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The Christian Science Monitor Daily for March 23, 2026
Rethink the news: Reducing news to hard lines and side-taking leaves a lot of the story untold. Progress comes from challenging what we hear and considering different views.
Your Thymus and Your Healthspan
Our thymus gland plays a central role in the development or our immune system, specifically for supporting T cell development (how these cells got their name, maturation and differentiation in the thymus) and discriminating between self and foreign, non-self antigen proteins with production of dendritic cells. As we age, our thymus gland shrinks—the process known as involution—with progressive change from spongy to fatty tissue, with loss of functionality. But this process, with respect to timeline and extent, markedly varies from one person to the next. And to make things even more complicated, our thymus gland anatomy and precise location in the chest also is highly variable. So the famous Frank Netter diagrams from the 1960s (such as at left below) don’t capture the remarkable heterogeneity that a random set of 12 chest CT scans (below at right). What I consider as 2 landmark papers in Nature this week (here and here) used AI to quantify health of the thymus in 2 large cohorts, and then correlate the metric to a broad array of health outcomes. In this edition of Ground Truths, I’m going to cover three questions: (1) How was thymus health determined by AI?; (2) How is thymus health linked to key clinical outcomes? and (3) Are there ways we can promote a healthy (aka rejuvenate) thymus gland in our later years? Subscribe 1. How was thymus health determined by AI? This was accomplished by extensive work developing and validating an AI pipeline for 2 stages, the first for localization and segmentation of the thymus bed, and the second to quantify a digital marker, termed the thymic health score. There’s a lot to this algorithmic development, so I won’t go into all the details, but just provide a rudimentary outline of what was done. The 1st stage used supervised learning with 2 radiologists reviewing 2,461 chest CT scans. That work trained a 3D U-Net model to automatically identify the thymic bed’s 3D cropped region using center of mass coordinates, which reached 99.8% accuracy. The 2nd stage used a foundation model that was pre-trained with SwAV (which stands for Swapping Assignment between multiple Views), a self-supervised model, that generated a high-dimensional thymus representation of 4,096 features. That compares to the radiology reductionist and subjective scoring of 0 to 3 where 0 means the thymus is fully degenerated and fatty, and 3 is considered dense, intact glandular soft tissue. Notably, the self-supervised learning (SSL) performance was superior to supervised (AUC ~0.75 vs 0.55, respectively) reflecting the shallowness of the 0-3 classifier vs SSL’s holistic, self-taught AI. The thymic health score ranged from 0 to 100, with the highest number indexed to fully preserved thymic health. The algorithmic work extended to explainability with both Shapely value distribution, meaning the model was holistic not relying on any “magic” pixel, and occlusion sensitivity, demonstrating the model’s performance was not affected by ribs, sternum, lung tissue, but rather focused on the thymic bed directly. Below are a few saliency maps from the occlusion sensitivity that indicate the thymic bed focus, not affected by neighboring structures, using the jet color scale. Now the AI was ready for processing ~25,000 CT scans, each over 30 MB files, from the 2 large participant cohorts to provide a thymic health score, it did so in less than 14 hours, which is less than 2 seconds per scan! Share 2. How is thymus health linked to key clinical outcomes? The two cohorts were the National Lung Screening Trial, NLST (N=25,031) and the Framingham Heart Study, FHS (N=2,581) each with baseline demographics and long term follow up of >12 years for health outcomes. From the NSLT, you can see below that increased age and body-mass index were correlated to reduced thymic health. And, overall, men had reduced thymic health scores compared with women. There are a lot of graphs in the paper for outcomes, for both the NLST and FHS cohorts. To simplify the major outcomes, below is a composite Figure with striking reduction of all-cause mortality and for the different causes of death. The results were consistent between the 2 cohorts. For example, the cardiovascular mortality hazard ratio average was 0.57 in NLST and 0.38 in FHS (weighted to be 0.53 for the aggregate). The reduction of mortality also extended to digestive diseases and pulmonary disease (data not shown below). Lung cancer incidence was reduced by 36% for high vs low thymic health (Figure below, with a panel -incidence and b panel-mortality, adjusted for age, sex, BMI, smoking status). Notably, there was a smoker’s paradox: lower incidence and improved survival for lung cancer in smokers who had a high thymus health score. Smoking was associated with lower thymic