WP1 D1.1 Progress report | UNITED4Surveillance

UNITED4Surveillance Grant Agreement Number 101102070 D1.1 PROGRESS REPORT Representing 24 countries in Europe, UNITED4Surveillance gathers expertise in public health, clinical microbiology, epidemiology and data-science to support the strengthening of integrated surveillance systems for infectious disease prevention and control on national and European level UNITED4Surveillance Grant Agreement Number 101102070 DELIVERABLE INFORMATION Grant Agreement number 101102070 Acronym UNITED4Surveillance Full Title Union and National Capacity Building 4 IntegraTED Surveillance Call EU4H-2021-JA3-IBA Topic EU4H-2021-JA-13 Type of Action EU4H Project Grants Start Date 01/01/2023 Durations (months) 36 Project Coordination RIVM Project coordinator Eelco Franz/Nika Ritsema (JAsurveilla[email protected]) Work Package (/Task): WP1 – Coordination Work Package Lead Eelco Franz / Nika Ritsema 1 - RIVM Deliverable D1.1 Progress Report Due date of deliverable 30/06/2024 Actual submission date 21/02/2025 File name D1.1_U4S_Progress-report_version2.0 Document status: final Confidentiality: PU -public KEYWORDS Progress report; UNITED4Surveillance; integrated infectious disease surveillance; capacity building DOCUMENT HISTORY Version Date Changes 1.0 28/06/2024 Final version D1.1 submitted by coordinator 2.0 21/02/2025 Deliverable report was adjusted based on comments from HaDEA from February 2025: textual changes were made in the milestone overview and some of the headings; consortium countries specified in chapter 3.1; and clarification in chapter 3.3 UNITED4Surveillance Grant Agreement Number 101102070 UNITED4Surveillance Grant Agreement Number 101102070 AUTHOR INFORMATION Lead beneficiary for this deliverable: 1 – RIVM Owner(s) of this document Owner of the content 1 - RIVM Co-owner 1 1.1 WR Co-Owner 2 2 - CIPH Co-Owner 2.1 2.1 - MoA Co-Owner 3 3 - SSI Co-Owner 4 4 - THL Co-Owner 5 5 - NIPH Co-Owner 6 6 – HSE Co-Owner 7 7 - ISS Co-Owner 7.1 7.1 Moh IT Co-Owner 7.2 7.2 IRFMN Co-Owner 7.3 7.3 - ARS Co-Owner 8 8 - SPKC Co-Owner 9 9 - NVSC Co-Owner 10 10 – MFH Co-Owner 11 11 - NIPH Co-Owner 11.1 11.1 NORW VET INST Co-Owner 11.2 11.2 HDIR Co-Owner 12 12 – NIZP PZH – PIB Co-Owner 13 13 - NIJZ Co-Owner 13.1 13.1 - UKCL Co-Owner 13.2 13.2 - NLZOH Co-Owner 14 14 - FOHM UNITED4Surveillance Grant Agreement Number 101102070 Co-Owner 15 15 - AGES Co-Owner 16 16 - Sciensano Co-Owner 17 17 - SZU Co-Owner 18 18 – HEALTH BOARD HB Co-Owner 19 19 – RKI Co-Owner 20 20 – CSFJA Co-Owner 21 21 – LNS Co-Owner 22 22 – MIN SAUDE Co-Owner 23 23 – BMSGPK Co-Owner 24 24 - SANTE PUBL FR Co-Owner 25 26 – ISCIII Co-Owner 26 27 – INSP Co-Owner 27 28 – MDS Co-Owner 28 29 – ANSES Co-Owner 29 30 - DISA Disclaimer Copyright message This document was produced under the terms and conditions of Grant Agreement No. 101102070 for the European Commission. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA. Neither the European Union nor the granting authority can be held responsible for them. © UNITED4Surveillance Consortium, 2023 This deliverable contains original unpublished work except where clearly indicated otherwise. Acknowledgement of previously published material and of the work of others has been made through appropriate citation, quotation or both. Reproduction is authorized provided the source is acknowledged. 1 UNITED4Surveillance Grant Agreement Number 101102070 TABLE OF CONTENT 1. EXECUTIVE SUMMARY .......................................................................................... 2 2. OVERVIEW MILESTONES AND DELIVERABLES ...................................................... 3 3. DESCRIPTION OF WORK & MAIN ACHIEVEMENTS PER WP ................................... 7 3.1 DESCRIPTION OF THE WORK WP1: COORDINATION ........................................................... 7 3.2 DESCRIPTION OF THE WORK WP2: OUTBREAK DETECTION .................................................. 8 3.2.1 Executive summary ................................................................................... 8 3.2.2 Improving laboratory-based reporting (Task 1) ............................................ 8 3.2.3 Outbreak & signal detection (Task 2) .......................................................... 9 3.3 DESCRIPTION OF THE WORK WP3: HOSPITAL SURVEILLANCE ............................................. 10 3.3.1 Executive summary ................................................................................. 10 3.3.2. Significant results / output ...................................................................... 11 3.3.3. Interesting common insights ................................................................... 