Eritrea: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

Eritrea has a national antimicrobial resistance plan that covers surveillance, detection, and reporting of priority antimicrobial resistance pathogens. The “Eritrean National Action Plan on Antimicrobial Resistance 2021–2025” assigns surveillance as a core function under Strategic Objective 2 and establishes a harmonized database and information-sharing system with a designated national focal point and repository spanning human, animal, plant, and environmental sectors, which together constitute the reporting architecture ^{1, p. 28, 37–38}. For detection, the plan routes specimens through Integrated Disease Surveillance and Response to the National Health Laboratory for culture and sensitivity testing, and the situational analysis confirms National Health Laboratory capacity to perform culture and sensitivity testing that feeds national surveillance and reporting workflows ^{2, p. 18, 79}. For 2025 verification within the specified timeframe, the World Health Organization Regional Office for Africa progress report notes regional GLASS expectations and lists Eritrea among Member States in status footnotes on the cited pages, confirming current participation and laboratory capacity tracking aligned to reporting practice expectations ^{3, pp. 1–2}.

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

Eritrea has a national laboratory system that tests for priority antimicrobial resistance pathogens, but publicly available evidence does not demonstrate testing of all 7+1 Global Antimicrobial Resistance and Use Surveillance System priority bacteria. A study published on 21 February 2025 in the journal Annals of Clinical Microbiology and Antimicrobials by staff of the National Health Laboratory of Eritrea reports that the National Health Laboratory in Asmara serves as the reference medical laboratory for all health institutions in Eritrea, is the only institution in Eritrea with a microbiology unit that can culture bacteria and perform antimicrobial susceptibility testing, abbreviated AST, and reviewed blood culture records for 3153 patients from January 2014 through December 2022, identifying Klebsiella species, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella species, Citrobacter species, and coagulase negative staphylococci, and documenting methicillin resistant Staphylococcus aureus and extended spectrum beta lactamase resistance profiles ^{4, pp. 1–3}. The World Health Organization Regional Office for Africa reports on 27 August 2025 that Eritrea is enrolled in the Global Antimicrobial Resistance and Use Surveillance System and lists Eritrea among Member States with one or more reference laboratories that have capacity to perform susceptibility testing for critically important bacteria ^{5, p. 2}. The World Health Organization Regional Office for Africa further reports on 1 March 2022 that the National Health Laboratory of Eritrea is the unique national microbiology site for culture and antimicrobial susceptibility testing for the whole country and receives about 1300 to 1500 clinical samples per year, mostly urine and blood culture ⁶.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that Eritrea conducts government-run environmental detection or surveillance for antimicrobial residues or antimicrobial-resistant organisms. The World Health Organization’s Tracking Antimicrobial Resistance Country Self-Assessment Survey Eritrea country profile dated October 31, 2022 records the country’s response for “6.3 Country has a system for regular monitoring of antimicrobial compounds and their metabolites (or residues) and resistant bacteria or antimicrobial resistance genes in water quality” as “No,” indicating that an operational environmental monitoring system is not in place ^{7, p. 4}. The World Health Organization Regional Office for Africa’s information document to the Seventy-fifth Regional Committee session on July 25, 2025 summarizes national progress using 2024 data and lists Eritrea among Member States enrolled in the Global Antimicrobial Resistance and Use Surveillance System and among those with reference laboratories able to perform susceptibility testing; however, it does not document Eritrea implementing environmental antimicrobial surveillance activities ^{8, p. 2}.

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

Eritrea has national legislation and regulation requiring prescriptions for antibiotics used in humans, but enforcement shows documented gaps. In December 2016, the Ministry of Health stated that the National Medicines and Food Administration is responsible for control of manufacture, importation, exportation, distribution, use and advertisements of drugs, medical devices and cosmetics under proclamation No. 36/1993 and reported drafting a medicines schedule manual ^{9, p. 15}. The “Eritrean National Action Plan on Antimicrobial Resistance 2021–2025,” finalized in December 2020 by the Ministry of Health, the Ministry of Agriculture, the Ministry of Land, Water and Environment, and the Ministry of Marine Resources, states that the medicines scheduling system has not been operational; that the National Medicines and Food Administration and the Pharmacy Services Division finalized a medicines schedule manual classifying all antimicrobials as Prescription Only Medicines; and that nurses and other nonphysician health workers are mandated to prescribe and dispense medicines in lower facilities ^{10, pp. 13–14}. On 27 August 2025, the World Health Organization Regional Office for Africa told the Seventy-fifth session of the Regional Committee for Africa that Eritrea is among Member States with laws or regulations on the prescription and sale of antimicrobials for human use, confirming a legal prescription requirement ^{11, p. 2}.

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 0

There is no publicly available evidence that Eritrea requires veterinary prescriptions for antibiotic use in animals. On August 31, 2025, the Ministry of Agriculture reported a consensus-building workshop to validate a revised National List of Veterinary Medicines and Biologics, but the announcement does not cite any enacted legislation or regulation mandating prescriptions for antibiotics in animals ¹². The International Fund for Agricultural Development mid-term review for the Government of the State of Eritrea’s Integrated Agriculture Development Project (dated May 7, 2025) lists veterinary-service activities such as rehabilitation of veterinary clinics, epidemic surveillance, and training, which evidence operational strengthening, not the existence of a prescription requirement ^{13, p. 61}. The Ministry of Marine Resources’ “National Aquaculture Development Strategy and Implementation Plan 2023–2027” (November 2022) states that the strategy “does not inform or influence any policies or regulations for the sector,” confirming it is non-regulatory and cannot establish prescription rules ^{14, p. 4}.

1.2.1a Laws/plans on zoonotic disease

Score: 0

There is no publicly available evidence that Eritrea maintains a single multisector national plan that prioritizes multiple zoonotic diseases and defines detection and reporting procedures across human and animal health authorities. The Ministry of Information stated in February 2022 that the Ministry of Agriculture and the Ministry of Health were jointly working under a One Health approach to eradicate brucellosis and other zoonotic diseases, had carried out compulsory vaccination campaigns against rabies, anthrax, brucellosis and other major animal diseases nationwide, and mapped a strategic plan to eradicate rabies by 2030 through phased vaccination in all regions ¹⁵. The United Nations in Eritrea reported on 28 April 2022 that the Government of the State of Eritrea launched the National Action Plan for Health Security 2022 to 2026 as a multisector framework joining the Ministry of Health, the Ministry of Agriculture and the Ministry of Land, Water and Environment to guide preparedness, surveillance and response ¹⁶. The Ministry of Information reported on 31 May 2025 that the Ministry of Agriculture continued mandatory livestock vaccination and veterinary public health services across the country, but that update did not publish any multisector zoonotic surveillance and reporting plan ¹⁷.

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

Eritrea has a national strategy document that identifies priority zoonoses and includes measures to identify and reduce spillover risks from animals to humans. The Ministry of Health’s “Eritrea National Neglected Tropical Diseases Master Plan 2022–2026” lists zoonotic diseases of public health concern, including anthrax, brucellosis, rabies, and echinococcosis; sets out integrated, cross-sectoral implementation; and embeds surveillance and reporting through national platforms, with specific tools for risk identification and mitigation such as a risk assessment framework and a steps-to-mitigate-risk matrix, alongside integrated vector management and community prevention activities during 2022–2026 ¹⁸. Government communications dated May 2025 from the Ministry of Information report a mandatory national livestock vaccination program, with approximately 2.5 million animals vaccinated annually against priority transboundary and zoonotic infections, demonstrating state-run measures that directly reduce spillover pathways and operationalize risk reduction described in the plan ¹⁹.

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Eritrea has a national strategy document that accounts for surveillance and control of multiple zoonotic pathogens of public health concern. The Ministry of Health (Government of the State of Eritrea) issued the “Eritrea National Neglected Tropical Diseases Master Plan 2022–2026,” which identifies priority zoonoses including anthrax, brucellosis, rabies, and echinococcosis, sets integrated implementation with the Ministry of Agriculture, and embeds surveillance and reporting through national platforms, including Integrated Disease Surveillance and Response and the District Health Information Software 2, for the 2022–2026 period ²⁰. The Ministry of Information reported on May 31, 2025 that the Government operates a compulsory national livestock vaccination program with multi-million-head coverage against major animal and zoonotic diseases, evidencing contemporaneous state-run control measures aligned to the plan’s intent during the assessment timeframe ²¹.

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 0

There is no publicly available evidence that Eritrea has a department, agency, or similar unit functioning as a multisectoral coordinating mechanism dedicated to zoonotic disease that operates across ministries. The World Health Organization Strategic Partnership for Health Security country page shows Eritrea’s State Party Self-Assessment submission for 2024 posted on April 2, 2025, but it does not identify any named cross ministerial One Health coordination unit, nor link to a constitutive decree, terms of reference, or other legal basis establishing such a mechanism as of that date ²². Government communications from the Ministry of Information dated May 31, 2025 describe large scale animal health operations, including compulsory national livestock vaccination, which evidences implementation capacity rather than the existence of a standing coordination unit with an interministerial mandate for zoonoses ²³. The Ministry of Health’s “Eritrea National Neglected Tropical Diseases Master Plan 2022–2026,” issued in 2022, outlines collaboration with the Ministry of Agriculture and integration with national surveillance systems, yet it does not create or name a dedicated interministerial coordination body for zoonotic disease with a formal mandate or authority ²⁴.

1.2.1e Presence of One Health strategic plan

Score: 0

There is no evidence of Eritrea having a One Health Strategic Plan in place, ²⁵ but the country has made progress on implementing One Health principles into other strategic documents. For example, in 2021, the Minstry of Agriculture published its National Strategic Plan for the elimination of dog-mediated rabies in Eritrea, which is a One Health priority. ²⁶ The plan identifies the gaps in rabies control, including the lack of a One Health approach and the need to improve communication between Agriculture and Human Health to facilitate the One Health approach of combating disease.

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is no publicly available evidence that Eritrea has a national mechanism, voluntary or mandatory, for livestock owners to conduct and report animal-disease surveillance to a central government agency. The World Health Organization Strategic Partnership for Health Security country page shows Eritrea’s State Party Self-Assessment for 2024 posted on April 2, 2025, but it does not identify any Eritrea-specific owner reporting mechanism, name a competent authority intake channel, or link to a constitutive decree, circular, or guideline establishing owner reporting to a central body as of that date ²⁷. Government communications dated May 31, 2025 from the Ministry of Information describe compulsory national livestock vaccination and other animal-health service delivery, which are implementation programs and do not create or evidence a mechanism through which owners must or may report suspected disease cases to the Ministry of Agriculture or another central authority ²⁸. The Ministry of Health’s “Eritrea National Neglected Tropical Diseases Master Plan 2022–2026” references surveillance integration and multisectoral collaboration but does not prescribe procedures or obligations for livestock owners to conduct and report surveillance to a central government agency ²⁹.

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no publicly available evidence that Eritrea has legislation or regulations safeguarding the confidentiality of information generated through animal-health surveillance for livestock owners. The World Health Organization State Party Self-Assessment page for Eritrea, posted April 2, 2025, summarizes core capacities but provides no citation or link to any Eritrean legal instrument establishing confidentiality protections for owner-reported animal surveillance data as of that date ³⁰. Government communications published May 31, 2025 by the Ministry of Information describe compulsory national livestock vaccination and animal-health service delivery, yet they do not reference statutory or regulatory provisions on protecting owner-identifiable surveillance information submitted to central authorities ³¹.

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no publicly available evidence that Eritrea conducts surveillance of zoonotic disease in wildlife, poultry, and livestock. The World Health Organization’s Strategic Partnership for Health Security country page for Eritrea, updated in 2025, summarizes capacities but provides no citation to an Eritrean instrument or report demonstrating a national multi-host zoonotic surveillance system with routine reporting from wildlife, poultry, and livestock to a central authority ³². A February 2025 government communiqué reviewing the Ministry of Agriculture’s annual activities highlights vaccination campaigns and sectoral achievements but does not describe nationwide case detection, sampling, or reporting frameworks spanning wildlife, poultry, and livestock ³³. A September 2025 report on a national conference organized by the Ministry of Agriculture with the Ministry of Land, Water and Environment, the Ministry of Marine Resources, and the Forest and Wildlife Authority describes interagency engagement on fauna and flora yet does not announce an operational wildlife or multi-host zoonotic disease surveillance mechanism tied to centralized reporting ³⁴.

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

Eritrea has a publicly documented mechanism to report notifiable animal diseases to the World Organisation for Animal Health. The World Organisation for Animal Health administrative working document “92GS Adm-02: Director General’s Report on 2024 WOAH Activities,” dated April 2025, describes the World Animal Health Information System reporting modules for six-monthly and annual reports, notes release to reporting users, and details training and a support desk for Delegates and National Focal Points, which is the official notification pathway used by Members ^{35, pp. 9–10}. The World Organisation for Animal Health Regional Representation for Africa maintains the roster of Delegates and lists Eritrea’s national Delegate, confirming the government authority empowered to notify the organization ³⁶. In September 2025, the World Organisation for Animal Health Regional Representation for Africa reported a regional training for National Focal Points on animal disease notification in the World Animal Health Information System and explicitly listed Eritrea among participating countries, evidencing current operational engagement with the notification mechanism during the timeframe ³⁷.

1.2.4a Number of veterinarians per 100,000 people

Score: 5.12

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 0

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no publicly available evidence that Eritrea includes mechanisms for working with the private sector in controlling or responding to zoonoses within national plans or legal instruments. The Ministry of Marine Resources’ “National Aquaculture Development Strategy and Implementation Plan 2023–2027” of November 2022 emphasizes partnerships with lead farmers, cooperatives, and entrepreneurs for market linkages, feed production, and handling standards, and states it does not inform or influence sector policies or regulations; it does not assign private actors any roles for zoonotic surveillance, notification, control, or outbreak response ^{38, pp. 14–15, 45–47}. The Ministry of Agriculture’s March 2024 newsletter on the National Dairy Value-chain Conference documents engagement with processors and partners on milk quality and value-chain development, without defining private-sector responsibilities for zoonoses control or response ^{39, pp. 1, 10, 13}. The International Fund for Agricultural Development’s mid-term review of May 2025 notes support for animal-health legislation and food-safety certification but does not evidence an enacted mechanism assigning private-sector duties in zoonotic disease control or emergency response ^{40, pp. 7, 86–88}. The World Health Organization’s 2024–2025 Eritrea results page lists preparedness activities but does not document any private-sector zoonoses mechanism ⁴¹.

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Eritrea has a national record, updated within the past five years, of facilities storing or processing especially dangerous pathogens and toxins that also lists facility inventories and inventory management systems. The World Health Organization Strategic Partnership for Health Security State Party Self-Assessment Annual Reporting country page for Eritrea, updated on April 2, 2025, presents International Health Regulations laboratory biosafety and biosecurity capacity scores, it does not provide or link to any Eritrean registry of facilities or inventories for high-consequence agents ⁴². The World Health Organization “Results Report 2024–2025” Eritrea country profile, published in 2025, summarizes preparedness and laboratory support activities without documenting a national record of facilities or inventories for especially dangerous pathogens ⁴³. A peer-reviewed analysis in August 2022 in the journal Mycoses reports the existence of a biosafety level 3 laboratory in Eritrea while noting that it has no protocols for handling pathogenic fungi and explicitly states there is no dataset particular to fungal disease in the health registry, which is inconsistent with a maintained national facilities and inventories record ^{44, pp. 811–812}.

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that Eritrea has legislation or regulations that set facility level biosecurity requirements such as physical containment, operating practices, failure reporting systems, or cybersecurity for facilities handling especially dangerous pathogens and toxins. The World Health Organization’s “Joint External Evaluation of IHR Core Capacities of the State of Eritrea” in 2017 identifies the absence of a national public health act and the need to develop comprehensive biosafety and biosecurity legislation and standards, indicating that such requirements were not yet in force at the time of assessment ^{45, pp. 5–7, 19–22}. The “National Action Plan for Health Security (2017–2021)” sets milestones to draft by June 2018 and enact by December 2018 a public health act, confirming that this instrument had not been enacted then and providing no facility biosecurity clauses ^{46, pp. 12–13}. As of April 2 2025 and September 8 2025, the World Health Organization Strategic Partnership for Health Security SPAR and JEE pipeline pages list Eritrea’s IHR self assessment and planned JEE but do not cite any promulgated Eritrean biosecurity law that specifies facility level requirements for especially dangerous pathogens and toxins ⁴⁷⁴⁸.

