Pan American Health Organization · 2024 · 24 pages
A capacity-building framework for national programmes addressing influenza, COVID-19 and other respiratory viruses with epidemic potential.
- Issuer
- Pan American Health Organization
- Edition
- 2024
- Audience
- National health authorities, public health professionals, infectious disease programme managers, epidemiologists, laboratory directors, pandemic preparedness planners
- Evidence
- Expert consensus (21 regional experts from 14 countries; online Delphi method) and pilot validation in Chile and Guatemala
- Reviewed
- 17 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO framework guides countries in the Americas to assess and strengthen their national capacities for surveillance, prevention, preparedness, and control of respiratory viruses with epidemic and pandemic potential. It defines five strategic objectives—surveillance, prevention and control, pandemic preparedness and response, operational research, and risk communication—each divided into programmatic elements with three progressive capacity levels (A: minimum, B: intermediate, C: high).
The framework emerged from regional expert consensus and pilot testing in Chile and Guatemala. It is not an assessment tool but a qualitative diagnostic instrument enabling countries to identify gaps and build integrated programmes that leverage existing seasonal influenza infrastructure for broader respiratory pathogen preparedness. The approach emphasizes integration of surveillance systems (SARI and ILI), laboratory capacity ranging from basic immunofluorescence to genomic sequencing, and multisectoral pandemic planning grounded in lessons from the H1N1pdm09 and COVID-19 pandemics.
Implementation involves designating technical and management focal points, conducting national workshops to assess capacities against the framework, and developing a National Action Plan with short-, medium-, and long-term actions. The framework aligns with IHR (2005) core capacities and is designed to strengthen both routine seasonal influenza programmes and readiness for future pandemic threats.
Key points
For clinicians — doses and thresholds as stated in the guideline
- SARI surveillance should be conducted in hospitalized patients, ICU admissions, and deaths; ILI surveillance should follow global and regional standards with full integration of epidemiology and laboratory components (Level B–C)
- National Influenza Centres should perform PCR for influenza A/B typing and subtyping, participate annually in WHO External Quality Assessment Project, and report new or unusual viruses to national authorities and WHO Collaborating Centres (Level B)
- Countries should achieve sequencing capacity (in-house or through reference laboratories) and share genetic sequences of public health importance through GISAID in a timely manner (Level C)
- Annual seasonal influenza vaccination plans should include at least three target populations: health workers, older adults, pregnant women, people with chronic diseases, and children, with capacity to measure coverage at national and subnational levels (Level C)
- National pandemic preparedness plans should include the Global Influenza Strategy 2019–2030 checklist for respiratory pathogen pandemic planning, with simulation exercises conducted with stakeholders to test and validate the plan (Level B)
- Infection prevention and control programmes must incorporate the eight WHO core components, including national IPC guidelines, education and training, surveillance of healthcare-associated infections, and multimodal implementation strategies (Level B)
- Countries should establish rapid response teams with terms of reference at subnational (province/region) level with regular training including tabletop simulation exercises (Level B)
- Risk communication and community engagement should include a dedicated RCCE unit or team working with a national all-hazard, multisectoral emergency plan, with training for Ministry of Health staff at national and subnational levels (Level B)
Capacity levels for surveillance of influenza and other respiratory viruses
Table extracted from the guideline
| Programmatic element | Level A (Minimum) | Level B (Intermediate) | Level C (High) |
|---|---|---|---|
| Surveillance of influenza and ORVs | SARI surveillance in accordance with global/regional standards; SARS-CoV-2 integrated into virological surveillance | SARI (hospitalized, ICU, deaths) and ILI surveillance in accordance with standards; SARS-CoV-2 integrated with influenza and ORVs surveillance | SARI and ILI surveillance with full integration of epidemiology and laboratory; includes unusual respiratory events; criteria to increase/reduce surveillance intensity |
| Laboratory capacity | Immunofluorescence for influenza or PCR for SARS-CoV-2; positive samples sent to reference lab; shares data through FluNet | Established National Influenza Centre recognized by WHO; annual WHO EQAP participation; PCR for influenza A/B typing, subtyping, B genotyping; reports new/unusual viruses; submits samples to WHO CC | Sequencing capacity (in-house or reference lab); antigenic characterization and antiviral resistance testing; shares genetic sequences and metadata through GISAID in timely manner |
| Data integration and management | Manages clinical, epidemiological, laboratory data independently (not integrated) | Manages data in organized, structured manner but not in central electronic platform | Manages all data in integrated manner with interoperability standards, e.g., PAHO Flu electronic platform |
| Reporting and analysis | Shares data regionally/globally through FluNet | Shares through FluNet and FluID; complies with reporting indicators; shares at least one PISA indicator | Shares through FluNet and FluID; complies with reporting and timeliness indicators; uses PISA indicator to guide public health measures; captures nominal SARI mortality data |
Source: Pan American Health Organization, Framework of a national program for preventing and controlling diseases caused by respiratory viruses with epidemic and pandemic potential. Reproduced in summary form.
