Gambia: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 50

The Gambia reportedly has a National Action Plan on antimicrobial resistance (AMR) in place for 2023–2027. However, since the plan is not publicly available, it is unclear whether it includes provisions for surveillance, detection, and reporting of AMR cases.

According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in September 2024, the Gambia has made progress in establishing a multisectoral coordination framework to address antimicrobial resistance (AMR), including the development of a National Action Plan for 2023–2027. However, the 2024 JEE noted that implementation is still at an early stage, and key sectors—such as fisheries—are not adequately engaged. Surveillance capacity reportedly remains low, and regulatory oversight of antimicrobial use in both human and animal health sectors is insufficient. More specifically, The Gambia has initiated efforts to collect antimicrobial resistance (AMR) data from designated sentinel surveillance sites, with four of seven sites currently generating data. Some laboratory capacity exists—particularly at the National Public Health Laboratory—and personnel have been trained in AMR surveillance. However, the system remains fragmented, lacking a national surveillance plan, standardization protocols, and consistent reporting to the national level. Key challenges include limited funding, insufficient laboratory infrastructure and resources across both human and animal health sectors, and a lack of capacity for susceptibility testing in the animal, aquatic, and crop sectors. Additionally, pathogen genomics capabilities are absent in the public sector. (pp. 16-17) ¹ These findings are echoed in a 2025 study, which reinforces the 2024 JEE report by stating that The Gambia has a “limited action plan for [a] national surveillance system for antimicrobial resistance” (p. 11). ² The 2021 Tripartite AMR Country Self-Assessment Survey (TrACSS) conducted by the World Health Organization (WHO) also indicates that Gambia has developed and demonstrated a national action plan on AMR in 2023 and 2024 respectively. ³

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

Score: 100

There is evidence that The Gambia has capacity to test for most priority antimicrobial resistant (AMR) pathogens, including Tuberculosis, influenza, HIV, malaria, marburg, measles, rubella, yellow fever, meningitis, polio and COVID-19. The Joint External Evaluation report (JEE) for The Gambia, published in September 2017, states that three Gambian laboratories (the Edward Francis Small Teaching Hospital, the National Public Health Laboratory [NPHL] and the Medical Research Council [MRC]) are conducting detection or reporting on some priority pathogens; these are considered sentinel sites. ⁴ The JEE specifies that the NHPL tests for multi-drug resistant tuberculosis, along with four other hospitals, which the JEE does not name. ⁵ This was reinforced by the 2024 JEE which additionally notes that “the National Public Health Laboratory specializes in several critical core tests”, including influenza PCR, arboviruses PCR, HIV serology, TB and malaria microscopy, HIV/TB GeneXpert, Plasmodium rapid diagnostic tests, bacterial culture, and PCR testing for COVID-19, mpox and Marburg virus” (p. 31). ⁶ “Bacterial culture” could potentially include E. coli, K. pneumoniae, S. aureus, Salmonella spp., P. aeruginosa, etc., but these are not specifically listed in any of the JEE reports. According to the Ministry of Health’s National Health Laboratory Services Policy for the period of 2021-2025, laboratory surveillance systems are well established for several key conditions, including measles, rubella, yellow fever, meningitis, polio, malaria, HIV, tuberculosis, and COVID-19 (p.10). ⁷

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no evidence that the Gambian government conducts environmental detection or surveillance activities for antimicrobial-resistant (AMR) organisms.

The Gambia has reportedly adopted a National Action Plan on antimicrobial resistance (AMR) for the period of 2023–2027. However, since the plan is not publicly available, it is unclear whether it includes environmental detection or surveillance activities (e.g., in soil, waterways) for antimicrobial residues or AMR organisms among its priorities. ⁸

Secondary sources—such as the 2024 Joint External Evaluation (JEE) report—indicate that no such environmental surveillance activities are currently conducted. Notably, while the AMR National Action Plan was endorsed by all relevant ministries, the Ministry of Fisheries and Water Resources did not participate in its adoption, highlighting a gap in cross-sectoral engagement. ⁹ The 2024 JEE specifically notes among the challenges that “National laboratory capacity for susceptibility testing in the animal, aquatic and crop sectors are weak” and that “resources across sectors to support AMR surveillance and pathogen outbreak investigations are limited” (p. 17). ¹⁰

Additionally, neither the National Health Laboratory Services Policy (2021–2025) nor the National Health Policy (2021–2030) reference environmental detection or surveillance for AMR. ¹¹¹² The Gambia's Ministry of Environment, Climate Change and Natural Resources; its Ministry of Health and Social Welfare; Ministry of Agriculture do not list any plan or make any mention of surveillance activities for antimicrobial residues or antimicrobial resistant organisms. ¹³¹⁴¹⁵

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

Score: 0

There is no evidence that The Gambia has national legislation or a regulation in place that specifically requires prescriptions for antibiotic use for humans. The Gambia's Medicines and Related Products Act (2014), which is the main law regulating drug dispensation, makes no specific mention of antibiotics. ¹⁶ Although there is mention of general prescription regulations in the Act, and in other guiding documents, such as The Gambia National Drug Policy (1994), regulation of antibiotic prescription is not specifically described. ¹⁷ The Joint External Evaluation (JEE) report for The Gambia, published in September 2017, notes that there is a National Medicines Policy (2007) that might provide more detailed guidance, but it is not available on the website of the Ministry of Health and Social Welfare, or elsewhere electronically. ¹⁸¹⁹ The World Health Organisation (WHO) reports that The Gambia does not have a national action plan on antimicrobial resistance. ²⁰ The Gambia's Standard Drug Treatment Guidelines (2001) provide information to prescribers about how to treat specific conditions, but do not make a recommendation about the requirement, in general, of prescriptions for antibiotics. Further, the Guidelines appear to be a reference tool for medical professionals, and not to have the force of a law or regulation. ²¹ Additionally, a 2017 study published in the Transactions of The Royal Society of Tropical Medicine and Hygiene states that The Gambia "does not have national policies restricting antibiotic use". ²² According to the 2024 JEE report “irrational prescription and over-the-counter sale of antimicrobials are prevalent in both human and animal health sectors” (p. 18). ²³
According to the WHO, in 2021, the Gambia reportedly carried out an analysis to better tackle the threat of antimicrobial resistance.The findings of this analysis indicate that although healthcare professionals demonstrate relatively strong awareness of antimicrobial resistance, the vast majority of hospitals—around 90%—do not have antimicrobial stewardship programmes in place to monitor and optimize antibiotic prescribing and usage. Additionally, oversight of the medication use process within hospitals remains weak. The WHO further reports that in April 2023, a National Drug Therapeutic Committee was established with a mandate to support the selection of appropriate antimicrobials, implement targeted measures to enhance their prescription and use, and develop and update relevant antibiotic guidelines and protocols. ²⁴

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

Score: 0

There is no evidence that there is a national legislation or regulation in place requiring prescriptions for antibiotic use for animals. Neither the Ministry of Health and Social Welfare, the Ministry of Environment, Climate Change and Natural Resources, nor the Ministry of Agriculture share relevant information via public websites ²⁵²⁶²⁷. The World Health Organization reports that The Gambia does not have an antimicrobial resistance national action plan ²⁸. The Gambia's Agriculture and Natural Resources (ANR) Policy (2009-2015), the latest such policy available on the website of the Ministry of Agriculture, makes no mention of antibiotics or prescriptions. ²⁹ Additionally, a 2017 study published in the Transactions of The Royal Society of Tropical Medicine and Hygiene states that The Gambia "does not have national policies restricting antibiotic use". While the study specifically reviewed the use of antibiotics among human patients, the statement is consistent with all available evidence on the veterinary use of antibiotics. ³⁰ The Gambia's Standard Drug Treatment Guidelines (2001) provide information to prescribers about how to treat specific conditions, but do not make a recommendation about the requirement, in general, of prescriptions for antibiotics, nor do they mention the use of antibiotics among animals or livestock. Further, the Guidelines appear to be a reference tool for medical professionals, and not to have the force of a law or regulation. ³¹ According to the 2024 JEE report “irrational prescription and over-the-counter sale of antimicrobials are prevalent in both human and animal health sectors” (p. 18). ³²

1.2.1a Laws/plans on zoonotic disease

Score: 100

There is evidence that The Gambia has national plans on zoonotic diseases.
According to the Joint External Evaluation report for The Gambia, conducted by the World Health Organization in September 2024, “Gambia has an updated Animal Health Act (2023), which lays the foundation for zoonotic disease control”(p. 20), which lays down the foundation for zoonotic disease control. ³³³⁴ The regulation prescribes “mandatory reporting of important animal and zoonotic diseases” (p.8) and establishes a ‘surveillance system’ that “involves one or more component activities intended to generate data and information on the health, disease or zoonosis status of animal populations” (p.13). The Act also mandates that veterinary services annually identify and publish a list of priority animal diseases. ³⁵ The 2024 JEE further adds that the Gambia has established national-level units for epidemiology and disease control within both the health and livestock ministries and has conducted various capacity assessments. Several One Health activities have been implemented, including the 2021 International Health Regulations–Performance of Veterinary Services (IHR–PVS) National Bridging Workshop, which resulted in a roadmap to strengthen coordination between human and animal health sectors. Capacity-building efforts have included a National Joint Risk Assessment focused on H5N1 and other zoonoses.³⁶
According to the previous JEE report for The Gambia, published in September 2017, the country has the National Ebola Virus Disease Preparedness and Response Plan 2014-2015, and the Integrated National Emergency Preparedness and Response Plan for Avian and Human Influenza 2015-2019. ³⁷ The JEE report mentions that "comprehensive multidisciplinary preparedness and response plans already exist for highly pathogenic avian influenza, Ebola viruses and generic health sector emergencies" and it confirms that a relatively stable workforce of veterinary paraprofessionals does exist at the national and regional level that can be trained to meet the capabilities required by Pathways for Veterinary Services (PVS). ³⁸ The website of the Ministry of Health and Social Welfare confirms the existence of these plans. ³⁹ Further, some of the details of the Ebola preparedness plan are discussed in the Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019. ⁴⁰ The website of the Ministry of Agriculture makes no mention of zoonotic diseases. ⁴¹

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

Score: 100

The Gambia has legislation that includes measures for risk identification and reduction for zoonotic disease spillover events from animals to humans.

The Animal Health Act (2023) contains several provisions that support zoonotic disease risk identification and reduction, though spillover prevention is not explicitly mentioned. According to its text, it incorporates the following mechanisms: (1) rapid alert system, which establishes a structured notification network, with a designated veterinary contact person to alert national and international authorities regarding risks to human health arising from animal-derived food or feed (Part XII, section 74); (2) data collection and information sharing, which Mandates veterinary services to gather disease data and integrate it into a national information system (sections 72–73); (3) biosecurity planning, which Defines a “biosecurity plan” and requires creation of standard operating procedures addressing potential disease pathways (including zoonoses); (4) sanitary measures and traceability that requires coordination with key stakeholders to enforce sanitary practices and implement animal/product traceability schemes aligned with international standards (sections 52–54); and (5) legal recognition of zoonotic control meaning that the Act’s purpose includes protecting both human health and animal welfare via effective disease control from “farm to fork”. While the Act outlines foundational tools for zoonotic risk management (e.g., alert systems, biosecurity), it does not explicitly mandate measures to prevent zoonotic spillover events, such as wildlife surveillance, habitat monitoring, or environmental pathogen testing. There is also no explicit mention of coordinating with environmental or wildlife agencies to proactively contain spillover risks. ⁴² This is noted in the 2024 Joint External Evaluation report by the World Health Organization, conducted in September 2024. The JEE report specifically stresses that “surveillance of priority zoonotic diseases is limited and collaboration between the human and animal health sectors is insufficient.” (p. 20). ⁴³

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

Score: 100

The Gambia has several foundational frameworks that support the surveillance and control of multiple zoonotic pathogens of public health concern.

The Animal Health Act (2023) legally mandates the identification and annual gazetting of priority animal diseases, including zoonoses. It establishes the legal basis for surveillance, data sharing, biosecurity, rapid alert systems, traceability, disease control, and—at least in principle—inter-ministerial collaboration. ⁴⁴ Additionally, the country has participated in relevant One Health initiatives, including a 2021 National Bridging Workshop (NBW) under the International Health Regulations–Performance of Veterinary Services (IHR–PVS) framework, which produced a roadmap to strengthen coordination between human and animal health sectors. A National Joint Risk Assessment was also conducted to assess threats such as H5N1 avian influenza and other priority zoonoses. ⁴⁵ The Integrated Disease Surveillance and Response (IDSR) framework identifies multiple notifiable diseases, including rabies, anthrax, avian influenza, and brucellosis. However, implementation of IDSR varies, and laboratory coordination across the three tiers of the health system remains weak, as noted in the 2024 Joint External Evaluation (JEE). ⁴⁶ Despite these efforts, significant gaps remain. The Gambia does not have a comprehensive national One Health strategy that integrates zoonotic surveillance across human, animal, and environmental sectors. Surveillance efforts largely exclude wildlife and environmental reservoirs, and intersectoral coordination remains limited beyond ad hoc activities like joint workshops. There is also a lack of routine multi-pathogen surveillance operations and no clearly defined, cross-cutting guidelines for the control of multiple zoonotic diseases.⁴⁷

The Joint External Evaluation (JEE) report for The Gambia, published in September 2017, notes that The Gambia has a National Ebola Virus Disease Preparedness and Response Plan (2014-2015), and an Integrated National Emergency Preparedness and Response Plan for Avian & Human Influenza (AHI) (2015-2019). The JEE also notes that The Gambia has a rabies vaccination scheme (which presumably does not include provisions for surveillance and control). ⁴⁸ However, there is no documentation of these plans on the website of the Ministry of Health or elsewhere on the internet. ⁴⁹ The Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019 lays out plans for animal health emergencies;it separately discusses rabies, Ebola, and Avian and Human Influenza. However, the links between these themes are not emphasized. ⁵⁰ The Ministry of Agriculture does not provide any relevant information via a public website. ⁵¹

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

Score: 0

The Gambia does not have an established department, agency, or similar unit functioning as a multi-sectoral co-ordinating mechanism dedicated to zoonotic disease that functions across ministries.

According to the "One Health Multisector Coordination Mechanism Operational Tool Pilot in the Gambia" published by the Tropical Gastroenterology and Health Research (TGHR) Institute website, a pilot of the Multisector Coordination Mechanism (MCM) operational tool was conducted in The Gambia in May 2022 to strengthen the One Health platform and develop a national action plan, involving multiple ministries and organizations including WHO and FAO, indicating a mechanism is being developed rather than fully established yet. ⁵²

The Joint External Evaluation (JEE) report of The Gambia (2024) indicates that while there is a formal national multisectoral steering committee on public health emergencies involving multiple ministries, the specific coordination mechanism dedicated to zoonotic diseases across ministries is underdeveloped and lacks sufficient authority, resources, and formal terms of reference. The country has made progress in legal frameworks and adopted a One Health approach to zoonotic diseases, but multisectoral coordination for zoonotic disease surveillance and response remains limited with sporadic activities and insufficient funding. There is a recognized need to establish a multisectoral One Health strategic plan with designated focal points from human, animal, wildlife, and environmental health sectors to improve coordination and data sharing. The IHR National Focal Point and multisectoral coordination mechanisms score low (1 out of 5), reflecting the infancy of formalized coordination across sectors for zoonotic disease management. Priority actions include finalizing legal frameworks, establishing terms of reference for coordination bodies, and enhancing multisectoral collaboration under the One Health platform (pages 14, 15, 19, 20). ⁵³⁵⁴

1.2.1e Presence of One Health strategic plan

Score: 0

Gambia does not have a One Health strategy in place. The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in September 2024, recommends that the country develop a multisectoral One Health strategic plan for the coordination and response to priority zoonotic diseases, with designated focal points from human, animal, wildlife and environmental sectors.⁵⁵

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

Score: 0

There is insufficient evidence to suggest that The Gambia has a national mechanism for owners of livestock to conduct and report on disease surveillance to a central government agency.

According to the 2024 Joint External Evaluation (JEE) conducted by the World Health Organization, the legal mandates governing livestock services in The Gambia remain fragmented, with responsibilities for sanitary animal health practices divided between the Department of Livestock Services and the Food Safety and Quality Authority. Despite this division, the two authorities have laid the groundwork for collaboration in reducing zoonotic disease risks across animal breeding, production, and processing environments. This effort is supported by the Animal Health Act of 2023, which includes a dedicated provision for such coordination. The Act specifically requires the Veterinary Services to “establish identification and traceability schemes on live animals and products of animal origin through the application of principles stipulated in international standards at the farm level and at the food processing and distribution levels to ensure public health and public safety”. ⁵⁶ The JEE further notes that basic biosecurity training has been delivered to farmers, and a community-based animal disease reporting system is in place. A trained sanitary defence committee, made up of local farmers acting as frontline reporters—similar to community animal health workers—has also been established. However, the JEE highlights challenges in the enforcement of mandatory reporting and notes gaps in legal and regulatory frameworks governing animal disease notification, indicating that reporting compliance is not yet comprehensive. Strengthening these legal frameworks and improving the livestock disease reporting system are identified as key priorities to improve epidemic preparedness and response within the One Health framework (pages 30-32). ⁵⁷ According to the WHO Gambia Biennial Report 2020–2021, the country intended to operationalize its One Health roadmap by first establishing a functional and sustainable multisectoral collaboration mechanism to align efforts across sectors. This was to be accompanied by improved coordination of surveillance systems for human, animal, and environmental health at all levels. ⁵⁸ However, there is no public evidence that these plans were implemented or that the proposed coordination mechanism became operational in the years since. ⁵⁹⁶⁰
The Joint External Evaluation (JEE) report for The Gambia, published in September 2017, cites activities related to zoonotic disease prevention performed by the Ministry of Health, and by the Ministry of Agriculture’s Department of Livestock Services (DLS), which monitors rabies in livestock but not in humans. However, the 2017 JEE notes that information is not formally shared across ministries. ⁶¹ Further, there is no mention of DLS zoonotic disease activities on the website of the Ministry of Agriculture, nor is there any mention of a dedicated national, cross-ministerial department or unit for zoonotic diseases on the website of the Ministry of Health. ⁶²⁶³
In addition, The Gambia is among the countries that have implemented the Food and Agriculture Organization (FAO) Event Mobile Application (EMA-i) for animal-disease reporting, which was upgraded in 2024 to EMA-i+ to strengthen electronic, real-time reporting and enhance interoperability with national databases. ⁶⁴ While this demonstrates progress in digital surveillance capability, there is no public evidence that its use is institutionalized nationwide or that reporting through EMA-i+ is mandatory for livestock owners.

