Partnership Contribution ANNUAL REPORT 2015

Pandemic Infl uenza Preparedness Framework

Partnership Contribution

ANNUAL REPORT 2015

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Table of contents

Executive summary

Overview of the PIP Framework

Laboratory and Surveillance Profi le

Regional Offi ce for Africa (AFRO)

Regional Offi ce for the Americas (AMRO/PAHO)

Regional Offi ce for the Eastern Mediterranean (EMRO)

Regional Offi ce for Europe (EURO)

Regional Offi ce for South-East Asia (SEARO)

Regional Offi ce for the Western Pacifi c (WPRO)

Laboratory and Surveillance Achievements

Burden of Disease Profi le

Regulatory Capacity Building Profi le

Planning for Deployment Profi le

Risk Communications Profi le

Preparing to respond to a pandemic

PIP Secretariat

PIP Advisory Group members

Looking to the future

Annex 1

PIP PC Priority Countries across each Area of Work

Training and workshops held with PIP PC funds

Country Laboratory & Surveillance indicators

Annex 2

03

06

12

15

18

21

24

27

30

33

36

39

44

46

49

50

51

52

53

53

55

58

63

List of Acronyms

AFRO

AHI

AMRO

AOW

BSF

CDC

CPA

EBS

ECBS

ECN

ECSPP

EID

EMP

EMRO

EQAP

ERC

EURO

GIP

GISRS

WHO HQ

IATA

ICAO

IDP

IHR

ILI

Regional Offi ce for Africa

Animal human interface

Regional Offi ce for the Americas

Area of Work

Band Selection Form

Centers for Disease Control and Prevention, Atlanta, Georgia (USA)

Critical Path Analysis

Event-based surveillance

WHO Expert Committee on Biological Standardization

Emergency Communications Network

Expert Committee on Specifi cations for Pharmaceutical Preparations

Emerging Infectious Disease

WHO’s Essential Medicines and Health Products Department

Regional Offi ce for the Eastern Mediterranean

External Quality Assessment Project

Emergency Risk Communication Systems

Regional Offi ce for Europe

WHO’s Global Infl uenza Programme

Global Infl uenza Surveillance and Response System

WHO headquarters

International Air Transport Association

International Civil Aviation Organization (ICAO)

Institutional Development Plans for regulatory capacity

International Health Regulations (2005)

Infl uenza-Like Illness

IPCIRR

ISST

IVTM

L&S

MERS-CoV

MOH

MS

NIC

NRA

OIE

OIR

PCR

PSC

PHEIC

PIP

BM

PIP PC

PQ

RO

RRT

RSS

SARI

SEARO

SMTA-2

WHO CC

WPRO

Infection Prevention and ControlInfl uenza Reagent Resource

Infectious Substance Shipping Training

Infl uenza Virus Tracking Mechanism

Laboratory and Surveillance

Middle East Respiratory Syndrome Corona Virus

Ministry of Health

WHO Member State

National Infl uenza Centre

National Regulatory Authority

World Organization for Animal Health

Outbreak Investigation and Response

Polymerase Chain Reaction

WHO Programme Support Costs

Public Health Emergency of International Concern

Pandemic Infl uenza Preparedness

Biological Material

Pandemic Infl uenza Preparedness Partnership Contribution

WHO Prequalifi cation

WHO Regional Offi ce

Rapid Response Training

Regulatory Systems Strengthening

Severe Acute Respiratory Infection

Regional Offi ce for South-East Asia

Standard Material Transfer Agreement-2

World Health Organization Collaborating Centre

Regional Offi ce for the Western Pacifi c

Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016 | Annual Report 2015 | 3

The Pandemic Infl uenza Preparedness (PIP) Framework

for the sharing of infl uenza viruses and access to

vaccines and other benefi ts is a broad-based partnership

adopted in May 2011 by the 194 Member States of the

World Health Organization (WHO) to improve global

pandemic infl uenza preparedness and response. The

Framework established a PIP Benefi t Sharing System

that includes an annual Partnership Contribution

(PC) to WHO from infl uenza vaccine, diagnostic and

pharmaceutical manufacturers using the WHO Global

Infl uenza Surveillance and Response System (GISRS). In

accordance with the high-level PC Implementation Plan

2013-2016 1, the PC is distributed across fi ve Areas of

Work (AOWs):

Executive summary

1. Laboratory and Surveillance

2. Burden of Disease

3. Regulatory Capacity Building

4. Planning for Deployment

5. Risk Communications

The capacities developed from these AOWs will

strengthen overall preparedness and capacity of

countries to respond to public health emergencies (see

fi gure below).

Vaccine virusdevelopment

AntiviralsDiagnostics

GISRS

Burdenof

Disease

Laboratory&

Surveillance

Vaccineproduction

Preparedness for pandemic interventions

RegulatoryCapacity Building

RiskCommuni-

cations

Planningfor

Deployment

INFORMATION

IMPLEMENTATIONof influenza specific interventions(e.g. vaccination, treatment, etc.)

PUBLIC HEALTH DECISIONS

& STRATEGY

INFLUENZAOUTBREAK

Community

Influenzavirus

REDUCTION OFMORTALITY

& MORBIDITY

Pandemic Infl uenza Preparedness Cycle

1 http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1

4 | Annual Report 2015 | Pandemic Influenza Preparedness Framework Partnership Contribution 2013 – 2016

2 Refers to both seasonal and non-seasonal infl uenza viruses

3 Virus detection is the fi rst step towards vaccine composition, see Critical Path Analysis from detection to protection, World Health Organization 2015

By the end of 2015, approximately US$ 31 million

was distributed for activities to prepare countries for

pandemic infl uenza across the fi ve AOWs. Of these

funds, 70% supported Laboratory and Surveillance

capacity-building activities to detect, monitor and

share novel infl uenza viruses. The balance supported

capacity-building activities in the remaining AOWs. This

report summarizes the results of implementing the PC

in 2015, providing for the fi rst time Regional and Area of

Work profi les.

Progress in 2015Building upon processes and procedures for work

planning developed in 2014, all projects met key

milestones in 2015. Highlights are described in the

sections below.

Laboratory and Surveillance

This area of work aims to improve country capacity to

detect, monitor and share infl uenza viruses for risk

assessment and to inform vaccine composition during

an infl uenza pandemic. The focus is on expanding the

Global Infl uenza Surveillance and Response System

(GISRS) so that more laboratories improve the quality of

their laboratory testing to better detect novel infl uenza

viruses and share these viruses with their networks. In

the Regions, 43 priority countries reported data on 21

indicators measuring their capacity to detect, monitor

and share novel infl uenza viruses and to sustain these

activities over time. Measurements taken for all countries

in August 2014 (baseline) compared with subsequent

measures made in February 2015 and again in August

2015 showed increasing capacity in all three areas.

Many countries have defi ned country implementation

plans for infl uenza virus surveillance, demonstrating

a commitment to sustaining pandemic infl uenza

preparedness activities into the future. Others are

actively working to establish WHO-recognized National

Infl uenza Centres (NICs). WHO offi cially recognized

Zambia’s NIC in 2015, increasing the total number of

Centres to 143 across 113 countries.

At the global level, improvement in virus detection was

demonstrated by the results of the 174 laboratories

from 137 countries around the world that participated

in the WHO External Quality Assessment Programme

(EQAP). A total of 103 countries reported 100% correct

results on the assessment panels. Virus-sharing has been

facilitated by better infl uenza detection capacity at the

national level, coupled with training to ship infectious

substances. In fact, 128 countries shared viruses2 with

WHO Collaborating Centres (CCs) for characterization

in 2015. These national eff orts to detect and share

infl uenza viruses strengthen GISRS and provide concrete

evidence of improvements towards global pandemic

infl uenza preparedness.3

Burden of Disease

Preparation for the next pandemic will require increased

global vaccine production capacity. This can only be

achieved if global seasonal vaccine demand increases

in parts of the world where it is not widely used. The

introduction of seasonal vaccine in new countries will

require disease and economic burden data to allow

policy-makers to compare the burden of infl uenza with

other health priorities. WHO is convening the countries

that are doing Burden of Disease studies so that they

can share their results and increase the overall picture

of burden of infl uenza in diff erent country setting. Forty

countries, including the 19 PIP PC priority countries, are

currently engaged in estimating the burden of infl uenza

using WHO methodology and technical support. These

national estimates will be used to produce a robust

global estimate for the burden of infl uenza by the end

of 2016.


4 http://www.who.int/risk-communication/pandemic-infl uenza-preparedness/en/

Regulatory Capacity-Building

Rigorous regulatory processes and practices are

essential to ensuring the approval and use of safe

and eff ective infl uenza vaccines and related products

in the event of a pandemic. 2015 saw regulatory

capacity assessments performed in 14 out of 16 PIP

priority countries. These assessments help countries

develop the standards necessary for eff ective

regulatory systems, market authorization processes

and pharmacovigilance. In 2015, 14 national regulatory

authorities (NRAs) adopted the Collaborative procedure

between WHO Prequalifi cation of Medicines Programme

and National Regulatory Authorities for the assessment

and accelerated national registration of WHO-prequalifi ed

pharmaceuticals and vaccines. This agreement between

WHO and national governments accelerates regulatory

approval of infl uenza vaccines and related products in a

public health emergency.

Planning for Deployment

Vaccines and anti-viral treatments need to be deployed

quickly to where they are needed from manufacturers,

global stockpiles or donating countries in order to save

lives during an infl uenza pandemic. The PIPDEPLOY

simulation tool was developed in 2015 to measure

and improve the time it takes to deploy vital infl uenza

products into countries during a pandemic. The fi rst

simulation will take place in 2016, paving the way for

improvement in response time by making sure that

national supply chain and regulatory systems together

work effi ciently and eff ectively during a pandemic.

Risk Communications

Risk communication during a crisis can prevent the

spread of rumours and false information that create

panic and hamper eff ective public health measures.

New guidelines, tools, resources, curricula and materials

were developed to disseminate pandemic infl uenza

skills and knowledge and build capacity in pandemic

infl uenza risk communication globally.4 Last year alone,

1500 people from 122 countries were trained in Risk

Communications.

Preparing for pandemic infl uenza has stimulated

the need for specialized training in emergency

communication and helped to develop the Emergency

Communication Network (ECN). The ECN now has

a roster of 150 trained communicators who can be

deployed to emergency situations to provide advice

and support for protecting populations at risk.

Next steps toward preparedness for pandemic

infl uenza

The Regions and AOW Programmes have defi ned

activities for 2016 that build upon the achievements

of 2015. A third round of data collection on the 21

indicators of laboratory and surveillance capacity for the

43 PIP priority countries was collected in the fi rst quarter

of 2016. This collection will help measure the impact

of the PIP PC funds over time and track improvements

in laboratories globally to detect, monitor and share

infl uenza viruses with human pandemic potential.


Overview of the PIP Framework

BackgroundNovel infl uenza viruses with human pandemic potential

can emerge anywhere in the world at any time. All

countries, therefore, need the capacity to detect, monitor

and share these viruses so that response measures can

rapidly be developed and global populations protected

in the event of a pandemic. The PIP Framework, which

grew out of the re-emergence of A(H5N1) infl uenza

in 2004, is a broad-based partnership adopted by

the 194 Member States of WHO on 24 May 2011 to

improve global pandemic infl uenza preparedness and

response. The Framework brings together public and

private partners, recognizing that “Member States have

a commitment to share on an equal footing H5N1 and

other infl uenza viruses of human pandemic potential

and the benefi ts, considering these as equally important

parts of the collective action for global public health”

(PIP Framework, section 1, Principle 3).

For over 50 years, WHO has been at the forefront of

infl uenza virus monitoring and risk assessment through

the work of a global alert mechanism for the emergence

of infl uenza viruses with human pandemic potential

known as the Global Infl uenza Surveillance and

Response System (GISRS). This international network

of public health laboratories specialized in infl uenza,

coordinated by WHO, and provides year-round

surveillance of infl uenza through its 143 laboratories in

113 countries.

Under the PIP Framework, countries are expected

to share viruses with human pandemic potential in

a rapid, timely and systematic manner with GISRS.

Likewise, manufacturers are expected to provide funds

and real-time access to essential infl uenza products

at the time of a pandemic. This arrangement is called

the PIP Framework Benefi t Sharing System. It has two

operational tools that ensure that manufacturers which

use GISRS share the benefi ts that arise from such use.

These two tools are:

1. The annual Partnership Contribution (PC), and

2. Standard Material Transfer Agreements-2 (SMTA2)

which ensure that at the time of the next pandemic,

WHO will have real-time access to specifi c quantities

of response supplies, notably vaccines, antiviral

medicines and diagnostics, that will be deployed to

countries in need.

The objective of the Benefi t Sharing System is, on

the one hand, to increase global health security by

strengthening capacities where they are weakest, and

on the other, to ensure equity of access to pandemic

response products by all countries, regardless of income

level. PIP PC funds support the capacity-building eff orts

that are underway.

Key principles of the PIP FrameworkIn the PIP Framework, Members States affi rmed the

fundamental principle that virus-sharing and benefi t-

sharing are equally important parts of collective action

of global public health. Intrinsic to this are several other

principles which guide implementation of the PIP

Framework. They are transparency, equity, collaboration

and partnership.

Transparency guides all facets of the implementation of

the Framework. Thus, program and fi nancial information

is freely shared with collaborators and partners: the

internet-based PIP PC implementation portal and the

PIP webpage enable regular access to up-to-date facts,

fi gures and reports on the use of funds and indicators

measure progress towards meeting milestones and

targets.

Equity refers to the commitment that WHO Member

States make to ensure that at the time of the next

pandemic, all countries will have real-time access to

life-saving pandemic infl uenza vaccines, diagnostic

tests and anti-viral medicines. The conclusion of SMTA2s

embodies the work that is being carried out to achieve

greater equity.

Collaboration on preparedness activities brings

together the three levels of WHO (headquarters, regional

and country offi ces) that work closely with GISRS

laboratories, industry and civil society to implement

capacity-strengthening projects in priority countries.

PIP aims to build a partnership with its broad stakeholder

base to promote shared ownership and support of the

PIP objectives and coherence on the implementation of

its strategies.


Overview of achievementsThe PIP PC funds are used to implement activities in the

fi ve AOWs defi ned in the PIP Partnership Contribution

Implementation Plan 2013-20165, approved by the

Director-General in January 2014 and updated in

January 2015.

These AOWs are:

1. Laboratory and Surveillance

2. Burden of Disease

3. Regulatory Capacity-Building

4. Planning for Deployment

5. Risk Communication

Activities identifi ed for support under each AOW are

directly linked to the fi ndings of the Gap Analyses

conducted in 20136.

Figure 1: The fi ve Areas of Work (AOWs) supported through PIP PC

5 http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1

6 http://www.who.int/infl uenza/pip/pip_pc_ga.pdf?ua=1

This report presents an overview of the achievements

and challenges in 2015. It provides technical descrip-

tions of the work undertaken as well as fi nancial

accounting of the funds for each AOW through Regional

and AOW profi les. Summaries of the achievements of

2014 are presented side-by-side with those of 2015 to

highlight that adequate preparation in 2014 led to the

improvements in preparedness in the WHO regions

reported here for 2015.

PREPAREDNESSRegulatory

Capacity Building

Burden ofDisease

Laboratory & Surveillance

RiskCommunications

Planning forDeployment

RESPONSE


Summary of 2014 Achievements

During 2014, the PIP Secretariat developed key processes

and procedures to enable effi cient, eff ective and

transparent management of funds, and implementation

of activities using standard approaches to monitor

and report on technical and fi nancial progress. During

this time, 54 work plans were developed across the

three levels of WHO. Starting in April 2014, funds were

distributed against approved 2014 work plans and by

August 2014, US$ 17.4 million had been distributed

across headquarters, Regional Offi ces and Country

Offi ces to implement activities in the fi ve AOWs. These

actions provide a fi rm foundation for the results of 2015.

The highlights of 2014 are presented in the table below.

Table 1: Highlights from 20147

Laboratory and Surveillance capacity-building

Burden of Disease

Regulatory capacity-building


Risk Communications

21 capacity indicators were defi ned to measure progress towards outputs and outcomes.

Baseline data were collected in the 43 countries prioritized for support in this area.

Seven countries participated in a training to learn how to develop national disease burden estimates using a new WHO manual.

Work started to revise the expedited review procedure to facilitate licensing of pre-qualifi ed antivirals and vaccines.

The new Collaborative procedure to address assessment and accelerated national registration of WHO-prequalifi ed pharmaceutical products and vaccines was developed and endorsed by the Expert Committee on Specifi cations for Pharmaceutical Preparations (ECSPP) in October 2014.

Model agreements between WHO and recipient countries of pandemic products were drafted.

Signifi cant training materials were developed, translated and published online.

AREA OF WORK ACTIONS

Table 2: Highlights from 2015 (See Regional and AOW profi les for complete results)

Laboratory and Surveillance capacity-building8,9

Burden of Disease



RiskCommuni-cations

Established and functioning event-based surveillance for infl uenza in 12 of the 43 PIP priority countries.

128 countries worldwide shared virus10 with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories.

66 countries consistently reported epidemiological data to regional or global platforms.

114 countries consistently reported virological data to a regional or global platform.

103 countries participated in EQAP and scored 100%.

40 countries, including 19 PIP PC priority countries, are estimating the burden of infl uenza using WHO methodology and technical support.

3 PIP priority countries completed robust national burden of infl uenza estimates.

6 countries are piloting the WHO economic burden tool.

WHO collaborative procedure for accelerated regulatory approval of infl uenza products adopted by 14 countries11.

14 of 16 priority countries assessed for regulatory capacity.

PIPDEPLOY tool to improve deployment of infl uenza products to countries was developed. The fi rst simulation will start mid-2016.

17 target countries12 had specifi c risk communication training and/or workshops.

The ECN has a roster of 150 people able to be deployed to health emergencies worldwide.


7 See Pandemic Infl uenza Preparedness Framework Partnership Contribution 2013-2016: Annual Report 2014. World Health Organization 2015 for complete 2014 results.

8 Data from regional and global data bases (see Annex 1)

9 Achievements for L&S at WHO HQ level were made with funds from PIP PC and other donors

10 Refers to seasonal and pandemic potential infl uenza viruses

11 United Rep. of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique, Burkina Faso, Cameroon, Benin, Mali, Armenia, Sri Lanka, Bhutan, and Myanmar

12 Barbados, Cambodia, Dominica, Egypt, Kazakhstan, Kenya, Republic of Moldova, Mongolia, Nepal, Saint Lucia, Saint Vincent and the Grenadines, Senegal, Sudan, Turkey, Ukraine, Uzbekistan, Viet Nam


Summary of 2015 Achievements

While 2014 focused on developing foundational

processes and procedures for the PC implementation

across all AOWs, by 2015 work was well underway to

ramp up the implementation pace of preparedness

projects in PIP priority countries. In 2015, WHO had

available US$ 13.3 million for Preparedness work. The

activities supported with these funds are starting to

show concrete improvements in pandemic infl uenza

preparedness as shown in Table 2.

