Sustaining and expanding genomic surveillance capacity requires broader investment in genomics that target both novel and pandemic pathogens. Currently, there is no standardized methodology to evaluate the cost and benefit of a multi-pathogen surveillance system. We propose a framework for pathogen genomic surveillance that links public health and systems considerations to a stepwise approach.

Introduction: While pathogen genomics using next-generation sequencing (NGS) has been recommended by the WHO as an essential tool for national communicable disease surveillance programmes, procurement and supply chain management (PSM) systems for this new technology are still evolving. To assess the status of PSM systems for pathogen genomics, we examined perspectives from end-users and manufacturers across South and Southeast Asia. Methods: Between 2022 and 2023, a cross-sectional survey was conducted among institutional partners supporting pathogen genomics among primarily low- and middle-income countries in South and Southeast Asia. This was complemented by qualitative interviews with the major regional NGS manufacturers. A PSM framework was employed to assess sales, procurement, production, distribution and post-sales support. Analyses are expressed as proportions and means or medians for continuous variables. Results: A total of 42 partners across 13 countries, 3 genomics manufacturers and 22 laboratory personnel contributed data to this assessment. PSM challenges were reported by all countries and for all sequencing platforms. High costs of equipment and consumables were identified by 85% of respondents. Long equipment purchasing lead times and reagent re-supply times were reported by 69% and 77% of countries, respectively, with reagent resupply times averaging 8 weeks (IQR 6.2–9.0). Additional barriers included customs clearance, variability of import procedures, taxes and duties. Manufacturers reported a range of strategies to respond to PSM bottlenecks, including establishing regional hubs, distributor networks and financing schemes. Conclusion: Coordinated national and regional efforts are required to improve PSM systems for pathogen genomic sequencing to enhance timely early disease detection and response capacity in South and Southeast Asia.

Artificial intelligence (AI)-enabled infectious disease surveillance platforms are expanding rapidly, but their roles within health systems remain poorly characterized. This review examined 20 platforms according to primary data inputs, surveillance function, AI methods, data privacy, geographic scope and pathogen focus. Three archetypes emerged: Early Warning Networks, Situational Awareness Platforms and Integrated Surveillance Platforms. Their comparative analysis highlighted how data type, integration and localization shape platform contributions to public-health decision making.

The COVID-19 pandemic coupled with recent upheavals in global trade and development assistance funding has disrupted routine immunization programmes and diverted health systems from the targets set in the Immunization Agenda 2030. Regulatory systems are often underappreciated or misunderstood but in fact play a critical role in enabling innovation and facilitating timely access to vaccines for sustained immunization, thereby building vaccine confidence and health system resilience. Regulation is the constant denominator throughout the vaccine life cycle, shaping the pathway from early research and development to approval and market entry and ultimately to equitable distribution and sustained safe use. This paper examines the role of regulation and proposes that regulation be reframed as a function of health system resilience and a structural determinant of immunization sustainability. We synthesize evidence across the vaccine regulatory life cycle, examining innovation facilitation, regional cooperation, public health strengthening and describe the roles of regulation in building health system resilience, namely driving sustainable vaccine access, enabling innovation, supporting regional collaboration and strengthening social acceptance. Without this shift in perspective, regulatory systems strengthening risks being underfunded, reactive, and fragmented; this will perpetuate inequities in vaccine access and undermine the sustainability of immunization programmes.