priority countries In 2014, the following countries received support under the PIP PC: Armenia, Tajikistan, Turkmenistan, Uzbekistan. Table 5: European Region 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
423,000 369,500 739,442 1,531,942 230,645 283,393 460,883 974,921 64%
Output 1 Output 2 Output 3 Total expenditure OVERALL REGIONAL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in mid-2014 in the 4 target countries and across all three L&S Outputs. As shown in Graph 10 the implementation rate for Armenia, Tajikistan and Uzbekistan averaged approximately 60%, and was over 80% in Turkmenistan. The overall financial implementation rate for the Region was 64%. The European regional office was the one least affected by the Ebola crisis and the overall level of implementation was therefore satisfactory.
22 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Graph 10: European Region 2014 Budget and Expenditure by country Armenia Output 1 Tajikistan Output 1 Tajikistan Output 2 Turkmenistan Output 1 Turkmenistan Output 2 Uzbekistan Output 1 Uzbekistan Output 2 Regional Office Output 3 TOTAL $0 $500,000 $1,000,000 $113,077 $175,500 $50,149 $110,500 $66,678 $105,000 $ 31,332 $ 97,000 $ 81,917 $ 110,500 $ 36,087 $ 40,000 $ 125,187 $ 154,000 $ 470,494 $ 739,442 $ 974,921 $ 1,531,942 $1,500,000 $2,000,000 Expenditure Budget
Graph 11: European Region L&S capacity by Output Data as of 31 Aug 2014
Output 3
Output 2
No data No capacity Partial capacity Capacity established
Output 1
0
1
2
3
4
5
6
Number of countries
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 23
Overview of technical progress Graph 11 illustrates the baseline capacities across the three Outputs in the 6 priority countries. Implementation originally planned for the Ukraine was virtually impossible due to civil conflict. Implementation in Kyrgyzstan is planned for 2015. However, progress in the four remaining target countries has been strong since implementation began on 1 July 2014. Work commenced in each of the four countries based on direct collaboration with Ministries of Health to devise and implement plans for strengthening pandemic preparedness. Output 1 Outbreak investigation and response was strengthened by national assessments, development of operational outbreak investigation and response plans, and training of outbreak response teams. Assessments of influenza surveillance and laboratory systems (see also Output 2) were undertaken in Tajikistan, Turkmenistan and Uzbekistan using the National Influenza Centre Laboratory Assessment Tool (NIC-LAT). Training in laboratory preparedness for emerging respiratory pathogens and laboratory quality assurance has been carried out with staff from all 17 NICs in the Region. Twenty-one staff from Turkmenistan and eleven from Tajikistan were trained and certified in shipping of infectious substances
• Knowledge
of appropriate case management of severe influenza infection has been greatly enhanced within the intensive care treatment units of four target countries and, in Uzbekistan, by initiating updating of clinical management guidelines for Severe Acute Respiratory Infections.
• Regional information sharing has improved because of the launch of the joint WHO EURO and ECDC influenza surveillance bulletin (FluNewsEurope www. flunewseurope.org) covering all countries in the WHO European Region. National influenza focal points from several target countries have been trained in data entry and are now regularly submitting data. In December 2014, PIP web pages describing PIP PC implementation in the WHO European Region went live on EUROs website (www.euro.who.int/pip) and are also available in Russian. Regional networks for influenza information sharing have been further strengthened.
Output 3
• •
• •
Challenges Going forward, a policy challenge at the country level will be to ensure that pandemic preparedness gets sufficient attention in light of other, competing health priorities. The operational priorities for 2015 include developing and testing of operational outbreak investigation and response plans, revising sentinel ILI and SARI surveillance guidelines, and ensuring that these are correctly implemented. A priority will also be to maintain the high quality influenza detection capacity thus far established, to enhance laboratory capacities for detection and monitoring, and to increase virus sharing. Maintaining momentum and sustaining good collaboration with national counterparts will also be important.
• •
Output 2 Sentinel influenza surveillance assessments (national and sentinel site levels) were undertaken in Armenia, Tajikistan, Turkmenistan and Uzbekistan using a sentinel surveillance system review tool. The main recommendations were to improve representativeness of sentinel sites, to improve data quality and to align/ integrate sentinel surveillance with routine/existing data collection practices to thus increase the efficiency of performing surveillance. In Armenia and Uzbekistan, through national influenza surveillance meetings there has been some strengthening of the collaboration between epidemiologists, virologists and doctors involved in surveillance and outbreak response.
•
•
24 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
SEAR
5) South-East Asia Region 2014 priority countries In 2014, the following countries were identified to receive support under the PIP PC: Bangladesh, Democratic People’s Republic of Korea, Indonesia, Myanmar, Nepal, Timor-Leste. Table 6: South-East Asia Region 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
842,000 400,000 403,750 1,645,750 160,918 195,391 178,759 535,068 33%
Output 1 Output 2 Output 3 Total expenditure OVERALL REGIONAL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in mid-2014 in the six countries that received support in 2014, and across all three L&S Outputs. As shown in Graph 12, implementation rates by target country ranged widely, from 2% in Myanmar to 53% in Indonesia. The overall financial implementation rate for the Region was 33%. This low rate was largely due to difficulties in making expenditures in DPRK, Myanmar and Nepal, and, in some part, due to the focus on Ebola preparedness rather than on pandemic influenza preparedness. Nonetheless, there has been some good progress.
Overview of technical progress Graph 13 illustrates baseline capacities across the three Outputs in the 6 priority countries. Systematic reviews of surveillance systems have established clear action plans for Bangladesh, DPR Korea and Nepal. There has been some strengthening of laboratory capacity and surveillance systems through training and guideline development. However, significant further capacity strengthening in many countries is still required. Sharing of information within
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 25
the regional network of NICs has improved slightly, but again, there remains much to do. Country capacities for shipping viruses are well advanced. Output 1 National influenza surveillance system reviews were conducted in Nepal and DPR Korea. Clinical case management training has been provided to 70 staff in Nepal. ILI surveillance reporting was added to weekly infectious disease reporting bulletins in Myanmar and Nepal. Starter reagents and consumables have been procured for the national reference laboratory in DPR Korea. In Indonesia a field assessment and data analysis for revamping laboratory network was carried out and national staff were trained in molecular virology, laboratory management and maintenance. A national workshop on quality assurance of the laboratory network was held.
•
Output 3 A regional consultation with the Directors of all National Influenza Centres contributed to developing a regional action plan tailored to country needs. All countries in the Region are now trained in handling dangerous goods, packaging, shipping and cold chain management. This enhances timely and qualitycontrolled sharing of biological material with a WHO CC. Nepal operationalised its capacity (BSL level 3) to handle highly pathogenic organisms.
• • •
Challenges Going forward, challenges at the country level will be competing health priorities, limited dedicated human resources for influenza and weak health system infrastructure. Concerning competing priorities, most countries have been focused on preparedness for Ebola and MERS-CoV and on responding to outbreaks such as cholera and hepatitis E. Consequently they have not considered pandemic influenza preparedness to be a priority. However, as a result of the Ebola crisis, all countries are now more focussed on system strengthening for disease preparedness in general, and influenza preparedness will also improve as a result. The renewed focus on disease preparedness is expected to result in strengthening of relevant systems, structures and human resources. The geographical characteristics of some countries make it difficult to reach and assist a number of areas at the sub-national level. Also, the embargo of the DPR Korea, made it difficult to improve capacities for influenza surveillance. In Myanmar and Timor-Leste there is a lack of experts who can engage in laboratory and epidemiological influenza surveillance. Priorities for 2015 vary depending on the country. In Indonesia, Bangladesh and Myanmar, the emphasis will be on laboratory strengthening as well as on strengthening SARI/ILI surveillance. In Timor-Leste, the emphasis will be on building skills in laboratory and public health staff and on establishing a National Influenza Centre. In Nepal and DPR Korea, building influenza capacity will focus on addressing the gaps identified by the national influenza surveillance system review.
•
Output 2 Bangladesh has some existing ILI and SARI surveillance capability along with a reasonably strong supporting laboratory network. A national influenza surveillance system review was carried out with a follow up national workshop to review surveillance guidelines. Sample collection and transport protocols have also been developed and in-house software for web-based information management system has been partly developed. A standard format for weekly reporting on influenza surveillance is now in use. ILI surveillance guidelines were developed in Myanmar with subsequent training of relevant staff at the national level. In Timor-Leste a series of training exercises were provided in influenza detection by PCR and in the surveillance of SARI and ILI. The links between human and animal health have been strengthened in Indonesia through a Ministerial Decree for cooperating and sharing data. A joint risk assessment model for animal health based on the WHO risk assessment guidelines were developed. Also in Indonesia, there was an evaluation of and refresher training in the early warning and response system (EWARS), as well as training of health workers in surveillance of ILI/SARI.