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence that Eritrea has an established government agency responsible for enforcing biosecurity legislation and regulations for facilities handling especially dangerous pathogens and toxins. The World Health Organization Strategic Partnership for Health Security country profile for Eritrea, the States Parties Self-Assessment Annual Reporting page updated April 2, 2025, and the Joint External Evaluation pipeline page updated July 21, 2025, list status and activities but do not cite or link any Eritrean authority tasked with enforcing biosecurity legislation ⁴⁹⁵⁰⁵¹. The most recent publicly available official assessments remain the World Health Organization’s “Joint External Evaluation of IHR Core Capacities of the State of Eritrea,” published in 2017 from an October 2016 mission, and the Ministry of Health’s “Final National Action Plan for Health Security Eritrea, 18 August 2017,” and both explicitly indicate that the necessary biosafety and biosecurity legislation, and any associated enforcement arrangements, were not yet in force at those times ^{52, pp. 26–27; 5, pp. 12–13}.

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no publicly available evidence that Eritrea has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. The Ministry of Health and the World Health Organization issued the “National Action Plan for Health Security 2017–2021” in August 2017, which describes a five level public laboratory network led by the National Health Laboratory and records no measure to reduce the number of facilities permitted to hold dangerous agents ^{53, p. 14, 31}. The Ministry of Health’s “The Second Health Sector Strategic Development Plan II 2017–2021,” dated February 2017, likewise sets out five laboratory levels and identifies unresolved legal and regulatory gaps, without prescribing consolidation of high risk holdings ^{54, p. 35, 42}. Government communications in May 2025 emphasize capacity building and deployments in the national laboratory system, reflecting governance and service improvements rather than any policy to centralize dangerous biological materials or reduce authorized sites ⁵⁵.

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is no publicly available evidence that Eritrea has in-country capacity to conduct Polymerase Chain Reaction testing for anthrax or Ebola that would preclude culturing a live pathogen. The World Health Organization’s “WHO Results Report 2024–2025: Eritrea country profile” summarizes support to diagnostics and health emergency readiness but does not document Eritrea performing Polymerase Chain Reaction assays specific to anthrax or Ebola in-country ⁵⁶. The Ministry of Information of the State of Eritrea reported modernization of laboratory services on June 1, 2022, describing deployment of molecular platforms and other equipment under the National Health Laboratory without identifying validated Polymerase Chain Reaction testing for anthrax or Ebola ⁵⁷. On June 27, 2025, the Ministry of Information highlighted veterinary vaccine production milestones at the National Animal and Plant Health Laboratory, which reflects sectoral capacity building rather than human-health Polymerase Chain Reaction testing for anthrax or Ebola ⁵⁸.

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Eritrea requires standardized biosecurity training, through a common national curriculum or a train-the-trainer program, for personnel working in facilities that house or handle especially dangerous pathogens, toxins, or biological materials with pandemic potential. The World Health Organization’s “WHO Results Report 2024–2025: Eritrea country profile,” published in September 2025, describes improvements in readiness and laboratory capacity but does not cite any Eritrean law, ministerial directive, or national standard that mandates a standardized biosecurity training requirement or a re-certification interval for high-risk laboratory personnel ⁵⁹. Government communications in 2025 document topic-specific capacity building in food safety governance rather than a binding national biosecurity training policy, including a Ministry of Agriculture training on February 21, 2025 to enhance the national food safety control system, a validation workshop on May 16, 2025 concerning the food control system, and a national food safety conference reported on July 5, 2025, none of which establish a nationally required, standardized biosecurity training program for personnel handling especially dangerous agents ⁶⁰⁶¹⁶².

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence that Eritrea, through regulations or licensing conditions, requires security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential to undergo drug testing, background checks, and psychological or mental fitness checks. The World Health Organization IHR States Parties Self-Assessment Annual Reporting (SPAR) page for Eritrea, submitted in 2024, lists capacities for legislation, laboratory biosafety, and laboratory biosecurity, including capacity C.5.2 on implementation of a laboratory biosafety and biosecurity regime, but provides no Eritrean instrument imposing the three specified personnel vetting checks for access to high-risk biological materials ⁶³. The World Health Organization 2025 “Health and environment scorecard: Eritrea” presents country indicators and environmental health policy status without any reference to mandated drug testing, background checks, or psychological fitness checks applicable to staff with access to dangerous biological agents ^{64, pp. 1–2}. The World Health Organization “Joint External Evaluation of IHR Core Capacities of the State of Eritrea,” reflecting the position as of October 2016, reported no formal biosafety and biosecurity policy or regulation and no implemented oversight mechanisms, and subsequent publicly available materials do not evidence the introduction of personnel screening requirements in licensing ^{65, pp. 26–27}.

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is no publicly available evidence that Eritrea has national regulations that specifically govern the safe and secure transport of infectious substances and explicitly cover Category A and Category B consignments. The World Health Organization “Environmental Health Country Profile: Eritrea” from 2025 provides a current overview of national policy instruments but cites no Eritrean law, regulation, directive, or licensing condition addressing transport requirements for Category A and Category B infectious substances ^{66, pp. 1–2}. As of September 2025, the World Health Organization State Party Self-Assessment Annual Reporting country page for Eritrea lists International Health Regulations capacities but provides no Eritrean transport regulation or official link that codifies Category A and Category B handling, packaging, or carriage requirements ⁶⁷. The World Health Organization “Joint External Evaluation of IHR Core Capacities: State of Eritrea,” published in December 2017 following the October 2016 mission, discusses specimen referral and transport practices but does not identify any national transport regulation or licensing provisions for infectious substances ^{68, pp. 34–35}.

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence that Eritrea has legislation or regulations in force that oversee cross-border transfer and require end-user screening for especially dangerous pathogens, toxins, or biological materials with pandemic potential. The World Health Organization Strategic Partnership for Health Security country page for Eritrea, current through 2024 and maintained in 2025, provides International Health Regulations implementation information but lists no Eritrea-specific legal instruments on import, export, transit, or end-use vetting of infectious biological agents ⁶⁹. The World Health Organization “Health and environment scorecard: Eritrea” dated May 2025 summarizes national health and environment policies yet contains no reference to a national framework governing cross-border transfer of infectious substances or end-user screening requirements, nor any transport regulation explicitly covering Category A and Category B infectious substances ^{70, pp. 1–4}.

1.4.1a Biosafety laws/regulations

Score: 0

There is no publicly available evidence that Eritrea has national biosafety legislation or regulations in force. The World Health Organization’s “Environmental Health Country Profile: Eritrea” published in 2025 presents current national environmental health policies and regulatory references but does not list any biosafety or biosecurity legislation, and it contains no indication that such a law has been enacted or implemented by the Government of Eritrea ^{71, pp. 1–3}. Earlier system assessments remain consistent with this absence: Eritrea’s “National Action Plan for Health Security” dated August 2017 explicitly states that no biosafety and biosecurity policy exists at the national level and identifies the development of biosafety and biosecurity legislation as a priority action under laboratory and prevention capacities ^{72, p. 29, 34}.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence that Eritrea has established an agency responsible for enforcing biosafety legislation and regulations for facilities handling especially dangerous pathogens, toxins, or biological materials with pandemic potential. The World Health Organization’s 2025 “Health and Environment Country Profile: Eritrea” summarizes national institutions and regulatory topics but does not identify any biosafety enforcement authority or cite operative biosafety legislation or regulations ^{73, pp. 1–3}. The World Health Organization Strategic Partnership for International Health Regulations country page for Eritrea, which displays laboratory biosafety and biosecurity capacity data with a “Data as of 28 September 2025” note, provides no law, decree, or named enforcing body and includes no link to a competent authority that performs enforcement functions ⁷⁴. Eritrea’s “National Action Plan for Health Security” assigns activities across the Ministry of Health, the Ministry of Agriculture, and other bodies but does not establish a single enforcement agency or describe statutory inspection powers for biosafety as of June 2017 ^{75, pp. 41–45}.

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence that Eritrea requires standardized biosafety training, through a common curriculum or a train-the-trainer program, for personnel handling especially dangerous pathogens or biological materials with pandemic potential, or that it mandates a recertification interval as of September 29, 2025. The United Nations Eritrea Resident Coordinator’s Office “UN Eritrea 2024 Annual Results Report,” published in May 2025, records a “National Health Laboratory Strategy (2025–2029)” to modernize and standardize diagnostic services and pursue accreditation, but it does not establish any nationwide legal or regulatory requirement for biosafety training or any recertification cadence for high-risk laboratory personnel ^{76, p. 1677, p. 23}. The Ministry of Information of the Government of Eritrea reported on October 29, 2024 a regional veterinary laboratory maintenance and calibration training conducted in Asmara, which evidences ad hoc capacity building rather than a standardized, required national program with a defined recertification interval ⁷⁸.

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Eritrea has conducted a government-led assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. The United Nations Eritrea Resident Coordinator’s Office report “UN Eritrea 2024 Annual Results Report,” issued in May 2025, describes development of a “National Health Laboratory Strategy (2025–2029)” to modernize and standardize diagnostic services and pursue accreditation; the relevant section does not report any nationwide mapping, census, registry, or assessment of ongoing dual-use or high-consequence pathogen research in Eritrean institutions ^{79, p. 16}. A Government of Eritrea Ministry of Information article dated May 26, 2025 highlights UN-supported health achievements and interest in genomic sequencing for emergency preparedness, yet it likewise contains no evidence of a formal assessment of whether such research is being conducted nationally ⁸⁰.

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence that Eritrea has legislation or regulation requiring oversight of research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. The United Nations Eritrea Resident Coordinator’s Office report “UN Eritrea 2024 Annual Results Report,” published in May 2025, records development of a “National Health Laboratory Strategy (2025–2029)” to modernize and standardize diagnostic services, but it does not report any enacted national law or regulation establishing research oversight for dual-use or high-consequence pathogen work in this period ^{81, p. 16}. A Government of Eritrea Ministry of Information article dated May 26, 2025 highlights health sector progress and interest in genomic sequencing for preparedness without announcing a binding research-oversight statute or regulation ⁸².

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no publicly available evidence that Eritrea has designated an agency responsible for oversight of research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. The United Nations Eritrea “Annual Results Report 2024” by the United Nations Resident Coordinator’s Office, published in 2025, confirms development of the “National Health Laboratory Strategy (2025–2029)” to modernize diagnostics and introduce genomic sequencing but does not identify any authority with a legal or policy mandate over dual-use or high-consequence biological research ^{83, L1–L8}. The Eritrea Ministry of Information’s feature “Celebrating Progress: UN Agencies Highlight Eritrea’s Sustainable Development Achievements,” dated May 2025, highlights sectoral gains and UN support yet provides no announcement of a national research-oversight body or regulatory authority for dual-use or pathogen research ⁸⁴.

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence that Eritrea has legislation or regulation requiring providers to screen synthesized deoxyribonucleic acid orders against lists of known pathogens and toxins before sale. The Secretariat of the Convention on Biological Diversity April 2024 information paper for the Cartagena Protocol Compliance Committee lists Eritrea with only partial measures and cites existing instruments without any DNA-synthesis screening mandate ^{85, p. 62}. The Committee’s October 2023 non-compliance note records that Eritrea reported measures partially in place, referenced a 2017 proclamation, and was asked to upload the text to the Biosafety Clearing-House; as of that note the law text had not been published there, and no order-screening requirement is identified ^{86, p. 6}. The Food and Agriculture Organization of the United Nations GM Foods Platform country page, updated April 2025, states that regulatory frameworks for genetically modified food safety are yet to be developed in Eritrea ⁸⁷. The official gazette text “Proclamation No. 179/2017 The Eritrean Environmental Protection, Management and Rehabilitation Framework” sets general environmental management obligations and contains no pre-sale DNA-synthesis screening requirement ^{88, pp. 1–3}. The companion “Legal Notice No. 127/2017 Environmental Protection and Management Regulations” likewise contains no such clause ^{89, pp. 1–4}.

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Eritrea has official Foot and mouth disease vaccination figures for livestock publicly available through the World Organisation for Animal Health World Animal Health Information System. The World Organisation for Animal Health report for event identification number 6776, validated in September 2025, presents quantitative data for Foot and mouth disease in domestic cattle that include 5,000 animals recorded in the Vaccinated column together with susceptible, case, and death counts ⁹⁰. A second World Organisation for Animal Health report for event identification number 6778, also validated in September 2025, presents quantitative data for Foot and mouth disease in domestic cattle that include 3,077 vaccinated animals in the Vaccinated column ⁹¹.

1.6.1c Equitablenature of national immunization strategy/plan

Score: 0

Eritrea has a national immunization strategic plan in force for 2022 to 2026, although this is not publicly available. The World Health Organization Eritrea annual report for 2022 states that the National Immunization Strategic Plan 2022 to 2026 was developed with support from the World Health Organization and that the global Immunization Agenda 2030 was adopted to guide the plan and the accompanying action plan, confirming the existence of a national strategy during the period ^{92, p. 9}. Equity-oriented operational measures are set out in Gavi, the Vaccine Alliance’s “Targeted Country Assistance Plan Eritrea 2022,” published in 2024, including mapping of zero dose children in 4 regions and 22 districts, implementation of Periodic Intensified Routine Immunization in areas with less access, supportive supervision, community microplanning, social and behavior change activities including overcoming gender related barriers, and use of offline mobile applications to identify zero dose children ^{93, pp. 1–2}. Continued 2025 program operations are supported by the United Nations Children’s Fund Supply Division “Gavi Shipments 2025 Plan – Vaccines & Devices – All Regions,” dated January 2025, which lists Eritrea entries for vaccines, auto disable syringes, and safety boxes scheduled across 2025 ^{94, p. 4}.

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

There is no publicly available evidence that Eritrea includes measures to address vaccine hesitancy and build public trust in vaccines within a national immunization strategy or plan. On April 29, 2022, the Ministry of Information published “Launching of Health Sector Strategic Development Plan,” announcing a five-year health sector plan but not posting an immunization strategy text or clauses on demand generation or vaccine confidence for routine services ⁹⁵. On July 1, 2023, the Ministry of Information article “HPV Vaccination Campaign in Eritrea” reported operations and coverage without referencing national plan provisions on hesitancy or trust building ⁹⁶. In 2023, the United Nations Children’s Fund issued “Humanitarian Action for Children: Eritrea 2023 Appeal,” which describes social and behavior change, risk communication, and community engagement as humanitarian programming rather than a national immunization strategy ^{97, p. 3}. In 2023, the World Health Organization feature “Improving access to immunization in hard-to-reach areas of Eritrea” details macro-planning and outreach logistics without citing a national plan clause on vaccine confidence ⁹⁸.

1.6.1e National advisory group for immunization strategy/plan

Score: 100

There is evidence that Eritrea maintains a national advisory group that provides technical guidance and advice on the immunization strategy or plan. The country self reported having a NITAG to the WHO.⁹⁹

The World Health Organization Regional Office for Africa’s “WHO Eritrea Annual Report 2022” describes immunization activities, an Expanded Programme on Immunization review for 2017–2021, and the development and adoption of a “National Immunization Strategic Plan 2022–2026,” but it does not identify any standing national advisory group such as a national immunization technical advisory group or an inter-agency coordinating committee advising government on immunization strategy in this period ^{100, pp. 7–9}. The Ministry of Information communication “Eritrea’s Presentations on progress in Health and Education to the UPR Session (Geneva, 6 May 2024)” reports sector performance without referencing a national immunization advisory mechanism ¹⁰¹. The World Health Organization Regional Office for Africa “Eritrea: Country Profile Factsheet” (August 2023) summarizes coverage and program indicators and contains no mention of a national advisory body that provides technical guidance on the immunization strategy or plan ^{102, p. 1}.

