Is Indonesia Ready for the Next Influenza A Outbreak? WHO Reveals the Critical Steps to Prevent a Pandemic.

Guidelines for the Control and Eradication of Influenza A Outbreaks in Indonesia Based on World Health Organization (WHO) Recommendations: An Integrated Approach to Surveillance, Laboratory Diagnosis, Clinical Management, Vaccination, Infection Prevention, and One Health

 

ABSTRACT

 

Influenza A viruses constitute an important group of respiratory viruses of major public health significance because they can cause seasonal influenza, zoonotic infections, human outbreaks, and pandemics when a novel influenza A virus emerges with the capacity for efficient human-to-human transmission. Indonesia is particularly vulnerable to influenza because of its high population density, extensive human mobility, intensive human–animal interactions, large poultry industry, and archipelagic geography, which may pose challenges to the uniform implementation of surveillance, detection, and response measures. Therefore, the control of influenza A outbreaks requires an integrated system encompassing epidemiological surveillance, virological surveillance, laboratory diagnosis, clinical care, infection prevention and control, vaccination, risk communication, and coordination between the human and animal health sectors.

 

This article aims to develop a framework for the control and response to influenza A outbreaks in Indonesia based on the recommendations and standards of the World Health Organization (WHO), particularly the Global Influenza Surveillance and Response System (GISRS), influenza surveillance guidance, clinical management guidance for influenza, public health and social measures (PHSM), and pandemic preparedness principles. The methodology consisted of a narrative review of WHO normative documents and official sources from the Ministry of Health of the Republic of Indonesia. The review indicates that the primary strategy should focus on early detection, rapid laboratory confirmation, prompt epidemiological investigation, case isolation and clinical management, contact tracing and risk-based monitoring, strengthened infection prevention and control (IPC), appropriate antiviral use, vaccination of priority groups, control of infection sources in animals, and transparent risk communication.

 

Influenza A control in Indonesia should be implemented through a One Health and risk-based approach, enabling an appropriate distinction between responses to seasonal influenza, zoonotic influenza, and influenza A viruses with pandemic potential. Such an integrated framework is essential to strengthen early warning capacity, accelerate public health response, reduce transmission, protect high-risk populations, and enhance national preparedness for potential influenza pandemics.

 

Keywords: influenza A, outbreak, GISRS, surveillance, One Health, vaccination, Indonesia, WHO.

 

1. INTRODUCTION

 

Influenza is an acute respiratory infection caused by influenza viruses. In humans, influenza A and influenza B viruses are the principal causes of seasonal influenza, whereas influenza A has more complex epidemiological characteristics because it has reservoirs in multiple animal species and can undergo genetic changes that result in viruses with novel epidemiological characteristics. The World Health Organization (WHO) distinguishes seasonal influenza from zoonotic influenza and influenza viruses with pandemic potential; therefore, control strategies should be tailored to the characteristics of the virus, patterns of transmission, disease severity, and the risk of human-to-human spread (WHO, 2024a).

 

The threat posed by influenza A is not limited to the number of cases but also involves the possibility of the emergence of novel viruses against which the population has insufficient immunity. Zoonotic influenza A viruses, including influenza A(H5), A(H7), and other animal-origin influenza viruses, can infect humans following exposure to infected animals or contaminated environments. Although zoonotic infections do not necessarily result in sustained human-to-human transmission, every human infection caused by a zoonotic influenza A virus requires epidemiological attention because it may indicate the potential for viral adaptation to humans (WHO, 2024b).

 

Through the Global Influenza Surveillance and Response System (GISRS), the WHO has established a global network for influenza epidemiological and virological surveillance. GISRS serves as a global mechanism for surveillance, preparedness, and response to seasonal influenza, zoonotic influenza, and influenza viruses with pandemic potential. The system also facilitates the sharing of data and biological materials among countries, enabling the evolution of influenza viruses to be monitored and public health risks to be assessed more rapidly (WHO, 2026a).

 

Indonesia is part of this global network. The Ministry of Health of the Republic of Indonesia conducts sentinel surveillance for Influenza-Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) as part of its respiratory disease surveillance system. This system is linked to Indonesia's commitment to GISRS through the National Influenza Centre (NIC) network. Surveillance data provide an important basis for analyzing influenza trends, informing public health decision-making, and strengthening preparedness for potential pandemic threats (Ministry of Health of the Republic of Indonesia, 2026).