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

Score: 0

There is no evidence of laws or guidelines that safeguard the confidentiality of information generated through surveillance activities for animals (or for owners).

The Animal Health Act of 2023 does not contain any explicit provisions to safeguard the confidentiality of surveillance data reported by livestock owners. While the Act strengthens the legal authority of veterinary services—granting powers to collect epidemiological data, publish priority disease lists, enforce biosecurity measures, and coordinate disease reporting—it does not mandate any data privacy protections for information submitted by livestock keepers. ⁶⁵ Although privacy is constitutionally recognized in The Gambia and the Data Protection Act (2021) provides a legal framework for the protection of personal data, there is no indication that these protections extend to animal health data or surveillance reports submitted by farmers or community-based animal health workers. ⁶⁶

The 2024 Joint External Evaluation (JEE) report specifically recommends that The Gambia “establish a multisectoral surveillance guideline for zoonotic diseases to improve data sharing and coordination among sectors,” a step which could also entail safeguarding the confidentiality of surveillance data. ⁶⁷

The voluntary disease surveillance system operated by the Department of Livestock Services (DLS) under the Ministry of Agriculture lacks an online platform, and as noted in the 2017 JEE, Gambian laboratories do not have an electronic management information system. ⁶⁸ While The Gambia has made broad commitments to supporting medical data privacy and upholding constitutional protections for personal privacy, it remains unclear if and how these commitments apply to the surveillance of animal health. ⁶⁹⁷⁰

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no formal, nationwide program in The Gambia for wildlife-based surveillance of zoonotic diseases. However, the country has seen early-stage, research-led initiatives.

A pilot study—part of the “ZooContact” project—was conducted to explore community–animal contact and pathogen sharing among wildlife in rural Gambian communities to inform the design of broader zoonotic surveillance efforts. ⁷¹ However, the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in September 2017 also reports that there have been specific past instances of surveillance, such as a 2008 avian influenza, monitoring collaboration between the Ministry of Health and the Ministry of Environment, Climate Change, and Natural Resources’ Department of Parks and Wildlife Management. ⁷² The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization reveals that Gambia conducts surveillance of zoonotic diseases in wildlife, poultry, and livestock as part of its One Health approach. Surveillance systems integrate animal health sectors with human health to monitor diseases across wild animals, poultry, and livestock populations. However, the JEE notes that wildlife disease surveillance remains limited and underdeveloped compared to livestock and poultry. Gambia faces challenges in fully implementing comprehensive zoonotic disease surveillance, especially in wildlife and vector populations, due to resource constraints and gaps in coordination and technical capacity. Improving surveillance coverage and strengthening multisectoral coordination for wildlife and vector-borne zoonoses are recommended priorities for enhancing the country’s early warning and response capacities (pages 30-33). ⁷³

Additionally, surveillance of disease in wildlife is listed as a goal in the Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019. ⁷⁴ Still, there is no mention of ongoing systematic surveillance on the relevant government websites, such as those of the Ministry of the Environment, Climate Change, and Natural Resources, the Ministry of Health, and the Ministry of Agriculture. ⁷⁵⁷⁶⁷⁷

While the Animal Health Act (2023) mandates that “the Veterinary Services shall ensure control of a notifiable disease through […] an early detection system, by way of both active and passive surveillance, which shall include […] representative coverage of target animal populations by field services,” there is no evidence that this provision is implemented in a way that specifically targets poultry, livestock, or wildlife populations. The law provides a general framework, but lacks operational clarity or defined surveillance protocols for these key animal groups. ⁷⁸ Official programs targeting poultry and domestic animals (cattle, sheep, goats, chickens) are in place, primarily via passive reporting, meaning that data is collected only when cases are voluntarily reported by veterinarians, farmers, or other stakeholders—without active outreach, investigation, or routine sampling by authorities, such as the Department of Livestock Services (DLS). ⁷⁹

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).

As per WAHIS system entry, on 25 March 2023, The Gambia reported wild bird surveillance, specifically related to Highly Pathogenic Avian Influenza. The notification is currently marked as “resolved”. This provides public evidence of the country's mechanism for reporting notifiable animal disease events—including wildlife outbreaks—to the World Organisation for Animal Health (WOAH). ⁸⁰

1.2.4a Number of veterinarians per 100,000 people

Score: 0.34

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

Score: 14.28

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

Score: 0

There is no publicly available evidence that The Gambia’s national zoonotic disease plan, legislation, or strategic documents include a formal mechanism for working with the private sector in controlling or responding to zoonotic diseases.

The websites of the Ministry of Agriculture and the Ministry of Health and Social Welfare make no mention of such a plan. ⁸¹⁸² Further, no documentation exists on these websites for the National Ebola Virus Disease Preparedness and Response Plan (2014-2015), and an Integrated National Emergency Preparedness and Response Plan for Avian & Human Influenza (AHI) (2015-2019), making it unclear whether they involve any private sector collaboration. ^83848586 The national laboratory system and the Directorate of Health Research (the public health research body) do not share relevant information via a public website. The Gambia's Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019 discusses animal health emergencies but not zoonoses specifically. The plan does not mention collaboration with private sector entities aside from the training of farmers in hygiene and the handling of livestock products. ⁸⁷

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

Score: 0

There is no evidence that The Gambia 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.

The National Health Laboratory Services Strategic Plan (2021–2025) outlines key objectives for improving The Gambia’s laboratory system, including the introduction of a Laboratory Information Management System (LIMS), strengthened biosafety and biosecurity protocols, and the establishment of a coordinated national laboratory network. However, the document does not include specific provisions for maintaining an updated inventory of facilities that store or process especially dangerous pathogens and toxins, nor does it detail inventory management systems for such high-risk agents. ⁸⁸ While the country operates a biosafety level 3 (BSL-3) laboratory (MRC Unit The Gambia (MRCG)) for handling high-risk pathogens, as noted in the 2024 Joint External Evaluation (JEE) report, the same report also states that “there is no national inventory system for high-risk pathogens and toxins, nor a regulatory framework to govern their storage and use” (p.26). In response to this gap, the JEE recommends that The Gambia develop a national legal framework for biosafety and biosecurity that includes all relevant sectors (human health, animal health, and agriculture) under the International Health Regulations (IHR) and conduct regular inventory of dangerous pathogens and toxins and establish a secure biobanking system for their storage and monitoring. ⁸⁹

In July 2025, the MRC Unit The Gambia hosted a regional biobanking and data management training in collaboration with the Pan-Africa Network for Genomic Surveillance of Poverty-Related Diseases and Emerging Pathogens (PANGenS), focusing on ethical standards, legal frameworks, and best practices in genomic data handling. However, it is not publicly known whether the workshop addressed the storage, inventory management, or governance of especially dangerous pathogens within the BSL-3 facility. ⁹⁰

The previous JEE report, conducted in September 2017, notes that the MRC Unit in The Gambia, funded by the United Kingdom government, operates at a high level of compliance with international biosafety standards, but the website of the MRC does not contain a list of facilities to deal with dangerous substances, nor details of their inventories. ⁹¹⁹² Neither the public defence agencies (through the Ministry of Interior), the national laboratory system, the Directorate of Health Research (the public health research body), the Ministry of Agriculture nor the Ministry of Higher Education, Research, Science, and Technology share relevant information via public websites. ^93949596 Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ⁹⁷ The Gambia Health Services Assessment 2019 report notes that more than half of The Gambia's health facilities lack facilities and guidelines for safe final disposal or appropriate storage of infectious waste. ⁹⁸ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ⁹⁹

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

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

The Joint External Evaluation report for The Gambia, conducted in September 2024, specifically notes that “there is no legislation or regulations on biosafety and biosecurity” (p.26). ¹⁰⁰ The previous JEE report for The Gambia, published in September 2017, also notes that The Gambia has no system to identify, secure, or process dangerous pathogens and toxins; nor does it have any related legislation or regulations. ¹⁰¹ Neither the public defence agencies (through the Ministry of Interior), the Ministry of Health (or its national laboratory system), the Directorate of Health Research (the public health research body), nor the Ministry of Agriculture, share relevant information via public websites. ^102103104105 Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹⁰⁶ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁰⁷

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 100

The Gambia has an established agency responsible for the enforcement of biosecurity legislation and regulations.

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization states that the Biosafety Unit within the National Public Health Laboratory in Gambia was established under the National Health Laboratory Services Policy (2021–2025) and is tasked with implementing a national biorisk management framework across public health laboratories, developing and enforcing biosafety protocols to minimize public health risks from pathogenic agents. Despite this mandate, biosafety and biosecurity activities in Gambia remain underfunded, and the country lacks a biobanking system for secure biological specimen storage. Furthermore, the JEE highlights the absence of a multisectoral coordination mechanism to comprehensively address biosafety and biosecurity across human health, animal health, and agriculture sectors (page 35). ¹⁰⁸¹⁰⁹

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

Score: 0

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

According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in September 2024 “there is no national inventory system for high-risk pathogens and toxins, nor a regulatory framework to govern their storage and use” (p. 26). ¹¹⁰ The previous JEE report, which was published in September 2017, also notes that there is “no mechanism for monitoring and developing an updated record and inventory of pathogens within facilities that store or process dangerous pathogens and toxins”. The 2017 JEE report notes that the Gambian unit of the privately-owned Medical Research Council (MRC) operates at a high level of compliance with international biosafety standards, but the website of the MRC does not contain any information about specific actions taken to consolidate inventories of dangerous pathogens and toxins into a minimum number of facilities. ¹¹¹¹¹²

However, there is some emerging recognition of the need for improved systems. As part of the National Action Plan for Health Security (NAPHS), WHO has proposed an activity described as “Build functional National Biobank lab to secure dangerous pathogens and toxin”. According to the WHO’s Strategic Preparedness Hub, The Gambia’s NAPHS is listed on the SPH portal but is not publicly accessible, as indicated by a “Document Availability: NO” status next to the country entry. While the portal confirms that a NAPHS for Gambia exists (with implementation activities mapped and a strategic period ending in 2026), the actual plan is not available for public download. ¹¹³¹¹⁴

There is no mention of facilities for the management of dangerous pathogens and toxins on the website of the Ministry of Health. ¹¹⁵ Neither the public defence agencies (through the Ministry of Interior), the Ministry of Health and Social Welfare's national laboratory system and its Directorate of Health Research (the public health research body), the Ministry of Agriculture, nor the Ministry of Higher Education, Research, Science, and Technology share relevant information via public websites. ^116117118 Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹¹⁹ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹²⁰

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

Score: 0

There is no public evidence of in-country capacity to conduct Polymerase Chain Reaction (PCR)-based diagnostic testing for anthrax and/or Ebola.

The 2024 Joint External Evaluation (JEE) report notes that The Gambia’s National Public Health Laboratory (NPHL) is equipped to perform several critical diagnostic tests, including PCR testing for influenza, arboviruses, COVID-19, mpox, and Marburg virus. Additional core laboratory capabilities include HIV serology, tuberculosis and malaria microscopy, HIV/TB GeneXpert, Plasmodium rapid diagnostic tests, and bacterial culture. However, the report does not mention PCR-based diagnostic capacity for anthrax or Ebola, suggesting that these high-risk pathogens are not currently included in the NPHL’s routine diagnostic portfolio. ¹²¹

The Joint External Evaluation (JEE) report for The Gambia, published in September 2017, notes that The Gambia has a National Ebola Virus Disease Preparedness and Response Plan (2014-2015), and some of the details of this Ebola preparedness plan are discussed in the government’s Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019. ¹²²¹²³ However, the Ebola preparedness plan is not available online, and the emergency preparedness plan has little information on testing.

Ebola and anthrax are not mentioned on the websites of the Ministry of Agriculture, the Ministry of the Interior, or the Gambia Armed Forces. Neither the public defence agencies (through the Ministry of Interior), the Ministry of Health and Social Welfare’s national laboratory system and its Directorate of Health Research (the public health research body), nor the Ministry of Agriculture share relevant information via public websites. ^124125126127 The Gambia Health Services Assessment Report 2019 indicates there is PCR testing available for HIV on-site at one health facility, but does not discuss PCR testing for Ebola or anthrax. ¹²⁸

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no evidence suggesting that biosecurity and biosafety training being provided on an ad hoc basis in The Gambia.

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization indicates that while Gambia’s Biosafety Unit is responsible for developing and implementing biosafety protocols in public health laboratories, the country currently lacks a standardized, mandatory biosecurity training program with a common curriculum or train-the-trainer approach specifically for personnel working with dangerous pathogens, toxins, or biological materials of pandemic potential. The JEE notes that biosafety and biosecurity activities, including workforce training, are underfunded and insufficiently developed, highlighting a critical gap in ensuring consistent and comprehensive biosecurity capacity among relevant personnel. Enhancing structured biosecurity training programs is among the recommended priorities for strengthening Gambia’s biorisk management framework (page 35). ¹²⁹

The previous JEE conducted in 2017 also identified similar shortcomings, indicating a persistent gap in biosafety training across sectors. ¹³⁰ Neither the public defence agencies (through the Ministry of Interior), the Ministry of Health and Social Welfare's national laboratory system and its Directorate of Health Research (the public health research body), the Ministry of Agriculture, nor the Ministry of Higher Education, Research, Science, and Technology, share relevant information via public websites. ^{131132133134135} Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹³⁶ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹³⁷

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

Score: 0

There is no evidence that 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 drug testing, background checks, and psychological or mental fitness checks.

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization reports that Gambia currently does not have specific regulations or licensing conditions requiring security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential to undergo drug testing, background checks, or psychological or mental fitness assessments. The JEE highlights gaps in the regulatory and legal frameworks related to biosafety and biosecurity, including the absence of detailed personnel vetting protocols for those handling high-risk biological materials. Strengthening such regulatory measures and personnel screening processes is identified as a key area for improvement to enhance biosecurity and safe management of dangerous pathogens (page 35). ¹³⁸

Neither the Ministry of Health, its national laboratory system and its Directorate of Health Research (the public health research body), the public defence agencies (through the Ministry of Interior), the Ministry of Agriculture, nor the Ministry of Higher Education, Research, Science, and Technology share relevant information via public websites. ^{139140141142143} Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹⁴⁴ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁴⁵

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

Score: 100

The Gambia has publicly available information on national regulations on the safe and secure transport of infectious substances (specifically including Categories A and B).

The 2024 Joint External Evaluation (JEE) confirms that The Gambia’s National Health Laboratory System has operational capacity to safely transport specimens from lower-tier facilities ("spokes") to higher-tier laboratories ("hubs") and to the national reference laboratory. This suggests that a specimen transport system exists and is functioning, at least internally within the national public health framework. The 2024 JEE further notes that The Gambia has made progress in human health specimen transport through the establishment of a Sample Referral Network, which includes real-time tracking and monitoring of samples and a dedicated coordination mechanism to manage operations. Specific personnel are assigned to oversee the movement of samples across the country. The report indicates that Gambia has national regulations for the safe and secure transport of infectious substances, including Categories A and B. However, these regulations are not yet fully comprehensive or consistently enforced across all sectors. Additionally, the JEE highlights that publicly available information on these transport regulations is limited, impacting transparency and compliance efforts. (p. 36). ¹⁴⁶

The National Health Laboratory Services Strategic Plan (2021-2025) for The Gambia identifies several critical gaps in the country’s laboratory specimen transport system. Notably, it cites that there are “no guidelines or weak systems for sample transportation” (p. 29) and that there is also inadequate training and the absence of standard procedures for the safe transport of infectious materials. The plan also highlights that no national laboratory network flow chart exists to guide sample collection and referral for more advanced testing. In response, the plan includes targeted objectives to improve this area: under the broader goal of providing quality laboratory testing services to all people, it aims to strengthen the safe and secure collection, packaging, and transportation of specimens both within the country and internationally (Strategy 2.2). Additionally, it calls for the development and implementation of an electronic, mobile, and web-based platform to enable effective specimen tracking across the national transport network (Strategy 7.3). ¹⁴⁷

The Gambia's Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019 states a goal of strengthening the transportation of samples, but does not go into any detail about existing regulations.The original plan, endorsed in 2016 and implemented between 2017 and 2019, was designed as a comprehensive framework to coordinate the government’s response to all types of health emergencies but it appears not to have been publicly updated since 2019. ¹⁴⁸ Similarly, The Gambia National Health Sector Strategic Plan (2014-2020) states a goal of strengthening the transport of samples, but does not go into any greater detail. ¹⁴⁹ Neither the Ministry of Transport, Works and Infrastructure, Ministry of Health and Social Welfare, its national laboratory system and its Directorate of Health Research (the public health research body), the public defence agencies (through the Ministry of Interior), the Ministry of Agriculture, nor the Ministry of Higher Education, Research, Science, and Technology share relevant information via public websites. ^{150151152153154}

While the 2017 JEE, states that standard operating procedures (SOPs) "for collection, packaging and transportation are available for diseases under surveillance", these SOPs are not shared via a public website, making it unclear whether they apply to Category A and B substances. ¹⁵⁵ The recommendations of the World Health Organisation's Ebola virus preparedness strengthening team's 2014 country visit to The Gambia suggest a lack of guidelines on the transportation of infectious substances, but that at least some training of Ebola response teams had occurred for transporting Category A substances. ¹⁵⁶.

Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹⁵⁷ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁵⁸

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

Score: 0

There is no evidence of a national legislation, regulation, or other guidance in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins and pathogens with pandemic potential.

The National Health Laboratory Services Strategic Plan (2021-2025) for The Gambia identifies several critical gaps in the country’s laboratory specimen transport system. Notably, it cites that there are “no guidelines or weak systems for sample transportation” (p. 29) In response, the plan includes targeted objectives to improve this area: under the broader goal of providing quality laboratory testing services to all people, it aims to strengthen the safe and secure collection, packaging, and transportation of specimens both within the country and internationally (Strategy 2.2). Additionally, it calls for the development and implementation of an electronic, mobile, and web-based platform to enable effective specimen tracking across the national transport network (Strategy 7.3). ¹⁵⁹

Neither the Ministry of Health and Social Welfare, the Ministry of Trade, Industry, Regional Integration and Employment, the Ministry of Agriculture, nor the Ministry of Higher Education, Research, Science, and Technology share relevant information via public websites. ^160161162163 The 2011 Gambia Trade Policy (which is the most recent available on the internet) is also silent on such regulations and guidance. ¹⁶⁴ Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹⁶⁵ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁶⁶

1.4.1a Biosafety laws/regulations

Score: 0

There is no evidence of national biosafety legislation and/or regulations in The Gambia.

The Joint External Evaluation (JEE) report for The Gambia, conducted in September 2024, notes that The Gambia has “no legislation or regulations on biosafety and biosecurity” (p. 26). The 2024 (JEE) specifically recommends that The Gambia develop a national legal framework for biosafety and biosecurity that comprehensively includes all relevant sectors—human health, animal health, and agriculture—in alignment with the International Health Regulations (IHR). ¹⁶⁷ This underscores a persistent gap, as the 2017 JEE report similarly highlighted the lack of a national legal framework to guide biosafety and biosecurity efforts across sectors. ¹⁶⁸

Although The Gambia does not have a formal biosafety law, the National Health Laboratory Services Strategic Plan (2021–2025) emphasizes the vital role of biosafety and biosecurity in safeguarding both laboratory personnel and the wider public from the risks of accidental exposure to or release of dangerous biological agents. This strategic plan serves as the country’s main guiding document in the absence of dedicated legislation. ¹⁶⁹
Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹⁷⁰ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁷¹

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

The Gambia does not have a dedicated agency responsible for the enforcement of biosafety legislation and regulations.

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization states that while Gambia has a Biosafety Unit within the National Public Health Laboratory responsible for developing and implementing biosafety protocols, there is no fully established, dedicated agency specifically tasked with the enforcement of biosafety legislation and regulations at the national level. Enforcement activities are fragmented and lack a clear, authoritative body with a mandate to oversee compliance across sectors (p. 35). ¹⁷²

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no evidence that The Gambia require biosafety training, using a standardized, required approach for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization indicates that Gambia does not currently have a standardized and mandatory biosafety training program for personnel working in facilities with especially dangerous pathogens, toxins, or biological materials with pandemic potential. The training that exists lacks a common curriculum or a train-the-trainer approach, and biosafety and biosecurity activities, including workforce capacity building, remain underfunded and insufficiently developed (p. 35). ¹⁷³

The National Health Laboratory Services Policy for 2021-2025 specifically notes that, due to “insufficient training”—amongst other factors such as low awareness of biosafety risks and inconsistent adherence to standard operating procedures (SOPs)—laboratory personnel in The Gambia remain at risk of laboratory-acquired infections when handling pathogenic organisms. ¹⁷⁴

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is insufficient evidence that The Gambia has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to the 2024 Joint External Evaluation (JEE), research and development (R&D) activities in The Gambia, including operational and implementation research approvals, are conducted on an ad hoc basis without a centralized or standardized framework. A key strength is the establishment of the Directorate of Health Research, which supports coordination of research efforts. The country benefits from collaborations with institutions such as the Medical Research Council (MRC) and the Institut Pasteur de Dakar, which assist with laboratory diagnostics and sample testing. An excess mortality study on COVID-19 has been completed, and research oversight is provided through the Joint Gambia Government and MRC Ethics Committee, alongside other scientific committees. However, the JEE highlights major challenges, including the absence of a legal framework for health emergency preparedness research, inadequate resources and networks for innovation, limited funding for health research, and an overall lack of capacity to sustain and expand R&D efforts in the health sector. ¹⁷⁵

Neither the Ministry of Health, its national laboratory system and its Directorate of Health Research (the public health research body), the public defence agencies (through the Ministry of Interior), the Ministry of Agriculture, nor the Ministry of Higher Education, Research, Science, and Technology share relevant information via public websites. ^{176177178179180} Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹⁸¹ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁸²

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

Score: 0

There is no publicly available evidence that the country has legislation and/or regulation requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in September 2024 notes that a key strength is the establishment of the Directorate of Health Research, which supports coordination of research efforts. ¹⁸³ A key part of its mandate is to promote the use of evidence-based research in shaping health policies and practices. The Directorate of Health Research is the primary agency responsible for health research oversight in The Gambia. According to the Ministry of Health’s website, its number one service is “oversight and coordination: leading and aligning health research activities.” However, it remains unclear whether this oversight extends to research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other forms of dual-use research, as no public documentation confirms the scope of its authority in these specific areas. ¹⁸⁴

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

Score: 0

There is a designated agency responsible for the overall oversight and coordination of health research in The Gambia. However, it is unclear whether this mandate specifically includes oversight of research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other forms of dual-use research.

The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in September 2024 notes that a key strength is the establishment of the Directorate of Health Research, which supports coordination of research efforts. ¹⁸⁵ A key part of its mandate is to promote the use of evidence-based research in shaping health policies and practices. The Directorate of Health Research is the primary agency responsible for health research oversight in The Gambia. According to the Ministry of Health’s website, its number one service is “oversight and coordination: leading and aligning health research activities.” However, it remains unclear whether this oversight extends to research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other forms of dual-use research, as no public documentation confirms the scope of its authority in these specific areas. ¹⁸⁶

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

Score: 0

There is no evidence of a national legislation, regulation, policy, or other guidance, requiring the screening of synthesised DNA before it is sold.

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization reports that Gambia does not have legislation or regulation requiring the screening of synthesized DNA against lists of known pathogens and toxins before sale. The JEE highlights gaps in regulatory frameworks related to advanced biotechnologies, including the absence of controls or oversight mechanisms for synthetic DNA screening to prevent misuse or accidental exposure to dangerous biological materials. Developing and implementing such regulations is recommended to strengthen biosafety and biosecurity measures in the country (page 36). ¹⁸⁷

Neither the Ministry of Health, its national laboratory system and its Directorate of Health Research (the public health research body), the public defence agencies (through the Ministry of Interior), the Ministry of Agriculture, nor the Ministry of Higher Education, Research, Science, and Technology share relevant information via public websites. ^{188189190191192} Further, while the Joint External Evaluation (JEE) report for The Gambia, published in September 2017, does not discuss the existence of such legislation, it notes that, more generally, The Gambia lacks systematic oversight of laboratory premises, scientists, and technicians. ¹⁹³ Although The Gambia is a party to the Biological Weapons Convention, it has not submitted Confidence Building Measures since 2011. Access to the 2011 submitted report is restricted, and it is not publicly available. ¹⁹⁴ There is no relevant information documented in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁹⁵

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: 100

Official foot-and-mouth disease (FMD) vaccination figures for livestock are publicly available through the OIE WAHIS database since 2020 for the Gambia. ¹⁹⁶

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

The Gambia has a national immunization strategy for the period of 2024-2028 and it is reportedly aimed at overcoming socioeconomic inequalities, geography, cultural/linguistic differences and/or gender barriers to vaccination.

The Gambia’s Expanded Programme on Immunization (EPI), in place since 1979, is now guided by the National Immunization Strategy 2024–2028, which aligns with the Global Vaccine Action Plan and Global Immunization Strategy. The programme ensures nationwide vaccine delivery, with a strong cold chain system, equitable access including for marginalized populations, and ongoing quality control. Vaccines for 16 antigens—including newer ones—are provided, and recent data show that 97% of 12-month-old children received at least one measles vaccine dose, while coverage for the second dose has increased to 79% since its 2012 introduction. Procurement and forecasting systems are robust, avoiding central-level stockouts and minimizing delivery disruptions, with support from Gavi, UNICEF, and WHO. Vaccines are distributed through a mixed push-pull system, and all health facilities offering immunization services are equipped with functional solar-powered cold chain equipment. Reflecting the strength of these systems, the 2024 Joint External Evaluation (JEE) awarded The Gambia the highest possible score—4—for National vaccine access and delivery (p.28). ¹⁹⁷ however, the National Immunization Strategy 2024–2028 itself does not appear to be publicly available.

The National Health Policy 2021–2030 acknowledges the Expanded Programme on Immunization (EPI) as a successful initiative in delivering essential health services. Among its key policy objectives is the elimination and control of communicable diseases—such as malaria, tuberculosis, HIV/AIDS, and other sexually transmitted infections including hepatitis—to the point where they no longer pose a major public health threat (Objective 3.3.2; p. 20). As part of this goal, the policy emphasizes the need to ensure the availability of effective, efficient, and resilient immunization services for all eligible individuals, recognizing immunization as a core pillar of disease prevention and a critical pathway toward achieving universal health coverage. ¹⁹⁸

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

Score: 0

There is insufficient evidence that the national immunization strategy include measures to address vaccine hesitancy and build public trust in vaccines.

The 2024 Joint External Evaluation (JEE) specifically notes that “The growing vaccine hesitancy among the population poses a challenge to immunization efforts.” (p.28). ¹⁹⁹ While The Gambia has reportedly adopted a National Immunization Strategy for 2024–2028, the document is not publicly available. ²⁰⁰ As a result, it is unclear whether the strategy includes measures to address vaccine hesitancy or to build public trust in vaccines. Furthermore, the National Health Policy 2021–2030—though broadly supportive of immunization as a key pillar of disease prevention—does not explicitly address the issue of vaccine hesitancy or outline any targeted interventions in this regard. ²⁰¹

1.6.1e National advisory group for immunization strategy/plan

Score: 100

The Gambia has a national advisory group that provides technical guidance and advice on the immunization strategy to government.

The Gambia has formally established a National Immunization Technical Advisory Group (NITAG), officially known as Gambia‑NITAG, to provide technical guidance on vaccine programs and immunization policy to the Ministry of Health. According to the launch announcement, “the newly found body has the mandate to provide recommendations on vaccine and immunization policies, strategies in accordance with the National Health Strategic Plan including the EPI Comprehensive Multi‑Year Plan”. As a nationally endorsed scientific advisory group, it interprets epidemiological and programmatic data to inform policy-making. ²⁰² However, there is limited publicly available information on its operations, such as membership composition, meeting later frequency, funding, Terms of Reference, or transparency practices. ²⁰³

1.6.1f Presence of an immunization programme for influenza

Score: 0

The Gambia does not have an influenza vaccination program.

According to available public sources—including the 2024 Joint External Evaluation (JEE) and World Health Organization data —The Gambia does not have an influenza vaccination program incorporated into its Expanded Programme on Immunization (EPI). ^204205206 There is no national influenza vaccine policy, and seasonal influenza vaccination (e.g., for high-risk groups such as pregnant women, children under 5, and elderly populations) is not part of routine immunization services. While research initiatives—such as the NASIMMUNE study using intranasal live attenuated influenza vaccine (LAIV)—demonstrate high acceptability and intent to vaccinate, these remain limited to trial settings and do not reflect a formal national policy. ²⁰⁷

1.7.1a Strategy/plan for resilience of health system

Score: 100

The Gambia’s National Climate Change Policy acknowledges the connections between climate change and infectious diseases.

The Gambia’s National Climate Change Policy 2016–2025, developed in 2016 and adopted in 2018, explicitly identifies health as a key sector vulnerable to climate change alongside forestry, rangelands, agriculture, fisheries, and coastal areas, emphasizing that “In Africa, climate change is multiplying existing health vulnerabilities” (National Climate Change Policy, 2016–2025, Sections 4.2 and 5). The policy underscores particular concerns about climate-sensitive diseases such as malaria, noted as “endemic and peaking in the rainy season,” and highlights the potential impacts of climate change on environmental factors that could alter breeding habitats and “vector-borne transmission pathways” (Section 5.3). Additionally, it raises the risk to the survival of important floristic species crucial for traditional and alternative medicine (Section 5.4). Broader health concerns addressed include heat-related effects on human health and productivity, along with the possibility that climate-induced changes in crop nutritional quality might exacerbate malnutrition levels, further impacting public health resilience (Sections 4.5 and 5.6). ²⁰⁸

The Long-Term Climate-Neutral Development Strategy 2050, approved in 2022, includes provisions for building “climate resilient people” through measures such as food security, ecosystem restoration, and social capacity strengthening. However, the publicly available version of the strategy does not specifically address infectious disease risks linked to climate change. ²⁰⁹

The World Health Organization (WHO) Country Cooperation Strategy for The Gambia (2024–2028) acknowledges that climate change is an emerging determinant of health and identifies several key challenges in this area. These include the inadequate enforcement of policies and regulatory frameworks and a lack of coordinated multisectoral action to address climate change, particularly with regard to building climate-resilient health systems and reducing disaster risks. The strategy also notes insufficient prioritization of healthy environments, alongside rising health threats from air pollution—both indoor and outdoor—linked to solid fuel use and environmental degradation. Although some multi sectoral initiatives have been launched to tackle health-related risk factors, the document highlights that collaboration with civil society and non-health sectors, including the private sector, remains limited. In response, the strategy outlines Strategic Priority 3: strengthening multisectoral collaboration and action to improve health and well-being across the population. ²¹⁰

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

Score: 100

The national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia’s National Health Laboratory System is well-structured, encompassing a comprehensive network that includes a national reference laboratory, clinical laboratories at peripheral health centres, district and general hospitals, teaching hospitals, the National Blood Transfusion Services, and a Biomedical Engineering Unit. The 2024 JEE specifically notes that “the National Health Laboratory System has some capacity in core tests identified by the IHR, including Polymerase Chain Reaction (PCR), serology, microscopy, rapid diagnostic tests and bacterial culture” (p. 31). The system includes the ability to safely transport specimens from spokes to hubs and from hubs to the reference laboratory, as well as the capacity to conduct higher-level diagnostic tests in collaboration with national and international reference laboratories, ensuring comprehensive testing availability. It further adds that the system has the capacity to safely transport specimens from lower-tier facilities to reference laboratories and can perform advanced diagnostic testing through collaboration with national and international reference laboratories, ensuring broad testing capabilities. However the 2024 JEE also notes that laboratories in the animal health sector lack capacity for advanced diagnostic testing, while human health laboratories frequently face shortages of essential supplies. Additionally, biomedical engineers struggle with limited access to necessary tools and have insufficient training for maintaining specialized equipment. ²¹¹

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

There is evidence of a national laboratory plan, but there is insufficient evidence that it includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing.

The Gambia has a National Health Laboratory Services Policy (2021–2025), which outlines the strategic direction for laboratory services, including during public health emergencies. The policy emphasizes the importance of building resilient laboratory systems capable of responding to emerging and re-emerging diseases, and improving coordination, quality, and accessibility of testing services across the country. Under the policy objective of providing quality laboratory testing services to all people (5.5.2) it specifically calls for the development of a dedicated emergency testing plan, stating the need to: “Develop a plan and budget to support laboratory public health emergency responses, which is mainstreamed with the national health emergency response plan for an early warning system (p. 20). However, while it includes general commitments to strengthening emergency preparedness, there is no publicly available evidence that it comprehensively details operational plans for testing for novel pathogens, rapid scale-up of laboratory capacity, or defining specific goals for testing during a health emergency. ²¹²

There is no evidence of a plan on the Ministry of Health, or Ministry of Agriculture website. ²¹³²¹⁴

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

Score: 0

The Gambia lacks a national laboratory that serves as a reference facility with international accreditation.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia does not currently have a national reference laboratory accredited under international standards such as ISO 15189:2003 or the U.S. Clinical Laboratory Improvement Amendments (CLIA). However, the report notes that “the National Public Health Laboratory Services (NPHL) and TB Reference Lab have been certified with Star 3 according to WHO’s Stepwise Laboratory Improvement Process Towards Accreditation [SLIPTA] scheme” (p. 32). SLIPTA is a World Health Organization initiative aimed at guiding laboratories in low- and middle-income countries toward international quality standards. A 3-star rating under SLIPTA reflects meaningful progress in quality systems and partial alignment with ISO standards—but it does not equate to formal international accreditation. ²¹⁵

Further improvements are still needed to reach full compliance, as highlighted in The Gambia’s National Health Laboratory Services Policy 2021–2025. Long-term objectives outlined in the policy include: “Ensure reference and teaching hospital laboratories are ISO 15189 accredited” and “Upgrade all other laboratory structures to meet acceptable standards” (p. 25-26). Implementation of these goals is to be guided by a five-year strategic plan, with the development of objectively verifiable indicators and tools to monitor progress throughout the process. ²¹⁶

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

Score: 0

The Gambia’s National Public Health Laboratory (NPHL) serves as a reference facility, but it is not subject to external quality assurance review.