scores whereas alcohol was not. Higher thymic health was linked to higher HDL cholesterol, lower triglycerides, lower fasting blood glucose, and lower systolic and diastolic blood pressure. Inflammation biomarkers, such as C-reactive protein and interleukin-6, were elevated in the people with lower thymic health scores. In their second paper, the same team looked at the relationship between thymic score and outcomes for 3,476 patients receiving cancer immunotherapy. The non-small cell lung cancer progression-free survival was reduced in patients with low thymic health score. A parallel relationship for survival was seen for other types of cancer including melanoma, breast, and kidney with a 44% lower risk among high thymic scores (Figure). A similar pattern was seen with different immune checkpoint inhibitors. The thymus health score outperformed programmed death ligand-1 (PD-L1)and tumor mutation burden (TMB) assay of the tumor and was an independent prognostic marker of progression-free survival. In this dataset, a direct connect with thymus score and adaptive immune function was noted with a correlation before cancer treatment for both T-cell diversity and thymus T-cell production (a metric known as T cell receptor excision circles). Thymus Removal Study There is a highly relevant citation about thymus function before moving onto ways to rejuvenate it. In 2023, a very important study of thymus removal during cardiothoracic surgery was published, with 1146 patients undergoing thymus removal vs 1146 matched controls (mean age 55 years). The adverse outcomes for thymus removal were striking, with a 2.9 higher risk of all-cause mortality and doubling of cancer incidence, 1.5 fold increase in cancer mortality, and 1.5-fold increase in autoimmune diseases. The immune function showed marked compromise after thymus removal, as reflected by CD4+ and CD8+ T cells (Figure below) Share Ground Truths 3. Are there ways we can promote a healthy (aka rejuvenate) thymus gland in our later years? In recent months we’ve learned a lot about the process of thymus involution and the pathways by which this may be modulated. Thymus involution is primarily due to loss to thymus epithelial cells (TECs) and there are 2 subtypes with different functions: the cortical, responsible for positive selection of T cells, and the medullary, for negative selection. When adipose tissue infiltrates the thymus, thymic adipocytes are pro-inflammatory, knocking out T-cell output. Likewise, systemic inflammation, or “inflammaging,” from smoking, obesity, and chronic stress promote thymic adipocytes. Now, from preclinical studies, we know about key pathways that account for these processes. Historically, back in 2014, FOXN1 was recognized as a single master transcription factor essential for TEC function, with studies in mice with forced FOXN1 upregulation leading to thymus regeneration. That laid the foundation for potential regrowth of quiescent thymus cells. It took awhile to find pathways to accomplish this goal and to even refute its role as the master regulator. The Liver-Thymus Axis Feng Zhang and his team recently showed that injection of an mRNA vaccine to the liver encoding DLL1, IL-7 and FLT3-L in combination, factors known to support thymopoiesis (Figure), successfully enhanced immune function in aged mice. However, the effect was transient. The FGF21 Story Two reports in 2025 addressed the thymus gland’s production of FGF21, a growth factor (fibroblast growth factor 21) and its control of thymus involution. This growth factor is also produced by the liver, but it doesn’t have impact on the thymus in aged rodent models. In contrast, The liver’s hepatocyte growth factor (HGF) has been shown to reverse senescent TEC structural changes. Growth hormone stimulates production of insulin growth factor-1 (IGF-1) in the liver and the thymus. Two small studies in human participants (TRIIM, for Thymus Regeneration, Immunorestoration, and Insulin Mitigation) of 6 and 50 people, respectively, treated with combined human growth hormone, metformin and DHEA, suggested the potential of slowing epigenetic aging and improving thymus mass and function. But the combination of drugs, small sample, and lack of controls make conclusions murky. Increased thymus FGF21 led to increased CD8 T cells in old mice and extended healthspan and improved physical performance. Building on the previous FOXN1 data, ablation of β-klotho, the obligatory co-receptor for FOXN1, accelerated thymic aging. The benefit to FGF21 was confirmed in a companion paper using an FGF21 knock-in mouse model showing thymus enlargement and increased TECs throughout the lifespan. (schematic Figure below). The accompanying editorial for these 2 papers speculated: “The proposed link between age-associated thymus involution and organismal aging is intriguing, and suggests we might seek to achieve systemic rejuvenation by counteracting thymic involution.” Other Factors Lessons from the Axolotl (Mexican Salamander) In an elegant set of experiments of the axolotl (Figure), known for its complete