Partnership Contribution Collection ProcessPIP Framework Section 6.14.3 establishes an annual

Partnership Contribution (PC) to be paid to WHO by

infl uenza vaccine, diagnostic and pharmaceutical

manufacturers using the WHO GISRS. Section 6.14.3

specifi es that the sum of the annual PC is equivalent to

50% of the running costs of GISRS, which in 2010 were

estimated to be US$ 56.5 million, setting the annual

amount to be collected at US$ 28 million. The collection

process begins in January/February each calendar year

with the publication of the PC questionnaire. This starts

the process of collecting the contribution that funds the

work plans for the following calendar year. The process

is fully described in the following sections.

Questionnaire & Contributor identifi cation

Every year, WHO issues the Partnership Contribution

Questionnaire in order to identify potential Contributors.

The purpose of this annual Questionnaire is to determine

if an entity is an infl uenza vaccine, diagnostic [or]

pharmaceutical manufacturer using the GISRS. The PIP

Framework considers a Contributor to be a company/

institution that meets the following criteria:

1. is an infl uenza vaccine, diagnostic and pharmaceutical

manufacturer (currently or in the past 15 years);

2. uses (or has used in the past 15 years) the WHO GISRS;

and

3. has developed or produced a human infl uenza

vaccine, antiviral, diagnostic or other product to

13 As of 02 March 2016

prevent, treat or diagnose infections from H5N1

or other infl uenza viruses with human pandemic

potential and such product has obtained provisional

or fi nal licensure, registration or market authorization.

“Use of GISRS” means a company/institution has used or

received:

• Materials (e.g. virus materials, such as candidate

vaccine viruses, wild-type viruses, cDNA, plasmids, or

reagents); and/or

• Services (e.g. antigenic and genetic characterization

of candidate vaccine viruses/seed material, antiviral

susceptibility assays); and/or

• Information (e.g. sequence information,

epidemiological data, antiviral susceptibility data,

pre and post-vaccine composition meeting reports);

developed and/or provided by or through GISRS.

Potential Contributors are identifi ed by the PIP

Secretariat using information from manufacturer

associations, internet searches and the Infl uenza Virus

Traceability Mechanism (IVTM) which identifi es non-

GISRS recipients of PIP Biological Materials (PIP BM).

A broad range of organizations including academic

institutions, government agencies, non-profi t

organizations and manufacturers of infl uenza products

are identifi ed. A link to the Questionnaire is sent by

email to all identifi ed entities.

Companies/institutions are identifi ed as Contributors

through their answers to the Questionnaire. Those so

identifi ed are sent a “Band Selection and Certifi cation

Form” (BSF) which requests them to calculate their year

average annual infl uenza product sales for 4 years and

to use that fi gure to place themselves into one of 23

“sales bands”. WHO enters each company’s sales band

into a weighted formula to determine how much each

contributor will pay. Once the formula is applied, each

contributor is sent an invoice which is payable within 30

days.

Table 3: PC Collection (2013-2016)

Entities contacted

Questionnaire Responses

Contributors identifi ed

Funds received13

194

89

32

$27,538,586

250

102

42

$26,964,062

256

90

39

$18,813,522

2013 2014 2015


Results of the Partnership Collection in 2014Based on answers to 2014 Questionnaire, 42 contributors

were identifi ed and US$ 26,964,062 was collected to

support activities implemented in 2015.

Results of the Partnership Collection in 2015Funds from the 2015 PC Collection process will

support activities in work plans approved for 2016

implementation. Collection of 2015 funds is still

underway. Detailed results of the PC collection are

found in Annex 2.

Use of PC fundsPIP PC funds were used in 73 countries in 2015. (See

Figure 2)

Why fi ve Areas of Work?The infl uenza A(H1N1) pandemic of 2009 highlighted

weaknesses in preparedness at the global, regional and

country levels. Two systemic reviews14 were performed

in its immediate aftermath that identifi ed areas where

global action was needed to strengthen the world’s

capacity to eff ectively and effi ciently respond to a

pandemic event. Lessons learnt from these reviews and

the PIP Framework’s Gap Analyses15 led the PIP Advisory

Group to recommend that the PIP PC preparedness

funds be used to strengthen capacity in fi ve critical

areas: laboratory and surveillance capacity, knowledge

of disease burden, regulatory aff airs, planning for

deployment of pandemic response supplies and

risk communications. These recommendations were

Figure 2: Countries using funds from PIP PC, 2015

14 These reviews were 1) a review of the International Health Regulations (2005) (http://apps.who.int/gb/ebwha/pdf_fi les/WHA64/A64_10-en.pdf) and 2) a review of the deployment of A(H1N1) vaccine(http://www.who.int/infl uenza_vaccines_plan/resources/h1n1_vaccine_deployment_initiative_moll.pdf).

15 Pandemic Preparedness Partnership Contribution, 2013-2016: Gap Analyses (November 2013)

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.


16 Critical Path Analysis: From detection to protection, World Health Organization 2015.

accepted by the Director-General. Each AOW developed

specifi c goals to improve pandemic infl uenza

preparedness. These are highlighted below in Table 4.

Expected Outcomes

Based on guidance from the Advisory Group, lessons

learned, the Gap Analyses and interactions with

stakeholders; the Secretariat developed a high-level

Partnership Contribution Implementation Plan 2013-

2016. The Plan specifi es that in a decade’s time the

allocation of the PC resources should result in the

following improvements in pandemic preparedness:

• All countries should have in place well established

core capacities for surveillance, risk assessment and

response at the local, intermediate and national level,

as required by the IHR.

Table 4: Pandemic infl uenza preparedness goals by

AOW

Laboratory and Surveillance capacity-building

Burden of Disease



Risk Communications

Improve national ability to detect, monitor and sharenovel infl uenza viruses

Provide training and support for burden of infl uenza estimates which will contribute to the development of a globalburden of infl uenza estimate

Build national regulatory capacity so that vaccines, diagnostic tests and antiviral medicines for infl uenza can be deployed quickly

Plan for effi cient and equitable deployment of vital suppliesfor pandemic infl uenza

Build national capacity to provide accurate publichealth information during emergencies


• All countries should have access to a NIC laboratory -

the backbone of GISRS.

• A clearer picture of the health burden that infl uenza

imposes on diff erent populations should be

established.

• All countries should have access to pandemic infl uenza

vaccines and antiviral medicines to help reduce

pandemic-related morbidity and mortality.

• All countries should have improved capacities to carry

out eff ective risk communications at the time of a

pandemic.

An analysis of the full scope of preparedness work that

will be required from the time of detection of a novel

virus to the protection of the global population was

developed in the Critical Path Analysis (CPA)16. This

analysis showed that additional areas will require PC

resources to achieve the improvements in pandemic

preparedness foreseen by the PC Implementation Plan

2013-2016.

How are results measured across Areas of Work?

The PC Implementation Plan 2013-2016 sets out the

expected outcomes and outputs for the 5 AOWs

currently supported. Each AOW has a set of performance

indicators that measure progress towards delivery of

defi ned outputs (deliverables) and expected changes

(outcomes) in levels of preparedness for an infl uenza

pandemic. These outcomes and outputs are measured

biannually using defi ned indicators. Baselines and

targets are set and reviewed regularly for each indicator.

Analysis of progress towards these targets is performed

every six months in order to ensure activities are

appropriate or draw attention to specifi c areas that need

corrective action. In the following section, progress is

presented by outputs and outcome in each AOW profi le.

The profi les focus on the achievements of 2015 and

preview work underway for 2016.



Laboratory and Surveillance Profi le

Following the 2009 A(H1N1) pandemic, strengthening

laboratory and surveillance (L&S) capacities were

identifi ed as key to improving national capacities to

conduct risk assessment and thereby increasing global

preparedness. Early in the process to distribute resources

among AOWs, it was recommended that L&S receive the

largest proportion of funds. Thus, 70% of preparedness

funds are allocated to strengthening L&S capacities in

countries.

All activities funded with the PC aim to achieve the

following outcome: “The capacity to detect and monitor

infl uenza epidemics is strengthened in developing

countries that have weak or no capacity.” The majority

of activities are under the responsibility of Regional

Offi ces that work through Country Offi ces to strengthen

capacities where they are most needed – in the

laboratories and at the fi eld level. Thus, at the regional

level, emphasis is placed on: 1) strengthening national

capacities to detect respiratory disease outbreaks due to

a novel virus (Output 1); and 2) strengthening national

capacities to monitor trends in circulating infl uenza

viruses (Output 2). Tying this together at the global

level is an emphasis on strengthening collaboration,

through the sharing of information and viruses, with

a view to improving the quality of the GISRS system

(Output 3). The focus is on strengthening data sharing,

enhancing laboratory capacities for infl uenza diagnosis

by polymerase chain reaction (PCR), improving quality

of viruses shared from countries, and strengthening

capacities to ship infectious substances (dangerous

goods).

This section will provide an overview of achievements

in each region (Regional Profi les) followed by the

achievements at the global level.

Improve national ability to detect, monitor and share novel infl uenza viruses

Target countries: Afghanistan, Algeria, Armenia, Bangladesh, Bolivia, Burundi, Cambodia, Cameroon, Chile, Congo

(Republic of ), Costa Rica, Djibouti, Dominican Republic, Ecuador, Egypt, Fiji, Ghana, Haiti, Indonesia, Jordan, Korea

DPR, Kyrgyzstan, Lao PDR, Lebanon, Madagascar, Mongolia, Morocco, Mozambique, Myanmar, Nepal, Nicaragua,

Sierra Leone, South Africa, Suriname, Tajikistan, The United Republic of Tanzania, Timor-Leste, Turkmenistan, Ukraine,

Uzbekistan, Viet Nam, Yemen, Zambia


Building Laboratory and Surveillance Capacity in 43

PIP priority countries

Since 2013, PIP PC funds have been directed to build

or strengthen laboratory and surveillance in countries

across all WHO regions to improve global pandemic

infl uenza preparedness.18 Gap assessments were

conducted and countries were prioritized19 according

to pre-defi ned criteria20 and taking into account the

following factors identifi ed by the PIP Advisory Group21:

• Fairness, equity and public health risk, particularly

vulnerability to infl uenza A(H5N1);

• Be evidenced-based and consider indicators such as

core capacities under the IHR, income, disease burden

and epidemiology;

• Consider the need for countries to have the critical

foundation of epidemiology and laboratory

surveillance;

• Take into account the modest amount of PC resources;

and

• Ensure the involvement of at least on country from

each region while maintaining the focus on countries

with the highest need.

The focus for the 43 PIP PC priority countries is on

improving laboratory and surveillance capacities so that

in a decade’s time, all countries are able to detect and

monitor infl uenza epidemics22. Twenty-one indicators

were developed to measure progress (See Table 5). The

indicators are grouped into four categories and data are

collected every six months against each indicator. These

indicators measure a country’s ability to detect, monitor

and share novel infl uenza viruses, as well as the ability to

sustain these practices into the future. Each indicator is

scored for each target country according to three levels

of capacity23 as provided by country representatives

and confi rmed through appropriate documentation. An

average of these scores across the indicator categories

is presented in the profi les for three data collection

periods:

• Baseline (August 2014),

• Period from September 2014 to February 2015,

• Period from March 2015 to August 2015.

17 31 August 2014

18 The African Regional Offi ce (AFRO), the Regional Offi ce for the Americas (AMRO/PAHO), The European Regional Offi ce (EURO), The Eastern Mediterranean Regional Offi ce (EMRO), The South-East Asia Regional Offi ce (SEARO), and The Western Pacifi c Regional Offi ce (WPRO).

19 See List of PIP PC Implementation target countries for Regional Offi ce in Annex 1.

20 See http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at pages 9-10.

21 See http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at page 8, Section 5 “Methodology”

22 See www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at page 12 “Outcome”

23 1= no capacity, 2= partial capacity, 3= full capacity

Detection capacity (43 PIP priority countries)

Number of countries with an established and functioning event-based surveillance system

Monitoring capacity (43 PIP priority countries)

Number of countries able to consistently report and analyse

virological data

Number of countries able to consistently report and analyse

epidemiological data

8 43 12

26

5

35

17

30

9

Output indicators

Support to WHO Regions and Countries

BASELINE 17 TARGET STATUS


Measuring progress in 2015

Indicators of performance

Laboratory and Surveillance indicators have been

grouped across four categories (see Table 5 below)

to measure the capacity of target countries to detect,

monitor and share novel viruses with human pandemic

potential and to sustain these actions into the future.

The Regional Profi les presented here highlight pre-

PIP PC gaps in Laboratory and Surveillance. They

also integrate the ongoing work of the four other

AOWs into regional profi les to show how all areas are

working together through the WHO Regional Offi ces to

strengthen national pandemic infl uenza preparedness.

Tracking capacity development over time

Capacity-building needs continuous eff orts over a

signifi cant period of time, especially in light of changing

country political situations or laboratory staff turnover.

WHO will monitor these country-level indicators over

time to track the progress of priority countries towards

improved national ability to detect, monitor and share

novel infl uenza viruses.

This remainder of this section will provide an overview

of achievements by region (Outputs 1 and 2) followed

by the achievements at the global level (Output 3).

Table 5: Laboratory and Surveillance capacity indicators measured for each of the 43 PIP priority countries.

See Annex 1 for details of indicator rationale and scoring criteria

Algorithm for laboratory detection of unusual infl uenza viruses

Registration in IRR or receiving testing kits from WHO CCs

PCR Testing ability

PCR Quality for non-seasonal infl uenza viruses

PCR Quality for seasonal infl uenza viruses

Sequencing ability

National “Early Warning” systems or Event-Based Surveillance (EBS)

National surveillance for ILI

National surveillance for SARI

Integration of laboratory and epidemiological data

Regular infl uenza surveillance reports/bulletins

Coordination at the Human Animal Interface

Reporting lab surveillance data to WHO through FluNet and/or regional databases

Reporting epidemiologic surveillance data to WHO through FluID and/or regional databases

Shipping capacity for infectious substances

Sharing samples with WHO CCs

Sharing sequence data

Country Implementation Plan developed

Rapid Response Team Training

Evidence of sustainability (integration in national plan)

WHO-recognized National Infl uenza Centre

DETECTION MONITORING SHARING SUSTAINABILITY


Algeria

Burundi

CameroonGhana

MadagascarMozambique

Republic of Congo

Sierra Leone

South Africa

TanzaniaZambia

Regional Offi ce for Africa (AFRO)PIP PC Achievements 2015

In 2015, the region experienced several major infectious

disease outbreaks including Ebola, Cholera, and

Meningitis, making it diffi cult to manage competing

disease priorities, often with the same staff responsible

at the national levels for sentinel surveillance of all

infectious diseases. The Regional Offi ce for Africa

(AFRO) focused on supporting Ghana and the United

Republic of Tanzania with PIP PC implementation

funds. These funds allowed AFRO to provide training

and technical support to these PIP target countries to

improve submission of weekly surveillance information

to WHO’s Collaborating Centre (US CDC) and GISRS

laboratories via FluNet and weekly epidemiological

bulletins. Provisional data analysed shows the results

for all 11 countries that are the target of PIP PC funds

for Laboratory and Surveillance capacity-building, even

though only two countries (Ghana and the United

Republic of Tanzania) have achievements that can be

directly attributed to PIP funds in 2015.

Detection capacity


Sharing Capacity

Number of countries sharing infl uenza virus with WHO CCs, H5 Reference Laboratories and Essential Regulatory Laboratories at least once a year in the past two years

Monitoring capacity

Number of countries able to consistently report and analyse virological data

Number of countries able to consistently report and analyse epidemiological data

1

NA28

11

NA29

325

830

8

1

11

11

826

027

Output indicators for priority countries: Algeria, Burundi, Cameroon, Congo, Ghana, Madagascar,

Mozambique, Sierra Leone, South Africa, The United Republic of Tanzania and Zambia

27 Lower capacity due to Ebola outbreak

28 No regional baseline, global baseline is 90

29 No regional target, global target is 108

30 Algeria, Cameroon, Ghana, Madagascar, Mozambique, South Africa, United Republic of Tanzania, Zambia

24 31 August 2014

25 Ghana, Mozambique, South Africa

26 Algeria, Cameroon, Ghana, Madagascar, Mozambique, South Africa, the United Republic of Tanzania, Zambia

2015 Laboratory & Surveillance programmatic results for PIP target countries


The boundaries and names shown and the designations used on this map do not imply the expression of any opinion

whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or

area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps

represent approximate border lines for which there may not yet be full agreement.


AFRO Detection Capacity AFRO Sharing Capacity

AFRO Monitoring Capacity

AFRO Sustaining Capacity

All countries have demonstrated capacity in PCR testing.

Laboratory algorithms and reagents are in place in most

priority countries. Event-based surveillance for infl uenza

is still a gap in AFRO with only three countries having full

capacity for EBS.

Countries still need support for shipping viruses to WHO

Collaborating Centres. Nonetheless, Ghana benefi ted

from training at a WHO Collaborating Centre (United

Kingdom) and provided training to neighbouring

countries (Nigeria, Côte D’Ivoire) in infl uenza virus

isolation techniques, thereby improving ability in the

region to isolate infl uenza viruses for shipping to GISRS

laboratories.

Monitoring capacity continues to improve from the

baseline level (31 August 2014). One of the biggest

challenges in this region is assisting countries to develop

and update their plans for national infl uenza sentinel

surveillance. Guidelines, protocols for investigation

of respiratory illness outbreaks and training were

produced by the Regional Offi ce through PIP PC funds.

Ghana benefi tted from the guidance and began to

actively send samples to the National Infl uenza Centre

for testing during 2015. Weekly epidemiological

bulletins are regularly being produced in all but two

target countries in the region.

Countries are working to develop national plans for

infl uenza surveillance. In 2015, Zambia obtained WHO

certifi cation as a National Infl uenza Centre31, increasing

regional capacity to detect and monitor viruses with

human pandemic potential.

31 Tanzania obtained WHO certifi cation in 2014

Ave

rag

e s

core

Baseline March 2015 September 2015

Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0


0

0

0

0

0

0

2

6

6

NA38

18

NA39

032

Pendingtools

033, 34

3

035, 36

240

Burden of Disease

Regionally representative estimates

Number of countries supported by the Partnership Contribution

with infl uenza disease burden estimates by 2016


Country readinessCountries and partners accessing web-based planning tools

Regulatory Capacity Building

Targeted training

Number of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic

Common approach for accelerated approvalNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency

Risk Communications

Training on risk communications

Number of trainings completed on IHR risk communications training website37

Support to priority countries

Targeted Member States will have benefi ted from IHR risk communications programme by end of 2016

Actions for 2016AFRO plans to provide PIP Partnership Contribution

funds to Burundi, Cameroon, Congo, Ghana, Madagascar,

Mozambique, Sierra Leone, the United Republic of

Tanzania and Zambia. AFRO will work to support

and maintain existing sentinel sites and laboratory

surveillance systems so that:

• Health care facilities/laboratories in the region have

equipment and reagent supplies;

• Detected infl uenza viruses can be transported from

districts to the national infl uenza laboratories and to

WHO Collaborating Centers;

• Laboratory technicians and data managers develop

and maintain their skill levels; and

• Existing surveillance sites are supervised for optimal

reporting of results locally and internationally.