The Gambia’s National Health Laboratory Services Policy (2021–2025) explicitly states that “there is no developed and well-coordinated quality management system for internal and external quality assessment” (p.12), underscoring that a national framework for continuous quality improvement is currently lacking. ²¹⁷ While some efforts, such as participation in WHO’s SLIPTA program, have been made at individual laboratories, a comprehensive and integrated system for external quality assurance (EQA) is not yet in place. ²¹⁸

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization confirms that the National Public Health Laboratory Services and TB Reference Lab have been certified with Star 3 according to WHO’s Stepwise Laboratory Improvement Process Towards Accreditation scheme. (p. 32) ²¹⁹

However, while it stands to reason that this EQA is applied to the NPHL for these pathogens—since the laboratory is the reference facility for TB, malaria, typhoid, and rotavirus, among others—this is not explicitly stated in the project documents of The Global Fund. ²²⁰ Neither the Ministry of Health, its national laboratory system and its Directorate of Health Research (the public health research body), nor the Ministry of Agriculture provide relevant information via public websites. ²²¹²²²

2.2.1a Nationwide specimen transport system

Score: 100

The Gambia has a nationwide specimen transport system in the human health sector, but it is limited in scope and not yet fully integrated across all relevant sectors.

According to the 2024 Joint External Evaluation (JEE) report, the country has established a Sample Referral Network with real-time tracking and monitoring capabilities, overseen by a dedicated coordination mechanism. The 2024 JEE specifically notes that “Specimens can be safely transported from peripheral health facilities to the intermediate labs where some tests are done and then other tests are referred to National Public Health Reference Laboratories, thus ensuring diagnostic services are available at all levels” (p.33). It further highlights that specific staff are assigned responsibility for the movement of samples across the country, and the system functions effectively for human health diagnostics. However, significant challenges remain: the animal health sector only has a limited and ad hoc specimen transport system; other One Health sectors, including environment, fisheries, and food safety, lack functional systems altogether; the cold chain infrastructure is insufficient, risking sample integrity during transport, especially under emergency conditions or in remote areas. ²²³

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

Score: 0

There is insufficient evidence to suggest that The Gambia has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia does not currently have a formal plan in place to rapidly authorize or license laboratories—such as private, veterinary, or research facilities—to supplement national testing capacity during an outbreak. ²²⁴

The National Health Laboratory Services Policy (2021–2025) does call for the development of a plan and budget to support laboratory public health emergency responses, which should be mainstreamed with the national health emergency response plan and tied to an early warning system. However, this remains a strategic objective rather than a currently implemented framework. ²²⁵

Neither the Ministry of Health, its national laboratory system and its Directorate of Health Research (the public health research body), nor the Ministry of Agriculture provide information on these systems via public websites. ²²⁶²²⁷

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

Score: 50

There is evidence that The Gambia is conducting ongoing event-based surveillance, but no evidence that the data are being analyzed on a daily basis.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia has made significant progress in implementing both indicator-based and event-based surveillance systems within the human health sector. The country adopted the third edition of the Integrated Disease Surveillance and Response (IDSR) strategy and has developed supporting documents such as a multi-hazard plan. Surveillance efforts are reinforced through bi-monthly joint technical support visits conducted under a One Health approach. ²²⁸ A key strength is the use of real-time disease notification tools, including an SMS-based system utilized by community health workers. Event-based surveillance successfully captures community-level data and supports real-time monitoring of outbreaks via mobile platforms. ²²⁹ However, surveillance remains weak in the animal and environmental health sectors, with limited reporting and low response capacity for zoonotic threats. Additionally, there is no formal coordination mechanism between human and animal health surveillance systems, and cross-sectoral data sharing is inconsistent, which undermines a comprehensive One Health response. Event verification and investigation capacity was rated Score 2, indicating that while systems are in place, they remain underdeveloped in key areas, particularly outside the human health sector. ²³⁰

There is no explicit evidence that surveillance data is analyzed on a daily basis in The Gambia. While the country has implemented real-time reporting tools, such as SMS-based disease notifications and mobile platforms for event-based surveillance in the human health sector, the report does not confirm a routine schedule of daily data analysis.²³¹ Neither the Ministry of Health, its national laboratory system and its Directorate of Health Research (the public health research body), nor the Ministry of Agriculture provides relevant information via public websites. ²³²²³³ The Gambia's Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019 does not contain any provisions for EBS. ²³⁴

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

Score: 0

There is no publicly available evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline.

According to the 2024 Joint External Evaluation (JEE) report, the "Gambia has a national steering committee for public health emergencies, involving multiple ministries and stakeholders for IHR-related events. However, the IHR focal point and coordination mechanisms are underdeveloped, with insufficient authority, resources and documentation to ensure full functionality" The report notes that while an individual has been designated to serve as the IHR focal person and has actively reported to WHO and other partners, there is no formally established National IHR Focal Point with a defined structure. The individual currently executing IHR duties lacks formal terms of reference, sufficient authority, resources, and around-the-clock availability, which limits the effectiveness of the mechanism. Furthermore, while a national steering committee for public health emergencies exists and involves multiple ministries and One Health stakeholders, coordination mechanisms remain underdeveloped, and funding to support IHR functions is inadequate. (p. 26) ²³⁵

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

The Gambia operates an electronic reporting surveillance system at both national and sub-national levels—primarily within the human health sector.

According to the 2024 Joint External Evaluation (JEE) report The Gambia has implemented the Integrated Disease Surveillance and Response (IDSR) system, including both indicator-based and event-based surveillance. Real-time reporting tools are in use, including an SMS-based disease notification system utilized by community health workers, enabling timely and decentralized data submission. Routine data collection and transmission occur electronically, supporting surveillance efforts across health facilities and administrative levels. However, the system is limited in scope: animal health and environmental sectors lack comparable electronic systems. Data sharing across sectors is inconsistent, weakening a unified One Health surveillance approach. (p. 46) ²³⁶

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

Score: 50

The Gambia's electronic reporting surveillance system collects ongoing or real-time laboratory data, but there is insufficient evidence to suggest that this data be disaggregated and analysed by age, ethnicity, etc.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia has implemented the third edition of the Integrated Disease Surveillance and Response (IDSR) strategy across the health sector, incorporating both indicator-based and event-based surveillance. The country also applies a One Health approach, including bi-monthly joint technical support visits, and is actively implementing strategic documents such as a multi-hazard plan to improve surveillance capacity. (p. 46) ²³⁷

The 2024 JEE notes that laboratory surveillance is integrated into standardized case-based forms, and surveillance findings are disseminated through the national epidemiologic and surveillance weekly bulletin. However, there is no centralized mechanism to integrate data from clinical case reports with microbiological laboratory data from One Health partners. Additionally, inadequate numbers of trained health workers are available to conduct advanced surveillance data analysis (e.g., geospatial or time-series analysis) across all health system levels. The report also highlights that laboratory capacity remains insufficient at all levels to adequately support both routine functions and emergency public health responses. (p. 47) ²³⁸

According to The Gambia National Health Laboratory Services Policy 2021–2025, the country aims to strengthen its laboratory surveillance systems by aligning with both national and international standards. One of the general policy objectives is: “To adopt best practices that comply with relevant and appropriate national and international laboratory information management systems (e.g. IDSR/HMIS).” Furthermore, under the policy objective to “Provide quality laboratory testing services to all people,” the policy calls for efforts to “Review/adapt, validate and print guidelines for the implementation of laboratory-based surveillance of AMR, vaccine preventable diseases, foodborne diseases and non-communicable diseases in the mainstream IDSR, One-Health context.” ²³⁹

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence that shows that Gambia has a wastewater surveillance system at a sub-national level. The environmental surveillance system in Gambia is being implemented in three sites where samples are collected routinely every two weeks at Tallinding Daru Salam, Kotu and Banjul sewage system. ²⁴⁰ Samples collected are sent to the regional polio laboratory in Dakar for analysis. The WHO and GPEI Q4 2025 Polio ES Bulletin confirms this. ²⁴¹

The Ministry of Health, with support from WHO-Gambia Country Office, conducted a three-day intensive capacity building training for stakeholders on environmental health surveillance (including wastewater surveillance) in August 2025. The aim of the training was to strengthen the country’s surveillance capability as part of the global polio eradication initiative.²⁴²

There is evidence that Gambia is strengthening its polio surveillance. According to the 2025 Polio Environmental Surveillance Bulletin, AFRO ES Consultants were supporting environmental surveillance (ES) optimization in the country during late 2025, focusing on capacity building for sample collectors. This complemented Acute Flaccid Paralysis (AFP) surveillance following a 2014 outbreak, as part of the regional effort to detect circulating poliovirus.²⁴³ However, AFRO ES Consultants appear to be a private sector organisation.

In 2025, the WHO reported that the Gambia continues its vigilance against polio resurgence following the detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) in 2021 and 2024 through environmental surveillance, suggesting that the country was conducting ES between those years, although it is unclear whether this is still ongoing.²⁴⁴

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records in The Gambia are not commonly in use, but there is evidence they are utilised.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia has implemented several electronic systems to support data collection, patient tracking, and disease surveillance. These include: DHIS2 (District Health Information Software 2): Widely used for routine health data reporting and management across the country; Electronic Integrated Disease Surveillance and Response (eIDSR): Used for real-time disease reporting and surveillance, including community-level inputs; Electronic Medical Records (EMRs): While not yet fully universal, EMRs are in place in several major hospitals and clinics and are gradually being rolled out more broadly. ²⁴⁵

The 2024 JEE report for The Gambia specifically recommends strengthening digital health infrastructure by scaling up the digitalization of health management information system (HMIS) data across all health facilities and ensuring interoperability with the electronic medical records (EMR) system. Additionally, it calls for the establishment of an EMR system at all healthcare facilities to enhance the efficient capture and tracking of essential health services utilization. ²⁴⁶

A peer-reviewed study from 2022, titled “Addressing challenges in the development of health information systems in The Gambia,” echoes concerns similar to those raised by the 2024 JEE regarding the limited implementation and capacity for electronic medical records (EHRs) and health information systems in The Gambia. Researchers of the study conducted a survey among 280 clinicians, revealing that 60% of healthcare facilities lacked EHR systems and 66% lacked database management systems, significantly affecting clinicians' willingness to implement electronic health systems. The study highlighted constraints such as limited IT infrastructure, staff shortages, and poor information management, which align closely with JEE-identified barriers to digital health system scale-up. ²⁴⁷

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no evidence that the national public health system has access to electronic health records of individuals in The Gambia.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia’s national public health system does not have comprehensive access to electronic health records (EHRs) across all healthcare facilities. While systems like DHIS2 (District Health Information Software 2) are in use for monitoring essential health services, their implementation is inconsistent due to: infrastructure limitations (e.g., poor internet access, lack of computers); inadequate staff training; absence of electronic monitoring systems in many facilities; tertiary facility data not integrated into DHIS2, complicating national health data assessments. Additionally, the 2024 JEE recommends The Gambia to “Establish an electronic medical records system at all healthcare facilities to facilitate efficient data capturing and tracking of essential health services utilization” and “Scale up the digitalization of health management information system data at all health facilities and ensure interoperability with the electronic medical records system.” These recommendations strongly suggest that EHR access is currently limited, fragmented, and not standardized at the national level. (p. 61) ²⁴⁸

The World Health Organization (WHO) Country Cooperation Strategy for The Gambia (2024–2028) confirms that the National Health Sector Strategic Plan 2022–2025 includes a commitment to “establish a national e-health programme.” The strategy further notes that “procurement processes have been initiated to scale up electronic medical records and introduce an electronic logistics management system that aims to further deploy technology to health facilities.” ²⁴⁹ However, the National Health Sector Strategic Plan 2022–2025 is not publicly available.

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no evidence that individual electronic health records are commonly in use in The Gambia, let alone whether there are any data standards in place that would regulate them.

The Gambia’s overarching National Health Policy for the period of 2021-2030 specifically notes that “the health sector does not have in place a robust electronic medical record system, laboratory information management system, integrated human resources information system, and a logistics management information system.” The document outlines a strategic objective to build a robust and integrated health information system that delivers secure, timely, reliable, and accurate data for evidence-based decision-making. To achieve this, the government aims to transition fully from paper-based records to computerized systems with reliable internet connectivity across all levels of the health sector. The policy also calls for the development of a legal framework to enforce mandatory and timely data reporting from both public and private health facilities. Additionally, it seeks to harmonize all monitoring and evaluation (M&E) systems into a single national platform and institutionalize performance reviews to guide policy and improve accountability. ²⁵⁰

The 2024 Joint External Evaluation (JEE) report does not mention ISO standards or comparable data governance frameworks in use. It notes instead that health information systems like the District Health Information Software 2 (DHIS2) are used inconsistently across the country due to infrastructure gaps, and that there is no centralized mechanism for integrating clinical and laboratory data from One Health partners. This lack of integration suggests that standardized data protocols are either underdeveloped or not widely enforced. ²⁵¹

Neither the Ministry of Health, its national laboratory system, nor its Directorate of Health Research (the public health research body) provide relevant information via public websites.

2.4.2a Data sharing mechanisms

Score: 0

There is insufficient evidence of established mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data.

According to the 2024 Joint External Evaluation (JEE) report, The Gambia has no formal, established mechanism to consistently share surveillance data across the human, animal, and environmental health sectors. While joint activities and coordination platforms exist in principle, the JEE emphasizes that data sharing across sectors is underdeveloped, particularly for zoonotic diseases. It specifically recommends that Gambia “establish a multisectoral surveillance guideline for zoonotic diseases to improve data sharing and coordination among sectors.” (p. 15) Moreover, the JEE points to limited collaboration between the Ministry of Health and the Food Safety and Quality Authority, especially in responding to foodborne outbreaks, and also notes that public awareness of zoonotic diseases remains low. ²⁵²

Neither the Ministry of Health and Social Welfare, its national laboratory system and its Directorate of Health Research (the public health research body), the Ministry of Agriculture, nor the Ministry of Environment, Climate Change and Natural Resources provide relevant information via public websites. ^253254255

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

Score: 0

There is partial public availability of de-identified health surveillance data on infectious diseases in The Gambia.

The Ministry of Health has occasionally published health-related reports and situation updates, such as COVID-19 Situation Reports summarizing case numbers, testing statistics, and response efforts. However, regular, comprehensive, and publicly accessible surveillance data—particularly in de-identified formats—is not consistently available online. Specifically, the Ministry of Health website does not routinely publish weekly epidemiological bulletins or detailed disease-surveillance reports. The Ministry’s official website does include dedicated sections titled “Service Statistics” and “Monthly Bulletins,” which suggest an intention to improve transparency. However, as of 26 July 2025, these sections display the message “to be added soon,” indicating that no such data is currently accessible. The website may have been updated recently, but full access to detailed surveillance outputs remains pending. ²⁵⁶²⁵⁷

Similarly, the Ministry of Agriculture and the Department of Livestock Services do not maintain public-facing dashboards or reports for animal disease surveillance data. ²⁵⁸

The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization (WHO) indicates that The Gambia does publish de-identified health-surveillance data on infectious diseases in the form of reports accessible through official government channels, such as the Ministry of Health. These reports provide aggregated epidemiological information to inform public-health actions while protecting individual privacy. However, the JEE also notes that the frequency and comprehensiveness of public data sharing could be improved, and efforts to enhance transparency and regular dissemination of surveillance data are recommended (pp 28–29). ²⁵⁹

Together, these findings suggest that while The Gambia demonstrates a degree of transparency through periodic publication of surveillance data, public access remains inconsistent and incomplete.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 0

The Gambia currently lacks a comprehensive data protection framework which could that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities.

The Ministry of Communications and Digital Economy adopted a Data Protection & Privacy Policy and Strategy in 2019, which explicitly says “personal data for the information they reveal relating … health” can only be subject to processing “where appropriate safeguards that are complementing those that are enshrined in the data protection and privacy law”. ²⁶⁰ However, the strategy is a non-binding policy document — it does not constitute enforceable legislation.

The Council of Europe (CoE), through its EU-funded “Support for the legislative process on data protection in The Gambia” initiative, is actively working with the Gambian government to draft data protection legislation aligned with international standards. The project supports institutional development and capacity building to lay the groundwork for a data protection authority and regulatory enforcement mechanisms. This confirms that no comprehensive data protection law is currently in force. ²⁶¹

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

Score: 0

The Gambia currently lacks enforceable legislation or regulations safeguarding the confidentiality of identifiable health information generated through health surveillance activities.

Although the Ministry of Communications and Digital Economy adopted a Data Protection & Privacy Policy and Strategy in 2019, this remains a non-binding policy document and does not constitute law. The strategy does acknowledge health-related personal data as sensitive and calls for appropriate safeguards—but only in the context of future legal protections. Importantly, there are no provisions currently in force that explicitly address protections against cyber threats, such as ransomware, in the handling of personal or health surveillance data. ²⁶² In addition, the Ministry adopted a National Cybersecurity Strategy 2022–2026, but this document also lacks specific provisions on the protection of health surveillance data or safeguards against cyber attacks such as ransomware. ²⁶³

2.4.5a Cooperative commitments or agreements within regions

Score: 50

There is evidence that the Government of The Gambia has made a commitment to share surveillance data during a public health emergency with other countries, although current evidence points primarily to disease-specific and sectoral initiatives rather than comprehensive multi-disease frameworks.