thymus regeneration after total surgical removal, mediators were identified. Surprisingly FOXN1 was dispensable. But midkine, a growth factor, appeared to be the driver, the initiator of thymus cell growth, survival, and repair. Other components that contributed were Postn+ (periostin-expressing mesenchymal niches) and Ccl19, a chemokine protein from the bloodstream. RANK and RANKL RANK (receptor activator of nuclear factor κB its ligand (RANKL) have been considered key regulators of medullary TECs. In a study of both aged mice and human thymus cell cultures, their key role was confirmed, with multiple benefits of resorting TEC function, recruitment of progenitor cells, and T cell development. Subscribe Summing Up This body of work strongly supports the health of the thymus gland as a critical regulator of human healthspan, not just a correlate or link. The new landmark studies are reinforced by the regenerative biology experimental models that have shown, via an array of mediators, that healthspan of aged mice is at least in part dependent on thymus gland function and its critical role for maintaining adaptive immunity. It sure seems that we’d be better off having an immune reservoir of naive T cells instead of a profile in older adults of exhausted, low quality, memory T cells, with a senescent phenotype. It is striking that we ignored the importance of the thymus gland for many decades. A wake-up call was the results of the thymectomy matched control study reviewed here, with the opposite of high thymic health score improved health outcomes. The convergence of AI and healthspan here is notable. The exceptional and laborious work for developing and validating (no less explaining) the AI to quantify thymus health set the foundation for probing the connect the major health outcomes in two cohorts with extensive follow-up. We’ve never had a way to meaningfully quantify the thymus gland before, so this represents important leverage of supervised, self-supervised, and transformer models. The study wouldn’t have been possible without AI. And it begs the question as to whether there are ways we can maintain our thymus at a high health score. But it’s not so simple to rejuvenate our thymus. There are multiple risks including the induction of autoimmunity, increasing the risk of cancer, and inducing a pro-inflammatory state. For example, factors that increase TEC proliferation could compromise the medulllary negative selection process and leak out auto-reactive (self-attacking) T cells. Thymic cells could be induced to proliferate, but we know, for example, that growth hormone and IGF-1 are associated with an increase risk of cancer. If thymus rejuvenation doesn’t clear out the accumulated senescent cells in older adults, then inflammation within the gland could block the production of TECs. Keeping these risks in mind, we now have identified many ways to keep our thymus healthy as we age that undoubtedly will be tested in clinical trials going forward. Ultimately, the benefit-to-risk tradeoffs will be defined. In the meantime, we have desperately needed an immunome. As I’ve stressed in multiple prior Ground Truths, we have no test in the clinic to assess a patient’s immune status! It was very encouraging for me to get an email from Hugo Aerts, the senior author of the landmark papers in the days after they were published: “I also wanted to say that your Substack on “Why We Need an Immunome” was inspiring for this work. We found it a very compelling perspective and greatly enjoyed reading it.” Just having an assessment of a person’s immune status via a chest CT scan, with millions of these performed per year, might help in guiding the right immunotherapy for cancer (e.g. more intensive, combinations for those with low thymic health scores) and help define people who are increased risk for age-related diseases of cancer, cardiovascular, and neurodegenerative. The main theme of Super Agers is that we now have many layers of data (genetics, proteins, biomarkers, organ clocks that can be integrated via multimodal AI) for us to define a person’s specific risk decades before one of these age-related diseases leads to symptoms, enabling prevention. From the new studies this week, we can add thymus health score as yet another way to understand a person’s risk, a window into their adaptive immune system and healthspan. And perhaps someday we will be able to safely rejuvenate the thymus, or maintain its health through one’s life, and use the thymus health score to monitor. NB: I wrote this post (No A.I.) A Quick Poll Loading... ********************************************************************* Thanks to Ground Truths subscribers (now > 200,000) from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. Please join! If you found this interesting PLEASE share it! Share Ground Truths Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered. Leave a comment Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support 47 summer interns in 2025! We aim to accept even more of the several thousand who will apply for summer 2026.