32 Senegal and Madagascar are collecting data for burden of disease analysis

33 Marketing authorization is ongoing in Ghana and Nigeria

34 Pharmacovigilance training/meetings ongoing in Ghana, Ethiopia, Gambia, Kenya, the United Republic of Tanzania and DR Congo

35 Agreements signed in the United Republic of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique

36 Joint reviews of capacity in preparation to sign Burkina Faso, Cameroon, Benin and Mali

37 WHO iLearn platform was used in 2015



40 Kenya and Senegal

Results from other Areas of Work that help the region to prepare for pandemic infl uenza (2015)

BASELINE TARGET STATUS


Bolivia (Plurinational State of)

Chile

Costa Rica

Dominican Republic

Ecuador

Haiti

Nicaragua

Suriname

Regional Offi ce for the Americas (AMRO/PAHO) PIP PC Achievements 2015

In 2015, the Region for the Americas (AMRO) supported

Chile, Costa Rica, Ecuador, Nicaragua and Suriname

with PIP PC implementation funds. These funds allowed

AMRO to provide training and technical support to

these PIP priority countries to improve epidemiology

and virology data collection. The Regional Offi ce worked

with countries to develop standard data reporting

formats that could be shared directly with the global

data reporting platform, WHO’s FluID. Funds were also

used to build human-animal interface surveillance in the

region. Provisional data analysed and presented below

shows that country capacity to monitor and detect

infl uenza viruses with pandemic potential is improving

in target countries and throughout the region as a result

of these eff orts.

Detection capacity


Sharing Capacity


Monitoring capacity



0

NA44

8

NA45

0

646

7

0

8

8

742

443

Output indicators for priority countries: Bolivia (Plurinational State of), Chile, Costa Rica, Dominican

Republic, Ecuador, Haiti, Nicaragua and Suriname





46 Bolivia, (Plurinational State of), Chile, Costa Rica, Dominican Republic, Ecuador and Nicaragua

41 31 August 2014

42 Bolivia, (Plurinational State of), Chile, Costa Rica, Dominican Republic, Ecuador, Nicaragua, and Suriname

43 Bolivia, (Plurinational State of), Chile, Ecuador, Suriname






AMRO Detection Capacity AMRO Sharing Capacity

AMRO Monitoring Capacity

AMRO Sustaining Capacity

Prior to PIP PC funding, AMRO/PAHO identifi ed there was

a gap in event-based surveillance in priority countries in

the region. The average scores for detection refl ected

the need for support in this area. PIP PC funds supported

trainings in EBS for infl uenza and data management in

the region in 2015 and we expect to see an increase in

country capacity for detection in the next round of data

collection as a result of this investment.

AMRO/PAHO has worked to enhance reporting of

epidemiological and virological data on infl uenza

into PAHO FluID to allow real-time ability to monitor

infl uenza spread throughout the region. In 2015, Chile,

Ecuador and Suriname reported data for the fi rst time

using this platform. A total of 783 virus samples were

submitted to WHO Collaborating Centre (CDC) for viral

characterization. PIP funds have facilitated a training

course targeting sample conservation and timely

submission to WHO Collaborating Centres to improve

sample submission. Fifty laboratory technicians

participated in this course in 2015.

The interactive PAHO FluID website launched in 2015

allows transparent access to monitoring and surveillance

data across the region (www.paho.org/reportesinfl uenza).

Bolivia (Plurinational State of ), Chile, Costa Rica and

Ecuador report full capacity for surveillance of patients

hospitalized with severe acute respiratory illness (SARI)

with samples routinely tested for infl uenza. PIP PC funds

are also supporting a landscape analysis of regional

activities being done to improve human-animal

interface surveillance in the region to identify gaps and

provide guidance to Member States on what is working

in countries.

Chile, Costa Rica, Ecuador and Nicaragua all have

recognized NICs. Most countries have established

country plans for sustaining Laboratory and Surveillance

activities. March 2015 data collection saw new country

plans reported for Costa Rica, Ecuador and Suriname.

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0


Actions for 2016AMRO continues to develop capacity in Chile, Costa

Rica, Ecuador, Nicaragua, Suriname and to increase

support to the region by working in Bolivia (Plurinational

State of ), Dominican Republic and Haiti. Activities to

strengthen preparedness in the entire region are being

planned. There are plans for a severe acute respiratory

infections (SARI-net) meeting, upgrades to regional

reporting systems, and training for laboratory logistics

both regionally and for larger countries in the region

(Brazil and Mexico). Several activities target improving

coordination at the human-animal interface, including

development of respiratory outbreak training materials

and a simulation exercise.

47 Costa Rica and Chile have estimates pending publication in peer-reviewed journal.

48 Bolivia (Plurinational State of) has been assessed. Haiti will be assessed in 2016.

49 Bolivia (Plurinational State of), Haiti, Honduras, Nicaragua, Guyana, and Peru are in process of signing the Collaborative agreement.




53 Barbados, Dominica, Saint Lucia, Saint Vincent and the Grenadines.

0

0

0

0

0

0

2

6

2

NA51

6

NA52

247

Pendingtools

048

12

049

453

Burden of Disease







Targeted training



Risk Communications


Number of trainings completed on IHR risk communications

training website50






Afghanistan

Djibouti

EgyptJordan

LebanonMorocco

Yemen

Regional Offi ce for the Eastern Mediterranean (EMRO)PIP PC Achievements 2015

During 2015, the Regional Offi ce for the Eastern

Mediterranean (EMRO) worked in seven countries

prioritized for PIP PC preparedness funds (Afghanistan,

Djibouti, Egypt, Jordan, Lebanon, Morocco and Yemen).

Complex emergencies are occurring in several of these

priority countries (Yemen, Afghanistan and Lebanon).

Nonetheless, infl uenza surveillance has gradually

started gaining visibility among public health priorities

at country level in the region. A regional database

(EMFLU) is being promoted as a key platform for

infl uenza surveillance information to link countries to

all levels of WHO. Provisional data analysed by indicator

type and shown in the charts below indicate that

capacity to detect, monitor and share infl uenza viruses

with pandemic potential varies widely, although there

is progress in countries where capacity has been the

weakest.

Detection capacity


Sharing Capacity


Monitoring capacity



4

NA58

7

NA59

555

360

2

1

7

7

456

157

Output indicators for priority countries: Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Morocco and Yemen

54 31 August 2014

55 Afghanistan, Djibouti, Egypt, Morocco, Yemen

56 Afghanistan, Egypt, Jordan and Morocco

57 Morocco



60 Egypt, Jordan, Morocco








EMRO Detection Capacity EMRO Sharing Capacity

EMRO Monitoring Capacity

EMRO Sustaining Capacity

Almost all priority countries are regularly performing

PCR testing for infl uenza. Ability to do event-based

surveillance has also improved in the region with all

countries having either full or partial capacity for this

indicator.

Virus sharing is steadily increasing from priority

countries. The Regional Offi ce has worked with ministries

of health, and partner organizations to train cohorts of

health workers to package and ship infl uenza viruses. As

a result, Afghanistan and Egypt have both made timely

contributions of virus samples to GISRS.

SARI/ILI surveillance has improved in the region. In

2015, two countries (Djibouti and Lebanon) initiated

SARI surveillance and two countries (Afghanistan and

Yemen) revived dormant SARI/ILI surveillance. Three

additional countries (Egypt, Jordan and Morocco)

strengthened existing SARI/ILI surveillance. Linkages

between epidemiological and virological information

have been enhanced, resulting in timely sample sharing

with laboratories and timely feedback from laboratories

to sentinel sites.

National Infl uenza Centres and infl uenza laboratories

in Afghanistan, Djibouti, Egypt, Jordan, Lebanon and

Morocco have been strengthened through assessments,

provisions of reagents and equipment, training and

linkages with WHO Collaborating Centres for Infl uenza.

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0


0

0

0

0

0

0

2

6

2

NA65

6

NA66

161

Pendingtools

062

12

063

267

Burden of Disease







Targeted training



Risk Communications



training website64



Actions for 2016The focus in future activities is to:

• Strengthen data management systems both at country

and regional level;

• Revise national pandemic infl uenza preparedness

plans in priority countries based on lessons from H1N1

outbreaks;

• Apply sentinel surveillance tools in assessments

planned for PIP priority countries;

• Sustain quality PCR testing in all priority countries

through provision of reagents, aligning support from

other donors such as US CDC and continue building

capacity of NIC staff ; and

• Enhance virus sharing with WHO Collaborating Centers

and ensure refl ection of regional infl uenza viruses in

GISRS databases.

61 Egypt has estimates, publication in process

62 Pakistan and Sudan have been assessed

63 Pakistan, Sudan, Afghanistan, Yemen, Iraq, Morocco are in the process of signing agreement

64 WHO’s iLearn platform was used in 2015



67 Egypt and Sudan




Armenia KyrgyzstanTajikistan

Ukraine

Uzbekistan

Regional Offi ce for Europe (EURO) PIP PC Achievements 2015

During 2015, the Regional Offi ce for Europe (EURO)

worked in Armenia, Kyrgyzstan, Tajikistan, Turkmenistan

and Uzbekistan. Ukraine is also a priority country for

PIP PC funds but work was unable to be performed in

this country in 2015 due to regional unrest. The EURO

Regional Offi ce has developed a EURO PIP website

(http://bit.ly/1P2DdiN) (in English and Russian) to

display information about the PIP Framework and the

achievements of the PIP PC implementation in target

countries. For a second infl uenza season, the joint WHO/

ECDC Infl uenza Surveillance Bulletin was published

to report and share infl uenza surveillance information

throughout the region. One area that needs further

support in the target countries is sharing of viruses and

information on novel viruses with human pandemic

potential. Nonetheless, provisional data analysed

by indicator type and shown in the chart below

demonstrate that regional capacity to detect, monitor

and share infl uenza viruses with pandemic potential is

moving in a positive direction.

Detection capacity


Sharing Capacity


Monitoring capacity



0

NA72

6

NA73

069

374

4

5

6

6

370

571

Output indicators for priority countries: Armenia, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan and Ukraine



68 31 August 2014

69 All six countries have established partial capacity

70 Ukraine, Uzbekistan and Kyrgyzstan

71 Armenia, Kyrgyzstan, Tajikistan, Ukraine, Uzbekistan



74 Armenia, Kyrgyzstan, Ukraine






EURO Detection Capacity EURO Sharing Capacity

EURO Monitoring Capacity

EURO Sustaining Capacity

All priority countries participated in EQAP in 2015

with Kyrgyzstan and Turkmenistan demonstrating

80% to 100% profi ciency in identifi cation of viral

samples. Armenia, Tajikistan and , Turkmenistan and

Uzbekistan have outbreak investigation and response

(OIR) guidelines and are working to institutionalize OIR

training curricula and to develop national case studies

to support monitoring and surveillance.

PIP PC funds are being used to develop capacity of

national infl uenza laboratories to ship infl uenza viruses

to WHO Collaborating Centres for viral characterization.

All fi ve target countries have benefi ted from Infectious

Substances Shipping Training and a total of 77 specialists

from these countries are now certifi ed shippers of

infectious substances.

Armenia, Kyrgyzstan, Tajikistan, Turkmenistan and

Uzbekistan have completed baseline assessments

of their infl uenza surveillance systems (including

laboratory surveillance) using the WHO/EURO sentinel

surveillance review tool and are currently applying

a new WHO/EURO tool to select sentinel sites for

improved surveillance systems. Armenia, Tajikistan

and Turkmenistan have revised their sentinel infl uenza

surveillance guidelines and national recommendations.

All target countries have strengthened their capacities

for infl uenza virological surveillance and are able to

detect and identify novel infl uenza viruses as part of

early warning and response.

Lack of fi nancial and human resources continue to

be challenges to sustaining the achievements of the

region. Five countries now have country plans agreed

with their ministries of health to strengthen capacity in

pandemic preparedness. National infl uenza laboratories

in Tajikistan, Turkmenistan and Uzbekistan are receiving

reagents and consumables through PIP PC funds to

ensure sustainability of their detection and monitoring

capabilities. These countries have received external

assessment of their capacities and mentoring support

to start the WHO NIC recognition process. Over 250

front-line clinicians working in the intensive care units

in all priority countries were trained to perform critical

care management of SARI using an evidence-based

approach.

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0


Actions for 2016

In their 2016 work plans, all fi ve PIP priority countries

requested for assistance in implementation of the

national OIR guidelines, in particular development of

training modules and curricula. To strengthen capacity

on SARI clinical management, countries need revision/

development of their national guidelines based on

the WHO SARI training materials and the International

Surviving Sepsis Campaign Guidelines. In 2016, all

priority countries will pilot the new sentinel surveillance

guidelines with further expansion of sentinel surveillance

sites where necessary. Infl uenza data management

systems will be improved for better data monitoring

and use. In addition, mentoring will continue to priority

countries to enable National infl uenza laboratories to

meet the requirements of WHO to become National

Infl uenza Centers. To facilitate progress in this domain,

procurement of reagents will continue so that the

75 Albania, Armenia, Croatia, Georgia, Kyrgyzstan, Republic of Moldova, Serbia and Ukraine have begun data collection

76 Armenia assessed; Georgia under assessment

77 Armenia has signed the Collaborative agreement; Five countries (Georgia, Republic of Moldova, Kazakhstan, Kyrgyzstan and Tajikistan) are in the process of signing

78 WHO’s ilearn system was used in 2015



81 Kazakhstan, Republic of Moldova, Turkey, Uzbekistan and Ukraine attended a risk communications capacity-building workshop.

0

0

0

0

0

0

8

6

2

NA79

6

NA80

075

Pendingtools

076

20

177

581

Burden of Disease







Targeted training



Risk Communications



training website78





National infl uenza laboratories have continuous

availability of reagents to facilitate detection and

monitoring of infl uenza viruses. Work will also continue

to make the mechanism for shipment of virus isolates/

specimens to the WHO CCs sustainable. Activities will

include identifying and addressing barriers to shipment

and advocacy for virus sharing at the decision making

level in target countries.


Bangladesh

DPR Korea

Indonesia

Myanmar

Nepal

Timor-Leste

Regional Offi ce for South-East Asia (SEARO)PIP PC Achievements 2015

In 2015, the Regional Offi ce for South-East Asia (SEARO)

worked with the following PIP PC priority countries:

Bangladesh, DPR Korea, Myanmar, Nepal, Indonesia and

Timor-Leste. Prior to PIP PC funding, laboratories across

the region had limited resources for effi cient function,

including equipment and reagents. PIP PC funds helped

laboratories in all priority countries to procure essential

equipment and reagents, therefore ensuring the

continuation of testing of samples.

Detection capacity


Sharing Capacity


Monitoring capacity



1

NA85

6

NA86

283

487

2

0

6

6

384

0

Output indicators for priority countries: Bangladesh, Democratic People’s Republic of Korea, Indonesia,

Myanmar, Nepal, Timor-Leste

82 31 August 2014

83 Indonesia, Timor-Leste

84 Bangladesh, Indonesia, Nepal



87 Bangladesh, Indonesia, Myanmar, Nepal








SEARO Detection Capacity SEARO Sharing Capacity

SEARO Monitoring Capacity SEARO Sustaining Capacity

Detection activities are strongly supported in the region

by laboratory algorithms and the ability of PIP priority

countries to perform PCR testing. PIP PC funds helped

laboratories in all priority countries to procure essential

equipment and reagents, ensuring continuity of sample

testing to enhance detection of novel infl uenza viruses.

Training on safe handling and transportation of sample

of infl uenza and emerging infectious disease agents

was conducted in all 11 countries of SEARO. This has

improved awareness about how to handle and transport

samples of infl uenza and other infectious agents.

Indonesia, with support from WHO, helped to train

colleagues in SARI in Timor-Leste. Timor-Leste now has

one SARI and ILI sentinel site functional and providing

data. Nepal expanded national infl uenza surveillance

sites from 10 to 20 by the end of 2015. Bangladesh used

PIP PC funds to identify infl uenza surveillance catchment

areas and strengthen representativeness of surveillance

baseline data.

All target countries in the region have National Infl uenza

Centers and all but one have country plans agreed with

ministries of health. Nonetheless, sustaining laboratory

activities is still diffi cult. Many countries still have a

shortage of staff and funding. Existing staff conduct

not only infl uenza surveillance and testing, but other

infectious disease outbreaks as well.

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0


0

0

0

0

0

0

2

6

2

NA92

6

NA93

088

089

3

390

194

Burden of Disease







Targeted training



Risk Communications



training website91



Actions for 2016The following actions will be targeted by SEARO in 2016:

• Expand ILI/SARI surveillance sites to cover entire

national populations;

• Train more health care workers on case management

for ILI/SARI;

• Advocate countries share virological and

epidemiological information between human and

animal health sectors;

• Support development of a NIC for Bangladesh; and

• Maintain laboratory reagent and equipment supplies

in laboratories across the region.

88 Indonesia and Nepal have started data collection to do estimates

89 Nepal was assessed for regulatory capacity

90 Sri Lanka, Bhutan, Myanmar have signed WHO Collaborative agreement

91 WHO’s iLearn platform was used in 2015



94 Nepal



Pendingtools


CambodiaLao PDR

Mongolia

Viet Nam

Regional Offi ce for the Western Pacifi c (WPRO) PIP PC Achievements 2015

In 2015, PIP PC funds in the Western Pacifi c supported

laboratory and surveillance activities under the Asia

Pacifi c Strategy for Emerging Diseases. Cambodia,

Lao PDR, Mongolia, Pacifi c Island Countries and Viet

Nam were priority recipients of funds. PIP PC funding

supported the 9th bi-regional (SEAR & WPR) Meeting of

National Infl uenza Centres and Infl uenza Surveillance

held in Phnom Penh, Cambodia last year. This meeting

brought together Asia Pacifi c countries to set directions

and priorities for infl uenza surveillance work for the year

to come. It was an example of countries and regions

working together to share laboratory best practices,

as well as information on seasonal and avian infl uenza

activity and epidemiology in the broader region.

Detection capacity


Sharing Capacity


Monitoring capacity



1

NA98

5

NA99

296

5100

4

0

5

5

597

0

Output indicators for priority countries: Cambodia, Fiji, Lao People’s Democratic Republic, Mongolia, Viet Nam



95 31 August 2014

96 Lao PDR, Viet Nam

97 Cambodia, Lao PDR, Mongolia, Fiji and Viet Nam



100 Cambodia, Lao PDR, Mongolia, Fiji and Viet Nam






WPRO Detection Capacity WPRO Sharing Capacity

WPRO Monitoring Capacity

WPRO Sustaining Capacity

Detection activities are strongly supported in the region

through the use of established laboratory testing

algorithms, availability of reagents and PCR capacity. In

the Western Pacifi c Region, 26 laboratories (including

PIP priority countries) participated in the WHO EQAP

with 87% of the countries scoring all samples correctly.

Infectious Substances Shipping Training (ISST) was

attended by 29 participants (including PIP priority

countries) and all participating countries passed the

course. Laboratories in Mongolia, Cambodia and Viet

Nam are now regularly isolating viruses, increasing the

number of viruses isolated and specimens shipped to

WHO Collaborating Centres.

A “right-size” approach to infl uenza surveillance is

promoted in the region for effi cient resource allocation.

PIP PC funds supported surveillance at geographically

representative ILI and SARI sites as well as transport of

specimens from these sites to national laboratories.

