Costa Rica is positioned as one of the key beneficiaries of the Pandemic Influenza Preparedness (PIP) Framework, a global initiative coordinated by the World Health Organization (WHO). This framework aims to improve preparedness, surveillance, and response capacities for influenza pandemics by providing financial and technical resources to strengthen both health infrastructure and national response capabilities. 

As part of the PIP Framework 2024-2025 work plan, PAHO organized a technical mission from February 13-15, 2024, in Costa Rica. This mission stood out as a successful example of interdisciplinary collaboration, integrating the support of specialists in epidemiology, laboratory, and information systems to strengthen public health capacities in the country. The objectives covered were: 1) monitoring PIP Framework activities, 2) analyzing a suspected case of Influenza A H3v in Costa Rica, and 3) developing the IT interface for FluNet and FluID to optimize reports to PAHO/WHO. 

During this mission, PAHO representatives worked closely with colleagues from the Ministry of Health, the Costa Rican Social Security Fund (CCSS), and the Costa Rican Institute for Research and Teaching in Nutrition and Health (INCIENSA). 

Implementing the PIP 2024-2025 Framework in Costa Rica 

Costa Rica reaffirmed its commitment to the Pandemic Influenza Preparedness (PIP) Framework 2024-2025, focusing on strengthening: 1) policies and plans, 2) collaborative surveillance through laboratory capacity and resilient surveillance systems via GISRS, 3) community protection, and 4) access to countermeasures. 

During the recent review of the work plan, the importance of a comprehensive and coordinated approach to improving pandemic preparedness was emphasized. Key actions highlighted include the need for the Ministry of Health to maintain strong leadership in the execution of the plan’s activities and the updating of the Pandemic Preparedness and Response Plan for respiratory pathogens, ensuring an operational, multisectoral, and multilevel approach. 

Recommended actions for countries: 

• Facilitate early warning through resilient surveillance systems strengthened by National Influenza Centers (NIC). 

• Update pandemic preparedness and response plans for pathogens in an integral, multisectoral, and multilevel manner. 

Analyzing a suspected influenza A(H3v) case 

In response to the country’s request for support, PAHO conducted an early action review (EAR) of a suspected case of Influenza A(H3v). This process revealed significant opportunities to improve multisectoral and multilevel coordination. Ultimately, the case was dismissed. 

The implementation of the early action review (EAR) identified strategic opportunities to enhance early detection and rapid response to public health emergencies. Key areas highlighted to ensure timely detection and an effective response to epidemics and pandemics include: a) timely and appropriate sampling procedures; b) ensuring effective and timely sample transport, including during non-working hours and holidays; and c) strengthening the capacity for interpreting typing and subtyping tests across the country’s laboratory network. 

Recommended actions for countries: 

• Develop organizational charts to facilitate the recognition of actors and roles. 

• Create information flows that simplify understanding and operation of processes. 

Strengthening Interoperability to optimize the information system for respiratory virus surveillance and response 

PAHO’s information systems specialists worked alongside the technology teams of the Ministry of Health, the CCSS, and INCIENSA to improve interoperability between national systems. Technical adjustments were made to the FluNet and FluID interfaces to optimize the country’s ability to share surveillance data promptly with PAHO and WHO. 

The cooperation in implementing technical capacities for process automation between PAHO, the Ministry of Health, the CCSS, and INCIENSA has strengthened the country’s surveillance technological infrastructure, driving the modernization and standardization of data collection and transmission processes, which has improved system efficiency and continuous monitoring. 

Recommended actions for countries: 

• Invest in technological infrastructure to enhance real-time monitoring of respiratory viruses circulating both locally and globally. 

• Strengthen collaboration across sectors to ensure efficient and effective information flow. 