•
• • •
26 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Graph 12: South-East Asia Region 2014 Budget and Expenditure by country
Bangladesh Output 2 DPR Korea Output 1 Indonesia Output 2 Myanmar Output 1 Nepal Output 1 Timor-Leste Output 1 Regional Office Output 3
$ 88,850 $ 200,000 $ 34,050 $ 200,000 $ 106,541 $ 200,000 $ 4,247 $ 200,000 $ 26,280 $ 200,000 $ 96,341 $ 242,000 $ 178,759 $ 403,750 $ 535,068 Expenditure Budget
TOTAL $0 $500,000 $1,000,000 $1,500,000
$ 1,645,750 $2,000,000
Graph 13: South-East Asia Region L&S capacity by Output Data as of 31 Aug 2014
Output 3
Output 2
No data No capacity Partial capacity Capacity established
Output 1
0
1
2
3
4
5
6
Number of countries
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 27
WPR
6) Western Pacific Region 2014 priority countries In 2014, the following countries were identified to receive support under the PIP PC: Cambodia, Fiji, Lao People’s Democratic Republic, Mongolia, Viet Nam. Table 7: Western Pacific Region 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
1,201,900 502,800 531,875 2,236,575 745,712 275,827 267,311 1,288,850 58%
Output 1 Output 2 Output 3 Total expenditure OVERALL REGIONAL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in mid-2014 in the 5 countries receiving support. The financial implementation rates for these countries ranged from 51% in Vietnam and 58% in Mongolia, through 61% in Fiji and 62% in Cambodia, to 64% in Lao PDR. For the Region as a whole, implementation neared 60% by the end of 2014. Overall, financial implementation progress is satisfactory for the Region.
28 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Graph 14: Western Pacific Region 2014 Budget and Expenditure by country Cambodia Output 1 Fiji Output 2 Lao PDR Output 1 Mongolia Output 1 Viet Nam Output 2 Regional Office Output 3 TOTAL $ 307,424 $ 491,900 $ 118,587 $ 194,800 $ 264,212 $ 410,000 $ 174,076 $ 300,000 Expenditure Budget
$ 157,240 $ 308,000 $ 267,311 $ 531,875 $ 1,288,850 $ 2,236,575
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
Graph 15: Western Pacific Region L&S capacity by Output Data as of 31 Aug 2014
Output 3
Output 2
No data No capacity Partial capacity Capacity established
Output 1
0
1
2
3
4
5
Number of countries
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 29
Overview of technical progress Graph 15 illustrates baseline capacities across the three Outputs in the 5 priority countries. Progress across the Region as whole has been good, although it has been stronger in some countries than in others. Some preparedness capacity improvements were seen in four of the countries receiving support in 2014, as a result of numerous training activities, but laboratory and surveillance system development is still required. Progress was hampered in Fiji because health officials were occupied with a major Dengue outbreak. Output 1 In Cambodia a wide range of training events were carried out focusing on capacities to detect, report and manage respiratory disease outbreaks. There has been on-going assessment in conjunction with the Cambodia Communicable Disease Control Department to improve both the link between laboratory and epidemiological components of surveillance and dissemination of weekly surveillance information. In Mongolia, coordination across the human-animal interface was improved through a One Health coordination meeting to facilitate cross-sectoral exchange of epidemiological information and surveillance data. A national forum on joint humananimal health emergency preparedness for the animal and human health sectors was held. In addition, NIC staff were trained and some basic laboratory equipment and supplies were procured for four regional laboratories, and weekly epidemiological and virological reports were published online. PIP PC funds supported the procurement of essential laboratory reagents and equipment to sustain advanced capacities at Viet Nam’s two NICs.
•
•
Output 2 In Viet Nam, activities focused on building capacities for influenza surveillance and outbreak investigation as well as for collaboration at the human-animal interface. Trainings at national, regional, and provincial levels were held in the areas of surveillance, rapid response and laboratory diagnosis. In Fiji, activities focused on an evaluation of the existing surveillance sites to guide training needs. In Mongolia national guidelines for ILI and SARI surveillance were revised and a series of trainings in case definitions for ILI and SARI were held for health professionals at sentinel sites to ensure the quality of the data reported and of sample collection and transportation. In Lao PDR, the capacity to respond to influenza outbreaks was enhanced by development of SOPs for a joint human-animal sector Rapid Response Teams and response plans. Joint human-animal ILI surveillance was conducted in five high risk provinces. A national toll-free hotline for the reporting of unusual respiratory events was introduced in quarter three, which led to the early detection of a respiratory disease cluster in quarter four.
•
• •
•
•
•
Output 3 Regional Office activities to date have focused on regional coordination, monitoring and evaluation of country-level implementation and improved information sharing between countries. There have also been infection prevention and control (IPC) training in the Pacific and regional meetings to determine progress made and to identify future directions of regional influenza surveillance and laboratory activities.
30 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Challenges Challenges at country level vary depending on national conditions.
• In • •
•
•
•
Cambodia, there are no regular national funds for operational support for ILI and SARI surveillance systems and further advocacy is required to make PIP a higher health priority. In Lao PDR, coordination between animal and human health sectors will be strengthened further, as will laboratory capacity for detecting unusual influenza viruses, and for improving response capacity. In Mongolia, a high turnover of rapid response team staff and surveillance officers necessitated repeated trainings. Moving forward, activities will focus on improving capacity of surveillance officers in analysis, interpretation and reporting of SARI and ILI surveillance data. Trainings in clinical management, infection prevention and control as well as in advanced laboratory techniques for virus isolation and sequencing will also be organized. In Viet Nam, delays in launching the national PIP work plan and the diversion of human resources to respond to a large measles outbreak hampered progress. Priority activities in 2015 will focus on strengthening national laboratory capacity, intersectoral collaboration and information sharing through regional and global platforms Fiji and Pacific Island Countries faced a major dengue outbreak which diverted country resources and attention away from influenza-related work, as evidenced by a sharp reduction in the numbers of influenza samples collected during the outbreak. In Fiji and Pacific Island Countries, priority activities in 2015 will focus on expanding the ILI network, improving the quality of influenza surveillance, and promoting the sustainability of this surveillance network. At the Regional level challenges in 2014 included the diversion of human resources to increase regional preparedness to respond to the potential introduction of Ebola virus disease in the Western Pacific, as well as staff deployment to West Africa. Activities planned for 2015 will focus on enhancing epidemiological data sharing at the regional and global levels, improving the use of data to inform decision-making and on promoting the publication of regional influenza epidemiology reports.
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 31
L&S Headquarters
7) Laboratory and Surveillance (Headquarters) 2014 priority countries In 2014, no countries received PIP PC funds under this area of work, although all Member States are eligible to receive support for shipment of viruses and participation in EQAP. Table 8: WHO HQ L&S 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
43,000 212,000 544,000 799,000 0 3,907 263,068 266,975 33%
Output 1 Output 2 Output 3 Total expenditure OVERALL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in mid-2014 across all 3 outputs. The implementation rate for Output 1 was 0%, for Output 2, 2% and for Output 3, was 48%, as shown in Graph 16. Though the overall rate of financial implementation was 33%, there was notable progress under Output 3.
32 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Overview of technical progress Although the financial implementation rate was low, progress was made in the development of normative guidance (protocols) to detect novel viruses. Likewise, progress was made in strengthening WHO systems for global management of influenza virological and epidemiological data. Pandemic influenza preparedness relies on an effective system for monitoring seasonal influenza, as this is the system that will provide comparative virological and epidemiological data at the time of a pandemic. Consequently, although a focus on pandemic preparedness is maintained, there is a significant overlap between PIP and routine work for monitoring seasonal influenza. Output 1 PCR detection protocols for the rapid detection of influenza viruses were updated. This will minimize the risk of missing positive specimens due to antigenic drift for seasonal viruses and increase the likelihood of detecting viruses with pandemic potential. Support was provided to the maintenance and promotion of the GISRS –EZCollab platform, which facilitates regular exchange and information sharing among GISRS members.
Output 2 The updated protocols for antiviral susceptibility surveillance have helped standardize testing across more laboratories. The development of e-training materials based on the Global epidemiological surveillance standards for influenza will increase access to standards when posted on the web in 2015. The meeting on the right-size of SARI/ILI surveillance held in June 2014 will provide further guidance to countries on the extent of surveillance required to meet specific surveillance objectives. The Influenza Risk Assessment Tool that has been produced and will be disseminated in 2015.
•
•
•
• Provision
Output 3
of seven training events on infectious substance shipping has increased the number of laboratory staff certified to ship viruses. This increases the potential for virus sharing with WHO CCs which can then perform virus characterisation for selection of candidate vaccine virus for seasonal viruses and those of pandemic potential.
Graph 16: Headquarters L&S 2014 Budget and Expenditure by Output $0
Detection capacity
$ 43,000
$ 3,907
Monitoring capacity
$ 212,000
$ 263,068
Expenditure $ 544,000 Budget
Strengthening networks
$ 266,975
TOTAL
$ 799,000
$0
$200,000
$400,000
$600,000
$800,000
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 33
• The •
•
2014 NIC Survey published in the Weekly Epidemiological Record9 has helped to provide data needed to strengthen the NIC designation and redesignation process. Some PIP PC funds have been used to support the further development and upgrading of the FluNet, FluID and FluMart, supporting the global influenza activity update published fortnightly on the WHO web site. Support for the Expert Working Groups on PCR and antiviral susceptibility has assisted the identification of suitable viruses to be included in panels for the 2015 EQAP panels.
Challenges The rapid evolution of influenza viruses makes frequent updating of testing protocols critical to enable the identification of viruses with novel or unusual properties. Maintaining and further developing systems to enable the collection of appropriate virological and epidemiological data, along with their subsequent appropriate and timely analysis, requires continuous coordination and communication, as well as access to relevant technical expertise. Maintaining and developing the appropriate systems and expertise, as well as widening and strengthening the GISRS network remain the major challenge for surveillance aspects of pandemic influenza preparedness. Consequently, further system strengthening and normative technical work will continue in 2015.
