Burundi: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

There is evidence that Burundi has a national AMR plan that covers surveillance, detection, and reporting of priority AMR pathogens. Burundi has a national AMR plan (2020-2023), which mentions mentions surveillance, detection, and reporting, there is no publicly available evidence that it has been renewed or updated. ¹ The AMR plan states, for example, that “The surveillance of antimicrobial resistance is still in its infancy in Burundi. Laboratory capacity remains weak, and a functional national network has not yet been established.” ²

The Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities for Burundi, conducted in March 2018 states that "No national system for antimicrobial resistance surveillance is currently operational. Data are collected sporadically from hospitals and are not reported systematically." The JEE does reference an AMR surveillance guide which identifies several laboratories designated specifically for the detection of Mycobacterium tuberculosis, including those at the National Institute of Public Health (INSP), Kamenge University Hospital Centre, Kamenge Military Hospital, Prince Regent Charles Hospital, and Prince Louis Rwagasore Clinic. The JEE does not clarify whether these facilities engage in broader surveillance, detection, or reporting of AMR pathogens. ³

There is no publicly available active AMR plan or related documentation on the websites of the Ministry of Public Health, the Ministry of Agriculture and Livestock, and the National Institute of Public Health (INSP). ⁴⁵⁶ There is no updated information from the WHO Global Database on AMR Country Self Assessments for Burundi's 2025 status and there are no AMR Action Plans listed for Burundi in the WHO Library of National Action Plans. ⁷

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

Score: 50

There is evidence that the country of Burundi has a national laboratory system that regularly tests for some priority AMR pathogens. The national laboratory is housed under the National Institute of Public Health, and has been active since 2004. ⁸ The Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities for Burundi, conducted in March 2018, mentions established laboratories for the detection of Mycobacterium tuberculosis, but did not assert the presence of a nationally coordinated system, or testing of other priority AMR pathogens. ⁹ The 2023 JEE, the report for which is not yet publicly available, attributed Burundi the lowest score of a 1 for "P.4.2 Surveillance of AMR". ¹⁰

No evidence of the laboratory's capacity to test for priority pathogens besides Tubercolisis was found on the Ministry of Public Health or Ministry of Agriculture and Livestock websites or from the National Institute of Public Health (INSP). ¹¹¹²¹³ A 2024 report titled "The burden of antimicrobial resistance (AMR) in Burundi", published by the US research organization Institute for Health Metrics and Evaluation, indicates that high mortality due to pathogens such as E. coli and Streptococcus pneumoniae indicates that testing likely does happen, but not as part of a national system. ¹⁴

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that Burundi conducts environmental surveillance for antimicrobial residues or AMR organisms in soil, water, or other ecosystems. Burundi's Tracking AMR Country Self Assessment Survey (TrACSS) 2022 Country Report does not mention environmental AMR surveillance activities. ¹⁵ No relevant documentation was found on the websites of the Ministry of Public Health, Ministry of Agriculture and the Environment, or the National Institute of Public Health. ¹⁶¹⁷¹⁸ The 2023 JEE, the report for which is not yet publicly available, attrivuted Burundi the lowest score of a 1 for "P.4.2 Surveillance of AMR". ¹⁹

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

Score: 50

There is available evidence that Burundi has national legislation requiring prescriptive authority for the use of antibiotics in humans.

Law No. 1/11 of 8 May 2020, issued by the National Assembly of Burundi, regulates the practice of pharmacy and the use of medicines for the health of humans. ²⁰ This law requires that antibiotics and other pharmaceuticals be provided only with a valid prescription. The law is enforced by the Burundian Regulatory Authority for Medicines for Human Use and Food (Autorité Burundaise de Régulation des Médicaments à usage humain et des Aliments, ABREMA), which oversees pharmaceutical regulation and compliance. ²¹

Despite the existence of the law, there are enforcement gaps. A 2025 study of prescribing patterns in Bujumbura Mairie revealed that 62.1% of outpatient prescriptions included antimicrobials, exceeding WHO recommendations (20–26.8%). ²² Moreover, 26.2% of prescriptions lacked documented indications, and Watch-group antibiotics (which should be restricted) were prescribed in 25.3% of cases, surpassing the WHO threshold of <20%. ²³ The Ministry of Public Health’s website focuses on health campaigns and public notices, while ABREMA’s site highlights registration, importation, and quality control processes, but does not detail any mechanisms for enforcing prescription-only antibiotic use. ²⁴²⁵

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

Score: 50

There is limited publicly available evidence confirming that Burundi has national legislation specifically requiring prescriptions for antibiotic use in animals.

Burundi has national legislation requiring prescriptions for antibiotic use in animals, established under Law No. 1/05 of February 11, 2021, which regulates the import, sale, and dispensing of veterinary drugs. ²⁶ The law states that veterinary drugs must be dispensed under the supervision of authorized professionals, effectively requiring prescriptions for their use. ²⁷ However, the law does not mandate that all antibiotics require prescriptions, nor does it provide a clear enforcement framework or penalty structure for violations. ²⁸ Enforcement of this legislation falls under the Ministry of Environment, Agriculture and Livestock and the Autorité Burundaise de Régulation des Produits Vétérinaires, des Pesticides et des Aliments (ABREVPA), which was formally established by Decree No. 100/083 of 4 July 2022 ²⁹. According to the decree, ABREVPA is responsible for regulating veterinary products and ensuring compliance with quality standards. ³⁰ The law is not accessible via the Ministry of Public Health, the FAOLEX database, or the Ministry of Agriculture and Livestock. A 2016 WHO Drug Information article comparing East African Community legislation mentions Decree No. 100/150 but provides no further evidence of veterinary-specific prescription requirements. ³¹

The 2018 Joint External Evaluation (JEE) for Burundi references a list of prescription-only medicines for both human and animal use and a National Committee for Monitoring Antimicrobial Consumption, yet it does not confirm the existence of legislation mandating prescriptions for antibiotics in animals. ³²

1.2.1a Laws/plans on zoonotic disease

Score: 0

Burundi does not have a publicly available national law or formal strategy document addressing zoonotic disease prioritization, detection, and reporting. The only documented plan is a contingency strategy for avian influenza (Plan de contingence de la grippe aviaire, 2013), but it does not constitute a national strategy for zoonotic disease prioritization, detection, and reporting. ³³ The Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities for Burundi, conducted in March 2018, noted that Burundi had established zoonotic surveillance committees composed of representatives from human health, animal health, and the community. These committees, however, were not functional due to lack of funding and operational support. ³⁴ The 2023 JEE, the report for which has not yet been published, awarded Burundi the lowest score of 1 for "P.5.1 Surveillance of zoonotic diseases". ³⁵

In 2025, Burundi launched a national One Health initiative titled “Enhancing National Capacities for Prevention, Preparedness and Response to Health Emergencies through a One Health Approach”, supported by the Pandemic Fund and implemented by WHO, FAO, and UNICEF. ³⁶ This multisectoral project aims to strengthen surveillance systems across human, animal, and environmental health sectors, improve laboratory diagnostics, and build a skilled workforce ³⁷. However, there is no evidence on the websites of the Ministry for Public Health or Agriculture of any formal strategies or laws being put in place following the introduction of the intitiative. ³⁸³⁹

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

Score: 0

Burundi does not have a publicly available national law or strategy document that outlines measures for identifying and reducing the risk of zoonotic disease spillover from animals to humans. The Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities for Burundi, conducted in March 2018, noted the absence of a zoonotic disease management policy, and while a contingency plan for avian influenza exists (Plan de contingence de la grippe aviaire, 2013), it is disease-specific and does not address broader risks across the human-animal-environment interface. ⁴⁰ The 2023 JEE, the report for which has not yet been published, scored Burundi a 1 for "P.5.1 Surveillance of zoonotic diseases". ⁴¹

In 2025, Burundi launched a national One Health initiative titled “Enhancing National Capacities for Prevention, Preparedness and Response to Health Emergencies through a One Health Approach”, supported by the Pandemic Fund and implemented by WHO, FAO, and UNICEF. ⁴²⁴³ This multisectoral project aims to strengthen surveillance systems across human, animal, and environmental health sectors, improve laboratory diagnostics, and build a skilled workforce ⁴⁴. However, there is no evidence on the websites of the Ministry for Public Health or Agriculture of any formal strategies or laws being put in place following the introduction of the intitiative. ⁴⁵⁴⁶

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

Score: 0

Burundi does not have a publicly available national strategy or guideline that addresses the surveillance and control of multiple zoonotic pathogens of public health concern. The Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities for Burundi, conducted in March 2018, noted that surveillance systems for priority zoonotic diseases were in place, but lacked functionality due to limited funding and coordination. ⁴⁷ The 2023 JEE, the report for which has not yet been published, scored Burundi a 1 for "P.5.1 Surveillance of zoonotic diseases". ⁴⁸
The Plan de contingence de la grippe aviaire (2013) is the only publicly available disease-specific plan, and it focuses solely on avian influenza. ⁴⁹ No other pathogen-specific or multisectoral surveillance plans were found on the websites of the Ministry of Public Health or the Ministry of Agriculture and Livestock. ⁵⁰⁵¹

In 2025, Burundi launched a national One Health initiative titled “Enhancing National Capacities for Prevention, Preparedness and Response to Health Emergencies through a One Health Approach”, supported by the Pandemic Fund and implemented by WHO, FAO, and UNICEF. ⁵² This multisectoral project aims to strengthen surveillance systems across human, animal, and environmental health sectors, improve laboratory diagnostics, and build a skilled workforce . However, there is no evidence on the websites of the Ministry for Public Health or Agriculture of any formal strategies or laws being put in place following the introduction of the intitiative.

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

Score: 0

There is no evidence of a fully functioning department, agency, or unit in Burundi that serves as a dedicated multi-sectoral coordinating mechanism for zoonotic disease across ministries.

Burundi has started developing a multi-sectoral coordinating mechanism dedicated to zoonotic disease that functions across ministries as part of its One Health Initiative for Pandemic Preparedness, supported by WHO, UNICEF, and FAO through the World Bank's Pandemic Fund. ⁵³ The mechanism involves collaboration among the Ministries of Public Health, Agriculture and Livestock, and Environment, and includes a steering committee and inter-ministerial planning team. ⁵⁴ The initiative is guided by international frameworks such as the Tripartite Zoonoses Guide and the Multisectoral Coordination Mechanism Operational Tool. ⁵⁵⁵⁶ There is no publicly available evidence of a permanent department or agency with a formal legal mandate to coordinate zoonotic disease management across sectors.

Wildlife census activities are managed by the Ministry of the Environment; however, the Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities for Burundi, conducted in March 2018, highlights a lack of coordination and information sharing between the Ministries of Public Health, Agriculture and Livestock, and the Environment. ⁵⁷ No publicly available information was found on the website of the Ministry of Public Health and the website of the Ministry of Agriculture and Livestock. ⁵⁸⁵⁹

1.2.1e Presence of One Health strategic plan

Score: 0

There is no evidence of Burundi having a One Health Strategic Plan in place, although in 2025, the country launch a new initiative focused on One Health principles in collaboration with WHO, UNICEF and FAO, with funding from the Pandemic Fund. ⁶⁰⁶¹

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

Score: 100

Burundi has some evidence of a national mechanism for livestock owners to conduct and report disease surveillance to a central government agency.

Article 7 of the 2009 law on the sanitation police for domestic and wild animals (Loi n° 1/28 du 24 décembre 2009), requires that animals affected, suspected of being affected, or dead from transmissible diseases be declared. ⁶² Article 4 provides a list of such diseases and stipulates that declarations must be made to the nearest local veterinary service, but does not specify how these declarations should be transmitted to a government agency, nor whether veterinary services are required to share this information centrally. ⁶³ The Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities for Burundi, conducted in March 2018, noted the absence of a national plan to encourage notification of zoonoses and rated the surveillance system as having limited capacity. ⁶⁴

In 2023, the Food and Agriculture Organization (FAO) provided Burundi’s Ministry of the Environment, Agriculture and Livestock (MINEAGRIE) with diagnostic reagents, veterinary medicines, and epidemiological surveillance kits. ⁶⁵ These were delivered to the International Livestock Research Institute (Direction Générale de l’Élevage) to support early warning and geolocation of outbreaks, and to facilitate real-time information sharing among provincial livestock officers. ⁶⁶⁶⁷

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

Score: 0

There is no evidence that Burundi has legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners).

Article 7 of the 2009 law on the sanitation police for domestic and wild animals (Loi n° 1/28 du 24 décembre 2009), requires that animals affected, suspected of being affected, or dead from transmissible diseases be declared. ⁶⁸ Article 4 provides a list of such diseases and stipulates that declarations must be made to the nearest local veterinary service, but does not specify how these declarations should be transmitted to a government agency, nor whether veterinary services are required to share this information centrally. There is no mention in the law of how this information is protected, or any measures to ensure confidentiality. ⁶⁹ The 2018 Joint External Evaluation (JEE) noted the absence of a national plan to encourage notification of zoonoses and rated the surveillance system as having limited capacity. ⁷⁰ The United Nations Conference on Trade and Development (UNCTAD) database does not list any general data privacy law for Burundi. ⁷¹

No publicly available information was found on the website of the Ministry of Public Health and the website of the Ministry of Agriculture and Livestock. ⁷²⁷³

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no evidence of a formal surveillance mechanism in Burundi for zoonotic disease in wildlife (e.g., wild animals, insects, other disease vectors), poultry and livestock. Article 7 of the Law No. 1/28 of 24 December 2009 on the sanitary police for domestic animals, wild animals, fish and bees requires that animals affected, suspected of being affected, or found dead from a disease considered transmissible must be declared. However, the law does not establish a formal mechanism through which such surveillance should be conducted. Article 4 provides a list of transmissible animal diseases and specifies that owners or persons responsible for an animal showing signs of a suspected disease must report it to the nearest local veterinary service. No further details are available on the practical surveillance system in place to manage these declarations. ⁷⁴ As of 2025, there is no publicly available evidence on the websites of the Ministry of Public Health nor the Ministry of Agriculture and Livestock of any formal surveillance mechanisms. ⁷⁵⁷⁶ The Joint External Evaluation (JEE) for Burundi, conducted in March 2018, noted that the Ministry of the Environment is responsible for maintaining a census of wildlife; however, it is not clear whether any surveillance of zoonotic diseases in wildlife has been undertaken by the ministry. ⁷⁷ A 2024 report published by the Food and Agriculture Organization (FAO) on mpox tracking recommends that Burundi works to increase zoonotic disease surveillance capacity to mitigate future outbreaks. ⁷⁸

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to The World Organisation for Animal Health (WOAH). According to the World Organization for Animal Health's (WOAH's) WAHIS databases, Burundi has ocassionally reported disease outbreaks, most recently a report of Rift Valley fever virus in 2022. ⁷⁹

1.2.4a Number of veterinarians per 100,000 people

Score: 0.45

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

Score: 19.53

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

Score: 0

There is no publicly available evidence that Burundi has a national plan on zoonotic disease or other legislation, regulations, or plans that include mechanisms for working with the private sector in controlling or responding to zoonoses.