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Lawyers for the ousted—and now partially reinstated—leadership team of Unknown Worlds, the studio behind Subnautica 2, are crying foul over news that the game will be released into early access in May. The release announcement earlier this week was made improperly, potentially “damaging the game and sowing additional confusion among the Subnautica community,” the lawyers said in a letter sent on Tuesday to Vice Chancellor Lori Will of Delaware’s Court of Chancery. In their letter, the lawyers also floated the idea of asking Will to find Krafton in contempt of the court’s ruling. The letter was sent just one day after Will’s bombshell ruling that publisher Krafton had breached its contract with Unknown Worlds’ executive team, when it fired them last June. The new issue isn’t necessarily the May early access timeframe, but how the news was announced. The letter and Krafton’s response have not been previously reported. A quick recap of prior events: Subnautica 2 is an unreleased, underwater survival adventure and the most-wishlisted game on Steam. Last year, longtime Unknown Worlds CEO Ted Gill, along with studio co-founders Charlie Cleveland and Max McGuire, were fired by Krafton. They swiftly sued, saying the publisher had terminated them to avoid paying out up to $250 million in potential performance-based bonuses. The studio leaders had hoped to earn that with an early access release of the game, which Krafton had blocked. The publisher argued in court that Subnautica 2 wasn’t ready, which the ousted execs disputed. On Monday, Will ruled that Krafton had violated its contract, firing the execs to avoid the performance payouts, and that it had to reinstate Gill and give him full authority over any early access release for Subnautica 2. On Tuesday, IGN reported on a new memo issued that day to Unknown Worlds staff by Steve Papoutsis, the executive Krafton had put in charge of Unknown Worlds after the 2025 firings. In the note, Papoutsis said that Subnautica 2 had passed a key development milestone “last week” and that he and Krafton had determined the game “is ready for Early Access release in May.” This news appeared to catch the lawyers for Gill, Cleveland and McGuire by surprise. On Tuesday night, they sent a letter to Will expressing “serious concerns” about whether it would be possible to forge an agreement with Krafton consistent with the judge’s order. Papoutsis’ memo was a problem, they wrote. He didn’t have the authority to declare anything about Subnautica 2’s release. As of 9am ET on Monday, March 16, the effective date of Will’s order, Papoutsis wasn’t CEO of Unknown Worlds. Gill was. And, per Will’s order, only Gill could make Subnautica 2 release decisions. They continued: Krafton self-servingly announced the launch without any regard to its impact on the game, the team, or the community—let alone this Court’s Opinion. Announcing the release of a game is momentous, and it is typically accompanied by significant marketing activity, fanfare, and community coordination. And most importantly, the announcement is carefully designed to maximize excitement for the game. That entire process was supposed to be driven by Mr. Gill. However, in defiance of the Court’s Opinion, Krafton has now taken that away, further damaging the game and sowing additional confusion among the Subnautica community. The lawyers speculated that Krafton had “intentionally leaked” Papoutsis’ memo and then issued an official statement to confirm the leak. Game File is a reader-supported publication. My reporting is only possible through support from readers like you. To support my work, consider becoming a free or paid subscriber. Subscribe On Wednesday, lawyers for Krafton defended their client in their own letter to vice chancellor Will, saying nothing they did violated her order nor showed contempt: Papoutsis’s message was simply celebrating the UW employees’ efforts toward a past event: Krafton’s pre-Opinion determination that Subnautica 2 was ready for Early Access release. There was nothing improper about conveying the results of the milestone review or thanking the development team for their dedication and talent. They added that Gill could still make his own call about Subnautica 2’s release: In his role as CEO, Gill will be able to assess independently his views on the state of Subnautica 2 and the appropriate release schedule; nothing in Papoutsis’s message alters Gill’s authority or discretion. Vice chancellor Will has not responded to the letters and doesn’t necessarily have to. Both parties were previously ordered by Will to confer this week and submit a proposed judgment consistent with her ruling. The letter from Gill’s attorney’s this week doesn’t indicate whether he would or would not support a May release for Subnautica 2. But it could limit his options. And, if Gill’s lawyers are right, the lack of marketing fanfare around the leak of the May date could dull the launch of the game. Any harm to Subnautica 2’s launch is an extra sensitive issue given the context of the legal dispute: millions of dollars of payouts are on the line, tethered to the scale of the game’s initial performance. In her ruling on Monday, Will noted that there was obvious “bad blood” between Gill’s side and Krafton but that the two would need to work together: “They can—and must—act in good faith to navigate their remaining contractual relationship.” Item 2: A new kind of couch co-op game A highlight of GDC each year is the Alt.Ctrl showcase that features games played with extremely experimental controllers. Perusing this year’s offerings last Friday, I found a game controlled with giant scissors, another with big toothbrushes and one that amounted to dumpster diving. My favorite was Pivot, a co-op game about collectively maneuvering a couch. It was developed by students at the University of Utah’s masters of arts and engineering games program. Players lift and tilt the physical couch in order to control the position of a virtual one. That virtual one is moving through an obstacle course on-screen, while being pursued by a giant skull. Developer Nishant Verma told me at GDC that the couch is made of styrofoam (this became more evident as I watched!) and that the name was a riff on an episode of the sitcom Friends. Item 3: In brief… 🚫 Ubisoft is laying off more than 100 workers at its Red Storm studio, as the North Carolina location known for decades for its Tom Clancy games, ceases in-house game development, VGC reports. 👀 On Monday, Nvidia’s revealed its DLSS 5 AI-driven graphics technology that purports to improve game graphics… and it has been roasted about it by the media and the online gaming public for the remainder of the week. The tech changed the faces of characters in footage from Resident Evil Requiem, Hogwarts Legacy and EA Sports FC, drawing accusations of giving carefully art-directed games the generic look of AI “slop.” Nvidia CEO Jensen Huang had said on Monday that “DLSS 5 is the GPT moment for graphics—blending handcrafted rendering with generative AI to deliver a dramatic leap in visual realism while preserving the control artists need for creative expression.” By mid-week, Huang was telling Tom’s Hardware that the new tech’s critics were “completely wrong” because game-makers could still “fine-tune the generative AI” to suit their game’s aesthetics.