9
See: WHO Weekly Epidemiological Record http://www.who.int/wer/en/
34 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
D. Burden of Disease
BOD Outcome & Outputs10 Outcome National policy makers will have influenza disease burden data needed for informed decisionmaking and prioritization of health resources.
the production of national estimates for hospital and economic burdens, using a newly developed Burden of disease training manual. Collection of data to allow development of disease burden estimates has started in some of the recipient countries, such as Nicaragua and Chile. The outline of a methodology to estimate the global influenza burden was also produced. Output 1 A draft approach and tool for estimating the economic burden of disease was developed, piloted and further refined following discussion at a global workshop. Discussions are on-going with a number of countries interested in piloting the tool further. A training manual based on the WHO Burden of disease Manual was developed. Two regional training events for burden of disease estimation were held for seven countries. One was held by EURO and one by AMRO (back-to-back with a workshop on evidence-based decision-making on national seasonal influenza vaccination policy). At the regional level, Chile and Nicaragua, following participation in the regional training event, have begun collecting data to estimate national disease burden and will publish results in a regional publication in 2015. In addition, EMRO partnered with the Imperial College London and the Aga Khan University to train a cohort of experts from the Region on mathematical modelling for disease burden estimation.
• Output 1 • Derive regionally representative influenza disease burden estimates from selected countries Output 2 Develop a global estimate of influenza disease burden derived from national estimates
• • • •
2014 priority countries In 2014, no countries received PIP PC funds under this area of work. Table 9: Burden of Disease 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
•
Output 1 Output 2 Total budget 2014 EXPENDITURE
743,000 85,000 828,000 94,254 0 94,254 11%
Output 1 Output 2 Total expenditure OVERALL IMPLEMENTATION RATE
• The
Overview of technical progress Capacity indicators for burden of disease were developed in collaboration with a WHO CC (US CDC). Baseline data will be collected from seven priority countries in March 2015. Notwithstanding the low financial implementation rate, progress was made in this area of work. A draft tool for estimating economic burden was developed and will be further refined and tested in 2015. Seven of the recipient countries participated in training on
Output 2 outline of a methodology to estimate the global influenza burden was written during a global workshop in December 2014. This methodology will be developed further and shared during 2015.
Challenges The major challenge in 2015 will be enrolling a sufficient number of countries having trained staff and linking them to expert mentors in order to pilot the economic burden tool. The global estimates of mortality and morbidity will depend on the quality of the national data that is collected and analysed.
10
Excerpt from PIP PC Implementation Plan 2013-2016: http://www.who.int/influenza/ pip/pip_pcimpplan_17jan2014.pdf?ua=1
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 35
Graph 17: Burden of Disease 2014 Budget and Expenditure by Output
Regionally representative estimates
$ 94,254 $ 743,000
$0
Global estimates
$ 85,000 Expenditure Budget
$ 94,254
TOTAL
$ 828,000
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
36 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
E. Regulatory Capacity Building
Regulatory Outcome & Outputs11 Outcome Countries with weak or no regulatory capacity will be able to regulate influenza products including vaccines, antivirals and diagnostics, and to accelerate national approval of these commodities in case of an influenza pandemic.
Overview of financial implementation Implementation of activities funded by the PIP PC started in mid-2014, and extended to seven recipient countries, and across all three Outputs. Implementation rates for Output 1, Output 2 and Output 3 were 97%, 5% and 0% respectively as shown in Graph 18 below. The overall financial implementation rate was 5%. Again, Ebola affected implementation, especially for Output 2, given that assessments had been planned in a significant number of African countries. There were also difficulties in scheduling NRA assessments in other regions. Under Output 3, although financial implementation was zero, technical progress was made.
• Output 1 Develop guidelines on regulatory preparedness for non-vaccine producing countries that enables them to expedite approval of influenza vaccines used in national immunization programs and/or deployed by United Nations agencies in response to a pandemic emergency Output 2 NRA capacity to regulate influenza products including vaccines, antivirals and diagnostics is strengthened Output 3 Regulatory processes to accelerate approval of influenza vaccines, antivirals and diagnostics during a public health emergency are incorporated into deployment plans for pandemic influenza products
Regulatory capacity In countries receiving vaccines from UN agencies, or countries that self-procure vaccines, the WHO harmonised assessment tool,12 defines three essential regulatory functions that are required to enable approval of influenza products at the time of a pandemic: a functioning regulatory system; a process for granting marketing authorisation; and a system for pharmacovigilance, with a focus on monitoring adverse events following immunization (AEFI). During an NRA Assessment, each country is assessed for its capacities in each of these functions and is scored between 0 to 100%. The baseline scores for 11 of the 16 PIP priority countries for Regulatory Capacity Building under the PIP PC Plan, as measured in March 2014, are shown in Table 11. Because data from individual country NRA assessments are confidential, only aggregate figures are presented. A score of 50% is regarded as the minimum capacity level to function at the most basic level in a country sourcing vaccines from UN Agencies or those selfprocuring. These baseline figures (which will be updated in March 2015) show that for the 11 countries for which complete data was available in March 2014, the area of greatest capacity building needs, is pharmacovigilance, although there is a wide range of capacities in all three areas (cf. spread between the highest and lowest scores). Regulatory system and marketing authorization capacities are generally stronger, but there is still need for improvement.
• •
2014 priority countries In 2014, the following countries received support under the PIP PC: Cambodia, Democratic Republic of the Congo (DRC), Georgia, Ghana, Kenya, Lao People’s Democratic Republic (Lao PDR), Nepal. Table 10: Regulatory Capacity Building 2014 Budget and Expenditure by Output (US$) 2014 BUDGET
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
30,000 1,625,500 340,000 1,995,500 29,210 74,779 0 103,989 5%
Output 1 Output 2 Output 3 Total expenditure OVERALL IMPLEMENTATION RATE 11
12
Excerpt from PIP PC Implementation Plan 2013-2016: http://www.who.int/influenza/ pip/pip_pcimpplan_update_31jan2015.pdf?ua=1
See WHO webpage Immunization Standards: Harmonized NRA Assessment Tool: http://www.who.int/immunization_standards/national_regulatory_authorities/ tools_revision_2014/en/
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 37
Overview of technical progress Overall, limited but significant progress was made in this area of work. The slow progress was partly due to the need to integrate PIP work with the NRA assessment program, which has been undergoing a re-organization to ensure that support for regulatory system strengthening is harmonized across vaccines, medicines and diagnostics. As a result, there were delays in conducting assessments in 2014. Nevertheless, some significant assessments were carried out in 5 of the 16 priority countries and capacity strengthening has begun. In addition, the ‘Collaborative procedure between WHO PQ of Medicines Programme and national medicines regulatory authorities in the assessment and accelerated national registration of WHO prequalified pharmaceutical products and vaccines’ was reviewed and revised by the WHO Expert Committee on Specifications for Pharmaceutical Preparations (ECSPP). Further consultations on these documents, and implementation workshops, are scheduled for 2015. Output 1 An inventory and review of existing WHO guidance of regulatory requirements relevant to pandemic influenza was completed. The workshop to develop the outline, scope and purpose of the regulatory guidance on pandemic influenza preparedness for non-vaccine producing countries is scheduled for June 2015.
•A
•
Output 3 revision of the expedited review procedure to facilitate licensing of pre-qualified antivirals and vaccines began. The new ‘Collaborative procedure’ addressing the assessment and accelerated national registration of WHO prequalified pharmaceutical products and vaccines was developed. The ‘Collaborative procedure’ was endorsed by the ECSPP in October 2014. Follow-up implementation workshops are planned.
Challenges The main challenge has been in encouraging priority countries to give sufficient attention to regulatory capacity building in an environment where: in-country resources for follow-up are limited; there are heavy demands from multiple donors (e.g. World Bank, GAVI, Global Fund, Gates Foundation, others); and there are competing public health priorities (e.g. Ebola outbreak). For priority countries in the African Region, the Ebola crisis has inhibited progress. Despite these difficulties, it is expected that work will be expanded and accelerated in 2015.
•
• Under Output 1, in June 2015, there will be a working group consultation to begin preparation of the guidelines on regulatory preparedness, with a followup international consultation in November.
Output 2 Following the development of the Joint (medicines and vaccines) NRA assessment tool in March 2014, NRA were completed in Kenya, Democratic Republic of the Congo, Ghana, Georgia and Nepal. The DRC assessment was undertaken jointly for vaccines and medicines, while the assessment in Kenya was undertaken for vaccines, medicines and diagnostics. All other assessments focused on regulatory capacity for vaccines. The regulatory capacity for marketing authorization and AEFI monitoring of influenza vaccines as well as pandemic influenza preparedness were specifically assessed in these countries. The resulting IDP (Institutional Development Plans) address weaknesses and propose concrete and costed actions for the country to implement. In all the aforementioned countries, as well as Bolivia, updated IDPs are being executed. All assessment and IDP updates have been uploaded to the WHO NRA share point13 and activities have been documented in the NRA Activity Planning and Monitoring System (APMS) 14.