11 3.4 DESCRIPTION OF THE WORK WP4: ONE HEALTH ............................................................ 13 3.4.1 Executive summary ................................................................................. 13 3.4.2 Significant results / output ....................................................................... 13 3.4.3 Next steps ............................................................................................. 13 3.5 DESCRIPTION OF THE WORK WP5: EVALUATION ............................................................ 14 3.5.1 Executive Summary ................................................................................ 14 3.5.2 Significant Results .................................................................................. 14 3.5.3 Next Steps ............................................................................................. 14 3.5.4 Risk Management ................................................................................... 14 3.6 DESCRIPTION OF THE WORK WP6: COMMUNICATION & DISSEMINATION ................................ 15 3.7 DESCRIPTION OF THE WORK WP7: SUSTAINABILITY ........................................................ 17 4. REFERENCES / SELECTED SOURCES OF INFORMATION ...................................... 18 5. LIST OF ABBREVIATIONS ................................................................................... 18 2 UNITED4Surveillance Grant Agreement Number 101102070 1. Executive summary UNITED4Surveillance is a Joint Action, co-funded by the European Union, and focusses on the EU4Health Programme’s objective to protect the population from cross-border health concerns. UNITED4Surveillance contributes to this general objective by: • Piloting solutions and sharing best practices that contribute to improved integrated infectious disease surveillance; • Defining a roadmap that guides the further development of inter-operable, digitalized, reliable and comprehensive surveillance systems at Member State level with a focus on laboratory-based reporting/outbreak detection, hospital surveillance, and One health surveillance. The general aim is to strengthen infectious disease surveillance systems at national level, with improvement of integration, interoperability, and digitalization of data sources; thereby supporting capacity building on the EU level. The project is divided in seven Work Packages (WP), with the focus on three core topics: outbreak detection/laboratory-based reporting, hospital surveillance, and One Health surveillance. The objective of WP2 Outbreak detection is to support outbreak detection and pandemic preparedness by improving real time surveillance for a more timely, coordinated response and is structured in two main technical tasks. In Task 1, an inventory of current needs and gaps with respect to laboratory-based reporting, a description of what a logical data model for handling laboratory data (with focus on subtyping and genotyping data) has been completed, and pilots to enhance national laboratory-based reporting structures in four EU Member States are ongoing. In task 2, a publicly available Signal Detection Tool for timely and accurate detection of signals in infectious disease surveillance data is being developed collaboratively. The tool will be piloted using preliminary gastrointestinal pathogens in eleven European countries during April to November 2024 and will be subsequently evaluated. WP3 Hospital surveillance supports the strengthening of infectious disease surveillance systems at the national level across eight participating EU Member States, which are either aiming to establish or improve sentinel-based, electronic hospital surveillance of serious infectious diseases/ syndromes or integrate clinical information on hospitalized patients with microbiological data. Member States performed different activities contributing to the objectives of the WP, such as semi-structured interviews with key stakeholders in hospital setting; developing a case definition of severe acute respiratory infection (SARI) for electronic health record (EHR)-based surveillance; analyzing how to extract hospitalizations due to respiratory infections from national hospital care registers; or investigation of interoperability possibilities within existing rotavirus infections surveillance systems. Pilot studies are ongoing and are expected to be completed by the end of 2024. WP4 One Health aims towards strengthening One Health surveillance at national level by integrating data from human, animal, and environmental domains. The work is performed over three disease groups: foodborne diseases, zoonotic influenza, and vector-borne diseases. The first year of the project was dedicated to identifying gaps