Afghanistan’s health system may be strained, but its influenza surveillance system continues to operate systematically, not only to monitor influenza, but also to test and report for COVID-19.
In August 2021, the Afghan health system was on the verge of collapse following regime change and an international funding freeze. Some health facilities have closed and programs have been suspended. Many health workers have either resigned or left the country, leaving fewer workers to attempt to respond urgently to emergencies. At the same time, COVID-19 continues to spread across the country, with insufficient resources available to contain it.
And yet, despite all these challenges, the country’s influenza surveillance system continues to function. The National Influenza Center and the WHO Afghanistan Influenza Team successfully advocated with the Ministry of Public Health to resume influenza surveillance activities and today they continue to build on the successes achieved during the COVID-19 pandemic.
This advocacy success is the result of years of Pandemic Influenza Preparedness Framework (PIP) Partnership Contribution (PC) investment. It is thanks to this investment that an influenza surveillance system was already operational when COVID-19 hit Afghanistan in February 2020 and could be leveraged to support the country’s response to the pandemic. The system was rooted in nine major hospitals in nine provinces, chosen for their geographical and demographic representativeness. In each hospital, a fully trained and qualified team had been assembled and was ready to take virus samples from infected patients. And the labs were equipped with the reagents and supplies they needed to perform differential diagnostic techniques for influenza.
The first COVID-19 sample was collected from a PIP-supported influenza sentinel site and shipped to the National Influenza Center for confirmation by polymerase chain reaction (PCR) testing. Afghanistan is one of the few countries in the region to use the integrated approach to surveillance promoted by GISRS+. Throughout the pandemic, it tested and reported both influenza and SARS-CoV2 within its sentinel network.
Having a well-established surveillance system and being able to transfer knowledge and skills to put that system to another use during a crisis can save lives in countries like Afghanistan. It is a model for the region from which other countries can replicate best practices.