 

In the Indonesian context, influenza A control must take into account geographical conditions, population mobility, international travel, urban population density, occupational settings, healthcare facilities, and close interactions among humans, poultry, pigs, other mammals, and wildlife. Therefore, influenza A cannot be addressed solely as a clinical problem within hospitals. Control measures should be implemented through a One Health approach involving coordination among human health, animal health, environmental health, laboratories, local governments, and communities.

 

The term "eradication" in the context of influenza should be interpreted with caution. Seasonal influenza cannot realistically be regarded as a disease that can be globally eradicated. Therefore, from a scientific perspective, the primary objectives should be control, outbreak response, interruption of transmission chains during specific events, and prevention of further outbreak expansion. The WHO also emphasizes that zoonotic influenza viruses are likely to continue to emerge; consequently, risk-based surveillance and preparedness must be maintained on an ongoing basis (WHO, 2024b).

 

Based on these considerations, an operational framework is needed to provide a basis for the control and response to influenza A outbreaks in Indonesia in accordance with WHO principles.

 

2. METHODOLOGY

 

This article employs a narrative review and evidence-informed policy analysis approach. The primary sources consisted of official WHO documents on influenza, including guidance on the Global Influenza Surveillance and Response System (GISRS), pandemic surveillance, clinical management of influenza, influenza vaccination, infection prevention and control (IPC), and public health and social measures (PHSM). Official documents from the Ministry of Health of the Republic of Indonesia concerning ILI/SARI surveillance were also reviewed to contextualize WHO recommendations within the Indonesian health system.

 

The analysis was conducted in five stages.

First, the epidemiological characteristics of influenza A were identified, and the associated threats were classified into seasonal influenza, zoonotic influenza, and influenza A viruses with pandemic potential.

Second, the key components of the WHO influenza framework applicable to the Indonesian context were identified, including surveillance, laboratory testing, outbreak investigation, case management, vaccination, infection prevention and control (IPC), risk communication, and cross-sectoral coordination.

Third, these components were mapped against the ILI/SARI surveillance system and the capacity of the influenza laboratory network in Indonesia.

Fourth, a risk-based response pathway was developed, covering the sequence of actions from case detection through outbreak containment or termination.

Fifth, operational recommendations were formulated based on the principles of One Health, risk-based response, and strengthened pandemic preparedness.

 

The WHO emphasizes that modern influenza surveillance extends beyond the simple collection of case numbers. It includes systematic screening, specimen collection, laboratory testing, genomic sequencing, data analysis, and information sharing to guide appropriate public health interventions (WHO, 2024c).

 

3. RESULTS AND DISCUSSION

 

3.1. Fundamental Principles for Influenza A Control

 

Influenza A control in Indonesia should be built upon six fundamental principles.

 

First, early detection. Cases should be identified as early as possible through community-based surveillance, healthcare facilities, sentinel ILI/SARI surveillance, laboratory surveillance, and reports of unusual health events or outbreaks.

 

Second, etiological confirmation. Influenza A cannot be determined solely on the basis of clinical symptoms. Laboratory testing is particularly important for severe cases, high-risk groups, clusters, outbreaks, zoonotic cases, or cases presenting with unusual epidemiological characteristics.

 

Third, rapid response. Once an epidemiological or laboratory signal indicates an increased level of risk, an investigation should be initiated promptly.

 

Fourth, transmission control. Control measures include infection prevention and control (IPC), case management, protection of healthcare workers, adequate ventilation, hand hygiene, risk-based mask use, and community-level interventions appropriate to the epidemiological situation.

 

Fifth, protection of vulnerable populations. Groups at increased risk of severe disease should receive priority for clinical care, vaccination, and preventive interventions.

 

Sixth, the One Health approach. When an association with animals is suspected, the investigation should not stop at the human case. Potential animal sources of exposure and relevant environmental factors should also be investigated.

 

The WHO emphasizes that influenza surveillance provides the foundation for decision-making on epidemic response and pandemic preparedness (WHO, 2017; WHO, 2024c).

 

3.2. Influenza A Surveillance System in Indonesia

 

Surveillance is one of the most important components of outbreak control. Indonesia has established sentinel ILI/SARI surveillance, which is used to monitor influenza and other respiratory viruses. This system forms part of the GISRS network and generates information that can support public health policy and pandemic preparedness (Ministry of Health of the Republic of Indonesia, 2026).