Barbados has reached a major milestone in its public health journey with the official designation by the World Health Organization (WHO) of the Best-Dos Santos Public Health Laboratory (BDSPHL) as a National Influenza Centre (NIC). This designation, celebrated in October 2023, marks a significant chapter in the country’s efforts to bolster its public health infrastructure and respond to infectious diseases on a global scale.

The BDSPHL, which opened in 2018, has evolved into a vital public health asset, driven by strong government leadership and collaboration with international health organizations, including the Pan American Health Organization (PAHO) and the Caribbean Public Health Agency (CARPHA).

The journey to NIC status was the result of the BDSPHL consistently adhering to rigorous standards set by the WHO and the collaborative efforts of BDSPHL’s leadership, government support, and international partnerships. Now, as part of the WHO’s Global Influenza Surveillance and Response System (GISRS), the laboratory plays a key role in providing essential influenza data, helping to shape more effective vaccines and treatments.

Moving forward, the BDSPHL is set to expand its role in public health, with plans to enhance laboratory services and build capacity in areas like cancer diagnostics, antimicrobial resistance surveillance, and genetic testing. The lab’s work not only strengthens Barbados’s public health response but also supports neighboring Eastern Caribbean nations, further solidifying Barbados’s position as a regional leader in public health.

The journey to NIC designation

The path to becoming a National Influenza Centre was not easy. It required BDSPHL to meet rigorous standards set by WHO, including establishing strict protocols for testing respiratory viruses, ensuring robust quality management systems, and consistently reporting influenza data.

International partnerships played a crucial role in this transformation. Collaboration with global health organizations, including the Pan American Health Organization (PAHO), World Health organization (WHO), the United States Centers for Disease Control and Prevention (US-CDC), and the Caribbean Public Health Agency (CARPHA), provided the technical expertise and support needed to elevate the lab to NIC status.

Prime Minister Mia Amor Mottley lauded the achievement as a measure of national pride, emphasizing that Barbados had proven its ability to reach global standards of excellence. “To have this designation by the World Health Organization says to the rest of the world that this lab has reached these standards and is capable of being trusted,” she stated during the designation ceremony.

A legacy of resilience and adaptation

The Best-Dos Santos Public Health Laboratory has consistently demonstrated its resilience and ability to adapt to emerging public health threats. During the COVID-19 pandemic, BDSPHL became one of the first labs in the Caribbean to secure test kits and reagents for detecting the virus, processing over 800,000 tests in just three years.

Beyond COVID-19, the lab has established programs for global salmonella and influenza surveillance, HIV and sexually transmitted infection examinations, and environmental monitoring, including water and air quality.

The lab’s success is not only a point of pride but also an economic driver for the country. It has created jobs for local professionals and positioned Barbados as a leader in public health innovation.

Looking ahead: A future of excellence and innovation

As Barbados continues to invest in its health infrastructure, the future of the Best-Dos Santos Public Health Laboratory looks brighter than ever. With $63 million allocated for primary health care and $2 million dedicated to laboratory services in the new financial year, the lab is poised to expand its offerings and integrate new technologies into its work. The government is already developing screening protocols for cancers, including pancreatic and breast cancers, and exploring further advancements in genetic testing and flow cytometry.

The lab’s NIC designation also underscores Barbados’ broader role in the region. BDSPHL has been instrumental in supporting neighboring Eastern Caribbean countries by offering training, sharing knowledge, and building capacity. Its work exemplifies the power of collaboration, not just within Barbados but across borders, as the lab continues to contribute to regional and global health security.

As Prime Minister Mottley reflected, “Investing in health means Barbados is moving from monitoring and diagnosing to research. Our people have the capacity to be at the cutting edge of the research capabilities that we need in this world to make lives better for our people.”

With a clear vision and unwavering commitment to public health excellence, the Best-Dos Santos Public Health Laboratory is set to remain a pillar of strength for Barbados and a beacon of innovation for the Caribbean and the wider global community.