In May 2023, a Memorandum of Understanding between The Gambia and Senegal was referenced under the Senegambian Malaria Initiative, outlining cross-border coordination and data sharing for malaria control and surveillance in border regions. ²⁶⁴ This agreement demonstrates a formal commitment to exchange surveillance data with a neighboring state, though limited in scope to a single disease. No public evidence was found of other finalized agreements extending this cooperation to multiple diseases or broader One Health emergencies.

The Gambia is a State Party to the International Health Regulations (IHR 2005), which obligates the country to notify and share public health event information with the World Health Organization (WHO) and other Member States in accordance with Article 6. This provides a legal foundation for cross-border data sharing during public health emergencies. Moreover, the 2021 IHR–PVS National Bridging Workshop held in Banjul emphasized strengthening One Health coordination and the development of Memoranda of Understanding (MoUs) to formalize mechanisms for joint surveillance and information exchange across sectors. The national roadmap from this workshop specifically identifies as a key activity “developing and signing MoUs with clear Terms of Reference with other stakeholders” to enhance regional collaboration and real-time information sharing. ²⁶⁵

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

Score: 50

There is evidence of a national system in place to provide support at the sub-national level (e.g. training, metrics standardization and/or financial resources) to conduct contact tracing but only in the event of an active public health emergency.

In July 2018, the Ministry of Health adopted a “Public Health Emergency Operations Centre Plan”, which serves as a framework providing a coordination mechanism with roles defined at national and sub‑national levels during emergencies — through which training, coordination, and resource distribution (including contact tracing operations) can be channeled once activated. ²⁶⁶

During the COVID-19 pandemic, WHO provided over USD 1.8 million in technical support to strengthen The Gambia’s response, with a key focus on contact tracing. This included training and equipping eight Rapid Response Teams (RRTs) — one national team (40 members) and seven regional teams (30 members each) — using standard WHO guidelines. WHO also trained around 350 surveillance officers, including health and veterinary staff, to support community-based surveillance. All teams received infection prevention equipment and digital tools to track cases and contacts, enabling timely investigation and public health interventions nationwide. ²⁶⁷ The Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017-2019 mentions the need to "train surveillance staff on contact tracing and follow-up," but does not contain any more detail of a national system. ²⁶⁸ There is no other relevant information on the Ministry of Health website. ²⁶⁹

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

Score: 0

There is no evidence that The Gambia provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support (paycheck, job security) and medical attention.

There is no relevant information on the Ministry of Health website or the Medical Research Council (MRC) Unit, The Gambia website. ²⁷⁰²⁷¹ During COVID-19 early response phases (April–July 2020), identified cases were quarantined in designated facilities, including hotels; contacts were later recommended for self-isolation at home. The Gambia COVID-19 Plan lays out a strategy for identifying and preparing isolation units or wards "where feasible for any suspected or probable cases." The plan does not outline any economic support for people who may be required to isolate, nor is it clear that the COVID-19 plan would be applied in the event of a different public health emergency. ²⁷² There is no documented evidence that the government implemented targeted cash transfers, wage replacement, job security guarantees, or other socio-economic support explicitly for quarantine or isolation cases. While broader economic stimulus and emergency health funding were mobilized—including a USD 10 million World Bank grant to support preparedness and response—these did not appear tailored to support individual-level quarantine compliance. ²⁷³

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is insufficient evidence of a joint plan or cooperative agreement between the public health system and border control authorities to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of an active or future public health emergency.

There is no evidence of an overarching plan on the Ministry of Health website or on the website of The Gambia Immigration Service, which serves as a border control agency. ²⁷⁴²⁷⁵

The 2024 WHO Joint External Evaluation (JEE) confirms that The Gambia has taken several steps to strengthen its ability to detect suspected or potential cases among international travelers at its points of entry (PoEs). Banjul International Airport, the Banjul Sea Port, and nine designated land border crossings are equipped with basic infrastructure, including isolation rooms at six land PoEs and advanced thermal scanners at the airport to screen incoming passengers. Some PoE staff have received specialized training on core International Health Regulations (IHR) capacities, and written procedures are in place for identifying and responding to ill travelers. However, significant gaps remain. These include the absence of a national multisectoral steering committee for coordinated planning, weak legal frameworks, lack of dedicated vector control programmes, and the fact that there is no designated programme unit for PoE and border health under the Directorate of Public Health Services—an institutional gap that limits effective coordination between the public health system and border control authorities. (p. 69) ²⁷⁶

The Health Sector Emergency Preparedness and Response Plan 2017-2019 does not outline a plan or cooperative agreement between the public health system and border control authorities.

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

Score: 100

The Gambia has an established applied epidemiology training program in the form of a Field Epidemiology Training Program (FETP).

The Gambia’s Field Epidemiology Training Program (GamFETP-Frontline) was established in 2015 and has since graduated 524 participants. The program is a collaboration between the U.S. Centers for Disease Control and Prevention (CDC), the Gambian Ministry of Health, and the African Field Epidemiology Network (AFENET), and it aims to build national capacity for surveillance, outbreak investigation, and emergency response. Its Frontline cohort 8 began in February 2020, delivering a 12-week curriculum combining classroom workshops with supervised fieldwork, training surveillance officers and port health staff to conduct case investigations, contact tracing, data analysis, and outbreak investigations. ²⁷⁷²⁷⁸

However, according to the 2024 Joint External Evaluation (JEE), The Gambia lacks a comprehensive policy or strategic framework for managing human resources across the public health sector, which results in uneven staffing and limited coordination during public health emergencies. Although there is no formal surge staffing plan in place, some temporary measures are applied on an ad hoc basis to address workforce needs during outbreaks or other emergency events. (p. 50) ²⁷⁹

Recent reporting from the Ministry of Health confirms that intermediate‑level FETP training is also underway, with support from the World Bank, preparing a broader cadre of public health professionals in areas such as disease surveillance, emergency response, and early warning systems. ²⁸⁰

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is evidence that Gambia’s Field Epidemiology Training Program (FETP) is inclusive of animal health professionals.

According to the 2024 Joint External Evaluation (JEE), The Gambia’s Field Epidemiology Training Programme (FETP) is recognized as a strength in national workforce development, specifically for its inclusion of veterinarians and veterinary paraprofessionals. This cross-sectoral participation reflects efforts to build a One Health–oriented workforce. However, the 2024 JEE also recommends expanding “workforce development initiatives, including the Field Epidemiology Training Programme, to train personnel in specialized areas such as veterinary public health”, signalling that current inclusion of animal health professionals is limited and not yet prevalent within the broader public health workforce development strategy. (p. 32) ²⁸¹ The previous JEE, which was published in September 2017, noted only one veterinarian and three veterinary technicians received FETP training. ²⁸² Neither the Ministry of Health, its national laboratory system, nor its Directorate of Health Research (the public health research body) provide relevant information via public websites. ²⁸³

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

Score: 0

There is no evidence of information about the number of trained field epidemiologists in the 2024 Joint External Evaluation (JEE) published by the WHO. ²⁸⁴ Neither the Ministry of Health, its national laboratory system, nor its Directorate of Health Research (the public health research body) provide relevant information via public websites. ²⁸⁵

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

The Gambia reportedly has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential, but the plan is publicly unavailable.

The 2024 Joint External Evaluation (JEE) states that “a draft legal framework, guidelines and standard operating procedures have been developed, including the Health Sector Emergency Preparedness and Response Plan.” However, it is unclear which version of the plan this refers to, as no such document is publicly available. The JEE lists three documents—the “Health Emergency Plan,” the “Gambia National Health Sector Emergency Preparedness and Response Plan (2023),” and the “Health Sector Emergency Preparedness and Response Plan”—among the supporting documentation provided by The Gambia, but makes no further reference to these documents in the report beyond noting the existence of a plan as a strength. ²⁸⁶

Previously, The Gambia had an overarching National Public Health Emergency Response Plan (HSEPRP) in place that addressed planning for multiple communicable diseases with epidemic or pandemic potential. This plan was multisectoral and all-hazards in nature, serving as a framework for coordinating national responses to public health emergencies. However, it covered the period 2017–2019. ²⁸⁷

There is some evidence that the government may be in the process of updating the plan—or may have already updated it—though no finalized or revised version has been publicly released as of the most recent evaluation. According to the World Health Organization’s Strategic Partnership for Health Security (SPH) database, The Gambia’s 2017–2019 HSEPRP is marked for revision, with the stated objective of developing and implementing a multisectoral and multihazard emergency preparedness plan by December 2024, incorporating recommendations from the 2024 Joint External Evaluation (JEE). A national consultant has been identified to lead the process; however, the activity is currently listed as “Not Started.” ²⁸⁸ It is unclear whether the SPH database had been updated prior to the finalization of the 2024 JEE, which itself lists a “Gambia National Health Sector Emergency Preparedness and Response Plan (2023)” among supporting documents—suggesting the plan may already have been revised, though no such version is publicly available.

The HSEPRP was inspired in part by The Gambia's National Ebola Virus Disease Preparedness and Response Plan (2014-2015), or NEVDP. The HSEPRP mentions both Ebola and Avian and Human Influenza, but is not meant to be a disease-specific plan. Rather, it provides a framework for coordination across different ministries, departments, and various other entities that constitute the Gambian health sector, to respond to any health emergency. ²⁸⁹ Separately, according to the Joint External Evaluation (JEE) report for The Gambia, published in September 2017, The Gambia also has an Integrated National Emergency Preparedness and Response Plan for Avian & Human Influenza (AHI) (2015-2019). ²⁹⁰ However, neither the NEVDP nor the Avian and Human Influenza plan are available on the website of the Ministry of Health. ²⁹¹

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

Score: 0

There is some indication that The Gambia’s overarching national public health emergency response plan may have been updated within the last three years, but this cannot be confirmed due to the lack of a publicly available document. The 2024 Joint External Evaluation (JEE) lists a “Gambia National Health Sector Emergency Preparedness and Response Plan (2023)” among the supporting documents and notes that a “draft legal framework, guidelines and standard operating procedures have been developed, including the Health Sector Emergency Preparedness and Response Plan.” ²⁹² However, the report does not clarify which version of the plan this refers to, and no other publicly available sources confirm that an updated plan exists on the Ministry of Health website. ²⁹³ Therefore, while the JEE suggests a possible update, the absence of a published document means this cannot be independently verified. ²⁹⁴²⁹⁵

3.1.1c One health principles by covering multiple threat types

Score: 0

There is insufficient evidence to suggest that if The Gambia's overarching national public health emergency response plan is indeed in place, it follow one health principles by covering multiple threat types.

It is unclear whether The Gambia’s overarching national public health emergency response plan follows One Health principles by addressing multiple threat types such as antimicrobial resistance, zoonotic disease spillover, biological accidents, or deliberate acts. The 2024 Joint External Evaluation (JEE) references a “Gambia National Health Sector Emergency Preparedness and Response Plan (2023)” and notes the development of draft legal frameworks, guidelines, and standard operating procedures. However, the plan itself is not publicly available, and the JEE does not provide further details on its content or scope. As no other sources confirm the existence or substance of this plan, it cannot be determined whether it incorporates a One Health, multi-hazard approach. ²⁹⁶²⁹⁷

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

It is unclear whether The Gambia’s overarching national public health emergency response plan includes consideration of health equity or mechanisms for identifying and addressing the needs of vulnerable populations such as those of lower socioeconomic status, older adults, or minority ethnic groups.

The 2024 Joint External Evaluation (JEE) refers to the existence of a “Gambia National Health Sector Emergency Preparedness and Response Plan (2023)” and notes the development of related legal and procedural documents. However, the plan is not publicly available, and the JEE provides no specific details on whether it incorporates equity-focused measures or provisions for vulnerable groups. In the absence of further documentation, these aspects cannot be independently verified. ²⁹⁸²⁹⁹

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

Score: 100

The Gambia has a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response.

The 2024 Joint External Evaluation (JEE) specifically notes that the private sector is involved in public health emergency response through an established multisectoral steering committee. This committee engages a wide range of stakeholders—including non-governmental organizations, religious and cultural leaders, the business community, patient associations, and key government entities such as the police, army, National Disaster Management Agency, and National Assembly—during public health emergencies. ³⁰⁰ It is unclear whether The Gambia’s overarching national public health emergency response plan includes provisions for formally coordinating with the private sector, as the plan is not publicly available and the 2024 JEE provides no further detail on the nature or scope of this engagement. ³⁰¹³⁰²

The Public Health Emergency Operations Centre Plan for The Gambia (2018) provides no further detail on the nature or scope of this engagement. The steering committee was established to guide the planning and development of the Public Health Emergency Operations Centre (PHEOC). This committee is tasked with applying incident management principles, conducting risk and capacity assessments, and determining the scope, structure, and operational model of the PHEOC. Its responsibilities cover a range of emergency management domains, including prevention and mitigation, preparedness activities, and continuity of operations planning. The committee also develops objectives, defines operational processes, and creates budgeting, monitoring, and evaluation plans—tailoring the size and function of the PHEOC to the nature of the event and the level of inter-agency collaboration required. ³⁰³

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

Score: 0

There is insufficient evidence to suggest The Gambia has a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

According to the 2024 Joint External Evaluation (JEE), since the establishment of the Public Health Emergency Operations Centre (PHEOC) in 2019, The Gambia has developed a draft legal framework, along with guidelines and standard operating procedures. These include the Health Sector Emergency Preparedness and Response Plan, as well as disease-specific response plans for Ebola virus disease, COVID-19, and mpox, in addition to the PHEOC Handbook and other related documents. These response plans are expected to include provisions for implementing non-pharmaceutical interventions (NPIs) during epidemics or pandemics. However, because the documents are not publicly available, it is not possible to verify whether or how NPIs are addressed. ³⁰⁴³⁰⁵ No further information can be found on the Ministry of Health’s website or in the publicly available Public Health Emergency Operations Centre Plan. ³⁰⁶³⁰⁷

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

Score: 100

There is evidence that the Gambia has activated their national emergency response plan for an infectious disease outbreak in the past year

On 18 July 2025, the Ministry of Health confirmed a mpox (monkeypox) outbreak following the detection of a case through routine surveillance. The Ministry declared it a public health event requiring immediate response, initiating measures such as active case search, contact tracing, enhanced surveillance, community engagement, and training of health workers—demonstrating activation of national response coordination mechanisms consistent with the Public Health Emergency Operations Centre (PHEOC) framework. ³⁰⁸

The Ministry has been providing daily updates to the public via its official Facebook page. On 26 July, it issued a guidance document titled “Mpox – Self-Isolation and Hotline Guidance for Suspected Cases”, which confirmed that the Rapid Response Teams (RRTs) had been activated to “promptly investigate suspected cases, facilitate timely laboratory testing, and provide clinical management while minimizing the risk of community transmission.” This reflects the operationalization of core public health emergency response functions under the national framework. Additionally, the Ministry urged individuals with mpox-like symptoms to self-isolate at home and to contact the toll-free national hotline (1025) for guidance and referral. The hotline functions as part of the national outbreak response infrastructure, facilitating timely case reporting and access to health services. ³⁰⁹ The World Health Organization does not list any recent exercises, and there is no evidence of any exercises being completed on the Ministry of Health website. ³¹⁰³¹¹

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

Score: 0

There is no publicly available evidence that the Gambia in the past year has identified a list of gaps and best practices in response.

In July 2025, The Gambia activated its national public health emergency response system in response to a confirmed mpox outbreak. This included deploying Rapid Response Teams (RRTs), conducting active case search and contact tracing, enhancing surveillance, and issuing public guidance on self-isolation and use of a toll-free national hotline—demonstrating implementation of the national emergency response framework under the Public Health Emergency Operations Centre (PHEOC). However, there is no publicly available evidence that the country has conducted a formal after-action review (AAR) or similar assessment in the past year to identify gaps and best practices arising from this or any other infectious disease response. Likewise, no documentation could be found indicating that The Gambia has developed a follow-up plan to address such gaps or to improve future response capabilities. ^312313314

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

Score: 0

There is no evidence that The Gambia has undergone a national-level biological threat-focused exercise with private sector representatives in the past year. There is no record of a planned or conducted simulation exercise being conducted by The Gambia on the World Health Organization (WHO) Simulation Exercise page, the WHO country page, or the Gambian Ministry of Health website. ^315316317

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

The Gambia has in place an Emergency Operations Center (EOC).

The Gambia has established a Public Health Emergency Operations Centre (PHEOC) as part of its broader efforts to strengthen emergency preparedness and response. Created under the Public Health Emergency Management Bill of 2019, the national PHEOC is housed within the Epidemiology and Disease Control Unit of the Ministry of Health and includes a dedicated physical structure, a developed PHEOC handbook, and designated staff for incident management. Regional PHEOCs have also been established, with personnel trained to implement the incident management system during public health emergencies. ³¹⁸ The PHEOC was notably activated during the July 2025 mpox outbreak, during which coordination mechanisms—including Rapid Response Teams and public communication tools—were mobilized. Although tabletop simulation exercises and a COVID-19 intra-action review have been conducted, the PHEOC network is not yet fully functional; key gaps remain, including the absence of a finalized legal framework, dedicated core staff, and a stable budget. ³¹⁹ The 2024 JEE recommends finalizing and adopting statutory legislation, policies, and guidelines for the PHEOC—ensuring that gender considerations are also integrated into these frameworks. ^320321322323

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

Score: 0

There is insufficient evidence to suggest that the Emergency Operations Center (EOC) is required to conduct a drill for a public health emergency scenario at least once per year.

