The World Health Organization has released a new report showing that significant progress has been made to build national and global preparedness for future influenza pandemics. This progress resulted from the collaborative multi-sectoral implementation of a WHO plan, funded by the benefit-sharing contributions of industry partners, to strengthen global health security against pandemic influenza.

The report, Pandemic Influenza Preparedness Framework: Partnership Contribution High Level Implementation Plan I Final Report 2014-2017, was released on 30 November. It details the progress of the High Level Implementation Plan I (HLIP I) from 2014-2017 under the WHO Pandemic Influenza Preparedness (PIP) Framework.

The report was prepared by the WHO Pandemic Influenza Preparedness (PIP) Framework, which brings together WHO member states, industry, other stakeholders and the WHO “to implement a global approach to pandemic influenza preparedness and response.” The report was circulated by Anne Huvos, manager of the PIP Framework Secretariat, in the WHO Department of Infectious Hazard Management, who said the announcement was made “with great pleasure and pride.”

The implementation plan focused on five areas of work in 72 countries in the six WHO regions: laboratory and surveillance, burden of disease, regulatory capacity building, risk communications, and planning for pandemic product deployment, according to the report.

“Of the 21 indicators established to monitor progress,” it said, “targets for 15 (71%) indicators were met or exceeded,” while “advances were made in each area.”

“This report shows in a transparent way the outcomes accomplished so far in each one of the areas of work. We cannot forecast when and how severe will be the next pandemic, but we can assure that each country worldwide will be better prepared due to the PIP Framework and its Partnership Contribution,” Jarbas Barbosa, chair of the PIP Framework Advisory Group (2016), said in the report.

The second High Level Implementation Plan (HLIP II) [pdf] has already been developed and will guide the investment priorities of the PIP Framework from 2018-2023.

Background of PIP Framework

The Pandemic Influenza Preparedness (PIP) Framework was adopted by the World Health Assembly in 2011, following the 2009 influenza pandemic caused by the A(H1N1) virus. During this pandemic, “[v]accines were in short supply, and there was slow distribution of donated vaccines to developing countries,” which resulted in the deaths of “151,000 to 575,400 in the first year alone,” and showed that the world was not prepared for a severe pandemic, the report said.

“Unanimously adopted by all 194 WHO Member States in May 2011, the PIP Framework is an international arrangement unlike any other,” according to the report. “It establishes a unique benefit sharing system to improve global pandemic influenza preparedness and response, with equity, partnership, and transparency at its heart.”

The benefit-sharing component of the PIP Framework is the Partnership Contribution, which is an annual contribution of funds to the WHO from industry partners, such as influenza vaccine, diagnostic and pharmaceutical manufacturers, that utilize the WHO Global Influenza Surveillance and Response System (GISRS).

Through the end of 2017, the Partnership Contribution raised USD $142 million. According to the report, USD $79 million of this went toward strengthening the pandemic influenza preparedness by funding HLIP I, USD $36 million was set aside for a future pandemic to fund response measures, USD $13 million went toward funding the PIP Secretariat, and USD $14 million went toward WHO programme support costs.

The report says that 76 agreements with industry to transfer virus materials for research were made during the four-year period. The report says of the Influenza Virus Traceability Mechanism (IVTM) set up to safeguard the transfers: “This system tracks where PIP biological materials have been sent. WHO uses IVTM to identify manufacturers and other institutions accessing these materials. Agreements are then signed with these entities to enable vaccine and other benefits to be available at the time of a pandemic. Seventy-six agreements, known as SMTA2s, were signed between 2014-2017.”

WHO Director General Dr Tedros Adhanom Ghebreyesus said in the report that PIP Framework “holds such importance for public health: it shows that nations can come together and solve the most difficult issues through innovative solutions; that countries will undertake the work needed to strengthen their preparedness capacities; and that partners – public, private and non-governmental – will sustain their commitment to achieving the highest level of preparedness so that our future global response is founded on solidarity and equity.”

Impacts Go Beyond Pandemic Influenza Preparedness

The report summarised the key impacts of the HLIP I for each of the five areas of work.

1. Laboratory and surveillance

• “National surveillance systems have improved to better detect and monitor influenza
• Global alert and response capacities have improved through GISRS including greater virus and information sharing”

2. Burden of disease

• “Influenza burden data are available to inform evidence-based policy”Regulatory capacity building

• “National regulatory authorities have improved capacities to better regulate products during a public health emergency”

4. Risk communications

• “Global and national systems are available for emergency risk communications”

5. Planning for deployment

• “The first global pandemic product deployment simulation was completed to improve response for when a pandemic strikes”

The report explained that these impacts under the PIP Framework also furthered 6 out of the 8 core capacities of the International Health Regulations (IHR), a 2005 agreement between 196 countries to work together for global health security. These 6 core capacity objectives of IHR include surveillance, response, preparedness, risk communication, human resources and laboratory.

“Although the objective of all PIP investments is to strengthen global pandemic influenza preparedness, the impact has been greater.” The report found that the “average IHR core capacity scores for PIP recipient countries increased from the baseline, which was measured before HLIP I started.”

Figure 2 above shows that “[m]ajor progress was made in risk communications where the average score increased by 20%, as well as preparedness and human resources where both average scores increased by 11%. When looking at all countries globally (Figure 3), countries that were targeted with PIP funds for improved pandemic influenza preparedness made similar or greater gains in their overall IHR core capacity scores. These findings highlight the collateral benefit of investing in pandemic influenza preparedness,” the report explained.

More Work to Come

Now that the first implementation plan has been completed, the second plan spanning from 2018-2023 has already begun. “HLIP II will build on each of the five areas of work to fill some of the gaps that remain in global preparedness, and will introduce an additional area of work, Influenza Pandemic Preparedness Planning,” according to the report.

“Lessons learnt from HLIP I in terms of achievements and gaps guided the development of HLIP II, which includes process measures to enable better monitoring of progress. It also synergizes with other programmes for strengthening preparedness and response to help countries achieve IHR 2005 core capacities,” Mahmudur Rahman, chair of the PIP Framework Advisory Group (2017-2019), said in the report.

“Significant progress has been made, but more work is needed,” the report concluded. “This is why PIP will continue to support pandemic influenza preparedness globally.”

Image Credits: WHO.