The Pan American Health Organization (PAHO) has published a document titled “Developing Pandemic Preparedness Plans for Respiratory Pathogens,” accessible in four languages: English, Spanish, Portuguese, and French. This resource offers a clear and concise approach to the four essential steps for updating or developing preparedness and response plans for respiratory pandemics. 

Based on Chapter 9 of Module 1 from the PRET initiative, the goal is for countries in the Americas to have strong, tested, and regularly updated operational plans, ensuring a quick and effective response to future threats. 

Public health emergency planning is essential to ensure that the capacities developed during previous crises are maintained and integrated into responses to new threats. PAHO values the efforts of countries in the region to strengthen their pandemic preparedness plans and supports these initiatives with tools and expertise, in line with the Preparedness and Resilience for Emerging Threats (PRET) initiative. 

The PRET initiative is an innovative strategy that leverages lessons learned from the COVID-19 pandemic and other emergencies, applying them to different pathogens based on their mode of transmission (respiratory, vector-borne, foodborne, etc.). The document highlights four key steps for respiratory pathogen pandemic planning: 

• Prepare, analyze the situation and engage stakeholders 

• Draft the plan. 

• Evaluate, finalize and disseminate the plan 

• Implement, monitor and continuously improve the plan 

In addition to this document, other important resources have been translated from English to Spanish to support countries in developing strategies to strengthen their pandemic preparedness and resilience, mitigating the impact on public health, the economy, and society. 

For more information, visit the PRET initiative page for the Americas Region, where you can find additional resources. 

The Respiratory Protection Program for Healthcare Workers aims to implement control measures to mitigate respiratory risks. The program includes both in-person and virtual training, as well as a manual (which is the first respiratory protection program manual published by PAHO. The training also provides guidance on successfully implementing the program at the national and institutional levels. 

The program covers several key aspects, including: a) necessary infrastructure, b) human and material resources required to support the program in different healthcare settings, c) selection criteria for appropriate respiratory protection equipment, including guidance on technical standards and quantities needed, d) fit testing procedures, e) training healthcare workers in equipment use, and monitoring equipment implementation. In addition to training, each country was provided with equipment for the program roll-out. 

The overall objective of the training is to strengthen the capacity of countries and healthcare facilities to establish respiratory protection programs, with a particular emphasis on the use of respiratory devices within infection prevention and control (IPC) programs. This training is critical given the risks highlighted by the COVID-19 pandemic, which demonstrated the transmission of respiratory illnesses in healthcare settings, adversely affecting both patients and healthcare workers. Implementing respiratory protection programs in these countries will enhance the protection of healthcare workers from respiratory exposure to potentially harmful chemical and physical agents, including future surges in COVID-19 or other respiratory illnesses. 

The respiratory protection course has been published in both languages and has 22,747 participants, of whom 13,630 have been certified. Additionally, the PCI course has been conducted in Spanish, with 230 participants, 136 of whom have been certified. In February 2024, outbreak management training was provided to 83 healthcare workers in three countries: Colombia, Guatemala, and Paraguay. 

Data competency refers to understanding the origin of data, properly managing, analyzing, and interpreting its meaning, and clearly communicating the results. To transform respiratory virus surveillance data into useful information for public health decisions, professionals need these skills and must be capable of contextualizing data and drawing relevant conclusions. 

Since its inception in June, the IHM/PHE team has defined a list of core data competencies based on existing epidemiology training and education programs, which was validated by international experts and SARInet plus members. Currently, a needs assessment is underway through a questionnaire sent to Member States. One-on-one consultations with countries will follow to further explore the identified needs, with the curriculum design expected to be completed by November 2024. This curriculum will enable Member States to select appropriate resources to strengthen their data competencies, enhancing their response to respiratory viruses. 

For more details, please contact Marc Rondy (rondymar@paho.org) or Claudia Jarquin (jarquincla@paho.org).