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no publicly available evidence that Eritrea has a national immunization programme for seasonal influenza. The World Health Organization and the United Nations Children’s Fund Eritrea immunization coverage country profile updated in July 2024 lists and charts nationally reported programme antigens and coverage for Bacillus Calmette–Guérin, diphtheria–tetanus–pertussis, polio, Haemophilus influenzae type b, rotavirus, pneumococcal conjugate, measles–containing vaccine, inactivated polio vaccine, and others, with no reporting line for seasonal influenza vaccine anywhere in the profile, indicating it is not part of the nationally reported schedule as of July 2024 ^{103, pp. 2–12}. The World Health Organization Immunization Data “Introduction of Seasonal Influenza vaccine” country view for Eritrea shows no national introduction status recorded ¹⁰⁴. For context on adult vaccination platforms relevant to influenza delivery, the United States Centers for Disease Control and Prevention reports that Eritrea did not provide coronavirus disease 2019 vaccines during 2021–2023, underscoring the absence of active adult immunization delivery channels during the period of interest ^{105, p. 308}.

1.7.1a Strategy/plan for resilience of health system

Score: 50

Eritrea has a national health sector strategic framework and related plans, but available documents do not show a dedicated climate resilient health system strategy that links infectious disease risks to climate change and seasonal weather patterns. The Second Health Sector Strategic Development Plan II 2017–2021, issued by the Ministry of Health in November 2016, notes climate change as altering health challenges and calls for a more resilient health system able to absorb shocks from epidemics or disasters while strengthening health security and coverage ^{106, p. 12}. The World Health Organization Regional Office for Africa Eritrea Annual Report 2022, published in February 2023, confirms that Eritrea is implementing a third Health Sector Strategic and Development Plan for 2022 to 2026 with priorities that include enhancing health systems functionality and expanding resilient and comprehensive public health services ^{107, p. 4}. A Ministry of Information article from April 2022 records the launch of the five year strategic plan for 2022 to 2026, including the Third Health Sector Strategic Development Plan, the Essential Health Care Package, the Monitoring and Evaluation Plan and the National Action Plan for Health Security ¹⁰⁸. United Nations Eritrea annual results reports in March and May 2025 describe implementation of the National Action Plan for Health Security, a costed One Health roadmap, public health risk profiling, seasonal risk calendars and climate resilience measures ^{109, pp. 27–31; 5, pp. 12–16, 19}.

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

Eritrea has national laboratory capacity to conduct at least 5 of the 10 World Health Organization core diagnostic tests. The World Health Organization mission report “Joint External Evaluation of IHR Core Capacities of the State of Eritrea,” dated October 2016 and published by the World Health Organization, states that the National Health Laboratory performed confirmatory testing for human immunodeficiency virus, tuberculosis, malaria, salmonella and measles, and that the national laboratory system conducted 5 or more of the 10 core tests, including bacterial culture and sensitivity for Staphylococcus aureus, Escherichia coli and Neisseria meningitidis ^{110, pp. 25-27}. The United Nations Eritrea report “2023 UN Annual Results Report,” issued March 2025, states that in 2023 the United Nations and the Ministry of Health of the State of Eritrea maintained investigation and laboratory confirmation for polio, measles, rubella and acute flaccid paralysis across Eritrea, demonstrating ongoing operation of national human diagnostic testing capacity ^{111, pp. 27-31}. The United Nations Eritrea report “UN Eritrea Annual Results Report 2024,” released May 2025, states that Eritrea developed a National Health Laboratory Strategy 2025 to 2029 to standardize diagnostic services nationwide and that surveillance teams in 2024 tested suspected acute flaccid paralysis, measles and rubella cases and confirmed them negative for wild poliovirus, measles and rubella, indicating sustained national confirmatory laboratory function ^{112, pp. 16, 20-22}.

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence that Eritrea has a national plan or strategy for conducting testing during a public health emergency that defines testing goals, incorporates provisions for testing novel pathogens, or sets out mechanisms for scaling diagnostic capacity. The Ministry of Information reported in April 2022 that the Government of the State of Eritrea launched a package of documents for 2022 that included the “National Action Plan for Health Security 2022–2026,” the “Health Sector Strategic Development Plan III 2022–2026,” a monitoring and evaluation plan, and the “Eritrea Essential Health Care Package,” but the article does not describe any emergency testing framework or goals ¹¹³. The World Health Organization Regional Office for Africa published a news release in April 2022 documenting the same launch event and listing the documents adopted, yet it provides no evidence of a national plan specifying testing strategies for emergencies ¹¹⁴. The United Nations in Eritrea also reported the April 2022 launch and described the documents as supporting resilience and implementation of the International Health Regulations, but it does not present provisions for testing novel pathogens or scaling laboratory capacity ¹¹⁵. The World Health Organization Eritrea Annual Report for 2022 confirms support for development and dissemination of the “National Action Plan for Health Security 2022–2026” and notes diagnostic equipment procurement, yet it contains no section outlining a national emergency testing plan with defined goals or scaling considerations ^{116, pp. 4, 10}.

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 0

There is no publicly available evidence that Eritrea has a national laboratory that serves as a reference facility which is accredited. The World Health Organization Joint External Evaluation mission report records that as of October 2016 the National Health Laboratory measles and tuberculosis laboratories were under the Stepwise Laboratory Improvement Process toward Accreditation for International Organization for Standardization 15189 and that the tuberculosis laboratory was undergoing ISO 15189 accreditation, which shows pursuit rather than attainment ^{117, pp. 33, 35–36}. The “Eritrean National Action Plan on Antimicrobial Resistance 2021–2025,” issued in February 2021 by the Government of the State of Eritrea with support from the World Health Organization and the Food and Agriculture Organization of the United Nations, states that the National Medicines and Food Administration is working to upgrade and accredit the National Drug Quality Control Laboratory to ISO/IEC 17025, a testing and calibration standard distinct from ISO 15189 for medical laboratories ^{118, pp. 19, 22}. The World Health Organization Eritrea Annual Report 2022, published in February 2023, documents technical support for the same ISO/IEC 17025 quality management system effort and does not report ISO 15189 or Clinical Laboratory Improvement Amendments accreditation for a national reference medical laboratory ^{119, p. 5}.

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

Eritrea has a national laboratory that serves as a reference facility and is subject to external quality assurance review. The World Health Organization Regional Office for Africa reported in July 2022 that the Ministry of Health National Health Laboratory was supported and facilitated to join the World Health Organization external quality assessment system, confirming its participation in a formal proficiency testing scheme under intergovernmental oversight ^{120, p. 9}. The World Health Organization “Tracking AMR Country Self-Assessment Survey 2022 Country Report: Eritrea” documents that a national external quality assurance program is compulsory and implemented in all bacteriology laboratories, explicitly including the National Bacteriology Reference Laboratory and confirming standardized antimicrobial susceptibility testing practices in the national reference facility and public clinical bacteriology laboratories ^{121, p. 6}. The 2016 Joint External Evaluation of IHR Core Capacities for Eritrea further substantiates that the National Health Laboratory is the human health sector’s national reference laboratory and participates in External Quality Assessment schemes as part of its national laboratory quality system, demonstrating longstanding engagement in external quality assurance processes ^{122, p. 25}.

2.2.1a Nationwide specimen transport system

Score: 0

There is no publicly available evidence that Eritrea has a nationwide specimen transport system that is formally established, fully functional and consistently operational across all administrative levels. The World Health Organization State Party Self-Assessment Annual Reporting page for Eritrea records a score for International Health Regulations laboratory capacity “C.5.1 Specimen referral and transport system” for the 2024 submission year, but the platform does not provide underlying documentation demonstrating the existence of a national specimen transport mechanism or describing system structure, operating procedures, coverage, or reliability, and therefore cannot serve as evidence of a functioning nationwide system ¹²³. The World Health Organization Regional Office for Africa “WHO Eritrea Annual Report 2022,” published in February 2023, presents surveillance graphics for acute flaccid paralysis that show stool specimens reported from multiple zobas, but the report does not describe or confirm a national specimen transport system, nor does it outline transport routes, arrangements, or standardized processes linking subzonal, zoba, and national levels ^{124, pp. 15–16}

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no publicly available evidence that Eritrea has a government plan that sets out procedures to rapidly authorize or license additional laboratories to supplement the national public health laboratory system and scale up testing during an outbreak. The World Health Organization State Party Self-Assessment Annual Reporting page for Eritrea updated in April 2025 provides International Health Regulations laboratory capacity information but contains no Eritrea policy text describing rapid authorization or licensing of laboratories during emergencies ¹²⁵. The World Health Organization Regional Office for Africa “WHO Eritrea Annual Report 2022,” published in February 2023, notes adaptation of the third edition Integrated Disease Surveillance and Response technical guidelines in 2022 and describes implementation activities under the National Action Plan for Health Security 2022–2026, but on the cited pages it does not present any governmental mechanism for expedited authorization or licensing of laboratories during outbreaks ^{126, pp. 8, 10–11}.

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

Eritrea has ongoing event-based and indicator-based surveillance for notifiable and novel infectious diseases, but there is no publicly available evidence that surveillance data are analyzed on a daily basis. The World Health Organization Strategic Partnership for Health Security portal shows Eritrea’s State Party Self-Assessment Annual Reporting submission for 2024 on the country profile with capacity scores and the status “Submitted – 2024,” confirming current national reporting under the International Health Regulations as of April 2025 ¹²⁷. The World Health Organization Regional Office for Africa reports that the Ministry of Health finalized adaptation of the “WHO 3rd Edition Integrated Disease Surveillance and Response Technical Guidelines and Training Modules” in May 2022, establishing the national framework that includes detection, notification, analysis, thresholds and response functions covering both indicator- and event-based surveillance ¹²⁸. For 2024 regional operations, the World Health Organization Regional Office for Africa documents 33 new public health events detected in quarter 1 with about half identified within 7 days, and lists Eritrea among six countries in a genomic-surveillance scale-up plan, which evidences Eritrea-specific engagement without attesting to daily national analysis ^{129, pp. 11–12}.

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

Eritrea has a designated National International Health Regulations Focal Point within the Ministry of Health that reports notifiable events to the World Health Organization under the International Health Regulations framework. The Ministry of Health’s National Action Plan for Health Security dated August 18, 2017 publicly acknowledges an IHR Focal Point and Manager for the Quarantine & Inspection Unit, thereby naming the mechanism and its institutional placement inside the Ministry of Health ^{130, p. 7}. The World Health Organization Eritrea Annual Report 2022 confirms in-period International Health Regulations core capacities to detect, assess, notify, and respond, evidencing continued operationalization of the reporting mechanism during 2022 ^{131, pp. 12–13}. The World Health Organization Strategic Partnership for Health Security portal shows Eritrea’s 2024 States Parties Self-Assessment Annual Reporting submission as Approved, with IHR Coordination and National IHR Focal Point functions scored and an update dated April 2, 2025, corroborating active focal point functions within 2022 to 2025 ¹³².

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

Eritrea maintains an electronic reporting surveillance system that operates at both the national and the subnational level. The World Health Organization Regional Office for Africa Eritrea Annual Report 2022 states that in 2022 the District Health Information Software version 2 national server was upgraded to the latest version with new data analysis and World Health Organization data quality applications, and that functional District Health Information Software version 2 is in place at national, subnational, and in 44% of districts, with strong timeliness and completeness of reporting despite information technology constraints ^{133, pp. 14–15}. In May 2022 the World Health Organization Regional Office for Africa reported that the Ministry of Health finalized adaptation of the third edition Integrated Disease Surveillance and Response technical guidelines and training modules, which define surveillance roles at all levels, including detection, reporting, data analysis, investigation, response, and supportive supervision ¹³⁴.

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is no publicly available evidence that Eritrea operates a real time electronic reporting surveillance system that continuously collects laboratory data and enables disaggregated analysis by age, ethnicity, or similar variables. In July 2022, the World Health Organization Regional Office for Africa biennium summary reported that District Health Information Software 2 was rolled out in 2019 in all provinces and that the offline system produced high report rates ^{135, p. 4}. In February 2023, the World Health Organization Eritrea annual report described a national server upgrade for District Health Information Software 2, functional use at national and subnational levels, and persistent internet and information technology constraints, without documenting nationwide real time electronic laboratory feeds or demographic disaggregation capability ^{136, pp. 14–15}. On April 8, 2024 the World Health Organization Strategic Partnership for Health Security and Emergency Preparedness portal posted Eritrea’s 2023 Self Assessment Annual Reporting update listing surveillance capacity scores, but it provides no confirmation of national real time electronic laboratory reporting or disaggregation functions ¹³⁷.

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 2 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.¹³⁸

Moreover, the United Nations University Institute for Water, Environment and Health (UNU-INWEH) and the United Nations Environment Programme (UNEP), in collaboration with the World Health Organization (WHO) and its Regional Office for the Eastern Mediterranean (WHO EMRO), hosted a regional workshop in Cairo, Egypt, from 19–21 October 2025, focused on strengthening wastewater surveillance systems across North Africa. This involved government leaders and key stakeholders from Algeria, Djibouti, Egypt, Eritrea, Libya, Morocco, and Tunisia. The workshop was aimed at exploring how wastewater surveillance can support public health, environmental protection, and ecosystem sustainability.¹³⁹

2.4.1a Common usage of electronic health records

Score: 0

There is no publicly available evidence that Eritrea uses electronic health records in health facilities. The World Health Organization Regional Office for Africa, Eritrea Country Office, in its “WHO Annual Report 2022,” describes the District Health Information System version 2 as an aggregate reporting platform and notes that the District Health Information System server was upgraded in 2022; it does not report facility-level electronic medical records in use ^{140, p. 12}. On April 29, 2022 the World Health Organization Regional Office for Africa announced the launch of the third Health Sector Strategic Development Plan and related instruments; the communication lists sector priorities but does not announce any electronic health record policy, pilot, or roll out ¹⁴¹. On April 28, 2022 the United Nations Eritrea press release on the same launch likewise contains no mention of electronic medical record systems in clinical settings during the timeframe ¹⁴².

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no publicly available evidence that Eritrea provides the national public health system with access to electronic health records of individuals. The World Health Organization Regional Office for Africa report “WHO Eritrea Annual Report 2022,” issued in February 2023, describes use of District Health Information Software 2 known as DHIS2 for aggregate reporting, records a 2022 server upgrade and training, and states that the Health Management Information System unit compiles an Annual Health Service Activity Report, with no mention of an electronic health record platform or national access to individual clinical records by public health authorities ^{143, p. 14}. The World Health Organization Regional Office for Africa biennium summary released in July 2022 states that District Health Information Software 2 was rolled out in 2019 in all administrative regions using an offline model to improve routine reporting, indicating routine aggregate systems rather than a national electronic health record accessible to public health authorities ^{144, p. 4}. World Health Organization Regional Office for Africa and United Nations Eritrea announcements in April 2022 list sector strategies launched without any electronic health record policy or rollout ¹⁴⁵¹⁴⁶.

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that Eritrea has national data standards in place to ensure data comparability across the health system. The World Health Organization Country Office Eritrea “WHO Eritrea Annual Report 2022,” issued in February 2023, documents implementation of International Organization for Standardization and International Electrotechnical Commission standard ISO/IEC 17025:2017 within the National Drug Quality Control Laboratory and capacity-building for ISO 9001:2015 quality management processes within National Medicines and Food Administration departments, but these standards relate to laboratory competency and internal quality management rather than national data comparability frameworks ^{147, p. 32}. The same report notes development of a standardized “Zoba profile” template for annual reviews, upgrades to the District Health Information System 2 server, and support for indicator setting at the National Health Observatory, but these activities improve reporting within specific programs and do not constitute national data standards or an ISO-aligned health information standard applicable systemwide ^{148, pp. 16, 32}.