To disseminate data collected through these systems,

WPRO produced a prototype for an online infl uenza

dashboard displaying epidemiological and virological

data for seasonal infl uenza and human infections with

avian infl uenza viruses.

Although all priority countries have WHO-recognized

National Infl uenza Centres and all but one has national

PIP plans agreed with ministries of health, sustaining

laboratory activities remains challenging. Many

countries still have a shortage of funding and staff who

must conduct surveillance and testing not only for

infl uenza, but also for other competing priority diseases.

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0

Ave

rag

e s

core


Target3

2

1

0


Actions for 2016WHO will hold a workshop in Viet Nam in May 2016

that will introduce public health professionals to the

methods of the WHO Manual for Estimating Disease

Burden Associated with Seasonal Infl uenza as well as

the WHO Manual for Estimating the Economic Burden of

Seasonal Infl uenza. To allow for more accurate estimates

of infl uenza disease burden, a protocol for hospital

admission surveys is being developed and piloted in

Cambodia in collaboration with US CDC.

Annual PanStop108 exercises will continue to test and

improve the functionality of regional and national

response capacities. Refresher trainings and “train-the-

trainer” courses for laboratory and surveillance staff will

increase capacity of sub-national staff .

101 Cambodia, Lao PDR and Mongolia are in the process of completing estimates

102 Cambodia and Lao PDR assessed for regulatory capacity for vaccines and antiviral medicines

103 The Philippines has signed; Lao PDR, Cambodia, Kiribati, Mongolia, Papua New Guinea are in the process of signing Collaborative agreement

104 WHO ilearn system used in 2015



107 Cambodia, Viet Nam, Mongolia

108 PanStop is a desktop simulation exercise for deployment of antivirals for pandemic infl uenza

0

0

0

0

0

0

3

6

2

NA105

6

NA106

0101

Pendingtools

0102

6

1103

3107

Burden of Disease







Targeted training



Risk Communications



training website104






109 31 August 2014

110 See Annex 1 for more information on these data sharing platforms

111 Results provided within 4 weeks of date of sample receipt

Information sharingWHO information sharing systems (FLUNET and FluID110)

have operated since 1997 and 2009 respectively to

receive surveillance data online from all Member States.

Both platforms were modifi ed in 2015 to ease data

transfer. The systems allow continuous analysis of data,

follow-up of inconsistencies and provision of assistance

in case of issues with data loading in order to encourage

countries to report regularly. Additional online graphs

have been added which show the country data in the

context of the global situation for a quick overview.

In 2015, both FluNet and FluID had more countries

reporting regularly to the system. The number of PIP

countries reporting to FluNet increased from 26 to 30.

Globally, this number has risen from 108 to 114. For

FluID, the number of PIP countries reporting increased

from fi ve to 11. Globally, the number of countries

reporting has risen from 55 to 66.

Infl uenza virus detectionPCR is the gold standard for identifying infl uenza virus

from specimens. WHO’s EQAP for infl uenza virus subtype

A by PCR was initiated in 2007 to monitor the quality

and comparability of the performance of participating

laboratories in routine molecular detection and

surveillance. The indicator, which measures number of

countries who participate in EQAP and score 100% on

Laboratory and Surveillance Achievements –Global Level (Output 3)

Sharing Capacity (global)

Number of countries that participate in

EQAP and score 100%

Number of countries sharing virus with WHO CCs, H5

Reference Laboratories and Essential Regulatory Laboratories

at least once a year in the past two years

Number of countries consistently reporting epidemiological

data to regional or global platforms

Number of countries which consistently report virological data

to a global platform

109

90

55

108

120

108

71

124

103

128

66

114

Output indicators


all panels, has remained relatively constant from the

baseline measurement. Small decreases in number of

participating laboratories scoring 100% refl ect the need

to continuously train laboratory technicians, including

new technicians, to maintain high quality use of PCR

to detect infl uenza viruses. In 2015, 174 laboratories

from 137 countries participated and 153 laboratories

reported results111. A total of 125/153 labs (81.7%)

reported 100% correct results for all samples. For the

infl uenza A(H7N9) sample, the correct rate of detection

increased from 135/156 (86.5%) in panel 13 to 141/153

(92.2%) in panel 14, which is comparable to that for

seasonal infl uenza viruses. The number of participants

performing H7 testing also increased to 136/153

(88.9%) in panel 14 from 114/156 (73.1%) in panel 13.

These improvements refl ect better preparedness for the

detection of infl uenza A(H7) virus.

In addition to ensuring the quality of laboratories

through the EQAP, WHO also identifi es national

laboratories that meet the standards to be designated

a National Infl uenza Centre (NIC). In 2015, Zambia’s

national infl uenza centre was recognized as a NIC. This

achievement demonstrates progress towards the L&S

outcome articulated in the Partnership Contribution

Implementation Plan 2013-2016, that in the next

decade, every country should have access to a NIC.


Infl uenza virus sharingThe infl uenza virus shipment fund was established

a number of years ago to improve sharing capacity

for infl uenza viruses and clinical specimens from

countries, in particular, resource poor ones, with WHO

Collaborating Centres (CCs). Viruses with pandemic

potential are classifi ed as dangerous goods when

transported. Consequently, Infl uenza Substance

Shipping Training (ISST) workshops are carried out

regularly to ensure that laboratory personnel obtain

the mandatory certifi cations for shipping infectious

substances (dangerous goods) under International

Civil Aviation Organization (ICAO) and International

Air Transport Association (IATA) regulations. These

certifi cates are valid for a period of two years. During

2015, 150 countries shared viruses with the WHO CCs

and eight ISST workshops were carried out.

Actions for 2016

Information sharing

Ongoing improvements to the data platform will

make it even more user-friendly and give automated

feedback to users and data managers. Regular data

accuracy checks and continuous feedback are essential

to encourage regular reporting.

Infl uenza virus detection

In 2016, an EQAP panel will be distributed to monitor

the quality and comparability of the performance of

participating laboratories in molecular detection and

surveillance of both seasonal viruses and those with

pandemic potential.

Infl uenza virus sharing

Continuous support for shipments will be provided

and more laboratories will be encouraged to share

specimens in a timely manner. More ISST workshops will

be provided to ensure that countries have laboratory

personnel who are certifi ed to ship the viruses

(dangerous goods).


Bri

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ing

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ll to

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her

: Oth

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Burden of Disease Profi leProvide training and support for burden of infl uenza estimates which will contribute to the development of a global burden of infl uenza estimate

Target countries: Albania, Armenia, Cambodia, Chile, Costa Rica, Croatia, Egypt, Georgia, Indonesia, Kyrgyzstan, Lao

PDR, Madagascar, Moldova (Republic of ), Mongolia, Nepal, Oman, Senegal, Serbia, Ukraine

All 6 WHO regions develop regional representative burden of

disease data to guide developing countries’ policy-making

Output 1: Derive regionally representative infl uenza disease burden estimates from selected countries


with disease burden estimates by 2016

Output 2: Derive a global estimate of infl uenza disease burden estimates from selected countries

Global estimate of infl uenza disease burden derived from national

estimates published

NA

0

0

6

December2016

19

On track

On track

3112

Outcome: National policy-makers will have infl uenza disease burden data needed for informed decision-making and

prioritization of health resources

Burden of Disease


112 Costa Rica, Chile and Egypt have estimates pending publication in peer-reviewed journals. A further 12 countries are fi nalizing estimates.



BackgroundThe burden of disease related to infl uenza is unknown

in most of the world. The available burden information

and vaccine cost eff ectiveness data derives from a few

countries located in temperate climates, which are

not representative of the majority of countries in the

developing world. Lack of representative data makes it

diffi cult to prioritize infl uenza prevention and control

measures against other competing health issues in

countries where resources are most limited. Recent

developments in surveillance capacity now provide

an opportunity to better understand infl uenza disease

burden in previously underrepresented areas of the

world. An inclusive description of disease burden is

needed to address gaps in understanding infl uenza

mortality, morbidity, high-risk groups and economic

impact, especially at the national level.

Developing national burden of disease estimates

that are inclusive takes time largely due to the lack of

adequate country-level data with which to estimate

disease burden. The challenges relate to identifying and

using national data in the following areas:

• New techniques for mortality estimation using

available national data, which are often incomplete,

need to be developed.

• Infl uenza morbidity including hospitalization

burden is diffi cult to measure because of the lack of

specifi c symptoms and the need to use laboratory

confi rmation.

• Several populations have long been recognized to

be at risk for severe complication due to infl uenza.

Specifi c data and a better understanding of what

factors contribute to greater risk for these populations

is needed.

• Costs to the economy, health care systems and

individuals, also known as economic burden, are

important factors infl uencing adoption of intervention

strategies. However, direct medical costs and the

indirect costs of lost productivity are country-specifi c,

depending heavily on social support structures of

each country. Countries need to collect cost data that

refl ect their national systems.

WHO has developed tools to fi ll national data gaps and

help countries to produce valid estimates for infl uenza

disease burden and also the economic burden of

infl uenza. The PIP PC and funds from other donors113

supports WHO’s Global Infl uenza Programme (GIP) to

provide these tools and associated trainings to 19 priority

countries so that they can produce national burden of

infl uenza and economic burden of infl uenza estimates

to improve policy decision-making for vaccination and

other protective health measures for seasonal infl uenza.

Achievements 2015Forty countries, including the 19 PIP PC priority

countries, are currently engaged in estimating the

burden of infl uenza using WHO methodology and

technical support. Many countries face a challenge to

generate national data to produce both the infl uenza

disease and economic burden estimates and progress is

slow but steady. The results are as follows:

• PIP priority countries, Chile, Costa Rica and Egypt, have

completed their national burden of disease estimates

for infl uenza and are awaiting publication in peer-

reviewed journals.

• Twelve other PIP priority countries114 are collecting

data or analyzing them to fi nalize burden of disease

estimates.

• A further 25 countries are expected to have estimates

based on WHO methodology by the end of 2016.

• WHO’s economic burden tool is being piloted by four

PIP priority countries, Chile, Costa Rica, Lao PDR and

Indonesia; and two other countries, Colombia and

Romania.

To provide advice and support to countries undertaking

infl uenza burden estimation, a Burden of Disease Expert

Advisory Group for infl uenza was convened in 2014. This

group holds monthly conference calls and has had two

face-to-face meetings since December 2014.

113 US CDC and Bill and Melinda Gates Foundation

114 Albania, Armenia, Cambodia, Croatia , Georgia, Indonesia, Kyrgyzstan, Lao People’s Democratic Republic, Madagascar, Mongolia, Nepal, Croatia, Pakistan, Republic of Moldova, Senegal, Serbia, Ukraine


Actions for 2016GIP’s Burden of Disease team will continue to support

countries in doing their national estimates using

WHO methods. A meeting is planned for July 2016 to

encourage researchers to share their estimates (pre-

publication), methodology and input data with others

in the global public health community.

Global and regional estimates of infl uenza burden will be

based on the most robust national estimates available in

2016. Work toward global and regional infl uenza burden

estimates is further enhanced by systematic reviews on

infl uenza risk factors, incidence and mortality which are

commissioned to external experts and make use of the

wide range of national data now available through the

eff orts of WHO and other researchers around the world.

By the end of the year, a draft estimate on the

hospitalized respiratory infl uenza disease burden and

mortality based on excess mortality from infl uenza will

be available.

The WHO economic burden tool, now being tested in six

countries (see above), will also be fi nalized in 2016.

Further work is needed to develop:

• tools to estimate cost-eff ectiveness of specifi c

interventions to treat and/or prevent infl uenza;

• tools/models to guide policy decisions on when and

where to use seasonal vaccine; and

• a global platform that holds global and regional burden

data, economic data, and risk factors information that

could be used to plan national infl uenza policies.


Regulatory Capacity Building Profi leBuild national regulatory capacity so that vaccines, diagnostic tests and antiviral medicines for infl uenza can be deployed quickly

Target countries: Armenia, Bolivia, Cambodia, Congo (Democratic Republic of ), Ethiopia, Georgia, Ghana, Haiti, Kenya, Lao PDR, Nepal, Pakistan, Sri Lanka, Sudan, United Republic of Tanzania, Uganda

By 2016, at least 16 countries will have improved their regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics and to accelerate national approval registration of these commodities in case of an infl uenza pandemic

Output 1: Develop guidelines on regulatory preparedness for non-vaccine producing countries that enable them to expedite approval of infl uenza vaccines used in national immunization programsRegulatory preparedness guidelines endorsed by the WHO Expert Committee on Biologicals Standardization (ECBS)

Output 2: NRA capacity to regulate infl uenza products includingvaccines, antivirals and diagnostics is strengthenedNumber of countries which developed regulatory capacity to oversee infl uenza products including vaccines, antivirals and diagnostics in case of a pandemic as per the WHO NRA assessment and IDP elaboration and implementation

Output 3: Regulatory processes to accelerate approval of infl uenza vac-cines, antivirals and diagnostics during a public health emergency are incorporated into deployment plans for pandemic infl uenza productsNumber of countries with a common approach for accelerated regulatory approval of infl uenza products in a public health emergency

NA

0

0

0

At least16

16115

48117

1

On track

1116

14118

awaitingECBS

endorse-ment

Outcome: Countries with weak or no regulatory capacity will be able to regulate infl uenza products including vaccines,

antivirals and diagnostics, and to accelerate national approval of these commodities in case of an infl uenza pandemic

Regulatory Capacity


The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,

territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.


BackgroundDuring the 2009 A(H1N1) pandemic, WHO

prequalifi cation (PQ) of a vaccine was not suffi cient to

obtain regulatory approval in over half of the countries

that received donated pandemic A(H1N1) vaccines.

There was no common regulatory process for countries

to use for product registration and many countries were

unable to follow the relevant WHO guidance documents

for product registration due to severely limited capacity

to respond to emergencies and/or weak or no regulatory

capacity to regulate infl uenza products. These realities

highlighted an urgent need for regulatory capacity

building to facilitate deployment and avoid bottlenecks

in regulatory processes, especially during public health

emergencies.

To prepare for a more rapid response to pandemic

infl uenza, the WHO Essential Medicines and Health

Products Department (EMP) is using PIP PC to conduct

activities that strengthen the capacity of regional/sub-

regional and/or national regulatory systems to:

• regulate infl uenza products (including vaccines,

antivirals and diagnostic tests) effi ciently and

eff ectively; and

• accelerate national approval of these commodities in

the event of an infl uenza pandemic.

115 Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, United Republic of Tanzania, Uganda, Bolivia, Haiti, Pakistan, Sudan, Armenia, Georgia, Nepal, Sri Lanka, Cambodia, Lao PDR

116 The NRA of 14 of 16 PIP priority countries were assessed. One country has acceptable capacity in the three areas of assessment: regulatory systems, marketing authorization and pharmacovigilance. Implementation of Institutional Development Plans (IDP) started in 14 of the 16 PIP countries. Enhancing regulatory capacity is a long-term investment and impact data is not yet available.

117 Democratic Republic of Congo, Ethiopia, Ghana, Kenya, United Republic of Tanzania, Uganda, Mozambique, Cote d’Ivoire, South Africa, Angola, Burkina Faso, Gambia, Cameroon, Benin, Central African Republic, Guinea, Malawi, Mali, Bolivia, Haiti, Honduras, Nicaragua, Guyana, Peru, Pakistan, Sudan, Afghanistan, Yemen, Iraq, Morocco, Armenia, Georgia, Rep. of Moldova, Kazakhstan, Kyrgyzstan, Tajikistan, Nepal, Sri Lanka, Bangladesh, Bhutan, Myanmar, Timor-Leste, Cambodia, Lao PDR, Kiribati, Mongolia, Philippines, Papua New Guinea

118 United rep. of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique, Burkina Faso, Cameroon, Benin, Mali, Armenia, Sri Lanka, Bhutan and Myanmar

119 http://www.who.int/immunization_standards/national_regulatory_authorities/role/en/

Achievements 2015

Guidelines on regulatory preparedness for non-

vaccine producing countries

PIP PC supported the development of draft guidelines

on regulatory preparedness for non-vaccine producing

countries. These guidelines are aimed at helping

countries expedite approval of infl uenza vaccines used

in national immunization programs and/or deployed

by United Nations agencies in response to a pandemic

emergency. In 2015, WHO:

• conducted a review and analysis of relevant guidance

and prepared a report that identifi ed gaps and

provided a foundation for the WHO guidelines;

• convened a stakeholder workshop (Tunis, Tunisia,

June 2015) to develop a framework for the new

guidelines. Participants included experts from WHO

and from national regulatory authorities (NRA), and

representatives from countries that do not produce

vaccines; and

• produced draft guidelines based on the report and the

framework developed during the workshop.

National Regulatory Authority capacity to regulate

infl uenza products

WHO is working with 16 target countries to identify

and address critical gaps with a focus on strengthening

regulatory systems and the two functions deemed

essential for countries that procure vaccines primarily

through United Nations agencies: marketing

authorization and pharmacovigilance.119

As of 31 December 2015, WHO had assessed the

National Regulatory Authorities (NRAs) of 14

countries, identifi ed gaps and developed institutional

development plans. The results of these assessments

(Figure 3) show that capacities in the three areas of

enquiry vary greatly within and across countries. The

majority of these countries do not meet critical criteria

in their regulatory systems, marketing authorization,

or pharmacovigilance functions and are, therefore,

unprepared for public health emergencies of any kind.

As a fi rst step, regulatory capacity-building activities

should aim at helping countries move out of critical and

into acceptable capacity, with particular emphasis on

pharmacovigilance.


A diverse range of activities was carried out in 2015 to

strengthen capacities across the three regulatory areas

of work (Table 6).

Figure 3: Snapshot of regulatory capacity status in 14 PIP Countries - The dots represent each country and show their current status in each area of regulatory capacity development.

Table 6: Sample of regulatory capacity-building activities supported by PIP PC in 2015

• WHO meeting to develop Guidelines on regulatory preparedness for vaccine non-producing countries in response to pandemic infl uenza emergency, regulators from 10 PIP target countries participated, June 2015, Tunis, Tunisia

• PQ product summary fi le (SPF) review of seasonal infl uenza vaccine, one participant from Ghana NRA participated, June 2015, Geneva, Switzerland

• One regulator from Nigeria NRA completed a rotational fellowship with the WHO PQ team, July-October 2015, Geneva, Switzerland

• Vaccine pharmacovigilance fellowship, WHO Collaborating Centre for Advocacy and Training in Pharmacovigilance, four participants from Democratic Republic of Congo and Ethiopia, September 2015, Accra, Ghana

• 38th International pharmacovigilance centers’ meeting, three participants from Ethiopia and Gambia, November 2015, New Delhi, India

• Inter-regional pharmacovigilance training, WHO-Uppsala Monitoring Centre, Health Sciences Authority of Singapore, eight participants from Cambodia, Lao PDR, Myanmar, and Philippines, September-October 2015, Singapore

• First Asia Pacifi c training course in pharmacovigilance, organized by WHO, JSS University in Mysore, India, and Uppsala Monitoring Centre, four participants from Cambodia, Lao PDR, February 2015, Mysore, India

• In-country training on Quality Management Systems for regulators, 40 participants, October 2015, Phnom Penh, Cambodia

• In-country training on Quality Management Systems for regulators, 27 participants, November 2015, Vientiane, Lao PDR

• WHO Workshop on sensitization towards Quality Management Systems for NRAs: 13 countries from the Eastern Mediterranean and European Regions, 31 participants, December 2015, Antalya, Turkey

Marketing authorization

Pharmacovigilance

Regulatorysystems

REGULATORY FUNCTION ACTIVITY

Regulatory SystemsPharmacovigilance

Marketing Authorization

Below critical capacity

Acceptable capacity

Desired capacity


Common approach for accelerated regulatory approval of infl uenza products in a public health emergency

The Collaborative procedure developed by WHO

Prequalifi cation of Medicines Programme and national

medicines regulatory authorities to assess and

accelerate national registration of WHO-prequalifi ed

pharmaceutical products and vaccines has been

adopted by 14 countries120. This agreement facilitates

the deployment of pharmaceutical products during a

public health emergency. To encourage more countries

to adopt the collaborative procedure, WHO:

• conducted an advocacy workshop in the South-

East Asia Region on the collaborative procedure for

registration of infl uenza vaccines as part of pandemic

infl uenza preparedness (Bangkok, Thailand, November

2015); and

• initiated the development of an addendum to

the collaborative procedure to cover vaccines for

emergency use.