•
• Under
Output 2, NRA assessments are planned for Armenia, Cambodia, Lao PDR, Pakistan and Sri Lanka. Training will be provided for regulators on marketing authorization of influenza products (vaccines, antivirals and diagnostics) pharmacovigilance including AEFI monitoring and Quality Management Systems (QMS) and review of Pre-Qualification dossiers. regulation and deployment of pharmaceutical products and vaccines during public health emergencies, mapping countries with licensed influenza vaccines that accept the expedited review procedure and developing criteria to facilitate licensing of pandemic influenza vaccines in emergencies.
• Under Output 3 there will be a PIP funded workshop on
13 14
See: http://workspace.who.int/sites/att/default.aspx See: https://extranet.who.int/gavi/NRAPlanning/Login.aspx
38 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Graph 18: Regulatory Capacity Building 2014 Budget and Expenditure by Output $ 29,210
Guidelines
$ 30,000
Targeted training
$ 74,779 $ 1,625,500
Common approach for accelerated approval
$0 $ 340,000
Expenditure Budget
$ 103,989
TOTAL
$ 1,995,500
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
Table 11: Baseline NRA capacities for 11* PIP priority countries (March 2014) PIP PRIORITY COUNTRIES REGULATORY SYSTEM MARKETING AUTHORISATION PHARMACOVIGILANCE
Average % Lowest % Highest % No. countries with <50%
63 40 91 2
63 40 92 1
57 33 92 5
* 10 countries were assessed between 2011-2013; 1 country was assessed in 2009
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 39
F. Planning for Deployment
Planning for Deployment Outcome & Outputs15 Outcome Plans for deployment of pandemic supplies including vaccines, antivirals and diagnostics, will be developed and regularly updated.
Overview of technical progress Many lessons were learned from the 2009 A(H1N1) pandemic regarding the deployment of pandemic products.16 Two key areas in particular delayed rapid deployment of response products. 1) Countries were slow to achieve “readiness” requirements. This was partly because requirements were too complex and partly because countries required technical assistance in a range of areas, and such assistance was not available. The time it took for countries to reach full readiness to receive pandemic vaccine donations in 2009-2010, is shown in Graph 21. In response, the PIP PC Planning for Deployment area of work seeks to accelerate readiness by simplifying national planning processes and requirements and to facilitate rational technical assistance when readiness factors are at-risk. 2) There were inefficiencies in vaccine delivery due to the failure of supply systems to match demand. The main causes were shortages in global cold chain capacity and frequent changes in demand from countries. In response, under the PIP PC Planning for Deployment a mapping of the international cold chain will be undertaken and simulation scenarios will be developed to formulate solutions to the most common demand changes. Very little progress has been possible in this area due to the Ebola crisis which placed critical demands on all logistics staff. There are, however, a number of work products in progress which are expected to be completed in the second quarter of 2015.
• Output 1 • A common approach to manage deployment operations is developed and shared with stakeholders and deployment partners. Output 2 Country deployment readiness systems are simplified and updated.
2014 priority countries In 2014, no countries received PIP PC funds under this area of work. Table 12: Planning for Deployment 2014 Budget and Expenditure by Output for (US$) 2014 BUDGET
Output 1 Output 2 Total budget 2014 EXPENDITURE
641,000 65,625 706,625 0 48,861 48,861 7%
Output 1 Output 2 Total expenditure OVERALL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in late-2014, and extended across both Outputs. The implementation rate for Output 1 was 0% and for Output 2 was 74% as illustrated in Graph 19. The financial implementation rate for the area of work as a whole at the end of 2014 was 7%. The overall rate of financial implementation was very low at 7%, almost entirely due to the limited human resource within WHO for logistics being diverted to work on the Ebola crisis. However, several significant activities are underway and due for completion in the second quarter of 2015.
15
Excerpt from PIP PC Implementation Plan 2013-2016: http://www.who.int/influenza/ pip/pip_pcimpplan_17jan2014.pdf?ua=1 See: http://apps.who.int/iris/bitstream/10665/78414/1/9789241503051_eng.pdf
16
40 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Graph 19: Planning for Deployment 2014 Budget and Expenditure by Output $0 $ 641,000
Deployment operations
$ 48,861
Expenditure Budget
Country readiness
$ 65,625
$ 48,861
TOTAL
$ 706,625
$0
$200,000
$400,000
$600,000
$800,000
Graph 20: Time to reach full “readiness” during A(H1N1) pandemic (2009-2010) Number of countries fulfilling pre-supply requirements
40 30 20 10 0 b 2 er 00 9 Oc b to 2 er 00 9 b 2 er 00 9 em ec b 2 er 00 9 10 10 20 20 y y r ar ua nu br e Ja F ch ar 20 10 10 20 l i r Ap M 2 ay 01 0 Ju 2 ne 01 0 J y ul 20 10 g Au 2 us 01 0
Se
em pt
m ve No
M
D
Letter of intent
Letter agreement
National deployment plan
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 41
Challenges As the Ebola crisis lessens, the small pool of WHO logistics staff will become increasingly available to carry out PIP tasks as planned, and implementation will significantly increase in 2015. Plans for 2015 include the development of a prototype common approach deployment simulation tool that will be sent to stakeholders, partners and then to countries for feedback before being finalised. The tool will then be used to conduct simulation exercises to familiarize all potential users. A mapping of global logistics capacities will also be undertaken and the results will be used to adapt the tool as necessary. Finally, during 2015 the requirements for country readiness will be defined, accompanied by the necessary technical support packages and templates. These materials will include a revised national deployment plan template and a model country recipient agreement. For deploying antiviral medicines, standard operating procedures will be developed along with tools for estimating target populations by risk category and socio-economic group.
42 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
G. Risk Communications
Risk Communications Outcome & Outputs17 Outcome Global risk communications capacities are strengthened with a special focus on pandemic influenza communications.
Table 13: Risk Communications 2014 Budget and Expenditure by Output for (US$) 2014 BUDGET
• Output 1 Access to risk communications training and platforms is increased enabling all countries to respond more effectively to a potential influenza pandemic or other Public Health Emergencies of International Concern (PHEIC). Output 2 Risk communications capacity is established in priority countries with little or no capacity. Output 3 Global Emergency Communications Network (ECN) operationalized to provide support to countries before, during and after public health emergencies
Output 1 Output 2 Output 3 Total budget 2014 EXPENDITURE
1,070,100 260,000 611,400 1,941,500 459,913 143,549 209,807 813,269 42%
• •
Output 1 Output 2 Output 3 Total expenditure OVERALL IMPLEMENTATION RATE
Overview of financial implementation Implementation of activities funded by the PIP PC started in January 2014 and extended to the targeted countries and across all three outputs. The financial implementation rate for the area of work was 42%. Implementation rates for Output 1, Output 2 and Output 3 were 43%, 55% and 34% respectively, and are shown in Graph 22. Implementation was stronger in this area of work than in others. This was partly due to the work beginning at the start of the year rather than at mid-year, as was true for all other areas of work, but was also a result of the Ebola crisis. Because of that crisis there was increased awareness of the need for effective risk communications and as a consequence, there were increased demands from countries for risk communications support.
2014 priority countries In 2014, the following countries received support under the PIP PC: Bangladesh, Bhutan, the Eastern Caribbean (Barbados, Dominica, Saint Lucia, Saint Vincent & the Grenadines), Egypt, Indonesia, Kazakhstan, Moldova, Nepal, Pakistan, Sudan, Suriname, Timor-Leste, Turkey, Ukraine, Uzbekistan, Viet Nam.
17
Excerpt from PIP PC Implementation Plan 2013-2016: http://www.who.int/influenza/ pip/pip_pcimpplan_17jan2014.pdf?ua=1
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 43
Overview of technical progress As of 31 December 2014, the self-reported Risk Communications capacity18 increased from 100 countries to 134, thereby exceeding the target of 120 countries. Large increases over the baseline were seen across all Regions: AFRO +62%; AMRO +57%; EMRO +27%; EURO +15%; SEARO +22%; WPRO +25%. However, 23 countries actually reported a decrease in capacity (by more than –5%) from the baseline measurement of 2013. While these figures are complex to interpret, one can observe an overall positive trend in the evolution of risk communications capacity according to Member State self-reporting. Decreases may be attributable to over-optimistic assessments or loss of limited capacity, mainly due to human resources movement. This observation reinforces the need for continuous monitoring and support until countries have developed self-sustaining and adequate capacities.
•
•
•
•
Output 1 A wide range of risk communication materials were developed, including on-line risk communication training material, a risk communications training manual, guidance on national capacity building, vaccine hesitancy training material and a risk communications capacity self-assessment tool. The demonstration and promotion of this material at many events and training sessions significantly improved awareness of and access to risk communications tools. This will allow Member States to review or build multi-hazard risk communications plans that include preparedness for pandemic influenza or other PHEICs. Collaboration with key partner institutions (e.g. OIE, US CDC, UNICEF, IFRC) is helping to ensure that similar, proven and more coordinated approaches to risk communications are used and that coordinated capacity building efforts in Member States are synergised. Partnerships with the Harvard School of Public Health, Hong Kong University and other reputed academic institutions are underway to create the evidence-based measurements of both risk communications outcomes and interventions for national risk communications capacity building. Based on member states self-reporting, the number of countries that meet 50% of the IHR risk communications milestones increases from 100 to at least 120 countries by the end of 2016
Output 2 Improved risk communications capacity has been achieved across many Member States. For example, risk communications training was delivered to 395 participants from 45 countries. As an example, two sub-regional workshops were held (in South East Europe and the Caribbean states). These included simulation exercises of the top hazards currently faced by a country, followed by the appearance of a novel influenza virus with pandemic potential. Support and training, has been driven by demand from countries generated through sensitisation work, or on requests due to emergencies (including Ebola, MERS CoV, influenza, cholera and dengue) that required additional support. While non-priority countries also received support, the spin-off benefit has been that lessons learnt in responding to these requests has led to further improvement of learning materials and tools. National risk communication plans and associated SOPs have been developed in Viet Nam and Sudan, respectively. Work with media started with the development and testing of learning materials and provision of media training in Kyrgyzstan, Viet Nam and at a South-East Asia regional training event for 10 countries. Where journalists have been briefed/trained, there is already an observably stronger interest and better interaction on health stories. This development and the increased interest in risk communications has been spurred by the topicality of Ebola in 2014.