The Public Health Emergency Operations Centre Plan for The Gambia (2018) emphasizes that tactical-level roles within the PHEOC require hands-on proficiency, which should be developed and maintained through ongoing training and exercises. It recommends both internal and external exercises, involving health partners and other emergency sectors, to strengthen capabilities and improve performance based on evaluation. The plan explicitly references skill drills and simulations as a means to test procedures such as alerting, information flow, and emergency resource activation, with each drill followed by a critique. The Plan specifically states that drills aim “to develop, evaluate and maintain skills in specific procedures, such as alerting and notification, passage of critical information, activation of emergency resources that constitute one or more components of the EOC operational plan. Part of every drill is a critique of the procedure being practiced and whether the facility properly supports it.” However, the plan does not mandate that the PHEOC conduct at least one drill per year, nor is there public evidence that such annual drills are consistently carried out. ³²⁴

The 2024 Joint External Evaluation (JEE) recommends conducting regular drills, functional exercises, and full-scale simulation exercises to test and assess the functionality of the Public Health Emergency Operations Centre (PHEOC). This recommendation suggests that such exercises are not currently conducted on a routine or annual basis, and that more systematic implementation is needed to evaluate and strengthen PHEOC operations. ³²⁵

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

Score: 0

There is no public evidence to show that the Public Health Emergency Operations Centre (PHEOC) has conducted, within the last year, a coordinated emergency response or emergency response exercise activated within 120 minutes of identifying a public health emergency or scenario.

The Public Health Emergency Operations Centre Plan (2018) recommends regular drills and simulation exercises but does not specify time thresholds for activation requirements. ³²⁶ The 2024 World Health Organization (WHO) Joint External Evaluation (JEE) similarly recommends that The Gambia conduct simulation exercises to test operational readiness, yet it does not report any actual events or drills meeting a 120-minute activation standard. ³²⁷

However, the PHEOC was reportedly activated in response to the 2022–2023 mpox outbreak, coordinating case detection, laboratory testing, and response measures in collaboration with WHO and other partners. This demonstrates that the centre is operational and can be mobilized during a real public health event. Nevertheless, publicly available information does not indicate when activation occurred relative to case detection, and no documentation confirms that activation met the 120-minute benchmark. ³²⁸³²⁹

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no public evidence that The Gambia has conducted a joint exercise involving public health, animal health, the private sector, and national security authorities in response to a potential deliberate biological event, such as a bioterrorism attack.

The 2024 Joint External Evaluation (JEE) explicitly states that “there is no multi sectoral coordination mechanism to address biosafety and biosecurity issues in human health, animal health, and agriculture,” indicating that any existing collaboration frameworks are either informal or undocumented. Furthermore, there is no evidence of standard operating procedures (SOPs), memoranda of understanding (MOUs), or formal agreements between these sectors to guide joint preparedness or response activities. This represents a significant gap in national preparedness for biological threats.
While the National Public Health Laboratory has developed a biosafety training manual and provided cascade training for healthcare workers—a noted strength—important cross-sectoral gaps remain. These include the absence of a formal biosafety or biosecurity training programme for the animal health sector, a lack of professional training in biological risk assessment, and the non-integration of biosafety education into health training curricula. The JEE recommends that The Gambia “develop and implement a comprehensive training plan for One Health staff on biological safety and security, based on an assessment of current training needs.” (p. 38) ³³⁰

To strengthen public health and security coordination, the JEE further recommends the development of MOUs and SOPs for joint responses across all hazards, the creation of multisectoral protocols for coordinated investigations and responses to biological, chemical, and radiological threats, and the training of sufficient numbers of frontline responders. It also calls for the development and implementation of a national protocol for joint incident reporting and information sharing between health and security authorities, and the systematic conduct of joint risk assessments and planning, building on existing collaboration at points of entry (POEs). No relevant documents or coordination frameworks could be found on public platforms maintained by the Ministry of Health, the National Disaster Management Agency (NDMA), or the Ministry of Interior. ^331332333

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

Score: 0

The Gambia does not have a dedicated section in its national public health emergency response plan—or in any other legislation, regulation, or strategy document—that outlines a risk communication plan specifically intended for use during a public health emergency.

According to the 2024 Joint External Evaluation (JEE), the Government established the Directorate of Health Promotion and Education within the Ministry of Health coordinates overall communication activities, and risk communication and community engagement (RCCE) is recognized as a key function, the country lacks an integrated, multi-hazard RCCE strategy or operational plan to guide emergency communication efforts. (p. 65) ³³⁴ Although there is a multisectoral RCCE working group and strong collaboration with media and traditional communicators, these structures are not supported by a formal risk communication framework. Furthermore, the absence of clear protocols, designated spokespersons, and systematic community-level engagement mechanisms further limits emergency communication preparedness. For these reasons, The Gambia’s RCCE capacity is rated at level 2 in the 2024 JEE, reflecting the need for structured planning and implementation during public health emergencies. ³³⁵

The earlier Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017–2019 did include a section on risk communication, but the plan is now outdated. While the 2024 JEE notes the existence of a new emergency preparedness plan, no specific details are provided, and the updated plan is not publicly available, making it impossible to verify whether it includes a current, functional risk communication component. Neither the Ministry of Health nor the National Disaster Management Agency (NDMA) provide relevant information via public websites. ³³⁶³³⁷

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

Score: 0

There is no publicly available risk communication plan or related strategy document in The Gambia that outlines how messages would be tailored and delivered to populations with different communication needs, such as those defined by language, geographic location, media access, vulnerability, or marginalization.

According to the 2024 Joint External Evaluation (JEE), The Gambia lacks an integrated, multi-hazard risk communication and community engagement (RCCE) strategy, and no section within the current national emergency response framework specifically addresses differentiated communication approaches. (p. 39) While the Directorate of Health Promotion and Education collaborates with media, traditional communicators, and the Association of Health Journalists, these efforts are not guided by a formal, inclusive communication plan. ³³⁸ The 2017–2019 Health Sector Emergency Preparedness and Response Plan included a section on risk communication, but it is now outdated. ^339340341

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

Score: 0

There is no public evidence that The Gambia’s risk communication plan—or any other legislation, regulation, or strategy document used to guide national public health response—designates a specific government position to serve as the primary spokesperson to the public during a public health emergency.

According to the 2024 Joint External Evaluation (JEE), the country lacks an integrated, multi-hazard risk communication and community engagement (RCCE) strategy, and no formal risk communication framework exists that defines roles and responsibilities, including the identification of official spokespersons. Although the Directorate of Health Promotion and Education leads communication efforts and collaborates with media partners and traditional communicators, these activities are not governed by a structured plan that includes clear designation of public communication roles. The outdated 2017–2019 Health Sector Emergency Preparedness and Response Plan did contain some provisions on risk communication, but no updated document is publicly available to confirm whether such a designation currently exists. ^342343344

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

Score: 100

There is evidence that The Gambia’s public health system has actively used online media platforms in the past year to inform the public about ongoing health concerns and combat misinformation.

Following the monkeypox (mpox) outbreak confirmed on 18 July 2025, the Ministry of Health began issuing updates via its official Facebook page, including public guidance on symptoms, self-isolation protocols, and contact information for a national toll-free hotline. Since the initial announcement, the Ministry has published four awareness-raising posts, including a press release confirming the outbreak, as well as further guidance on self-isolation and accessing care. On 26 July, the Ministry posted “Mpox – Self-isolation and Hotline Guidance for Suspected Cases,” which urged symptomatic individuals to isolate and contact the hotline (1025) for support. ^345346347348

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

Score: 100

There is no public evidence that senior leaders in The Gambia—such as the current President or Ministers—have shared misinformation or disinformation about infectious diseases in the past two years.In contrast, the Ministry of Health has been actively engaged in combating misinformation, particularly via social media.

In one of its awareness posts, the Ministry emphasized: “Every piece of false information on health has the potential to endanger lives. Misinformation is like wildfire; it spreads rapidly and can cloud the truth, leading to disastrous consequences for public health. Always share accurate information on health to help people make the right decisions.” ³⁴⁹

However, there is a history of false health information being spread by leaders in The Gambia. Former President Yahya Jammeh, who ruled for 22 years until he was voted out in 2016, falsely claimed he could cure AIDS with a body rub and a banana, according to The New York Times. ³⁵⁰

3.6.1a Percentage of households with Internet

Score: 45.32

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

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

Score: 60

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

Score: 54.17

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

Score: 100

There is no public evidence that The Gambia has implemented restrictions on the export or import of medical goods—such as medicines, oxygen, medical supplies, or personal protective equipment (PPE)—in the past year due to an infectious disease outbreak.

No official statements, legal notices, or policy updates suggest such measures were enacted in response to recent public health threats like the 2025 M-Pox outbreak. ³⁵¹³⁵² The Medicines Control Agency (MCA) is the authority responsible for overseeing the import and export of medicines and related products. Its regulatory framework is outlined in the Guideline for Import and Export of Medicines and Related Products, which provides general provisions on licensing, documentation, and customs clearance. However, these guidelines do not include any provisions specific to emergency response or restrictions triggered by infectious disease outbreaks. ³⁵³

While The Gambia did impose some export bans on essential goods in the early months of the COVID-19 pandemic (March 2020), there is no evidence of similar interventions being made within the last year. Additionally, there is no indication that any such decision—past or present—was based on international recommendations, structured scientific risk assessments, or a formal decision-making framework involving expert guidance or emergency health policies. ³⁵⁴

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

Score: 100

There is no public evidence that The Gambia has implemented restrictions on the export or import of medical goods—such as medicines, oxygen, medical supplies, or personal protective equipment (PPE)—in the past year due to an infectious disease outbreak. No official statements, legal notices, or policy updates suggest such measures were enacted in response to recent public health threats like the 2025 M-Pox outbreak. ³⁵⁵³⁵⁶

The Medicines Control Agency (MCA) is the authority responsible for overseeing the import and export of medicines and related products. Its regulatory framework is outlined in the Guideline for Import and Export of Medicines and Related Products, which provides general provisions on licensing, documentation, and customs clearance. However, these guidelines do not include any provisions specific to emergency response or restrictions triggered by infectious disease outbreaks. ³⁵⁷

While The Gambia did impose some export bans on essential goods in the early months of the COVID-19 pandemic (March 2020), there is no evidence of similar interventions being made within the last year. Additionally, there is no indication that any such decision—past or present—was based on international recommendations, structured scientific risk assessments, or a formal decision-making framework involving expert guidance or emergency health policies. ³⁵⁸

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

Score: 0

In the past year, The Gambia confirmed an outbreak of mpox (monkeypox), prompting a national public health response that included activation of Rapid Response Teams and issuance of self-isolation guidance. ³⁵⁹ However, no travel restrictions—either inbound or outbound—were announced by the Ministry of Health, and no such measures appear on its official website or social media channels. Instead, the Ministry of Health issued statements and updates via its official Facebook page, providing public guidance on symptoms, self-isolation protocols, and contact information for a national toll-free hotline (1025). These updates focused on community-level disease management and public awareness, and did not include any mention of travel restrictions. ^{360361362363364} This aligns with international monitoring sources such as Pandemic International SOS, which maintains a dedicated page for mpox-related travel restrictions and does not list The Gambia as having implemented any such measures. ³⁶⁵

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

Score: 100

The Gambia uses a risk-based approach to international travel-related measures.

The 2024 Joint External Evaluation (JEE) notes that The Gambia has 11 designated points of entry (PoEs), including Banjul International Airport and Banjul Seaport, and some procedures in place—such as thermal screening, isolation areas, and referral pathways to health facilities. However, the 2024 JEE also highlights several gaps. There is no National Multisectoral Steering Committee for the strategic planning of international travel-related health measures. Legal documentation and formal coordination mechanisms are limited, and PoEs lack a comprehensive vector control programme. Some PoE staff have been trained in International Health Regulations (IHR) core capacities, but this is not yet standardized across all locations. (p. 57) ³⁶⁶

4.1.1a Doctors per 100,000 people

Score: 0.79

4.1.1b Nurses and midwives per 100,000 people

Score: 7.89

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

The Gambia has developed a Human Resources for Health (HRH) Strategic Plan (2022–2026), aligned with its National Health Policy (2021–2030). ³⁶⁷

Although the full HRH Strategic Plan is not publicly available, both the Human Resources for Health Overview from May 2023 and the 2024 Joint External Evaluation (JEE) confirm that the plan is in place. The May 2023 overview explains that implementation of the plan has faced delays due to increased demand for healthcare workers during the COVID-19 pandemic, but emphasizes that coordinated implementation remains a national priority. ³⁶⁸³⁶⁹

The overview identifies several systemic challenges: 78.89% of professional health staff are concentrated in urban areas, particularly in the Greater Banjul Area, leaving rural and remote regions underserved. Notably, no health professional cadre meets the World Health Organization (WHO)’s recommended density threshold of 4.45 health workers per 1,000 population. The HRH landscape also reflects an insufficient staff mix and imbalances in workforce distribution, with support staff numbers nearing excess, and weak institutional capacities for information, supervision, and monitoring. To address these gaps and better inform workforce planning, the country is urged to conduct a comprehensive Health Labour Market Analysis, which would support evidence-based policymaking and resource allocation. ³⁷⁰

According to the 2024 JEE, The Gambia has undertaken strategic implementation of its human resources for health (HRH) policy, guided by staffing requirements necessary to deliver the essential health care package. Both the human and animal health sectors conduct periodic workforce reviews and apply evidence-based staffing norms to ensure effective personnel distribution. However, significant gaps remain: there is no integrated plan for surge capacity, human resources are insufficient for meeting International Health Regulations (IHR) functions, and workforce tracking systems are underdeveloped. The incentive scheme to reduce staff attrition is poorly implemented, and there is no national training plan that encompasses both the human and animal health sectors, including legal workforce considerations. ³⁷¹

4.1.1d Health system capacity for essential health services

Score: 0

The Gambia has limited capacity within its health system to deliver essential health services.

While the country has a National Public Health Strategy 2021–2030, the presence of a comprehensive national strategy does not necessarily confirm that the country currently has sufficient capacity to implement or sustain these services. Evidence from the 2024 Joint External Evaluation (JEE) indicates that The Gambia’s health system demonstrates a sound organizational structure but continues to face major resource and operational limitations. The system is organized across primary, secondary, and tertiary levels of care, with a functioning health workforce supporting essential services, including free immunizations, maternal and child care, and mental health programs. Dedicated units within the Ministry of Health monitor system performance and quality assurance. Yet systemic gaps persist: limited funding affects the procurement of medicines, equipment, and supplies, leading to frequent stockouts; shortages of specialized personnel—especially in infectious disease and critical care—undermine complex case management; and digital health systems (DHIS2) remain underutilized, particularly at tertiary facilities. Weak referral networks and the absence of an operational national health insurance scheme further constrain access and continuity of care. ³⁷²

For context, the country’s National Public Health Strategy 2021–2030 aims to ensure quality and equitable access to essential services for all, with a focus on achieving Universal Health Coverage (UHC). The strategy emphasizes aligning the essential health care package with the country’s disease burden and addresses maternal and child mortality, communicable diseases, malnutrition, and emerging threats such as epidemic and pandemic-prone diseases. It also covers non-communicable diseases (NCDs)—including hypertension, diabetes, injuries, and substance abuse—as well as mental health, oral health, and eye care. Services are structured across the three levels of care—primary, secondary, and tertiary—with the Primary Health Care (PHC) strategy serving as the foundation. The plan specifically calls for delivering a tailored essential health service package to all individuals, regardless of age, nationality, or socioeconomic status, through key approaches such as adapting services to epidemiological changes, reducing inequalities, standardizing quality through accreditation, strengthening referral systems, expanding public–private partnerships, and guaranteeing free healthcare for the elderly (65+). ³⁷³

The World Health Organization’s State Party Self-Assessment Annual Reporting (SPAR) 2024 provides quantitative evidence confirming these challenges. The Gambia’s average capacity score for C9: Health Service Provision is 20%, with sub-indicators of 20% for C9.1 (Case Management for IHR-relevant hazards), 20% for C9.2 (Infection Prevention and Control and Chemical/Radiation Decontamination Capacity), and 20% for C9.3 (Access to Essential Health Services). ³⁷⁴ These figures indicate that while the health system provides basic services, functional capacity to sustain and scale them during health emergencies remains limited.

In 2022, the World Health Organization reported progress in strengthening The Gambia’s health system, particularly following the COVID-19 pandemic. Development of the National Health Sector Strategic Plan 2021–2025—costed using the One Health Tool (OHT)—and regular Joint Annual Reviews (JARs) have improved coordination and accountability between the Ministry of Health and partners. WHO-supported reforms have enhanced partner alignment, workforce planning, and subnational empowerment. ³⁷⁵ Despite these efforts, human-resource shortages, funding constraints, and uneven service delivery persist, limiting the overall sufficiency of essential health-service provision.

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no evidence of a plan to ensure continuity of essential health services during a public health emergency in the Gambia.