Actions for 2016

Guidelines on regulatory preparedness for non-vaccine producing countries

A stakeholders consultation was held April 2016, Geneva,

Switzerland, to review the draft guidelines and provide

comments to the drafting group. The fi nalized guidelines

will be submitted to the WHO Expert Committee on

Biological Standardization for endorsement in October

2016.

NRA capacity to regulate infl uenza products

The NRA of the two remaining PIP target countries,

Sudan and Haiti, will be assessed in 2016 so that gaps

can be identifi ed and institutional development plans

prepared. Trainings and workshops will continue in

priority countries to address regulatory gaps, and WHO

will monitor progress on each of the three critical areas

for national regulatory capacity.

120 United Rep. of Tanzania, Uganda, Ethiopia, Ghana, Kenya, Mozambique, Burkina Faso, Cameroon, Benin, Mali, Armenia, Sri Lanka, Bhutan, Myanmar

Common approach for accelerated regulatory approval of infl uenza products in a public health emergency

WHO will continue to raise the profi le of the collaborative

procedure for pharmaceutical products and vaccines

by conducting a regional advocacy workshop in the

Western Pacifi c Region.

WHO will continue to develop the addendum to the

collaborative procedure to cover vaccines for emergency

use.


WHO`s fi ve-step regulatory capacity-building model

Guidelines on regulatory preparedness for non-vaccine producing countries

Since the 1990’s, the WHO programme on regulatory systems strengthening (RSS) has implemented a fi ve-

step capacity building model with the goal of helping countries meet and sustain regulatory functionality for

medicines and other health products as per established WHO indicators. To date, WHO has assessed more than

100 NRA around the world using tools developed in-house. WHO complements these assessments with the

use of newly developed tools that specifi cally assess regulatory capacity for infl uenza vaccines, and pandemic

infl uenza preparedness.

The fi ve-step approach includes developing and maintaining a benchmark tool for assessing NRAs using a set

of indicators to measure performance for the recommended regulatory functions. It may entail either a self-

assessment of functions by the NRA or a WHO assessment of the functions by an international team of experts. This

assessment leads to the identifi cation of strengths and gaps which are refl ected in an Institutional Development

Plan (IDP), or in special cases, in a road map as well. After endorsement of the IDP by the government (NRA

and/or Minister of Health) it can be used to tailor the technical support to the specifi c needs of that particular

authority and country. Once the proposed activities are implemented (including training and technical support),

a re-assessment, or other monitoring mechanisms, allow verifi cation of the progress achieved. Based on the

progress made and the remaining gaps a new plan for technical support is developed and implemented.

Revision of indicators

and assessment

process every

2-3 years

Re-assessment

every 2-5 years or

7 years

With or without a

road map for

prequalification of

products

WHO support through

technical assistance,

in-country training

and Global Learning

Opportunities (GLO)

WHO electronic

platform to monitor

NRA information and

assessment reports,

IDP, training, etc.

1 2 3 4 5

Benchmarking development of NRA assessment

tool

Assessment of NRA

Developmentof Institutional

Development Plan (IDP)

Providingtechnical support, training / learning

and networking

Monitoringprogress & impact


Planning for Deployment Profi lePlan for effi cient and equitable deployment of vital supplies for pandemic infl uenza

Target countries: Armenia, Bolivia, Cambodia, Congo (Democratic Republic of ), Ethiopia, Georgia, Ghana, Haiti,

Kenya, Lao PDR, Nepal, Pakistan, Sri Lanka, Sudan, United Rep. of Tanzania, Uganda

Output 1: A common approach to manage deployment operations is developed and shared with stakeholders and deployment partners

A common deployment approach is developedwith multiple deployment stakeholderendorsement

Number of training and simulation exercises with deployment

stakeholders

Output 2: Country deployment readiness systems are simplifi ed and updated

Model country recipient agreement is revised and updated

Countries and partners accessing web-basedplanning tools

0

0

0

0

1

16

1

8

In process

Pendingtools

Draftavailable

Simulation exercise set for

mid-2016

Outcome: Plans for deployment of pandemic supplies including vaccines, antivirals and diagnostics, will be developed

and regularly updated





BackgroundAn analysis of vaccine deployment activities in the

A(H1N1) pandemic in 2009121 identifi ed slow country

readiness and a high number of deployment systems as

bottlenecks in the eff ectiveness of delivering donated

vaccines. Multiple agencies acted as responders,

including UN agencies, government agencies, industry

and civil society. Each responder had diff erent

operational platforms, few of which had been used in

emergencies. The large number of competing systems

led to two key bottlenecks:

1. Respondents were not suffi ciently aware of the

actions of others and the reciprocal impact of each

other’s activities, especially the impact on recipient

countries; and

2. Multiple responder systems experienced operational

failures in attempts to fi t domestic and other systems

into an emergency mode.

In addition, countries were overwhelmed by competing

health priorities and had diffi culties in developing a

“ready” status, which was a requirement to receiving

and making immediate use of the initially limited supply

of vaccines.

PIP PC funds are being used to provide solutions to

these challenges. The fi rst is to develop and participate

in simulation activities to avoid losing institutional

knowledge gained and to continually test operational

systems. While each responder will likely continue

to operate a unique system, simulating a combined

response provides an opportunity to adapt towards a

single system.

The second is to assess existing country deployment

plans to identify common gaps across countries,

weaknesses in the approaches for readiness, and develop

a quantifi cation of the needs for technical support that

could facilitate rapid deployment. Filling these gaps with

immediate technical support will prevent a situation

where a country needs vaccines or supplies but is not

ready to deploy them without assistance.

Achievements 2015The simulation tool designed to identify and correct

bottlenecks in vaccine delivery to countries in public

health emergencies, PIPDEPLOY, was pilot tested in early

2015. The tool captures the time it takes to perform key

interactions in the supply chain. It also measures which

actions fail the most frequently so that improvements can

be made to effi ciently handle these actions. Responders

use this information to evaluate and prepare their

internal systems for pandemic infl uenza. WHO solicited

external IT companies to develop the simulation tool

through a rigorous, competitive bidding process. A fi rm

was selected and began work to fully develop the tool

in late 2015. Unlike commercially available supply chain

simulators, the complexity in an emergency response is

capturing the number of complex interactions and any

related bottlenecks. The product is undergoing fi nal

quality testing and is expected to be available in a live

version in 2016.

Evaluation of country deployment plans, including

quantifi cation of technical assistance needed and gaps

in methodologies has been completed. The subsequent

draft report considers the development of a roster

of individuals to respond to a core set of capacities

to facilitate deployment in the event of a national

emergency. However, the fi nal report will describe a

model whereby national and/or international agencies

agree to release staff to an emergency response team.

This model, if agreed, could reduce administrative delays

and the concurrent risks of managing large numbers of

individual consultants.

Actions for 2016The simulation tool will go live in 2016, to be preceded

by brief web-based trainings on the concept and use

of the system. National deployment plans will move to

another phase of development in 2016. This phase will

include an assessment of current plans against those of

2009 with subsequent updating to fi ll identifi ed gaps.

121 A review of the deployment of A(H1N1) vaccine (http://www.who.int/infl uenza_vaccines_plan/resources/h1n1_vaccine_deployment_initiative_moll.pdf)


Risk Communications Profi leBuild national capacity to provide accurate public health information during emergencies

Target countries: Afghanistan, Barbados, Bangladesh, Bhutan, Burkina Faso, Cambodia, Dominica, Ecuador, Egypt, Honduras, Fiji, Gabon, Indonesia, Kazakhstan, Kenya, Lao PDR, Lebanon, Mauritania, Mexico, Moldova (Republic of ), Mongolia, Mozambique, Nepal, Pakistan, Panama, Saint Lucia, Saint Vincent and the Grenadines, Senegal, Seychelles, Sudan, Suriname, Timor-Leste, Turkey, Ukraine, Uzbekistan, Viet Nam, Yemen, Zimbabwe

Output 1: Access to risk communications training and platformsis increased enabling all countries to respond more eff ectivelyto a potential infl uenza pandemic Tools and web-based risk communications training material access-ible to Member States in all language versions by December 2015

Number of registered users of online material

Number of trainings completed on IHR risk communications training website122

Output 2: Risk communications capacity is established in priority countries with little or no capacityTargeted Member States will have benefi ted from IHR risk communications programme by end of 2016

Output 3: Global Emergency Communications Network (ECN) operationalized to provide support to countries before, during and after public health emergenciesProportion of requests for risk communications surge support responded to within 72 hours by WHO in 2015/16

0

0

0

0

0

30

80%

194

500

200

513

96

17

100%

Available in English

Outcome: Global risk communications capacities are strengthened with a special focus on pandemic infl uenza communications

Risk Communications





123 http://www.who.int/risk-communication/pandemic-infl uenza-preparedness/en/

BackgroundOver the last two years, risk communication has rapidly

moved up political agendas and transformed from an

ill-defi ned, underfunded public health technical fi eld to

a core, crosscutting element of health emergency and

outbreak preparedness and response. In 2012, when

the PIP PC funding began, there was little support for

risk communication. It was treated as an afterthought

in both emergency preparedness and response. In 2014

and 2015, challenges faced and lessons learnt in the

international response to the Ebola outbreak in West

Africa highlighted the importance of building national

and international capacity for risk communication.

The PIP PC funded risk communication project aims to

strengthen global resources and tools available to all

countries and stakeholders for eff ective pandemic risk

communication. The project provides targeted support

for national risk communication capacity building

in 30 priority countries by supporting governments

and national/local journalists. In addition, a global

Emergency Communications Network (ECN) has been

established so that experts can be deployed quickly to

support risk communication emergencies.

Achievements 2015Through PIP PC funds, WHO developed new guidelines,

tools, resources, curricula and materials to disseminate

pandemic infl uenza skills and knowledge and build

capacity in pandemic infl uenza risk communication

globally.123 Highlights of these tools and resources

include:

• Standard risk communication curricula for workshops

and trainings with modules on pandemic risk

communication, and vaccine hesitancy;

• Online PIP risk communication training platform with

a contact database of over 1,000 training participants;

• Simulation and tabletop exercises designed around

testing risk communication capacity in response to a

pandemic infl uenza outbreak or other proxy diseases

with pandemic potential in Turkey, Republic of

Moldova, Kingdom of Saudi Arabia, Kenya, Cambodia,

Kazakhstan, Switzerland and Jordan;

• Vaccine safety communication training course

developed and tested;

• Multiple regional and sub-regional workshops across

WHO’s African, European, Eastern Mediterranean and

Americas regions to engage senior decision-makers in

investing in risk communication preparedness; and

• Training package developed and sub-regional media

workshops to provide technical trainings for around 50

journalists and support responsible reporting during

pandemic infl uenza.

WHO has worked closely with decision-makers to

provide expertise and sustained support for national

pandemic infl uenza risk communication capacity

building in priority countries. Important meetings and

risk communication plans completed include:

• Country-level engagement and support in priority

countries including Egypt, Sudan, Kazakhstan,

Republic of Moldova, Turkey, Ukraine, Uzbekistan,

Cambodia, Mongolia and Viet Nam124;

• On-request risk communication capacity-building/

emergency support to countries experiencing

infl uenza outbreaks;

• Providing risk communication capacity-building

sensitization and engagement following outbreaks of

respiratory illnesses such as Middle East Respiratory

Syndrome Coronavirus (MERsCoV); and

• Rapid national risk communication capacity

assessment in 20 EMRO countries.

WHO’s ECN has been expanded in numbers and areas

of expertise to include media communication, vaccine

communication, community engagement, social

mobilization and partner communication among

others. Three ECN pre-deployment trainings took place

during the period under review and the curriculum and

the simulation exercise contained content on pandemic

infl uenza and vaccine-related communication issues.

There is currently a roster of 150 staff , consultants,

partners, and government experts and offi cials trained in

emergency risk communication able to be deployed for

pandemic communications. The ECN roster deployment

rate is around 80%.

124 Hands-on support with development of National risk communication plans in Viet Nam and Sudan


Actions for 2016Work will continue in 2016 to expand the Online PIP

Risk Communications training platform to train more

people around the world in risk communications. In

addition, through PIP funding in 2015, a new national

risk communication assessment tool was developed

under IHR and is being piloted and used in 2016. Other

ongoing activities in 2016 include:

• Risk communication outcome monitoring tool

developed with the Harvard School of Public Health;

and

• A partnership with the World Organization for

Animal Health (OIE) with joint training of animal and

human health professionals for pandemic infl uenza

preparedness.

Risk communication capacity-building: PIP’s ‘hands-on’ approachA new hands-on approach is helping build

global and national capacity in pandemic

infl uenza risk communication. Simulation and

table-top exercises provide participants with the

opportunity to fi nd out how prepared they are for

an outbreak with pandemic potential. Participants

are given details of a fi ctive setting including

economic, cultural and political characteristics.

Through a series of increasingly challenging

“injects”, they learn about an evolving public

health situation and are given a series of tasks

they must execute in small groups within tight

deadlines.

Exercises can take place in a classroom, a simulated

fi eld environment or in the workplace, and may

unfold over many days. Through PIP, around

300 participants have taken part in simulation

and table-top exercises to practice pandemic

infl uenza risk communication in Turkey, Republic

of Moldova, Kingdom of Saudi Arabia, Kenya,

Cambodia, Kazakhstan, Switzerland and Jordan.

Regional risk communication workforce in the Eastern Mediterranean RegionIn December 2015, PIP’s fi rst regionally-focused

Emergency Communications Network (ECN)

training took place in Amman, Jordan. Public

health offi cials from 13 countries in the Eastern

Mediterranean attended including Afghanistan,

Egypt, Iraq, Islamic Republic Of Iran, Jordan,

Oman, Lebanon, Libya, Morocco, Pakistan, Saudi

Arabia, Sudan and Tunisia. Participants spent six

days in a classroom environment undertaking

intensive morning-to-night training and drills in

emergency risk communication. Over the fi nal

three days and two nights, participants took part

in an around-the-clock simulation exercise to

practice their new skills and knowledge. Within a

scenario of a rapidly escalating outbreak of novel

infl uenza, participants were deployed to a “fi eld-

like” environment as risk communication experts

working in a race against time to limit disease

spread and help prevent a pandemic. Graduates

of the program joined the ECN – a global roster

of trained communication specialists who can be

deployed in public health emergencies.

Prioritizing pandemic communication in WHO’s African RegionCapacity-building work in AFRO was delayed

due to the Ebola outbreak. But on the fl ip side,

the project team was able to leverage the Ebola

experience into high-level political commitment

for epidemic and pandemic risk communication.

In 2015, in two high-level meetings in Nairobi

and Dakar, senior government health emergency

decision-makers from 44 countries in the

region convened to learn about and plan for

strengthening their national emergency risk

communication (ERC) systems. As part of a

table-top exercise, participants developed risk

communication plans in response to a simulated

novel infl uenza outbreak with pandemic potential

outputs. The meetings focused on guiding

principles, national priorities and concrete actions

for national risk communication capacity building

in the African Region.


Preparing to respond to a pandemic

Figure 4: Response funds, 2012-2015

25

20

15

10

5

0

Mil

lio

ns

Response fund

Total available:

$22,723,424

2014: $7,280,297

2015: $3,115,038

2012: $4,892,671

2013: $7,435,418

Guiding principles governing the use of PIP PC response fundsThirty per cent of PIP PC funds are held in reserve for

use when the next infl uenza pandemic is declared

by WHO (Figure 4). In October 2014, the Advisory

Group developed Guiding Principles for the use of PIP

Partnership Contribution ‘Response’ Funds125, recognizing

that “at the time of a pandemic, time will be of the

essence and there will be limited or no opportunities

to convene the Advisory Group or hold interactions

with industry and other stakeholders to discuss the

use of ‘Response’ resources.”126 The Guiding Principles,

developed by the Advisory Group in consultation with

industry and other stakeholders, will provide the basis

for the Director-General to decide on the use of the PC

for response purposes without further advice from the

Advisory Group, or interaction with industry and other

stakeholders.127

It is anticipated that these funds will be needed to

access and transport some of the pandemic infl uenza

vaccine that has been secured through the Standard

Material Transfer Agreements (SMTA2s).128 Additionally,

antiviral medicines, diagnostic tests and other related

products will be needed for an eff ective response. Rapid

and eff ective deployment of these supplies to countries

in need will require these reserved funds as well as

additional fi nancial resources.129

125 http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1

126 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section I, paragraph 8

127 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section I, paragraph 9

128 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section II, paragraph 3

129 See http://www.who.int/infl uenza/pip/guiding_principles_pc_response_funds.pdf?ua=1, section II, paragraphs 4 and 7


PIP Secretariat

General functionsThe PIP Secretariat is the unit within WHO that manages,

administers and coordinates the implementation of

the PIP Framework as a whole and the Partnership

Contribution (PC) in particular. The PIP Secretariat is

funded in part through PC resources130. The Secretariat

also seeks additional support through extra-budgetary

grants for specifi c components, such as the conclusion

of SMTA2s.

Implementation of PC fundsThe PIP Secretariat benefi ts from three years of

experience in collecting and implementing the PC

funds. In 2015, the Secretariat had the strong support

and collaboration of six project managers, one in

each WHO Regional Offi ce. Additionally, each of the

fi ve headquarters-based Areas of Work (AOWs) had a

designated focal point for their PIP-funded projects.

Monthly video-teleconferences with the Regional Offi ce

project managers and regular meetings with the AOW

focal points helped coordinate the projects and ensure

synergies were captured. Solutions were found to

challenges in implementation as they arose. Biannual

planning meetings held in July and December 2015

helped standardize operating procedures and formulate

specifi c 2016 work plans, targeting gaps in capacity in

countries in each region.

Achievements 2015

Project management processes and procedures

Standardized templates and procedures, with associated

guidance notes, were developed for use by regions and

departments receiving PIP PC preparedness funds. The

documents establish standard approaches to technical

and fi nancial project planning, monitoring, review and

reporting. Work plans for 2016 were developed using

these tools and changes are being made to simplify

processes based on feedback from Regional and

Country Offi ces, and AOW focal points.