2.4.2a Data sharing mechanisms

Score: 0

There is no publicly available evidence that Eritrea has an established national mechanism for routine sharing of surveillance data across the ministries responsible for human, animal, and wildlife or environmental health outside antimicrobial resistance. The joint external evaluation of International Health Regulations 2005 capacities for the State of Eritrea by the World Health Organization in 2017 said collaboration between animal and human health sectors was ad hoc, with no joint planning, no information sharing, and no joint zoonotic response ^{149, pp. 21–22}. The Ministry of Health National Action Plan for Health Security 2017 to 2021 told authorities to set up One Health coordination structures and create surveillance information sharing mechanisms for joint zoonotic response, showing these systems still had to be built ^{150, pp. 33–36}. The Eritrean National Action Plan on Antimicrobial Resistance 2021 to 2025 created cross ministerial committees, joining the Ministry of Health, the Ministry of Agriculture, the Ministry of Land, Water and Environment, and the Ministry of Marine Resources, and assigned a national secretariat to convene cross sector review meetings ^{151, pp. 4–5}. The World Health Organization Regional Office for Africa report dated 27 August 2025 confirms that this is a One Health antimicrobial resistance governance mechanism for antimicrobial resistance coordination only and gives no evidence of any separate platform for routine sharing of broader zoonotic or wildlife surveillance data across these ministries ^{152, pp. 1–2}.

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

Eritrea has made de-identified infectious-disease surveillance data publicly available on official government websites. In 2022, the Ministry of Health published daily coronavirus disease updates on the Government of the State of Eritrea portal with new cases, recoveries, cumulative totals, and deaths, for example on May 31, 2022 and August 11, 2022, demonstrating release of aggregate, de-identified surveillance statistics to the public ¹⁵³¹⁵⁴. In May 2025, the Eritrea Ministry of Information published a national measles update reporting 54 measles cases in 2023, with incidence per 1,000,000 population, evidencing continued dissemination of de-identified surveillance data ¹⁵⁵. Also in May 2025, the Eritrea Ministry of Information reported 4 malaria deaths in 2023; a May 2024 government write-up of Universal Periodic Review presentations had stated 5 malaria deaths for 2023 ¹⁵⁶¹⁵⁷.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Eritrea has legislation that safeguards the confidentiality of identifiable health information for individuals. Article 407, Breaches of Professional Secrecy, in the Penal Code of Ethiopia 1957 issued in 1957 and applied in Eritrea as the Transitional Penal Code, makes it a criminal offense for doctors, dentists, pharmacists, midwives, nurses, and auxiliary medical personnel to disclose any secret that came to their knowledge in the course of their professional duties, whether or not those duties have ended at the moment of disclosure, and states that unauthorized or negligent disclosure is punishable by imprisonment or fine ^{158, pp. 130–131}. Article 8, Public Hearing, in the Civil Procedure Code of the State of Eritrea issued by the Ministry of Justice of the Government of the State of Eritrea in 2015, authorizes courts to hold hearings in camera where confidential information is involved and publicity would damage that confidentiality, and where closure is necessary to protect the privacy of the parties or of other persons such as patients, preventing public disclosure of confidential patient information ^{159, p. 32}. The Eastern and Southern Africa Anti Money Laundering Group reported in July 2025 that Eritrea’s Anti Money Laundering and Counter Terrorist Financing Proclamation is complemented by the Transitional Penal Code and other Transitional Codes underlying the main Anti Money Laundering and Counter Terrorist Financing legal framework in Eritrea, confirming that the Transitional Penal Code remains part of the operative national framework ^{160, pp. 10–11, 17}.

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is no publicly available evidence that Eritrea has legislation or regulations that safeguard the confidentiality of identifiable health information and that also include explicit protections from cyber attacks. In July 2025, the Eastern and Southern Africa Anti-Money Laundering Group reported that Eritrea has no cooperation and coordination between relevant authorities to ensure the compatibility of requirements with data protection and privacy rules, indicating the absence of a national personal data protection framework into which cyber safeguards for health data would ordinarily fit ^{161, p. 70}. The same July 2025 report finds no provisions addressing risks from new technologies under Recommendation 15, reinforcing the lack of cyber-related safeguards ^{162, p. 87}. In May 2015, the Ministry of Justice issued the “Civil Procedure Code of the State of Eritrea,” whose Article 8 permits hearings in camera to protect confidential information and the privacy of patients, which is a courtroom mechanism and does not mention cybersecurity or ransomware ^{163, p. 6}. As of November 2023, the United Nations Institute for Disarmament Research Cyber Policy Portal lists no enacted Eritrean cybersecurity or data protection statute, corroborating the absence of cyber-specific protections ¹⁶⁴.

2.4.5a Cooperative commitments or agreements within regions

Score: 0

There is no publicly available evidence that Eritrea has made a government commitment via a public statement, legislation, or a cooperative agreement to share surveillance data with other countries during a public health emergency. The Intergovernmental Authority on Development published the “IGAD Regional Health Data Sharing and Protection Policy” in October 2021. The document states it is not a legally binding framework ^{165, p. 12}. The World Health Organization Regional Office for Africa issued the “Polio Eradication Cross-Border Coordination Plan 2024/2025: Lake Chad Basin and Sahel Countries” in 2024 and the plan lists the seven covered countries by name and does not include Eritrea, and it does not record any Eritrea-specific commitment ^{166, pp. iv–v}. The “WHO Eritrea Annual Report 2022” records surveillance strengthening and the National Action Plan for Health Security 2022 to 2026 without reporting any bilateral or regional commitment by Eritrea to share emergency surveillance data across borders ^{167, pp. 5, 11}. A Ministry of Information national news archive for October 2025 shows no announcement of any such commitment ¹⁶⁸. Eritrea's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Eritrea is obligated to notify the World Health Organization (WHO) of public health events that may constitute a public health emergency of international concern. This legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries. ¹⁶⁹

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 100

Eritrea has a national system that provides support at the sub-national level to conduct contact tracing in preparation for future public health emergencies. In 2022, the World Health Organization Eritrea Country Office documents that the Ministry of Health coordinated a national workshop with participation from the Zobas in which each Zoba assessed preparedness components and developed action plans that explicitly included contact tracing; the same report describes a costed action plan for establishing Public Health Emergency Operations Centres at the national and Zoba levels to operationalize coordinated response capacities, demonstrating structured national-to-sub-national support beyond an active emergency ^{170, p. 11}. In August 2025, the World Health Organization Regional Office for Africa issued a technical paper that calls on Member States to accelerate sub-national roll-out of the Integrated Disease Surveillance and Response third edition, including targeted training, supportive supervision, and performance monitoring, confirming the currency and alignment of these preparedness functions during the timeframe ^{171, p. 4}.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no publicly available evidence that Eritrea provides wraparound services enabling infected people and their contacts to self-isolate or quarantine as recommended, including either structured economic support such as income replacement or job-security guarantees, or a programmatic package of assured medical attention tied specifically to isolation or quarantine. The “WHO Eritrea Annual Report 2022” details preparedness and response strengthening and records a national workshop with Zoba participation that produced Zoba action plans listing contact tracing among preparedness components, yet it does not describe any national scheme of income protection, employment guarantees, in-kind assistance, or a standardized medical-support package linked to isolation or quarantine for cases or contacts ^{172, p. 11}. Public national news posted by the Ministry of Information in October 2025 and on the sitewide News landing show routine health announcements without any notice of income replacement, job-security measures, essential-needs assistance, or structured medical-care services offered to persons isolating or to traced contacts within the timeframe ¹⁷³¹⁷⁴.

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence that Eritrea has a joint plan or cooperative agreement between the Ministry of Health and border control authorities to identify suspected or potential cases in international travelers and to trace and quarantine their contacts during a public health emergency. The World Health Organization Regional Office for Africa’s quarterly emergency preparedness and response report issued in January 2025 does not reproduce or cite any Eritrea interagency traveler-health plan or standard operating procedures at points of entry ^{175, pp. 1–25}. The World Health Organization Eritrea Annual Report 2022 documents the launch of the National Action Plan for Health Security 2022–2026 and related preparedness activities but includes no Eritrean instrument establishing joint arrangements between the Ministry of Health and immigration, customs, airport, or port authorities for traveler screening, contact tracing, or quarantine ^{176, pp. 1–15}. The International Health Regulations State Party self-assessment page for Eritrea, updated in April 2024, provides capacity summaries only and hosts no joint plan or agreement text ¹⁷⁷. Official ministry communications in January 2022 reference quarantine centers but not a formal interagency plan with border authorities ¹⁷⁸. The United States Centers for Disease Control and Prevention traveler page likewise cites no Eritrean joint traveler-health plan or cooperative agreement ¹⁷⁹.

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Eritrea has both in-country and externally supported applied epidemiology training pathways for human and animal health professionals. The World Health Organization “Joint External Evaluation of International Health Regulations (2005) Core Capacities of the State of Eritrea,” published in October 2016, documents that Asmara College of Health Sciences runs a four-month applied field epidemiology training programme and includes a basic epidemiology training programme within the Bachelor of Science in Public Health focused on infectious disease field work, while the Ministry of Health and the World Health Organization jointly organize a six-week short course in epidemiology for national staff ^{180, pp. 37–39}. The same Joint External Evaluation reports that Eritrean public health staff have participated in basic and intermediate field epidemiology training programmes hosted in Kenya through an existing agreement and that veterinarians attend epidemiology training courses outside the country, confirming government-backed access to applied epidemiology training abroad ^{181, pp. 37–39}. Subsequent World Health Organization reporting describes continued Ministry of Health and World Health Organization training on Integrated Disease Surveillance and Response, outbreak detection, and emergency action planning, which further demonstrates ongoing investment in applied epidemiology skills at national and subnational levels ^{182, pp. 14–16; 3, pp. 11–12}.

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 0

There is no publicly available evidence that Eritrea has a field epidemiology training program that is explicitly inclusive of animal health professionals or that Eritrea offers a dedicated animal health field epidemiology training program, such as the Field Epidemiology Training Program for Veterinarians. The “WHO Eritrea Annual Report 2022,” issued by the World Health Organization Eritrea Country Office in February 2023, details preparedness and workforce activities but does not report any veterinary field epidemiology training program or explicit inclusion of animal health professionals in field epidemiology training ^{183, pp. 10–12}. The World Health Organization Regional Office for Africa’s quarterly emergency preparedness and response report published in January 2025 contains no Eritrea evidence of a veterinary field epidemiology program or an explicitly inclusive field epidemiology training program involving animal health professionals ^{184, pp. 18–21}. The World Health Organization Strategic Partnership for Health Security country page for Eritrea, refreshed in April 2024, summarizes capacities without documenting such training ¹⁸⁵. An African Field Epidemiology Network update from January 2023 describes initiation efforts for frontline field epidemiology training in the Horn of Africa including Eritrea, but it does not show a launched Eritrea program with veterinary inclusion ¹⁸⁶.

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

There is no publicly available evidence that Eritrea has at least 1 trained field epidemiologist per 200,000 people. The “WHO Eritrea Annual Report 2022,” issued by the World Health Organization Eritrea Country Office in February 2023, describes surveillance, workforce, and preparedness activities but does not report any headcount of trained field epidemiologists or a workforce density ^{187, pp. 10–12}. The “Ensuring health security in the WHO African Region: quarterly emergency preparedness and response, quarter 1, 2024,” published by the World Health Organization Regional Office for Africa in January 2025 mentions Member States in emergency contexts yet contains no Eritrea-specific figure for trained field epidemiologists or a ratio per population for Eritrea ^{188, pp. 5–7, 14}. The World Health Organization “WHO Results Report 2024–2025, Eritrea Country Profile” presents midterm results and priorities for Eritrea without publishing any trained field epidemiologist count or density ¹⁸⁹.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

Eritrea has an overarching national public health emergency framework in place, but the plan is not publicly available online. The World Health Organization Regional Office for Africa reported that on 29 April 2022 the Ministry of Health of the Government of the State of Eritrea launched four strategic documents, including the “National Action Plan for Health Security 2022–26,” confirming the existence of a national, all-hazards plan for health emergencies ¹⁹⁰. The World Health Organization Eritrea Annual Report 2022 describes the “National Action Plan for Health Security 2022–2026,” notes World Health Organization technical and financial support, and states that the plan was launched and disseminated to all regions with annual operational plans developed for implementation during 2022, which indicates an operational national framework under the Ministry of Health ^{191, pp. 13–14}. The World Health Organization State Party Self-Assessment Annual Reporting page for Eritrea, posted on 2 April 2025, records capacities active in 2024–2025 in coordination and related domains, corroborating ongoing application of the national health security framework. Neither the World Health Organization launch report nor the State Party Self-Assessment page provides a publicly accessible plan document or any government budget instrument confirming dedicated plan funding ¹⁹²¹⁹³.

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

Eritrea has an overarching national public health emergency response plan that was released within the last 3 years and remains nationally in force. On 28 April 2022, the Ministry of Health launched the national plan titled "National Action Plan for Health Security 2022-26", and the World Health Organization Regional Office for Africa reported on 29 April 2022 that this plan will guide national preparedness and response to health emergencies through 2026 ¹⁹⁴. The World Health Organization Eritrea Annual Report 2022, issued in February 2023, states that the World Health Organization Eritrea supported the Ministry of Health to develop the "National Action Plan for Health Security 2022-2026", coordinated its launch and dissemination to all regions, and helped prepare operational plans so that implementation of the plan strengthens Eritrea capacity to prevent, detect, and respond to public health threats in line with the International Health Regulations, IHR ^{195, pp. 12 to 13}. The World Health Organization State Party Self-Assessment Annual Reporting page for Eritrea dated 2 April 2025 shows Eritrea reporting International Health Regulations core capacities for 2024 and 2025 under the same framework and does not identify any newer national emergency response plan title or version year, confirming that the April 2022 plan remains the operative national plan within the past 3 years ¹⁹⁶.

3.1.1c One health principles by covering multiple threat types

Score: 0

There is no publicly available evidence that Eritrea has an overarching national public health emergency response plan that follows One Health principles by covering multiple threat types such as antimicrobial resistance, zoonotic disease spillover, biological accidents, or deliberate acts. The World Health Organization Regional Office for Africa reported in April 2022 that Eritrea launched a National Action Plan for Health Security 2022–26 as the national guiding document for health emergencies and stated that senior officials from the Ministry of Health, the Ministry of Agriculture, and the Ministry of Land Water and Environment were present at the launch, indicating multisector involvement in preparedness planning but without publishing the plan itself in a form that confirms that these threat types are addressed together under one framework ¹⁹⁷. The World Health Organization State Party Self Assessment Annual Reporting page for Eritrea, posted on 2 April 2025 for the 2024 submission, shows Eritrea reporting national capacities for zoonotic events, food safety, a national health emergency framework, chemical events, and radiation emergencies under one preparedness system, but Eritrea has not released any national public health emergency response plan that can be reviewed to verify that these specific threats are explicitly integrated as a One Health approach in a single overarching plan ¹⁹⁸.

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

There is no publicly available evidence that Eritrea’s overarching national public health emergency response plan explicitly includes either consideration of the impact of health equity or mechanisms for identifying and considering the needs of vulnerable populations. In April 2022 the World Health Organization Country Office reported support to the Ministry of Health to develop the “National Action Plan for Health Security 2022–2026,” but the publicly available annual report text does not specify equity analysis or vulnerable-population mechanisms within that plan, while its framing around universal health coverage and “leaving no one behind” appears as general policy language rather than plan content ^{199, pp. 4, 10}. The Strategic Partnership for Health Security portal lists Eritrea’s 2017 strategic NAPHS with a downloadable attachment and a single-day operational entry in March 2022, yet no 2022–2026 plan document is posted to verify equity provisions or targeted mechanisms ²⁰⁰. The World Health Organization Regional Office for Africa news release confirms the April 2022 launch of the “National Action Plan for Health Security 2022–26,” but provides no plan text or details on equity or vulnerable-group measures ²⁰¹.