According to the Joint External Evaluation (JEE) for Burundi, conducted in March 2018, the country does not have a comprehensive zoonotic disease management policy, with the exception of a contingency plan for avian influenza, which makes no reference to collaboration with the private sector. The JEE report further notes that the Ministry of Agriculture and Livestock has identified six zoonotic diseases of public health concern: rabies, tuberculosis, toxoplasmosis, brucellosis, anthrax, and avian influenza. The evaluation also notes the existence of zoonotic surveillance committees that bring together representatives from human health, animal health, and the community, though these committees are currently non-functional due to insufficient funding, and it remains unclear whether private sector participation is envisaged. Finally, the JEE highlights the absence of a formal plan or legislative framework for the overall control and response to zoonotic diseases in Burundi. ⁸⁰ The 2023, the full report for which is not ye publicly available, gives Burundi the lowest score of 1 for "P.5.2 Response to zoonotic diseases". ⁸¹

Law No. 1/28 of 24 December 2009 on the sanitary police for domestic animals, wild animals, fish and bees requires that animals affected, suspected of being affected, or dead from a transmissible disease must be declared. However, it does not specify whether the private sector has any role in controlling or responding to zoonoses. ⁸² There is no publicly available evidence of private sector collaboration in controlling or responding to zoonoses on the websites of the Ministry of Health or the Ministry of Agriculture. ⁸³⁸⁴

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

Score: 0

There is no publicly available evidence that Burundi has in place a record, updated within the past five years, of the facilities in which especially dangerous pathogens and toxins are stored or processed, including details on inventories and inventory management systems of those facilities. According to the 2018 Joint External Evaluation (JEE) for Burundi, the country is lacking adequate infrastructure to store and process dangerous pathogens, recommending that "the country should classify the pathogens, toxins and other dangerous substances and identify and equip any containment structures (storage, handling)." ⁸⁵ There is no further evidence of such facilities on the websites of the Ministry of Health nor the Ministry of Agriculture. ⁸⁶⁸⁷ A State Party to the Biological Weapons Convention (BWC), Burundi is obligated to submit annual Confidence-Building Measure (CBM) reports on its biological research activities to the United Nations Office at Geneva (UNOG). The CBM database states that Burundi last submitted a report in 2025, however, the report is not publicly available. ⁸⁸ The Biological Weapons Convention National Implementation Measures Database does not include any evidence of facilities to store and process dangerous pathogens. ⁸⁹

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that Burundi has in place legislation and/or regulations related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems, and/or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed.

The 2018 Joint External Evaluation of Burundi suggests that the country must develop such a legal framework, implying that there is none such framework in existence. ⁹⁰ There is no evidence on the websites of the Ministries of Health or Agriculture suggestins such a framework has since been developed. ⁹¹⁹² A State Party to the Biological Weapons Convention (BWC), Burundi is obligated to submit annual Confidence-Building Measure (CBM) reports on its biological research activities to the United Nations Office at Geneva (UNOG). The CBM database states that Burundi last submitted a report in 2025, however, the report is not publicly available. ⁹³ The United Nations Institute for Disarmament Research Biological Weapons Convention National Implementation Measures Database, under the section "Biosafety and biosecurity", merely mentions that "Burundi has various laws that may be relevant for the control of biological agents and toxins. These include the following: Environmental law; Law N.1/04 on the management of pesticides in Burundi); Law No. 1/06 of 21 March 2011 regulating the practice of the veterinary profession; Decree-Law N. 1/033 of 30 June 1993 on Plant Protection in Burundi; and the Public Health Code." ⁹⁴

The 2006 National Biosafety Framework suggests that the country should develop containment mechanisms and a national alert system for biotechnological incidents. ⁹⁵ A draft Biosecurity Law, drafted in 2024, includes measures for physical confinment of genetically modified organisms and their products, though there is no evidence that this law has been passed as of September 2025. ⁹⁶

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence that Burundi has an established agency (or agencies) responsible for the enforcement of biosecurity legislation and regulations, nor that such legislation/regulation exists. The 2018 Joint External Evaluation of Burundi suggests that the country must develop such a legal framework, implying that there is none such framework in existence. ⁹⁷ There is no evidence on the websites of the Ministries of Health or Agriculture suggestins such a framwork has since been developed. ⁹⁸⁹⁹ A State Party to the Biological Weapons Convention (BWC), Burundi is obligated to submit annual Confidence-Building Measure (CBM) reports on its biological research activities to the United Nations Office at Geneva (UNOG). The CBM database states that Burundi last submitted a report in 2025, however, the report is not publicly available. ¹⁰⁰ The United Nations Institute for Disarmament Research Biological Weapons Convention National Implementation Measures Database, under the section "Biosafety and biosecurity", merely mentions that "Burundi has various laws that may be relevant for the control of biological agents and toxins. These include the following: Environmental law; Law N.1/04 on the management of pesticides in Burundi); Law No. 1/06 of 21 March 2011 regulating the practice of the veterinary profession; Decree-Law N. 1/033 of 30 June 1993 on Plant Protection in Burundi; and the Public Health Code." ¹⁰¹

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

Score: 0

There is no publicly available evidence that shows that Burundi has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

The 2018 Joint External Evaluation (JEE) for Burundi explicitly notes that the country does not maintain a national inventory or classification of especially dangerous pathogens and lacks a record of sites where such pathogens and toxins are held. The report recommends that Burundi “classify pathogens, toxins, and other dangerous substances, and identify and equip appropriate containment structures for their storage and handling.” ¹⁰² There is no further evidence of actions to consolidate inventories of dangerous pathogens and toxins on the websites of the Ministries of Health, Agriculture, Defense, or the National Public Health Institute. ^103104105106

In 2024, the the National Institute of Public Health opened a P3 security level biocontainment laboratory, but is not specified if this laboratory will hold especially dangerous pathogens, though a United Nations Development Programme report does mention that it will "handle highly infectious germs in a secure environment". ¹⁰⁷

The Biological Weapons Convention National Implementation Measures Database does not include any evidence of laws or regulations that establish facilities to store and process dangerous pathogens, or actions to consolidate inventories. ¹⁰⁸

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

Score: 0

There is no publicly available evidence that Burundi possesses in-country capacity to conduct Polymerase Chain Reaction (PCR)–based diagnostic testing for anthrax or Ebola. The Joint External Evaluation (JEE) for Burundi, conducted in March 2018, indicates that while the country has the capacity to perform diagnostic tests that do not involve culturing live pathogens, this capacity is limited. Specifically, the National Public Health Institute (INSP) and the Kamenge University Hospital Centre are reported to be capable only of testing for cholera, malaria, meningitis, and measles. ¹⁰⁹ While a World Health Organization (WHO) report published in 2019 states that Burundi has either "GeneXpert, or conventional real time Polymerase Chain Reaction (PCR)", it does not concretely state that PCR testing is used, and there is no further evidence suggesting so on the websites of the websites of the Ministry of Public Health, Ministry of Defense, Ministry of Higher Education and Scientific Research, Ministry of Agriculture, or the National Public Health Institute. ^{110111112113114115}

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Burundi requires biosecurity training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. According to the Joint External Evaluation (JEE) for Burundi, conducted in 2018, the country has not developed any legal or regulatory framework requiring such training, and existing laboratory instruction is delivered on an ad hoc basis rather than through a coordinated national program. ¹¹⁶

All biosecurity and biosafety training reported in Burundi to date has been externally supported, primarily through initiatives led by international partners such as the Africa Centres for Disease Control and Prevention (Africa CDC) and the Food and Agriculture Organization (FAO), which have provided capacity-building and technical training for personnel at the National Public Health Institute (INSP) and other public health laboratories. ¹¹⁷¹¹⁸

There is no further evidence of biosecurity training requirements on the websites of the Ministries of Health, Agriculture, or Defense. ^119120121

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

Score: 0

There is no publicly available evidence that Burundi has regulations or licensing conditions specify that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to the following checks: drug testing, background checks, and psychological or mental fitness checks. There is no mention of such regulations in the 2018 Joint External Evaluation, nor on the websites of the Ministries of Health, Defense, or Agriculture. ^122123124125

A State Party to the Biological Weapons Convention (BWC), Burundi is obligated to submit annual Confidence-Building Measure (CBM) reports on its biological research activities to the United Nations Office at Geneva (UNOG). The CBM database states that Burundi last submitted a report in 2025, however, the report is not publicly available. ¹²⁶ The Biological Weapons Convention National Implementation Measures Database does not include any evidence of laws or regulations that establish such measures. ¹²⁷

A draft national biosafety/biosecurity law (avant-projet de loi sur la biosécurité), published in 2024, does not include any mention of the above mentoned checks. Furthermore, it has not yet been enacted and does not specifically mention dangerous materials. ¹²⁸

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

Score: 0

There is no publicly available evidence that Burundi has established national regulations governing the safe and secure transport of infectious substances, including those classified as Categories A and B. According to the Monthly Bulletin of the World Health Organization (WHO) Representative Office in Burundi (Bulletin Mensuel du Bureau de la Représentation de l’OMS au Burundi), published in February 2019, a simulation exercise was conducted on 22 February 2019 to “assess sampling capacities, packaging, transport, and examination of laboratory samples.” ¹²⁹ In 2024, "a sub-regional workshop was held in Bujumbura, Burundi, on the development and updating of standard operating procedures for the transport, security, storage and handling of environmentally sensitive goods in Customs controlled areas." ¹³⁰ While these activities demonstrates some level of training and preparedness supported by the WHO, there remains no evidence of a national legal or regulatory framework specifically addressing the safe and secure transport of infectious substances. The 2018 Joint External Evaluation (JEE) for Burundi did not identify any such regulation, and no related information was found on the websites of the Ministries of Health, Agriculture, or Defense. ^131132133134

The Biological Weapons Convention National Implementation Measures Database cites the Customs Code and the Aviation Code as including measures on the transport of dangerous goods, though neigher code contains specific, detailed regulations on the safe and secure transport of infectious substances. ^135136137

A draft national biosafety/biosecurity law (avant-projet de loi sur la biosécurité), published in 2024, introduces sections on the transportation of genetically modified organisms and their products thatcould potentially regulate such activities once adopted, but it has not yet been enacted and does not specifically mention dangerous materials. ¹³⁸

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

Score: 0

There is no publicly available evidence that Burundi has enacted legislation or regulations to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, or biological materials with pandemic potential. The 2018 Joint External Evaluation (JEE) for Burundi does not reference any such framework or regulatory provisions. ¹³⁹

Article 25 of the 2012 Civil Aviation Code of Burundi (Code de l’Aviation Civile du Burundi) includes general provisions on the transportation of dangerous goods, requiring relevant authorities to issue technical instructions and authorisations for their safe transport. However, the law does not specifically mention infectious substances, dangerous pathogens, or toxins with pandemic potential. ¹⁴⁰

A draft national biosafety/biosecurity law (avant-projet de loi sur la biosécurité), published in 2024, introduces sections on “notification and authorization” that could potentially regulate such activities once adopted, but it has not yet been enacted and does not specifically mention dangerous materials. ¹⁴¹ No further relevant information is available via the official websites of the Ministries of Public Health, Defense, or Agriculture. ^142143144

1.4.1a Biosafety laws/regulations

Score: 0

There is no publicly available evidence that Burundi currently has an enacted national biosafety legislation or regulations in force. The websites of the Ministry of Public Health, Agriculture, and the National Public Health Institute (INSP) contain no references to such a legal framework. ^145146147 The Joint External Evaluation (JEE) for Burundi, conducted in March 2018, stated that the country lacked biosafety legislation. ¹⁴⁸

A draft national biosafety and biosecurity law (Avant-projet de loi sur la biosécurité) has been developed and published in 2024. ¹⁴⁹ This draft law establishes an institutional framework and includes provisions on notification, authorization, and risk management related to biological materials. While this demonstrates progress toward creating a comprehensive biosafety framework, the draft has not yet been enacted, and therefore, Burundi still lacks binding national biosafety legislation as of 2025. ¹⁵⁰

A State Party to the Biological Weapons Convention (BWC), Burundi is obligated to submit annual Confidence-Building Measure (CBM) reports on its biological research activities to the United Nations Office at Geneva (UNOG). The CBM database states that Burundi last submitted a report in 2025, however, the report is not publicly available. ¹⁵¹ The United Nations Institute for Disarmament Research Biological Weapons Convention National Implementation Measures Database, under the section "Biosafety and biosecurity", merely mentions that "Burundi has various laws that may be relevant for the control of biological agents and toxins. These include the following: Environmental law; Law N.1/04 on the management of pesticides in Burundi); Law No. 1/06 of 21 March 2011 regulating the practice of the veterinary profession; Decree-Law N. 1/033 of 30 June 1993 on Plant Protection in Burundi; and the Public Health Code." ¹⁵²

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence that Burundi has an established agency responsible for enforcing biosafety legislation or regulations. No mention of such an agency appears on the websites of the Ministry of Public Health, the National Public Health Institute (INSP), or the Ministry of Agriculture and Livestock. ^153154155

The most recently published 2018 Joint External Evaluation (JEE) of IHR Core Capacities in respect of Burundi noted the absence of biosafety legislation. ¹⁵⁶ The 2023 JEE, the full report from which is not publicly available, attributed the lowest score possible to Burundi for "P.7.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities". ¹⁵⁷ Although a National Biomedical Waste Management Plan exists, it does not include biosafety provisions, and the 2014 National Policy on Medical Biology Laboratories also highlighted the lack of regulations in this area. ¹⁵⁸

A draft national biosafety and biosecurity law was developed in 2024, but it has not yet been adopted, and no agency currently has a formal enforcement mandate. ¹⁵⁹ As a State Party to the Biological Weapons Convention, Burundi is required to submit annual CBM reports to the United Nations Office at Geneva. While the country submitted a CBM report in 2025, it is not publicly available. ¹⁶⁰ The VERTIC database also lists no relevant legislation appointing an agency responsible for enforcement. ¹⁶¹

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence that Burundi requires standardized or mandatory biosafety training—such as a national curriculum or train-the-trainer program—for personnel working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The most recently published 2018 Joint External Evaluation (JEE) of IHR Core Capacities in respect of Burundi highlighted the absence of biosafety legislation and capacity-building programs. ¹⁶² The 2023 JEE, the full report from which is not publicly available, attributed the lowest score possible to Burundi for "P.7.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities". ¹⁶³ No evidence of a national biosafety training framework was found on the websites of the Ministry of Public Health, the Institut national de santé publique du Burundi (INSP), or the Ministry of Agriculture and Livestock. ^164165166

Burundi does, however, have the Burundian Association for Biosafety and Biosecurity (ABUBB), an independent national body focused on raising biosafety and biosecurity awareness, promoting risk prevention, and supporting best practices. However, ABUBB does not have legal authority to enforce training requirements. ¹⁶⁷

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Burundi has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. The most recently published 2018 Joint External Evaluation (JEE) of IHR Core Capacities in respect of Burundi does not indicate that such an assessment has been carried out. ¹⁶⁸ The 2023 JEE, the full report from which is not publicly available, attributed the lowest score possible to Burundi for "P.7.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities". ¹⁶⁹ There is no evidence of such as assessment on the websites of the Ministry of Public Health, the Institut national de santé publique du Burundi (INSP), or the Ministry of Agriculture and Livestock. ^170171172

While Burundi submitted a Confidence-Building Measures (CBM) reports to the United Nations Office at Geneva (UNOG) under the Biological Weapons Convention (BWC) in 2025, which are intended to promote transparency and confidence among states parties regarding biological research activities, the report is not publicly available. ¹⁷³ Burundi is a member of the East African Community (EAC), which has established a mobile laboratory network for the diagnosis of BSL3/4 pathogens, though there is no evidence that Burundi has conducted a national assessment to identify ongoing research on especially dangerous pathogens or dual-use research. ¹⁷⁴¹⁷⁵

