Bottleneck and enabler evaluation of avian influenza health event — Guatemala, January-February 2023

In February 2023, H5N1 was identified in 11 wild pelicans in Izabal, Guatemala. These were the first known cases of H5N1 in the country. This study assessed the timeliness of the response to this One Health event using the "7-1-7" benchmarks, which propose the following metrics: detection within seven days, notification within one day, and completion of early response within seven days. Open-ended interviews were conducted in September 2023 with nine key informants from the Ministry of Agriculture, Livestock, and Food (MAGA) and the Ministry of Health and Social Assistance (MSPAS) who were directly involved in the response. Participants included epidemiologists, laboratory analysts, and other relevant personnel. Interviews were analyzed using UNICEF's "Human-Centered Design 4 Health" approach to qualitative fieldwork. Detection and notification were completed in one day, while early response was completed in 34 days. Key enablers of the response included interregional notification and cooperation, availability of earmarked emergency funds, event-based surveillance, and support from laboratories across public and private sectors. Reported bottlenecks included limited national laboratory testing capacity, challenges in inter-agency and intra-agency communication, workforce constraints, and equipment shortages. This outbreak response met the detection and notification criteria but did not achieve the 7-day target for completing early response activities. As one of the few qualitative studies examining avian influenza response in Central America, these findings highlight how strengthening a One Health approach, particularly in communication, workforce, and laboratory capacity, could enhance preparedness for future outbreaks.