The syndromic surveillance system is designed to provide early warning of outbreaks and other important public health events, so that immediate action can be taken. Its main objective is to rapidly detect and respond to signals that might indicate outbreaks of serious epidemic-prone diseases. In 2019, sentinel sites identified following TC Pam have been reviewed and 17 new sentinel sites have been identified and added onto the 11 existing sites based on population coverage. There will be 28 sentinel sites covering 6 provinces and 13 islands (covering over 80% of the total population).

Thirteen Syndromes and specific Diseases are reported on a weekly basis by surveillance focal points in all sentinel sites. Additional syndromes and diseases were included in 2021 according to the evolving context of epidemics and pandemic, these syndromes are; Dengue-zika-Chika like illness, Severe Acute Respiratory Infections, Ciguatera Fish poisoning, Acute Jaundice, Acute Fever and Neurological symptoms, Acute Flaccid Paralysis, Neo-natal Tetanus, Pertussis and Diphtheria. In addition, any unexpected events, deaths, cluster of illness, bird or animal die off should be reported by sentinel sites.

Event-based surveillance is the organized and rapid capture of information about events that are potential risk to public health. This information can be rumors and other ad-hoc reports transmitted through formal channels (i.e., established routine reporting systems) and informal channels (i.e., media, health workers and non-governmental organizations reports), including:

• Events related to occurrence of disease in humans, such as clustered cases of a disease or syndromes, usual disease patterns or unexpected deaths as recognized by health workers and other key informants in the country; and
• Events related to potential exposure for humans, such as events related to diseases and deaths in animals, contaminated food products or water and environmental hazards including chemical and radio-nuclear events. When it comes to the timely detection of outbreaks and important public health events, indicator- based surveillance systems often fail. Furthermore, the systems are not suited to the detection of rare but high-impact outbreaks (Severe Acute respiratory Syndrome, Avian influenza) or emerging and unknown diseases. Event-based surveillance systems rely on the immediate reporting of events and are designed to detect:
• Rare and new events that are not specifically included in indicator-based surveillance.
• Events that occur in populations, which do not access healthcare through formal channels.

The purpose of immunization safety surveillance is to ensure that adverse events occurring at community level are being detected early and are responded to in an appropriate and timely manner, to reduce the negative impact on the health of individuals and on the immunization programme. It is important for any information obtain through immunization safety surveillance to be immediately assessed and analyzed to identify and respond to problems.

This system was established in 2021 following the introduction of the COVID-19 vaccine and the priority for this system is to expand to include the routine vaccinations that are immunized in the country. As this is a new system, therefore is it is vital the system is expanded and sustain to ensure the effective immunization program in country. The following key activities are to assist with the long them expansion of the AEFI surveillance system.

Vaccine Preventable Disease Surveillance System is a crucial public health initiative aimed at monitoring and controlling vaccine-preventable diseases (VPDs) in Vanuatu. Its primary objectives are to detect, investigate, and respond to VPD outbreaks, ensure timely reporting of cases, and maintain an accurate database of VPD occurrences. This system plays a vital role in enhancing the country's overall healthcare by enabling early detection of potential outbreaks and facilitating a swift response to contain and prevent the spread of infectious diseases. By continually monitoring vaccine-preventable diseases and their patterns, the system aids health authorities in making informed decisions about vaccination strategies, allocation of resources, and implementation of targeted interventions, ultimately improving population health and reducing the burden of vaccine-preventable illnesses in Vanuatu.

The Vanuatu Public Health Laboratory (VPHL) based surveillance is a crucial component of the country's healthcare system, aimed at monitoring and detecting infectious diseases and other health-related threats in the population. Through a network of well-equipped laboratories, the VPHL collects, analyses, and disseminates data on various communicable diseases, including outbreaks, to enable timely and effective response measures. This surveillance system plays a pivotal role in disease prevention, early detection, and containment, thereby safeguarding public health, minimizing the spread of infections, and enhancing the overall health outcomes for the people of Vanuatu. By closely monitoring disease patterns, the VPHL provides valuable insights that inform policy-making, resource allocation, and targeted interventions, leading to improved health security and resilience for the nation.