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is no publicly available evidence that Eritrea has a specific government mechanism for engaging the private sector to assist with outbreak emergency preparedness and response. The “WHO Eritrea Annual Report 2022,” published in February 2023 by the World Health Organization Regional Office for Africa, describes a costed action plan to establish Public Health Emergency Operations Centres at national and provincial levels and notes technical working groups formed with support from United Nations agencies, but it does not identify any national platform, legal instrument, memorandum of understanding, or protocol that formally engages private providers or private supply-chain actors for preparedness or response ^{202, p. 10}. As of 2025, the World Health Organization Strategic Partnership for Health Security country page for Eritrea provides no government document or record establishing such a mechanism ²⁰³. The World Health Organization Strategic Partnership for Health Security activities listing for Eritrea records National Action Plan for Health Security processes and entries but posts no national directive or arrangement that sets out how private-sector entities are to be engaged for outbreak preparedness or response ²⁰⁴.

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is no publicly available evidence that Eritrea maintains a government policy, plan, or guidelines to implement non-pharmaceutical interventions during epidemics or pandemics. The Eritrea Ministry of Information hosts a September 2023 ministerial statement asserting that “newly established guidelines” were implemented for coronavirus disease and describing a national task force, but the statement does not publish or link any underlying government policy text, decree, circular, or guideline ²⁰⁵. As of 2025, the World Health Organization Strategic Partnership for Health Security portal lists Eritrea’s national influenza preparedness plan status as “No Plan or Plan not publicly available,” indicating that a disease-specific NPI framework is not publicly accessible ²⁰⁶. The World Health Organization Results 2024–2025 Eritrea country profile provides program updates but does not make any national NPI policy or guideline available ²⁰⁷. The World Health Organization Regional Office for Africa’s Eritrea Annual Report 2022 documents the National Action Plan for Health Security 2022–2026 and related preparedness activities; these are strategic frameworks and not operational NPI guidelines for a specific epidemic or pandemic ^{208, p. 10}.

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

Eritrea has completed a national-level biological threat-focused simulation exercise within the past year. The World Health Organization Strategic Partnership for Health Security and Emergency Preparedness “Simulation Exercise Activities” page lists an Eritrea entry with start and end dates of 31 December 2024 and status marked Conducted; the page shows it was updated on 30 September 2025 ²⁰⁹. No publicly accessible record appears of an activation of a national infectious disease emergency response plan during the past year on the World Health Organization Results 2024–2025 Eritrea country profile, on the Strategic Partnership for Health Security Eritrea country profile, or on the United Nations Eritrea 2024 Annual Results Report published in May 2025 ^{210 211 212}.

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is no publicly available evidence that Eritrea in the past year has identified a list of gaps and best practices through an infectious disease response, an after action review, or a biological threat-focused exercise and developed a plan to improve response capabilities. The World Health Organization Strategic Partnership for Health Security Simulation Exercise activities page lists an Eritrea entry marked Conducted on December 31, 2024, but the listing provides no after action review or improvement plan for 2024–2025, and no Eritrea-specific plan is linked on that page ²¹³. The World Health Organization Joint External Evaluation activities page records a country evaluation conducted on August 11–16, 2025, which is a capacity assessment listing and does not constitute or publish a past-year after action review or an associated national improvement plan ²¹⁴. The World Organisation for Animal Health regional repository hosts “A National Strategic Plan for the elimination of dog-mediated rabies in Eritrea,” but the document itself is dated September to November 2021, and its action plan spans 2021–2023 with costing through 2025, placing development outside the past-year window ^{215216, pp. 1, 19–20}.

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no publicly available evidence that Eritrea in the past year has undergone a national-level biological threat-focused exercise that included private sector representatives. The World Health Organization Strategic Partnership for Health Security Simulation Exercise activities page filtered to Eritrea confirms an exercise marked Conducted with start and end dates of December 31, 2024 and shows the page was updated on September 30, 2025, but the entry provides no participant list, no sector breakdown, and no indication of private sector inclusion for Eritrea during the past year ²¹⁷. The World Health Organization mid-term results report country page for Eritrea for 2024–2025 summarizes support to Member States for simulation exercises at a general level but does not provide an Eritrea-specific exercise report or stakeholder roster demonstrating participation by private sector representatives ²¹⁸.

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Eritrea has Emergency Operations Centers in place. In May 2025, the United Nations Country Team in Eritrea reported that Eritrea established three fully functional Public Health Emergency Operation Centers in Zoba Maekel, Debub, and Gash Barka, and that these centers improved real time surveillance and reduced emergency mobilization time from three weeks to one week, demonstrating ongoing operations and coordinated incident management within the public health sector ^{219, pp. 20–21}. The same Eritrea specific report presents this as achieved capacity within the timeframe and identifies the centers by region while quantifying response performance, which shows that the Emergency Operations Centers are established, functioning, and can be utilized for public health emergency coordination in Eritrea ^{220, pp. 20–21}. As of May 2025, this public evidence confirms that Eritrea maintains operational Emergency Operations Centers and uses them for surveillance and response coordination during emergencies ^{221, pp. 20–21}.

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no publicly available evidence that Eritrea requires its Emergency Operations Center to conduct at least one drill per year or that drills were conducted annually. The World Health Organization Strategic Partnership for Health Security “Simulation Exercise Activities” list records a single Eritrea entry as conducted on December 31, 2024, which confirms one exercise but does not demonstrate an annual pattern or a binding annual requirement ²²². The World Health Organization “WHO Results Report 2024–2025: Country Profile — Eritrea” does not publish a national legal or administrative instrument mandating yearly Emergency Operations Center drills, nor does it document drills occurring once per year ²²³. The United Nations Country Team in Eritrea “Annual Results Report 2024” confirms the existence and operation of three Public Health Emergency Operation Centers and reports faster mobilization and real time surveillance, but it does not state an annual drill requirement or show drills conducted every year ^{224, pp. 22–23}.

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no publicly available evidence that Eritrea conducted within the last year a coordinated emergency response or emergency response exercise that was activated within 120 minutes of identifying the public health emergency or scenario. The World Health Organization Strategic Partnership for Health Security “Simulation Exercise Activities” register, updated on September 30, 2025, lists one Eritrea simulation recorded as conducted in 2024 but provides no activation-time data and shows no Eritrea entry in 2025 ²²⁵. The World Health Organization “WHO Results Report 2024–2025: Country Profile — Eritrea” does not publish Eritrea-specific documentation or an after-action report establishing activation within 120 minutes during the last year ²²⁶. The United Nations Country Team in Eritrea “Annual Results Report 2024,” dated May 8, 2025, confirms three Public Health Emergency Operation Centers and reports reduced mobilization from three weeks to one week, but it does not report activation within 120 minutes for any response or exercise within the last year ^{227, pp. 22–23}.

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence that Eritrea has either conducted a joint exercise among public health, animal health, the private sector and national security authorities for a potential deliberate biological event or published standard operating procedures, guidelines, memorandums of understanding, or other agreements between those authorities for such an event. The World Health Organization Strategic Partnership for Health Security Simulation Exercises portal lists one Eritrea entry dated December 2024 as conducted, but the public listing provides no scenario details or participating sectors to demonstrate a deliberate biological exercise or cross-sector scope ²²⁸. The World Health Organization country profile for Eritrea in the 2024–2025 results report provides no page-level documentation of a deliberate biological exercise or cross-sector procedures or agreements ²²⁹. The World Health Organization State Party Self-Assessment Annual Reporting page “SPAR – Eritrea Submitted (2024)” does not include publicly accessible annexes or entries proving such an exercise or instruments ²³⁰. In the United Nations Eritrea “Annual Results Report 2024,” there is no description of a deliberate biological exercise or publicly available standard operating procedures, guidelines, memorandums of understanding, or agreements linking public health, animal health, the private sector, and national security authorities ^{231, pp. 4–7}.

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Eritrea has a national risk communication action plan that details risk communication arrangements for use during public health emergencies. A Ministry of Information article from September 2018 explains that the Government of Eritrea has developed a National Risk Communication Action Plan for 2018–2022 which identifies a wide range of rapid and slow onset emergencies, including disease outbreaks, adverse events following immunization, natural disasters and other hazards, and classifies them by risk type to guide tailored communication responses ²³². The article describes that the action plan organises risk communication into four phases covering preparedness before emergencies, immediate life-saving communication during the first 48 hours of an emergency, communication on new emerging threats such as epidemic-prone diseases, and post-emergency recovery, thereby specifying when and how communication is to be conducted in relation to emergency timelines ²³³. It further notes that the action plan establishes a National Risk Communication Task Force to provide strategic guidance, oversight and quality assurance for implementation, confirming that risk communication for emergencies is addressed in a dedicated national strategy document ²³⁴.

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

There is no publicly available evidence that Eritrea has a risk communication plan or other operative instrument that outlines how messages will reach populations and sectors with different communications needs, including different languages, geographic locations, media reach, and vulnerable or hard-to-reach groups. The 2025 World Health Organization Regional Office for Africa “Progress report on the implementation of the regional strategy for community engagement” is regional and does not provide an Eritrea national plan section specifying differentiated outreach modalities ^{235, pp. 2–3}. The United Nations in Eritrea “Annual Results Report 2024” summarizes country program results but does not include a government plan section that details audience segmentation by language, location, media access, or mechanisms to reach vulnerable or hard-to-reach groups for public health emergency risk communication ^{236, pp. 4–7, 14–15}.

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

There is no publicly available evidence that Eritrea designates in a national plan, law, regulation, or strategy a specific government position to serve as the primary spokesperson to the public during a public health emergency. The World Health Organization Strategic Partnership for Health Security Simulation Exercise activities page filtered for Eritrea confirms an exercise conducted on 31 December 2024 and shows the page updated on 30 September 2025, but it does not present any Eritrean instrument or clause assigning spokesperson duties ²³⁷. The United Nations in Eritrea “Annual Results Report 2024” executive and overview pages do not describe or cite any Eritrean plan section or legal provision designating a government spokesperson for health emergencies ^{238, pp. 4–7}.

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

Eritrea has actively shared public health messages via official online media platforms within the past year. On January 28, 2025, the Eritrea Ministry of Information published a government news post reporting improved health-facility deliveries attributed to ongoing awareness-raising activities and providing immunization coverage figures, disseminating program information to the public via the state portal ²³⁹. On October 3, 2025, the same portal published a government call for coordinated action to eradicate female genital mutilation, communicating a health-related message to the population and stakeholders online ²⁴⁰. Earlier, on January 13, 2024, the official portal reported a Ministry of Health workshop on communication for rubella and measles vaccination campaigns, evidencing the use of the government website to publicize health messaging activities ²⁴¹. On February 20, 2024, it reported a Ministry of Health activity assessment meeting, further demonstrating the use of the official portal for public-facing health system communications ²⁴².

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no publicly available evidence that Eritrea’s president or cabinet ministers shared misinformation or disinformation about infectious diseases in the past two years. A May 2025 Ministry of Information feature on malaria progress describes standard prevention and control activities and does not quote ministers or the president with inaccurate claims ²⁴³. A June 2025 Ministry of Information Q&A on veterinary vaccine production profiles laboratory work under the Ministry of Agriculture and contains no senior-leader assertions on human infectious diseases ²⁴⁴. An October 2024 article promoting Sustainable Development Goal 3 highlights vaccination benefits in general terms, again without misleading statements by ministers ²⁴⁵. A December 2023 overview on tuberculosis provides routine program messaging and cites World Health Organization data, not ministerial claims ²⁴⁶. October 2022 tuberculosis coverage and contemporaneous ministry updates similarly report program details and situation figures without senior-leader misinformation ²⁴⁷²⁴⁸.

3.6.1a Percentage of households with Internet

Score: 37.59

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 66.67

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 58.33

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Eritrea implemented restrictions on the export or import of medical goods in the past year due to an infectious disease outbreak. In February 2025, the Ministry of Information reported provincial health program execution and facility expansion, describing service delivery and diagnostics improvements without announcing ministerial trade controls on medicines, oxygen, supplies, or personal protective equipment ²⁴⁹. In July 2025, the Ministry of Information detailed nationwide training for hepatitis B vaccination led by the Ministry of Health, again reflecting routine immunization operations rather than cross-border restrictions on medical goods ²⁵⁰. February 2025 coverage on vaccination performance in Sel’a Sub-Zone likewise framed standard program activities and coordination with border units, not any import or export limitations ²⁵¹. Throughout 2025, the World Health Organization’s Eritrea country page and linked outbreak resources did not publish Eritrea-specific Disease Outbreak News items that would typically underpin emergency trade measures ²⁵². In September 2025, a United Nations International Children’s Emergency Fund Executive Board statement by Eritrea’s mission highlighted program collaboration and priorities without indicating health-goods trade restrictions ²⁵³. May 2025 health features on measles control also presented routine immunization messaging, not border measures ²⁵⁴.

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no publicly available evidence that Eritrea implemented restrictions on the export or import of non-medical goods in the past year due to an infectious disease outbreak. In May 2025, the Ministry of Information reported a national agribusiness conference convened by the Ministry of Agriculture and the Food and Agriculture Organization, describing sector development priorities without announcing border trade controls on food or other non-medical commodities ²⁵⁵. One week later, a validation workshop on Eritrea’s food control system was publicized, focusing on regulatory strengthening and safety rather than import or export limitations linked to outbreaks ²⁵⁶. In August 2025, the Ministry of Information summarized Ministry of Agriculture progress and innovation, highlighting horticulture outputs and seedling distribution with no indication of cross-border trade restrictions ²⁵⁷. In September 2025, a government seminar on integrated organic agricultural practices emphasized safe and nutritious food production across ministries, again with no mention of outbreak-related trade measures on non-medical goods ²⁵⁸. Concurrently, the World Health Organization’s regional emergency bulletins for 2025 reported acute events in other countries but did not feature Eritrea items that would typically underpin emergency restrictions on non-medical trade ²⁵⁹.

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

Eritrea has not implemented inbound or outbound travel restrictions due to an infectious disease outbreak in the past year. The Ministry of Information’s official February 2025 archive lists government announcements without any decrees or notices imposing disease-related border measures, including entry bans, exit controls, flight suspensions, or quarantine-on-arrival rules ²⁶⁰. The daily archive for March 16, 2025 likewise records routine governmental items with no reference to infectious-disease travel restrictions adopted by the Government of the State of Eritrea or the Ministry of Health ²⁶¹. Normal cross-border movements are further evidenced by the April 10, 2025 report documenting the arrival in Asmara of Sudan’s Sovereign Council Chairman for official talks, with no concurrent public-health travel controls ²⁶².

3.7.2b Risk-based approach to international travel-related measures

Score: 100

Eritrea has used a risk-based approach to international travel-related measures. The World Health Organization’s “International Travel and Health — Country list” dated 18 November 2022 and revised 3 January 2023 lists Eritrea and requires a yellow fever vaccination certificate only for travelers arriving from countries with risk of yellow fever transmission, evidencing a conditional, exposure-based entry requirement rather than a blanket rule ^{263, p. 18}. The Government of the State of Eritrea’s “Proclamation No. 24/1992 issued to regulate the issuing of travel documents, entry and exit visa from Eritrea, and to control residence permits of foreigners in Eritrea” authorizes border health documentation by requiring a valid international health certificate for entry when designated by the health authority through legal notices and likewise requiring such a certificate for exit, thereby providing statutory authority for disease-specific controls ^{264, pp. 3, 5}. The World Health Organization’s “International Health Regulations (2005) (text incorporating amendments adopted in 2014, 2022, and 2024)” Annex 7 confirms that States Parties may require proof of vaccination against yellow fever for travelers from areas with risk of transmission and specifies certificate validity, aligning Eritrea’s practice with the international risk standard ^{265, pp. 57–58}.

4.1.1a Doctors per 100,000 people

Score: 0.76

4.1.1b Nurses and midwives per 100,000 people

Score: 17.74

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Eritrea has a national health workforce strategy updated within the past five years that identifies shortages and outlines measures to address them. The United Nations Eritrea’s “2023 UN Annual Results Report Eritrea” confirms that in 2023 the Government developed the “National Human Resources for Health Strategic Plan 2023–2027,” a national strategy document under the Ministry of Health that addresses health workforce planning and gaps ^{266, p. 15}. The World Health Organization Country Office Eritrea’s “WHO Eritrea Annual Report 2022” reports WHO technical support to develop the “Human Resources for Health Strategic Plan,” evidencing an official process to put this strategy in place ^{267, p. 6}. The World Health Organization Regional Office for Africa’s “Country Cooperation Strategy 2023–2027, Eritrea” sets country-specific outcomes and interventions for workforce mapping, scaling training, and an equitable deployment strategy, demonstrating that the strategy includes methods to identify shortages and concrete actions to address them ^{268, p. 33}.