 

Surveillance should be conducted at several levels.

A. Community surveillance

Monitoring should focus on increases in acute respiratory illness, particularly in schools, dormitories, Islamic boarding schools (pesantren), workplaces, healthcare facilities, nursing homes, and other high-density communities.

 

B. ILI surveillance

ILI surveillance is used to detect changes in influenza-like illness trends and to help determine when influenza activity is increasing in a particular area.

 

C. SARI surveillance

SARI surveillance is designed to detect severe acute respiratory infections requiring greater clinical and epidemiological attention.

 

D. Virological surveillance

Specimens should be tested to determine the virus type and subtype, particularly when unusual epidemiological patterns are identified.

 

E. Genomic surveillance

Genomic sequencing can be used to identify genetic changes, determine phylogenetic relationships, detect the emergence of particular variants, and assess potential changes in viral characteristics.

 

In 2024, the WHO updated the GISRS integrated surveillance standards, emphasizing the continuum from screening, specimen collection, and laboratory testing to sequencing, data analysis, and data sharing (WHO, 2024c).

 

3.3. Early Detection and Outbreak Investigation

 

Any unusual increase in influenza A cases should be evaluated epidemiologically. Signals requiring particular attention include:

1. a sudden increase in ILI or SARI cases;
2. an increase in the proportion of influenza A-positive specimens;
3. the emergence of clusters of cases with epidemiological links;
4. severe influenza A infection in individuals without clearly identifiable risk factors;
5. unusual deaths associated with respiratory disease;
6. influenza A infection following contact with poultry or mammals;
7. cases occurring among healthcare workers caring for patients with influenza;
8. the emergence of an influenza A virus that is antigenically or genetically distinct from currently circulating viruses;
9. suspected human-to-human transmission of a zoonotic influenza A virus; and
10. an increase in cases in areas or populations that previously showed little or no influenza activity.

 

An outbreak investigation should answer the following questions: Who is becoming ill, when did illness begin, where did the cases occur, how was transmission likely to have occurred, what was the potential source of exposure, and has there been any change in the characteristics of the virus?

 

Epidemiological data should be integrated with laboratory findings. The WHO emphasizes that effective surveillance should characterize the number of cases, affected populations, geographical distribution, disease severity, impact on the health system, and effectiveness of interventions (WHO, 2017).

 

3.4. Laboratory Diagnosis

 

Laboratory diagnosis is a fundamental component of outbreak investigation and response, particularly when zoonotic or pandemic potential is suspected. Laboratory confirmation should be performed in laboratories with appropriate capabilities, procedures, and biosafety measures.

 

The WHO states that the diagnosis of zoonotic influenza infection requires laboratory testing, and specimens from suspected cases should be handled safely and confirmed by competent laboratories (WHO, 2024b).

 

Laboratory investigations may include:

• molecular detection of influenza A;
• subtyping;
• virus isolation or culture in appropriately equipped facilities;
• antigen detection for specific indications;
• antigenic characterization;
• genomic sequencing;
• phylogenetic analysis; and
• antiviral susceptibility testing when indicated.

 

For surveillance purposes, laboratory results should be integrated with epidemiological data. This is important because the mere detection of a virus does not necessarily indicate the magnitude of the public health risk. Risk is determined by the combined characteristics of the virus, patterns of transmission, disease severity, population susceptibility, and the capacity of the health system.

 

3.5. Clinical Management of Cases

 

Influenza A cases should be classified according to disease severity and underlying risk factors. In 2024, the WHO updated its clinical practice guidelines for influenza to cover seasonal influenza, pandemic influenza, and novel influenza A viruses that may cause severe disease in humans, including zoonotic viruses such as A(H5N1), A(H5N6), and A(H7N9) (WHO, 2024d).

 

Patients should undergo:

1. clinical assessment;
2. identification of risk factors for severe disease;
3. assessment of respiratory status;
4. evaluation for complications;
5. laboratory testing as clinically indicated;
6. supportive care;
7. antiviral therapy according to clinical indications and applicable guidelines; and
8. isolation or appropriate healthcare arrangements according to the risk of transmission.

