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The recent COVID-19 pandemic has been yet another example that problems require cooperation dynamics that involve a multiplicity of actors of different nature and scope. Like all cooperation processes, those developed within the framework of the Respiratory Virus Surveillance, Diagnosis, Prevention and Control Systems, clinical management and immunizations will be strengthened if and only if each actor involved identifies that, to better perform its essential functions, it needs the good performance of the functions of the other members of the surveillance system. However, the identification of interdependence dynamics is not a simple and straightforward process.

Like any other system, respiratory virus surveillance, prevention and control, clinical management and immunizations systems are composed of units or agents that perform different functions, linked through information feedback processes. There are three aspects to consider make up the hard core of these surveillance systems. The first is associated with the functions performed by the different agents that make up the system, such as, for example, the functions inherent to laboratories, epidemiological surveillance, clinical management, data analysts, immunizations teams, policies decision makers and so on. The second aspect is related to the information that is processed among the agents through different communication channels or media; this information is relevant and fundamental for the verification of their mutual dependencies. The third aspect is related to the actions carried out within the framework of the surveillance system in order to contribute to the health, social, economic and political well-being of the communities involved. 

One of the most important objectives of the PAHO/WHO Strategic Plan 2020-2025 establishes the commitment to support countries to build and improve their surveillance mechanisms and strengthen surveillance capacity for the detection of emerging and epidemic pathogens. Within this framework, PAHO has been working with its Member States to provide strategic guidance, technical support, and coordination of essential activities to strengthen their surveillance systems for influenza, SARS-CoV-2, and other respiratory viruses. This meeting will be coordinated by the PAHO Influenza Team and will be attended by Caribbean member states and technical experts from PAHO and WHO, U.S.A CDC and CARPHA, among others.

Justification

The Caribbean countries have strengthened their surveillance capacities during the SARS-CoV-2 pandemic. They have shown high surveillance and epidemiological skills, which involve active surveillance sites and contact tracing for COVID-19. Some countries in the Caribbean have implemented the WHO CC influenza-SARS-CoV-2 multiplex molecular diagnostic and have strengthened their genomic surveillance. New skills in clinical management and prevention practices have been developed and acquired. Health policies have occupied media and government space and new vaccines have been introduced through vaccination campaigns. The pandemic offers new challenges to strengthen its surveillance systems through influenza, SARS-CoV-2 and other respiratory viruses integration. Taking as a framework strengthening of influenza and SARS-CoV-2 surveillance, the 4th SARInet Caribbean countries will try to identify the mutual need of the different stakeholders to improve their performance and contribute to a better health and well-being of the communities they work for. 

Objectives

1. To identify the essential functions of epidemiological, laboratory, clinical and immunization teams and their mutual needs in the integration of the surveillance system of respiratory viruses to improve their performance. 
2. To develop a training course for professionals from the Caribbean Sub-Region working in epidemiological, laboratory, clinical management and immunization, in order to develop an action plan aimed at strengthening their surveillance, prevention and control systems and the clinical management of respiratory viruses considering their mutual needs. 
3. To favor the rooting of the existing national and international cooperation spaces and the emergence of new ones, which will result in the strengthening of the surveillance, prevention, control systems and clinical management of respiratory viruses in the Region.

First, the current epidemiological context was presented at the regional and global levels. The guidelines that frame the current surveillance strategies were presented, as well as the situation of surveillance of COVID-19, influenza and other respiratory viruses in the region of the Americas. Subsequently, the participants identified the most relevant aspects for the consolidation of the current surveillance of COVID-19 and other respiratory viruses at present and in the long term.

Second, the consultation consisted of addressing the components of monitoring transmission trends, severity, impact, and genomic surveillance, taking into account the following strategies: a) representative for monitoring circulating variants/lineages; b) aimed at detecting potential variants of interest or concern.

In order to partially meet the second objective and the third in its entirety, a series of public health questions in general were subsequently analyzed in order to identify which of them can be answered in a sustainable way through sentinel surveillance, complementary systems or adjustments to existing systems.

Finally, the consultation was aimed at analyzing the progress and needs of the SARinet Network in its eight years of existence since its creation in 2014. Since then, the network has advanced with the initial proposed objectives and has additionally developed activities that have contributed to the strengthening surveillance of influenza and other respiratory viruses (RVO), including activities during the SARS-CoV-2 pandemic and integrating SC-2 surveillance into the VIOVR platform.

However, due to the pandemic, RVO surveillance has had varying degrees of interruption, so it was considered pertinent to discuss possible mechanisms to revitalize the network so that it can respond to the current needs and challenges of the countries of the Region. In this sense, a summary of the advances and achievements obtained by the network and an inventory of the different activities carried out in recent years were shown. Additionally, two similar experiences were presented: the surveillance network for influenza and COVID-19 in the European Region and the initiative of emergency medical teams (EMT) in the Americas. The participants considered that these experiences were inspiring and also invited to reflect on the aspects that SARInet needs to improve and venture into.

A proposal was also presented for the renewal of SARInet in terms of organization, updating of the terms of reference and management mechanisms. The invited members reviewed and discussed these issues and the commitments made at the inaugural meeting of SARInet in May 2014. The need to update the terms of reference was maintained, also adjusting the mission and vision of the network according to the current situation.

As conclusions of the consultation, it has been possible to identify that currently the countries of the region have developed a universal surveillance of COVID-19 that has allowed optimal monitoring of the epidemiological situation to guide public health measures. In turn, many countries previously had sentinel surveillance systems for influenza and other respiratory viruses that have been weakened in the current context. In addition, some countries in the region have acquired epidemiological and laboratory surveillance capabilities that they did not previously have.

From the consultation, 5 general recommendations to the countries: 1. maintain surveillance of COVID-19 to continue responding to the pandemic until alternative surveillance systems can respond robustly to identified public health needs; 2. Strengthen existing surveillance systems for influenza and other respiratory viruses, integrating SARS-CoV-2 when the epidemiological situation allows it and, in each context, initiate a transition that guarantees sustainable medium- and long-term surveillance without losing capacities acquired during the COVID-19 pandemic; 3. Maintain monitoring of transmission trends, severity, and impact, taking advantage of existing surveillance systems for influenza and other respiratory viruses, including SARS-CoV-2; 4. Strengthen genomic surveillance in the region, linking it to sentinel surveillance, as well as other complementary systems that allow compliance with the main objectives of this surveillance; 5. Strengthen or implement complementary surveillance systems that allow the detection of emerging events of interest to public health in relation to SARS-CoV-2, influenza and other respiratory viruses, with early detection and universal coverage.