The Biological Weapons Convention National Implementation Measures Database states that "inaccordance with Article 245 of Law No. 1/ 012 of 30 May 2018 on the code of the supply of health care and services in Burundi, biomedical research can only be undertaken after acquiring permission from the National Ethics Committee for the protection of human beings subject to biomedical and behavioural research, and after authorisation from the Minister in charge of public health". This Law, however, does not constitute evidence that an assessment has been conducted to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. ¹⁷⁶¹⁷⁷

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

Score: 0

There is no publicly available evidence that Burundi has a national policy overseeing dual-use research, including research involving especially dangerous pathogens, toxins, or pathogens with pandemic potential. The most recently published Joint External Evaluation, conducted in 2018, noted that the country lacks a legal framework for biosecurity and does not maintain a pathogen monitoring system. ¹⁷⁸ The 2023 evaluation, the full report from which is not publicly available, attributed the lowest score possible to Burundi for "P.7.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities". ¹⁷⁹ There is no further evidence of such a policy available on the websites of the Ministry of Public Health, the Ministry of National Defence, the Ministry of Agriculture and Livestock, the Ministry of Higher Education and Scientific Research, or the National Public Health Institute (INSP). ^{180181182183184}

Burundi is a State Party to the Biological Weapons Convention (BWC) and is required to submit annual Confidence-Building Measures (CBM) reports to the United Nations Office at Geneva (UNOG). While the country submitted a CBM report in 2025, it is not publicly available. ¹⁸⁵ The VERTIC BWC Legislation Database does not list any legislation or regulations for Burundi, nor is there a publicly available record, updated within the last five years, of facilities where especially dangerous pathogens or toxins are stored. ¹⁸⁶

The Biological Weapons Convention National Implementation Measures Database states that "i naccordance with Article 245 of Law No. 1/ 012 of 30 May 2018 on the code of the supply of health care and services in Burundi, biomedical research can only be undertaken after acquiring permission from the National Ethics Committee for the protection of human beings subject to biomedical and behavioural research, and after authorisation from the Minister in charge of public health". ¹⁸⁷ However, there is no evidence on the websites mentioned above of any such oversight taking place. ^{188189190191192}

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

Score: 0

There is no publicly available evidence that Burundi has an agency responsible for the oversight of research involving especially dangerous pathogens, pathogens with pandemic potential, or other dual-use research. The most recently published Joint External Evaluation report (2018) noted that the country lacks a legal framework for biosecurity and does not maintain a pathogen monitoring system. ¹⁹³ The 2023 evaluation, the full report from which is not publicly available, attributed the lowest score possible to Burundi for "P.7.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities". ¹⁹⁴ There is no publicly available evidence of such an agency on the websites of the Ministry of Public Health, the Ministry of National Defence, the Ministry of Agriculture and Livestock, the Ministry of Higher Education and Scientific Research, or the National Public Health Institute (INSP). ^{195196197198199}

Burundi is a State Party to the Biological Weapons Convention (BWC) and is required to submit annual Confidence-Building Measures (CBM) reports to the United Nations Office at Geneva (UNOG). While the country submitted a CBM report in 2025, it is not publicly available. ²⁰⁰ The VERTIC BWC Legislation Database lists no legislation or regulations for Burundi, nor any publicly available record, updated within the last five years, of facilities storing especially dangerous pathogens or toxins. ²⁰¹

The Biological Weapons Convention National Implementation Measures Database states that "i naccordance with Article 245 of Law No. 1/ 012 of 30 May 2018 on the code of the supply of health care and services in Burundi, biomedical research can only be undertaken after acquiring permission from the National Ethics Committee for the protection of human beings subject to biomedical and behavioural research, and after authorisation from the Minister in charge of public health". However, there is no evidence of the existence or work of the Committee on the above websites. ^{202203204205206}

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

Score: 0

There is no publicly available evidence that Burundi has implemented a requirement for screening synthesized DNA prior to sale. Burundi’s National Biosecurity Framework (Cadre National de Biosécurité) addresses the transfer, safe handling, and use of genetically modified organisms (GMOs) and living modified organisms (LMOs). ²⁰⁷ Articles 9 and 10 of the 2024 draft law on the security of biotechnology (LOI 2006 SUR LA SÉCURITÉ EN BIOTECHNOLOGIE) establishes that “no person may engage in the importation, transfer, use, dissemination, or placing on the market of a genetically modified organism or a derived product of a genetically modified organism without prior informed consent or explicit written authorization from the Ministry of Environment.” ²⁰⁸

Neither of these documents explicitly require reading or screening the genetic sequence of DNA before allowing its sale, and there is no evidence of such a requirement on the websites of the Ministry of Transport, Ministry of Public Health, Ministry of Defence, Ministry of Agriculture and Livestock, the National Public Health Institute (INSP), or the Ministry of Higher Education and Scientific Research. ^{209210211212213214}

As a State Party to the Biological Weapons Convention (BWC), Burundi is required to submit annual Confidence-Building Measures (CBM) reports to the United Nations Office at Geneva (UNOG). While Burundi submitted a CBM report in 2025, it is not publicly available. ²¹⁵ The VERTIC BWC Legislation Database does not list any legislation or publicly available records of facilities storing especially dangerous pathogens or toxins updated within the last five years. ²¹⁶

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 50

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

Score: 0

No official foot-and-mouth disease (FMD) vaccination figures for livestock in Burundi are publicly available through the OIE database. The OIE WAHIS database shows surveillance and control measures, but current vaccination figures are not displayed for FMD in Burundi's profile. ²¹⁷

1.6.1c Equitablenature of national immunization strategy/plan

Score: 0

There is evidence that Burundi has a national immunization program, primarily outlined through the country’s Expanded Program on Immunization (EPI), however no full program document of which is publicly available, and there exists a plan to ensure equitable distribution. The EPI includes measures to ensure equitable distribution of vaccines and incorporates incorporates elements aimed at reducing geographic and economic disparities. Burundi's EPI was introduced in 1980, and appears to have been most recently updated in 2025 with the inclusion of a Malaria vaccine. ²¹⁸²¹⁹ No EPI policy document is publicly available on the website of the Ministry of Public Health. ²²⁰

The most recently available third-party reports, from UNICEF and the Vaccine Alliance, indicate that Burundi aims for equitable distribution of vaccines, particularly by focusing on outreach to rural and underserved areas through mobile vaccination teams and integration of immunization services into primary healthcare, however, there is no official documentation available to suggest this is a direct result of the EPI. ²²¹²²²

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 the national immunization strategy/plan include measures to address vaccine hesitancy and build public trust in vaccines. The Expanded Program on Immunization (EPI) was introduced in 1980, and appears to have been most recently updated in 2025 with the inclusion of a Malaria vaccine to the national vaccination programme. ²²³²²⁴ No EPI policy document is publicly available on the website of the Ministry of Public Health. ²²⁵ However, reporting suggests that Burundi is actively working to address vaccine hesitancy amongst religious communities. ²²⁶

1.6.1e National advisory group for immunization strategy/plan

Score: 100

There is publicly available evidence that Burundi has a national advisory group that provides technical guidance and advice on the immunization strategy/plan to government.

The Expanded Program on Immunization (EPI) was introduced in 1980, and appears to have been most recently updated in 2025 with the inclusion of a Malaria vaccine to the national vaccination programme. ²²⁷²²⁸ No EPI policy document is publicly available on the website of the Ministry of Public Health, and there is no information on the website suggesting the existence of an advisory group. ²²⁹ No further evidence is available in the most recent Regional Immunization Technical Advisory Group (RITAG) Report of the meeting conducted in 2020. ²³⁰

The World Health Organization's National Immunization Advisory Mechanism lists self-reported answers by Burundi stating that the country has a NITAG, that it has formal written terms of reference, that at least 5 areas of expertise are represented in the NITAG as core membership, and that it met twice in 2024. ²³¹

1.6.1f Presence of an immunization programme for influenza

Score: 0

Burundi does not have an immunization programme for influenza. According to the World Health Organization immunization data portal, influenza vaccinations in Burundi were not available between 2020-2024, and the country does not have a national programme for influenza vaccinations. ²³² Ministy of Health information on the country's Expanded Program on Immunization (EPI) does not mention influenza. ²³³

1.7.1a Strategy/plan for resilience of health system

Score: 100

There is evidence that Burundi has a strategy or plan to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose, that includes the threat of infectious diseases. The National Health Plan (2016-2025) includes explicit recognition of climate change and environmental threats as health risks, including epidemic and infectious disease risks in the context of changing environmental conditions. The policy frames health planning in the context of an "epidemiological transition and constantly changing environmental conditions" and emphasizes the need for intersectoral collaboration to address environmental determinants of health. It also aims to strengthen epidemic surveillance and response systems, including integrated disease surveillance at the community and health system levels, to ensure timely detection and early control measures for epidemics. ²³⁴

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

Score: 50

There is evidence that Burundi’s national laboratory system has the capacity to test for at least 5 of the 10 World Health Organization (WHO)-defined core tests, though the testing methods used are not specified. According to the 2018 World Health Organization Joint External Evaluation (JEE), the National Institute of Public Health and the Kamenge Hospital Center could test for cholera, malaria, meningococcal meningitis, and measles, while haemorrhagic fevers and acfute flaccid paralysis samples were sent to external laboratories. ²³⁵ There is evidence since that the national laboratory system also has the capacity to test for HIV though serological and virulogical testing. ²³⁶²³⁷

There is no public evidence of routine testing for other core diseases (e.g., influenza, hepatitis B, syphilis), and no national list of available tests or the methods used for disease testing are published on the websites of the Ministry of Health or the National Institute of Public Health. ²³⁸²³⁹ There is evidence that the country has PCR testing capabilities in the context of Covid-19. ²⁴⁰

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence that Burundi has a national plan or strategy in place that explicitly addresses conducting diagnostic testing during public health emergencies, including considerations for testing novel pathogens, scaling capacity, or defining testing goals.

The 2018 Joint External Evaluation for Burundi indicates the existence of contingency plans, such as the 2013 National Contingency Plan for Emergency Management and the 2013–2016 Action Plan for National Capacity Building for the Reduction of Risks, Preparation, and Response in Emergencies. ²⁴¹ However, these plans focus primarily on disaster preparedness and response and do not explicitly mention diagnostic testing during public health emergencies. ^242243244

Burundi's 2025 World Bank Pandemic Fund project "Enhancing National Capacities for Prevention, Preparedness, and Response to Health Emergencies", co-led by the FAO, UNICEF, and WHO and launched in April 2025, aims to strengthen Burundi's capacity to prepare for, prevent, and respond to health emergencies, including those involving novel pathogens. The project also includes a measure towards capacity building for testing. ²⁴⁵ There is no publicly available document describing the details of the project. ²⁴⁶

Additionally, Burundi has revised and approved its Mpox Response Plan and Marburg-Ebola Preparedness Plan in April 2025. Reporting on the plan, however, does not include any mention of testing novel pathogens. ²⁴⁷

Burundi's Public Health Emergency Operations Center (COUSP) is responsible for "health monitoring, preparation and response to epidemics, pandemics, health disasters and any other public health emergencies by collaborating with all stakeholders, whether public, associative or private." The COUSP website allows individuals to make an appointment for Covid-19 tests, but has no further information about other diagnostic testing during public health emergencies. ²⁴⁸

The last National Action Plan for Health Security (NAPHS) development workshop was conducted in 2018, and no documentation has been published since about any NAPHS plan developed by Burundi. ²⁴⁹

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

Score: 0

There is currently no publicly available evidence that Burundi’s national reference laboratories are accredited according to local or international standards such as International Organization for Standardization (ISO 15189).

The country’s two main reference laboratories — the National Institute of Public Health (INSP) and the Kamenge University Hospital Centre — were noted in the 2018 Joint External Evaluation (JEE) as lacking full testing capacity, being able to conduct diagnostic tests only for cholera, malaria, meningococcal meningitis, and measles at that time. ²⁵⁰

While the INSP website states that its laboratory performs analyses “in accordance with a quality assurance system (ISO 15189),” there is no confirmation of formal accreditation through an internationally recognized body. There is likewise no evidence of accreditation or related updates on the websites of the Ministry of Public Health or INSP. ²⁵¹²⁵²

Additionally, the website of the Burundian Bureau of Standardization and Quality Control references adherence to international standards such as ISO/IEC 17020, ISO/IEC 17021, ISO/IEC 17025, and ISO/IEC Guide 65, but also acknowledges that it “should as far as possible pursue international recognition through the appropriate accreditation,” indicating that such accreditation has not yet been obtained. ²⁵³

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

Score: 0

There is no publicly available evidence that the National Reference Laboratory of the National Institute of Public Health in Burundi that serves as a reference facility which is subject to external quality assurance review.

According to the 2018 Joint External Evaluation of IHR Core Capacities of the Republic of Burundi, some laboratories in Burundi were certified by the National Institute of Public Health (INSP) for measles testing, and several laboratories participated in external quality control (EQC) programs in areas such as bacteriology, virology, hematology, parasitology, and serology. ²⁵⁴ However, the country lacked mechanisms to measure changes in the quality of laboratory analyses. In the most recent 2023 JEE, the report for which is not yet publicly available, Burundi received a score of 2 (“limited capacity”) for indicator D.1.4 on laboratory quality systems. ²⁵⁵

The 2018 JEE reported that only 0.008% of public laboratories participated in EQC programmes, without identifying which facilities were involved. ²⁵⁶ There is no publicly available information on current participation in EQA programmes via the websites of the Ministry of Public Health, the Ministry of Agriculture, or the INSP. ^257258259

The website of the Burundian Bureau of Standardization and Quality Control notes that it promotes activities related to standardization, metrology, quality assurance, and testing in Burundi and collaborates with several laboratories. However, it does not indicate whether these laboratories are subject to external quality assurance review. ²⁶⁰

2.2.1a Nationwide specimen transport system

Score: 100

There is evidence that Burundi has a specimen transport system covering most of the country, though it remains limited in scope and capacity.

