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Table 8 Recurring “Specific Problems”, lessons learned, ongoing actions and related strategic lines, WNV AARs in Slovenia, Italy, Greece and Serbia, April–May 2019*

From: West Nile virus in Europe: after action reviews of preparedness and response to the 2018 transmission season in Italy, Slovenia, Serbia and Greece

Recurring “Specific Problems” Lesson Learned Ongoing actions Derived Strategic Line
1. Lack of strong evidence on the impact of the use of biocides in preventing transmission of WNV infection to humans was mentioned as a critical factor in Italy, where most human cases are documented in semi-urban and rural contexts, in Greece, where human cases are documented in both urban and rural contexts, and in Slovenia (where the possibility of licensing insecticides for out-door use is being discussed). Persisting “unknowns” related to WNV such as the role of certain bird species in WNV transmission and ecology, the impact of vector control on human transmission and on the development of resistance to insecticides were consistently described in interviews as elements of fragility undermining the implementation of solid preparedness and response plans against this disease.   The development of a research agenda for the “known unknowns”, not only at national but also at international level, could also be advocated for in the longer term.
Where feasible, with a long term prospect, research activities at national level could include the assessment/monitoring of vector control effectiveness/efficacy and surveillance of resistance to insecticides (suggested by Italy and Greece) and the in depth mapping and continuous monitoring of breeding sites (suggested by Serbia).
2. Sustainability of vector monitoring and surveillance Legal framework, mandate and funding allocations were described as crucial in ensuring the establishment and the sustainability of existing vector monitoring/surveillance programmes in particular in Slovenia and in Serbia. A project has been approved in Slovenia to pilot mosquito surveillance of WNV
In Greece, active vector surveillance at the national level is being organised for 2019 (as occurred in some previous years)
Where feasible, advocate for the relevance of vector monitoring (e.g. to generate nationally standardised maps of distribution of potential WNV vectors) and surveillance activities in improving WNV preparedness and response. Promotion of harmonized legislation with reference to entomological surveillance mandate and budget could be a strategy to clarify roles and responsibilities.
3. Lack of flexibility of procurement processes Serbia and Greece highlighted the complexity and lack of flexibility of procurement processes as a major issue for example in aspects related to vector control. Serbia has established a high-level committee to improve the implementation of vector control activities. In the framework of national legislation, foster the adoption of procurement services and procedures that can facilitate the prompt implementation of activities for WNV surveillance and response, including procurement of biocides and appropriate and timely implementation of vector control activities.
4. Media pressure Due to the exceptional transmission season, 2018 led to an increase in media pressure in all the countries that underwent the AARs. This pressure was described as very high at the national level in Greece, Serbia and Slovenia while in Italy this pressure was more evident at the sub-national level.   Strengthen skills and capacity of public health staff in communication and media management by encouraging training targeting One Health professionals and, where relevant, produce WNV communication standard operating procedures across sectors.
  1. * The points in this table were mentioned by at least two of the four countries that conducted the AAR on the WNV 2018 transmission season. The lessons learned column provides details on the specific context and on the countries each point refers to.