130 http://apps.who.int/gb/ebwha/pdf_fi les/WHA66/A66_17Add1-en.pdf?ua=1 at paragraph 29.

Work plans and funds distribution

Between August and December 2015, 53 work plans for

2016 were developed and approved, and a fi rst tranche

of US$ 9.8 million was distributed. These funds covered

both staff and activity costs.

Synergies

Building on the PIP global team established in 2014,

there was further integration of PIP PC-funded

activities to complement preparedness capacity-

building eff orts in other programmes and initiatives.

This included the programme for International Health

Regulations 2005 (IHR) at headquarters, US CDC-funded

infl uenza programmes and other disease surveillance

programmes in WHO Regional Offi ces.

Stakeholder Communications

Signifi cant eff orts were made to continue to increase

the frequency and quality of the existing high-level

communication with stakeholders. The following

communication eff orts were notable in 2015:

• PIP PC Implementation Portal: Quarterly updates

were made to this web-based system that is designed

to increase transparency and information about the

use of funds received from manufacturers under the

annual PC and detailed in the PIP PC Implementation

Plan (2013-2016).

• PIP Framework e-Newsletter: Six issues of the bi-

monthly news brief on implementation of the PIP

Framework were distributed to a mailing list of over

2,000 recipients.

• Outreach: The Secretariat held bi-monthly

teleconferences with industry and civil society

representatives throughout 2015 to discuss issues

arising from the implementation of the PIP Framework.

• Poster: A large portable poster for use at exhibitions

and conferences was developed to better explain

how the PIP Framework works to improve pandemic

preparedness.

• Critical Path Analysis (CPA): The fi nal version of

the CPA, which outlines the full scope of the process

from virus detection to population protection, was

published.


PIP Advisory Group members

Role of the Advisory GroupThe oversight mechanism of the PIP Framework includes

the World Health Assembly, the Director-General and

the independent Advisory Group. The Advisory Group

monitors and provides guidance to strengthen the

functioning of the WHO GISRS and undertake necessary

assessments of the trust-based system needed to protect

public health and to help ensure implementation of

the Framework131. The Group has 18 members drawn

from three Member States in each WHO region, with a

skill mix of internationally-recognized policy-makers,

public health experts and technical experts in the fi eld

of infl uenza.

Advisory Group Members in 2015The PIP Secretariat acknowledges the exemplary

dedication and commitment to excellence that the

Advisory Group has shown since its very fi rst meeting. The

quality of the guidance and recommendations provided

to the Director-General have signifi cantly supported

and improved the Secretariat’s implementation. The

Secretariat extends its sincere thanks to the Advisory

Group. Its members in 2015 are listed in Table 7 below.

131 Taken from article 7.2.1 of the Pandemic Infl uenza Preparedness Framework for the sharing of infl uenza viruses and access to vaccines and other benefi ts

Table 7: Advisory Group Members in 2015

Professor Tjandra Y AditamaChairman, National Institute of Health Research and Development, Ministry of Health, Indonesia

Dr William Kwabena AmpofoSenior Research Fellow & Head of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana

Professor Chris BaggoleyChief Medical Offi cer Australia

Dr Jarbas Barbosa da Silva, Jr.Secretary (Vice Minister) of Health Surveillance, Ministry of Health, Brazil

Dr Rainer EngelhardtAssistant Deputy Minister of the Infectious Disease Prevention and Control Branch, Public Health Agency, Canada

Professor Didier HoussinPresident, French Agency for Food, Environmental, Occupational Health and Safety (ANSES), France

Dr Olav HungnesDirector, Norwegian National Infl uenza Centre, Norwegian Institute of Public Health, Norway

Dr Amr Mohamed KandeelChief Preventive Aff airs and Endemic Diseases Sector, First Undersecretary, Ministry of Health and Population, Egypt

Professor Oleg Ivanovich KiselevDirector, Research Institute of Infl uenza, Ministry of Public Health and Social Development, National Infl uenza Centre, Russian Federation

Dr Cuauhtémoc ManchaDeputy Director General of Preventive Programs, National Centre for Preventive Programs

Dr Frances McGrathDeputy Director of Public Health, Clinical Leadership, Protection and Regulation, Ministry of Health, New Zealand

Professor Ziad MemishAssistant Deputy Minister of Health for Preventive Medicine, Saudi Arabia

Dr Janneth MghambaAssistant Director for Epidemiology and Disease Control, Ministry of Health & Social Welfare, United Republic of Tanzania

Dr Hama Issa MoussaNational Technical Assistant, Institutional Support Unit, Ministry of Public Health, Niger

Dr Huma QureshiExecutive Director, Pakistan Medical Research Council, Pakistan

Professor Mahmudur RahmanDirector, Institute of Epidemiology, Disease Control and Research, Bangladesh

Dr P V VenugopalFormer Director of International Operations, Medicines for Malaria Venture, Public Health Specialist, India

Professor Yu WangDirector-General, Chinese Center for Disease Control and Prevention, China

ADVISORY GROUP MEMBER


Looking to the future

Lessons learnt from PIP PC implementationUsing the current invoice cycle of the PC, funds

are generally received during the 4th quarter of an

implementation year and into the 1st and 2nd quarters

of the following year (see Figure 5). The relatively

long period of time to receive funds means that there

is uncertainty over how much WHO will receive and

when. Work plans are developed and approved but

there are delays in implementation across all AOWs

because of when funds are received by WHO. Several

disbursements were made in September 2015 as work

plans were approved.

Alignment of the PC collection and implementation

process, facilitated by a simplifi ed PC collection

process that is transparent and fair for all, will help

AOWs, Regional and Country Offi ces better plan critical

activities.

Next steps toward improving preparation and response to a pandemic infl uenza eventAll recipients of the PIP PC will continue to implement

activities in their approved work plans in 2016 to

meet the targets set for the projects, according to the

agreed indicators of outcomes and outputs in the PC

Implementation Plan 2013-2016. However, it is clear

that in order to meet the expectations for pandemic

preparedness in the Plan, additional AOWs and more

low and middle-income countries will need the support

of the PIP PC in the future.

Figure 5: Collection and implementation cycle for the PIP Partnership Contribution 2014-2015

* As of 17 August 2015

** L&S request for money was made later

March – November 2014November 2014 – August 2015

October 2014 – August 2015

March – September 2015

March – September 2015

Collection

Collection process(questionnaire, band selection form, invoicing)

Payments coming in

Project plans development**

Project plans approval by ADGO

Disbursement

Jan May Jul Sep Nov 2015 March May Jul Sep

Project plans development

USD 27,138,843received *

Mar


Annex 1PIP PC Priority Countries across each Area of Work

Table 8: Laboratory & Surveillance - 43 PIP Priority Countries

Table 9: Burden of Disease - 19 PIP Priority Countries

COUNTRY WHO REGION

Afghanistan

Algeria

Armenia

Bangladesh

Bolivia (Plurinational State of)

Burundi

Cambodia

Cameroon

Chile

Costa Rica

Djibouti

Dominican Republic

DPR Korea

Ecuador

Egypt

Fiji

Ghana

Haiti

Indonesia

Jordan

Kyrgyzstan

Lao PDR

Lebanon

Madagascar

Mongolia

Morocco

Mozambique

Myanmar

Nepal

Nicaragua

Republic of Congo

Sierra Leone

South Africa

Suriname

Tajikistan

United Republic of Tanzania

Timor-Leste

Turkmenistan

Ukraine

Uzbekistan

Viet Nam

Yemen

Zambia

EMRO

AFRO

EURO

SEARO

AMRO

AFRO

WPRO

AFRO

AMRO

AMRO

EMRO

AMRO

SEARO

AMRO

EMRO

WPRO

AFRO

AMRO

SEARO

EMRO

EURO

WPRO

EMRO

AFRO

WPRO

EMRO

AFRO

SEARO

SEARO

AMRO

AFRO

AFRO

AFRO

AMRO

EURO

AFRO

SEARO

EURO

EURO

EURO

WPRO

EMRO

AFRO

COUNTRY WHO REGION

Albania

Armenia

Cambodia

Chile

Costa Rica

Croatia

Egypt

Georgia

Indonesia

Kyrgyzstan

Lao PDR

Madagascar

Moldova, Republic of

Mongolia

Nepal

Oman

Senegal

Serbia

Ukraine

EURO

EURO

WPRO

AMRO

AMRO

EURO

EMRO

EURO

SEARO

EURO

WPRO

AFRO

EURO

WPRO

SEARO

EMRO

AFRO

EURO

EURO

Table 10: Regulatory Capacity Building - 16 PIP Priority Countries

COUNTRY WHO REGION

Armenia

Bolivia, (Plurinational State of)

Cambodia

Democratic Republic of the Congo

Ethiopia

Georgia

Ghana

Haiti

Kenya

Lao PDR

Nepal

Pakistan

Sri Lanka

Sudan


Uganda

EURO

AMRO

WPRO

AFRO

AFRO

EURO

AFRO

AMRO

AFRO

WPRO

SEARO

EMRO

SEARO

EMRO

AFRO

AFRO


Table 11: Planning for Deployment - 16 PIP Priority Countries

COUNTRY WHO REGION

Armenia

Bolivia, (Plurinational State of)

Cambodia

Democratic Republic of the Congo

Ethiopia

Georgia

Ghana

Haiti

Kenya

Lao PDR

Nepal

Pakistan

Sri Lanka

Sudan


Uganda

EURO

AMRO

WPRO

AFRO

AFRO

EURO

AFRO

AMRO

AFRO

WPRO

SEARO

EMRO

SEARO

EMRO

AFRO

AFRO

Table 12: Risk Communications - 38 PIP Priority Countries

COUNTRY WHO REGION

Afghanistan

Bangladesh

Barbados

Bhutan

Burkina Faso

Cambodia

Dominica

Ecuador

Egypt

Fiji

Gabon

Honduras

Indonesia

Kazakhstan

Kenya

Lao PDR

Lebanon

Mauritania

Mexico

Moldova, Republic of

Mongolia

Mozambique

Nepal

Pakistan

Panama

Saint Lucia

Saint Vincent and theGrenadines

Senegal

Seychelles

Sudan

Suriname

Timor-Leste

Turkey

Ukraine

Uzbekistan

Viet Nam

Yemen

Zimbabwe

EMRO

SEARO

AMRO

SEARO

AFRO

WPRO

AMRO

AMRO

EMRO

WPRO

AFRO

AMRO

SEARO

EURO

AFRO

WPRO

EMRO

AFRO

AMRO

EURO

WPRO

AFRO

SEARO

EMRO

AMRO

AMRO

AMRO

AFRO

AFRO

EMRO

AMRO

SEARO

EURO

EURO

EURO

WPRO

EMRO

AFRO


Trainings and workshops held with PIP PC funds

Table 13: Summary of information sharing platforms globally and in the regions (2015)

Table 14: Summary of L&S capacity-building trainings and by region

PLATFORM NAME

AMRO

DATA TYPE URL

Ecuador

Panama

Jamaica

Trinidad & Tobago

Bolivia

Colombia

Costa Rica

Honduras

Nicaragua

Mexico

Brazil

Argentina

Regional Offi ce

Epidemiology data management (Ecuador, Colombia, Peru, Bolivia, Paraguay)

Viral isolation (Panama, Colombia, Costa Rica, Honduras, Nicaragua, El Salvador)

Epidemiology data management (Jamaica, Dominica, Haiti, Belize, Saint Lucia, Puerto Rico)

Laboratory training including viral isolation and real time PCR

Unusual Respiratory Events training





Burden of Disease Workshop (Argentina, Barbados, Brazil, Canada, Caribbean Public Health Agency (CARPHA), Chile, Colombia, Costa Rica, Cuba, Dominica, Ecuador, El Salvador, Honduras, Mexico)

Laboratory logistics (Argentina, Barbados, Brazil, Canada, CARPHA, Chile, Colombia, Costa Rica, Cuba, Dominica, Ecuador, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, Saint Vincent and the Grenadines, Uruguay)

Pyrosequencing (Ecuador)

Laboratory logistics

Economic Burden of Disease

Laboratory algorithms

July 2015

July 2015

December 2015

August 2015

October 2015

April 2015

August 2015

May 2015

June 2015

April 2015

April 2015

December 2015

November 2015

September 2015

November 2015

FluNet

FluID

SARInet

PAHO FluID

WHO/ECDCBulletins

Infl uenza virological data

Infl uenza epidemiological data

Infl uenza and other respiratory viruses epidemiological data

Infl uenza and other respiratory viruses epidemiological data

Infl uenza virological & epidemiological data

Global

Global

Regional(AMRO)

Regional(AMRO)

Regional(EURO)

http://www.who.int/infl uenza/gisrs_laboratory/fl unet/en/

http://www.who.int/infl uenza/surveillance_monitoring/fl uid/en/

http://www.sarinet.org/

http://ais.paho.org/phip/viz/fl umart2015.asp

https://fl unewseurope.org/


Table 14, continued: Summary of L&S capacity-building trainings and by region

EURO

Armenia

Kyrgyzstan

Tajikistan

Turkmenistan

Uzbekistan

Intercountry

Outbreak Investigation and Response Guideline Development Workshop

Critical Care training

Infectious Substances Shipping Trainings

National annual fl u surveillance meeting

Infectious Substances Shippers Training (ISST) and Biorisk Management Advanced Training Programme (BRM ATP)

Training molecular identifi cation of circulation human infl uenza viruses for KGZ NIC

Practical Laboratory Training Course on Molecular Identifi cation of Infl uenza in the Russia NIC

1st workshops to initiate development of National operational OIR guideline

2nd workshops to fi nalize National operational OIR guideline

Training molecular identifi cation of circulation human infl uenza viruses for TJK NIC



2nd workshops to fi nalize National operational OIR guideline

Two workshops on sentinel surveillance for SARI and ILI for health personnel of sentinel sites

Training molecular identifi cation of circulation human infl uenza viruses for TKM NIC


National meeting on infl uenza surveillance

Workshop on the development of “National Guidance on the Critical Care of Patients with SARI”


Training molecular identifi cation of circulation human infl uenza viruses for UZB NIC


National Infl uenza Surveillance Meeting

Annual Infl uenza meeting for NIS countries (Saint Petersburg)

OIR Guideline implementation (Berlin)

WHO group course on Infl uenza Bioinformatics Basics for Lab experts from 16 countries (NIC Saint Petersburg)

Principles of PCR assays’ development and validation (NIC Saint Petersburg)

LQSI training for Lab experts (Sochi, Russian Federation)

February 2015

September 2015

November 2015

December 2015

December 2015

September 2015

November 2015

May 2015

October 2015

October 2015

November 2015

April 2015

November 2015

November 2015

October 2015

March 2015

November 2015

June 2015

August 2015

November 2015

December 2015

November 2015

November 2015

December 2015

September 2015

May 2015

April 2015


Table 14, continued: Summary of L&S capacity-building trainings and by region

EMRO

SEARO

WPRO

Regional Offi ce

Regional

Expert consultation on gaps in research and policy on infl uenza surveillance and health systems to monitor and assess infl uenza events of international concern

Group Work on PIP Implementation with Country Focal

Expert consultation on fi nalization of available tools to assess SARI/ILI sentinel surveillance

Intercountry training on data analysis, scientifi c writing and publishing for epidemiologists and virologists

Intercountry training/certifi cation workshop on laboratory specimen collection, transportation, shipment of infl uenza and other pandemic prone respiratory viruses as per IATA regulations

Intercountry workshop on advanced epidemiological data analysis

Intercountry laboratory training workshop on infl uenza virus genotyping by Sanger sequencing

9th bi-regional meeting of the National Infl uenza Centres and Infl uenza Surveillance. Cambodia, joint meeting with WPRO

Regional meeting on PIP Jakarta

Training of trainers of sequencing and phylogenetic analysis of viruses, at Centers for Disease Control & Prevention in Atlanta

Training of trainers of screening antiviral susceptibility of infl uenza viruses by sequencing and antiviral resistance testing WHO CC for Reference & Research on Infl uenza, Victorian Infectious Diseases Reference Laboratory in Melbourne, Australia

IATA certifi cation training, Manila

9th bi-regional meeting of the National Infl uenza Centres and Infl uenza Surveillance. Cambodia, joint meeting with SEARO

Informal Consultation to Strengthen/Upgrade Surveillance for Early Detection of Public Health Events in the WPR, Manila

Enhanced training workshop on infl uenza laboratory diagnosis, China

Workshop on Strengthening ILI surveillance and laboratory testing, Cambodia

Meeting of human and animal health sectors to improve information-sharing, risk assessment and response to emerging zoonoses, including infl uenza, Mongolia

Meeting on setting priorities communicable diseases and events, Mongolia

May 2015

June 2015

August 2015

October 2015

October 2015

November 2015

December 2015

August 2015

April 2015

October 2015

July 2015

November 2015

August 2015

September 2015

November 2015

November 2015

November 2015

November 2015


Country Laboratory & Surveillance indicators

Laboratory and Surveillance Capacity indicators measured by the WHO Regional Offi cesThe high-level PC Implementation Plan 2013-2016

has clear outcome and output indicators listed for

L&S. However, it was determined early on in the

implementation process that these were not sensitive

enough to capture the full extent of the capacity in the

countries and thus to identify the key areas for support

in the PIP PC target countries.

The PIP Secretariat worked together with the regional

and headquarters infl uenza programs to agree on a set

of 21 indicators that measured ability to detect monitor

and share novel infl uenza viruses and actions that would

sustain those abilities into the future. The detailed

indicator rationale and scoring criteria are presented in

Table 15.

The baseline data for these indicators were collected in

31 August 2014. Two further rounds of data collection

were undertaken in February 2014 and August 2015.

A third round was conducted in March 2016. The data

in this report have been thoroughly reviewed and

validated.

For 2016, to minimize the potential for variations in

interpretation of the criteria at the country level, WHO

Country Offi ces will answer a series of questions and the

scores will be automatically calculated based on their

responses. WHO headquarters will continue to report its

data using the global databases.


Info

rma

l la

bo

rato

ry g

uid

an

ce

or

alg

ori

thm

exi

stin

g, b

ut

no

t fo

rma

lly d

ocu

me

nte

d a

nd

/or

no

t st

rict

ly p

ut

in u

se.

Re

gis

tere

d in

IRR

or

ag

ree

me

nt

wit

h W

HO

CC

s b

ut

no

re

ag

en

ts

rece

ive

d in

th

e p

ast

18

mo

nth

s,

an

d n

o o

the

r so

urc

es

ava

ilab

le

for

pri

me

rs a

nd

oth

er

rea

ge

nts

in

th

e p

ast

18

mo

nth

s.

Po

ten

tia

l in

fl u

en

za P

CR

te

stin

g

ab

ility

, e.g

. hav

ing

PC

R m

ach

ine

a

nd

re

ag

en

ts, b

ut

no

ev

ide

nce

o

f fu

nct

ion

ing

.

At

lea

st o

ne

na

tio

na

l la

bo

rato

ry

pa

rtic

ipa

ted

bu

t n

on

e a

chie

ved

a

10

0%

sco

re o

n n

on

-se

aso

na

l v

iru

ses

in t

he

last

WH

O

infl

ue

nza

PC

R E

QA

P.

