Position statement 2024

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

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

Annual Report 2021-2022

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The Foundation for Influenza Epidemiology

The GIHSN is supported by a dedicated fund, the Foundation for Influenza Epidemiology.

The Foundation for Influenza Epidemiology was created in September 2015 by Sanofi under the auspices of Fondation de France to formalize several years of commitment to epidemiological research on severe influenza.

This funding mechanism was established to facilitate additional funding from other donors for this world-scale active surveillance project.

4 new donors have joined the Board in addition to Sanofi: Illumina, Seqirus, Abbott and IFPMA/IVS

All donations collected through this foundation are dedicated to epidemiological research in the field of severe influenza and other respiratory viral diseases.


Foundation governance

The governance of the Foundation for Influenza Epidemiology is ensured by an Executive Committee (EC). The Executive Committee is the decision maker, in charge of the strategic directions related to the project. Based on pre-established criteria, the Executive Committee selects applicant sites for funding allocation each year. The Executive Committee is composed of donors representatives and three independent experts.

Scientific oversight is ensured by an Independent Scientific Committee involving some of the world’s top flu epidemiology/virology/policy experts including representatives from US CDC and WHO.

Coordination of the network and operational implementation, including data collection & hosting, is supported by an independent organization: Impact Healthcare.

Members of the Scientific Committee

Independent Experts:

  • Marta NUNES, CERP, University of Lyon, France (Chair)
  • Bruno LINA, University of Lyon, France (former Chair)
  • Joseph BRESEE, The Task Force for Global Health, USA
  • John McCAULEY, Crick Institute, London, UK
  • John PAGET, Netherlands Institute for Health Services Research, Utrecht, Netherlands
  • Justin ORTIZ, University of Maryland, USA
  • Cecile VIBOUD, Fogarty International Center at the National Institutes of Health (NIH), USA
  • Wenqing ZHANG, Global Influenza Program, WHO, Geneva (Observer)
  • Sandra S CHAVES, Foundation for Influenza Epidemiology, France (Observer)

Site Representatives:

  • Melissa K ANDREW, Canadian Serious Outcomes Surveillance Network, Halifax, Canada
  • Sonia M RABONI, Virology Laboratory, Infectious Diseases Division, Universidade Federal do Paraná, Brazil
  • Xavier LOPEZ LABRADOR, Virology Laboratory, Genomics and Health, FISABIO, Spain


A constructive dialog with WHO Global Influenza Program has been developed. Early February 2023, the GIHSN shared with WHO its first descriptive report presenting phylogenetic threes of circulating influenza strains from hospitalized patients captured by the GIHSN surveillance platform.

It is expected that those sequencing results from 226 influenza cases collected in 11 countries from 1st September 2022 to 1st February 2023 will add disease severity perspective to the large dataset of influenza surveillance data generated by the WHO Global Influenza Surveillance and Response System ( GISRS ) and will support the WHO advisory group of experts to issue recommendations on the composition of the influenza vaccines for the following season.

In September 2023, the GIHSN shared with WHO an updated report.

In October 2023, a Memorandum of Understanding was signed between the World Health Organization and the Foundation for Influenza Epidemiology to develop further cooperations between the GIHSN and the WHO’s GISRS genomic surveillance network. Main areas of collaboration identified include: Virus co-circulation and alert mechanisms; Combination of severity and sequencing for strain selection; Burden of disease estimation.



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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).


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.


The GIHSN has three main objectives :

  1. Evaluate the burden of severe influenza disease, defined as hospitalization related to community-acquired influenza or complications following an influenza infection;
  2. Quantify the distribution of the different influenza viruses (A(H1N(H3N2), B/Yamagata, and B/Victoria) among these severe cases; and
  3. III. Measure the effectiveness of influenza seasonal vaccines to prevent these hospitalizations using a test-negative design.


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