 

Groups at increased risk of influenza-related complications include pregnant women, young children, older adults, and individuals with chronic diseases or impaired immune function (WHO, 2024e).

During an outbreak, healthcare workers should maintain a heightened level of clinical vigilance for severe pneumonia, hypoxemia, sepsis, encephalitis, severe dehydration, and other organ complications.

 

3.6. Use of Antiviral Medications

 

Antiviral medications are an important component of influenza management, particularly for patients with severe disease or those at increased risk of complications. The WHO 2024 clinical guidelines provide recommendations for antiviral treatment in both severe and non-severe influenza, as well as for post-exposure prophylaxis in specific circumstances (WHO, 2024d).

 

Antiviral medications should not be used indiscriminately. Treatment decisions should take into consideration:

• disease severity;
• time since symptom onset;
• risk group;
• suspected virus type or subtype;
• patterns of antiviral resistance;
• laboratory test results, when available; and
• applicable national guidelines.

 

GISRS also contributes to the monitoring of antiviral resistance, enabling treatment policies and recommendations to be adapted to changes in circulating influenza viruses (WHO, 2026b).

 

3.7. Infection Prevention and Control in Healthcare Facilities

 

Healthcare facilities can become sites of amplified transmission when infection prevention and control (IPC) measures are inadequate. Therefore, healthcare facilities should establish effective triage and separation systems for patients presenting with respiratory symptoms.

Key IPC components include:

• triage of patients with respiratory symptoms;
• separation or cohorting of patients according to transmission risk;
• hand hygiene;
• use of personal protective equipment according to risk;
• respiratory hygiene and cough etiquette;
• adequate ventilation;
• appropriate medical waste management;
• environmental cleaning and decontamination;
• management of patient crowding;
• protection of healthcare workers; and
• reporting of infections among healthcare workers.

 

The WHO emphasizes that healthcare facilities with inadequate IPC capacity can become amplifiers of infectious disease transmission to healthcare workers, patients, communities, and potentially across national borders (WHO, 2025).

 

3.8. Isolation, Contact Tracing, and Monitoring

 

During an outbreak, patient isolation should be adapted to the risk of transmission and the capacity of healthcare facilities. The objective is not only to protect other patients but also to interrupt chains of transmission.

 

Contact tracing should be prioritized according to risk. Close contacts of patients infected with zoonotic influenza A viruses or viruses with pandemic potential require particular attention.

 

Contacts may be categorized as follows:

High risk: direct exposure to respiratory secretions, unprotected exposure to an infected patient, or intensive exposure to infected animals.

Moderate risk: close contact with an infected patient while using some form of protective measures.

Low risk: indirect exposure or contact occurring with adequate protection.

 

Contact monitoring may include symptom monitoring, laboratory testing according to risk, and provision of information regarding warning signs requiring medical attention.

The WHO's 2026 guidance on public health and social measures (PHSM) identifies case-finding and contact management as important domains of public health interventions for influenza epidemics and pandemics (WHO, 2026c).

 

3.9. Influenza Vaccination

 

Vaccination is a major component of seasonal influenza prevention. The WHO recommends that countries consider influenza vaccination programmes and give particular attention to priority groups, including healthcare workers, pregnant women, older adults, and individuals with chronic diseases or specific medical conditions (WHO, 2024e; WHO, 2024f).

 

In the Indonesian context, vaccination priorities may include:

1. healthcare workers;
2. older adults;
3. pregnant women;
4. individuals with chronic diseases;
5. children, in accordance with national policy;
6. residents of long-term care facilities;
7. workers at increased risk of occupational exposure; and
8. other groups determined according to epidemiological conditions and vaccine availability.

 

The WHO periodically updates influenza vaccine composition recommendations based on global influenza virus surveillance. Therefore, influenza vaccination policies in Indonesia should take into account WHO vaccine composition recommendations as well as regional influenza epidemiology (WHO, 2026b).

 

For specific zoonotic influenza A viruses, human vaccination has a different context from seasonal influenza vaccination. In 2025, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) updated recommendations concerning A(H5) influenza vaccines for groups at occupational or environmental risk of exposure to H5 viruses. These groups may include laboratory workers, animal outbreak response personnel, poultry workers, veterinarians, and healthcare workers involved in the management of certain human cases, subject to national policies and vaccine availability (WHO, 2026d).

