Improving compliance with reporting requirements of the IHR: The International Health Regulations are a legal instrument that requires States Parties to establish and maintain core capacities for surveillance and response to public health risks and emergencies. States Parties are expected to provide annual updates on their IHR capacities to WHO. In coordination with key UN partners, such as the International Atomic Energy Agency, World Organisation for Animal Health (WOAH) and International Civil Aviation Organization, PASB developed technical documents to guide States Parties in completing the States Parties Self-Assessment Annual Reports (SPAR) and applying the IHR Monitoring and Evaluation Framework. In both 2022 and 2023, all 35 States Parties complied with the mandatory annual report to WHO. This was the first time this happened in two consecutive years and represents an improvement over the 32 submissions in 2021 and 29 in 2020. During the biennium, PASB also supported a review of 22 voluntary IHR components in 18 countries.

Strengthening IHR core capacities: The Region saw significant improvement in its average core public health capacities under the IHR during the biennium. While North America’s average core capacity score peaked at 87%, South America increased its score by 2% from 2021 to 2022, reaching 67%. PASB developed and disseminated IHR country profiles based on annual reporting data from 2010 to 2021. Additionally, four COVID-19 after-action reviews and two intra-action reviews were conducted. Technical cooperation was provided to Ecuador and El Salvador for implementation of contingency plans and procedures in response to chemical incidents. PASB also helped to conduct an evaluation of core capacities and develop national action plans to strengthen health security in Guatemala and Guyana. In addition, in preparation for the 2023 Pan American Games in Chile, PASB responded to a request from Brazil and Chile to lead a regional simulation exercise (SIMEX). Twenty four countries and territories participated, contributing to enhanced preparedness for the games.

Strengthening IHR zoonotic disease core capacities in the Dominican Republic and Suriname: Following a voluntary external evaluation of their SPAR-C12 (zoonotic diseases) capacities, the Dominican Republic and Suriname developed road maps to strengthen preparedness for zoonotic diseases. PAHO engaged with key stakeholders, donors, and partners to build strategic alignment in support of national efforts to reduce the risk of future spillover infectious disease events. PASB worked to establish consensus on priority actions and coordination mechanisms related to SPAR-C12 (zoonotic diseases) together with partners, including the executive secretariat of COMISCA, FAO, WOAH, US CDC, International Regional Organization of Plant and Animal Health, and Inter-American Institute for Cooperation on Agriculture.

Reducing risks from disasters: Twenty-one countries updated their national risk assessments for health emergencies. PASB promoted the Hospitals Resilient to Health Emergencies and Disasters initiative, which prioritizes ”smart” standards to bolster health care facilities against health emergencies and disasters, and 20 countries launched the initiative. Caribbean countries integrated smart standards with technical support from PASB, and Barbados assessed 10 facilities for A70 standards. In Belize, eight health facilities were retrofitted with European Union and United Kingdom financing.

Strengthening preparedness to respond to migration crises: PASB worked together with 11 countries and other partners to implement activities at subnational level with an emphasis on border communities, health sector coordination, planning, health information, epidemiological surveillance, risk communication, and emergency care. In Guatemala and Honduras, Ministry of Health personnel and strategic partners improved coordination to address complex humanitarian health concerns. Over 3500 health staff and community workers were trained in these two countries, 51 500 migrants and local residents received health care, and 37 facilities were improved with supplies and infrastructure improvements. PASB also monitored regional health and migration crisis responses using platforms like the Inter-Agency Coordination Platform for Refugees and Migrants from the Bolivarian Republic of Venezuela and the Proceso de Quito.

Increasing safety for persons with disabilities during emergencies and disasters: In Guatemala, PASB supported the inclusion of persons with disabilities and their families in inclusive emergency and disaster risk management, rolling out the Disability Inclusion in Hospital Disaster Risk Management (INGRID-H) tool in six hospitals. The INGRID-H methodology was implemented in 286 health facilities in nine countries (Chile, Colombia, Dominican Republic, Ecuador, Guatemala, Honduras, Mexico, Peru, and the Bolivarian Republic of Venezuela).

Strengthening preparedness capacities within PASB and Member States: PASB strengthened readiness capacities across the Region to better prepare national authorities as well as its own personnel for health emergencies, and updated its regional roster of experts with highly qualified and specialized professionals. Training to strengthen coordination mechanisms and Emergency Operations Centers was provided for 18 countries in the Caribbean. Experts from Chile, El Salvador, Guatemala, and Peru were trained to use the HOPE platform, a virtual collaborative tool to improve coordination in health emergencies and facilitate crisis management.

Reinforcing emergency medical teams (EMT): Two new EMTs, Americares and Heart to Heart International, were recognized through the WHO global classification process, bringing to nine the total number of classified teams in the Region. During the response to COVID-19, $3.6 million in EMT equipment was procured for 11 countries, strengthening national EMT surge capacities. PASB trained 951 professionals from 15 countries using the SIMEXamericas digital platform. Best practices for EMT preparedness, readiness, response, and coordination were promoted in a forum co-organized with the Secretariat of Health of Mexico in partnership with AECID and the Ford Foundation. With technical support from PASB, four countries (Dominican Republic, Ecuador, Nicaragua, and Panama) integrated SISMED911, a software program that supports the complete cycle of prehospital emergency case management, into their prehospital services.

Enhancing pandemic and epidemic preparedness and response systems: PASB helped Argentina, Chile, and Guatemala to strengthen their epidemic response systems. Simulation exercises for pandemic preparedness were performed in the Plurinational State of Bolivia, Costa Rica, Guatemala, Mexico, Panama, and Suriname, along with a regionwide exercise held in Colombia. PASB supported the response to various outbreaks such as avian influenza, using a One Health approach.