While The Gambia has an Essential Health Package in place and outlines continuity planning within its emergency preparedness framework, the 2024 Joint External Evaluation (JEE) highlights that “there is inadequate guidance for the continuity of essential health services during emergencies.” The Directorate of Health Services leads coordination efforts, and the health system benefits from available infrastructure at primary, secondary, and tertiary levels. Supporting measures include motorbikes and ambulances (provided by Riders for Health and the Expanded Programme on Immunization), use of the DHIS2 system to monitor service delivery during emergencies, quarterly reviews, and a trained core group of healthcare workers. However, the country lacks specific, operationalized guidelines and a dedicated monitoring and evaluation system to assess service continuity during crises. Additional constraints include insufficient funding, shortages of essential supplies, low staff motivation, and limited patient isolation capacity, with no dedicated units. These gaps weaken the ability to ensure uninterrupted access to essential health services during public health emergencies. ³⁷⁶

The World Health Organization (WHO) Country Cooperation Strategy 2024–2028 echoes these concerns, noting that maintaining access to essential health services remains a challenge during emergencies. It recommends enhancing community engagement to address social and cultural barriers, integrating public health emergency functions into planning and budgeting, and increasing health system resilience to withstand shocks. ³⁷⁷

4.1.2a Hospital beds per 100,000 people

Score: 27.26

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

Score: 0

The Gambia does not have dedicated biocontainment or isolation units for patients with highly communicable diseases.

According to the 2024 Joint External Evaluation (JEE), during public health emergencies, including the COVID-19 pandemic, patient isolation has relied heavily on the Edward Francis Small Teaching Hospital (EFSTH). However, the facility lacks purpose-built isolation infrastructure, and improvised solutions were used to manage infectious patients. The absence of fully equipped, standalone isolation facilities limits the country’s ability to safely manage high-consequence infectious diseases. The 2024 JEE notes this as a challenge under the health system’s capacity to ensure continuity of essential health services during emergencies. (p. 59) ³⁷⁸

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

Score: 0

There is no public evidence that The Gambia has demonstrated the capacity to expand isolation infrastructure in response to an infectious disease outbreak within the past two years.

Although a national outbreak of mpox (monkeypox) was confirmed in July 2025 and prompted a rapid public health response, including case investigation and self-isolation guidance, there are no indications that this led to the establishment of new isolation units or surge capacity. ^379380381382 The 2024 Joint External Evaluation (JEE) explicitly identified inadequate isolation facilities at clinics and hospitals as a persistent challenge, with no mention of improvements or contingency infrastructure being implemented since. ³⁸³

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

Score: 0

There is no publicly available evidence of a national or international procurement protocol or contract framework that can be systematically utilized by The Gambia’s Ministry of Health or Ministry of Agriculture for the routine acquisition of laboratory supplies (e.g. reagents, media, equipment) or medical supplies (e.g. personal protective equipment, diagnostic tools).

Although the Public Health Epidemiology and Disease Control Unit is tasked with logistics before, during, and after health emergencies—and a procurement team, supported by a logistician stationed at the Ministry of Health, is reportedly in place—these operational structures are not underpinned by a documented or standardized procurement mechanism for day-to-day or routine supply management. ³⁸⁴³⁸⁵ Neither the National Health Laboratory Services Policy 2021–2025 nor the Performance Audit Report by the Ministry of Health on the Storage and Distribution of Drugs by the Central Medical Store includes provisions outlining such a protocol for regular procurement processes. ³⁸⁶³⁸⁷

The Gambia operates under a centralized public procurement system regulated by the Gambia Public Procurement Authority (GPPA), established under the Public Procurement Act, 2004. The GPPA provides the legal and institutional framework for procurement across all ministries and public entities, including the Ministries of Health and Agriculture. Its Procurement Policy and Operations Department develops national procurement policies and best practices, while the Compliance and Procurement Practices Department monitors and audits all public sector procurement processes to ensure transparency, accountability, and adherence to national regulations. The GPPA also supports human resource capacity through its Career Development and Training Department and the Gambia Public Procurement Institute (GPPI), which deliver standardized procurement training and certification programs. However, while this centralized system establishes a general governance and oversight mechanism for public procurement, there is no publicly available evidence of any sector-specific procurement protocol or contract framework tailored to routine health or laboratory supply needs.

The Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017–2019, now outdated, makes no reference to any procurement agreements or structured supply frameworks for either routine or emergency operations. ³⁸⁸ Although the 2024 Joint External Evaluation (JEE) notes that an updated emergency preparedness plan has been adopted, the new version remains publicly unavailable, making it impossible to verify whether it includes relevant procurement mechanisms. ³⁸⁹³⁹⁰

Furthermore, the 2024 JEE explicitly confirms that there is no plan or agreement with distributors or manufacturers for the procurement of medical countermeasures during emergencies, and that The Gambia has not participated in any regional or international procurement agreements for such supplies. While this further highlights limited surge capacity, the evidence also indicates that even routine procurement systems remain fragmented and lack a coherent national framework linking the Ministries of Health and Agriculture to standardized supply-chain mechanisms. ³⁹¹

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

Score: 0

There is no publicly available evidence that The Gambia currently maintains a formal national stockpile of medical supplies—including medicines, vaccines, personal protective equipment (PPE), laboratory reagents, or medical countermeasures—for use during public health emergencies or disasters.

According to the 2024 Joint External Evaluation (JEE), The Gambia does not maintain a stockpile of medical countermeasures for national use during emergencies. The assessment explicitly states, “There is no stockpile of medical countermeasures for national use during emergencies,” underscoring a significant gap in the country’s public health preparedness. (p. 55) ³⁹²

The Gambia's Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017–2019 identified as a goal the provision of “an appropriate stockpile of emergency medicines, vaccines, and non-medical supplies.” However, it appears that this objective was never realized, as the 2024 JEE confirms the continued absence of such a stockpile ³⁹³³⁹⁴.

A 2021 capacity assessment conducted in The Gambia similarly concluded that no stockpiles of medical supplies or countermeasures exist. While the Public Health Epidemiology and Disease Control Unit is responsible for managing logistics before, during, and after emergencies—and a procurement team and supply chain management system are in place to support resource distribution—the absence of pre-positioned supplies remains a critical vulnerability. A logistician based at the Ministry of Health supports procurement activities; however, without a standing reserve of essential materials, the country remains heavily reliant on external partners and reactive procurement during public health crises. ³⁹⁵ For example, during the COVID-19 pandemic, The Gambia relied on donations of personal protective equipment (PPE), oxygen concentrators, and test kits from partners such as the World Health Organization (WHO), the United Nations Development Programme (UNDP), and China Aid. Similarly, in response to the 2022 measles outbreak, vaccines and cold chain equipment were urgently sourced through Gavi, the Vaccine Alliance. ³⁹⁶

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

Score: 0

There is insufficient evidence that The Gambia has a stockpile of laboratory supplies (e.g. reagents, media) for national use during a public health emergency.

The 2024 Joint External Evaluation (JEE) specifically states that “There is no stockpile of medical countermeasures for national use during emergencies,” highlighting a critical gap in preparedness, though it does not explicitly address the existence or absence of laboratory supply stockpiles. (p. 55) ³⁹⁷ The Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017–2019 identifies as a goal the provision of “an appropriate stockpile of emergency medicines, vaccines, and non-medical supplies,” but it does not indicate whether this goal was ever operationalized. Moreover, this plan is now outdated, and while the 2024 JEE implies that a new Emergency Preparedness and Response Plan has been adopted, which may contain provisions related to stockpiling, the document itself is not publicly available, making verification impossible. ³⁹⁸³⁹⁹

In addition, neither the National Health Laboratory Services Policy 2021–2025 nor the Performance Audit Report by the Ministry of Health on the Storage and Distribution of Drugs by the Central Medical Store include provisions on stockpiling laboratory supplies. A review of publicly available sources— including the websites of the Ministry of Interior, the Ministry of Health and Social Welfare (and its affiliated laboratory system), the National Disaster Management Agency, and the Medicines Control Agency—reveals no additional information regarding the existence of emergency reserves of laboratory supplies. ^400401402403

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no evidence that The Gambia conducts or requires an annual review of a national stockpile to ensure sufficient supply for public health emergencies.

The 2024 Joint External Evaluation (JEE) explicitly states, “There is no stockpile of medical countermeasures for national use during emergencies,” highlighting a persistent gap in preparedness. (p. 55) ⁴⁰⁴ While the Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017–2019 identified the creation of an emergency stockpile as a goal, there is no indication that this objective was ever implemented. ⁴⁰⁵ Moreover, this plan is now outdated. Although the 2024 JEE suggests that a new emergency preparedness plan has been adopted, the document is not publicly available, and therefore its contents—such as any requirement for annual review—cannot be verified. ⁴⁰⁶

Relevant national policies and audit reports, including the National Health Laboratory Services Policy 2021–2025 and the Performance Audit Report on the Storage and Distribution of Drugs by the Central Medical Store, do not reference stockpiling or any review mechanism. ⁴⁰⁷⁴⁰⁸ A review of publicly available sources—including the websites of the Ministry of Interior, the Ministry of Health and Social Welfare (and its affiliated laboratory system), the National Disaster Management Agency, and the Medicines Control Agency—reveals no additional information regarding the existence of emergency reserves or any procedures for their routine assessment. ^409410411412

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

Score: 0

There is no evidence that The Gambia has a plan or agreement to leverage domestic manufacturing capacity to produce medical supplies—such as medical countermeasures, medicines, vaccines, equipment, or PPE—for national use during a public health emergency.

A USAID Assessment of the Health System in The Gambia from 2019 confirms that the country has “no internal/domestic pharmaceutical manufacturing industry and does not produce active pharmaceutical ingredients or manufacture drugs. With no manufacturing base, the country is completely reliant on foreign companies to supply the entire volume of the diverse set of products needed.” This structural dependency significantly limits The Gambia’s capacity to rapidly source or produce essential medical supplies during emergencies. ⁴¹³

The Gambia COVID-19 Plan, which reportedly included budget lines for laboratory equipment and personal protective equipment (PPE), did not provide details on where these supplies would be sourced, and the plan itself remains publicly unavailable as of July 2025. ⁴¹⁴ During the COVID-19 response, The Gambia reportedly procured second-hand equipment, such as ventilators and ambulances, from Turkey. It also received large PPE donations from Turkey, China, and the West African Health Organization, though media reports indicated persistent shortages of protective gear for health workers. ⁴¹⁵

The Health Sector Emergency Preparedness and Response Plan for All Hazards 2017–2019, now outdated, did not contain any information on domestic manufacturing capacity or procurement mechanisms. ⁴¹⁶ While the 2024 Joint External Evaluation (JEE) notes that an updated version of the plan has been adopted, it remains publicly unavailable, and it is therefore unclear whether it includes relevant provisions. ⁴¹⁷ No additional relevant information could be found on the websites of the Ministry of Health, the National Disaster Management Agency, or the Gambia Armed Forces. ^418419420

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

Score: 0

There is no evidence that The Gambia has a plan or agreement to leverage domestic or regional public or private sector manufacturing capacity to produce laboratory supplies—such as reagents, media, or diagnostic materials—for national use during a public health emergency.

A USAID Health System Assessment from 2019 confirms that The Gambia has “no internal/domestic pharmaceutical manufacturing industry and does not produce active pharmaceutical ingredients or manufacture drugs,” indicating that the country remains fully dependent on external markets for the procurement of both medical and laboratory commodities. ⁴²¹ No subsequent government policy or strategy document provides evidence of national capacity to manufacture or assemble laboratory reagents, test kits, or consumables domestically.

Similarly, there is no publicly available evidence of a national plan or mechanism for the procurement or expedited sourcing of laboratory supplies during public health emergencies. While The Gambia’s COVID-19 Preparedness and Response Plan reportedly included budget lines for laboratory equipment and diagnostic reagents, it remains unpublished as of July 2025, and no official information clarifies how these materials were procured. ⁴²² During the COVID-19 response, the country relied heavily on international donations for both diagnostic and protective materials, including supplies received from Turkey, China, and the West African Health Organization (WAHO). Reports from this period also indicated shortages of laboratory consumables and testing reagents, underscoring the absence of a sustainable and coordinated procurement mechanism. ⁴²³

There is likewise no evidence of a plan or mechanism to expedite the importation of laboratory materials through customs or points of entry during public health emergencies. The outdated Health Sector Emergency Preparedness and Response Plan for All Hazards 2017–2019 does not include any reference to domestic production, procurement frameworks, or customs clearance procedures for laboratory goods. ⁴²⁴ Although the 2024 Joint External Evaluation (JEE) indicates that a new preparedness plan has been adopted, this updated document remains publicly unavailable, and it is unclear whether it includes any provisions for the sourcing or import facilitation of laboratory materials. ⁴²⁵ Additionally, no relevant information could be found on the websites of the Ministry of Health, the National Disaster Management Agency, or the Gambia Armed Forces that would indicate any specific laboratory-supply mechanisms or expedited importation protocols. ^426427428

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

The Gambia has a basic system for emergency logistics and supply chain management at national and subnational levels, though it remains underdeveloped and lacks key components such as formal emergency stockpiles, comprehensive contingency plans, and structured coordination mechanisms.

According to the 2024 Joint External Evaluation (JEE), The Gambia’s logistics and supply chain management systems provide limited support during health emergencies, and there are no formal procurement agreements with manufacturers or distributors for emergency use. The JEE further notes that the country’s pandemic preparedness plan lacks sufficient provisions for medical countermeasures or emergency deployment mechanisms. ⁴²⁹ While the existing supply chain system functions under the broader health service framework, it has been activated and adapted during emergencies—for example, through the temporary subcommittee established during the COVID-19 pandemic to coordinate the flow of countermeasures and critical supplies. However, The Gambia has not participated in regional or international procurement frameworks for emergency commodities, and there is no documented system that integrates both public and private sector actors for logistics coordination.

The National Pharmaceutical Services Directorate maintains an inventory of resources intended for disaster and epidemic response, while the Public Health Epidemiology and Disease Control Unit is responsible for coordinating logistics before, during, and after emergencies. A procurement team and a functioning supply chain management process exist within the Ministry of Health, supported by a designated logistician, and resource distribution is conducted based on assessed needs. However, these structures appear to function primarily within the routine health system, without a clearly defined emergency-specific operational plan or regular simulation exercises to test their performance during crises. ⁴³⁰

Despite these limitations, the 2024 JEE highlights that The Gambia’s vaccine supply system has remained reliable and resilient during emergencies, successfully preventing stockouts and maintaining the cold chain through solar-powered equipment at district health facilities. (p. 55) ⁴³¹ This demonstrates that while an emergency logistics mechanism is not formally institutionalized, core elements such as cold chain management for vaccines do provide partial capacity that supports emergency response functions.

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

Score: 0

There is no evidence that The Gambia has a formal plan, program, or national guidelines for dispensing medical countermeasures (MCMs)—such as antibiotics, vaccines, therapeutics, or diagnostics—during a public health emergency.

A 2021 capacity assessment confirmed The Gambia has a basic system in place for activating and coordinating medical countermeasures (MCMs) during public health emergencies and reportedly maintains a draft national plan for countermeasures and personnel deployment. However, there is no formalized plan that defines procedures for the sending and receiving of MCMs and response personnel during emergencies, nor are such protocols tested through tabletop exercises or simulations. While guidelines do exist for managing epidemic-prone diseases and other International Health Regulations (IHR)-relevant hazards at appropriate levels of the health system, the absence of tested operational procedures limits the country’s readiness to deploy and distribute MCMs effectively in a crisis. ⁴³²

The 2024 Joint External Evaluation (JEE) does not reference any national guidelines or formal program for dispensing MCMs during emergencies—such as protocols for mass vaccination, therapeutic deployment, or diagnostic distribution. It specifically notes that “the emergency logistics and supply chain management systems are underdeveloped and currently unable to provide adequate support for health emergencies.” ⁴³³

However, the Medicines Control Agency (MCA) issued a 2021 Emergency Use Authorization (EUA) guideline that enables the approval of unregistered medicines, vaccines, and in-vitro diagnostics during declared public health emergencies, ensuring rapid regulatory clearance when needed. Additionally, the MCA emergency-use policy, which came into effect in March 2022, underscores the importance of streamlined regulatory pathways for swift access to medical products during public health emergencies, though it does not cover dispensing logistics or distribution procedures to the population. ⁴³⁴

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

Score: 0

The Gambia has no plan in place to facilitate workforce surge in an emergency.

According to the 2024 Joint External Evaluation (JEE), The Gambia does not have a formal personnel surge plan, though ad hoc procedures have been used to provide support during public health events. Some foundational elements are in place, including training materials for orienting surge personnel and documented collaboration with stakeholders during responses to COVID‑19, the H5N1 avian influenza outbreak, and the acute kidney injury event. However, significant gaps remain. There are no intermediate-level plans detailing systems for pre-deployment, deployment, and post-deployment of health personnel, and no formal procedures or decision-making protocols for the sending and receiving of surge staff. (p. 49) Additionally, The Gambia lacks plans for deploying emergency medical teams or rapid response teams, has not conducted tabletop exercises to test deployment systems, and has no active collaboration with regional or international surge personnel networks such as the Global Outbreak Alert and Response Network (GOARN). These challenges are compounded by insufficient logistical and financial resources to support effective surge operations. ⁴³⁵

According to The Gambia’s Public Health Emergency Operations Centre (PHEOC) Plan (July 2018), one of the PHEOC’s core operational objectives is the acquisition and deployment of resources, including surge capacity, services, and materials to support all emergency functions. The logistics section of the PHEOC is tasked with overseeing the acquisition, tracking, storage, staging, maintenance, and disposition of tactical and operational resources required for effective emergency response—specifically including surge personnel. The plan also emphasizes the need for competent and trained human resources, both for routine operations and surge response, to ensure the PHEOC functions effectively. It notes that staff should ideally be familiar with international public health response systems, and outlines roles such as PHEOC facility manager, information management staff, ICT support, and GIS specialists, in addition to the broader response workforce. ⁴³⁶

However, the overarching Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017–2019, which previously may have guided such efforts, is now outdated. While the 2024 JEE notes that an updated emergency response plan has been adopted, it remains publicly unavailable, and it is therefore unclear whether workforce surge planning may have been addressed in the new version. ⁴³⁷⁴³⁸

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is insufficient evidence suggesting that The Gambia has a plan in place to receive health personnel from other countries to respond to a public health emergency.