 

3.10. Public Health and Social Measures

 

When transmission of influenza A increases, non-pharmaceutical interventions may be implemented according to the level of risk.

In 2026, the WHO issued specific guidance on public health and social measures (PHSM) for influenza epidemics and pandemics. The guidance encompasses five major domains:

1. individual protection;
2. environmental interventions;
3. case-finding and contact management;
4. social interventions; and
5. travel-related measures.

 

The WHO emphasizes that the implementation of these measures should take into account their effectiveness, proportionality, public acceptability, human rights, equity, available resources, and socioeconomic impacts (WHO, 2026c).

 

Accordingly, restrictions on community activities should not be regarded as an automatic response to every increase in influenza activity. Interventions should be proportionate to the epidemiological evidence and the level of public health threat.

 

3.11. Risk Communication

 

The success of outbreak control depends substantially on public trust. Delayed, inconsistent, or contradictory information can lead to either public panic or resistance to recommended interventions.

Risk communication should clearly explain:

• what is known;
• what remains unknown;
• how the virus is transmitted;
• who is at risk;
• how people can protect themselves;
• when medical care should be sought;
• how vaccines work;
• why laboratory testing is necessary; and
• what actions are being taken by the government.

Information should be communicated consistently by the central government, local governments, healthcare facilities, healthcare professionals, and other relevant institutions.

Risk communication should also be capable of addressing misinformation concerning vaccines, antiviral medications, the origin of the virus, and the risk of transmission.

 

3.12. One Health Approach

 

Influenza A is a classic example of a disease requiring a One Health approach because several influenza A viruses have animal reservoirs or animal sources of infection.

When zoonotic influenza A is suspected, investigations in humans should be conducted concurrently with investigations in animals and the environment.

 

The One Health framework encompasses the following sectors:

 

Human Health Sector

• case detection;
• diagnosis;
• clinical management;
• surveillance; and
• contact investigation.

Animal Health Sector

• surveillance of poultry and mammals;
• investigation of animal deaths or illness;
• laboratory testing;
• control of infection sources; and
• farm biosecurity.

Environmental Sector

• investigation of exposure sites;
• environmental monitoring;
• waste management; and
• identification of human–animal contact points.

Food and Trade Sector

• monitoring of production chains;
• food safety; and
• risk-based regulation of trade in animals and animal products.

 

The WHO emphasizes that preventing zoonotic influenza requires surveillance in both human and animal populations, rapid investigation of every human infection, and risk-based pandemic preparedness and planning (WHO, 2024b).

 

3.13. Stages of Influenza A Outbreak Response in Indonesia

 

The response framework can be divided into five stages.

 

Stage 1 – Preparedness and Alert

This stage is initiated when increased influenza activity or a specific epidemiological signal is detected.

Key activities include:

• strengthening ILI/SARI surveillance;
• reinforcing laboratory capacity;
• monitoring influenza trends;
• ensuring the availability of personal protective equipment;
• ensuring healthcare facility preparedness; and
• strengthening risk communication.

 

Stage 2 – Investigation

This stage is initiated when an unusual cluster or increase in cases is identified.

Key activities include:

• signal verification;
• epidemiological investigation;
• specimen collection;
• laboratory testing;
• identification of potential exposure sources; and
• contact mapping.

 

Stage 3 – Response

This stage is initiated once an outbreak has been confirmed.

Key activities include:

• isolation of cases according to transmission risk;
• clinical management;
• antiviral treatment according to indications;
• contact tracing;
• implementation of IPC measures;
• vaccination in accordance with applicable policies;
• risk-based community interventions; and
• control of animal infection sources when relevant.

 

Stage 4 – Control

The objective is to halt the increase in cases and prevent further spread.

Key indicators include:

• a decline in new cases;
• absence of uncontrolled secondary transmission;
• a decline in the positivity rate;
• no evidence of viral changes associated with increased risk; and
• stabilization of healthcare system and hospital capacity.

 

Stage 5 – Post-Outbreak Evaluation

The evaluation should cover:

• speed of detection;
• speed of laboratory confirmation;
• response time;
• coverage of contact tracing;
• mortality;
• hospital burden;
• antiviral use;
• vaccination effectiveness;
• effectiveness of risk communication;
• laboratory capacity; and
• cross-sectoral coordination.