in the current surveillance systems by performing systems mappings and stakeholder analysis, as well as designing pilot studies to bridge these gaps. For this purpose, participating EU Member States have performed an analysis to identify stakeholders for their One Health surveillance, organized workshops with stakeholders to identify gaps, and worked towards plans for pilot studies. In 2024, countries started their pilots to improve their One Health surveillance systems. This progress report is submitted as deliverable D1.1 as part of WP1 Coordination. The report provides an overview of the general and scientific progress and results of the project (per work package) during the first half of the Joint Action (period from 01/01/2/23 until 30/06/2024). 3 UNITED4Surveillance Grant Agreement Number 101102070 2. Overview milestones and deliverables Within the first reporting period 33 milestones and 9 deliverables were due. 23 milestones were achieved in time, 5 milestones were achieved with a minor delay (<1 month) and 5 milestones had a delay of more than 1 month. All 9 deliverables with a due date in the first reporting period were submitted on time. For two deliverables an extension of the due date was requested and subsequently granted by HaDEA. Table 1 gives an overview of all project milestones with a due date in the first reporting period and their actual status. In Figure 1 the status and submission of deliverables in the first reporting period is presented. Table 1 Overview and status of milestones due in the first reporting period (01/01/2023 – 30/06/2024) MS # Description WP Due date Delivery date Notes 1 Kick-off meeting to mark the start of the Joint Action WP1 28-Feb-2023 15-Feb-2023 Kick-off meeting on 14 and 15 February 2023 in Utrecht, the Netherlands. 2 Communication /dissemination plan WP6 28-Feb-2023 24-Feb-2023 3 Project communication materials (logo + “brand design” + templates) WP6 28-Feb-2023 24-Feb-2023 4 External Expert Advisory Board (EEAB) established WP1 31-March2023 30-March2023 The EEAB was established: Dr. Valentina Rizzi, senior scientific officer at EFSA Dr. Bruno Ciancio, head of section surveillance at ECDC Dr. Carlos Carvalho, principal expert digital surveillance at ECDC Prof. Christos Hadjichristodoulou, professor hygiene and epidemiology at University of Thessaly, Greece 5 Internal project management guidance, for effective results-oriented steering of the project WP1 31-March2023 26-Jan-2023 Monthly Steering Committee meetings, make use project management tools (e.g. iObeya and X-matrix) for the progress of milestones and deliverables for each WP. 6 Member States Survey has been defined, agreed upon and launched for Hospital surveillance WP3 31-March2023 6-April-2023 7 Agreed harmonized methodology regarding goal description, stakeholder analysis and systems mapping across tasks for One Health surveillance WP4 31-March2023 30-March2023 4 UNITED4Surveillance Grant Agreement Number 101102070 8 Project website for internal and external communication WP6 31-March2023 30-March2023 9 Consortium Agreement between all partners of the Joint Action WP1 30-April2023 30-June2023 Consortium agreement was signed by all partners. This process took longer than expected. 10 WP2 kick-off workshop to: (1) introduce participants; (2) introduce their country’s lab surveillance system including needs & gaps and relation to national policies; (3) produce an overview of lab-reporting data elements that are within scope. WP2 30-April2023 26-April2023 Held on 26 April 2023 in Copenhagen, Denmark 11 Logical data model: back-to-back workshop with kick-off workshop to discuss scope of data elements, cases, entity-relationship model and testing strategy. WP2 30-April2023 27-April2023 Held on 27 April 2023 in Copenhagen, Denmark 12 Survey on surveillance and outbreak detection systems. Gathering information about the use of surveillance systems, terminology, data formats and outbreak detection methods in the different member states. WP2 30-April2023 30-April2023 13 Member States Survey hospital surveillance to create an inventory of current surveillance systems for severe infections leading to hospitalization in all Member States participating WP3 30-April2023 30-April2023 14 Inventarisation and planning made for workshops on Member State level to make an in-depth analysis of their One Health surveillance systems WP4 30-April2023 31-May-2023 15 Workshop on outbreak detection use cases. Reviewing existing outbreak detection systems and discussing gaps and needs. Identify common use cases for outbreak detection and common terminology WP2 31-May-2023 31-May-2023 On 30 and 31 May 2023 the workshop on outbreak detection use cases took