At

lea

st o

ne

na

tio

na

l la

bo

rato

ry

pa

rtic

ipa

ted

bu

t n

on

e a

chie

ved

a

10

0%

sco

re o

n s

ea

son

al

vir

use

s in

th

e la

st W

HO

in

fl u

en

za P

CR

EQ

AP.

Se

qu

en

cin

g e

qu

ipm

en

t a

nd

p

ote

nti

al c

ap

aci

ty a

vaila

ble

, b

ut

no

t fu

nct

ion

ing

in t

he

pa

st

12

mo

nth

s.

Pla

nn

ing

to

est

ab

lish

a n

ati

on

al

Ea

rly

Wa

rnin

g S

yste

m e

.g.

rele

va

nt

de

fi n

itio

ns,

pro

toco

ls,

pro

ced

ure

s a

nd

ta

rge

ted

tr

ain

ing

ma

teri

als

etc

. un

de

r d

eve

lop

me

nt.

Alg

ori

thm

est

ab

lish

ed

, fo

rma

lly d

ocu

me

nte

d a

nd

st

rict

ly p

ut

in u

se.

Re

gis

tere

d u

ser

of

IRR

or

ag

ree

me

nt

wit

h W

HO

CC

s w

ith

re

ag

en

ts r

ece

ive

d in

th

e

pa

st 1

8 m

on

ths;

or

rea

ge

nts

re

ceiv

ed

fro

m o

the

r so

urc

es

in t

he

pa

st 1

8 m

on

ths.

Infl

ue

nza

PC

R t

est

ing

act

ive

ly

be

ing

pe

rfo

rme

d w

ith

e

vid

en

ce o

f re

po

rtin

g.

At

lea

st o

ne

na

tio

na

l la

bo

rato

ry p

art

icip

ate

d a

nd

a

chie

ved

a s

core

of

10

0%

on

n

on

-se

aso

na

l vir

use

s in

th

e

last

WH

O in

fl u

en

za P

CR

EQ

AP.

At

lea

st o

ne

na

tio

na

l la

bo

rato

ry p

art

icip

ate

d a

nd

a

chie

ved

a s

core

of

10

0%

on

se

aso

na

l vir

use

s in

th

e la

st

WH

O in

fl u

en

za P

CR

EQ

AP.

Infl

ue

nza

vir

us

ge

ne

s se

qu

en

ced

in t

he

pa

st 1

2

mo

nth

s.

Fun

ctio

na

l na

tio

na

l Ea

rly

Wa

rnin

g S

yste

m w

ith

re

lev

an

t d

efi

nit

ion

s, p

roto

cols

an

d

pro

ced

ure

s e

tc. i

n p

lace

.

SCO

RE

TWO

(Par

tial

cap

acit

y)

Th

is in

dic

ato

r m

eas

ure

s la

bo

rato

ry

pre

par

ed

ne

ss fo

r d

ete

ctio

n o

f in

fl u

en

za

viru

ses

wit

h p

and

em

ic p

ote

nti

al.

Th

is in

dic

ato

r m

eas

ure

s a

cou

ntr

y’s

acc

ess

to

re

age

nts

th

rou

gh

re

gis

trat

ion

in t

he

IRR

or

by

agre

em

en

t w

ith

a W

HO

CC

, or

thro

ug

h u

sin

g

WH

OC

C e

stab

lish

ed

SO

Ps

wit

h in

-co

un

try

cap

acit

y to

syn

the

size

/ord

er/

imp

ort

pri

me

rs

etc

.

Th

is in

dic

ato

r m

eas

ure

s th

e c

ou

ntr

y’s

st

atu

s w

ith

re

gar

ds

to t

he

ab

ility

to

pe

rfo

rm

infl

ue

nza

PC

R t

est

ing

.

Th

is in

dic

ato

r m

eas

ure

s th

e q

ual

ity

of

the

P

CR

te

stin

g t

o d

ete

ct n

on

-se

aso

nal

infl

ue

nza

vi

ruse

s w

ith

pan

de

mic

po

ten

tial

bas

ed

on

th

e p

erf

orm

ance

in t

he

last

pan

el o

f th

e W

HO

In

fl u

en

za P

CR

EQ

AP.

Th

is in

dic

ato

r m

eas

ure

s th

e q

ual

ity

of

the

PC

R

test

ing

to

de

tect

se

aso

nal

cir

cula

tin

g v

iru

ses

bas

ed

on

th

e p

erf

orm

ance

in t

he

last

pan

el o

f th

e W

HO

Infl

ue

nza

PC

R E

QA

P.

Th

is in

dic

ato

r m

eas

ure

s se

qu

en

cin

g

cap

abili

tie

s fo

r in

fl u

en

za v

iru

ses.

Th

is in

dic

ato

r m

eas

ure

s th

e s

tatu

s o

f a

n

atio

nal

sys

tem

to

ide

nti

fy u

nu

sual

or

un

exp

ect

ed

illn

ess

eve

nts

. Th

ese

sys

tem

s ar

e

oft

en

cal

led

Eve

nt

Bas

ed

Su

rve

illan

ce (E

BS

) o

r “e

arly

war

nin

g” s

yste

ms

and

use

mu

ltip

le

sou

rce

s o

f o

ffi c

ial a

nd

un

offi

cia

l re

po

rts,

in

clu

din

g m

ed

ia r

ep

ort

s.

pre

v6

mth

s

pre

v1

8 m

ths

pre

v6

mth

s

pre

v6

mth

s

pre

v6

mth

s

pre

v1

2 m

ths

pre

v6

mth

s

Alg

ori

thm

fo

r la

bo

rato

ry d

ete

ctio

n

of

un

usu

al i

nfl

ue

nza

v

iru

ses

Re

gis

tra

tio

n in

IRR

or

rece

ivin

g k

its

fro

m

WH

OC

Cs

PC

R T

est

ing

PC

R q

ua

lity

fo

r n

on

-se

aso

na

l in

fl u

en

za

vir

use

s

PC

R q

ua

lity

fo

r se

aso

na

l in

fl u

en

za

vir

use

s

Se

qu

en

cin

g

Na

tio

na

l “E

arl

y

Wa

rnin

g”

syst

em

s o

r E

ve

nt

Ba

sed

S

urv

eil

lan

ce (

EB

S)

No

lab

ora

tory

a

lgo

rith

m e

sta

blis

he

d.

No

t re

gis

tere

d in

IRR

, a

nd

no

ag

ree

me

nt

wit

h W

HO

CC

s, a

nd

no

o

the

r so

urc

es

ava

ilab

le

for

pri

me

rs a

nd

oth

er

rea

ge

nts

.

No

infl

ue

nza

PC

R

test

ing

ab

ility

.

No

lab

ora

tory

p

art

icip

ate

d in

th

e la

st

WH

O In

fl u

en

za P

CR

E

QA

P.

No

lab

ora

tory

p

art

icip

ate

d in

th

e la

st

WH

O In

fl u

en

za P

CR

E

QA

P.

No

eq

uip

me

nt

an

d n

o

seq

ue

nci

ng

ca

pa

city

av

aila

ble

.

No

na

tio

na

l Ea

rly

Wa

rnin

g S

yste

m

such

as

Eve

nt

Ba

sed

S

urv

eill

an

ce.

SCO

RE

ON

E(M

inim

al c

apac

ity)

SCO

RE

THR

EE(C

apac

ity

esta

blis

hed

)TI

ME

-FR

AM

EIN

DIC

ATO

R R

ATIO

NA

LEIN

DIC

ATO

R

Ta

ble

15

: De

tail

ed

in

dic

ato

r ra

tio

na

le a

nd

sco

rin

g c

rite

ria

fo

r 4

ca

teg

ori

es

of

La

bo

rato

ry a

nd

Su

rve

illa

nce

in

dic

ato

rs

DE

TE

CT

ION


ILI s

urv

eill

ance

exi

stin

g b

ut

wit

h g

aps

in

colle

ctin

g d

ata

rou

tin

ely

* an

d s

ub

mit

tin

g

sam

ple

s re

gu

larl

y**

to a

lab

ora

tory

in t

he

p

ast

12

mo

nth

s.

*19

or

mo

re w

ee

ks d

uri

ng

th

e N

ort

he

rn

He

mis

ph

ere

infl

ue

nza

se

aso

n (w

ee

k 4

0 –

w

ee

k 2

0) o

r 1

3 o

r m

ore

we

eks

du

rin

g t

he

S

ou

the

rn H

em

isp

he

re s

eas

on

(we

ek

18

–

we

ek

40

), o

r 3

2 w

ee

ks o

r m

ore

du

rin

g t

he

w

ho

le y

ear

for

cou

ntr

ies

wit

h y

ear

-ro

un

d

surv

eill

ance

.

**id

eal

ly o

n a

we

ekl

y b

asis

, ho

we

ver

no

la

ter

than

1 m

on

th a

fte

r co

llect

ion

of

sam

ple

s.

SA

RI s

urv

eill

ance

exi

stin

g b

ut

wit

h g

aps

in

colle

ctin

g d

ata

rou

tin

ely

* an

d s

ub

mit

tin

g

sam

ple

s re

gu

larl

y**

to a

lab

ora

tory

in t

he

p

ast

12

mo

nth

s.

* 3

2 w

ee

ks o

r m

ore

in a

ye

ar.

**id

eal

ly o

n a

we

ekl

y b

asis

, ho

we

ver

no

m

ore

th

an 1

mo

nth

aft

er

colle

ctio

n o

f sa

mp

les.

Lab

ora

tory

an

d e

pid

em

iolo

gic

dat

a sh

are

d

info

rmal

ly b

ut

no

re

po

rts

of

inte

gra

ted

la

bo

rato

ry a

nd

ep

ide

mio

log

ic d

ata.

In t

he

pas

t 1

2 m

on

ths

bu

lleti

ns/

rep

ort

s p

ub

lish

ed in

th

e p

ub

lic d

om

ain

du

rin

g

the

infl

uen

za s

easo

n b

ut

less

th

an o

nce

a

mo

nth

.

Ad

-ho

c co

ord

inat

ion

i.e.

join

t m

ee

tin

gs,

sh

arin

g o

f in

form

atio

n a

nd

join

t in

vest

i-g

atio

n, b

ut

no

do

cum

en

ted

fu

nct

ion

al

coo

rdin

atio

n m

ech

anis

m in

pla

ce.

ILI s

urv

eill

ance

be

ing

car

rie

d o

ut,

sa

mp

les

be

ing

co

llect

ed

ro

uti

ne

ly*

and

se

nt

to a

lab

ora

tory

re

gu

larl

y**

in

the

pas

t 1

2 m

on

ths.

*19

or

mo

re w

ee

ks d

uri

ng

th

e N

ort

h-

ern

He

mis

ph

ere

infl

ue

nza

se

aso

n

(we

ek

40

– w

ee

k 2

0) o

r 1

3 o

r m

ore

w

ee

ks d

uri

ng

th

e S

ou

the

rn H

em

i-sp

he

re s

eas

on

(we

ek

18

– w

ee

k 4

0),

or

32

we

eks

or

mo

re d

uri

ng

th

e w

ho

le

year

for

cou

ntr

ies

wit

h y

ear

-ro

un

d

surv

eill

ance

.

**id

eal

ly o

n a

we

ekl

y b

asis

, ho

we

ver

no

late

r th

an 1

mo

nth

aft

er

colle

ctio

n

of

sam

ple

s.”

SA

RI s

urv

eill

ance

be

ing

car

rie

d o

ut,

sa

mp

les

be

ing

co

llect

ed

ro

uti

ne

ly*

and

se

nt

to a

lab

ora

tory

re

gu

larl

y**

for

dia

gn

osi

s o

f in

fl u

en

za in

th

e p

ast

12

mo

nth

s.

* 3

2 w

ee

ks o

r m

ore

in a

ye

ar.

**id

eal

ly o

n a

we

ekl

y b

asis

, ho

we

ver

no

mo

re t

han

1 m

on

th a

fte

r co

llect

ion

o

f sa

mp

les.

Su

rve

illan

ce r

ep

ort

s w

ith

inte

gra

ted

la

bo

rato

ry a

nd

ep

ide

mio

log

ical

dat

a

pu

blis

he

d.

In t

he

pas

t 1

2 m

on

ths

bu

lleti

ns/

re-

po

rts

pu

blis

he

d in

th

e p

ub

lic d

om

ain

at

leas

t m

on

thly

du

rin

g t

he

infl

ue

nza

se

aso

n.

Do

cum

en

ted

fu

nct

ion

al c

oo

rdin

atio

n

me

chan

ism

in p

lace

.

SCO

RE

TWO

(Par

tial

cap

acit

y)

Th

is in

dic

ato

r m

eas

ure

s th

e c

ou

ntr

y’s

sta

tus

wit

h r

eg

ard

to

th

e e

xist

en

ce o

f a

nat

ion

al

surv

eill

ance

sys

tem

wh

ere

pat

ien

ts w

ith

no

n-

seve

re r

esp

irat

ory

dis

eas

es

such

as

ILI o

r si

mila

r ar

e m

ed

ical

ly a

tte

nd

ed

at

an o

utp

atie

nt

or

pro

-vi

de

r se

ttin

g. A

s a

rou

tin

e d

uri

ng

th

e fl

u s

eas

on

, sa

mp

les

sho

uld

be

co

llect

ed

fro

m a

su

bse

t o

f p

atie

nts

an

d s

en

t to

a la

bo

rato

ry fo

r d

iag

no

sis

of

infl

ue

nza

. Th

is s

ho

uld

be

do

ne

as

de

fi n

ed

in

the

WH

O G

lob

al E

pid

em

iolo

gic

al S

urv

eill

ance

S

tan

dar

ds

for

Infl

ue

nza

.

Th

is in

dic

ato

r m

eas

ure

s th

e c

ou

ntr

y’s

sta

tus

wit

h r

eg

ard

to

th

e e

xist

en

ce o

f a

nat

ion

al

surv

eill

ance

sys

tem

wh

ere

ho

spit

aliz

ed

pat

ien

ts

wit

h s

eve

re r

esp

irat

ory

dis

eas

e s

uch

as

SA

RI

are

me

dic

ally

att

en

de

d. A

s a

rou

tin

e, s

amp

les

sho

uld

be

co

llect

ed

ide

ally

fro

m a

ll o

r a

sub

set

of

pat

ien

ts a

nd

se

nt

to a

lab

ora

tory

for

dia

gn

o-

sis

of

infl

ue

nza

. Th

is s

ho

uld

be

do

ne

as

de

fi n

ed

in

th

e W

HO

Glo

bal

Ep

ide

mio

log

ical

Su

rve

illan

ce

Sta

nd

ard

s fo

r In

fl u

en

za.

Th

is in

dic

ato

r m

eas

ure

s w

he

the

r la

bo

rato

ry a

nd

e

pid

em

iolo

gic

su

rve

illan

ce d

ata

are

lin

ked

an

d

inte

gra

ted

to

pro

du

ce s

urv

eill

ance

up

dat

es.

Th

is in

dic

ato

r m

eas

ure

s th

e e

xte

nt

to w

hic

h t

he

d

ata

colle

cte

d t

hro

ug

h in

fl u

en

za s

urv

eill

ance

is

colla

ted

into

ro

uti

ne

bu

lleti

ns

and

sh

are

d in

th

e

pu

blic

do

mai

n.

Th

is in

dic

ato

r m

eas

ure

s th

e e

xte

nt

to w

hic

h a

ni-

mal

an

d h

um

an h

eal

th a

uth

ori

tie

s co

ord

inat

e

acti

viti

es

in r

esp

on

se t

o in

fl u

en

za-r

ela

ted

eve

nts

o

f p

ote

nti

al p

ub

lic h

eal

th s

ign

ifi ca

nce

.

pre

v1

2m

ths

pre

v1

2m

ths

pre

v6

mth

s

pre

v1

2m

ths

pre

v6

mth

s

ILI N

ati

on

al

surv

eil

lan

ce

SA

RI N

ati

on

al

surv

eil

lan

ce

Inte

gra

tio

n o

f la

bo

rato

ry a

nd

e

pid

em

iolo

gic

da

ta

Bu

lle

tin

s -

Re

gu

lar

Infl

ue

nza

su

rve

illa

nce

rep

ort

s

Hu

ma

n A

nim

al

inte

rfa

ceco

ord

ina

tio

n

No

ILI s

urv

eil-

lan

ce (n

o a

ctiv

e

site

s p

rovi

din

g

dat

a o

r sa

mp

les

in t

he

pas

t 1

2

mo

nth

s)

No

SA

RI s

urv

eil-

lan

ce (n

o a

ctiv

e

site

s p

rovi

din

g

dat

a o

r sa

mp

les

in t

he

pas

t 1

2

mo

nth

s)

No

lin

kag

e o

f la

bo

rato

ry w

ith

e

pid

em

iolo

gic

d

ata.

In t

he

pas

t 1

2

mo

nth

s n

o

bu

lleti

n/r

ep

ort

p

ub

lish

ed

in t

he

p

ub

lic d

om

ain

.

No

evi

de

nce

of

coo

rdin

atio

n.

SCO

RE

ON

E(M

inim

al c

apac

ity)

SCO

RE

THR

EE(C

apac

ity

esta

blis

hed

)TI

ME

-FR

AM

EIN

DIC

ATO

R R

ATIO

NA

LEIN

DIC

ATO

R

Ta

ble

15

, co

nti

nu

ed

: De

tail

ed

in

dic

ato

r ra

tio

na

le a

nd

sco

rin

g c

rite

ria

fo

r 4

ca

teg

ori

es

of

La

bo

rato

ry a

nd

Su

rve

illa

nce

in

dic

ato

rs

MO

NIT

OR

ING

Re

po

rts

sub

mit

ted

for

< 2

0 w

ee

ks in

th

e

No

rth

ern

He

mis

ph

ere

se

aso

n (w

ee

k 4

0

-we

ek

20

), o

r fo

r <

13

we

eks

in t

he

So

uth

-e

rn H

em

isp

he

re s

eas

on

(we

ek

18

-w

ee

k 4

0),

or

for

< 3

2 w

ee

ks d

uri

ng

th

e w

ho

le

year

for

cou

ntr

ies

wit

h y

ear

-ro

un

d s

urv

eil-

lan

ce in

th

e p

ast

12

mo

nth

s.

Re

po

rts

sub

mit

ted

for

< 2

0 w

ee

ks in

th

e

No

rth

ern

He

mis

ph

ere

se

aso

n (w

ee

k 4

0

-we

ek

20

), o

r fo

r <

13

we

eks

in t

he

So

uth

-e

rn H

em

isp

he

re s

eas

on

(we

ek

18

-w

ee

k 4

0),

or

for

< 3

2 w

ee

ks d

uri

ng

th

e w

ho

le

year

for

cou

ntr

ies

wit

h y

ear

-ro

un

d s

urv

eil-

lan

ce in

th

e p

ast

12

mo

nth

s.

ISS

T r

ece

ive

d in

th

e p

ast

2 y

ear

s o

r va

lid

exp

ort

pe

rmit

in p

lace

, bu

t n

ot

bo

th.

On

e s

hip

me

nt

in t

he

pas

t 1

2 m

on

ths.