•
• •
•
•
18
Output 3 While the initial plan for year 1 was to set up systems for the operationalization of the ECN concepts, the Ebola crisis and other demands from countries (e.g. for support in dealing with Influenza or MERS-CoV) triggered an accelerated implementation of the ECN concept. While the ECN provides mechanisms, tools and procedures, the emergency operations themselves are led and financed by the outbreak response department or humanitarian emergency departments. The large number of deployments (35 ECN members and 12 non-ECN members to over 10 countries) has provided extensive support to these countries. It has also generated learning that will be integrated during the further systematisation of ECN planned for 2015.
44 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Challenges As with all new programs, one of the key challenges is to create and sustain the momentum and buy-in from Member States to engage actively in capacity building activities. The aim at this early stage was to advocate that risk communications capacity building be taken more seriously. In that sense, the Ebola crisis highlighted the critical need for effective risk communications. Sensitization and introductory training events showed good participation of technical staff and consequently events at the political level are now scheduled. Similarly to other areas of work, the Ebola crisis diverted limited resources away from PIP activities. However, as previously stated, the crisis highlighted the need for effective risk communications and provided an opportunity for WHO to promote a multi-hazard approach to emergency preparedness, including for influenza. During 2014, investment was focussed on developing training materials and tools, piloting training events, working with a limited number of countries and putting Emergency Communications Network (ECN) systems in place. A priority for 2015 will be to intensively assist countries establish effective and sustainable risk communication systems that can also be used in time of pandemic.
Additional priorities for 2015 include: Scaling-up activities by focusing on: further improving access to online training materials; translating tested learning materials and tools into additional languages; rolling-out country-level training on a larger scale; scaling-up mentoring activities in countries; and expanding the pool of ECN trainees through two additional training events in English and French. Finalizing evidence-based measures for monitoring the effectiveness of risk and pandemic risk communication activities along with associated capacity building. Focusing on impact measurement and systems to allow WHO to adjust its risk communications capacity building program to the needs and demands of countries. Maintaining and extending the collaborative approach to risk communications capacity building across disease programs and with other agencies. This will improve the sustainability of capacity building and improve cross-sectoral coordination during outbreak response.
•
• • •
Graph 21: Risk Communications 2014 Budget and Expenditure by Output Training on risk communication Support to priority countries $ 459,913 $ 1,070,100
$ 143,549 $ 260,000 Expenditure
Emergency communications network
$ 209,807 $ 611,400
Budget
$ 813,269
TOTAL
$ 1,941,500
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 45
4. PIP Secretariat
General Functions The PIP Secretariat is the unit within WHO that manages, administers, and/or coordinates, as appropriate, implementation of the PIP Framework as a whole, and the Partnership Contribution in particular. The PIP Secretariat sits within the Health Security Cluster at WHO Headquarters, and within that, in the Department of Pandemic and Epidemic Diseases, Global Influenza Programme. In 2014, it had six staff to manage and implement all components of the PIP Framework – virus sharing, benefit sharing and governance. The PIP Secretariat aims to implement the PIP Framework to the fullest in as transparent, efficient and effective a manner as possible – building a new partnership paradigm with its many stakeholders – to achieve the goal of strengthening pandemic influenza preparedness as an integral part of increased global public health security. As such, to date, activities carried out by the PIP Secretariat have included the following:
Benefit Sharing SMTA 2/Legal Negotiate and conclude Standard Material Transfer Agreements 2 (SMTA2) Coordinate and facilitate the process related to handling genetic sequence data under the PIP Framework
• •
• Collection
Partnership Contribution - Research to identify potential contributors - Maintain contributor database - Develop and issue annual on-line Questionnaire - Issue Band Selection and Certification Form - Prepare invoices - Draft and publish reports PC Implementation - Coordinate and manage development, review and approval of work plans & budgets across RO and HQ - Monitor implementation - Prepare evidence-based technical and financial reports
•
Virus Sharing
• Provide •
support as needed to GISRS labs on PIP Framework implementation Maintain, review and upgrade the Influenza Virus Traceability Mechanism (IVTM), as appropriate
Governance
• Ensure coordination, coherence, and synergy across • • Organizational programmes and initiatives Manage all actions related to the Advisory Group Spearhead the 2016 Review
Communications & Outreach
• Develop • •
targeted, informative and user-friendly communications products Coordinate media interactions Maintain and update PIP webpage
The PIP Secretariat is funded in part, through Partnership Contribution resources. Indeed, given the breadth of the activities to be implemented under the PIP Framework, the PIP Secretariat also seeks additional support through extra-budgetary grants for specific components, such as the conclusion of SMTAs 2.
46 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Implementation of PC Preparedness funds In 2014, in collaboration with, and through the strong support of, the six WHO Regional Offices and many departments and divisions across WHO Headquarters, the PIP Secretariat undertook the following with respect to implementation of PIP PC funds: 1) Established project management processes and procedures Standardized templates and procedures, with associated guidance notes, were developed for use by all Regions and Departments receiving PIP PC preparedness funds. The documents establish standard approaches to technical and financial project planning, monitoring, review, and reporting. 2) Oversaw development of work plans and distribution of funds Following approval of the PIP PC Implementation Plan 2013–2016 by the WHO Director-General in January 2014, work plans were developed by all recipients of PIP PC using the standardized templates and procedures mentioned above. This resulted in a common work plan structure that allows aggregated financial and narrative reporting at global, regional and country levels across all Outputs, Outcomes and Key Deliverables. Between May and August 2014, 54 work plans were approved and approximately US$ 17.36M was distributed. Funds cover both staff and activity costs, as more fully detailed herein. 3) Developed a global PIP PC team Implementation of a program as ambitious as the PIP PC Implementation Plan 2013–2016 requires dedicated human resources to ensure timely, effective, coordinated and accountable implementation across the Organization. During 2013, PIP Focal Points were designated within each Regional Office, as well as at Headquarters for each Area of Work. These PIP Focal Points have overall responsibility for all PIP Framework activities within their Region, or, in the case of HQ, their Areas of Work. No PIP PC funds are used to support the salary of PIP Focal Points.
At the same time, it was recognized that distribution of PIP PC funds to Regions and HQ departments for implementation of preparedness activities would require significant oversight and management. As such, a PIP PC Project Manager was recruited at each Regional Office and at Headquarters in the PIP Secretariat. These staff are dedicated 100% to the implementation and management of PIP PC activities and their salaries are covered by PIP PC funds. Additionally, at HQ, each area of work has funds set aside to cover part or all of the salary of staff that implement PC activities. Every effort has been –and continues to be – made to limit the funds allocated to supporting WHO staff. Thus, across all 3 levels of WHO and across all five Areas of Work significant numbers of professional and administrative staff support PIP Framework implementation without charge to PIP funds. 4) Built synergies across programs Closely linked to the effort to develop a global team was the recognition that PIP PC funds should supplement and complement preparedness capacity building efforts undertaken in other programs or initiatives. Thus, the global team building efforts included working with colleagues in the Global Action Plan for Influenza Vaccines (‘GAP’) and the International Health Regulations 2005 (‘IHR’) to ensure that PIP PC work plans support additional, rather than duplicative or replacement, activities. 5) Improved communications with stakeholders Significant efforts were made to increase the frequency and enhance the quality of communications with stakeholders. The following communication products were developed and released: PIP PC Implementation Portal: a web-based system to increase transparency and information about the use of funds received from manufacturers under the annual Partnership Contribution and detailed in the PIP PC Implementation Plan (2013-2016) PIP Framework e-Newsletter : a bi-monthly news brief on implementation of the PIP Framework, distributed to a mailing list of over 2000 recipients Critical Path Analysis (CPA): a technical document that provides a high level overview of the complex, multi-sectoral path that starts at the time of the detection of a new influenza virus and culminates
•
• •
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 47
•
with the protection of the global community. The CPA shows the extent of the work to be undertaken to strengthen global capacities, highlights the areas that are weakest and need strengthening, and serves as the roadmap for the current and next phases of work. PIP Brochure: an advocacy document that explains the purpose of the PIP Framework, its components and its importance in pandemic influenza preparedness and response
In addition to these products, the Secretariat instituted bi-monthly “information dialogues”, via teleconference, with industry and civil society organizations. These provide a regular opportunity for the Secretariat to update stakeholders on implementation and allow stakeholders to ask questions of the Secretariat. Feedback on these initiatives has been positive.