During the visit, the PAHO team toured three sentinel sites dedicated to Severe Acute Respiratory Infection (SARI) and Influenza-like Illness (ILI) surveillance in the capital, Paramaribo. Several challenges were identified, such as the need to improve data capture and adherence to case definitions, as well as the importance of strengthening regular training at these sites.

Additionally, a training session was held with the Public Health Bureau team to develop a weekly respiratory virus surveillance bulletin. The PISA methodology was used in this training, which will enable more effective monitoring of respiratory virus trends through the implementation of specific thresholds.

As part of the mission, the capabilities of Suriname’s National Influenza Laboratory were also assessed, with the aim of improving integrated surveillance of viruses such as influenza, Respiratory Syncytial Virus (RSV), and SARS-CoV-2.

Finally, communication protocols and the strategy for sharing surveillance results were reviewed, with key recommendations provided to optimize processes and enhance the country’s preparedness for future health emergencies.

This mission demonstrates the commitment of both PAHO and Suriname to improving respiratory disease surveillance and ensuring better preparedness for potential pandemics in the future.

The Call to action is for national authorities and the Pan American Sanitary Bureau (PASB) to establish the Intersectoral Commission for the Prevention and Control of Zoonotic Influenza in the Americas. The support of all relevant stakeholders, including international organizations and subregional mechanisms, is critical to this aim. Under this Call, the PASB shall continue to serve as the convening entity of the Intersectoral Commission.

The Intersectoral Commission aims to foster One Health (OH) at country level, bringing together diverse perspectives and interests to ensure sustainable national and regional early detection, response and control for AI and other zoonotic influenza. PASB shall produce a draft statute of the Intersectoral Commission based on the inputs of the Regional Meeting on the Intersectoral Commission for the Prevention and Control of Avian Influenza (and other Zoonotic Influenza) in the Americas held on 12–14 March 2024 in Rio de Janeiro, Brazil.

The draft statute shall be shared with Member States and other relevant stakeholders, including international organizations and subregional mechanisms. All participants of this meeting are urged to facilitate a participative in-country revision of the draft statute of the Intersectoral Commission. In due course, PASB shall submit the proposed statute of the Intersectoral Commission to its Governing Bodies. By working collaboratively within this framework and in the spirit of achieving the establishment and operationalization of the Intersectoral Commission, Member States and all relevant stakeholders will contribute to a successful outcome on the health and food security in the Americas and beyond.

This Call to action is in response to the PASB regional OH policy, which calls for Member States to implement OH strategies/actions and for the PASB to provide technical cooperation. Furthermore, the request to establish the Intersectoral Commission, including hosting its technical and administrative secretariat, respond to appeals to the PASB from different animal health mechanisms and organizations. These includes the Permanent Veterinary Committee of the Southern Cone (CVP), the General Secretariat of the Andean Community (SGCAN), and the International Regional Organization for Agricultural Health (OIRSA).

The Southern Agricultural Council (CAS) comprised by the Ministers of Agriculture of Argentina, Bolivia, Brazil, Chile, Paraguay and Uruguay has also endorsed this initiative. Additionally, the creation of this commission was also recommended during the Regional Consultation for Strengthening Intersectoral Work at the Human-Animal Interface of Avian Influenza, held in Rio de Janeiro, Brazil, 14-16 March 2023.

Credits and thanks to the Pan American Health Organization (PAHO).

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Regional Meeting on an Intersectoral Commission for the Prevention and Control of Avian Influenza (and other Zoonotic Influenza) in the Americas

The objectives of the workshop were:
1) to review the procedures for integrated SARI sentinel surveillance in the country.
2) to describe the stages of data analysis and obtain national estimates of effectiveness of influenza vaccines.
3) to understand and interpret the results obtained effectiveness for decision making.

The participants of the workshop include the national heads of the surveillance, immunization and respiratory virus laboratory areas at the national level and from the federative units of Brazil; and epidemiologists belonging to the same departments.

Credits and thanks to the Pan American Health Organization (PAHO)