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I recently participated in a symposium of the Denver-based Institute for Science & Policy, during which I had a “fireside chat” with Tony Mills of the American Enterprise Institute. Mills has written extensively on the politicization of science, and the two of us had a very enjoyable hour-long conversation on the topic. You can watch it below. The main questions we dealt with are why there is such a vast partisan gap in trust of science, and to what extent this is a unique moment. Mills helpfully brings a good deal of data to the discussion, as he did in this useful piece at Issues in Science & Technology. Tusk depends on reader support. To support this work, please become a paid subscriber. Subscribe Note this graph, drawing on a range of survey data to demonstrate partisan attitudes toward science since 1970s. As it demonstrates, there’s been a very sharp partisan divergence in confidence in science during the Trump Era, starting prior to the Covid pandemic. At least in part, we can attribute this to a rise in populist anti-science rhetoric embraced by Trump, his appointees, and those in his media orbit. But as the graph also shows, the partisan divide has existed in the past, and it’s not always in the same direction. The largest divergence in party views toward science prior to 2016 was in the 1970s, when liberals equated scientific achievement with the military-industrial complex and thus trusted it less. That era of scientific mistrust is often overlooked. Indeed, as Mills notes, the Moon landings (1969-72), which today are considered one of the last great moments of national unity, were experienced nothing like that at the time. There was sharp debate back then over whether the Apollo missions were worth the vast expenditures when the country had so much else to deal with. It’s outside the dataset, and we don’t have the partisanship lens for it, but the 1950s was another deeply anti-science decade, with critics of intellectuals and college professors alleging their ties to communism and their lack of commitment to basic American moral beliefs. This was the subject of Richard Hofstadter’s 1962 book Anti-Intellectualism in American Life, in which he quotes religious leaders like Franklin Graham: [In place of the Bible] we substituted reason, rationalism, mind culture, science worship, the working power of government, Freudianism, naturalism, humanism, behaviorism, positivism, materialism, and idealism. [This is the work of] so-called intellectuals. Thousands of these “intellectuals” have publicly stated that morality is relative—that there is no norm or absolute standard.… This fervor was heavily whipped up by Sen. Joe McCarthy (R-Wisconsin), although it’s clear that not all his fellow Republicans were on board with his red-baiting. What ended that era? The simple answer is the 1957 launch of Sputnik. Americans became afraid that they were losing to Soviet scientists, and suddenly university researchers and government projects were awash with funding. In our conversation, I asked Mills about the possibility of us having a Sputnik moment again that would rally the American public in favor of science today. Mills argued that the COVID-19 pandemic was essentially a Sputnik moment — a terrifying threat to all Americans that required scientific advances to address. But thanks in part to political polarization and the populist and conspiratorial leanings of Donald Trump, we got the opposite of a unifying moment. Many Americans turned against science, despite science actually stepping up in that moment. As we discussed in the chat, it’s not clear what scientists could or should be doing in this moment to increase faith in their work. As Mills notes, one of the chief complaints against scientists and professors is that they’ve become too political; scholars becoming even more political might not help them achieve their goals. This (mainly Republican-driven) anti-science era will end, of course, but it’s not clear what event will bring that about. Share
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PRET for impact: Advancing pandemic preparedness in the Democratic People’s Republic of Korea
IN THE SPOTLIGHT PRET for impact: Advancing pandemic preparedness in the Democratic People’s Republic of KoreaThe Democratic People’s Republic of Korea (DPR Korea) is making significant progress in strengthening pandemic preparedness, with dedicated support from the WHO South‑East Asia Regional Office (SEARO) and the Pandemic Influenza Preparedness (PIP) Partnership Contribution (PC).Aligned with the WHO Global Influenza Strategy and the Pandemic Influenza Preparedness (PIP) Framework Partnership Contribution High‑Level Implementation Plan III (2024–2030), the country is strengthening its capacity to prepare for and respond to influenza and other respiratory threats. In early 2025, a core team from the Ministry of Public Health of the Democratic People’s Republic of Korea (DPRK) participated in a two‑day virtual workshop, which included a mini‑simulation exercise. The workshop was organized by WHO SEARO in collaboration with the Preparedness and Resilience for Emerging Threats (PRET) Secretariat