The Royal Centre for Disease Control (RCDC) in Bhutan has been conducting influenza surveillance for more than a decade. Since the 2009 H1N1 influenza pandemic, significant developments have been made to enhance and sustain influenza virological surveillance. These improvements have led to WHO recognising Bhutan’s National Reference Laboratory as a National Influenza Centre in the WHO Global Influenza Surveillance and Response System (GISRS).
The Virology and Molecular Laboratory at the Royal Centre for Disease Control (RCDC) under the Ministry of Health of Bhutan has served as the national reference laboratory for influenza surveillance since the 2009 H1N1 influenza pandemic. Bhutan leveraged the response to the 2009 pandemic by developing laboratory capacity for the detection of influenza viruses. Subsequently, the country established a sentinel influenza surveillance system which was later digitalized. Bhutan benefitted from the setting up of this national surveillance system as shown during the COVID-19 pandemic. The country quickly scaled-up the existing influenza surveillance system and made other hospitals as universal surveillance sites for detecting SARS-CoV-2.
The continuous strengthening of the influenza laboratory was complemented by periodic assessments by WHO and other partner agencies, such as the US Centers for Disease Control and Prevention (CDC). In 2018, RCDC expressed its interest to become a National Influenza Centre (NIC) in the WHO Global Influenza Surveillance and Response System (GISRS).
An extensive laboratory assessment using the WHO laboratory assessment tool (LAT) for NICs is a prerequisite for NIC recognition by WHO. In 2018, the WHO South-East Asia Regional Office (SEARO) and the WHO Collaborating Centre (CC) at the US CDC jointly organized a preliminary preparatory onsite laboratory assessment with the laboratory lead and other staff personnel. During the preliminary assessment, equipment maintenance, locally adapted standard operating procedures, transportation of specimens, and quality management were some of the areas identified for further strengthening.
The RCDC has been addressing these issues, with support from WHO and the WHO CC at the US CDC. The RCDC demonstrated significant advancements during the COVID-19 pandemic response, especially in enhancing the overall testing capacity at their virology and molecular laboratory. A follow-up remote assessment was conducted in 2021.
The final assessment revealed the success of efforts made by RCDC to improve and maintain laboratory standards that are essential to achieve NIC recognition by WHO. Despite certain chronic challenges, such as equipment maintenance and human resource turnover, RCDC has implemented measures to ensure high quality and safe testing of influenza viruses. Further, RCDC shares influenza viruses with WHO CCs, participates in the global external quality assurance programme conducted by WHO annually, and reports laboratory data to FluMART.
Following the recommendation by SEARO to consider recognizing RCDC as a NIC, in April 2023 the WHO Global Influenza Programme officially announced the recognition of RCDC, Bhutan as the latest NIC in GISRS.
