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The COVID-19 pandemic has further exposed weaknesses in disease surveillance and highlighted the importance of strategic and targeted investments for optimal response.  Ensuring laboratories and clinics are connected and have good geographic representativeness is essential if we are to understand the public health relevance of the circulating pathogens.

Public health is a collective responsibility.  The role of the industry however is often perceived as constrained to development of countermeasures, manufacturing or as a transactional partner, leading to missed opportunities for joint investments. The Pandemic Accord currently under discussion offers an opportunity to build resilient ecosystems for pandemic preparedness, based on a true collaborative model leveraging both industry catalytic funding and in-kind contributions. Robust infectious disease surveillance systems constitute a shared objective for both public and private sectors. In addition to pandemic preparedness objectives, expanding surveillance data availability is critical to support and incentivize R&D for countermeasures given the high investment risks associated.

There is a unanimous call to improve surveillance, but existing systems may experience capacity constraints in case of scope expansion or surge in demand. Collaboration with additional types of surveillance systems, particularly agile ones, can enhance response and effectiveness, in line with the WHO Mosaic Respiratory Surveillance Framework.  The Foundation for Influenza Epidemiology (FIE) offers the opportunity to join forces and to contribute to a more comprehensive respiratory virus surveillance system by scaling up the existing Global Influenza Hospital Surveillance Network (GIHSN).

The GIHSN, initially started with a focus on influenza, has now expanded to become the largest global hospital network documenting respiratory viruses’ circulation and burden (including 100 hospitals in 20+ countries so far). It works in close collaboration with WHO. It is co-funded by local health systems (relying on existing infrastructures) and the FIE which provides catalytic grants from the private sector[1]. This federated network relies on an agile and empowered community of surveillance sites which remain owners of the data they generate, get access to capacity building, funding, and high quality cross-country scientific exchanges. The FIE has demonstrated over more than 10 years solid governance and transparency, allowing to attract an operating budget of more than 2.5M$ per year so far. More than 85% of the budget is allocated at country level for data collection. To date, more than 150,000 hospitalized patients have been screened by the network.

The GIHSN offers critical capabilities in support of future needs and incentives to engage industry. To build the mutual trust needed for the Pandemic Accord, FIE is calling for private sector, multilaterals, member states and civil society to join forces to scale up the GIHSN. We trust that the proof of concept of this newly called Global Catalytic Fund for Surveillance could be achieved in 3 years with a yearly operating budget of 10M$ only.

Cedric MAHE, PhD
President, Foundation for Influenza Epidemiology
www.gihsn.org

[1] Donors currently include Sanofi, CSL Seqirus, Abbott and Pfizer

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of the GIHSN

To inform policy decisions, national health authorities need to understand the burden of influenza disease and the impact of current vaccination programs in their countries. The Global Influenza Hospital Surveillance Network (GIHSN) is a platform able to generate strong epidemiological and medical evidence on the burden of severe influenza and the public health impact of influenza vaccines.

The GIHSN was initiated by Sanofi Pasteur in 2011 to fill the gap in epidemiology and public health knowledge. The GIHSN gathers several sites affiliated with national health authorities (see Implementing partners).

Background

According to the World Health Organization (WHO), seasonal influenza epidemics affect an estimated 5–15% of the total population worldwide, with 3–5 million cases of severe illness, resulting in 250,000–500,000 deaths. However, few data are available for many parts of the world where active surveillance is lacking. In addition, the viruses and the severity of influenza epidemics vary greatly between years and geographical areas. To address the rapidly evolving antigenicity of circulating influenza viruses, twice annually, the WHO re-evaluates the viruses that should be included in the seasonal influenza vaccines.

To inform policy decisions, national health authorities need to understand the burden of influenza disease and the impact of current vaccination programs in their countries.

High-quality, active surveillance networks are needed to better understand influenza epidemiology and therefore better control influenza epidemics. Data from existing sentinel physician networks are used in several countries to conduct annual studies on the effectiveness of vaccines in preventing medically attended influenza like illness (ILI). These networks, however, do not collect data on the impact of influenza infection on hospitalization or on the impact of influenza vaccines on influenza-related hospitalization, which substantially influence evaluation of the benefits and cost-effectiveness of influenza vaccines.

Active surveillance networks are also powerful advocacy instruments for highlighting the often-underestimated impact of influenza. While hospital surveillance systems already exist for detecting outbreaks of respiratory viruses, few focus on the actual burden of serious influenza cases using the specific outcome of laboratoryconfirmed influenza ; instead, the burden is most often estimated from hospital databases using criteria prone to various biases.

Rational and scientific objectives

Severe cases of influenza requiring hospitalization are probably the most influential factors in term of flu vaccination advocacy and cost-benefit evaluation of vaccination. In addition, little is known about the effect of influenza vaccine on the prevention of severe disease.

Indeed, previously published studies are prone to various biases. A design based on a network of hospitals is easier to standardize for quality insurance reasons and easier to coordinate than a General Practitioners (GP) network approach. Finally the availability of diagnostic capacities at hospital make influenza case ascertainment more reliable.