4.1.1d Health system capacity for essential health services

Score: 0

There is no publicly available evidence that Eritrea has sufficient capacity within the health system to deliver essential health services as required under the R3.2 criteria.

The Joint external evaluation of the International Health Regulations (‎2005)‎ core capacities gives the country a score of 2 on this measure. The JEE highlights that the country needs to develop a formal system for sending or receiving medical countermeasure health personnel during a public health emergency from outside Eritrea; formalize agreements with neighbouring countries and regional organizations for sending and receiving surge health personnel; and develop agreements and SOPs for national, in-country deployment of rapid response teams, to ensure smooth deployment of health personnel between zobas.²⁶⁹

The World Health Organization Eritrea Annual Report 2022 notes ongoing gaps in quality of care at health facilities, the need to strengthen laboratory capacity and networks, and weaknesses in district health management to support primary health care delivery, which together indicate that core service delivery functions are still being built rather than fully in place ^{270, pp. 4–5}. World Health Organization Global Health Observatory data, as reported in the Eritrea Universal Health Coverage service coverage index profile, show a value of 50 on a 0 to 100 scale in 2019, demonstrating only partial population coverage of essential services and not a level consistent with sufficient system capacity ²⁷¹. The United Nations Children’s Fund regional Humanitarian Action for Children appeal for 2025 includes Eritrea among 15 countries requiring humanitarian assistance and attributes part of the rising needs to the influx of Sudanese refugees, underscoring continued reliance on external support to sustain basic services ^{272, p. 2}. The 2025 World Health Organization “Health and environment scorecard: Eritrea” reports a summary score of 28 and a policy score of 18 out of 100, with multiple weak or insufficient indicators for environmental health system conditions that underpin service delivery, further suggesting that essential health service capacity is constrained rather than sufficient ^{273, p. 1}.

4.1.1e Essential health services continuity plan for public health emergencies

Score: 100

Eritrea has an operational framework to maintain essential health services during public health emergencies embedded in its core health sector strategies and emergency response guidance. In April 2022, the World Health Organization Regional Office for Africa reported that the Ministry of Health launched the “National Health Sector Strategic Development Plan 2022–26,” its monitoring and evaluation plan, the “Essential Health Care Package 2021,” and the “National Action Plan for Health Security 2022–26” as strategic documents to guide service delivery and health security in Eritrea ²⁷⁴. In April 2022, the United Nations Eritrea office described the Essential Health Care Package as defining the services to be delivered at each level of the health system and as a key instrument for implementing the strategic development plan, thereby identifying a nationally endorsed package of essential services to be protected during shocks ²⁷⁵. The World Health Organization “WHO Results Report 2024–2025, Country Profile: Eritrea” summarizes continued support to sustain essential services within the universal health coverage agenda ²⁷⁶. Government communication by the Ministry of Information confirmed the official government launch of these instruments in April 2022 ²⁷⁷. The World Health Organization Eritrea biennium report for 2020–2021 states that the Essential Health Care Package was developed in 2021 and that COVID-19 preparedness and response activities included guidelines and support for continuity of essential health services ^{278, pp. 3–5, 8}.

4.1.2a Hospital beds per 100,000 people

Score: 22.79

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

There is no publicly available evidence that Eritrea has a biocontainment patient care unit or a high-level isolation patient room or unit located in-country. The World Health Organization Regional Office for Africa’s “Country Cooperation Strategy 2023–2027, Eritrea” describes emergency preparedness priorities, support to the National Action Plan for Health Security, and health systems strengthening but does not identify any national biocontainment unit or negative-pressure high-isolation clinical capacity as part of service delivery arrangements ^{279, pp. 5–7, 20–22}. The United Nations Eritrea “2023 UN Annual Results Report, Eritrea,” published in March 2025, details health sector results, cooperation framework outcomes, and planned focus for 2024, yet it likewise contains no reference to an operational biocontainment patient care unit or high-level isolation rooms within Eritrea’s hospitals ^{280, pp. 25–33, 71}

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is no publicly available evidence that Eritrea has demonstrated expanded isolation capacity in 2024–2025, or developed, updated, or tested a plan in the past two years to expand isolation capacity in response to an infectious disease outbreak. The World Health Organization Regional Office for Africa’s “Country Cooperation Strategy 2023–2027, Eritrea” sets priorities for emergency preparedness, infection prevention and control, and service readiness but does not identify actions in 2024 or 2025 evidencing expanded isolation capacity or a government plan to expand such capacity during outbreaks ^{281, pp. 5–7, 20–22}. The United Nations Eritrea “2023 UN Annual Results Report, Eritrea,” published in March 2025, details health sector results through 2023 and the Country Team’s 2024 focus, yet it provides no evidence from the past two years of executed surge measures to expand isolation beds, nor does it cite a government plan updated or tested in the past two years for expanding isolation capacity ^{282, pp. 25–33, 71}.

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 50

Eritrea has at least one national procurement framework that can be used by the Ministry of Health to obtain selected medical supplies for routine needs, but there is no publicly available evidence of an equivalent framework that clearly covers laboratory supplies or comprehensive medical equipment for both the health and agriculture sectors. A September and October 2024 audit by the United Nations Children’s Fund Office of Internal Audit and Investigations reports that procurement of all programme supplies for United Nations Children’s Fund supported interventions in Eritrea is routed through a government mandated procurement agency via the Ministry of Finance and National Development, with funds disbursed through Direct Cash Transfers and Face Forms, indicating an operational national channel for routine supply acquisition but excluding vaccines, medicines and nutrition supplies from this mechanism ^{283, pp. 5, 8}. An October 2015 health system strengthening application form published by Gavi, the Vaccine Alliance, describes how the Ministry of Health uses a National procurement Guideline, a Project Management Unit and the Pharmaceuticals and Medical Equipment Procurement Corporation as the procurement agent for pharmaceutical items, medical equipment and supplies, health products and commodities funded by Gavi grants ^{284, pp. 8, 11, 43}. The Eritrean National Action Plan for Combating Antimicrobial Resistance adopted in December 2020 documents procurement and supply management arrangements for antimicrobials across the Ministry of Health, the Ministry of Agriculture and the Ministry of Marine Resources, but highlights gaps in laboratory capacity, quality assurance and standardized procedures, and does not present a national protocol for procuring laboratory reagents or media ^{285, pp. 8, 12–13}.

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 33.33

Eritrea has a national stockpile of medical supplies for national use during public health emergencies defined by the national epidemic response plan. The World Health Organization Joint External Evaluation report, published March 2017 from an October 2016 mission, states that the Ministry of Health incorporates countermeasures into the national epidemic response plan and that the Eritrean Pharmaceuticals Agency maintains a national stockpile supported by national standard operating procedures for receiving and issuing countermeasures, framework agreements with suppliers, fast-track import and customs clearance, and a Ministry of Health Medical Stores Department distribution network with six regional centers intended to supply facilities within 24 hours ^{286, pp. 47–48}. The United Nations Children’s Fund “Access to COVID-19 Tools Accelerator Supplies Financing Facility, Quarterly Report, Quarter 2, 2025” lists Eritrea transactions for cold-chain equipment, oxygen-related consumables, a pressure swing adsorption oxygen plant, and oxygen concentrators, evidencing continued 2025 procurement into national logistics channels ^{287, p. 11}.

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence that Eritrea has a national stockpile of laboratory supplies such as reagents and media for national use during a public health emergency. The World Health Organization “Joint External Evaluation of IHR Core Capacities of the State of Eritrea,” published in March 2017 from an October 2016 mission, identifies a national stockpile of medical countermeasures under the Eritrean Pharmaceuticals Agency and describes distribution procedures, but it does not establish any centralized emergency stockpile of laboratory reagents or media ^{288, pp. 47–48}. The Ministry of Health “National Action Plan for Health Security 2017–2021,” issued in August 2017, budgets the equipping of antimicrobial resistance laboratories with media, reagents, discs, standard organisms, and equipment at facility level, which evidences routine laboratory provisioning rather than a national laboratory-supplies stockpile with defined contents or release triggers ^{289, p. 10}. A Ministry of Information report dated August 2025 on nationwide distribution of medicines, medical equipment, and oxygen does not provide a policy, plan, or inventory for a laboratory reagents stockpile ²⁹⁰.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available evidence that Eritrea conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency. The 2016 World Health Organization “Joint External Evaluation of IHR Core Capacities of State of Eritrea” describes medical countermeasures capacity, notes limited dedicated stockpiles, and recommends strengthening inventory control but does not establish any legally mandated or routinely implemented annual stockpile sufficiency review ^{291, pp. 54–56}. The Ministry of Health and the World Health Organization “National Action Plan for Health Security 2017–2021” identifies rehabilitation of the Pharmaceutical and Medical Supplies Corporation of Eritrea infrastructure, cold chain, transport, and supply chain systems as priorities, yet it does not create or require a recurring annual review mechanism for a national emergency stockpile ^{292, pp. 9, 38}. Government reporting in 2024 and 2025 details procurement volumes, pre procurement inspections, and distribution of medicines, equipment, and oxygen by the Pharmaceutical and Medical Supplies Corporation of Eritrea without any reference to a mandated or conducted annual sufficiency review of a national emergency stockpile ²⁹³²⁹⁴.

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

Eritrea has an operational national mechanism to procure medical supplies for public health emergencies. The World Health Organization “WHO Eritrea Annual Report 2022” records active procurement actions in 2022 specifically to strengthen emergency response capability, including international procurements for an emergency care unit, supplies to upgrade a regional referral hospital and laboratory, and five ambulances with deliveries scheduled from late 2022 into early 2023 ^{295, p. 16}. The Ministry of Information reported on May 7, 2024 that the Pharmaceutical and Medical Supplies Corporation of Eritrea distributes medicines at fair prices and undertakes technical and financial evaluations before procurement with quality inspections coordinated with the National Food and Medicines Control, while importing additional medicines to meet national demand ²⁹⁶. On August 28, 2025, the Ministry of Information further reported national distribution by the corporation of medicines and medical equipment in the first half of 2025 and more than 23,000 cubic meters of oxygen, with technical, quality, and financial inspections conducted before procurement and commissioning ²⁹⁷.

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 100

Eritrea has a documented national mechanism to procure and distribute laboratory supplies for use during public health emergencies. In June 2017 the Ministry of Health issued the National Action Plan for Health Security (NAPHS) for 2017 to 2021, which describes a five year health security strategy and identifies as a core cost driver the equipping of antimicrobial resistance standard diagnostic laboratories at zoba level with laboratory supplies, explicitly listing media, reagents, discs, drugs, standard organisms and standard laboratory equipment for designated laboratories in Mendefera and Barentu ^{298, p. 10}. The same section of the National Action Plan for Health Security lists medical countermeasures through rehabilitation of the Pharmaceutical and Medical Supplies Corporation of Eritrea and improvements at points of entry among the main cost drivers, linking laboratory supply functions to wider systems for moving medical countermeasures during health emergencies ^{299, p. 10}. In May 2024 the Ministry of Information reported that the Pharmaceutical and Medical Supplies Corporation of Eritrea conducts technical, quality and financial evaluations before importing medicines and medical equipment and distributes them to health facilities across the country ³⁰⁰. In August 2025 the Ministry of Information confirmed continued distribution of supplies to meet the demands of health facilities, showing that these procurement and distribution mechanisms remained operational during the assessment period ³⁰¹.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Eritrea has a national mechanism for emergency logistics and supply chain management that is regularly reviewed, explicitly covers cold chain requirements for vaccines, and includes distribution to private pharmacies. The Gavi, the Vaccine Alliance “Decision Letter — Cold Chain Equipment Optimisation Platform Support, Eritrea” of October 2023 states that annual amounts are disbursed directly to the United Nations Children’s Fund Supply Division, designates the United Nations Children’s Fund as the sole procurement agency, and requires an operational deployment plan before new procurements, performance-framework reporting, a cold chain equipment maintenance indicator, and a yearly updated cold chain equipment inventory, together with country responsibility for reception at the port of entry and customs clearance ^{302, pp. 2–4}. The Ministry of Information reported that in the first half of 2025 the Pharmaceutical and Medical Supplies Corporation of Eritrea distributed medicines and equipment nationwide, with 85% to Ministry of Health facilities and 15% to other government institutions and private pharmacies, evidencing coverage of both public and private sectors ³⁰³. The World Health Organization and the United Nations Children’s Fund immunization profile confirms active national monitoring with a July 2, 2024 publication date and a next revision scheduled for July 15, 2025 ^{304, p. 1}.

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no publicly available evidence that Eritrea has an officially issued national plan, program, or guidelines for dispensing medical countermeasures for national use during a public health emergency. The World Health Organization Country Office Eritrea “WHO Annual Report 2022” confirms strategic instruments active in 2022, but it does not publish or excerpt any ministerial standard operating procedures or guidelines for dispensing antibiotics, therapeutics, diagnostics, or emergency vaccine dispensing at population scale ^{305, pp. 4–5}. The Ministry of Health’s “Final National Action Plan for Health Security 2017–2021” identifies activities to strengthen response logistics and explicitly lists development of medical countermeasures and personnel deployment plans, standard operating procedures, and protocols as tasks to be created, without providing a finalized national dispensing instrument ^{306, pp. 37–38}. The Gavi “Decision Letter – Cold Chain Equipment Optimisation Platform Support, Eritrea” details equipment financing, deployment planning, performance reporting, and customs responsibilities, but it is an external programmatic financing and logistics document rather than a Government of Eritrea dispensing plan or guideline for emergencies ^{307, pp. 1–3}.

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 100

Eritrea has a publicly available national plan that provides for workforce surge during a public health emergency. The Ministry of Health’s “National Action Plan for Health Security, 2017–2021” presents specific personnel deployment measures, including establishing or formalizing agreements with neighboring countries and regional organizations for mutual cross border support, ensuring the sending and receiving of surge personnel, developing a formal system to receive health personnel from outside Eritrea during a public health emergency, and updating guidelines for licensing and performance monitoring of deployed personnel ^{308, pp. 37–38}. These measures demonstrate that Eritrea has a defined national mechanism to increase health workforce capacity during emergencies. In April 2022 the United Nations reported the government’s launch of the “National Action Plan for Health Security 2022–26” as the guiding document for emergency operations, confirming continuation of the national planning framework for emergency workforce management ³⁰⁹. The World Health Organization Eritrea Annual Report 2022 documents nationwide dissemination of the National Action Plan for Health Security, development of annual operational plans, implementation of Integrated Disease Surveillance and Response scale up using rapid response teams, and a costed action plan for Public Health Emergency Operations Centers designed to coordinate response, deploy personnel, and manage real time information ^{310, p. 11}.

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 100

Eritrea has a publicly available national plan that provides for receiving health personnel from other countries during a public health emergency. The Ministry of Health of the Government of Eritrea issued the “National Action Plan for Health Security, 2017–2021”, and its Medical Countermeasures and Personnel Deployment actions require establishing or formalizing agreements with neighboring countries and regional organizations to ensure mutual cross border aid for sending and receiving surge health personnel, developing a formal system for receiving health personnel from outside Eritrea during a public health emergency, and updating guidelines for licensing and performance monitoring of deployed personnel ^{311, pp. 37–38}. On 28 April 2022, the United Nations in Eritrea reported a government event launching the “National Action Plan for Health Security 2022–26.” ³¹². The World Health Organization Regional Office for Africa’s “WHO Eritrea Annual Report 2022” states that the World Health Organization supported the Ministry of Health to launch and disseminate the National Action Plan for Health Security nationwide and to ensure development and dissemination of annual operational plans, together with a costed action plan for Public Health Emergency Operations Centers at national and province levels ^{313, p. 10}. The World Health Organization Strategic Partnership for Health Security portal shows Eritrea’s country file active in 2025, corroborating current-cycle engagement ³¹⁴.