According to the 2018 Joint External Evaluation of IHR Core Capacities of the Republic of Burundi, the country has Standard Operating Procedures in place for the collection, packaging, storage, and transport of specimens to national laboratories under surveillance. However, the 2018 JEE reports that “in 80% of districts, there is a system for the secure transfer of samples to national laboratories capable of performing advanced diagnostic tests in the context of diseases under surveillance.” Local transport of specimens is carried out by trained health personnel, and the country has a sample transfer system for priority diseases such as measles and acute flaccid paralysis. In the 2023 JEE, the full report for which is not publicly available, Burundi scored 2 (limited capacity) in section D.1.2, compared to a score of 4 (sufficient capacity) in 2018. ²⁶¹²⁶²

No publicly available national policy or strategy governing a standardized, nationwide specimen transport network was found on government websites as of 2025, suggesting the system continues to function primarily through disease-specific and partner-supported mechanisms rather than a fully integrated national structure. ^263264265

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

Score: 0

There is no evidence to suggest that Burundi has in place a system to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. There is no mention of such a system in the 2018 Joint External Evaluation report for Burundi. ²⁶⁶ No further evidence was found on the websites for the Ministry of Public Health, the Ministry of Agriculture, or The National Public Health Institute (Institut national de santé publique (INSP)). ^267268269 A 2020 World Bank COVID-19 preparedness and response assessment also makes no mention of such a system being in place. ²⁷⁰

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

Score: 50

There is evidence that Burundi conducts ongoing event-based surveillance and analysis for infectious diseases, but not indicator-based surveillance. According to the 2018 Joint External Evaluation of IHR Core Capacities of the Republic of Burundi, the country has a minimal event-based surveillance system, but “real-time event-based monitoring is in nascent stages and only takes place implicitly, without relying on indicators or procedures.” The JEE recommended establishing an interoperable, interconnected, real-time event-based reporting system to improve early detection and response. ²⁷¹ Burundi has an event-based surveillance system in place, although there is not information on how frequent the data are analyzed.²⁷²

While the Ministry of Public Health and the Public Health Emergency Operations Center (COUSP) provide periodic reporting for notifiable diseases, there is no publicly available information detailing an established, functional national event-based surveillance system for novel or unusual health events. ²⁷³²⁷⁴ During the COVID-19 pandemic, the WHO and Africa CDC provided support to strengthen early detection and reporting mechanisms, including training for health personnel on reporting unusual events. However, these ad-hoc initiatives did not appear to lead to the creation of an ongoing surveillance system. ²⁷⁵²⁷⁶

Burundi scored a 40% for or "C.6.1 Early warning function: indicator- and event-based surveillance" in the most recent WHO SPAR report, conducted in 2024. ²⁷⁷

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

There is publicly available evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline. While the WHO extranet lists Burundi's IHR focal point page as "forthcoming," there is evidence that Burundi reported cases of Mpox in 2024 through the National Reference Laboratory of the National Institute of Public Health and Ministry of Health. ²⁷⁸²⁷⁹ The 2023 Joint External Evaluation, the full report for which has not yet been published, awarded Burundi the lowest score of 1 for "P.3.1 National IHR Focal Point functions". ²⁸⁰

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 0

There is no no publicly available evidence that Burundi operates an electronic reporting surveillance system at both national and sub-national levels, though progress is being made. According to the "Detect: National Laboratory" section of the 2018 Joint External Evaluation for Burundi, notifiable diseases are reported using the District Health Information Software 2 (DHIS2) for human health and the World Animal Health Information System (WAHIS) for animal and wildlife health. However, paper-based and telephone notifications remain widespread, particularly at sub-national levels. Notification reports are typically transmitted from peripheral health facilities (covering 45 districts across 129 communes) to provincial health offices (17 provincial offices), and then relayed to the national level. The private sector, including hospitals and laboratories, is not integrated into the system. ²⁸¹

More recent evidence from the World Bank’s 2023 assessment of Burundi’s health system indicates that the country is developing digital health initiatives to strengthen surveillance. This includes the National Digital Health Development Plan (PNDIS II 2020–2024) and the 2021 Digital Health Management Program (PROGISSA), which aim to enhance epidemiological surveillance and the flow of health data across levels of the system. A Public Health Emergency Operations Center (COUSP) was also established in 2020 to improve reporting and management of public health emergencies, including the COVID-19 pandemic. While the PNDIS II 2020–2024 and PROGISSA, not publicly available, suggest progress toward a more integrated electronic reporting system, full operational coverage at both national and sub-national levels has not yet been confirmed, and the system still faces challenges in interoperability and real-time reporting. ²⁸²²⁸³

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

Score: 50

There is evidence that Burundi operates a fully integrated electronic reporting surveillance system capable of collecting ongoing or real-time laboratory data, although some limited capacity exists. The 2018 Joint External Evaluation for Burundi notes that a real-time monitoring system is in place at the national level for collecting and validating information, but sub-national surveillance remains insufficient, and paper-based notifications continue in some districts. In practice, notification reports are transmitted from peripheral health facilities (covering 45 districts across 129 communes) to provincial health offices (17 provinces), and then relayed to the national level. Only a portion of the country’s laboratories participates in the surveillance system, and private sector hospitals and laboratories are not integrated. ²⁸⁴

More recent evidence from the World Bank 2023 assessment indicates that Burundi is strengthening digital health initiatives under the National Digital Health Development Plan (PNDIS II 2020–2024) and the 2021 Digital Health Management Program (PROGISSA), not publicly available, which aim to improve data capture and surveillance reporting. However, these initiatives do not yet confirm full real-time laboratory data collection or the integration of all laboratories nationwide. ²⁸⁵²⁸⁶ No additional publicly available evidence has been found on the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ²⁸⁷²⁸⁸

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 7 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.²⁸⁹

In 2023, the Burundi Ministry of Health declared a national public health emergency after reporting the detection of circulating vaccine-derived poliovirus type 2 from one case of acute flaccid paralysis (AFP) and five environmental samples. The initial risk assessment (multi-country and regional), and field investigation both for the AFP case and the positive environmental samples were completed by local and national public health authorities with support from partners of the Global Polio Eradication Initiative (GPEI).²⁹⁰ In response to this, Dr Désiré Nolna, Burundi’s country coordinator for the Global Polio Eradication Initiative, stressed the need to implement quality campaigns in a timely manner, while fully operationalizing a consistent environmental surveillance system to enable early detection and adequate sample collection, while WHO experts in the field were, at the time, supporting Burundi with additional sample collection to further bolster polio surveillance, while assessing the possibility of opening new environmental surveillance sites for early detection of silently circulating poliovirus. ²⁹¹

2.4.1a Common usage of electronic health records

Score: 50

There is evidence that electronic health records (EHRs) are not commonly in use, but there is evidence that they are used in Burundi. According to the 2015 WHO Africa e-Health country report, primary, secondary, and tertiary care facilities, laboratory and pathology information systems, vaccination alert systems, and pharmacy information systems largely do not use EHRs, with only electronic medical billing systems implementing them. ²⁹² A 2017 study on Burundi’s national e-health architecture further noted that the system was largely donor-driven, resulting in unequal distribution of hardware across facilities, limited internet connectivity, and very few health-oriented digital applications. Paper-based instruments remained predominant in health administration. ²⁹³ However, a study was conducted in 2019 in 11 hospitals in Burundi usig electronic medical records, suggesting that there is some digital health capacity in the country. ²⁹⁴

More recent evidence from the 2023 World Bank assessment of Burundi’s health system indicates that the country is implementing digital health initiatives under the National Digital Health Development Plan (PNDIS II 2020–2024) and the 2021 Digital Health Management Program (PROGISSA), not publicly available, aim to improve health information collection and reporting. However, these initiatives focus on aggregated health data and surveillance rather than fully operational EHRs at the facility or patient level. Private sector hospitals and laboratories remain largely outside these systems, and paper-based records continue to be widely used. ²⁹⁵²⁹⁶ The 2018 Joint External Evaluation (JEE) for Burundi also does not report the routine use of EHRs, and there is no further information available on the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ^297298299

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no publicly available evidence that Burundi’s national public health system has access to electronic health records (EHRs) of individuals in the country. According to the 2015 WHO African Region e-health country report, primary, secondary, and tertiary care facilities—as well as laboratory information systems, pathology information systems, the automatic vaccination alerting system, and pharmacy information systems—do not use EHRs. Only electronic medical billing systems were reported to use limited digital tools. ³⁰⁰

A 2017 national e-health architecture study similarly found that Burundi’s health information system was largely donor-driven, with an unequal distribution of equipment, limited internet connectivity, and few digital health applications in use, leaving paper-based records predominant. ³⁰¹ There is no mention of EHR systems in the 2018 Joint External Evaluation report for Burundi, and no additional evidence has been identified on the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ^302303304

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that Burundi has fully implemented national data standards (e.g., ISO standards) to ensure the comparability of health data. According to the 2018 Joint External Evaluation of IHR Core Capacities of the Republic of Burundi, Burundi relies on a mix of paper-based reporting and the District Health Information System (DHIS2) for electronic data collection and reporting at national and sub-national levels. However, the system is not fully interoperable, and the absence of standardized data formats and reporting procedures limits data comparability across facilities and regions. ³⁰⁵

Recent investments in digital health infrastructure through the National Digital Health Development Plan (PNDIS II 2020–2024) and the 2021 Digital Health Management Program (PROGISSA), not publicly available, include components aimed at improving data quality and interoperability, but these do not explicitly refer to the adoption of formal international data standards for comparability. ³⁰⁶³⁰⁷ There is no additional evidence on the websites of the Ministry of Public Health or the National Public Health Institute (INSP) indicating the implementation of such standards. ³⁰⁸³⁰⁹

2.4.2a Data sharing mechanisms

Score: 0

There is no publicly available evidence that Burundi has established mechanisms for systematic data sharing between the ministries responsible for human, animal, and wildlife surveillance. According to the 2018 Joint External Evaluation (JEE), information is occasionally shared between the human and animal health sectors during crises, but the country lacks formal partnerships or interministerial mechanisms for routine data exchange between the Ministry of Public Health, Ministry of Agriculture and Livestock, and Ministry of Water, Environment, and Urban Planning. The JEE specifically notes that Burundi does not have a formal One Health approach and recommends that the country “should establish an interministerial committee using the One Health approach.” ³¹⁰ No additional evidence of integrated surveillance or data-sharing mechanisms is available via the websites of the Ministry of Public Health, the Ministry of Agriculture, or the National Public Health Institute (INSP). ³¹¹³¹²

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

Score: 0

There is no publicly available evidence that Burundi makes de-identified health surveillance data on infectious diseases accessible through government websites. According to the 2018 Joint External Evaluation (JEE), Burundi conducts surveillance for human and animal diseases, but reporting is primarily internal and aimed at national authorities, with no indication that routine de-identified datasets are published for public use. ³¹³

There is some evidence of data reporting on the website of the Ministry of Public Health, but these documents are published in response to specific outbreaks rather than regularly. ³¹⁴ There is no further evidence of de-identified health surveillance data being published on the websites of the Ministry of Agriculture or the National Public Health Institute. ³¹⁵³¹⁶

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is publicly available evidence that Burundi has legislation safeguarding the confidentiality of identifiable health information. In May 2018, Burundi enacted the Health Care and Health Services Provision Code (Law n° 1/012 of 30 May 2018), which includes provisions on the protection of personal health data. The law states that "All patients have the right to decide the use of their medical information concerning them and the conditions in which they can be disseminated to third parties. Health agencies must guarantee the confidentiality of information that they hold on their patients even after their death. Compliance with medical confidentiality may be waived in the case provided for by law." ³¹⁷ While the law establishes a legal basis for the confidentiality of patient information, it is not listed in the UNCTAD data protection legislation database or the African Law database (Droit Afrique). ³¹⁸³¹⁹

In addition, Article 25 of the 2005 Law on the Legal Protection of Persons Infected by HIV/AIDS (Loi n° 1/018 du 12 May 2005) mandates that data relating to persons infected with HIV be kept confidential, though it does not explicitly cover all identifiable health information. ³²⁰

The 2018 Joint External Evaluation (JEE) for Burundi does not reference this law or any broader data protection legislation. ³²¹ There is no additional publicly available evidence of regulations on the protection of identifiable health information on the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ³²²³²³

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

Score: 0

There is no evidence that Burundi has laws, regulations, or guidelines specifically safeguarding the confidentiality of identifiable health information that include protections against cyber attacks. The country does not have a comprehensive data protection law. No cybersecurity-specific laws have been listed in the UNCTAD data protection legislation database or the African Law Database (Droit Afrique). ³²⁴³²⁵ The 2018 Joint External Evaluation (JEE) for Burundi does not mention any laws or regulations addressing cybersecurity or the protection of health data from digital threats. ³²⁶

Neither the Health Care and Health Services Provision Code (Law n° 1/012 of 30 May 2018), which includes provisions on the protection of personal health data nor Article 25 of the 2005 Law on the Legal Protection of Persons Infected by HIV/AIDS (Loi n° 1/018 du 12 May 2005) explicitly address general identifiable health information or protections from cyber threats. ³²⁷³²⁸ Law No. 1/10 of 16 March 2022 on the Prevention and Repression of Cybercrime does not include any protections for citizens against cyber attacks in the health sector. ³²⁹ There is no further information publicly available on the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ³³⁰³³¹

2.4.5a Cooperative commitments or agreements within regions

Score: 0

There is no publicly available evidence that Burundi has made a public commitment to share surveillance data during a public health emergency with other countries in the region for one or more diseases. Burundi is a member of the East African Community Integrated Disease Surveillance and Response Network (EAIDSNet), which aims to improve Integrated Disease Surveillance & Response (IDSR) data quality, strengthen laboratory networks, and enhance cross-border surveillance, preparedness, investigation, and collaboration. ³³²³³³ However, there is no evidence that Burundi has formally committed to share surveillance data during public health emergencies with other member states.

In 2004, Burundi signed a cooperation protocol with the Democratic Republic of Congo, Kenya, Uganda, and Tanzania, supported by the WHO Regional Office for Africa. The protocol aimed to scale up cross-border surveillance activities, hold emergency meetings during epidemics, and share epidemiological information via bulletins and newsletters. There is no publicly available evidence that this agreement establishes ongoing obligations to share data during active public health emergencies, nor have updates to this protocol been found. ³³⁴

The 2018 Joint External Evaluation (JEE) for Burundi does not mention any national commitment to share surveillance data with other countries. ³³⁵ There is no further evidence available on the Ministry of Public Health and National Public Health Institute (INSP) websites regarding commitments to share surveillance data during public health emergencies. ³³⁶³³⁷

The country's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Burundi 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. ³³⁸

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

Score: 0

There is no publically available evidence that Burundi has a national system in place to provide structured support at the sub-national level (e.g., training, standardized metrics, or financial resources) for conducting contact tracing during a public health emergency.

