Optimizing surveillance post-pandemic: an evaluation of COVID-19 and other respiratory virus surveillance systems in the Philippines, April 2023

On May 5, 2023, the World Health Organization removed the public health emergency of international concern (PHEIC) designation for the COVID-19 pandemic, noting reduced global risk of severe COVID-19 due to widespread infection and vaccine-induced immunity. Several months prior, the Philippine Department of Health (DOH) requested technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to evaluate its COVID-19 surveillance ecosystem and inform decision-making for sustainable respiratory virus monitoring. This manuscript describes the evaluation methodology, findings, and recommendations to inform these surveillance transitions. In April 2023, an evaluation team from DOH, CDC, and Task Force for Global Health conducted a cross-sectional evaluation of six surveillance systems (COVID-19 case-based, traveler screening, and genomic surveillance; influenza-like illness surveillance, severe acute respiratory infection surveillance, and the Respiratory Syncytial Virus surveillance pilot) at 26 sites across three Philippine regions. Using tailored data collection tools, we analyzed systems’ structure, processes, attributes, and key performance indicators. Findings were categorized into three areas: surveillance system scope and design, system performance, and laboratory capacity. Although the DOH expanded and upgraded systems for COVID-19 surveillance, including universal case surveillance, contact tracing, and molecular testing and genomic sequencing, rapid development of multiple, isolated systems during the pandemic created inefficiencies and data discrepancies. Prioritizing COVID-19 surveillance strained staff capacity, impacting other surveillance efforts. Key findings included variable reporting completeness and timeliness and underutilization of sentinel sites. Challenges included fragmented data systems, heavy workloads, and resource limitations. Staff adaptability and dedication demonstrated their commitment to surveillance compliance. Progress in molecular testing and genomic sequencing was notable. Pandemic-era surveillance of respiratory viruses requires adaptation to the interpandemic period. Recommendations focus on right-sizing COVID-19 surveillance while strengthening other surveillance systems, integrating respiratory virus surveillance systems, enhancing staff capacity, and improving stakeholder coordination. These findings offer valuable insights for transitioning to sustainable respiratory virus surveillance post-pandemic.