48 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
5. Financial implementation
As specified in the Framework, Partnership Contributions are paid annually, commencing in 2012.19 As of 31 December 2014, the total received was $60,642,259 (see Graph 22). In May 2012, the Executive Board decided that for the period 2012-2016, 70% of resources should be allocated to preparedness and 30% to response.20 In addition, in March 2013, the Director-General accepted a recommendation from the Advisory Group that a portion of PC funds, not exceeding 10%, averaged over the years 2013-2016, should be used by the PIP Secretariat to enable work, either on-going but at risk, or not yet undertaken because of lack of funds, to be made possible so as to meet the objectives of the PIP Framework.21 Graph 23 shows the funds assigned to preparedness, response and the PIP Secretariat.
Graph 22: Receipts, by year of invoice (US$) 70 $60,642,259 60 2014: $15,048,215
50 2013: $27,473,044
Millions
40
30
20 2012: $18,121,000
10
0 2012 2013 2014
Graph 23: Assignment of PC Funds to Preparedness, Response and the PIP Secretariat
$6,064,227
$16,373,412 $38,204,620
Preparedness
Response
PIP Secretariat
19 20
See: PIP Framework Section 6.14.3. See: http://apps.who.int/gb/ebwha/pdf_files/EB131/B131_4-en.pdf?ua=1 and http:// apps.who.int/gb/ebwha/pdf_files/EB131-REC1/B131_REC1-en.pdf#page=18 See: http://www.who.int/influenza/pip/pip_pcimpplan_17jan2014.pdf?ua=1 at page 6.
21
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 49
Preparedness
Preparedness Assignment As of 31 December 2014, $60,642,259 had been received by WHO. Of that, $38,204,620 were assigned to Preparedness (Graph 24). At the time of development of 2014 work plans, $25.3m was available for Preparedness. A total of $17.36m was distributed against approved work plans, while $7.9m was not distributed at that time. The $17.36m was distributed across the five Preparedness Areas of Work (Graph 27) to seven WHO Major Offices (Graph 28). Graph 24: Funds assigned to Preparedness, by year of invoice (US$) 45 40 35 30 2013: $17,308,016
$38,204,620 2014: $9,480,375
Millions
25 20 15 10 5 0 2012 2013 2014 2012: $11,416,229
50 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Graph 25: Timeline of receipts, and funds available for Preparedness in 2014 (US$) 70 60 50 40 30 20 10 $25,261,355 available for preparedness
De
c-
12
3 13 13 l-13 -13 t-13 13 r-13 r-13 -1 nnba p ay Ju Aug Ja Ju Ap Fe M M Se
4 3 4 4 4 3 3 14 14 t-14 t-14 -14 14 r-14 r-14 -1 -1 l-1 t-1 ov-1 ec-1 an-1 cv gba p ay Jun Ju J Oc No Oc Ap Fe De D M N Au M Se
Overall funds
Preparedness
Response
Secretariat
Graph 26: Status of preparedness funds, 2014 (US$)
$17,363,945
$7,897,410
0
5
10
15 Millions
20
25
30
Distributed
Not distributed
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 51
Graph 27: Budget distribution by Area of Work (US$) 14 $11,892,320
12 10 Millions
8 6 4 2 $828,000 $1,995,500 $1,941,500 $706,625
0 Laboratory & Surveillance Burden of Disease Regulatory Capacity Risk Communications Planning for Deployment
Graph 28: Budget distribution by Region/HQ and Area of Work (US$) 7 $6,270,625
6 5 4 Millions
WHO Major Office AF: African Region AM: Region of the Americas EM: Eastern Mediterranean Region EU: European Region SE: South-East Asia Region WP: Western Pacific Region HQ: Headquarters
3 $2,121,300
$2,256,500 $1,645,750 $1,531,942
$2,236,575
Laboratory & Surveillance Burden of Disease Regulatory Capacity Risk Communications Planning for Deployment
2 $1,301,253
1 0 AF AM EM EU SE WP HQ
52 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Implementation
Implementation As of 31 December 2014, total Preparedness expenditures were $6,113,652. Further breakdowns of budgets, expenditures and implementation rates are shown in the following tables:
• Table 14: by WHO region and HQ • Table 15: by Area of Work • Table 16: by Region and L&S Output • Table 17: by HQ Area of Work and Output • Table 18: by staff and activities
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 53
Table 14: 2014 Budget and expenditure by WHO region and HQ (US$) REGION/HQ BUDGET EXPENDITURE % IMPLEMENTATION
African Region Region of the Americas Eastern Mediterranean Region European Region South-East Asia Region Western Pacific Region Headquarters Direct costs sub-total PSC TOTAL
1,301,253 2,121,300 2,256,500 1,531,942 1,645,750 2,236,575 6,270,625 17,363,945 17,363,945
169,554 660,341 454,228 974,921 535,069 1,288,851 1,327,347 5,410,311 703,341 6,113,652
13 31 20 64 33 58 21 31 35
Table 15: 2014 Budget and expenditure by Area of Work (US$) AREA OF WORK OUTPUT BUDGET EXPENDITURE % IMPLEMENTATION
Laboratory & Surveillance Detection capacity Monitoring capacity Strengthening networks Sub-total Burden of Disease Regionally representative estimates Global estimates Sub-total Regulatory Capacity Guidelines Targeted training Common approach for accelerated approval Sub-total Risk Communications Training on risk communication Support to priority countries Emergency communications network Sub-total Planning for Deployment Deployment operations Country readiness Sub-total Direct costs sub-total PSC TOTAL
4,011,000 3,031,200 4,850,120 11,892,320 743,000 85,000 828,000 30,000 1,625,500 340,000 1,995,500 1,070,100 260,000 611,400 1,941,500 641,000 65,625 706,625 17,363,945 17,363,945
1,341,714 1,067,486 1,940,738 4,349,938 94,254 94,254 29,210 74,779 103,989 459,913 143,549 209,807 813,269 48,861 48,861 5,410,311 703,341 6,113,652
33 35 40 37 13 11 97 5 2 5 43 55 34 42 74 7 31 35
54 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Table 16: 2014 Budget and expenditure for WHO Regions, by L&S Output (US$) AREA OF WORK OUTPUT BUDGET EXPENDITURE % IMPLEMENTATION
African Region
Detection capacity Monitoring capacity Strengthening networks Sub-total
158,000 475,000 668,253 1,301,253 365,600 291,400 1,464,300 Sub-total 2,121,300 977,500 780,500 498,500 Sub-total 2,256,500 423,000 369,500 739,442 Sub-total 1,531,942 842,000 400,000 403,750 Sub-total 1,645,750 1,201,900 502,800 531,875 Sub-total 2,236,575 11,093,320 11,093,320
33,321 136,234 169,554 66,480 134,023 459,839 660,341 104,637 174,946 174,645 454,228 230,645 283,393 460,883 974,921 160,918 195,391 178,759 535,069 745,712 275,827 267,311 1,288,851 4,082,964 530,785 4,613,749
21 20 13 18 46 31 31 11 22 35 20 55 77 62 64 19 49 44 33 62 55 50 58 37 42
Region of the Americas Detection capacity Monitoring capacity Strengthening networks Eastern Mediterranean Region Detection capacity Monitoring capacity Strengthening networks European Region Detection capacity Monitoring capacity Strengthening networks South-East Asia Region Detection capacity Monitoring capacity Strengthening networks Western Pacific Region Detection capacity Monitoring capacity Strengthening networks Direct costs sub-total PSC TOTAL
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 55
Table 17: 2014 Budget and expenditure for Headquarters, by Area of Work and Output (US$) AREA OF WORK OUTPUT BUDGET EXPENDITURE % IMPLEMENTATION
Laboratory & Surveillance Detection capacity Monitoring capacity Strengthening networks Sub-total Burden of Disease Regionally representative estimates Global estimates Sub-total Regulatory Capacity Guidelines Targeted training Common approach for accelerated approval Sub-total Risk Communications Training on risk communication Support to priority countries Emergency communications network Sub-total Planning for Deployment Deployment operations Country readiness Sub-total Direct costs sub-total PSC TOTAL
43,000 212,000 544,000 799,000 743,000 85,000 828,000 30,000 1,625,500 340,000 1,995,500 1,070,100 260,000 611,400 1,941,500 641,000 65,625 706,625 6,270,625 6,270,625
3,907 263,068 266,974 94,254 94,254 29,210 74,779 103,989 459,913 143,549 209,807 813,269 48,861 48,861 1,327,347 172,555 1,499,902
2 48 33 13 11 97 5 5 43 55 34 42 74 7 21 24
Table 18: 2014 Budget and expenditure for staff and activities (US$) COST CATEGORY BUDGET EXPENDITURE % IMPLEMENTATION
Activities Staff Direct costs sub-total PSC TOTAL
14,417,110 2,946,835 17,363,945 17,363,945
4,429,498 980,813 5,410,311 703,341 6,113,652
31 33 31 35
56 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Response
Response As specified by the Executive Board in May 2012, 30% of funds received are reserved for pandemic response activities. In October 2014, following consultations with industry and civil society, the Advisory Group submitted to the Director-General Guiding Principles for use of PIP Partnership Contribution ‘Response’ Funds. These were accepted by the Director-General in November 2014.22 All of the funds assigned to response remain in reserve for use when a pandemic occurs. Graph 29: Funds assigned to Response, by year of invoice (US$) 18 $16,373,412 16 14 12 Millions 10 8 6 4 2 0 2012 2013 2014 2012: $4,892,671 2013: $7,417,723 2014: $4,063,018
Graph 30: Status of response funds, 2014 (US$)
$16,373,412
0
5
10 Millions
15
20
Distributed
Not distributed
22
See: http://www.who.int/influenza/pip/guiding_principles_pc_response_funds. pdf?ua=1
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 57
PIP Secretariat
PIP Secretariat As directed by the Director-General a portion of PC funds not exceeding 10%, averaged over the years 2013-2016, was assigned for use by the PIP Secretariat (Graph 31). As of 31 December 2014, $2,950,939 was distributed to the PIP Secretariat (Graph 32). Expenditures for the PIP Secretariat during 2013 and 2014 were $2,950,939.