During the COVID-19 pandemic, the government conducted contact tracing efforts, reportedly “on its own” in May 2020, with limited external support. ³³⁹ WHO noted that it had previously been asked to train local health workers in case identification and contact tracing and was “ready to do so again if requested,” indicating that the national system may lack sustained capacity. ³⁴⁰ Evidence also indicates that the Ministry of Public Health deployed teams from the Fight Against AIDS project to assist local health authorities, but details on the type and scope of support are not publicly available. ³⁴¹

Press releases from the Ministry of Public Health mention ongoing contact tracing of cases, for example for Mpox and Covid, but do not indicate that these activities are part of a formal national system. ³⁴²³⁴³ The 2018 Joint External Evaluation (JEE) report for Burundi does not reference an established contact tracing system capable of rapid expansion during public health emergencies. ³⁴⁴ Similarly, no information on such a system is available via the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ³⁴⁵³⁴⁶ While there is reporting that indicated Burundi has approved its Mpox Response Plan and Marburg-Ebola Preparedness Plan, these plans are not publicly available on the above websites. ^347348349

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

Score: 0

There is no publicly available evidence that Burundi provides wraparound services to enable infected individuals or their contacts to self-isolate or quarantine as recommended, including economic support (e.g., income replacement or job protection) or guaranteed medical care. The 2018 Joint External Evaluation (JEE) for Burundi makes no mention of such services. ³⁵⁰ Similarly, no information was found on the websites of the Ministry of Public Health or the National Public Health Institute (INSP) indicating that a formal system exists to support isolation or quarantine. ³⁵¹³⁵² There is no evidence that Burundi's response to the Covid-19 pandemic or the recent Mpox outbreak included wraparound services. ³⁵³³⁵⁴

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence of a joint plan or cooperative agreement between Burundi’s public health system and border control authorities to identify suspected or potential cases in international travelers and trace or quarantine their contacts during a public health emergency. The 2018 Joint External Evaluation (JEE) for Burundi notes a "lack of memorandums of understanding [MOUs] between human and animal health authorities and authorities in charge of national and local security", and both the 2018 JEE and the 2023 JEE (the report of which is not yet available online) scores the section on "Public health and safety authorities (e.g., law enforcement, border control, and customs) liaising during a suspected or confirmed biological event" as 1 (no capacity). ³⁵⁵³⁵⁶

In response to COVID-19, Decree No.100/088 (revised in October 2020, originally passed April 2020) established a committee to "Combat the Spread and Contamination of COVID-19 in Burundi." While the committee includes members of the public health system, there is no evidence that it includes border control authorities or monitors international travelers. ³⁵⁷ Further searches of the Ministry of Public Health, National Public Health Institute (INSP), and Ministry of Agriculture and Livestock websites yielded no additional evidence. ^358359360 A 2020 World Bank COVID-19 preparedness and response assessment similarly does not report any such agreements. ³⁶¹

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

Score: 100

There is some publicly available evidence that Burundi currently has an applied epidemiology training program, such as a Field Epidemiology Training Program (FETP), operating in the country, though there is no evidence that government provides resources to send citizens abroad for such training. According to the 2018 Joint External Evaluation (JEE), Burundi does not have field epidemiology training programs in either the human health (FETP) or animal health (FETPV) sectors and lacks local training in veterinary medicine and field epidemiology. ³⁶² However, a master’s degree course in epidemiology was launched in January 2018 with support from the Belgian Technical Cooperation to strengthen capacity in public paramedical schools, reporting 58 graduates in 2022. ³⁶³

The African Field Epidemiology Network (AFENET) includes Burundi among its Countries of Operation, but there is no evidence from the network, or from a general media search, of an active in-country FETP or any government-supported opportunities for Burundians to participate in applied epidemiology training abroad. ³⁶⁴ No additional evidence of government-funded applied epidemiology training programs was found via the websites of the Ministry of Public Health, AFENET, or the Africa Centers for Disease Control and Prevention. ^365366367368

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 0

There is no evidence that Burundi offers field epidemiology training programs explicitly inclusive of animal health professionals, nor a dedicated animal health Field Epidemiology Training Program (FETPV). According to the 2018 Joint External Evaluation (JEE), Burundi does not have a field epidemiology training program in the human health (FETP) or animal health (FETPV) sectors and lacks local training in veterinary medicine and field epidemiology. ³⁶⁹ A master’s degree in epidemiology was established in January 2018 with support from the Belgian Technical Cooperation to strengthen capacity in public paramedical schools; however, this program is focused on human health and does not include animal health professionals. ³⁷⁰

The African Field Epidemiology Network (AFENET) includes Burundi among its Countries of Operation, there is no evidence from the network, or from a general media search, of an active in-country FETP or any government-supported opportunities for Burundians to participate in applied epidemiology training abroad. ³⁷¹ No additional information was found on the websites of the Ministry of Public Health, AFENET, or the Africa Centers for Disease Control and Prevention indicating the existence of an animal health FETPV program in Burundi. ^372373374375

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

Score: 0

There is no publicly available evidence that Burundi has at least one trained field epidemiologist per 200,000 people. According to the 2018 Joint External Evaluation (JEE), the country lacks a Field Epidemiology Training Program (FETP) in the human health sector and a corresponding FETPV program in the animal health sector, as well as local training in veterinary medicine and field epidemiology. ³⁷⁶ While a master’s degree in epidemiology was established in 2018 with support from the Belgian Technical Cooperation, this program focuses on human health and does not indicate the number of graduates or their deployment across the country. ³⁷⁷

The African Field Epidemiology Network (AFENET) includes Burundi among its Countries of Operation, there is no evidence from the network, or from a general media search, of an active in-country FETP or any government-supported opportunities for Burundians to participate in applied epidemiology training abroad. They do, however, report that there were 58 graduates and 3 frontline cohorts in 2022, for a population of 14 million. ³⁷⁸

No additional information was found on the websites of the Ministry of Public Health, AFENET, or the CDC indicating the existence of an animal health FETPV program in Burundi. ^379380381382

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

There is evidence that Burundi has a national public health emergency response plan which addresses multiple communicable diseases with epidemic or pandemic potential, although the plan is not publicly accessible.

According to a 2025 World Bank document, in August 2020, a harmonized national contingency plan for emergency management was validated, though it is not publicly available. The plan aims to “alleviate suffering in communities affected by disasters and improve the living conditions of vulnerable people.” ³⁸³ According to reporting, the plan assesses six major risks, including health risks with epidemic and pandemic potential such as COVID-19, cholera, malaria, and Ebola virus disease, as well as the risk of flooding. ³⁸⁴ Evidence also exists of earlier general emergency response plans and action plans; however, these do not specifically address public health emergencies. The 2012 and 2013 National Contingency Plans for Emergency Management (Plan de Contingence National de Gestion des Urgences) focus on disaster preparedness and response but do not mention epidemic or pandemic diseases. ³⁸⁵³⁸⁶ Similarly, the Action Plan for National Capacity Building for the Reduction of Risks, Preparation, and Response in Emergencies (2013–2016) does not reference public health emergencies. ³⁸⁷

The 2018 Joint External Evaluation (JEE) for Burundi notes that the country did not have a national multi-hazard plan for preparedness and response to public health emergencies and highlights that authorities had not conducted a mapping of risks and resources, which is essential for developing such a plan. ³⁸⁸

No additional information about the plan is available on the websites of the Ministry of Public Health, the Ministry of Agriculture, or the National Public Health Institute (INSP). ^389390391 The last National Action Plan for Health Security (NAPHS) development workshop was conducted in 2018, and no documentation has been published since about any NAPHS plan developed by Burundi. ³⁹² According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, but it is not publicly available. ^393394395396

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

Score: 0

There is no publicly available evidence that the national public health emergency response plan has been updated in the last three years.

In August 2020, a harmonized national contingency plan for emergency management was validated. The plan aims to “alleviate suffering in communities affected by disasters and improve the living conditions of vulnerable people.” ³⁹⁷ According to reporting, the plan assesses six major risks, including health risks with epidemic and pandemic potential such as COVID-19, cholera, malaria, and Ebola virus disease, as well as the risk of flooding. The plan is not publicly accessible and no additional information about the plan is available on the websites of the Ministry of Public Health, the Ministry of Agriculture, or the National Public Health Institute (INSP). ^398399400

The last National Action Plan for Health Security (NAPHS) development workshop was conducted in 2018, and no documentation has been published since about any NAPHS plan developed by Burundi. ⁴⁰¹ According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, but it is not publicly available. ^402403404405

3.1.1c One health principles by covering multiple threat types

Score: 0

There is no evidence that the national public health emergency response follows one health principles by covering multiple threat types, e.g. antimicrobial resistance, zoonotic disease spillover, biological accidents or deliberate acts.

In August 2020, a harmonized national contingency plan for emergency management was validated which aims to “alleviate suffering in communities affected by disasters and improve the living conditions of vulnerable people.” ⁴⁰⁶ While the full plan is not publicly available, World Bank reporting states that it "outlines coordination structures and strategic objectives for addressing epidemic-prone diseases (COVID-19, cholera, malaria, Ebola), floods, land movement hazards, population influx, drought-induced food insecurity, and technological risks." ⁴⁰⁷

No additional information about the plan is available on the websites of the Ministry of Public Health, the Ministry of Agriculture, or the National Public Health Institute (INSP). ^408409410 The last National Action Plan for Health Security (NAPHS) development workshop was conducted in 2018, and no documentation has been published since about any NAPHS plan developed by Burundi. ⁴¹¹ According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. ^412413414415

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Burundi does not have an overarching national contingency plan that includes consideration of vulnerable populations, or an explicit mention of health equity. In August 2020, a harmonized national contingency plan for emergency management was validated which aims to “alleviate suffering in communities affected by disasters and improve the living conditions of vulnerable people.” The plan is not publicly available. ⁴¹⁶

However, no public evidence indicates that the plan includes formal mechanisms for identifying and addressing the needs of specific vulnerable groups or explicit equity considerations in planning and response. The last National Action Plan for Health Security (NAPHS) development workshop was conducted in 2018, and no documentation has been published since about any NAPHS plan developed by Burundi. ⁴¹⁷ According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. ^418419420421

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

Score: 0

There is no publicly available evidence that Burundi has an established mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response. The 2018 World Health Organization Joint External Evaluation (JEE) for Burundi makes no mention of such a mechanism and highlights significant gaps in national preparedness and coordination structures. Specifically, the report states that “the authorities have not undertaken a mapping of risks and resources as a preliminary step which is essential to the development of such a plan.” ⁴²² The Action Plan for Strengthening National Capacities for Risk Reduction, Preparedness and Response to Emergencies in Burundi (2013–2016) notes the marginal role of the private sector in emergency relief situations, indicating that structured engagement has not been prioritized historically. ⁴²³ While a national harmonized contingency plan was validated in 2020 to address major risks including health emergencies, no reference to private sector engagement was found in publicly accessible summaries of this plan. ⁴²⁴ There is no further reference to private sector engagement on the websites of the Ministry of Public Health or the National Public Health Insitute. ⁴²⁵⁴²⁶

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

Score: 0

There is no publicly available evidence that Burundi has a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic. No NPI plan or guidelines were found on the websites of the Ministry of Public Health or the National Institute of Public Health. ⁴²⁷⁴²⁸ There is no reference of NPIs in the 2018 World Health Organization Joint External Evaluation (JEE) report for Burundi. ⁴²⁹

While some NPIs were applied during the COVID-19 pandemic, no overarching, publicly available framework or guidance for their systematic implementation in epidemic or pandemic situations has been identified. According to the World Bank’s COVID-19 preparedness and response assessment, Burundi implemented NPIs during the COVID-19 pandemic, including isolation, hygiene promotion, temperature screening at points of entry, and public gathering restrictions. However, these actions appear to have been ad hoc measures rather than part of a pre-existing NPI plan or guidance. ⁴³⁰

Earlier national emergency planning documents—such as the Action Plan for Strengthening National Capacities for Risk Reduction, Preparedness and Response to Emergencies in Burundi 2013–2016 and the National Strategy and Action Plan for Risk Prevention and Disaster Management 2012–2015—focus on general disaster risk management but do not address NPIs for epidemic control. ⁴³¹⁴³² In August 2020, the government validated a harmonized national contingency plan for emergency management, which aims to address multiple disaster risks, including those with epidemic and pandemic potential. However, the content of this plan is not publicly available, and there is no evidence confirming that it includes an NPI framework. ⁴³³

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. ⁴³⁴ While the COUSP is tasked with managing crisis response and interventions during public health emergencies, there is no information regarding NPIs on the COUSP website or in the UNDP's reporting. ⁴³⁵⁴³⁶

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

Score: 100

There is evidence that Burundi has activated its national emergency response plan for an infectious disease outbreak in the past year, but there is no evidence that it has completed a national-level biological threat–focused exercise during this period, either in collaboration with the World Health Organization (WHO) or independently.

The Africa Centers for Disease Control (AfricaCDC) reports that in 2025 Burundi approved its Mpox Response Plan and Marburg-Ebola Preparedness Plan in response to increased reports of cases domestically. ⁴³⁷ These plans, however, are not publicly available. ⁴³⁸⁴³⁹

The 2018 World Health Organization Joint External Evaluation for Burundi noted gaps in simulation exercises and response preparedness and emphasized the absence of regular multi-sectoral biological threat exercises. ⁴⁴⁰

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

Score: 50

There is evidence that Burundi has undertaken efforts in the past year to identify gaps and best practices in its outbreak response and to develop plans to improve response capabilities.

According to Africa CDC, Burundi revised and approved its Mpox Response Plan and Marburg-Ebola Preparedness Plan following a validation meeting held by the Ministry of Health on March 11, 2025. This meeting included development partners and key stakeholders, indicating a multi-sectoral review and update process. ⁴⁴¹⁴⁴² While the specific details of the revisions are not publicly available, the process suggests that lessons from previous outbreaks and gaps in response were considered during the revision of these plans.

The 2018 WHO Joint External Evaluation (JEE) highlighted that Burundi lacked regular after-action reviews or national-level simulation exercises to assess emergency response and strengthen capacities. ⁴⁴³ No more recent updates from the Ministry of Public Health, the National Public Health Institute (INSP), WHO, or other international partners indicate that further valuations have been conducted in 2024–2025. ⁴⁴⁴⁴⁴⁵

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

Score: 0

There is no evidence that Burundi has, in the past year, undergone a national-level biological threat-focused exercise that included private sector representatives.

The most recent threat-exercise was conducted in April, 2025. ⁴⁴⁶ There is no indication that private sector representatives were involved in this exercise.

No additional national-level biological threat-focused exercises have been reported on the WHO Disease Outbreak News website or on the Ministry of Public Health or National Institute of Public Health (INSP) websites for 2024–2025. ^447448449

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

There is evidence that Burundi has an Emergency Operations Center (EOC) in place.

According to the 2018 Joint External Evaluation (JEE), Burundi has a Public Health Emergency Operations Center (COUSP) that coordinates response activities during outbreaks and other public health emergencies. ⁴⁵⁰⁴⁵¹ The World Bank COVID-19 preparedness and response assessment (2020) also confirms that the EOC was activated during the COVID-19 pandemic to manage response activities, coordinate laboratories, and oversee surveillance and contact tracing. ⁴⁵² 2024 UNICEF reporting suggests that the EOC was activated during the Mpox emergency. ⁴⁵³

However, while the EOC exists at the national level, there is limited evidence of functional EOCs at sub-national levels, and private sector integration or multi-sectoral coordination outside health ministries appears limited. ^454455456

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

Score: 0

There is no publicly available evidence that the Emergency Operations Center (EOC) is required to conduct a drill for a public health emergency scenario at least once per year or that they conduct a drill at least once per year. According to a World Bank assessment of Burundi’s COVID-19 preparedness and response, the country began preparing for potential Ebola outbreaks in 2018 by strengthening public health response capacities, including upgrading the National Institute of Public Health (INSP) laboratory, establishing rapid intervention teams, and finalizing the Public Health Emergency Operations Center. ⁴⁵⁷ A simulation exercise in December 2019 included Burundi alongside seventeen other African countries to test the readiness of Public Health Emergency Operations Centers. ⁴⁵⁸ However, there is no evidence that the Burundi EOC conducts drills for public health emergency scenarios at least once per year, or that such drills are mandated. The 2018 Joint External Evaluation (JEE) notes that Burundi is in the process of operationalizing its EOC with support from WHO and other partners. Training for Ministry of Public Health officials began in 2017, and the JEE recommends that Burundi “establish an emergency operations center with multisectoral, trained and functional emergency response teams.” ⁴⁵⁹ No evidence was found on the websites of the Public Health Emergency Operations Center (COUSP), Ministry of Public Health or the National Public Health Institute (INSP) regarding annual drills or the operational status of the EOC. ^460461462

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

Score: 0

There is no publicly available evidence that Burundi's Emergency Operations Center (EOC) has conducted a coordinated emergency response within the past year, activated within 120 minutes of identifying a public health emergency.

On July 25, 2024, the Government of Burundi declared an Mpox outbreak following the confirmation of three cases by the National Reference Laboratory. While the EOC did respond and trained and deployed 246 rapid response teams to improve the country's capacity to respond to the outbreak, there is no evidence specifying the time of activation. ⁴⁶³

There is no further evidence available on the websites of the Public Health Emergency Operations Center (COUSP, Ministry of Public Health and the National Public Health Institute (INSP) regarding the EOC's delay-time during emergency responses. ^464465466

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence that Burundi's public health and national security authorities have conducted an exercise to respond to a potential deliberate biological event (i.e., bioterrorism attack). Likewise, there is no evidence of standard operating procedures (SOPs), guidelines, memorandums of understanding (MOUs), or other formal agreements between public health and security authorities for responding to such events.