at WHO headquarters and the WHO Country Office for the DPRK. Read more A REGIONAL CONSULTATION GUIDES WHO SEARO IN DEVELOPING A ROADMAP FOR IMPLEMENTING THE PREPPAREDNESS AND RESILIENCE FOR EMERGING THREATS (PRET) INITIATIVE BASED RESPIRATORY PATHOGEN PANDEMIC PREPAREDNESSInfluenza and other respiratory pathogens with pandemic potential continue to pose major public health risks globally. To strengthen regional preparedness and response, Member States of the WHO South‑East Asia Region (SEAR) convened in Colombo, Sri Lanka, to review and provide input on the draft Roadmap and Action Framework for Broad Respiratory Pathogen Pandemic Planning (2026–2031). Supported through the Pandemic Influenza Preparedness (PIP) Partnership Contribution (PC) funds, the proposed roadmap aims to advance robust, integrated preparedness and response capacities for influenza and other respiratory threats across SEAR. This work is aligned with the Preparedness and Resilience for Emerging Threats (PRET) initiative and the SEAR Strategic Roadmap on Health Security and Health System Resilience for Emergencies Read moreSRI LANKA’S USE OF ANTIVIRALS TO REDUCE THE SEASONAL INFLUENZA BURDEN Sri Lanka is strengthening its influenza response by placing greater emphasis on rapid testing, timely treatment, and integration with maternal health services. With support from WHO, the country is building a stronger evidence base on the burden of influenza and the value of vaccination, advancing a holistic approach to protect vulnerable populations and enhance pandemic preparedness. To reduce hospitalizations and deaths from seasonal influenza, Sri Lanka is taking proactive steps to expand access to rapid diagnostic testing and ensure prompt initiation of treatment. National clinical guidelines recommend the use of oseltamivir for individuals at high risk of complications, helping prevent severe illness and shorten the duration of infection. This strategy not only saves lives but also supports local pharmaceutical production, contributing to a reliable supply of antivirals for both seasonal outbreaks and future pandemics.Read moreBHUTAN BOOSTS PANDEMIC INFLUENZA READINESS WITH PANDEMIC INFLUENZA PREPAREDNESS FRAMEWORK PARTNERSHIP CONTRIBUTION SUPPORTED TRAINING AND SIMULATIONSOriginally developed in 2012, the National Influenza Pandemic Preparedness and Response Plan (NIPPRP) has long served as Bhutan’s central framework for managing influenza threats. In 2024, the plan underwent a comprehensive update to reflect evolving global and regional guidance, lessons learned from the COVID‑19 pandemic, and new capacities developed under the PIP Framework. The revised NIPPRP is now more clearly aligned with Bhutan’s broader emergency and disaster risk management structures, ensuring a coordinated, whole‑of‑government approach to pandemic response. As part of efforts to strengthen national pandemic preparedness, Bhutan conducted three national‑level training sessions followed by simulation exercises on influenza pandemic preparedness and response at five sentinel hospitals between April and May 2025, with support from the PIP Partnership Contribution (PC). These activities brought together more than 140 health professionals and key partners from across the country, with a focus on operationalizing the updated NIPPRP and enhancing readiness at key frontline facilities. Read moreSTRENGTHENING INFLUENZA SURVEILLANCE: WHO BRINGS TOGETHER INFLUENZA EXPERTS FROM SOUTH-EAST ASIA AND WESTERN PACIFIC REGIONSThe World Health Organization (WHO) convened the 18th Bi‑regional Meeting of National Influenza Centres (NICs) and Influenza Surveillance for the WHO South‑East Asia and Western Pacific Regions from 9–11 September 2025. Hosted by the WHO South‑East Asia Regional Office (SEARO), the meeting brought together representatives from Member States, Territories, and Areas across both regions, alongside experts from the WHO Collaborating Centres for Reference and Research on Influenza in Australia and Japan, the WHO Collaborating Centre for Studies on the Ecology of Influenza in Animals in the United States, quadripartite partners (WOAH and FAO), and other technical counterparts. The consultation provided a platform to review progress, share experiences, and outline priorities for strengthening influenza and respiratory pathogen surveillance across the two WHO regions.Read moreNETWORKS AND TECHNICAL PARTNERSHIPSSTRENGTHENING PANDEMIC READINES: SOUTH-EAST ASIA ADVANCES UNITY STUDIES UNDER THE PANDEMIC INFLUENZA PREPAREDNESS INITIATIVEThe WHO Global Influenza Surveillance and Response System (GISRS) Investigations & Studies initiative, also known as Unity Studies, provides a standardized, globally coordinated framework to support these efforts. Originally developed for influenza and adapted during COVID-19, Unity Studies enable countries to conduct rapid, nationally led investigations and studies to assess transmissibility, severity, susceptibility, and intervention effectiveness. To better prepare for future influenza pandemics, WHO has recently launched a network of sites which will be ready to conduct these investigations and studies rapidly in the event of a pandemic, or epidemic of an emerging or