 

The findings of the post-outbreak evaluation should be incorporated into subsequent preparedness and response plans to strengthen the country's capacity to detect, investigate, and respond to future influenza threats.

 

3.14. Operational Matrix for Influenza A Control

 

Component	Key Actions	Primary Responsible Authority	Indicator
Surveillance	ILI/SARI and community-based surveillance	Ministry of Health / Provincial and District Health Offices	Detected case trends
Laboratory	PCR, subtyping, and genomic sequencing	Laboratory network / National Influenza Centre (NIC)	Time to laboratory confirmation
Investigation	Case and cluster investigation	Health Offices / Epidemiological Investigation Teams	Proportion of cases investigated
Clinical management	Triage and clinical management	Healthcare facilities	Case-fatality rate (CFR) / hospitalization rate
Antiviral therapy	Treatment according to clinical indications	Physicians / Healthcare facilities	Appropriate antiviral use
Infection Prevention and Control (IPC)	PPE, ventilation, and hand hygiene	Healthcare facilities	Healthcare-associated infection rate
Vaccination	Prioritization of high-risk groups	Immunization programmes / Healthcare facilities	Vaccination coverage
Contact management	Contact tracing and monitoring	Surveillance teams	Proportion of contacts monitored
One Health	Integrated human–animal surveillance	Human and animal health sectors	Exposure source identified
Risk communication	Public information and communication	Government	Consistency of information
Evaluation	After-action review (AAR)	Central and local governments	Improvement plan developed

 

3.15. Influenza A Preparedness Indicators for Indonesia

 

Influenza A preparedness should not be assessed solely on the basis of the number of hospitals or laboratories available. More meaningful indicators include:

1. the proportion of ILI/SARI cases successfully captured by the surveillance system;
2. time from symptom onset to specimen collection;
3. time from specimen collection to laboratory result;
4. capacity for influenza A subtyping;
5. genomic sequencing capacity;
6. capacity to detect zoonotic influenza;
7. capacity to conduct outbreak investigations;
8. availability of antiviral medications;
9. availability of influenza vaccines;
10. vaccination coverage among priority groups;
11. IPC capacity;
12. proportion of healthcare workers adequately protected;
13. risk communication capacity;
14. integration of human and animal health data; and
15. speed of response to epidemiological signals.

 

Through its global influenza strategy, the WHO considers surveillance, disease prevention, control, and pandemic preparedness to be interconnected components of a single system rather than independent programmes (WHO, 2024g).

 

3.16. Integrated Response Model for Indonesia

 

Based on a synthesis of WHO guidance, an integrated response model for Indonesia can be formulated as follows:

DETECTION → VERIFICATION → LABORATORY CONFIRMATION → INVESTIGATION → RISK STRATIFICATION → ISOLATION/CLINICAL MANAGEMENT → CONTACT TRACING → IPC → VACCINATION/ANTIVIRAL THERAPY AS INDICATED → ONE HEALTH → RISK COMMUNICATION → MONITORING → EVALUATION

This model should remain dynamic and adaptable. When the virus is a seasonal influenza virus with well-characterized epidemiological features, the response can focus primarily on surveillance, vaccination, clinical care, and protection of high-risk populations.

 

Conversely, if zoonotic influenza A or a novel influenza A virus with evidence suggestive of human-to-human transmission is detected, the level of response should be escalated. This should include intensive investigation, viral characterization, strengthened IPC, contact tracing, genomic surveillance, and enhanced national and international coordination.

 

3.17. Implementation Challenges in Indonesia

 

Several major challenges may affect influenza A control in Indonesia, including heterogeneous laboratory capacity across regions, the country's vast geographical area, high population mobility, variations in healthcare capacity, limitations in human resources, and suboptimal integration of human and animal health data.

 

Other challenges include delays in reporting, variability in specimen quality, limited sequencing capacity, vaccine hesitancy, and the dissemination of misinformation through social media.

 

Therefore, strengthening the influenza control system should not begin only after an outbreak has occurred. Capacity should be developed continuously during the inter-pandemic period through training, simulation exercises, laboratory strengthening, procurement and maintenance of essential supplies, development of surveillance networks, and cross-sectoral coordination.

 

The WHO states that pandemic preparedness should strengthen core functions, including emergency coordination, collaborative surveillance, community protection, clinical care, and equitable access to medical countermeasures (WHO, 2019).