The 2018 Joint External Evaluation (JEE) for Burundi notes that while the country has the National Strategy for Risk Prevention and Disaster Risk Management Action Plan (SNPRGC), which established a national platform for disaster risk prevention and management under the authority of the Ministry of Public Security, collaboration between public health and national security authorities remains limited. The JEE specifically highlights the lack of MOUs, joint training programs for public health staff and security authorities, standard operating procedures, and joint simulation exercises. ⁴⁶⁷

A regional biological threat-focused exercise was conducted in December 2019, involving seventeen African countries, including Burundi, to test the readiness of Public Health Emergency Operations Centers. The exercise reportedly aimed to "define linkages with national emergency management authorities," but no further details on Burundi’s specific participation or inclusion of national security and private sector actors are available. ⁴⁶⁸

No updated evidence from the Ministry of Public Health or the National Public Health Institute (INSP) indicates that such exercises, SOPs, or agreements have been established since 2019. ⁴⁶⁹⁴⁷⁰ The World Bank COVID-19 preparedness and response assessment also does not mention any coordination mechanisms or agreements with national security authorities for deliberate biological events. ⁴⁷¹

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. While the COUSP is tasked with managing crisis response and interventions during public health emergencies, there is no information regarding such exercises on the COUSP website or in the UNDP's reporting. ⁴⁷²⁴⁷³ There is equally no information available regarding publicly available standard operating procedures, guidelines, memorandums of understanding (MOUs), or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event on the COUSP website. ⁴⁷⁴

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

Score: 0

There is insufficient evidence to indicate that Burundi has a risk communication plan specifically for use during a public health emergency. According to the 2018 Joint External Evaluation (JEE) for Burundi, the country "does not have a multi-hazard and multisectoral communication plan, which is essential to timely and appropriate mobilisation and coordination in the case of public health emergencies." ⁴⁷⁵ The JEE notes that Burundi has implemented structures and initiatives within the Ministry of Public Health to manage risk communication, including the creation of a multisectoral committee intended to coordinate interventions and disseminate messages at peripheral and local levels. However, there is no public information available on the committee’s activities, and no official online presence or documentation of the risk communication plan could be found on the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ⁴⁷⁶⁴⁷⁷

In August 2020, a harmonized national contingency plan for emergency management was validated, which "aims to alleviate suffering of communities affected by disasters and improve the living conditions of vulnerable people." While the plan covers health risks with epidemic and pandemic potential, including COVID-19, cholera, malaria, and Ebola, the full plan is not publicly available, and no reporting provides details on risk communication strategies, or whether the plan includes mechanisms for multisectoral coordination of public messaging. ⁴⁷⁸

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. While the COUSP is tasked with managing crisis communication and interventions during public health emergencies, there is no information regarding a communication plan on the COUSP website or in the UNDP's reporting. ⁴⁷⁹⁴⁸⁰

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

Score: 0

There is no publicly available evidence that Burundi has a risk communication plan or any legislation, regulation, or strategy document that explicitly outlines how public health messages will reach populations and sectors with different communication needs.

According to the 2018 Joint External Evaluation (JEE) for Burundi, the country “does not have a multi-hazard and multisectoral communication plan, which is essential to timely and appropriate mobilisation and coordination in the case of public health emergencies.” ⁴⁸¹ While a multisectoral committee within the Ministry of Public Health has been established to coordinate risk communication, there is no documentation on how the committee adapts messaging for populations with different languages, geographic locations, media access, or vulnerable and hard-to-reach groups. ⁴⁸²

The 2020 harmonized national contingency plan for emergency management is not publicly available, and there is no further information publicly available on the websites of the Ministry of Public Health or the National Public Health Institute. ^483484485

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. While the COUSP is tasked with managing crisis communication and interventions during public health emergencies, there is no information regarding a communication plan on the COUSP website or in the UNDP's reporting. ⁴⁸⁶⁴⁸⁷

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

Score: 100

There is some evidence that Burundi has a designated position within the government to serve as the primary spokesperson to the public during a public health emergency, despite the absence of a formal risk communication plan. The Joint External Evaluation (JEE) for Burundi, conducted in March 2018, notes that the country does not have a national multi-hazard plan for preparedness and response to public health emergencies but indicates that there exists “a spokesperson at the Ministry of Health, responsible for communication” ⁴⁸⁸ The Public Health Emergency Operations Center (COUSP) under the Ministry of Health lists communication as one of their responsabilities and includes a "head of the health information system and communication department" in their organizational chart.

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

Score: 100

There is evidence that Burundi's public health system has actively shared messages via online media platforms in the past year to inform the public about ongoing public health concerns.

The Ministry of Public Health has utilized digital platforms to communicate with the public during health emergencies. For instance, during the 2024 Mpox outbreak, the Ministry issued public statements confirming cases and outlining response measures, including treatment and contact tracing efforts. These updates were disseminated through various media channels, including official government platforms and the Ministry's Facebook and X pages. ^489490491

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

Score: 0

There is publicly available evidence that senior leaders have shared misinformation or disinformation on infectious diseases in the past two years. In 2024 the President of Parliament stated, regarding Mpox, "These white people! They keep poisoning us and creating viruses to decimate us. So how can you trust them and expect them to come to your aid and help you get rid of this disease? I don't believe in this nonsense." ⁴⁹²

There are further concerns voiced in media about lack of transparency and delayed communication, but these do not strictly concern the sharing of disinformation. ^493494495

3.6.1a Percentage of households with Internet

Score: 17.93

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 34.16

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

Score: 63.33

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

Score: 66.67

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

Score: 100

There is no evidence that Burundi has, in the past year, issued a restriction—without international or bilateral support—on the export or import of medical goods (e.g., medicines, oxygen, medical supplies, PPE) due to an infectious disease outbreak. Although Burundi experienced an mpox outbreak in July 2024, available reports do not provide evidence that the response involved restrictive trade measures. ⁴⁹⁶⁴⁹⁷ International guidance from Africa CDC during the Mpox response specifically discouraged travel or trade bans and instead promoted coordinated international support. ⁴⁹⁸ There is no evidence that Burundi deviated from this guidance. No evidence of export/import restrictions on medical goods in 2024–2025 was found on the websites of the Ministry of Public Health or WHO Disease Outbreak News. ⁴⁹⁹⁵⁰⁰

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

Score: 100

There is no evidence that Burundi has, in the past year, imposed restrictions on the export or import of non-medical goods—such as food, textiles, or other consumer products—due to an infectious disease outbreak. While the country experienced a significant Mpox outbreak in 2024, there is no evidence in Burundian or international media that Burundi implemented trade restrictions on non-medical goods in response to this or any other infectious disease event. In August 2025, Burundi and the Democratic Republic of Congo (DRC) signed a memorandum of understanding to reduce non-tariff barriers by implementing new sanitary and phytosanitary regulations. This agreement aims to facilitate trade between the two countries by enhancing standardization, quality control, and certification processes,. ⁵⁰¹⁵⁰² There is no evidence of imposed restrictions on the export or import of non-medical goods on the websites of the Ministry of Public Health or the Ministry of Agriculture, nor on the World Health Organization (WHO) Disease Outbreak News platform. ^503504505

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

Score: 100

In the past year, Burundi has not implemented inbound or outbound travel restrictions specifically due to infectious disease outbreaks. There is no evidence on the website of the Ministry of Public Health or in Burundian or international media that Burundi issued any inbound or outbound travel restrictions during the 2024 Mpox outbreak. ⁵⁰⁶ The World Health Organization (WHO) and Africa Centers for Disease Control and Prevention (Africa CDC) did not recommend travel bans, emphasizing the importance of solidarity and coordinated support instead of restrictive measures. ^507508509

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

Score: 0

There is no evidence that Burundi systematically employs a risk-based approach to international travel-related measures, particularly during infectious disease outbreaks. In the past year, the country has not implemented travel restrictions or other measures specifically tied to infectious disease events such as Mpox. ^510511512 The 2023 Joint External Evaluation, for which the full report is not yet publicly available, scored Burundi the lowest score possible (1) for all indicators under the technical area "PoE. Points of entry and border health". ⁵¹³

Recent restrictions or advisories affecting travel to and from Burundi have been issued by other countries (e.g., the United States) based on immigration, security, or precautionary concerns, but there is no evidence that they were based on risk assessments conducted by Burundian authorities.⁵¹⁴ There is no publicly available guidance, legislation, or documented policy indicating that Burundi employs a risk-based framework for managing international travel during public health emergencies available on the websites of the Ministry of Public Health or the Ministry of Foreign Affairs. ⁵¹⁵⁵¹⁶

4.1.1a Doctors per 100,000 people

Score: 0.61

4.1.1b Nurses and midwives per 100,000 people

Score: 9.05

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

There is evidence that Burundi has, in the last five years, updated its public workforce strategy to identify fields where there is an insufficient workforce and develop strategies to address these shortcomings. While there is no evidence of a general workforce strategy in Burundi, The Strategic Plan of the National Institute of Public Health (2021-2025) identifies critical gaps in the health workforce and proposes strategies to address these shortcomings (Section 3.2: Weaknesses, pages 15-16). The plan acknowledges the insufficiency of health professionalsand the need for continuous training and capacity building, and proposes targeted recruitment efforts to fill critical positions (Page 80) to ensure equitable access to healthcare services. ⁵¹⁷

4.1.1d Health system capacity for essential health services

Score: 0

There is no evidence to suggest that Burundi’s health system currently has sufficient capacity to deliver essential health services.

According to reporting from the World Health Organization, Unicef, and Amnesty International, Burundi has insufficient health infrastructure, shortages of qualified healthcare workers, and inadequate financing; health facilities are unevenly distributed, with rural areas particularly underserved, and there is a persistent lack of essential medicines and equipment. Free healthcare is only provided to children under 5, pregnant women, retirees, and their dependents. While vaccination and maternal health programs exist, coverage is inconsistent, and service delivery often depends on external partners and donor support. ^518519520

The Burundian government allocated 263.9 billion Burundian francs (approximately 91.7 million USD) to the health sector in the 2024/2025 state budget, a 2.2% decrease from the previous year. This allocation represents 5.2% of the national budget, down from 8.6% in 2023/2024. ⁵²¹

The World Health Organization's 2018 Joint External Evaluation (JEE) scores the country 1 on this measure and highlights gaps in laboratory capacity, surveillance, and the ability to respond to outbreaks. ⁵²²

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no publicly available evidence that Burundi has a formal plan to ensure continuity of essential health services during a public health emergency. The 2018 Joint External Evaluation (JEE) for Burundi does not mention any specific strategy or guidance for maintaining essential services during outbreaks or other public health emergencies. ⁵²³ The 2023 JEE, the report for which is not yet available, scored Burundi a 1 for "2023 JEE R.3.3 Continuity of essential health services (EHS)," indicating a low capacity to ensure continuity. ⁵²⁴

In 2020, Burundi validated a harmonized National Contingency Plan for Emergency Management, which addresses multi-hazard risks including epidemics, but the full report is not publicly available and reporting on the plan does not specify strategies for maintaining essential health services alongside emergency response activities. ⁵²⁵ No updates or publicly accessible documentation from the Ministry of Public Health or the National Public Health Institute (INSP) indicate that a dedicated continuity-of-care plan has been established in the past year. ⁵²⁶⁵²⁷

4.1.2a Hospital beds per 100,000 people

Score: 14.47

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

Score: 0

There is insufficient evidence that Burundi has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit and/or patient isolation room/unit located within the country. While there is evidence that Burundi has used isolation centers during the 2024 Mpox outbreak, reporting suggests that these are implemented by external partners on an ad-hoc basis, and there is no evidence that they are capable of treating patients with highly communicable diseases. ^528529530 The CDC mentionted that "insufficient isolation units" posed a challenge to Burundi's Mpox response. ⁵³¹

The 2018 Joint External Evaluation (JEE) for Burundi notes that tertiary hospitals have isolation units but does not specify their capabilities for treating patients with highly communicable diseases. ⁵³² There is no further information available regarding isolation units on the websites of the Ministry of Public Health or the National Institute of Public Health. ⁵³³⁵³⁴

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

Score: 100

There is some evidence that Burundi has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years, though there is no publicly available information that the country has developed a plan to do so. In 2024, following the Mpox outbreak, the government rehabilitated 10 isolation and treatment units at district hospitals to increase patient management capacity. These efforts were supported by the Africa Centers for Disease Control and Prevention, which provided biosafety training, enhanced molecular testing capacity, and assisted with sample management. ⁵³⁵⁵³⁶

There is no evidence on the websites of the Ministry of Public Health or the National Health Institute suggesting that a plan has been developed to expand isolation capacity in the country. ⁵³⁷⁵³⁸

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

Score: 0

There is insufficient evidence of a national procurement protocol in place that can be utilized by the Ministries of Health and Agriculture for the acquisition of laboratory supplies (such as equipment, reagents and media) and medical supplies (equipment, PPE) for routine needs.

The Central Purchasing Office for Essential Medicines, Medical Devices, Laboratory Products, and Laboratory Equipment of Burundi (CAMEBU) manages a national procurement protocol for acquiring laboratory and medical supplies. Established by Decree No. 100/035 on March 29, 2000, CAMEBU operates under the Ministry of Public Health and is tasked with importing and distributing essential medicines, medical devices, and laboratory materials to public and private health facilities across the country. CAMEBU procures these supplies through international calls for tenders, evaluating both local and international offers. While the legal deadline for procurement procedures is set at 120 days, reports indicate that the process often extends up to 8 months. ⁵³⁹⁵⁴⁰

Despite this established procurement framework, there is limited evidence to suggest that the Ministries of Health and Agriculture actively utilize this protocol for the routine acquisition of laboratory supplies (e.g., equipment, reagents, and media) and medical supplies (e.g., equipment, PPE). ⁵⁴¹⁵⁴² Burundi's Directorate of Pharmacies, Drugs, and Laboratories (DPML) does not have an active website.