re-emerging respiratory pathogen. The WHO South-East Asia Region now hosts six sites of WHO GISRS Unity Studies across the five countries including Sri Lanka, strengthening regional capacity for early pandemic investigations. From 13–16 July 2025 in Colombo, the Global Public Health Summit offered an opportunity to advance this agenda. Read moreSTRENGTHENING PANDEMIC PREPAREDNESS THROUGH UNITY STUDIES: REAL-WORLD APPLICATIONS FROM INDIA IN WHO’S SOUTH-EAST ASIA REGION As countries continue to strengthen their pandemic preparedness through investments in resilient health systems during the interpandemic period, the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS) Investigations & Studies Global Initiative, Global Initiative, commonly known as Unity Studies, remains a vital framework for respiratory pathogen pandemic preparedness. These standardized epidemiological protocols enable countries to rapidly generate high‑quality data on transmissibility, infection severity, population immunity, and the effectiveness of public health interventions. To highlight how Unity Studies protocols are being adapted and applied in national settings, WHO Headquarters, together with WHO Regional Offices, including the WHO South‑East Asia Regional Office (SEARO), hosted a global webinar. The session showcased case studies from India and the United Kingdom (UK), demonstrating innovative approaches to respiratory virus surveillance and pandemic readiness. Read moreSTRENGTHENING REGIONAL INFLUENZA SURVEILLANCE AND PREPAREDNESS: WHO SEARO HOSTS HIGH-LEVEL WEBINAR AMID RISING H5 THREATS In response to the increasing detection of avian influenza A(H5) cases in humans globally and within the WHO South‑East Asia Region, the WHO Regional Office for South‑East Asia (SEARO) convened a regional webinar on 25 July 2025 to review preparedness mechanisms, strengthen surveillance pathways, and promote timely reporting of unusual respiratory events. The virtual session brought together more than 50 participants from Ministries of Health, National Influenza Centres (NICs), National IHR Focal Points (NFPs), WHO Headquarters, WHO Country Offices across the Region, and WHO Collaborating Centres (CCs) for influenza. The webinar provided an opportunity to share situational updates, discuss surveillance gaps, and reinforce coordination mechanisms critical for early detection and rapid response to avian influenza threats. Read moreOther Key PIP Updates (July-December 2025)MEMBER STATES:Bangladesh drafted and conducted a series of Core Group Meetings in 2025 to review and update the National Pandemic Preparedness and Response Plan for Respiratory Pathogens. In addition, the country carried out Rapid Response Team (RRT) trainings on seasonal and avian influenza and other re‑emerging infectious diseases. Bangladesh also updated its epidemiological data‑training programme for physicians at sentinel surveillance sites, using a revised epidemiological data‑collection tool.Bhutan revised and updated its National Influenza Pandemic Preparedness and Response Plan (NIPPRP) in 2025 and developed a national Standard Operating Procedure (SOP) for influenza outbreak management. DPR Korea conducted a nationwide simulation exercise in July 2025 to support the update of its National Influenza Pandemic Preparedness Plan (2019). This followed a PRET‑based virtual orientation and mini‑simulation exercise held in May 2025 by SEARO and the WHO PRET Secretariat. The comprehensive exercise, conducted across central and provincial levels, assessed strengths and gaps in pandemic influenza preparedness and response. The feedback gathered has been incorporated into the revised draft plan to address identified weaknesses and strengthen overall readiness.India conducted a targeted nationwide online re‑orientation training on review and updates to the influenza portal for all State Surveillance Officers (SSOs) and relevant officials using the Integrated Health Information Platform (IHIP). The training emphasized correct marking and reporting of influenza samples as “unsubtypable” or “not subtyped” where applicable, to ensure accurate national surveillance.Maldives conducted simulation exercises in three atolls based on its existing National Pandemic Preparedness and Response Plan (NPPRP). The country plans to conduct similar exercises in three additional atolls after updating the NPPRP in 2026. In addition, Maldives conducted training on FluID and FluMart as part of a broader data‑management training package for Ministry of Health and Health Protection Agency officials, aimed at improving routine reporting to WHO platforms and the DHIS2 system.In Myanmar, technical support was provided to the National Influenza Centre (NIC) through dedicated human‑resource support (January–December 2025) to sustain data management and laboratory detection capacity for influenza and other emerging and re‑emerging respiratory viruses. This support also included strengthening genomic sequencing capacity.Nepal conducted a consultative workshop on the National Pandemic Preparedness and Response Plan (NPPRP) in July 2025. The workshop engaged key stakeholders from multiple sectors to review lessons from past pandemic responses, assess