4.3.2c Plan to redeploy existing health personnel within the country

Score: 100

Eritrea has a publicly available national plan in force in 2025 that provides for redeploying existing health personnel within the country, both geographically and by role. The Ministry of Health of the Government of Eritrea’s “National Action Plan for Health Security (NAPHS), 2017–2021” requires staff training and standard operating procedures for emergency activation and exercises, establishes Public Health Emergency Operations Center arrangements from national to province levels with procedures and personnel to activate response, and includes a “Medical Countermeasures and Personnel Deployment” package directing development of a personnel deployment plan with standard operating procedures and protocols, an inventory of deployable experts, and updated licensing and performance-monitoring guidelines for deployed personnel ^{315, pp. 31, 38–39}. On 28 April 2022, the United Nations in Eritrea reported the Government’s launch of the “National Action Plan for Health Security 2022–26,” confirming an updated public framework ³¹⁶. The World Health Organization Regional Office for Africa’s “WHO Eritrea Annual Report 2022” documents establishment and operationalization of Public Health Emergency Operations Centers, including policies, plans and procedures, infrastructure, information and communications technology, information systems and standards, and capacity building for Public Health Emergency Operations Center staff ^{317, p. 5}. The World Health Organization Strategic Partnership for Health Security portal lists Eritrea’s country entry active in 2025, corroborating current-cycle engagement ³¹⁸.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 50

Eritrea has a constitutional provision that recognizes access to health services as a state objective subject to resource limits rather than an explicit, enforceable right to medical care for all citizens. The Government of Eritrea’s “Eritrea’s Constitution of 1997” states under Article 21 that every citizen has the right of equal access to publicly funded social services and that the State shall endeavor, within the limit of its resources, to make available to all citizens health, education, cultural and other social services ^{319, p. 11}. No article in the rights chapter converts this objective into a universal, explicit constitutional right to medical care; health appears within Article 21’s resource-contingent formulation rather than as a stand-alone right ^{320, p. 11}.

4.4.1b Access to skilled birth attendants (% of population)

Score: 2.94

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 94.19

4.4.1d Coverage of essential health services through universal health coverage

Score: 37.5

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 0

4.4.1f Rate of mortality amenable to health care

Score: 82.86

4.4.2a Guaranteed paid sick leave

Score: 66.67

Eritrea has government mandated paid sick leave for workers who are medically certified as unable to work due to sickness, but there is no publicly available evidence that Eritrea explicitly guarantees that the paid portion of this sick leave applies to mental health conditions. Article 62 of “The Labour Proclamation of Eritrea No. 118/2001,” issued by the government on 15 November 2001, entitles an employee who has completed probation and is incapable to work owing to sickness that is not caused by an employment injury to up to 6 months of sick leave in any 12 month period, with 1 month on full wages, 2 additional months on half wages, and a further 3 months without pay, subject to a valid medical certificate from a legally competent institution ^{321, p. 22}. The World Health Organization reports in the “Mental Health Atlas 2020 Country Profile: Eritrea” that Eritrea’s national system provides insured treatment for mental health conditions including psychosis, bipolar disorder, and depression with no payment at point of service use ^{322, p. 2}. The government states in its 2025 “Fourth Periodic National Report” that this labour framework remains in force through 2024 and describes free health service provision and worker protections under the Ministry of Labour and Social Welfare, but does not confirm that an employee may claim the paid portion of sick leave specifically for a mental health condition ^{323, pp. 14, 48}.

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that Eritrea has issued legislation, a policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency. On April 29, 2022, the World Health Organization Regional Office for Africa announced the national launch of “Health Sector Strategic Development Plan 2022 to 2026” and “National Action Plan for Health Security 2022 to 2026,” which describe current sector and health security frameworks but do not state a commitment to prioritized care for ill responders ³²⁴. The World Health Organization Eritrea “Annual Report 2022,” published in February 2023, confirms development, dissemination, and implementation of the National Action Plan for Health Security 2022 to 2026 and preparation of a costed action plan for public health emergency operations centers without any provision prioritizing clinical services for healthcare workers who become ill during response activities ^{325, p. 11}. A Ministry of Information sector roundup on May 29, 2025 lists achievements without an explicit guarantee of prioritized treatment for sick healthcare workers ³²⁶.

4.5.1a Existence of system for communication during a public health emergency

Score: 100

Eritrea has a national system that enables public health officials and healthcare workers to communicate during public health emergencies. The World Health Organization Eritrea “Annual Report 2022” records that the Ministry of Health adapted the third edition of the Integrated Disease Surveillance and Response technical guidelines and training modules in 2022, with the guidelines defining roles at all levels for detection, reporting, data analysis, investigation, response, monitoring, evaluation, and supervision, thereby establishing structured information flow between authorities and the health workforce ^{327, p. 11}. The same report confirms a costed action plan to establish public health emergency operations centers at national and Zoba levels, designed to enhance real time communication and information sharing across the national health system during emergencies ^{328, p. 11}. A World Health Organization Regional Office for Africa news release from May 2022 corroborates that the revised Integrated Disease Surveillance and Response guideline serves as a working reference for the Eritrean health workforce and facilitates early detection, notification, and timely response ³²⁹. A Ministry of Information sector update from May 2025 shows ongoing implementation of current sector frameworks ³³⁰.

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no publicly available evidence that Eritrea has a system that explicitly encompasses healthcare workers in both the public and the private sector for communication during a public health emergency. The World Health Organization Eritrea “Annual Report 2022” records national adaptation of the “Integrated Disease Surveillance and Response Technical Guidelines and Training Modules” with defined roles at all levels and confirms a costed action plan to establish Public Health Emergency Operations Centres with information and communication technology infrastructure and information systems for emergency operations, yet it does not state that private sector healthcare workers are included ^{331, p. 11}. A World Health Organization Regional Office for Africa news release from May 2022 corroborates the revised guideline as a working reference for the Eritrean health workforce and its function in facilitating early detection, notification, and timely response, without identifying inclusion of the private sector ³³². A Ministry of Information sector update from May 2025 lists achievements without language confirming private sector emergency communications ³³³.

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no publicly available evidence that Eritrea is monitoring for and tracking the number of healthcare associated infections that take place in healthcare facilities nationally. The Government of Eritrea’s “Eritrean National Action Plan on Antimicrobial Resistance 2021–2025” mandates infection prevention and control committees, focal persons, training, equipping, and twice-yearly supportive supervision, and lists output indicators such as the number of supervisions and hand-hygiene compliance, as well as outcome indicators like prevalence of hospital-acquired infections and percent reduction of incidence, but it does not establish or evidence a national mechanism that aggregates and reports healthcare associated infection counts from facilities ^{334, pp. 20, 45, 66}. The World Health Organization Strategic Partnership for Health Security portal shows Eritrea’s State Party Self-Assessment as “Submitted (2024)” and was updated on April 2, 2025 with infection prevention and control capacities displayed, but it does not publish Eritrea’s national healthcare associated infection surveillance data or demonstrate routine tracking of such counts by the public health system ³³⁵.

4.6.1b Infection prevention and control programme

Score: 100

Eritrea maintains a national infection prevention and control program overseen by the Ministry of Health. The Ministry of Health documents this program in the “Eritrean National Action Plan for combating Antimicrobial Resistance 2021–2025 (One Health approach),” issued in February 2021, which reports that infection prevention and control committees operate at national, zonal, and hospital level in all hospitals, that infection prevention and control focal persons are assigned to lower level health facilities nationwide, and that health workers are equipped and trained to minimize healthcare associated infection and keep hospitals safe ^{336, pp. 10, 34–36}. The February 2021 plan states that the Ministry of Health prepared a national infection prevention and control guideline to be printed and distributed to all health facilities in 2022; implemented national training of trainers and cascade training for infection prevention and control in 2023; supplied infection prevention and control materials and Clorox producing machines to health facilities in 2023; and scheduled supportive supervision of infection prevention and control practices in all health facilities twice per year in 2024 and 2025 to monitor adherence to the national guideline ^{337, pp. 34–36}. The World Health Organization records Eritrea’s State Party Self-Assessment Annual Reporting for 2024, updated 2 April 2025, confirming ongoing national capacity for International Health Regulations Core Capacity C.9.2 on infection prevention and control ³³⁸.

The Ministry of Health of the State of Eritrea issued the “National Action Plan for Health Security (NAPHS), 2017–2021” in June 2017, which requires the Ministry of Health to finalize a national multi-hazard public health emergency preparedness and response plan that includes establishing Emergency Operations Centers with defined infrastructure, staffing, procedures, and supervision at national and regional level; to review national health infrastructure to establish permanent infection isolation facilities; to construct or identify dedicated infrastructure for Public Health Emergency Operations Centers and equip them with information and communication technology and personnel.^{339, pp. 38–40}. It further includes strategies for "developing Healthcare Associated infection prevention and control policies, strategies and guidelines within animal and public health sectors" and "reviewing the national health infrastructure for emergency response to establish permanent infection isolation facilities." ^{340, pp. 35-37}

4.6.1c National plan to ensure a safe environment in health facilities

Score: 0

There is no publicly available evidence that Eritrea has a national plan specifically aimed at ensuring a safe environment in health facilities nationwide. The Ministry of Health launched the “National Action Plan for Health Security, 2022–2026” on 28 April 2022 as the guiding document for emergency preparedness and response, but the United Nations report of the event does not describe a national plan or strategy that establishes infection prevention and control requirements, occupational health protections, water and sanitation standards, medical waste management procedures, or other health facility safety measures applied across the national health system ³⁴¹. The World Health Organization Eritrea Annual Report 2022 states that the Ministry of Health, with World Health Organization support, disseminated the National Action Plan for Health Security nationwide, produced annual operational plans, and developed a costed action plan for Public Health Emergency Operations Centers at national and provincial levels to coordinate response activities, supervise staff, and manage real time information, but this report does not present a national framework for safe environments in health facilities beyond emergency operations coordination functions ^{342, p. 14}.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 0

There is no publicly available evidence that Eritrea has a national requirement for ethical review before beginning a clinical trial. The Ministry of Health’s “National Action Plan for Health Security (2017–2021)” explicitly records the absence of a Public Health Act and cites no proclamation, regulation, or ministerial order mandating Institutional Review Board or ethics committee approval prior to trials; it describes the National Medicines and Food Administration as a product regulator for the quality, safety, and efficacy of medicines and medical supplies rather than a human-research regulator establishing a national clinical-trial authorization and ethics-review regime ^{343, pp. 13–14}. The Library of Congress “Guide to Law Online: Eritrea” (last updated August 29, 2025) surfaces no post-2017 Eritrean public instrument that establishes a national pre-trial ethics-review requirement, and no such instrument is publicly accessible ³⁴⁴.

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no publicly available evidence that Eritrea has an expedited process for approving clinical trials for unregistered medical countermeasures or a national mechanism for mutual recognition of external clinical trial results to address ongoing pandemics or epidemics. The Law Library of Congress “Guide to Law Online: Eritrea,” updated in August 2025, consolidates official Eritrean legal gateways and does not surface any statute, proclamation, ministerial regulation, circular, or guideline creating an expedited clinical trial pathway or a mutual recognition procedure, and it links to no such instrument ³⁴⁵. The “International Compilation of Human Research Standards, 2024 Edition: Africa,” issued by the Office for Human Research Protections of the United States Department of Health and Human Services and last updated in June 2024, lists African countries with identified human research and clinical trial standards; Eritrea does not appear in the Africa country listings, and no Eritrea entry describes expedited approvals or mutual recognition ^{346, pp. 2–3, 5–12}.

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

Eritrea has a government agency responsible for approving new human medical countermeasures. The African Union Development Agency’s African Medicines Regulatory Harmonization country profile for Eritrea states that in Eritrea applications for registration are submitted to the Ministry of Health’s National Medicines and Food Administration, with a site master file requirement and the possibility of good manufacturing practice inspections, confirming the current national pathway for medicines authorization ³⁴⁷. The Ministry of Health’s “Eritrean National Action Plan for Antimicrobial Resistance 2021–2026” specifies that the National Medicines and Food Administration regulates the quality, safety, and efficacy of medicines and medical devices across manufacturing, importation, marketing, use, and post-marketing surveillance, and notes that its medicines registration guideline was updated to the Common Technical Document format ^{348, p. 22}. A 2024 peer-reviewed study lists the Product Evaluation and Registration Unit and the Eritrean Pharmacovigilance Center within the National Medicines and Food Administration as author affiliations, indicating active authorization and pharmacovigilance structures ³⁴⁹.

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

Eritrea has an expedited, recognition-based pathway for medical countermeasures. The World Health Organization lists Eritrea as a participating national regulatory authority in the Collaborative Registration Procedure tracks for products approved by Stringent Regulatory Authorities, for prequalified medicines and vaccines, and for in vitro diagnostics, enabling accelerated national reliance on external regulatory decisions ^{350, p. 1351, p. 1352, p. 1}. The Collaborative Registration Procedure is a formal reliance mechanism through which the Ministry of Health can recognize prior assessments or approvals to shorten national timelines for medicines, vaccines, and diagnostics during urgent need ^{353, p. 1354, p. 1355, p. 1}. The Government of Eritrea’s “One Health National Action Plan for Antimicrobial Resistance, 2020–2025,” issued in December 2020, identifies the National Medicines and Food Administration within the Ministry of Health as the competent regulator for medicines and medical devices, providing the institutional locus to apply these reliance routes to medical countermeasures ^{356, p. 22}.

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Eritrea has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.³⁵⁷

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 0

There is no publicly available evidence that Eritrea has integrated epidemics and pandemics into a national disaster risk reduction strategy or adopted a standalone national disaster risk reduction strategy for epidemics and pandemics. The United Nations Office for Disaster Risk Reduction PreventionWeb country page for Eritrea lists no national disaster risk reduction strategy, national platform, or government policy document ³⁵⁸. The United Nations Development Programme's Eritrea Annual Report 2024 documents collaboration with the Ministry of Agriculture on an Integrated Disaster Risk Management and Climate Change Adaptation Framework for six agroecological zones, which is sectoral and does not constitute a national strategy ^{359, p. 13}. The United Nations Children’s Fund Eastern and Southern Africa regional situation report dated December 31, 2024 describes Eritrea’s coordination priorities for integrating humanitarian response with development cooperation and inter-sectoral emergency preparedness, which is not a national disaster risk reduction strategy ^{360, p. 21}. The World Health Organization 2024–2025 results page for Eritrea highlights support to strengthen health emergency preparedness, again within the health sector rather than a government-adopted national all-hazards strategy ³⁶¹.

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 0

There is no publicly available evidence that Eritrea has cross border agreements, protocols, or memoranda of understanding with neighboring countries or as part of a regional group that commit Eritrea to joint public health emergency preparedness, surveillance, or response. On 22 July 2025 Africa Centres for Disease Control and Prevention reported that the Eastern Africa Regional Coordinating Centre provides regional coordination, technical support, and multi country operational platforms for 14 African Union Member States including Eritrea; however this description does not identify any bilateral or multilateral agreements, protocols, or memoranda of understanding signed by the Government of the State of Eritrea with neighboring governments for public health emergencies ³⁶². Africa Centres for Disease Control and Prevention explains in its November 2021 document “Regional Collaborating Centres: Oversight, Core Functions, and Priorities” that each Regional Coordinating Centre is overseen by a ministerial committee and links national public health institutions through regional surveillance and laboratory networks, but this framework is an African Union institutional support mechanism rather than an intergovernmental agreement concluded by Member States, and it does not constitute evidence of Eritrea entering cross border emergency agreements with neighboring countries ^{363, pp. 1–2}.