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

Score: 0

There is no publicly available evidence to suggest that Burundi maintains a stockpile of medical supplies—including medical countermeasures (MCMs), medicines, vaccines, medical equipment, or personal protective equipment (PPE)—for national use during a public health emergency. The 2018 Joint External Evaluation for Burundi explicitly notes that the country lacks a stockpile of medical supplies and has no agreements with manufacturers or distributors to obtain essential materials during a public health emergency. The JEE also highlights the absence of any national plan defining procedures for sending, receiving, or distributing medical supplies in such scenarios, as well as the lack of regional or international agreements for acquisition, sharing, or distribution of these resources. ⁵⁴³ The 2023 JEE, the full report for which is not yet available, awards Burundi the lowest score of 1 for "R.1.5 Emergency logistic and supply chain management". ⁵⁴⁴

The Department of Pharmacies, Drugs and Laboratories within the Ministry of Public Health (Direction des Pharmacies, des Médicaments et des Laboratoires, DPML) serves as Burundi’s pharmaceutical regulatory authority and is responsible for the registration and authorization of new medicines. However, DPML does not appear to maintain a public website. Additional sources, including the websites of the Ministry of Public Health and the Ministry of Defense, provide no further evidence regarding national stockpiles or emergency distribution plans. ⁵⁴⁵⁵⁴⁶

While the National Health Plan (2016-2025) meantions that stockpile capacities have grown over the years, it also states that shortages of essential medications still frequently occurred. ⁵⁴⁷

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

Score: 0

There is no publicly available evidence to suggest that Burundi maintains a stockpile of laboratory supplies for national use during a public health emergency. The 2018 Joint External Evaluation for Burundi explicitly notes that the country lacks a stockpile of medical supplies and has no agreements with manufacturers or distributors to obtain essential materials during a public health emergency. The JEE also highlights the absence of any national plan defining procedures for sending, receiving, or distributing medical supplies in such scenarios, as well as the lack of regional or international agreements for acquisition, sharing, or distribution of these resources. ⁵⁴⁸ The 2023 JEE, the full report for which is not yet available, scores Burundi a 1 for "R.1.5 Emergency logistic and supply chain management". ⁵⁴⁹

The Department of Pharmacies, Drugs and Laboratories within the Ministry of Public Health (Direction des Pharmacies, des Médicaments et des Laboratoires, DPML) serves as Burundi’s pharmaceutical regulatory authority and is responsible for the registration and authorization of new medicines. However, DPML does not appear to maintain a public website. Additional sources, including the websites of the Ministry of Public Health and the Ministry of Defense provide no further evidence regarding national stockpiles or emergency distribution plans. ^550551552

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no evidence that the country conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency. The 2018 Joint External Evaluation for Burundi explicitly notes that the country lacks a stockpile of medical supplies and has no agreements with manufacturers or distributors to obtain essential materials during a public health emergency. The JEE also highlights the absence of any national plan defining procedures for sending, receiving, or distributing medical supplies in such scenarios, as well as the lack of regional or international agreements for acquisition, sharing, or distribution of these resources. ⁵⁵³ The 2023 JEE, the full report for which is not yet available, scores Burundi a 1 for "R.1.5 Emergency logistic and supply chain management". ⁵⁵⁴

The Department of Pharmacies, Drugs and Laboratories within the Ministry of Public Health (Direction des Pharmacies, des Médicaments et des Laboratoires, DPML) serves as Burundi’s pharmaceutical regulatory authority and is responsible for the registration and authorization of new medicines. However, DPML does not appear to maintain a public website. Additional sources, including the websites of the Ministry of Public Health and the Ministry of Defense provide no further evidence regarding national stockpiles or emergency distribution plans. ⁵⁵⁵⁵⁵⁶

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

Score: 0

There is no evidence that Burundi has a plan or agreement to leverage domestic manufacturing capacity to produce, or a mechanism to procure, medical supplies (e.g., MCMs, medicines, vaccines, equipment, PPE) for national use during a public health emergency. The 2018 Joint External Evaluation (JEE) for Burundi explicitly notes that the country lacks a stockpile of medical supplies and does not have agreements with manufacturers or distributors to obtain them during public health emergencies. The JEE further highlights that Burundi does not have defined procedures for sending, receiving, or distributing medical supplies nationally and lacks regional or international agreements for the acquisition, sharing, and distribution of such supplies. ⁵⁵⁷ The 2023 JEE, the full report for which is not yet available, scored Burundi a 1 for "R.1.5 Emergency logistic and supply chain management". ⁵⁵⁸

While Burundi has received PPE and other medical supplies through partnerships with Gavi and UNICEF during the COVID-19 response, there is no evidence that these efforts were tied to a formal plan or agreement to leverage procurement capacity or ensure ongoing access to essential medical supplies. ⁵⁵⁹

The Department of Pharmacies, Drugs, and Laboratories (Direction des Pharmacies, des Médicaments et des Laboratoires, DPML) within the Ministry of Public Health is the national pharmaceutical regulatory authority and is responsible for the registration and authorization of new medicines. However, DPML does not have a publicly accessible website, and there is no additional evidence via the websites of the Ministry of Public Health or Ministry of Defense regarding any national mechanisms to procure or produce medical supplies during public health emergencies.

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

Score: 0

There is no publicly available evidence that Burundi has a plan or agreement to leverage domestic manufacturing capacity to produce laboratory supplies (e.g., reagents, media) for national use during a public health emergency. Similarly, there is no publicly available evidence of a formal plan or mechanism for the procurement of laboratory supplies for national use or a system to expedite such supplies through points of entry during a public health emergency.

The 2018 Joint External Evaluation (JEE) for Burundi highlights that the country lacks stockpiles and agreements with suppliers for both medical and laboratory supplies and does not have defined procedures for the acquisition, distribution, or sharing of these materials at national, regional, or international levels. ⁵⁶⁰ The 2023 JEE, the full report for which is not yet available, scored Burundi a 1 for "R.1.5 Emergency logistic and supply chain management". ⁵⁶¹ While Burundi has received some laboratory reagents and diagnostic kits through international support during the COVID-19 pandemic—such as donations coordinated via WHO and UNICEF—there is no indication of a formal mechanism or plan that ensures ongoing access or expedites laboratory supply logistics during emergencies. ⁵⁶²

The Department of Pharmacies, Drugs, and Laboratories (Direction des Pharmacies, des Médicaments et des Laboratoires, DPML) within the Ministry of Public Health oversees the registration and authorization of new laboratory products, but DPML does not have a publicly accessible website, and there is no evidence via the Ministry of Public Health or the Ministry of Defense websites of any national protocols for laboratory supply procurement or expedited delivery. ⁵⁶³⁵⁶⁴

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

There is no evidence that Burundi has a formal system or mechanism at the national or subnational levels for emergency logistics and supply chain management. Available information indicates that the country relies primarily on international support and ad hoc measures to manage medical and laboratory supply needs during public health emergencies. The 2018 Joint External Evaluation (JEE) for Burundi highlights the absence of stockpiles, agreements with suppliers, and procedures for the distribution of medical or laboratory supplies, suggesting that no structured logistics or supply chain system exists. ⁵⁶⁵ The 2023 JEE, the full report for which is not yet available, awarded Burundi the lowest score of 1 for "R.1.5 Emergency logistic and supply chain management". ⁵⁶⁶

Although Burundi has received support from organizations such as World Health Organization, UNICEF, and Gavi for the provision of vaccines, PPE, and laboratory reagents during the COVID-19 pandemic, there is no publicly available evidence that these efforts are coordinated through a national system covering both public and private sectors, or that they include specific considerations such as cold chain management for vaccines. ⁵⁶⁷ The World Bank’s 2025 reporting on Burundi's Proposed Contingent Emergency Response Project (CERP) similarly notes the absence of established mechanisms for rapid procurement and distribution of medical and laboratory supplies during emergencies. ⁵⁶⁸ There is no further evidence of a supply chain plan on the websites of the Ministry of Health or Defense, though there is evidence of a project funded by the World Bank to support the creation of one. ^569570571

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

Score: 0

There is no publicly available evidence that Burundi has a plan, program, or formal guidelines in place for dispensing medical countermeasures (MCMs) for national use during a public health emergency, including antibiotics, vaccines, therapeutics, or diagnostics. The 2018 Joint External Evaluation (JEE) for Burundi explicitly notes that the country lacks stockpiles of medical supplies and does not have agreements with manufacturers or distributors for emergency procurement. The JEE also highlights the absence of procedures for sending, receiving, or distributing medical supplies during a public health emergency, as well as the lack of regional or international agreements to support such distribution. The 2023 JEE, the full report for which is not yet available, scored Burundi a 1 for "R.1.5 Emergency logistic and supply chain management". ⁵⁷² There is no further evidence of such a plan available on the websites of the Ministry of Health or Defense. ⁵⁷³⁵⁷⁴

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, but it is not publicly available. There is no information regarding a plan or program for MCMs on the COUSP website or in the UNDP's reporting. ⁵⁷⁵⁵⁷⁶

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

Score: 0

There is no publicly available evidence that Burundi has a formal plan in place to facilitate health workforce surge in the event of a public health emergency. The 2018 Joint External Evaluation (JEE) for Burundi highlights general gaps in human resource capacity and notes that the country lacks systems for mobilizing and training additional personnel during emergencies. ⁵⁷⁷ The 2023 JEE, the full report for which is not yet publicly available, scored Burundi a 1 for "R.1.4 Activation and coordination of health personnel in a public health emergency." ⁵⁷⁸ There is no further information available regarding a health workforce surge plan on the website of the Ministry of Health. ⁵⁷⁹

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. There is no information regarding the facilitation of a health workforce surge on the COUSP website or in the UNDP's reporting. ⁵⁸⁰

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence that Burundi has a formal plan to receive health personnel from other countries to respond to a public health emergency. The 2018 Joint External Evaluation (JEE) for Burundi notes gaps in human resource surge capacity and does not indicate the existence of agreements, memorandums of understanding (MOUs), or protocols with other countries or international agencies to provide foreign health personnel during emergencies. ⁵⁸¹ The 2023 JEE, the full report for which is not yet publicly available, scored Burundi a 1 for "R.1.4 Activation and coordination of health personnel in a public health emergency." ⁵⁸²

During past outbreaks, including COVID-19 and mpox, international organizations such as WHO and UNICEF have offered technical assistance and personnel support to Burundi. ⁵⁸³⁵⁸⁴ However, these appear to have been ad hoc deployments rather than guided by a pre-existing national plan. There is no publicly available evidence indicating the reception of foreign health workers into Burundi’s emergency response system on the website of the Ministry of Health. ⁵⁸⁵

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. There is no information regarding the reception of foreign health personnel on the COUSP website or in the UNDP's reporting. ⁵⁸⁶⁵⁸⁷

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no publicly available evidence that Burundi has a formal plan to redeploy existing health personnel within the country—either geographically or by role—during a public health emergency. The 2018 Joint External Evaluation (JEE) for Burundi identifies gaps in surge capacity and human resources for health but does not reference any protocols, guidelines, or contingency plans for redeploying staff to high-need areas or reassigning personnel to different roles in response to an outbreak. ⁵⁸⁸ The 2023 JEE, the report for which has not yet been published, awards Burundi the lowest score of 1 for "R.1.4 Activation and coordination of health personnel in a public health emergency". ⁵⁸⁹

No publicly available documents from the Ministry of Public Health or the National Public Health Institute (INSP) describe procedures for reassigning or relocating health workers during emergencies. ⁵⁹⁰⁵⁹¹

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. There is no information regarding the redeployment of health personnel on the COUSP website or in the UNDP's reporting. ⁵⁹²

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

The Constitution of Burundi explicitly guarantees citizens’ right to health and access to medical care. Article 55 of the Constitution of the Republic of Burundi (2018) states that “every person has the right to access health care," and contains no mention that the care is free.⁵⁹³

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

Score: 63.24

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

Score: 98.69

4.4.1d Coverage of essential health services through universal health coverage

Score: 29.17

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: 77.5

4.4.1f Rate of mortality amenable to health care

Score: 83.24

4.4.2a Guaranteed paid sick leave

Score: 0

Workers in Burundi are not legally entitled to paid sick leave. The Labour Code of Burundi (2020) does not provide sick leave for workers. ⁵⁹⁴

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no evidence that the government of Burundi has issued legislation, a formal 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. The Joint External Evaluation for Burundi (2018) highlights the absence of a comprehensive public health emergency response plan and makes no reference to any framework that guarantees preferential treatment for healthcare workers. It does note the existence of bonuses and allowances for health personnel during emergencies, but these are financial incentives rather than health service prioritization mechanisms. ⁵⁹⁵ There is likewise no such provision in the National Health Policy 2016–2025 or in the Strategic Plan of the National Institute of Public Health (2021-2025), and no further evidence is available on the website of the Ministry of Public Health. ^596597598

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

Score: 0

There is no evidence that Burundi has a system in place for public health officials and healthcare workers to communicate during a public health emergency.

The Joint External Evaluation of IHR Core Capacities of the Republic of Burundi notes that the country was in the process of establishing an Emergency Operations Center (EOC) with the support of the World Health Organization to strengthen coordination and communication capacities. As part of its existing framework, the Ministry has created an Information, Education and Communication service (Service IEC), which is responsible for social mobilization and public communication during health emergencies. However, the IEC service does not have an independent online presence, and there is no evidence indicating that it facilitates communication with health workers. There is no further information available on the website of the Ministry of Public Health. ⁵⁹⁹⁶⁰⁰

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. ⁶⁰¹⁶⁰² While the website of the COUSP states that communication during health crises is their responsibility, there is no evidence of a system in place for such communication on their website or in the UNDP's reporting. ⁶⁰³⁶⁰⁴

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

Score: 0

There is no evidence that Burundi has a system in place for public health officials and healthcare workers to communicate during a public health emergency, therefore there is no evidence that such a system encompasses healthcare workers in both the public and private sector.

The 2018 Joint External Evaluation of IHR Core Capacities of the Republic of Burundi notes that the country was in the process of establishing an Emergency Operations Center (EOC) with the support of the World Health Organization to strengthen coordination and communication capacities. As part of its existing framework, the Ministry has created an Information, Education and Communication service (Service IEC), which is responsible for social mobilization and public communication during health emergencies. However, the IEC service does not have an independent online presence, and there is no evidence indicating that it facilitates communication with health workers. There is no further information available on the website of the Ministry of Public Health. ⁶⁰⁵⁶⁰⁶

According to the United Nations Development Programme, the Public Health Emergency Operations Center (COUSP) deployed a Strategic and Operational Plan (SOP) for 2026-2030, which is not publicly available. ⁶⁰⁷⁶⁰⁸ While the website of the COUSP states that communication during health crises is their responsibility, there is no evidence of a system in place for such communication on their website or in the UNDP's reporting. ⁶⁰⁹⁶¹⁰

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

Score: 0

There is no publicly available evidence that the national public health system is monitoring for and tracking the number of healthcare associated infections (HCAI) that take place in healthcare facilities. There is no information on HCAI surveillance or reporting available on the websites of the Ministry of Public Health of Burundi or the National Public Health Institute. ⁶¹¹⁶¹² According to the 2018 Joint External Evaluation (JEE), the country lacks a national plan to combat HCAIs, as well as any surveillance systems for at-risk groups in hospitals. It also highlights that guidelines for protecting health personnel are inadequate and that there is limited training for healthcare workers on infection prevention and control. ⁶¹³ The 2023 JEE, the report for which is not yet publicly available, awarded Burundi the lowest score of 1 for "R.4.2 HCAI surveillance". ⁶¹⁴

The Strategic Partnership for Health Security (SPH) Portal states that Burundi does possess an AMR plan, but the plan is not accessible online, and there is no documentation to indicate its operational scope related to surveillance, detection or reporting. ^615616617 A study conducted by the Burundi Network for Infection Prevention and Control (RBPCI) in December 2023 found that of "46 HCFs assessed, 93% do not have an IPC program and 87% do not have an IPC team […] 89% of the health facilities have not yet established a system for monitoring health-care associated infections [and] 87% do not regularly monitor IPC practices." ⁶¹⁸⁶¹⁹

4.6.1b Infection prevention and control programme

Score: 0

There is no evidence of an infection prevention and control (IPC) program in Burundi. While the country has IPC focal points under the Ministry of Health, there is no evidence that a national program exists, and IPC initiatives are highly limited in scope. According to the World Health Organization Joint External Evaluation (JEE) for Burundi conducted in 2018, the country has an IPC focal point within the Ministry of Public Health and has developed some IPC guidelines, particularly in the context of Ebola preparedness and response activities. However, the JEE explicitly notes the absence of a comprehensive national IPC program and highlights major gaps in implementation and monitoring at the national and facility levels. ⁶²⁰ A study conducted by the Burundi Network for Infection Prevention and Control (RBPCI) in December 2023 found that of "46 HCFs assessed, 93% do not have an IPC program and 87% do not have an IPC team." ⁶²¹⁶²² No standalone IPC strategy or policy document is available on the website of the Ministry of Public Health of Burundi, and there is no mention of such in the National Health Plan (2016-2025). ⁶²³⁶²⁴ The 2023 JEE, the report for which has not yet been published, awards Burundi the lowest score of 1 for "R.4.1 IPC programmes". ⁶²⁵

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

Score: 0

There is no publicly available evidence of a plan to ensure a safe environment in health facilities nationally.