Strengthening national and regional surveillance capacity networks: PASB continued to support the integration of surveillance for influenza, COVID-19, and other respiratory viruses to enhance regional capacities in surveillance, including integrated sentinel surveillance in 11 countries. Guidelines for integrated surveillance were reviewed in Guyana, Saint Lucia, Suriname, and Trinidad and Tobago. In a joint initiative with the US CDC, PASB continued working on a pilot study on the functionality of sentinel versus universal surveillance in Argentina, Chile, and Mexico.

Enhancing surveillance and virology testing in Central America and the Caribbean: PASB worked to strengthen surveillance and virology testing capacity in the Caribbean and Central America for arboviruses in general, but also for severe acute respiratory syndrome (SARS), influenza, and other respiratory viruses. Promoting collaboration and joint work within the framework of the IHR, as was the case in Guatemala and Guyana, was key to achieving this goal. The increased capacity in the Caribbean was reflected in the improvement of reports and of surveillance during dengue outbreaks.

Implementing the Strategy on Regional Genomic Surveillance for Epidemic and Pandemic Preparedness and Response: The first meeting of the PAHO Genomic Surveillance Regional Networks (PAHOGen) brought together for the first time four of the most important networks that use genomic data for surveillance: ViGenDA (arboviruses), RESVIGEN (formerly Covigen but now including all respiratory viruses), PulseNet (foodborne pathogens), and ReLAVRA+ (antimicrobial resistance). Laboratories in 30 countries and territories are actively participating in the genomic surveillance of different epidemic-prone pathogens, and 25 countries and territories have laboratories with sequencing capacity. The Bahamas, Dominican Republic, and Honduras gained sequencing capacity for the first time, while laboratories in El Salvador and Jamaica received training and equipment to begin sequencing activities.

Information sharing on detection, verification, and events monitored: Since the last semester of 2023, PASB has been sharing all signals captured daily through a public domain webpage, including those under verification and events reported by IHR National Focal Points. During 2022–2023, the Bureau reviewed more than 4.3 million pieces of information, followed 5392 potential signals, and assessed and recorded 309 events in the Event Management System. PASB produced 80 epidemiological alerts or updates, briefings or technical notes, situation analyses, and summary reports for public dissemination on the PAHO website, along with nine regional risk assessments. In addition, PASB contributed to two biregional risk assessments and 18 global risk assessments in collaboration with other WHO regions. Further updates were provided on public health emergencies through public dashboards, geographic analysis, and bulletins through various platforms.

Mounting a timely response to ongoing and emerging emergencies: PASB monitored and/or managed responses to 126 emergencies, including seven protracted emergencies: COVID-19, the humanitarian crisis in the Bolivarian Republic of Venezuela and neighboring countries, Haiti’s civil unrest and earthquake recovery, the volcanic eruption in Saint Vincent and the Grenadines, mpox, polio, and mass migration. PASB responded to 34 new emergencies during the biennium, including hurricanes and tropical storms in Belize, Cuba, and Nicaragua; volcanic activity in Colombia and Ecuador; droughts in Brazil and Suriname; flooding in the Plurinational State of Bolivia, Colombia, Cuba, Haiti, and Suriname; mass migration; and several outbreaks of infectious diseases such as Legionella in Argentina, respiratory syncytial virus in Chile, and dengue in multiple countries. During the biennium, 280 international shipments totaling 580 metric tons of critical health supplies, goods, and medicines from the regional logistics hub in Panama were delivered to 37 countries and territories. Agreements on logistics were established or continued with strategic partners such as Direct Relief and Project HOPE.

Responding to the mpox outbreak in the Americas: On 24 May 2022, PASB established an Incident Management Support Team to lead the response to mpox, which was declared a public health emergency of international concern by the WHO Director-General on 23 July 2022. PASB delivered technical cooperation including supplies, in some cases, to ensure laboratory detection capacity, strengthen surveillance, and implement infection prevention and control measures. The Bureau also synthetized evidence to develop clinical guidelines for therapeutic options and joined efforts to combat stigma and discrimination through risk communication and community engagement. Following a special session of the 59th Directing Council in 2022, Member States mandated PAHO to take steps to support access to vaccines for mpox via its Revolving Fund (Resolution CDSS2.R1). By the end of this period, PASB had supported the distribution of over 71 400 vaccines to nine countries, with a focus on the vaccination of vulnerable communities.

Bolstering health services for vulnerable communities in complex situations: In Colombia, PASB engaged 166 community members in rural areas to participate in building sustainable community surveillance systems. PASB also deployed health brigades reaching 2487 people and delivered critical supplies. In Haiti, in addition to efforts to combat cholera (see below), the Bureau provided supplies to health facilities to support victims of gang violence and maintain essential health services. PASB also aided internally displaced persons at 26 sites in Haiti, offering medical consultations and mental health support, carrying out IPC measures and decontamination, and vaccinating over 10 000 people against cholera. In December 2022, PASB, with financial support from partners, opened a fully functional ambulatory emergency room at the Hôpital Universitaire la Paix in Port-au-Prince. In the Bolivarian Republic of Venezuela, PASB focused efforts on essential services such as emergency and maternity rooms and on reducing barriers to primary care for Indigenous people and migrants.

Mapping risk assessment and exposure to natural hazards in Latin America and the Caribbean: PASB provided instrumental support to 11 countries in disaster mitigation and response planning for major acute public health events with the use of geospatial information. Through new online GIS tools, PASB can offer long-term and real-time insights into exposure to natural hazards, enabling informed decision-making processes for mitigation and preparedness activities. The Bureau conducted online training sessions aimed at equipping a diverse range of professionals from various sectors with the necessary skills to effectively utilize the tools. As a result, PASB generated a total of 94 risk and exposure reports covering 71 natural hazards.