place at RKI in Berlin, Germany 16 Workshop on results of the survey (milestone 13), draft version of report, and preliminary plans for pilots on Hospital surveillance WP3 30-June2023 23-May-2023 On 22 and 23 May 2023 the workshop took place at ISS in Rome, Italy 17 Report on the Member State Survey and description of piloting plans on Hospital surveillance WP3 30-June2023 30-June2023 10 UNITED4Surveillance Grant Agreement Number 101102070 3.3 Description of the work WP3: Hospital surveillance 3.3.1 Executive summary Work Package 3 (WP3) Hospital surveillance supports the strengthening of infectious disease surveillance systems at the national level across eight participating Member States, which are either aiming to establish or improve sentinel-based, electronic hospital surveillance of serious infectious diseases or syndromes (Latvia, the Netherlands, Malta, and Slovenia) or integrate clinical information on hospitalized patients with microbiological data (Finland, Italy, Norway, and Poland). Pilot studies are ongoing and are expected to be completed by the end of 2024. In Task 3.1 relying on sentinel-based approach, progress has been made towards the WP3 objectives by Latvia who analyzed data received from hospitals and medical doctors using the electronical notification form, by Netherlands who completed a stakeholder analysis and semi-structured interviews with key stakeholders in the hospital setting, and by Slovenia who developed a case definition of SARI (severe acute respiratory infection) for electronic health record (EHR)-based surveillance. However, there has also been delays as both Latvia and Malta having to accommodate the introduction of new information technology (IT) systems within their pilot scope, Latvia found the piloting to take longer than planned due to General Data Protection Regulation (GDPR), which was similar in the Netherlands where different interpretations of GDPR were found to be one of main barriers for SARI surveillance. In Task 3.2 using nation-wide register-based public health surveillance, progress has been made towards the WP3 objectives by Finland who analyzed how to extract hospitalizations due to respiratory infections from the national hospital care registers, by Poland who investigated the interoperability possibilities within their existing systems surveillance of rotavirus infections, and Norway where the interpretation of the applicable Act allows for compiling health data from the health registries for public health surveillance. However, it has also become apparent that the current legislation needs to be changed in Finland to allow combining of register data for non-COVID-cases, in Italy to use data for surveillance and link with other data sources, and in Slovenia to continue SARI surveillance after 2024. There are discussions ongoing with regional authorities in Italy to allow the linkage of laboratory and clinical data for purpose of public health surveillance. In terms of crosslinks, different interpretations of the GDPR and amended public health acts have emerged as an important topic in common between countries. These legal issues have implications for the linkage of multiple data sources where data comparability has also been highlighted as an issue. Lastly, the need for a framework for collaboration with relevant stakeholders has become apparent. During the project, there have been some significant changes in the individual country’s situation, which might influenced the scope of the pilot studies. For example, seven piloting Member States in WP3 have received preliminary or final approval for the EU4Health (CP-g-23-01) Direct Grants to MS authorities: improving and strengthening national surveillance systems. The DG application process may increased the workload for persons involved in WP3 in small MS and delayed the pilot start, but overall the grants will form a positive continuation for the WP3 work. In Finland and Norway, there have been major organizational changes. The Finnish Institute for Health and Welfare (THL) underwent extensive negotiations in 2024 to reduce its staff, making it harder to add personnel to WP3 work. Since the start of 2024 the Norwegian Institute of Public Health (NIPH) is now data controller for the main health registers, which gives NIPH a clear mandate to use them for statistics. The introduction of new systems for the laboratories in Latvia, and delays in the roll-out of new systems at the casualty department in Malta, have meant that the original goal of the pilots had to be adapted somewhat. Whereas in the Netherlands there is an ongoing adjustment of the Public Health Act, which is expected to facilitate the robust infectious disease surveillance in hospitals. 