The World Health Organization Joint External Evaluation (JEE) for Burundi (2018) noted that infection prevention and control (IPC) activities existed in a fragmented manner, with some IPC guidelines available but without a coordinated national IPC program or standardized measures to ensure environmental safety across health facilities. The report highlighted the need to develop a national IPC plan that includes water, sanitation, and hygiene (WASH) standards in healthcare settings, appropriate waste management, and environmental decontamination procedures. ⁶²⁶ A UNICEf report published in 2024 states that the WASH context in Burundi's health facilities is "extremely fragile," with only 48% of health facilities meeting a basic level of sanitation. ⁶²⁷

No further evidence is available on the websites of the Ministry of Public Health or the National Public Health Institute. ⁶²⁸⁶²⁹ A study conducted by the Burundi Network for Infection Prevention and Control (RBPCI) in December 2023 found that of "46 HCFs assessed, 93% do not have an IPC program and 87% do not have an IPC team." ⁶³⁰⁶³¹

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 0

There is no publicly available evidence that there a national requirement for ethical review (e.g., from an ethics committee or via Institutional Review Board approval) before beginning a clinical trial in Burundi. While an Ethics Committee was established in 2019, there is no mention of any legal requirement that clinical trials must gain the Committee's approval in the National Health Plan (2016-2025) or Law No. 1/042 of May 30, 2018, establishing the Code for the Provision of Health Care and Services in Burundi (which does mandate Committee permission for biomedical research). ^632633634 The Burundian Regulatory Authority for Medicines for Human Use and Food, which is tasked with ensuring clinical trials "conform to norms," does not have an active website. ⁶³⁵

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

Score: 0

There is no evidence that there is an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics. There is no mension of MCM or mutual recognition of clinical trials on the website of the Minstry of Public Health, nor in the National Health Plan (2016-2025), Law No. 1/042 of May 30, 2018, establishing the Code for the Provision of Health Care and Services in Burundi, or Decree No. 100/039 of February 26, 2021 on the Creation, Organization, and Operation of the Burundian Authority for the Regulation of Medicines for Human Use and Food, which does not have an active website. ^636637638639

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 0

There is insufficient evidence that there is a government agency responsible for approving new medical countermeasures (MCM) for humans in Burundi. The Department of Pharmacies, Drugs and Laboratories (DPML), under the Ministry of Public Health of Burundi, is considered the national pharmaceutical regulatory authority and is responsible for the registration and authorization of new medicines. ⁶⁴⁰ However, DPML does not have an official website or publicly available documentation outlining its regulatory procedures. There is no further evidence available on the website of the Ministry of Health, nor in the National Health Plan (2016-2025). ^641642643

Law No. 1/11 of 8 May 2020, issued by the National Assembly of Burundi, regulates the practice of pharmacy and the use of medicines for the health of humans. ⁶⁴⁴ The law is enforced by the Burundian Regulatory Authority for Medicines for Human Use and Food (Autorité Burundaise de Régulation des Médicaments à usage humain et des Aliments, ABREMA), which oversees pharmaceutical regulation and compliance, but does not include any evidence of MCM. ⁶⁴⁵

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no evidence of an expedited process for approving medical countermeasures (MCM) for human use or recognition of approval decisions taking place elsewhere during public health emergencies. The Department of Pharmacies, Drugs and Laboratories (DPML), under the Ministry of Public Health of Burundi, is considered the national pharmaceutical regulatory authority and is responsible for the registration and authorization of new medicines. ⁶⁴⁶ However, DPML does not have an official website or publicly available documentation outlining its involement with MCM approvals. There is no mension of MCM or mutual recognition of clinical trials on the website of the Minstry of Public Health, nor in the National Health Plan (2016-2025), Law No. 1/042 of May 30, 2018, establishing the Code for the Provision of Health Care and Services in Burundi, or Decree No. 100/039 of February 26, 2021 on the Creation, Organization, and Operation of the Burundian Authority for the Regulation of Medicines for Human Use and Food. ^647648649650

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

Score: 100

Burundi has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁶⁵¹

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

Score: 0

There is no publicly available evidence that epidemics and pandemics are itegrated into the national risk reduction strategy or that there a standalone national disaster risk reduction strategy for epidemics and pandemics.

In August 2020, a harmonized national contingency plan for emergency management was validated. The plan aims to “alleviate suffering in communities affected by disasters and improve the living conditions of vulnerable people.” ⁶⁵² According to reporting, the plan assesses six major risks, including health risks with epidemic and pandemic potential such as COVID-19, cholera, malaria, and Ebola virus disease, as well as the risk of flooding. However, the plan is not publicly available. ⁶⁵³

The 2018 Joint External Evaluation (JEE) for Burundi notes that the country did not have a national multi-hazard plan for preparedness and response to public health emergencies and highlights that authorities had not conducted a mapping of risks and resources, which is essential for developing such a plan. ⁶⁵⁴

No additional information about the plan is available on the websites of the Ministry of Public Health or the National Public Health Institute (INSP). ⁶⁵⁵⁶⁵⁶ The Voluntary National Report for the Midterm Review of the Implementation of the Sendai Framework for Disaster Risk Reduction 2015-2030 discusses Burundi's response to Covid-19, but does not generally integrate epidemics or pandemics into any risk reduction strategy. ⁶⁵⁷

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 0

There is no publicly available evidence that Burundi has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to public health emergencies. The 2018 Joint External Evaluation (JEE) for Burundi indicates that Burundi does not have formal protocols or memorandums of understanding (MOUs) for cross-border collaboration in the event of a public health emergency of international concern, nor for broader public health emergency management. ⁶⁵⁸

Burundi is a member state of the East African Community (EAC), for whom the prevention and control of communicable and non-communicable diseases is an explicit regional objective. ⁶⁵⁹⁶⁶⁰ In February 2018, Burundi and other EAC member states issued a joint communique during the EAC Heads of State retreat, committing to strengthen the network of medical reference laboratories and the regional rapid response system to address health threats, including pandemics and bioterrorism. ⁶⁶¹ Despite this, there is no evidence of formalized agreements or signed MOUs as a result of Burundi's EAC membership.

In December 2019, the World Health Organization (WHO) reported that the Democratic Republic of the Congo (DRC) and its nine neighboring countries, including Burundi, endorsed a joint framework to enhance cross-border collaboration for preparedness and response to Ebola virus and other outbreaks. ⁶⁶² However, there is no publicly available evidence of formalized agreements or signed MOUs for these initiatives. No additional information could be found on the websites of the Ministry of Public Health or the National Public Health Institute. ⁶⁶³⁶⁶⁴

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 0

There is no publicly available evidence that Burundi has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to animal health emergencies.

The 2018 Joint External Evaluation (JEE) for Burundi indicates that Burundi does not have formal protocols or memorandums of understanding (MOUs) for cross-border collaboration in the event of animal health emergencies. ⁶⁶⁵ Burundi is a member state of the East African Community (EAC), for whom the prevention and control of communicable and non-communicable diseases is an explicit regional objective. ⁶⁶⁶⁶⁶⁷ In February 2018, Burundi and other EAC member states issued a joint communique during the EAC Heads of State retreat, committing to strengthen the network of medical reference laboratories and the regional rapid response system to address health threats, including pandemics and bioterrorism. ⁶⁶⁸ Despite this, there is no evidence of formalized agreements or signed MOUs regarding animal health emergencies as a result of Burundi's EAC membership.

In December 2019, the World Health Organization (WHO) reported that the Democratic Republic of the Congo (DRC) and its nine neighboring countries, including Burundi, endorsed a joint framework to enhance cross-border collaboration for preparedness and response to Ebola virus and other outbreaks. ⁶⁶⁹ However, there is no publicly available evidence of formalized agreements or signed MOUs regarding animal health emergencies for these initiatives. No additional information could be found on the websites of the Ministry of Public Health or the National Public Health Institute. ⁶⁷⁰⁶⁷¹

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Burundi is fully a State Party to the Biological Weapons Convention (BWC) with the same legal effect as ratification. ⁶⁷²⁶⁷³

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

Score: 100

Burundi submitted confidence building measures for the Biological Weapons Convention in 2025, though the report is not publicly available. ⁶⁷⁴

5.3.1c Submission of UNSCR 1540 reports

Score: 100

In 2008 and 2018 Burundi provided the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee). ⁶⁷⁵

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

Burundi is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), the Australia Group (AG), or the Proliferation Security Initiative (PSI). ^676677678

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

Score: 0

Burundi completed a Joint External Evaluation (JEE) in 2023, but it has not yet published a full public report. ⁶⁷⁹ The last publicly available JEE was conducted in 2018. ⁶⁸⁰

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

Score: 0

Burundi has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years. ⁶⁸¹

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

Score: 0

Burundi has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. Their last published gap analysis dates to 2012. ⁶⁸²

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

Score: 0

There is no publicly available evidence that Burundi has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years. According to 2025 World Bank reporting, "Burundi does not have a dedicated, nationwide financial mechanism specifically designed for large-scale disaster response." ⁶⁸³ Recent capacity-building measures to address Covid-19 and Mpox have been financed by international parnters. ^684685686 The 2024/2025 budget does not include any funds earmarked to address pandemic or epidemic threats, stating only that Burundi received funds from the World Bank for an ongoing project related to Covid-19. ⁶⁸⁷ There is no budgetary information available on the websites of the Ministry for Public Health or the National Intitute for Public Health. ⁶⁸⁸⁶⁸⁹

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

Score: 0

While Burundi conducted a Joint External Evaluation (JEE) report in 2023, the document is not yet publicly available. ⁶⁹⁰ The last publicly available JEE was conducted in 2018. ⁶⁹¹ Similarly, Burundi conducted a NAPHS workshop in April 2025, documentation from which is not publicly available. ⁶⁹²

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

Score: 0

Burundi has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. Their last published gap analysis dates to 2012. ⁶⁹³

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is evidence of a publicly identified special emergency public financing mechanism and funds which Burundi can access in the face of a public health emergency (such as through a dedicated national reserve fund, an established agreement with the World Bank pandemic financing facility/other multilateral emergency funding mechanism, or other pathway identified through a public health or state of emergency act).

Burundi participates in the African Public Health Emergency Fund (APHEF), which was established in 2012 to provide resources for rapid response to public health emergencies across the African region. APHEF funds have been used in Burundi to support the provision of emergency medical supplies and the prevention of outbreaks such as cholera, and malaria. The last documented disbursement from this fund occurred in 2014, and Burundi has not paid into the fund between 2019-2025. ⁶⁹⁴

The World Bank’s Contingent Emergency Response Project (CERP) establishes an additional pathway for Burundi to mobilize emergency funds through the activation of a Contingent Emergency Response Component (CERC). Burundi activated the CERP in 2023, although this was specifically in response to an El Niño, not to address epidemic threats. ⁶⁹⁵

There is no publicly available evidence of a domestic national emergency reserve fund or a national legal mechanism that guarantees immediate public financing during health emergencies on the websites of the Ministry of Public Health or Ministry of Finance. ⁶⁹⁶⁶⁹⁷

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

Score: 0

There is no publicly available evidence that senior leaders (president or ministers), in the past three years, have made a public commitment either to support other countries to improve capacity to address pandemic or epidemic threats by providing financing or support, or to improve the country’s domestic capacity to address pandemic or epidemic threats by expanding financing or requesting support to improve capacity. No public statements from senior leaders have been identified regarding efforts to strengthen the national health system in relation to the recent Mpox outbreak. Additionally, no further evidence was found on the websites of the Ministry of Public Health or the Ministry of Foreign Affairs. ⁶⁹⁸⁶⁹⁹ Press releases from the United Nations and the World Health Organization contain no statements made by Burundian senior leaders. ⁷⁰⁰⁷⁰¹

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

Score: 0

There is no publicly available evidence that the country has, in the past three years, provided other countries with financing or technical support to improve capacity to address epidemic threats, nor that they have requested financing or technical support from donors to improve the country’s domestic capacity to address epidemic threats. While Burundi activated World Bank Contingent Emergency Response Project (CERP) in 2023, this was specifically in response to an El Niño, not to address epidemic threats. ⁷⁰² No further evidence was found on the websites of the Ministry of Public Health or the Ministry of Foreign Affairs. ⁷⁰³⁷⁰⁴

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

Score: 0

Burundi has not fulfilled its full contribution to the WHO within the past two years, carrying a balance of 5,740 USD in 2025. ⁷⁰⁵

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

Score: 0

There is no evidence of a publicly available plan or policy for sharing genetic data, epidemiological data, clinical specimens, and/or isolated specimens (biological materials) with international organisations and/or other countries that goes beyond influenza. There is no evidence of such a plan on the websites of the Ministry of Public Health, Ministry of Higher Education and Scientific Research, Ministry of Agriculture and Livestock, or the National Public Health Institute.^706707708709 There is no mention of such a plan or policy in the National Health Plan (2016-2025). ⁷¹⁰

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

Score: 100

There is no publicly available evidence indicating that Burundi has failed to share influenza virus samples in accordance with the World Health Organization's (WHO) Pandemic Influenza Preparedness (PIP) Framework during the past two years. No evidence was found on the PIP's website or in the most recent progress report that Burundi has failed to share samples. ⁷¹¹⁷¹² There is no evidence in Burundian or international media that Burundi has failed to share influenza virus samples in the past two years.

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

Score: 100

There is no public evidence that Burundi has failed to share pandemic pathogen samples during an outbreak in the past two years. A review of the World Health Organization (WHO) Disease Outbreak News website shows no indication that pandemic pathogen samples were withheld following the declaration of any disease, and WHO reporting suggest that Burundi has shared samples of Mpox during a recent oubreak. ⁷¹³⁷¹⁴ There is no evidence in Burundian or international media that Burundi has failed to share pandemic pathogen samples in the past two years.

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: 17

6.1.1f Accountability of public officials

Score: 25

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: 25

6.1.4a Risk of terrorism

Score: 25

6.1.4b Level of illicit arms flows within the country

Score: 100

6.1.4c Risk of organized criminal activity

Score: 25

6.1.5a Presence or risk of armed conflict

Score: 50

6.1.6a Government territorial control

Score: 0

6.1.7a International tensions

Score: 50

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

Score: 75.6

6.2.2a UNDP Gender Inequality Index score

Score: 40.09

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

Score: 7.61

6.2.3b Share of employment in the informal sector

Score: 0

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: 62.5

6.3.1a Adequacy of road network

Score: 0

6.3.2a Adequacy of airports

Score: 25

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 100

6.4.2a Change in forest area (percentage points)

Score: 100

6.4.3a Natural disaster risk

Score: 0

6.5.1a Total life expectancy (years)

Score: 41.68

6.5.1b NCD mortality rate

Score: 52.66

6.5.1c Population aged 65+

Score: 94.95

6.5.1d Tobacco use (% of adults)

Score: 58.38

6.5.1e Level of adult obesity (%)

Score: 96.17

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

Score: 61.5

6.5.2a Access to potable water

Score: 65.95

6.5.2b Access to at least basic sanitation facilities

Score: 44.92

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: 0.86

6.5.4a Trust medical and health advice from the government

Score: 100

6.5.4b Trust medical and health advice from medical workers

Score: 50