From the guideline
Verbatim
“The objective of this framework is to encourage countries to implement and sustain capacities to the highest level possible within what could be a program for respiratory viruses with epidemic and pandemic potential.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia and having contributed to WHO work on health emergencies, I see this framework as a practical tool for Georgian authorities to benchmark our respiratory disease preparedness against regional standards. Following our COVID-19 experience and ongoing seasonal influenza surveillance, the structured progression from level A to C helps identify concrete next steps—particularly strengthening laboratory sequencing capacity, integrating SARI and ILI data platforms, and formalizing multisectoral pandemic planning at subnational levels. One implementation caveat for Georgia and neighbouring countries is that reaching level C capacities, especially sustained investment in genomic surveillance and real-time data integration, requires long-term political and financial commitment that may compete with other public health priorities; the framework wisely does not expect all countries to progress beyond level A, but rather to sustain the highest achievable level within national resources and to use the self-assessment process to inform targeted capacity-building investments.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 17 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this framework offers a structured approach to assess existing respiratory disease surveillance and preparedness infrastructure, building on national experience with seasonal influenza programmes and the COVID-19 response. Georgian authorities would need to evaluate current SARI and ILI sentinel surveillance against the framework’s progressive levels, consider the capacity of the National Centre for Disease Control and Public Health laboratory network for molecular diagnostics and sequencing, and review whether pandemic preparedness plans incorporate the multisectoral and subnational elements described at levels B and C. The framework’s emphasis on integration (linking epidemiological, laboratory, and vaccination data through platforms such as PAHO Flu) and on cold chain adequacy for both routine and emergency vaccination would be particularly relevant for countries planning to sustain influenza immunization and prepare for future respiratory pathogen threats in a region with variable healthcare infrastructure.
Questions this guideline answers
Quick answers
What are the three capacity levels in this framework?
Level A represents minimum capacities (e.g., basic SARI surveillance, immunofluorescence testing, FluNet reporting). Level B is intermediate (e.g., SARI and ILI surveillance, National Influenza Centre with PCR, FluNet and FluID reporting). Level C is the highest capacity (e.g., fully integrated surveillance of unusual events, sequencing capacity, timely GISAID sharing, weekly integrated reports).
How does this framework relate to IHR (2005) core capacities?
Each of the five strategic objectives explicitly aligns with IHR (2005) core capacities: surveillance links to C4 (laboratory), C5 (surveillance), and C12 (zoonotic diseases); prevention and control to C7 (health emergency management), C8 (health service delivery), C9 (IPC), and C11 (points of entry); preparedness to C7; and risk communication to C10.
What target populations should be included in seasonal influenza vaccination?
At level A, at least one target population (health workers, older adults, pregnant women, people with chronic diseases, or children). At level B, at least two target populations. At level C, three or more target populations with capacity to measure coverage at national and subnational levels by target group.
What laboratory tests are required at each capacity level?
Level A requires immunofluorescence for influenza (small countries) or PCR for SARS-CoV-2, with positive samples sent to reference labs and data shared via FluNet. Level B requires an established National Influenza Centre performing PCR for influenza A/B typing and subtyping, annual WHO EQAP participation, and sample submission to WHO Collaborating Centres. Level C adds sequencing capacity (in-house or reference lab), antigenic characterization, antiviral resistance testing, and timely sharing of sequences and metadata through GISAID.
Related on GMJ
Interconnected resources
GMJ News coverage
- Influenza surge in Southern Hemisphere prompts PAHO call for vaccination and health system readinessSep 2026
- Close Contact Alone May Not Drive Influenza Transmission, Controlled Study SuggestsJul 2026
- UK flu and COVID-19 surveillance data to May 2027 shows continued monitoring amid seasonal trendsOct 2026
- Community Health Workers Boost COVID-19 Testing Among Formerly Incarcerated PeopleAug 2026
Quality & accreditation
- ASF PHC — Standard 4 — Acute & Same-Day Care · Primary Health Clinic
- ASF PHC — Standard 7 — Governance & Staffing · Primary Health Clinic
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- Microplanning Manual for Malaria Elimination in the Region of the Americas. Version for field personnel
- Maternal and neonatal tetanus elimination in Latin America and the Caribbean: Field Guide
- Manual of procedures for leishmaniasis surveillance and control in the Region of the Americas. Second edition
- Guidance on active case-finding for acute flaccid paralysis, measles, and rubella
- Protocol for the Use of the Performance Monitoring Tool for the National Expanded Program on Immunization
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- 2024
- Status
- Current
- Published
- 2024-01-01
- Languages
- Spanish, English
- Scope
- National programmes for prevention and control of influenza, SARS-CoV-2, and other respiratory viruses with epidemic and pandemic potential in the Americas
- Audience
- National health authorities, public health professionals, infectious disease programme managers, epidemiologists, laboratory directors, pandemic preparedness planners
- Pages
- 24
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus (21 regional experts from 14 countries; online Delphi method) and pilot validation in Chile and Guatemala
- Record history
- Created 17 Oct 2026 · updated 17 Oct 2026 · next check Apr 2027
Pan American Health Organization. Framework of a national program for preventing and controlling diseases caused by respiratory viruses with epidemic and pandemic potential. Washington, D.C.: PAHO; 2024. (PAHO/PHE/IHM/COVID-19/23-0012). Available from: https://iris.paho.org/handle/10665.2/59510GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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