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Countries in the Asia Pacific Region face an ever-present risk of an emerging novel pathogen with pandemic potential. The increased emergence and re-emergence of novel sub-types of avian influenza viruses in the Region, including in new areas, pose a risk for a pandemic and warrant enhanced preparedness to promptly contain such potential threats to regional and global health security.
Since 2023, Cambodia has seen a steady uptick in human cases of avian influenza (H5N1) and the circulation of various subtypes. The country successfully detected and implemented outbreak response measures, leveraging its national capacities, and working in collaboration with their National Influenza Centre, the H5 Reference Laboratory, and WHO Collaborating Centres for Influenza, to curb the spread of the disease.
National influenza centres (NICs) provide oversight and support for the initial stage of testing influenza viruses and are the backbone of WHO’s Global Influenza Surveillance and Response System (GISRS), a global mechanism and resource for surveillance and control of influenza and other respiratory viruses. GISRS comprises 151 NICs in 129 countries, seven WHO Collaborating Centres and 12 H5 Reference Laboratories.
Cambodia leverages its influenza network to curb the spread of avian influenza
Dr Ly Sovann, Director, Communicable Disease Control, Department of Ministry of Health, Cambodia, shared the value of the influenza network and multisectoral collaboration in strengthening influenza preparedness in the country: “We noticed that despite our efforts, we kept having pandemics every few years: SARS in 2003, Swine Flu in 2009 and COVID-19 in 2020. We had to decide if we should prepare for the next pandemic in nine years or find a different way to address this recurrence. Our strategy was ‘stop the source’; focus on testing samples for early detection and encourage our physicians, both private and public, to report cases and facilitate timely testing.”
According to Dr Sovann, the key to streamlining an effective outbreak response included managing bureaucracy and hierarchy, making it easy to report information, having human resources available to deploy rapidly, and making emergency financial mechanisms available to support frontline responses to verified outbreaks. The country’s national medical reference laboratory and National Influenza Centre provided laboratory testing 24/7, free of charge and without any bureaucratic hurdles — thus incentivizing healthcare providers and outbreak investigators (at provincial and national levels) to support early detection. Whenever health providers suspected a case, they sent a sample to one of the national laboratories that were available to promptly test samples and would then share this information with the rapid response team for further action.
Cambodia’s Ministry of Health has a hotline to enable reporting of suspected cases of avian influenza that greatly facilitated early detection. The government thus prioritized ‘transparency, trust and collaboration’, encouraging the human, animal, agriculture and environment ministries to share information promptly and without barriers.
Cambodia is an example of how the GISRS network can be leveraged for early detection and disease outbreak response of respiratory viruses. Each year, surveillance and laboratory data and virus sharing by NICs form the basis for WHO’s recommendations for the composition of seasonal influenza vaccines, as well as relevant risk assessment activities.
Since 2007, annual bi-regional NIC meetings have provided an opportunity for the NICs, ministries of health, WHO and partners to strengthen the Global Influenza Surveillance and Response System. The meetings enable collaboration among influenza surveillance network members and policymakers to ensure that evidence-based strategies are developed and implemented across the Asia Pacific Region. In 2024, 30 NICs and two National Laboratories—representing 26 countries and areas across Asia and the Pacific—convened to enhance regional preparedness efforts for seasonal influenza, zoonotic influenza and future pandemics, leveraging collaboration among experts involved in surveillance of influenza and other respiratory viruses, and to set regional priorities.
The meeting, funded by United States Centers for Disease Control and Prevention (US CDC) and the Pandemic Influenza Preparedness (PIP) Framework, saw participation from NICs, WHO Collaborating Centres, H5 Reference Laboratories, the UN Food and Agriculture Organization, the World Bank, the World Organisation for Animal Health, Asian Development Bank, Chinese Center for Disease Control and Prevention (CCDC), National Institute of Infectious Diseases, Japan, US CDC, and The Peter Doherty Institute for Infection and Immunity, Australia.
The meeting emphasized the importance of continued prompt data and virus sharing, and continued collaboration among institutions and stakeholders working on influenza and other respiratory viruses including, NICs, WHO Collaborating Centres for influenza, H5 Reference Laboratories, partners and other key stakeholders, to further strengthen influenza surveillance and response systems in the Region.