11 UNITED4Surveillance Grant Agreement Number 101102070 3.3.2. Significant results / output • Finland was able to analyze, how to extract hospitalizations due to respiratory infections (influenza, SARS-CoV-2 or respiratory syncytial virus (RSV)) from the national hospital care registers considering the coding practices in the Finnish health care. • Latvia prepared information materials for hospitals and General Practitioners (GP) about the electronic notification system (how to use it and submit electronic urgent notification about infectious disease), and analyzed data received from hospitals and medical doctors using the electronical notification form. • Malta explored the available data sources and issues with data-linking to enable automated hospitalbased surveillance and held meetings with hospital stakeholders agree on data sharing. Protocols are being drafted for hospital syndromic surveillance using EHR. • The Netherlands completed a stakeholder analysis report, a semi-structured interviews report with key stakeholders in the hospital setting and signed a collaboration agreement by the National Institute for Public Health and the Environment (RIVM) and two main hospital associations for the SARI project using a blueprint for SARI surveillance. • Norway has delivered a detailed report on the value, legal and technical aspects of relevant data sources investigated with the purpose of surveillance of hospital admissions with respiratory tract infections in Norway to better understand the possibilities and hurdles. • Poland learnt in detail (variables & format) about data in existing systems and their interoperability possibilities to enhance the routine surveillance system - with data useful for the control and prevention of rotavirus infections. • Slovenia finalized a case definition of SARI infection for electronic health record (EHR)-based surveillance developed (based on an ICD-10-CM code list) and developed a data model with respective coding for clinical and laboratory data for EHR-based surveillance. 3.3.3. Interesting common insights In general, there have been some very interesting insights coming from the piloting work at a national level, for example in Finland where a specific ICD-10-code for RSV is seldom used or in Norway where the interpretation of the Personal Health Data Filing System Act is now considered the main legal basis for SARI surveillance in “peace time”. Both Latvia and the Netherlands have referred to the reluctance of other organizations and unclear stakeholder roles and responsibilities as potential barriers to their respective pilots. In the pilots three common themes have emerged between the WP3 participating countries: (i) Legal issues / GDPR As mentioned in the outset, legal issues and GDPR persist to be a challenge in many countries including Italy, Finland, Latvia and Slovenia. These challenges are experienced to different extents, for example in Italy there is no possibility of data linkage with other sources at national or regional level so it might need to be done at hospital level, while in Finland the legislation does allow for data linkage between the relevant data sources but this only relates to COVID-19 cases and is temporary. The frequency of the data in Latvia is made more challenging by GDPR due to the coordination required to be given permission, however in Slovenia the legal basis for using EHR-based healthcare data for surveillance purposes of communicable diseases is expected be resolved by a new Act. (ii) Linking multiple data sources Several countries have assessed the linking of multiple data sources, namely Italy, Malta, Poland and Slovenia. In Italy the context is quite unique as it is refined to the Tuscany region, where the use of a national pseudonymized ID code is not permitted due to GDPR, which obstructs data linkage between laboratory and clinical data. In Malta and Poland, the array of data sources available has caused both positive and negative ramifications, such as in Malta where automation will allow for the validation of surveillance case definitions with the laboratory results and discharge ICD-10 codes, whereas in Poland the divergence of data collection 12 UNITED4Surveillance Grant Agreement Number 101102070 goals has meant it is difficult to collect common variables. This differs in Slovenia where a national system for recording and exchanging EHR’s on national level is the primary data source and only for secondary use purposes will technical solutions provide linkage between clinical, microbiological and cause of death data. (iii) Blueprint / framework With regards to the development of a blueprint or a framework, Malta, Poland and the Netherlands are undertaking this work within their pilot. In Malta, the focus is on structured protocols and real-time surveillance through the EHR, whereas in Poland the attention is put towards the framework of collaboration in transmitting and integrating routinely collected data. In the Netherlands a different approach has been adopted as RIVM have engaged relevant stakeholders with the aim of developing a blueprint for sustainable, national SARI surveillance. 