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Health Assembly in 2011 to improve sharing of influenza virus samples with human pandemic potential, as well as access to and sharing of other benefits, such as medical countermeasures and surveillance data. Other areas of the framework include laboratory and surveillance capacity building, regulatory capacity building, community engagement and risk communication, and planning for deployment. PIP was negotiated together with WHO Member States and the pharmaceutical industry, which contributes financially to framework implementation and commits to donating a percentage of vaccine product to lower-income countries.53 National Pandemic Influenza Preparedness Plans—At the behest of WHO, approximately 95 Member States have published national pandemic influenza preparedness plans. These plans articulate the capacities and capabilities needed to respond to an outbreak of pandemic influenza in humans, including intersectoral coordination and partnerships, risk communication, and surveillance and monitoring. However, only 17 countries have published or revised their plans since 2014, and 99 countries are still without a publicly available plan. In addition, national plans vary widely in terms of their level of quality and comprehensiveness.71 WHO 2019-2030 Global Influenza Strategy*—The WHO Global Influenza Strategy provides a framework for WHO, Member States, and other partners to address influenza with the aim of strengthening seasonal prevention and control and preparedness for influenza pandemics. The strategy outlines 4 overarching objectives for the next decade: promoting research and innovation to address unmet public health needs, strengthening global influenza surveillance and data utilization, expanding seasonal influenza prevention and control policies to protect vulnerable populations, and strengthening pandemic preparedness and response for a safer world.54 Partnership for Influenza Vaccine Introduction (PIVI)—PIVI was established based on the recognition that a strong in-country vaccine delivery system not only reduces the burden of annual seasonal influenza and other vaccine-preventable illnesses, but it can also save lives during a pandemic event. An initiative of the US CDC, PIVI partners with national health ministries to train healthcare workers in flu vaccine delivery and establish networks of vaccine distribution to ensure vaccines can be delivered to the most vulnerable populations.70 34 Global Influenza Surveillance and Response System (GISRS)—GISRS is a global monitoring, surveillance, and response system for seasonal, pandemic, and zoonotic influenza. Among its many functions, GISRS acts as a global alert for novel or emerging influenza viruses and recommends the composition of the vaccine for the upcoming influenza season. GISRS is comprised of National Influenza Centers (NICs), WHO Collaborating Centers, Essential Regulatory Laboratories, and H5 Reference Laboratories.72 * Examples of other relevant WHO initiatives include the Global Action Plan (GAP) for Influenza Vaccines, the WHO Pandemic Influenza Vaccine Deployment Initiative, the WHO Initiative for Vaccine Research, the WHO National Immunization Technology Advisor Group (NITAG), and other WHO specialized advisory committees. Emergency Response Mechanisms With the establishment of the WHO Health Emergencies Programme following the Ebola epidemic in West Africa, the international response system received an overhaul in the way it responds to disease outbreaks. WHO now provides operational capabilities in addition to its traditional expert technical and normative roles. Through the Health Emergencies Programme, WHO was clearly defined as the coordination and technical lead for any international response to health crises, including managing collaborations with any health partners in the field. Also, with the establishment of the Health Emergencies Programme, a new financing mechanism, the Contingency Fund for Emergencies, was developed to facilitate cash flow and provide the initial funds necessary to mount a response to health emergencies.73 In this new approach, WHO leads the international response to major internationally important outbreaks, and it would be the lead agency for the health response to any high-impact respiratory pathogen event. Large-scale disease outbreak response efforts require multisectoral collaboration, and so WHO closely coordinates with the broader UN humanitarian system in these responses. Mechanisms to alert relevant authorities— including the Inter-Agency Standing Committee* , UN country offices, non-governmental organization (NGOs), and private-sector partners—are in place.73,74 This kind of coordination would be expected and critical in the response to a high-impact respiratory pandemic. While many processes to initiate and scale up response efforts would apply across all diseases, additional considerations unique to high-impact respiratory pathogens may not be adequately addressed in these response guidelines, including the WHO’s Emergency Response Framework.74 During such a pandemic scenario, regional, national, and local needs could severely outpace existing international capacities and resources, and countries could not expect emergency medical response teams to assist them. Donated medical countermeasures, personal protective equipment, and other technical assistance * The Inter-Agency Standing Committee is the UN’s primary mechanism for coordination of any (UN or otherwise) agencies in a humanitarian assistance. The Inter-Agency Standing Committee is composed of the heads of UN and non-UN organizations that are involved in humanitarian response to emergencies, including health crises (source: https://interagencystandingcommittee.org/). 35 that they might receive in geographically limited outbreaks might not be available. During a large-scale respiratory outbreak, widespread humanitarian needs might arise, such as food insecurity or poverty associated with job losses. Concerns have been raised regarding the existing mechanisms intended to deal with these issues, citing inadequate coordination and planning among WHO and the broader
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