Enhanced surveillance system is an innovative and comprehensive initiative aimed at ensuring the safety and security of large gatherings and events in the country. Its primary objectives revolve around early detection, monitoring, and prevention of potential threats, including public health emergencies, civil disturbances, and criminal activities. This system leverages cutting-edge technologies such as, real-time data analysis, and integrated communication networks to provide authorities with timely and accurate information. Its importance lies in safeguarding the well-being of citizens and visitors during major events, enabling effective response measures, and enhancing overall public safety. The aim of the enhanced surveillance system is to create a secure and harmonious environment that fosters the enjoyment of gatherings and strengthens the nation's resilience against unforeseen challenges.

The Vanuatu Health Security initiative is a paramount undertaking that centers on the effective implementation of International Health Regulation (IHR) and the Asia Pacific Strategy for Emerging Diseases (APSED). By focusing on these two critical aspects, Vanuatu aims to bolster its capacity to detect, prevent, and respond to health threats and infectious diseases. The initiative's significance lies in its commitment to enhancing public health preparedness and strengthening the country's health systems to mitigate the potential impact of emerging diseases and other health security challenges. Through fostering international cooperation, advancing surveillance and reporting mechanisms, and fortifying health infrastructure, Vanuatu aspires to create a safer, healthier environment for its citizens and contribute to regional and global health security endeavours.

One Health approach system is a comprehensive and collaborative framework that integrates human, animal, and environmental health to address complex health challenges in Vanuatu. Its primary objectives are to enhance disease surveillance, prevent zoonotic disease outbreaks, and promote sustainable and holistic health practices across communities. By recognizing the interconnectedness between human, animal, and ecosystem health, the One Health approach aims to improve health outcomes, strengthen health systems, and foster a more resilient society. Its importance lies in the proactive and interdisciplinary nature of the system, fostering collaboration among health professionals, veterinarians, environmentalists, and policymakers, thereby mitigating health risks, safeguarding biodiversity, and promoting the overall well-being of Vanuatu's population and ecosystems.

The Vanuatu Health Research Innovation is a groundbreaking initiative that exemplifies the unit’s commitment to advancing healthcare and well-being. Its importance lies in its transformative approach to health research, fostering innovation, and facilitating evidence-based policymaking. The primary aim of research program is to address critical health challenges in Vanuatu by conducting cutting-edge research that explores various aspects of public health, medical advancements, and social determinants of well-being. Through collaboration with local and international experts, the unit aims to generate knowledge, develop sustainable solutions, and improve healthcare access and delivery, ultimately enhancing the overall health outcomes and quality of life for the people of Vanuatu.

The Vanuatu Field Epidemiology Training Program (VFETP) is a new and critical initiative aimed at strengthening the country's public health response to infectious diseases and other health threats. By providing frontline health professionals with rigorous training in epidemiology and disease surveillance, the program equips them with the necessary skills to effectively detect, investigate, and respond to disease outbreaks and health emergencies.

VFETP plays a vital role in building a skilled workforce capable of conducting timely and accurate epidemiological assessments, which are essential for evidence-based decision-making, outbreak control, and health system improvement. As an integral part of Vanuatu's health infrastructure, the program will contribute significantly to safeguarding the well-being of its population and enhancing overall health security in the region.

The Vanuatu Outbreak Alert System (VOAS) is a comprehensive public health initiative designed to effectively detect, respond, and prevent disease outbreaks throughout the nation. At its core, VOAS prioritizes community engagement and mobilization to foster a collective and proactive approach to health emergencies. By empowering local communities with knowledge and resources, the system aims to build a robust network of vigilant individuals who can identify potential outbreaks early on and rapidly alert health authorities. The primary objectives of VOAS are to enhance disease surveillance, promote timely reporting of suspected cases, and facilitate efficient coordination between community members and health officials.

This system's importance lies in its ability to curb the spread of infectious diseases, thereby saving lives and safeguarding the overall well-being of Vanuatu's population. By fostering a culture of active participation and cooperation, VOAS seeks to ensure a swift and targeted response to any potential health threats, ultimately strengthening the resilience of the nation's health infrastructure.