Graph 31: Funds assigned to the PIP Secretariat by year of invoice (US$) 7 $6,064,227 6 2014: $1,504,822
5 2013: $2,747,305
Millions
4
3
2
2012: $1,812,100
1
0 2012 2013 2014
Graph 32: Status of PIP Secretariat funds, 2014 (US$)
$2,950,939
$3,113,288
0
1
2
3 Millions
4
5
6
7
Distributed
Not distributed
58 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
Table 19: Budget and expenditure for the PIP Secretariat BIENNIUM BUDGET EXPENDITURE % IMPLEMENTATION
2012-2013 2014-2015 Direct costs sub-total PSC TOTAL
1,312,656 2,938,938 4,251,594 4,251,594
929,290 1,682,160 2,611,450 339,489 2,950,939
71 57 61 69
Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 59
Table 20: Overall Summary of 2014 Expenditures (31 December 2014) (US$) 2013/16 BUDGET ALLOCATED IN 2014 SPENT IN 2014
PREPAREDNESS
Laboratory & Surveillance 19,430,500 4,011,000 3,031,200 4,850,120 11,892,320 743,000 85,000 828,000 30,000 1,625,500 340,000 1,995,500 1,070,100 1,802,000 1,500,000 Sub-total Deployment operations Country readiness Sub-total 5,832,000 1,276,000 343,000 1,619,000 69,674,500 2,870,836 32,834,271 105,379,607 11,515,133 13,226,260 130,121,000 260,000 611,400 1,941,500 641,000 65,625 706,625 17,363,945 16,445,469 15,302,259 49,111,673 5,366,574 6,164,037 60,642,284 17,494,000 12,234,000 Sub-total 49,158,500 5,055,000 960,000 Sub-total 6,015,000 735,000 5,815,000 500,000 7,050,000 2,530,000 Sub-total Training on risk communication Support to priority countries Emergency communications network Guidelines Targeted training Common approach for accelerated approval Regionally representative estimates Global estimates Monitoring capacity Strengthening networks
Detection capacity
1,341,714 1,067,486 1,940,738 4,349,938 94,254 94,254 29,210 74,779 103,989 459,913 143,549 209,807 813,269 48,861 48,861 5,410,311 5,410,311 2,611,450 1,042,829 9,064,590
Burden of Disease
Regulatory Capacity
Risk Communications
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Planning for Deployment
Total for Preparedness
Planning contingency / not yet allocated*
Response
Total for Preparedness & Response
Secretariat
PSC**
TOTAL
* The Planning Contingency will be assigned to Preparedness or Response components, as warranted by achievement of deliverables and circumstances. The current amount corresponds to funds not yet allocated to specific Preparedness activities;
** 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.;
*** 2012-2014 expenses
Annex 1. Laboratory & Surveillance indicator definitions
INDICATOR SHORT NAME NO CAPACITY PARTIAL CAPACITY CAPACITY ESTABLISHED
INDICATOR RATIONALE
Country plan Discussion with MoH not yet started. The plan being discussed between WHO CO/RO and MOH and is under review.
This indicator measures the degree to which the country is actively participating in the planning for the work to be accomplished. Ideally this plan would be a MOH Plan or it could be developed by the Country Office and agreed to by the MOH. It can be simple but should contain activities for targeted improvements, timelines and budgets. No integration in a national plan/ national plans. Agreed to be part of a national plan/national plans with integration under development.
An implementation plan agreed between MoH and WHO CO/RO in place.
Sustainability
This indicator measures the integration of this project into an overall national plan to increase the chance for long term sustainability of the capacity building efforts. The high level activities of this project can be part of a national plan for surveillance, preparedness and response, etc. No NIC designated by MOH. NIC designated by country, pending WHO recognition. Potential influenza PCR testing ability e.g. having PCR machine and reagents, but no evidence of functioning. At least one national laboratory participated but none achieved a 100% score on seasonal viruses in the last WHO influenza PCR EQAP. At least one national laboratory participated but none achieved a 100% score on non-seasonal viruses in the last WHO influenza PCR EQAP. Informal laboratory guidance or algorithm existing, but not formally documented and/or not strictly put in use. No influenza PCR testing ability.
Integrated with a national plan/ national plans.
NIC
This indicator measures progress towards a countrydesignated and WHO-recognized NIC (National Influenza Centre) status.
NIC recognized by WHO.
PCR testing
This indicator measures the country’s status with regards the ability to perform influenza PCR testing.
Influenza PCR testing actively being performed with evidence of reporting. At least one national laboratory participated and achieved a score of 100% on seasonal viruses in the last WHO influenza PCR EQAP. At least one national laboratory participated and achieved a score of 100% on non-seasonal viruses in the last WHO influenza PCR EQAP. Algorithm established, formally documented and strictly put in use.
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EQAP Seasonal No laboratory participated in the last WHO Influenza PCR EQAP. No laboratory participated in the last WHO Influenza PCR EQAP. No laboratory algorithm established.
This indicator measures the quality of the PCR testing to detect seasonal circulating viruses based on the performance in the last panel of the WHO Influenza PCR EQAP.
EQAP Non-seasonal
This indicator measures the quality of the PCR testing to detect non-seasonal influenza viruses with pandemic potential based on the performance in the last panel of the WHO Influenza PCR EQAP.
Algorithm
This indicator measures laboratory preparedness for detection of influenza viruses with pandemic potential.
INDICATOR SHORT NAME NO CAPACITY PARTIAL CAPACITY CAPACITY ESTABLISHED
INDICATOR RATIONALE
Reagents IRR Registered in IRR or agreement with WHOCCs but no reagents received in the past 18 months, and no other sources available for primers and other reagents in the past 18 months.
This indicator measures a country’s access to reagents through registration in the IRR or by agreement with a WHOCC, or through using WHOCC established SOPs with in-country capacity to synthesize/order/import primers etc. Not registered in IRR, and no agreement with WHOCCs, and no other sources available for primers and other reagents.
Registered user of IRR or agreement with WHOCCs with reagents received in the past 18 months; or reagents received from other sources in the past 18 months.
Shipping
This indicator measures a country’s ability to ship influenza No ISST in the past ISST received in the past 2 years clinical specimens/virus isolates with pandemic potential 2 years and no valid or valid export permit in place, out of the country to a WHOCC of GISRS with appropriate export permit. but not both. ISST (Infectious Substance Shippers Training) and export permit for such materials. No shipment in the past 12 months. One shipment in the past 12 months. In the past 12 months bulletins/ reports published in the public domain during the influenza season but less than once a month. Reports submitted for < 20 weeks in the Northern Hemisphere season (week40-week 20), or for <13 weeks in the Southern Hemisphere season (week18-week 40), or for < 32 weeks during the whole year for countries with year-round surveillance in the past 12 months. Reports submitted for < 20 weeks in the Northern Hemisphere season (week 40-week 20), or for <13 weeks in the Southern Hemisphere season (week18-week 40), or for < 32 weeks during the whole year for countries with year-round surveillance in the past 12 months. In the past 12 months no bulletin/ report published in the public domain. No report in the past 12 months.
ISST received in the past 2 years and valid export permit in place.
Sharing
This indicator measures a country’s sharing virus isolates and/or clinical specimens with WHOCCs.
At least 2 shipments in the past 12 months. In the past 12 months bulletins/ reports published in the public domain at least monthly during the influenza season. Reports submitted for 20 or more weeks during the Northern Hemisphere season (week 40-week 20), or for 13 or more weeks during the Southern Hemisphere season (Week 18 – Week 40), or for 32 or more weeks during the whole year for countries with year-round surveillance in the past 12 months. Reports submitted for 20 or more weeks during the Northern Hemisphere season (week 40-week 20), or for 13 or more weeks during the Southern Hemisphere season (Week 18 – Week 40), or for 32 or more weeks during the whole year for countries with year-round surveillance in the past 12 months.
Bulletins
This indicator measures the extent to which the data collected through influenza surveillance is collated into routine bulletins and shared in the public domain.
Virological data
This indicator measures the regularity of reporting virological data to WHO through FluNet and /or Regional Office Databases.
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Epidemiological data
This indicator measures the regularity of reporting epidemiologic data to WHO through FluID and/ or Regional Office Databases.
No report in the past 12 months.
INDICATOR SHORT NAME NO CAPACITY PARTIAL CAPACITY CAPACITY ESTABLISHED
INDICATOR RATIONALE
ILI ILI surveillance existing but with gaps in collecting data routinely* and submitting samples regularly** to a laboratory in the past 12 months. *19 or more weeks during the Northern Hemisphere influenza season (week 40 – week 20) or 13 or more weeks during the Southern Hemisphere season (week 18 – week 40), or 32 weeks or more during the whole year for countries with year-round surveillance. **ideally on a weekly basis, however no later than 1 month after collection of samples.