 

3.18. Policy Implications

 

Indonesia requires an influenza A control system capable of transitioning from routine surveillance to emergency response without losing continuity of data and situational awareness.

Five strategic priorities should be emphasized.

 

First, strengthen the national contribution to GISRS. ILI/SARI surveillance should continue to be strengthened and integrated with laboratory, genomic, and epidemiological information.

 

Second, strengthen the laboratory network. Capacity for influenza A detection, subtyping, genetic characterization, and antiviral resistance surveillance should be established and maintained at appropriate levels across the laboratory network.

 

Third, strengthen the One Health approach. Human and animal health data should be interoperable and linked to enable more rapid detection and assessment of zoonotic risks.

 

Fourth, strengthen vaccination and protection of high-risk groups. Vaccination policies should be based on epidemiological evidence, risk assessment, vaccine availability, and regularly updated WHO recommendations.

 

Fifth, build a culture of preparedness. Communities, healthcare workers, local governments, laboratories, the livestock sector, and other relevant sectors should understand their respective roles before an outbreak occurs.

 

4. CONCLUSION

 

Influenza A represents a dynamic public health threat encompassing seasonal influenza, zoonotic influenza, and the potential emergence of novel viruses with pandemic potential. Therefore, controlling influenza A outbreaks in Indonesia cannot rely solely on patient treatment but requires an integrated system linking epidemiological surveillance, virological surveillance, laboratory diagnostics, genomic surveillance, clinical care, infection prevention and control (IPC), vaccination, risk communication, and control of infection sources in animals.

 

In accordance with WHO recommendations, early detection is the cornerstone of influenza preparedness and response. Indonesia's ILI/SARI surveillance system should continue to be strengthened as part of GISRS and integrated with laboratory testing, genomic sequencing, epidemiological analysis, and data-sharing mechanisms. Every influenza A case with unusual characteristics—particularly cases associated with animal exposure, severe disease, clusters, or suspected human-to-human transmission—should promptly undergo epidemiological and laboratory investigation.

 

From a clinical perspective, patients should be classified according to disease severity and underlying risk factors. Vulnerable groups require particular attention, and antiviral therapy should be administered according to clinical indications and applicable guidelines. Healthcare facilities should strengthen IPC measures to prevent them from becoming sites of outbreak amplification.

 

Vaccination is an important instrument for reducing the burden of seasonal influenza, particularly among priority groups such as healthcare workers, pregnant women, older adults, and individuals with chronic diseases. For specific zoonotic influenza A viruses, vaccination strategies require additional considerations and should be tailored to the level of exposure risk, vaccine availability, and national policies.

 

Ultimately, influenza A control in Indonesia should be implemented through a One Health and risk-based response approach. The practical objective is not simply to "eradicate influenza," because global eradication of influenza is not a realistic goal. Rather, the objectives are to detect threats as early as possible, interrupt chains of transmission during specific events, prevent widespread dissemination, reduce morbidity and mortality, and prevent influenza events from developing into larger public health crises.

 

With sensitive surveillance systems, responsive laboratory networks, prepared clinical services, appropriately targeted vaccination, strong IPC measures, transparent risk communication, and effective One Health coordination, Indonesia can strengthen its national capacity to address influenza A across seasonal and zoonotic contexts and to respond effectively when viruses with pandemic potential emerge.

 

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World Health Organization. (2019). Pandemic influenza preparedness in WHO Member States. WHO Global Influenza Programme.

 

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World Health Organization. (2022). Vaccines against influenza: WHO position paper – May 2022. WHO.

 

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World Health Organization. (2024e). Global Influenza Programme: Vaccine use. WHO.

 

World Health Organization. (2024f). Developing and strengthening national seasonal influenza vaccination programmes. WHO.

 

World Health Organization. (2024g). Joint national and international surveillance review of ILI/SARI sentinel surveillance: Indonesia. WHO Regional Office for South-East Asia.

 

World Health Organization. (2025). Framework and toolkit for infection prevention and control outbreak preparedness, readiness and response. WHO.

 

World Health Organization. (2026a). Global Influenza Surveillance and Response System (GISRS). WHO Global Influenza Programme.

 

World Health Organization. (2026b). Global Influenza Programme: Influenza vaccine recommendations and surveillance outputs. WHO.

 

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