current mechanisms, and gather critical inputs for strengthening national preparedness. Key recommendations included revising the 2019 NPPRP and developing an updated Influenza Pandemic Preparedness Plan aligned with emerging risks, national priorities, and relevant international frameworks. Nepal also held a two day workshop dedicated to advancing the National Action Plan for Genomic Surveillance, aimed at reinforcing the country’s capacities for early detection and monitoring of emerging respiratory pathogens.Sri Lanka received the final report from WHO on the feasibility assessment for conducting an Influenza Burden of Disease (BoD) study in the country. The assessment, conducted from 28 April to 9 May 2025, included a desk review of existing data sources, document review, visits to sentinel surveillance sites, and key informant interviews. The study identified critical data sources required for a future BoD assessment, as well as their availability and quality. Officials from the Epidemiology Unit, the National Influenza Centre (NIC), and SARI/ILI sentinel hospitals across the country participated in the assessment.Timor Leste conducted on‑the‑job training and monitoring activities at two sentinel surveillance sites to strengthen surveillance and laboratory capacity for the detection of SARI, ILI, ARI, and other respiratory infections. REGIONAL OFFICE:SEARO conducted a Member States Consultation on the first draft of the Regional Roadmap and Strategic Action Framework for implementing WHO’s PRET‑based broad respiratory pathogen pandemic planning for 2026–2031. The consultation took place on 29–30 October 2025 during the final two days of the Regional PIP PC Annual Review and PRET Meeting in Colombo, Sri Lanka. Participants included representatives from Member States, WHO Country Offices, WHO SEARO, WHO Headquarters, partner agencies, and invited multidisciplinary technical experts. They reviewed the draft and provided detailed feedback, which has since been incorporated into a revised version. The consultation helped shape a shared regional vision for robust, PRET‑aligned pandemic preparedness, building on country‑level progress, addressing existing gaps and challenges, and aligning with global and regional health security frameworks. The publication is planned for release during the SEAR regional committee in 2026.SEARO documented the evolution of the National Influenza Pandemic Preparedness Planning process in the Region, tracing its development from its origins as a planning tool for responding to avian influenza outbreaks in 2006, through the experiences of the 2009 and 2019 pandemics, to the current status. The document outlines the way forward for respiratory pathogen pandemic planning across all 10 SEAR countries, aligning future national plans with WHO’s PRET Framework for broad respiratory pathogen pandemic preparedness.The Infectious Hazard Management (IHM) Unit has drafted the WHO South‑East Asia Regional Guidance on Influenza Prevention and Control, aligned with the Global Influenza Strategy and other regional initiatives. The draft is currently under review. Although this technical product was developed in response to a request from the Ministry of Public Health of the Democratic People’s Republic of Korea (MoPH‑DPRK), SEARO is finalizing it for use not only in DPRK but also across all Member States in the Region.The Immunization and Vaccine Development (IVD) Unit, in collaboration with WHE/SEARO, completed a regional landscape analysis on key barriers, challenges, and opportunities for the introduction of seasonal influenza vaccination in WHO South‑East Asia Regional (SEAR) countries.Additionally, the Immunization and Vaccine Development (IVD) Unit has completed a regional landscape analysis of influenza vaccine procurement systems across the WHO South‑East Asia Region (SEAR).KEY MEETINGS AND PUBLICATIONSMEETINGS:Six-month progress review of the implementation of the PIP-PC workplans in SEAR, focusing on Outputs 1 and 2 for the period January to June 2025, and held virtually across three sessions on 4, 8, and 10 July 2025. Read moreAnnual Regional Meeting (Hybrid) on Pandemic Influenza Preparedness (PIP) Partnership Contribution (PC) and WHO’s Preparedness and Resilience for Emerging Threats (PRET) Implementation in SEAR in Colombo, Sri Lanka, 27 to 30 October 2025. Read more18th Bi-regional Meeting (Virtual) of National Influenza Centres (NICs) and influenza surveillance in WHO South-East Asia and Western Pacific Regions from 9 to 11 September 2025. Read morePUBLICATIONSImplications of influenza A virus surveillance in Southeast Asian Region countries: a scoping review of approaches for the surveillance of swine influenza viruses at human-swine interfaces. Read moreAnnual South-East Asia regional meeting on operational planning for implementation of global influenza strategy and preparedness for respiratory viruses in 2025 Report on annual review meeting of implementation of pandemic influenza preparedness (PIP) partnership Contribution (PC) Fund in South-East Asia Region and the simulation exercise on PRET Status of influenza in who south-East Asia Region
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