Co

un

try

’s s

eq

ue

nce

s b

ein

g u

plo

ade

d b

y a

W

HO

CC

to

a p

ub

licly

acc

ess

ible

dat

abas

e

in t

he

pas

t 1

2 m

on

ths.

Re

po

rts

sub

mit

ted

for

20

or

mo

re

we

eks

du

rin

g t

he

No

rth

ern

He

mi-

sph

ere

se

aso

n (w

ee

k 4

0 -

we

ek

20

),

or

for

13

or

mo

re w

ee

ks d

uri

ng

th

e

So

uth

ern

He

mis

ph

ere

se

aso

n (w

ee

k 1

8 -

we

ek

40

), o

r fo

r 3

2 o

r m

ore

we

eks

d

uri

ng

th

e w

ho

le y

ear

for

cou

ntr

ies

wit

h y

ear

-ro

un

d s

urv

eill

ance

in t

he

p

ast

12

mo

nth

s.

Re

po

rts

sub

mit

ted

for

20

or

mo

re

we

eks

du

rin

g t

he

No

rth

ern

He

mi-

sph

ere

se

aso

n (w

ee

k 4

0 -

we

ek

20

),

or

for

13

or

mo

re w

ee

ks d

uri

ng

th

e

So

uth

ern

He

mis

ph

ere

se

aso

n (w

ee

k 1

8 -

we

ek

40

), o

r fo

r 3

2 o

r m

ore

we

eks

d

uri

ng

th

e w

ho

le y

ear

for

cou

ntr

ies

wit

h y

ear

-ro

un

d s

urv

eill

ance

in t

he

p

ast

12

mo

nth

s.

ISS

T r

ece

ive

d in

th

e p

ast

2 y

ear

s an

d

valid

exp

ort

pe

rmit

in p

lace

.

At

leas

t 2

sh

ipm

en

ts in

th

e p

ast

12

m

on

ths.

Co

un

try

up

load

ing

se

qu

en

ces

to a

p

ub

licly

acc

ess

ible

dat

abas

e in

th

e

pas

t 1

2 m

on

ths.

SCO

RE

TWO

(Par

tial

cap

acit

y)

Th

is in

dic

ato

r m

eas

ure

s th

e r

eg

ula

rity

o

f re

po

rtin

g v

iro

log

ical

dat

a to

WH

O

thro

ug

h F

luN

et

and

/o

r R

eg

ion

al O

ffi c

e

Dat

abas

es.

Th

is in

dic

ato

r m

eas

ure

s th

e r

eg

ula

r-it

y o

f re

po

rtin

g e

pid

em

iolo

gic

dat

a to

W

HO

th

rou

gh

Flu

ID a

nd

/ o

r R

eg

ion

al

Offi

ce

Dat

abas

es.

Th

is in

dic

ato

r m

eas

ure

s a

cou

ntr

y’s

ab

ility

to

sh

ip in

fl u

en

za c

linic

al s

pe

ci-

me

ns/

viru

s is

ola

tes

wit

h p

and

em

ic

po

ten

tial

ou

t o

f th

e c

ou

ntr

y to

a G

ISR

S-

asso

ciat

ed

WH

OC

C w

ith

ap

pro

pri

ate

IS

ST

(In

fect

iou

s S

ub

stan

ce S

hip

pe

rs

Trai

nin

g) a

nd

exp

ort

pe

rmit

for

such

m

ate

rial

s.

Th

is in

dic

ato

r m

eas

ure

s a

cou

ntr

y’s

sh

arin

g v

iru

s is

ola

tes

and

/or

clin

ical

sp

eci

me

ns

wit

h W

HO

CC

s.

Th

is in

dic

ato

r m

eas

ure

s sh

arin

g o

f in

fl u

en

za v

iru

s g

en

eti

c se

qu

en

ces

for

use

glo

bal

ly.

pre

v

12

m

ths

pre

v

12

m

ths

pre

v

24

m

ths

pre

v

12

m

ths

pre

v

12

m

ths

Re

po

rtin

g la

bo

rato

ry

surv

eil

lan

ce d

ata

to

W

HO

th

rou

gh

Flu

Ne

t a

nd

/or

Re

gio

na

l d

ata

ba

ses

(Vir

olo

gic

al D

ata

)

Re

po

rtin

g

ep

ide

mio

log

ic

surv

eil

lan

ce d

ata

to

W

HO

th

rou

gh

Flu

ID

an

d/o

r R

eg

ion

al

da

tab

ase

s (E

pid

emio

log

ica

l Da

ta)

Sh

ipp

ing

ca

pa

city

Sh

ari

ng

sa

mp

les

wit

h

WH

OC

Cs

Sh

ari

ng

/usi

ng

seq

ue

nce

da

ta

No

re

po

rt in

th

e

pas

t 1

2 m

on

ths.

No

re

po

rt in

th

e

pas

t 1

2 m

on

ths.

No

ISS

T in

th

e

pas

t 2

ye

ars

and

n

o v

alid

exp

ort

p

erm

it.

No

sh

ipm

en

t in

th

e p

ast

12

m

on

ths.

No

se

qu

en

ces

shar

ed

.

SCO

RE

ON

E(M

inim

al c

apac

ity)

SCO

RE

THR

EE(C

apac

ity

esta

blis

hed

)TI

ME

-FR

AM

EIN

DIC

ATO

R R

ATIO

NA

LEIN

DIC

ATO

R

Ta

ble

15

, co

nti

nu

ed

: De

tail

ed

in

dic

ato

r ra

tio

na

le a

nd

sco

rin

g c

rite

ria

fo

r 4

ca

teg

ori

es

of

La

bo

rato

ry a

nd

Su

rve

illa

nce

in

dic

ato

rs

SH

AR

ING


Th

e p

lan

be

ing

dis

cuss

ed

b

etw

ee

n W

HO

CO

/RO

an

d M

OH

an

d is

un

de

r re

vie

w.

RR

T e

stab

lish

ed

, bu

t n

o t

rain

ing

in

the

pas

t 1

2 m

on

ths.

Ag

ree

d t

o b

e p

art

of

a n

atio

nal

p

lan

/nat

ion

al p

lan

s w

ith

in

teg

rati

on

un

de

r d

eve

lop

me

nt.

NIC

de

sig

nat

ed

by

cou

ntr

y,

pe

nd

ing

WH

O r

eco

gn

itio

n.

An

imp

lem

en

tati

on

pla

n a

gre

ed

b

etw

ee

n M

oH

an

d W

HO

CO

/RO

in

pla

ce.

RR

T e

stab

lish

ed

an

d t

rain

ed

in t

he

p

ast

12

mo

nth

s.

Inte

gra

ted

wit

h a

nat

ion

al p

lan

/n

atio

nal

pla

ns.

NIC

re

cog

niz

ed

by

WH

O.

SCO

RE

TWO

(Par

tial

cap

acit

y)

Th

is in

dic

ato

r m

eas

ure

s th

e d

eg

ree

to

wh

ich

th

e c

ou

ntr

y is

act

ive

ly p

arti

cip

atin

g in

th

e

pla

nn

ing

for

the

wo

rk t

o b

e a

cco

mp

lish

ed

. Id

eal

ly t

his

pla

n w

ou

ld b

e a

MO

H P

lan

or

it

cou

ld b

e d

eve

lop

ed

by

the

Co

un

try

Offi

ce

an

d a

gre

ed

to

by

the

MO

H. I

t ca

n b

e s

imp

le

bu

t sh

ou

ld c

on

tain

act

ivit

ies

for

targ

ete

d

imp

rove

me

nts

, tim

elin

es

and

bu

dg

ets

.

Th

is in

dic

ato

r m

eas

ure

s R

apid

Re

spo

nse

Te

am (R

RT

) tra

inin

g d

eliv

ere

d t

hro

ug

h

this

pro

ject

. Th

e p

urp

ose

of

the

tra

inin

g is

to

en

sure

th

at R

RTs

are

tra

ine

d a

nd

re

ady

to r

esp

on

d t

o u

nu

sual

eve

nts

incl

ud

ing

h

um

an c

ase

s/cl

ust

ers

of

infe

ctio

n w

ith

no

vel

infl

ue

nza

vir

use

s an

d o

utb

reak

s o

f se

vere

re

spir

ato

ry d

ise

ase

s.

Th

is in

dic

ato

r m

eas

ure

s th

e in

teg

rati

on

o

f th

is p

roje

ct in

to a

n o

vera

ll n

atio

nal

p

lan

to

incr

eas

e t

he

ch

ance

for

lon

g t

erm

su

stai

nab

ility

of

the

cap

acit

y b

uild

ing

e

ff o

rts.

Th

e h

igh

leve

l act

ivit

ies

of

this

p

roje

ct c

an b

e p

art

of

a n

atio

nal

pla

n fo

r su

rve

illan

ce, p

rep

are

dn

ess

an

d r

esp

on

se,

etc

.

Th

is in

dic

ato

r m

eas

ure

s p

rog

ress

to

war

ds

a

cou

ntr

y-d

esi

gn

ate

d a

nd

WH

O-r

eco

gn

ize

d

NIC

(Nat

ion

al In

fl u

en

za C

en

tre

).

pre

v6

mth

s

pre

v1

2 m

ths

pre

v6

mth

s

pre

v6

mth

s

Co

un

try

Im

ple

me

nta

tio

n P

lan

Ra

pid

Re

spo

nse

Tr

ain

ing

Su

sta

ina

bil

ity

(ev

ide

nce

of)

NIC

Sta

tus

Dis

cuss

ion

wit

h

Mo

H n

ot

yet

star

ted

.

No

RR

T

est

ablis

he

d.

No

inte

gra

tio

n

in a

nat

ion

al

pla

n/n

atio

nal

p

lan

s.

No

NIC

d

esi

gn

ate

d b

y M

OH

.

SCO

RE

ON

E(M

inim

al c

apac

ity)

SCO

RE

THR

EE(C

apac

ity

esta

blis

hed

)TI

ME

-FR

AM

EIN

DIC

ATO

R R

ATIO

NA

LEIN

DIC

ATO

R

Ta

ble

15

, co

nti

nu

ed

: De

tail

ed

in

dic

ato

r ra

tio

na

le a

nd

sco

rin

g c

rite

ria

fo

r 4

ca

teg

ori

es

of

La

bo

rato

ry a

nd

Su

rve

illa

nce

in

dic

ato

rs

SU

STA

INA

BIL

ITY


Annex 2

PIP PC Implementation work planning scheduleThe Partnership Contribution (PC) is allocated to

specifi c Areas of Work (AOWs) according to defi ned

work plans from WHO headquarters, Regional and

Country Offi ces. The work planning is done according

to WHO’s biennial fi nancial cycle. To facilitate this,

work plans were created for the 2014-2015 biennium

but disaggregated for each individual year. Work plan

development for all AOWs began with a meeting in

October 2014 that brought together Regional Offi ce

programme offi cers and headquarter AOW programme

offi cers to share achievements and challenges from the

past year. Recommendations for funding are made by

the Secretariat to the Director, Pandemic and Epidemic

Diseases, who also reviews the plans and makes

recommendations to the Assistant Director General for

approval.

All funds received by WHO are managed through

Awards. Awards are assigned to work plans and the

Award numbers allow funds to be tracked and reported

on across WHO. The PIP Secretariat keeps track of the

fi nancial implementation rate for each Regional Offi ce

and AOW, intervening when necessary to meet any

implementation challenges where and when they occur.

Figure 6 shows that the fi nancial implementation rate of

the budget overall for the 2014-2015 biennium was over

75%, indicating that much of the work planned for this

time period was performed according to the schedule

set out in the work plans for the biennium.

2015 PIP PC Financial Expenditure

Introduction

Reported below is the summary fi nancial data for 2015,

which is the second year of the WHO biennial fi nancial

cycle of 2014-15.

Collection of Funds (Partnership Contribution)

As specifi ed in the PIP Framework, Partnership

Contributions (PC) are paid annually and began in 2012.

In 2015, activities were funded by the contributions

collected in 2014. The 2014 Collection process started

with the publication of the 2014 PC Questionnaire,

used by WHO to identify infl uenza vaccine, diagnostic

and pharmaceutical manufacturers using GISRS. Based

on answers to the Questionnaire, 42 contributors were

identifi ed. As of 31 December 2014, WHO received

US$ 15,059,381 and by 15 March 2015 US$ 25,922,891.

As seen in Figure 7, as of March 2016 the Secretariat has

collected 96% of the 2014 PC Collection funds, with a

total of US$ 26,964,062.

Figure 6: Implementation rate of PIP PC for 2014-2015

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

% OverallImplementation

Total work plan distribution (2014-15): $30,690,703

77%


Experiences in collecting the 2014 PC have highlighted

some challenges including non-response to the PC

Questionnaire and the Band Selection Form (BSF). The

latter is used by the Secretariat to calculate the individual

amount due by each contributor. Additionally, some

companies have been unable to make payments in full.

In accordance with guidance provided by the Advisory

Group, industry and other stakeholders, the Secretariat

used the most recent Questionnaire answers and

BSF information submitted by entities in previous PC

Collection years in order to move forward with the

2014 Collection process. This ensured that all entities

identifi ed as a Contributor were factored into the

formula, ensuring that entities that did submit their

forms were not adversely impacted. The Secretariat also

gave companies facing payment issues the possibility

of paying their contribution in installments. Table 16

below details individual payments by entity for 2014.

Figure 7: 2014 contributions expected vs received, as of March 2016

Table 16: PC by entity for 2014, as of March 2016

Alere Inc.

Becton, Dickinson & Company

BIKEN

BioCSL Pty Ltd.

Cepheid

CNBG - Beijing Tiantan Institute of Biological Products Co., Ltd.

CNBG - Changchun Institute ofBiological Products Co., Ltd.

CNBG - Shanghai Institute of Biological Products Co., Ltd.

Denka-Seiken Co., Ltd.

F. Hoff mann-La Roche Ltd.

Fluart Innovative Vaccines Ltd.

Focus Diagnostic

GlaxoSmithKline

Green Cross Corp.

InDevr

Institute of Vaccine and Medical Biologicals IVAC

Kitasato Daiichi Sankyo Vaccine Co. Ltd.

Medicago

MedImmune (AstraZeneca)

Nanosphere, Inc.

Novartis

Princeton BioMeditech Corporation

Protein Sciences

PT BioFarma

Qiagen

Quidel

Response Biomedical Corp

Saint-Petersburg Scientifi c Research Institute of Vaccines and Sera

Sanofi Pasteur

Serum Institute of India

Sinovac Biotech Co. Ltd.

Takeda Pharmaceuticals Int.

The Chemo-Sero-Therapeutic Research Institute (Kaketsuken)

The Government Pharmaceutical Organization (GPO)

UMN Pharma

Vabiotech

Zydus Cadila Healthcare Ltd.

TOTAL (US$)

39,071

83,975

699,790

979,706

2,799

83,975

83,975

139,958

475,857

6,158,153

83,925

30,791

6,158,153

335,879

2,799

2,799

335,899

2,799

1,399,580

2,799

2,799,160

2,799

2,779

2,799

2,799

2,799

2,789

30,791

6,158,153

2,799

139,958

2,799

699,790

2,799

2,799

2,799

2,769

26,964,062

ENTITY 2014

26.9M

2014

28M


Distribution of FundsIn May 2012, the Executive Board decided that for the

period 2012-2016, 70% of resources should be assigned

to preparedness and 30% to response.132 All of the funds

assigned to response remain in reserve for use when a

pandemic occurs.

Additionally, in March 2013, the Director-General

accepted a recommendation from the Advisory Group

that a portion of PC funds, not exceeding 10%, averaged

over the years 2013-2016, should be used by the PIP

Secretariat to enable work, either on-going but at risk, or

not yet undertaken because of lack of funds, to be done

in order to meet the objectives of the PIP Framework.133

Furthermore, a percentage of PC funds is taken by WHO

as part of its standard budget processes for Program

Support Costs (PSC).134

Figures 8 and 9 below summarize the further

distribution of funds assigned for preparedness in the

2014-15 biennium across each AOW and across the

WHO regions and headquarters. Figure 4 (page 49)

shows the amount set aside for Response.

Figure 8: Distribution of preparedness funds in 2014-15 by Area of Work

Figure 9: Distribution of preparedness funds in 2014-15 by WHO region and HQ

132 See: http://apps.who.int/gb/ebwha/pdf_fi les/EB131/B131_4-en.pdf?ua=1 and http://apps.who.int/gb/ebwha/pdf_fi les/EB131-REC1/B131_REC1-en.pdf#page=18

133 See: http://www.who.int/infl uenza/pip/pip_pcimpplan_update_31Jan2015.pdf?ua=1 at page 6

134 WHO Program Support Cost (PSC) is calculated at 13% of direct costs for the Preparedness and Secretariat components, and 7% of direct costs for the Response component.

Funds for both AOWs and for major Offi ces are

distributed according to approved work plans that have

been developed to meet the outcomes and objectives,

and according to the budget, defi ned in the PIP PC

Implementation Plan 2013-2016.

Implementation Expenditures2015 work plans were developed in Quarter 4 of 2014

with the expectation that the majority of funds would

be received and in line with the distribution outlined in

the PIP PC Implementation Plan, 2013-2016.

Expenditure of FundsThe overall expenditure rate for activities during 2014-

2015 was 77%. Across the biennium and all offi ces/

AOWs, staff costs represented 23% of this total

expenditure with staff costs in 2015 being 24%. Figures

10 and 11 present the expenditure of funds in 2014-

2015 by AOW and region. Table 17 presents the overall

summary of expenditure for the biennium.

$22,370,997

$1,540,800

$3,955,406

$1,995,500

$828,000

Laboratory& Surveillance

RiskCommunications

RegulatoryCapacityBuilding

Planning for Deploy- ment

Burden ofDisease

$30,690,703

HQ

AF

AMEM

EU

SE

WP

$9,763,356

$1,301,253

$3,010,382$4,753,872

$3,317,603

$3,765,528

$4,778,709


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lio

ns

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2015

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$17,879,247

$633,107$1,117,428

$3,349,970

$675,517

5

4

3

2

1

0

Mil

lio

ns

HQ AFRO AMRO EMRO EURO SEARO WPRO

2015

2014

$978,614

$769,033

$2,494,292

$3,163,370$2,902,247

$3,015,493

$4,556,199

Figure 10: Expenditure in 2014-2015 by area of work

The majority of funds in 2015 were spent for L&S,

although there was also signifi cant spending on risk

communications.

For L&S, just under US$ 1M was spent at headquarters

on normative work and support for the shipping of

virus samples. In the regional offi ces spending was in

the range of US$ 2-3M for AMRO, EMRO, EURO, SEARO

and WPRO. Expenditure in AFRO was lower in 2015 as

activities were funded in only two countries.

Figure 11: Expenditure in 2014-2015 by WHO region and HQ on L&S


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World Health Organization20 Avenue Appia1211 Geneva 27

Switzerland

PIP Framework SecretariatPandemic and Epidemic Diseases

Outbreaks and Health Emergenciesemail [email protected]

http://www.who.int/infl uenza/pip/en/

WH

O/O

HE

/PE

D/2

01

6.0

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Partnership Contribution ANNUAL REPORT 2015

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