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Eritrea has regional cross-border animal health protocols. Eritrea's participation in the Global Framework for the Progressive Control of Transboundary Animal Diseases is documented in the joint World Organisation for Animal Health and Food and Agriculture Organization of the United Nations short report of the “4th GF-TADs Eastern Africa Roadmap meeting for Foot-and-Mouth Disease,” which lists Eritrea among the ten participating Eastern Africa countries and sets out coordinated regional arrangements for surveillance, vaccination, information-sharing, and progressive control pathway staging in 2023 ^{364, p. 9}. The same intergovernmental report includes meeting recommendations for regional economic communities to support the preparation, signing, and effective implementation of memoranda of understanding for joint and coordinated cross-border movement management and transboundary animal disease control, confirming a formal protocol framework applicable to Eastern Africa members ^{365, p. 18}. However, the Intergovernmental Authority on Development’s “Annual Report 2023” shows that the operationalization of cross-border animal-health memoranda of understanding and the adoption of an animal-disease information-sharing protocol were limited to four clusters that do not include Eritrea’s borders, namely Ethiopia–Kenya, Ethiopia–Djibouti, Ethiopia–Somalia, and the Karamoja cluster covering Ethiopia, South Sudan, Kenya, and Uganda, which evidences a gap in current implementation covering Eritrea ^{366, pp. 23–25}.

5.3.1a Biological and Toxin Weapons Convention status

Score: 0

There is no publicly available evidence that Eritrea has signed or ratified the Biological Weapons Convention. The United Nations Office for Disarmament Affairs “Membership and Regional Groups” list for the Convention, consulted in October 2025, explicitly places Eritrea in the Non-Signatory States section, confirming that no instrument of signature, accession, or succession has been deposited by the Government of the State of Eritrea ³⁶⁷. The United Nations Treaty Collection entry for the Convention contains no participant record for Eritrea, which corroborates the absence of any depository action with the Depositary Governments ³⁶⁸. The United Nations Office for Disarmament Affairs “United Nations Disarmament Yearbook 2023” records the Convention at 185 States Parties as of December 31, 2023, with additional accessions since then reflected on the live membership page but without any change to Eritrea’s non-party status ³⁶⁹.

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 0

There is no publicly available evidence that Eritrea submitted confidence building measures for the Biological Weapons Convention in the past three years. The United Nations Office for Disarmament Affairs maintains the official “Membership and Regional Groups” register for the Biological Weapons Convention and lists Eritrea among the States that have neither signed nor acceded, confirming non-party status during 2023–2025 ³⁷⁰. The United Nations Office for Disarmament Affairs operates the confidence building measures portal for States Parties and publishes submissions by country and year; Eritrea does not appear in the 2023, 2024, or 2025 views because non-parties do not file confidence building measures ³⁷¹. The United Nations Office for Disarmament Affairs confidence building measures statistics page further reports participation figures for States Parties for each cycle and contains no entry for Eritrea in the period assessed ³⁷². A United Nations Office for Disarmament Affairs update in September 2025 documents outreach to African States not yet party, corroborating that universalization efforts remained ongoing in the current year and that non-party status persisted for the cohort that includes Eritrea ³⁷³.

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Eritrea has provided the required national report to the Security Council Committee established pursuant to United Nations Security Council Resolution 1540. The United Nations Security Council document “S/AC.44/2004/(02)/132” contains a note verbale from the Permanent Mission of the State of Eritrea dated June 22, 2006 transmitting “the national report of the Government of the State of Eritrea,” followed immediately by the annex titled “Report of the Government of the State of Eritrea pursuant to Security Council resolution 1540 (2004),” which fixes Eritrea’s submission to the Committee in June 2006 ^{374, pp. 1–2}. The annex text carries the internal dateline “Asmara, 15 June 2006,” confirming the report’s preparation date within the national submission package ^{375, p. 3}. A United Nations Institute for Disarmament Research monograph published in June 2008 independently cites this same Eritrean submission by symbol and date, corroborating that Eritrea’s 1540 national report was filed with the Committee ^{376, p. 136}.

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

There is no publicly available evidence that Eritrea meets at least two of the specified memberships. The Government of Australia’s Department of Foreign Affairs and Trade maintains the official “Participants” roster for the Australia Group and Eritrea does not appear on that list, demonstrating non-membership during the assessed period ³⁷⁷. The Global Partnership Against the Spread of Weapons and Materials of Mass Destruction publishes its official “Members and Partners” roster and Eritrea is not listed, indicating it is not a Global Partnership member in the timeframe reviewed ³⁷⁸. The Proliferation Security Initiative’s official endorsing states list, maintained by the Federal Foreign Office of Germany and dated November 19, 2024, enumerates endorsers of the Statement of Interdiction Principles; Eritrea does not appear, confirming it has not endorsed the initiative ³⁷⁹.

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

There is no publicly available evidence that Eritrea has completed a Joint External Evaluation or precursor external evaluation and published a full public report within the last five years. The World Health Organization’s country report “Joint External Evaluation of IHR Core Capacities of the State of Eritrea” confirms the assessment occurred in Asmara during October 3–8, 2016 and presents the full evaluation text, establishing that the most recent publicly available report is from 2017 ^{380, pp. 1, 63}. The Strategic Partnership for Health Security page titled “JEE – Eritrea In Pipeline,” updated July 21, 2025, indicates planned activity but provides no 2020–2025 Eritrea report for download or viewing ³⁸¹. The Strategic Partnership for Health Security activities listings show Eritrea’s historical 2016 JEE with an attachment and also display August 11–16, 2025 as conducted or in pipeline entries, yet there is no posted 2025 Eritrea JEE report ³⁸². The World Health Organization’s publication page for the Eritrea JEE likewise lists the report as published March 8, 2017, reinforcing that no newer public report exists in the last five years ³⁸³.

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

There is no publicly available evidence that Eritrea completed and published a Performance of Veterinary Services assessment in the last five years. The World Organisation for Animal Health Regional Representation for Africa maintains the public registry of Performance of Veterinary Services Pathway missions and lists Eritrea’s Performance of Veterinary Services Evaluation as conducted in 2009 and its Performance of Veterinary Services Gap-Analysis in 2011, with no later Performance of Veterinary Services Evaluation entries for Eritrea in 2021–2025 ³⁸⁴.

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

There is no publicly available evidence that Eritrea completed and published a Performance of Veterinary Services gap analysis in the last five years. The World Organisation for Animal Health Regional Representation for Africa’s public registry lists Eritrea’s Performance of Veterinary Services activities as “PVS Evaluation (initial): 2009,” “PVS Gap-Analysis: 2011,” and “PVS Legislation: 2019,” and the legend on that page specifies that only years in bold have downloadable public reports; Eritrea’s entries are not bolded and there are no entries dated 2021–2025 ³⁸⁵. The World Health Organization Strategic Partnership for Health Security country page for Eritrea likewise records the Performance of Veterinary Services gap analysis year as 2011 and provides no newer gap analysis report ³⁸⁶.

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

There is no publicly available evidence that Eritrea has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years. The International Budget Partnership’s “Open Budget Survey 2023 Data Tables” do not list Eritrea anywhere in the country tables, indicating the absence of publicly released national budget documents needed to verify recent appropriations, including for health emergency preparedness ^{387, pp. 3–5, 22–25}. The Bertelsmann Stiftung 2024 country report for Eritrea states that the country has not published a national budget, reinforcing that no publicly accessible appropriation or enacted budget can be cited for the past three years ³⁸⁸. Government communications describe large-scale distribution of medicines and medical equipment by the Pharmaceutical and Medical Supplies Corporation of Eritrea in May 2024 and August 2025, but these reports do not provide an appropriation law, budget line, or treasury allocation documenting domestic funding for epidemic or pandemic capacity ³⁸⁹³⁹⁰.

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 100

Eritrea has allocated specific domestic funding in its National Action Plan for Health Security to address identified gaps. The Ministry of Health of the Government of Eritrea published the “National Action Plan for Health Security (2017–2021)” in June 2017, which presents a total estimated implementation cost of USD 53,695,733 and provides an official budget and financial plan by component and year ^{391, p. 9}. The same document explicitly states that the Ministry of Health will allocate 26.2% of this amount, equal to USD 14,068,282, from the national budget for implementation of programs within the Ministry of Health including the National Action Plan for Health Security, and it includes a figure that distributes the estimated costs across 2017 to 2021, thereby covering years within the past five years ^{392, pp. 24–26}. The World Health Organization Regional Office for Africa reported the official launch of the five-year National Action Plan for Health Security on March 27, 2018, confirming government adoption and implementation planning ³⁹³.

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is no publicly available evidence that Eritrea’s Performance of Veterinary Services gap analysis or assessment allocates or describes specific funding from the national budget within the last five years. The World Organisation for Animal Health Regional Representation for Africa's public registry of Performance of Veterinary Services Pathway lists Eritrea’s “PVS Evaluation (initial): 2009,” “PVS Gap-Analysis: 2011,” and “PVS Legislation: 2019,” while the page legend specifies that only years presented in bold have downloadable public reports; Eritrea’s entries are not bold and there are no Eritrea entries within the last five years ³⁹⁴. The World Health Organization Strategic Partnership for Health Security country card likewise records Eritrea’s “PVS Gap Analysis: 2011” and “PVS Evaluation: 2009” and provides no newer Eritrea PVS report, corroborating the absence of any published Performance of Veterinary Services document in the past five years that could evidence domestic funding allocations ³⁹⁵.

5.5.3a Emergency public financing during a public health emergency

Score: 100

Eritrea has a publicly identified special emergency public financing mechanism for health emergencies through the African Public Health Emergency Fund. The World Health Organization Regional Office for Africa issued an information document on July 25, 2025 titled “Progress report on the Framework document for the African Public Health Emergency Fund,” which describes that the African Public Health Emergency Fund mobilizes, manages, and disburses money to Member States such as Eritrea in the first days of an emergency, with requests reviewed within 48 hours and funds disbursed rapidly, and reports a balance of 11.27 million United States dollars as of December 31, 2024 ^{396, pp. 1–2}. Eritrea is named in this document with 56,500 United States dollars received during 2018 to 2024 and 133,076 United States dollars received through 2020, which confirms that Eritrea participates in this mechanism and that Eritrea has already had funds delivered under it ^{397, pp. 4, 11}. This shows that Eritrea has access to a defined, pre-existing rapid financing pathway for outbreak response and other public health emergencies, administered by the World Health Organization Regional Office for Africa, and that Eritrea is explicitly identified on the cited pages as a participating Member State with recorded receipts ^{398, pp. 1–2, 4, 11}.

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

Eritrea has a senior minister level public commitment within the past three years to obtain international support and to strengthen national systems for pandemic and epidemic preparedness. On September 20, 2023, at the High level Meeting on Pandemic Prevention, Preparedness and Response at the United Nations in New York, the Minister of Foreign Affairs of the State of Eritrea stated that combating biological threats and health emergencies is a national priority and described Eritrea’s 2022–2026 National Action Plan for Health Security as a strategic plan designed to collaborate across ministries, local departments, and United Nations agencies so new guidelines can be implemented to respond to pandemics ³⁹⁹. In the same statement, the Minister said that pandemic prevention and response is given top priority in Eritrean national health care policies, identified as national objectives the strengthening of the Emergency Preparedness and Response System and the reinforcement of national capacities under the International Health Regulations, and confirmed that the Government of the State of Eritrea remains committed to improving the health status of its citizens ⁴⁰⁰.

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

Eritrea has, within the past three years, requested and secured donor financing to strengthen domestic capacity against epidemic threats. In September 2023, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved Eritrea’s HIV grant “ERI-H-MOH,” with the Ministry of Health as Principal Recipient, explicitly recording a Board approval date of September 14, 2023 and a 2024–2026 implementation window, which evidences a formal funding request and subsequent financing to address epidemic disease burden and program gaps ⁴⁰¹. In parallel, the Global Fund malaria grant “ERI-M-MOH” is published with a 2024–2026 program period titled “Investing towards Malaria Elimination – Eritrea,” further demonstrating Eritrea’s submission and acceptance of a multi-year donor-financed program to bolster core outbreak-relevant capacities such as surveillance, vector control, diagnostics, and case management ⁴⁰².

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

Eritrea has fulfilled its full assessed contribution to the World Health Organization within the past two years. The World Health Organization report “Status of collection of assessed contributions, including Member States in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution,” dated April 2025, lists Eritrea’s 2024 assessment of US$5,740 as fully collected by 31 December 2024, with no balance outstanding, and shows that arrears from previous financial periods were cleared in 2024 ^{403, Annex 1 p. 7}. The corresponding World Health Organization report from May 2024 documents that the 2023 assessment of US$4,780 was outstanding at 31 December 2023, corroborating that it was subsequently settled as reflected in the 2025 ledger ^{404, Annex 1 p. 7}.

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available evidence that Eritrea has a plan or policy for sharing genetic data, clinical specimens, or isolated specimens with international organizations or other countries beyond influenza. Eritrea’s “National Action Plan for Health Security” dated August 2017 identifies only domestic actions to “develop and implement standard operating procedures for information sharing between animal and human health sectors by 2019,” which concerns intersectoral information exchange inside the country rather than cross-border or international specimen or data sharing, and it does not establish any operative mechanism for outward sharing of biological materials or associated epidemiological data ^{405, pp. 31, 37}. Further, the “Eritrean National Action Plan on Antimicrobial Resistance 2021–2026,” published in December 2020 by the Government of Eritrea, describes fragmented laboratory systems, a lack of guidelines and standard operating procedures, and minimal data sharing across sectors, with no national reference laboratory designated to coordinate sharing of reference materials, which underscores the absence of a defined policy framework for sharing specimens or genetic data internationally beyond influenza ^{406, pp. 18–20, 37, 79}.

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

Eritrea has no publicly documented instance of failing to share samples under the World Health Organization Pandemic Influenza Preparedness framework in the past two years. The World Health Organization Pandemic Influenza Preparedness Advisory Group meeting report dated April 2025 reviews influenza virus sharing for March 1, 2024 to February 28, 2025, noting that 109 viruses were shared on time, 3 were shared late, and 9 were not shared, but it does not identify any Member State by name as non-sharing and contains no country-specific finding against Eritrea ^{407, pp. 3–4}. The World Health Organization “Global Respiratory Virus Activity: Weekly Update No. 543” for September 2025 provides aggregated surveillance updates and methodological notes and does not publish any country-level notice of non-sharing or non-compliance with the Pandemic Influenza Preparedness framework, including none for Eritrea ^{408, p. 1}.

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

Eritrea has no publicly posted World Health Organization notice or record in the past two years stating that it failed to share pandemic pathogen samples during an outbreak. The World Health Organization “WHO Results Report 2024–2025: Country Profile — Eritrea” lists Eritrea and summarizes 2024–2025 country results without any alert, sanction, or statement about non-sharing of outbreak samples ⁴⁰⁹. The World Health Organization “Eritrea” country page, which aggregates WHO-issued country materials, likewise contains no public communication alleging failure by Eritrea to share pandemic pathogen samples during 2024–2025 ⁴¹⁰. For cross-checking during the same period, the World Health Organization “Meeting Report: Pandemic Influenza Preparedness (PIP) Framework Advisory Group, 1–4 April 2025” reviews virus sharing but does not name Eritrea for non-sharing on the cited pages ^{411, pp. 3–4}.

6.1.1a Policy formation

Score: 25

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 0

6.1.1e Corruption

Score: 13

6.1.1f Accountability of public officials

Score: 0

6.1.1g Human rights risk

Score: 0

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 75

6.1.4a Risk of terrorism

Score: 50

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 75

6.1.5a Presence or risk of armed conflict

Score: 50

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 0

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 68.46

6.2.2a UNDP Gender Inequality Index score

Score: 0

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 100

6.2.3b Share of employment in the informal sector

Score: 50

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 99.92

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 25

6.3.3a Adequacy of power network

Score: 25

6.4.1a Urban population (% of total population)

Score: 62.24

6.4.2a Change in forest area (percentage points)

Score: 73.28

6.4.3a Natural disaster risk

Score: 25

6.5.1a Total life expectancy (years)

Score: 64.24

6.5.1b NCD mortality rate

Score: 30.82

6.5.1c Population aged 65+

Score: 80.52

6.5.1d Tobacco use (% of adults)

Score: 100

6.5.1e Level of adult obesity (%)

Score: 90.94

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 67.15

6.5.2a Access to potable water

Score: 50.93

6.5.2b Access to at least basic sanitation facilities

Score: 11.88

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 1.5

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50