13 UNITED4Surveillance Grant Agreement Number 101102070 3.4 Description of the work WP4: One Health 3.4.1 Executive summary In Work package 4 One Health, we aim towards strengthening One Health surveillance at national level by integrating data from human, animal, and environmental domains. The work is done in three different disease groups: foodborne diseases, zoonotic influenza, and vector-borne diseases. The pathogens selected for improving One Health surveillance in these above-mentioned groups are: Salmonella (Belgium, Lithuania, and the Netherlands), Shiga toxin-producing Escherichia coli STEC (Denmark and Italy), swine influenza virus (Norway), both avian and swine influenza virus (Austria, Belgium and Denmark), West Nile virus (Spain), tickborne encephalitis virus (Lithuania) and Francisella tularensis (Austria). In the first year of the project, we identified gaps in the current surveillance systems and designed pilots to bridge these gaps during the second year. For this purpose, countries performed analyses to identify stakeholders for their One Health surveillance, organized workshops with stakeholders to identify gaps, and planned pilots. Since the start of 2024, countries have started to improve or set up new One Health surveillance systems, which include a wide variety of activities: developing surveys and/or protocols, setting up collaborations with other stakeholders, improving/developing diagnostic tests, sequencing of samples, automating data sharing between stakeholders and many more. 3.4.2 Significant results / output The stakeholder analyses that were done early 2023 highlighted that there are a wide variety of potential stakeholders from the human, veterinary, or environmental sectors, both at the national, European and/or global level. Countries identified both governmental, private, and commercial stakeholders, which posed challenges in the pilots due to differences in stakeholders’ interests. For example, if commercial laboratories decide to contribute to One Health surveillance by forwarding isolates (for instance Salmonella) from a farm to the public health or veterinary institutes, this may lead to control measures at the farm due to animal or public health risks. This might further lead to economic loss for the farmer (and commercial laboratories) and hence less willingness to collaborate in the surveillance. There might also be legal and privacy issues (GDPR), which can hamper data sharing between stakeholders if it could lead to identifying persons or companies. Despite these challenges, countries have been able to improve their One Health surveillance systems by identifying all stakeholders, expanding their current stakeholder-network with additional partners, making information on specific pathogens available to a wider public, exploring new surveillance sources (testing of ticks, wild birds, or pigs for the presence of pathogens), improving diagnostics (culture-independent testing), and increased sharing of sequence data. To maximize the learning experience from U4S, countries arranged disease-group specific meetings to exchange information on lessons learned and to get input on the existing challenges. 3.4.3 Next steps The pilots are now roughly halfway and will run for the remainder of 2024, and in some countries until mid2025. The aim is to further improve One Health surveillance systems by strengthening the existing systems, continuing to seek additional collaborators, improve new diagnostic methods, sharing of sequence data, setting up new data sharing/visualization platforms amongst a wide range of other ongoing activities. During the piloting phase the countries continue to collaborate with each other, learn from each other and share best practices. 