This indicator measures the country’s status with regard to the existence of a national surveillance system where patients with non-severe respiratory diseases such as ILI or similar are medically attended at an outpatient or provider setting. As a routine during the flu season, samples should be collected from a subset of patients and sent to a laboratory for diagnosis of influenza. This should be done as defined in the WHO Global Epidemiological Surveillance Standards for Influenza. No ILI surveillance (no active sites providing data or samples in the past 12 months)
ILI surveillance being carried out, samples being collected routinely* and sent to a laboratory regularly** in the past 12 months. *19 or more weeks during the Northern Hemisphere influenza season (week 40 – week 20) or 13 or more weeks during the Southern Hemisphere season (week 18 – week 40), or 32 weeks or more during the whole year for countries with year-round surveillance. **ideally on a weekly basis, however no later than 1 month after collection of samples.
SARI
This indicator measures the country’s status with regard to the existence of a national surveillance system where hospitalized patients with severe respiratory disease such as SARI are medically attended. As a routine samples should be collected ideally from all or a subset of patients and sent to a laboratory for diagnosis of influenza. This should be done as defined in the WHO Global Epidemiological Surveillance Standards for Influenza. No SARI surveillance (no active sites providing data or samples in the past 12 months)
SARI surveillance existing but with gaps in collecting data routinely* and submitting samples regularly** to a laboratory in the past 12 months. *32 weeks or more in a year. **ideally on a weekly basis, however no more than 1 month after collection of samples.
SARI surveillance being carried out, samples being collected routinely* and sent to a laboratory regularly** for diagnosis of influenza in the past 12 months. *32 weeks or more in a year. **ideally on a weekly basis, however no more than 1 month after collection of samples.
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Integration
This indicator measures whether laboratory and epidemiologic surveillance data are linked and integrated to produce surveillance updates.
No linkage of Laboratory and epidemiologic laboratory with data shared informally but no epidemiologic data. reports of integrated laboratory and epidemiologic data. No national Early Warning System such as Event Based Surveillance. Planning to establish a national Early Warning System e.g. relevant definitions, protocols, procedures and targeted training materials etc. under development.
Surveillance reports with integrated laboratory and epidemiological data published. Functional national Early Warning System with relevant definitions, protocols and procedures etc. in place.
EBS
This indicator measures the status of a national system to identify unusual or unexpected illness events. These systems are often called Event Based Surveillance (EBS) or “early warning” systems and use multiple sources of official and unofficial reports, including media reports.
INDICATOR SHORT NAME NO CAPACITY PARTIAL CAPACITY CAPACITY ESTABLISHED
INDICATOR RATIONALE
RRT
This indicator measures Rapid Response Team (RRT) No RRT established. RRT established, but no training training delivered through this project. The purpose of in the past 12 months. the training is to ensure that RRTs are trained and ready to respond to unusual events including human cases/clusters of infection with novel influenza viruses and outbreaks of severe respiratory diseases. No evidence of coordination. Ad-hoc coordination i.e. joint meetings, sharing of information and joint investigation, but no documented functional coordination mechanism in place. Sequencing equipment and potential capacity available, but not functioning in the past 12 months. Country’s sequences being uploaded by a WHO CC to a publicly accessible database e.g. GISAID in the past 12 months.
RRT established and trained in the past 12 months.
AHI
This indicator measures the extent to which animal and human health authorities coordinate activities in response to influenza-related events of potential public health significance.
Documented functional coordination mechanism in place.
Sequencing
This indicator measures sequencing capabilities for influenza viruses.
No equipment and no sequencing capacity available. No sequences shared.
Influenza virus genes sequenced in the past 12 months.
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Sequence sharing
This indicator measures sharing of influenza virus genetic sequences for use globally.
Country uploading sequences to GISAID or other publicly accessible databases in the past 12 months.
Annex 2. Laboratory & Surveillance indicator baselines by region The following graphs show the baseline data for the capacity indicators for each Output per region.
African Region (AFR) Graph 33: AFR L&S Output 1 capacity indicator baselines N = 11 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
EB
S PC es RT
tin
g
R g in IR hm ts rit nc e o n e g qu Al ag Se Re
g in pp i Sh
AP EQ
S
s ea
on
al No nS s ea
on
al
AP EQ
Graph 34: AFR L&S Output 2 capacity indicator baselines N = 11 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
SA
RI
IL
I
AH
I
n tio ra g te In
B
le ul
tin
s
RR
T
y an lit pl bi y a n tr ai un st u Co S
Graph 35: AFR L&S Output 3 capacity indicator baselines N = 11 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
NI
C g in ar h S
es pl m sa
l ica og l ro Vi
l g in ica ar og h l io es m nc e de i qu Ep Se
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Region of the Americas (AMR) Graph 36: AMR L&S Output 1 capacity indicator baselines N = 8 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
EB
S PC es RT
tin
g
R g in IR hm ts rit nc e o n e g qu Al ag Se Re
g in pp i Sh
AP EQ
S
s ea
on
al No nS s ea
on
al
AP EQ
Graph 37: AMR L&S Output 2 capacity indicator baselines N = 8 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
SA
RI
IL
I
AH
I
n tio ra g te In
B
le ul
tin
s
RR
T
y an lit pl bi y a n tr ai un st u Co S
Graph 38: AMR L&S Output 3 capacity indicator baselines N = 8 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
NI
C g in ar h S
es pl m sa
l ica og l ro Vi
l g in ica ar og h l io es m nc e de i qu Ep Se
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Eastern Mediterranean Region (EMR) Graph 39: EMR L&S Output 1 capacity indicator baselines N = 7 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
EB
S PC es RT
tin
g
R g m in IR ith ts nc e or n e u g l q A ag Se Re
l l g na na in so so pp i a a e Se Sh -S AP on Q N E AP EQ
Graph 40: EMR L&S Output 2 capacity indicator baselines N = 7 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
SA
RI
IL
I
AH
I
n io at r g te In
B
le ul
tin
s
RR
T
y an lit pl bi y a n tr ai un st u Co S
Graph 41: EMR L&S Output 3 capacity indicator baselines N = 7 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
NI
C g in ar Sh
es pl m sa
l ca gi o l ro Vi
l g ca rin gi o ha l s o i ce m en de i u q Ep Se
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European Region (EUR) Graph 42: EUR L&S Output 1 capacity indicator baselines N = 6 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
EB
S PC es RT
tin
g
R g m in IR ith ts nc e or n e u g l q A ag Se Re
l l g na na in so so pp i a a e Se Sh -S AP on Q N E AP EQ
Graph 43: EUR L&S Output 2 capacity indicator baselines N = 6 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
SA
RI
IL
I
AH
I
n io at r g te In
B
le ul
tin
s
RR
T
y an lit pl bi y a n tr ai un st u Co S
Graph 44: EUR L&S Output 3 capacity indicator baselines N = 6 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
NI
C g in ar Sh
es pl m sa
l ca gi o l ro Vi
l g ca rin gi o ha l s o i ce m en de i u q Ep Se
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South-East Asia Region (SEAR) Graph 45: SEAR L&S Output 1 capacity indicator baselines N = 6 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
EB
S PC es RT
tin
g
R g m in IR ith ts nc e or n e u g l q A ag Se Re
l l g na na in so so pp i a a e Se Sh -S AP on Q N E AP EQ
Graph 46: SEAR L&S Output 2 capacity indicator baselines N = 6 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
SA
RI
IL
I
AH
I
n io at r g te In
B
le ul
tin
s
RR
T
y an lit pl bi y a n tr ai un st u Co S
Graph 47: SEAR L&S Output 3 capacity indicator baselines N = 6 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
NI
C g in ar Sh
es pl m sa
l ca gi o l ro Vi
l g ca rin gi o ha l s o i ce m en de i u q Ep Se
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Western Pacific Region (WPR) Graph 48: WPR L&S Output 1 capacity indicator baselines N = 5 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
EB
S PC es RT
tin
g
R g m in IR ith ts nc e or n e u g l q A ag Se Re
l l g na na in so so pp i a a e Se Sh -S AP on Q N E AP EQ
Graph 49: WPR L&S Output 2 capacity indicator baselines N = 5 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
SA
RI
IL
I
AH
I
n io at r g te In
B
le ul
tin
s
RR
T
y an lit pl bi y a n tr ai un st u Co S
Graph 50: WPR L&S Output 3 capacity indicator baselines N = 5 countries Data as of 31 Aug 2014
Level of capacity per indicator ( % of countries )
100 90 80 70 60 50 40 30 20 10 0
No data No capacity Partial capacity Capacity established
NI
C g in ar Sh
es pl m sa
l ca gi o l ro Vi
l g ca rin gi o ha l s o i ce m en de i u q Ep Se
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Annex 3. Certified financial statements The following graphs show the baseline data for the capacity indicators for each Output per region.
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Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2014 | 73
74 | Annual Report 2014 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016
World Health Organization 20 Avenue Appia 1211 Geneva 27 Switzerland PIP Framework Secretariat Pandemic and Epidemic Diseases Health Security email pipframework@who.int
http://www.who.int/influenza/pip/en/
WHO/HSE/PED/GIP/PIP/2015.2