1. Group 2 Summary

2. Objective 1: Need for strengthening comprehensive national influenza surveillance systems 1) How have surveillance strategies changed? – Countries still in containment phase are testing all samples, but plan to eventually only test subset – Most countries had sentinel surveillance sites, but some added sites; others added Points of Entry – Reporting of ILI and SARI from district hospitals added – There was previously difficulty in recruiting sentinel sites, but since the Pandemic, clinicians are volunteering to be included

3. Objective 1: Need for strengthening comprehensive national influenza surveillance systems – Difficulty in comparing various data sources; uncertainty about denominators, especially when adding new sentinel sites – On the other hand, the long-standing sentinel systems are a consistent anchor – Adding new sentinel sites was not a problem, but accommodating the extra lab burden was

4. Objective 1: Need for strengthening comprehensive national influenza surveillance systems – NICs are largely diagnostic labs that are required to test ALL samples, making it difficult to adapt to a mitigation strategy – Challenge of policy keeping up with scientific reality – still being in “containment” mode despite widespread transmission; different phases in different areas – Even though we are eager to just move to mitigation - there is actually more political commitment to action during containment phase, facilitating action – How to explain to public / politicians that there are fewer cases during mitigation phase (because of lower testing)?

5. 2) Will your current surveillance systems be able to monitor activity and detect unusual events? – Overall, Qualified Yes – Countries with H5N1 are used to dealing with event-based and severe pneumonia surveillance – Event-based surveillance requires coordination among epi / clinicians / labs; this requires national leadership – many ministerial-level people do not understand role of laboratory – NICs have opportunity to influence decisions when they are part of national committees – Challenges are very different in countries with different levels of development (e.g., small, less developed countries may have rapid informal processes)

6. 3) How do you plan to strengthen the current systems? A prerequisite is a strong lab – and so if there are not decentralized lab capacities, this needs to be developed

7. Objective 2: Developing an NIC contingency plan 4) Does your NIC have a contingency plan? If not, how handling increased workload? 5) Are there plans to create contingency plans? – Only one country had a formal NIC-specific contingency plan – all others plan to develop this – Some countries already have experience in dealing with surge, largely based on H5N1 experiences – Cross-training other lab staff – NIC contingency plans should be tied into national preparedness plans in order to assure long-range capacity-building – Labs need to have good SOPs in place as a prerequisite for surge capacity – It is challenging to develop surge capacity in private facilities not controlled by the government – Perhaps part of an NIC contingency plan includes the right to stop testing all samples (being a strictly diagnostic lab)

8. Objective 3: Need for a shift from containment to mitigation, and identification of public health measures 6) Have your countries implemented or planned to implement mitigation measures? What types? 8) Lessons learned? – Examples include school closures as soon as a case occurred; home quarantine; warnings to not visit affected areas (all during containment phase) – Dealing with religious gatherings has been an important (but sensitive) topic – It is useful to prepare the public in advance for certain measures – Technical agencies often plan for one thing but are forced to do another (e.g., planning for home isolation but being ordered to institute strict inpatient isolation)

9. 7) What is your decision-making process to apply these measures? Who is involved? Does NIC have a role? NIC provides the data – helps with timing of measures NICs may be a part of the decision-making as well Depending on the measure, it may involve multiple sectors (e.g. for e.g. school closure, it has to include MoEd Some decisions must be very high-level (like cancellation of mass gatherings) Identifying trigger points is a challenge, but NIC data is valuable But what are the trigger points? This is often provided by NIC. Many plans had to be adapted since they were developed for a worst-case scenario

10. 9) What are primary concerns/needs/priorities during the coming months Include: Resources and surge capacity; Food shortage management; Rumor management Some countries have given up hope of getting vaccine, so are concentrating on non-pharma measures How and when to use vaccine (e.g., one country has committed to get large qty. of vaccine and now not sure if they even need all of it, and there is debate about when and how to give it Influenza surveillance must become a year-round activity, not just seasonal

11. Objective 4: Need for regional influenza information sharing mechanisms (e.g., bulletin), review paper. 10/11/12) Are you interested in knowing flu activities in other countries in region? What info do you want? Regional sharing? Yes it’s important – want to know everything There has already been good information sharing Not necessary to create new mechanisms but rather build upon existing mechanisms (e.g., NICs, PacNet) and make people aware of these All countries willing to contribute (much easier since SARS and H5N1)

12. 13) Necessary to draft review article? Willing to participate in such effort? Not clear what the purpose of the article is? Is it a critical evaluation of lessons learned, or just a list of activities? Could be useful to convince decision-makers to adopt things best practices Could be quite a political pandora’s box if it highlights deficiencies in certain countries Willing to participate

13. Discussion