14 UNITED4Surveillance Grant Agreement Number 101102070 3.5 Description of the work WP5: Evaluation 3.5.1 Executive Summary The goal of Work Package 5 (WP5) Evaluation is to assess whether the Joint Action has achieved its planned results, delivered the expected benefits, and made the desired changes. This involves evaluating the process, outputs, and outcomes. WP5 has successfully developed a comprehensive evaluation plan, detailing all activities, objectives, methodologies, indicators, timelines, and monitoring mechanisms. The evaluation plan has been validated by an external evaluator, and the initial results have been shared via a PDF document on Microsoft Teams with the coordinator and other WP leads. Key evaluation activities include sending surveys after each in-person meeting or workshop and conducting an annual evaluation survey. These surveys are designed to gauge partner satisfaction and collect feedback on project processes and outcomes. Additionally, focus groups for WP leaders using the ORID (Objective, Reflective, Interpretive, Decisional) Discussion Method are organized to gain deeper insights into the quality of collaboration and to identify potential obstacles. 3.5.2 Significant Results The outcomes of the first evaluation survey were presented at the General Assembly. We received 41 responses from 17 countries. Key findings include: • 63.41% of respondents rated their overall satisfaction as 4 out of 5. • 56.1% rated communication within the project as above average. Participants provided valuable feedback, including a desire for: • More face-to-face meetings. • Improved support for project-related queries. • Better coordination among overlapping EU-funded projects. • Enhanced cross-WP communication. Additionally, participants recommended better communication about project updates and WP deliverables, adherence to tasks and milestones, and increased use of the U4S Teams channel for cross-collaboration. The results of the evaluation workshop will be included in the forthcoming evaluation report, providing crucial insights into project implementation and progress. 3.5.3 Next Steps Moving forward, WP5 will: • continue monitoring project activities and evaluating progress towards objectives; • send out the second evaluation survey after the second project year; • prepare a final evaluation report, incorporating all survey results. 3.5.4 Risk Management One identified risk is the lower-than-expected response rate from partners. We have addressed this by designing short and simple surveys and sending reminders as needed to ensure higher response rates. 15 UNITED4Surveillance Grant Agreement Number 101102070 3.6 Description of the work WP6: Communication & Dissemination The main objective of Work Package 6 (WP6) Communication & Dissemination is to achieve efficient and effective visibility, awareness, and acceptance of the project to internal and external stakeholders. During the first half (01/01/2023 – 01/06/2024) of the project the following dissemination activities were implemented: 1. Developed UNITED4Surveillance website: https://united4surveillance.eu/. The information on the website is updated regularly (updating information on WP’s, sharing news on partners' activities and their achievements. 2. Created UNITED4Surveillance infographic: https://united4surveillance.eu/infographicunited4surveillance/ 3. Created UNITED4Surveillance logo, style guide and developed dissemination templates (presentation template, deliverable report template and etc.). 4. Developed UNITED4Surveillance dissemination plan. 5. Developed UNITED4Surveillance National dissemination plan template, which was shared with the partners. UNITED4Surveillance partners in their national dissemination plans provided information about their planned national dissemination activities. Also, they were asked to periodically submit their dissemination activities reports. Structured information on dissemination activities until May 2024 is given below: Conferences, Meetings, and Workshops: (national and international level) • Number of Activities: 89 • Number of Persons Reached: 685 • Description: A substantial portion of the dissemination efforts involved active participation in conferences, meetings, and workshops. These events provided platforms for presenting research findings, engaging in discussions, and networking with key stakeholders in the field. Press Releases: • Number of Activities: 5 • Number of Persons Reached: no data collected. • Description: Press releases were issued to announce significant milestones, project updates, and key findings. These releases were targeted at both specialized and general media outlets to ensure wide coverage. Scientific Journals: • Number of Activities: 2 • Number of Persons Reached: no data collected. • Description: Articles were published in reputable scientific journals. These publications were crucial for disseminating detailed research outcomes and methodologies to the academic and scientific communities. Websites: • Number of Activities: 22 • Number of Persons Reached: 8,000 16 UNITED4Surveillance Grant Agreement Number 101102070 • Description: Dedicated project websites and partner websites were used to share information, reports, and resources. These websites served as crucial tools for project documentation and public engagement. Annual Reports: • Number of Activities: 6 • Number of Persons Reached: no data collected. • Description: Annual reports were compiled and distributed to provide comprehensive overviews of project progress, achievements, and future plans. These reports were aimed at stakeholders, funders, and interested parties. Other Means (LinkedIn posts, newsletters, non-scientific publications, brochures, etc.): • Number of Activities: 14 • Number of Persons Reached: no data collected. • Description: A variety of other dissemination channels were employed, including social media posts, newsletters, brochures, and non-scientific publications. These methods helped in reaching a broader audience and maintaining continuous engagement. This WP also supports WP2, WP3 and WP4 in achieving a trainings package based on the performed activities. A first brainstorm meeting was organised with representatives from the ECDC Virtual Academy (EVA) platform for close collaboration on the development of these training packages. During the remaining period of the project partners will ensure dissemination of the project results and its activities, and update their national dissemination plans (if relevant) and dissemination reports. 17 UNITED4Surveillance Grant Agreement Number 101102070 3.7 Description of the work WP7: Sustainability The main aim of Work Package 7 (WP7) Sustainability is to assist Member states to ensure that project outcomes, activities, and benefits extend not only during the project duration but also contribute to the longterm aim: strengthening integrated European health surveillance systems. To achieve the specific objectives of this WP the Joint Action Sustainability plan and National sustainability plan template were developed. The suggested sustainability actions relate and are described based on core work package activities and tasks (WP2, WP3 and WP4). UNITED4Surveillance partners completed and provided their national sustainability plans. Member states plan sustainability activities based on their participation in WP and ongoing activities (piloting solutions and etc.). Also, most of the partners already thought and foresight the possibly funds to ensure the sustainability of the UNITED4Surveillance activities in their countries, staff, and other resources. The National sustainability plans were accompanied by an indication of possible challenges for the sustainability activities: lack of funding, changes of staff, legal and/or technical challenges as well as insufficient involvement of different stakeholders. The Joint action Sustainability plan will be updated regularly taking into account the relevance of the activities and other important sustainability issues. Partners will also be asked regularly to update their national sustainability plans (if relevant). The status of progress on incorporating sustainability into national sustainability plans will be collected from partners in November 2024, May 2025 and November 2025 and the results of the survey will be used to assess changes and progress. The final result of WP7 will be the Roadmap to implementation of integration infectious diseases surveillance. A first brainstorm session was held to further shape the goals and ambitions for the roadmap: a practical set of tools, trainings, guidance and/or templates for all Member States to use and benefit from, regardless of the current level of development of their surveillance systems. 18 UNITED4Surveillance Grant Agreement Number 101102070 4. References / Selected sources of information 1. European Centre for Disease Prevention and Control. Lessons from the COVID-19 pandemic. ECDC. Available from: https://www.ecdc.europa.eu/en/publications-data/lessons-covid-19-pandemic-may-2023 2. EUR-Lex. Regulation (EU) 2016/679 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data. Available from: https://eurlex.europa.eu/eli/reg/2016/679/oj 5. List of abbreviations ECDC European Centre for Disease Prevention and Control EEAB external expert advisory board EFSA European Food Safety Authority EHDS European Health Data Space EHR electronic health record EU/EEA European Union/European Economic Area EU-HIP EU Interoperability with HERA’s IT Platform EVA ECDC Virtual Academy GA general assembly GDPR General Data Protection Regulation GP general practitioner HaDEA European Health and Digital Executive Agency IT information technology JA joint action MS member state NPHIs national public health institutes SARI severe acute respiratory infection SC steering committee SOP standard operating procedure WP work package