According to the 2024 Joint External Evaluation (JEE) conducted by the World Health Organization (WHO), “There is a lack of collaboration with regional or international personnel deployment agreements, such as the Global Outbreak Alert and Response Network (GOARN).” While ad hoc personnel deployment has taken place during events such as the COVID‑19 pandemic and the H5N1 avian influenza outbreak, these efforts were informal and not guided by a documented national plan. (p. 54) ⁴³⁹ Neither the public defence agencies (through the Ministry of Interior), the Ministry of Health, nor the The National Disaster Management Agency share additional relevant information via public websites. ^440441442

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no publicly available plan or formal mechanism in The Gambia for redeploying existing health personnel within the country—either by geographic region or by role—during a public health emergency. While ad hoc reallocations have occurred (e.g. personnel shifting between regions or roles in response to COVID‑19 or other emergencies), these are not guided by documented policy or standardized protocols.

The 2024 Joint External Evaluation (JEE) highlights that there is no intermediate-level plan outlining systems for pre-deployment, deployment, or post-deployment of health personnel, and no tabletop exercises or simulations have been conducted to test internal redeployment procedures. (p. 54) ⁴⁴³ Similarly, a 2021 capacity assessment confirms that, although a draft national countermeasures and personnel plan exists, it does not include guidance for the deployment or redeployment of personnel during health emergencies, nor has it been validated through practical exercises. ⁴⁴⁴ Neither the public defence agencies (through the Ministry of Interior), the Ministry of Health, nor the The National Disaster Management Agency share additional relevant information via public websites. ^445446447

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 0

The 1997 Constitution of The Gambia, as last amended in 2018, does not contain a specific section that explicitly guarantees citizens the right to medical care. Instead, it includes a set of non-binding provisions under Chapter XX: Directive Principles of State Policy, which outline the government’s broader social and developmental objectives. Specifically, Section 216(4) states that “The State shall endeavour to facilitate equal access to clean and safe water, adequate health and medical services, habitable shelter, sufficient food and security to all persons.” However, this provision is non-binding because, under Section 211(2), the directive principles “shall not confer legal rights or be enforceable in any court.” As such, while these principles express important policy goals, they do not impose legally enforceable obligations on the government, and individuals cannot claim these rights in court if unmet. In contrast, enforceable rights are set out in Chapter IV: Protection of Fundamental Rights and Freedoms, and the right to medical care is not included among them. In recent years, there were attempts to adopt a new constitution—including draft versions in 2020 and 2024—which reportedly included stronger language on the right to health, but these efforts were ultimately rejected by the National Assembly, and no replacement has been promulgated as of mid‑2025. ⁴⁴⁸⁴⁴⁹

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

Score: 76.47

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

Score: 98.55

4.4.1d Coverage of essential health services through universal health coverage

Score: 39.58

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: 98.63

4.4.1f Rate of mortality amenable to health care

Score: 67.43

4.4.2a Guaranteed paid sick leave

Score: 100

Workers in The Gambia are guaranteed paid sick leave, including for mental health problems.

Specifically, workers in The Gambia are entitled to up to 14 days of paid sick leave per year, payable at their regular wage rate, contingent upon submission of a valid medical certificate. This entitlement applies from the start of employment, but unused sick leave cannot be carried over or paid out at the end of the year. The legal framework for this benefit is established in Section 110 of the Labour Act 2023, which confirms employees’ rights to accumulate paid sick leave and requires that it be compensated at no less than the employee’s usual earnings. The law specifically defines sick leave as applicable to "bodily or mental illness, disease, or injury". ⁴⁵⁰

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available legislation, policy, or official statement indicating that the Gambian government has committed to providing prioritized healthcare services—such as fast-tracked medical care or specialized treatment—to healthcare workers who become ill as a result of responding to a public health emergency.

The 2024 Joint External Evaluation (JEE) does not reference any such policy on prioritized treatment for frontline healthcare workers or first responders during outbreaks.⁴⁵¹ Domestic policy documents, including the National Occupational Health and Safety Policy for Healthcare Workers (2018), address protection from workplace hazards but do not include provisions guaranteeing priority access to healthcare for infected or exposed staff. ⁴⁵² Independent reports and media coverage of the COVID‑19 response in The Gambia confirm that while training and psychosocial support for health workers were provided, there is no documented system of prioritizing treatment or care for healthcare workers falling ill during emergencies. ⁴⁵³ The Gambia COVID-19 Plan, published by the Ministry of Health in March 2020, discussed providing additional training and personal protective equipment to healthcare workers, but does not outline a policy to prioritize healthcare services to healthcare workers who may get sick. ⁴⁵⁴

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

Score: 0

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

While The Gambia’s Public Health Emergency Operations Centre (PHEOC) Plan of 2018 includes Standard Operating Procedures (SOPs) that outline channels for communication during emergencies, these measures remain largely internal and coordination-focused. The SOPs include vertical briefings, where team leads and supervisors are required to keep their teams informed; horizontal briefings through mandatory participation in planning meetings involving the Steering Committee, Rapid Response Teams, the PHEOC, hospitals, partners, and regional health teams; and the routine dissemination of situation reports and new intelligence at both national and regional levels. The SOP also provides for press releases and media briefings to inform the public. While the system focuses primarily on coordination and information flow, it serves as a foundational mechanism for communication among emergency health actors during public health crises. ⁴⁵⁵

However, according to the 2024 Joint External Evaluation (JEE), “there is no integrated multi-hazard risk communication and community engagement (RCCE) strategy with a clear risk communication plan to ensure effective and coordinated communication during public health emergencies.” ⁴⁵⁶

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

Score: 0

There is no evidence confirming whether the communication system during public health emergencies in The Gambia explicitly includes healthcare workers in the private sector.

The Public Health Emergency Operations Centre (PHEOC) Plan (2018) refers broadly to communication with “hospitals” and “partners,” which may imply some level of engagement beyond the public sector, but it does not specifically mention private healthcare providers. ⁴⁵⁷ The absence of detail, combined with the 2024 Joint External Evaluation's observation that there is no integrated, multi-hazard risk communication strategy, suggests that coordination with private sector healthcare workers may be limited or informal. ⁴⁵⁸

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

Score: 0

There is limited evidence that the national public health system in The Gambia is monitoring and tracking healthcare-associated infections (HCAIs), according to the 2024 Joint External Evaluation (JEE), which assigned a score of 1 out of 5 for this capacity. ⁴⁵⁹

While some foundational elements are in place—such as IPC committees and officers in hospitals, quarterly monitoring of IPC services by the WASH Unit, and available laboratory support for surveillance—critical gaps remain. These include the lack of developed or adopted HCAI surveillance tools, insufficiently trained healthcare workers, inadequate financial resources, and weak implementation of healthcare waste management guidelines and SOPs, all of which limit the effectiveness of HCAI surveillance efforts nationally. (p. 62) ⁴⁶⁰⁴⁶¹

4.6.1b Infection prevention and control programme

Score: 0

There is no evidence of an established national infection prevention and control (IPC) programme in The Gambia.

According to the 2024 Joint External Evaluation (JEE), the Ministry of Health has not designated a specific body to coordinate IPC efforts, and there is no comprehensive legal framework, national policy, or set of standard operating procedures addressing IPC and healthcare-associated infections (HCAIs) through a One Health approach. Instead, IPC-related activities are fragmented across several programmes, including the Occupational Health and Safety programme, which focuses on protecting healthcare workers; the Water, Sanitation and Hygiene (WASH) programme, which aims to improve access to clean water and hygiene facilities; and the Epidemiology and Disease Control programme, which supports surveillance of HCAIs. (p. 62) ⁴⁶²

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

Score: 100

The Gambia has a plan to ensure a safe environment in health facilities nationally. However, the 2024 Joint External Evaluation (JEE) assigned a score of 1 out of 5 for this capacity. ⁴⁶³

While The Gambia does have a Water, Sanitation and Hygiene (WASH) programme, which supports efforts to improve hygiene infrastructure and practices in health facilities, overall implementation remains fragmented and under-resourced. Notable strengths include the installation of functional hand washing platforms, ventilated pit latrines, and the availability of WASH guidelines and health waste management standard operating procedures in most facilities. The government, with support from partners such as UNICEF, has also funded solar-powered boreholes and water system renovations to improve continuous water supply. However, significant gaps persist, including inadequate WASH and IPC supplies, insufficient infrastructure, lack of isolation centres, incomplete construction of infectious disease treatment facilities, and limited funding and capacity-building activities at both national and regional levels. (p. 62) ⁴⁶⁴⁴⁶⁵

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is a national requirement for ethical review before beginning a clinical trial in The Gambia.

The Medicines and Related Products Act, 2014 in its Section 39(3)(b) requires that anyone conducting a clinical trial must submit an “ethical clearance certificate issued for medical research by an approved institution” to the Medicines Control Agency (MCA). ⁴⁶⁶ However, neither the Act nor the MCA website provides further detail on the approval process. ⁴⁶⁷⁴⁶⁸

Documents from the Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine (MRCG at LSHTM)—a UK-affiliated academic research institution—indicate that the Gambia Government/MRCG Joint Ethics Committee has been responsible for ethical review in the country since 1980. According to its Constitution, the Committee is an independent body jointly overseen by the Ministry of Health and the MRCG at LSHTM, tasked with protecting the interests of research participants and their communities. It reviews all human-subject research, including observational and interventional studies, outbreak-related research, and postgraduate student projects, in accordance with international ethical standards. These descriptions imply that the Joint Ethics Committee functions as the approved institution referenced in the 2014 Act, though the specific legal link is not clearly stated. ⁴⁶⁹⁴⁷⁰

Additionally, the Draft National Science, Technology and Innovation Policy (2015–2024) from the Ministry of Higher Education, Research, Science and Technology affirms the government's commitment to ensuring that researchers and clinical trial participants are ethically protected. ⁴⁷¹

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

Score: 100

The Gambia has an expedited regulatory process in place for approving clinical trials involving unregistered medical countermeasures (MCMs) during public health emergencies.

According to the Emergency Use Authorization (EUA) Guidelines issued by the Medicines Control Agency (MCA) in 2022, the agency may authorize the emergency use of unregistered medicines, vaccines, and in-vitro diagnostics (IVDs) when a declared public health emergency poses a serious or life-threatening risk to the population. The EUA may be granted based on the totality of scientific evidence available—including data from well-controlled clinical trials where available—and requires that the known and potential benefits of the product outweigh its risks. Additional conditions include the absence of adequate, approved alternatives and proof of manufacturing under Good Manufacturing Practices (GMP) or a functional Quality Management System (QMS). The product must also be either included on the World Health Organization (WHO) Emergency Use Listing (EUL) or authorized by a recognized reference regulatory authority. ⁴⁷²

According to the Constitution of The Gambia Government/MRCG Joint Ethics Committee, expedited review is available for emergency studies—such as research on interventions to control an outbreak of infectious disease—as well as for amendments to ongoing studies. Further details on eligibility for expedited review are outlined in the Committee’s Standard Operating Procedures (SOP-EC-01); however, this document is not publicly available as of July 2025. ⁴⁷³

Despite the presence of these expedited mechanisms, the 2024 Joint External Evaluation (JEE) notes that “the country lacks a legal framework that includes health emergency preparedness research,” indicating that regulatory and governance structures remain underdeveloped and fragmented. As a result, while fast-track ethical and regulatory review pathways exist in principle, they may not embedded within a comprehensive legislative framework, limiting their effectiveness and consistency in emergency contexts. ⁴⁷⁴

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

In The Gambia, the Medicines Control Agency (MCA) is the government agency responsible for approving new medical countermeasures (MCMs) for human use.

Established under the Medicines and Related Products Act, 2014, the MCA is mandated to regulate the manufacture, importation, exportation, distribution, use, and advertisement of medicines and related products, including vaccines, therapeutics, and diagnostics. This includes issuing marketing authorizations and granting Emergency Use Authorizations (EUAs) for unregistered products during public health emergencies. ^475476477

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

The Gambia has an expedited process for approving medical countermeasures (MCM) for human use.

The Medicines Control Agency (MCA) is the national regulatory authority responsible for approving medical countermeasures (MCMs) for human use in The Gambia. While the MCA does not publicly reference a comprehensive expedited approval framework in its core legislation, it has issued a 2021 Guideline for Emergency Use Authorisation (EUA). This guideline outlines procedures for the temporary approval of unregistered medical products—such as medicines, vaccines, and in vitro diagnostics—during declared public health emergencies. The EUA process enables the MCA to authorize products based on emergency conditions, provided that there are no adequate, approved alternatives available, and the product is supported by scientific evidence suggesting potential benefit. However, while the guideline allows for consideration of products listed by the World Health Organization (WHO) Emergency Use Listing or approved by a reference institution, it does not include formal provisions for the recognition of approval decisions made by other regulatory authorities during public health emergencies. ⁴⁷⁸

The 2024 Joint External Evaluation (JEE) further notes that The Gambia lacks a comprehensive legal framework to support health emergency preparedness research. ⁴⁷⁹

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

Score: 100

Gambia has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁴⁸⁰

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

Score: 100

Epidemics and pandemics are integrated into The Gambia’s National Disaster Risk Management Strategy 2024–2032, which serves as the country’s overarching framework for disaster risk reduction (DRR). ⁴⁸¹

This strategy replaces earlier draft efforts and does not include a standalone plan specifically for epidemics or pandemics. Instead, it takes a multisectoral approach, aligning with the Sendai Framework for Disaster Risk Reduction 2015–2030, and emphasizes the mainstreaming of DRR across all relevant sectors—including health, agriculture, education, infrastructure, land use, and climate change. Although approved by Cabinet, the 2024 strategy and its accompanying policy document have not yet been made publicly available. ^482483484

This 2024 policy marks The Gambia’s first fully endorsed national DRR framework in over a decade, following the unfinalized National Plan of Action for Disaster Risk Reduction 2012–2017, which stalled during its consultation phase. Implementation is overseen by the National Disaster Management Agency (NDMA), which coordinates DRR activities across national and subnational levels, leveraging multi-sector platforms to integrate preparedness, response, and recovery functions into public governance. Supporting initiatives—such as hazard mapping, early warning systems, standard operating procedures, and information-sharing platforms—have been developed in collaboration with international partners including the World Bank and United Nations agencies. ⁴⁸⁵

According to the 2024 Joint External Evaluation (JEE), a National Multisectoral Steering Committee on Public Health Emergencies exists to coordinate responses to epidemics and pandemics. However, coordination remains sporadic, and awareness of International Health Regulations (IHR) obligations is limited among both stakeholders and communities. ⁴⁸⁶

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

The Gambia has cross-border agreements and affiliations with neighboring countries for public health emergencies.

The government of The Gambia is involved, albeit indirectly, through its membership in the World Bank-funded West African Health Organisation (WAHO), in the Regional Disease Surveillance Systems Enhancement Project in West Africa (REDISSE) for cooperation during epidemics and disease outbreaks. ⁴⁸⁷ REDISSE focuses on strengthening surveillance and cross-border information sharing across West Africa and aims to provide "immediate and effective response" to public health crises or emergencies. The Gambia is also affiliated with the African Vaccine Regulatory Forum and the African Field Epidemiology Network, which have both coordinated regional responses to public health emergencies such as COVID-19 and Ebola. ⁴⁸⁸⁴⁸⁹

In addition, The Gambia participates in regional coordination through the West Africa Health Organization and collaborates with the Africa Centres for Disease Control and Prevention (Africa CDC), both of which facilitate information exchange and joint public health preparedness efforts. ⁴⁹⁰⁴⁹¹ While these channels reflect active engagement in regional mechanisms, there is no public evidence of formal, bilateral memoranda of understanding (MOUs) with neighboring countries specifically addressing cross-border public health emergency response. The 2024 Joint External Evaluation (JEE) does not address this issue, though the 2017 JEE mentioned informal collaboration with Senegal for information exchange at border posts, without further public documentation on its operational details. ⁴⁹²⁴⁹³

Further, The Gambia's Health Sector Emergency Preparedness and Response Plan Related to All-Hazards 2017–2019 outlines the intention to sign a memorandum of understanding (MoU) with Senegal to facilitate collaboration on public health emergency surveillance. However, there is no public evidence that such an MoU was ever formalized or implemented. ⁴⁹⁴ While media reports confirm that The Gambia and Senegal engaged in bilateral cooperation during the COVID-19 pandemic—including border closures and joint containment efforts—these appear to have been informal and situational rather than governed by a structured agreement. For instance, The Gambia officially sealed its border with Senegal on March 23, 2020, as a containment measure. ⁴⁹⁵

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 0

There is no public evidence that The Gambia has formal cross-border agreements, protocols, or Memoranda of Understanding (MOUs) with neighboring countries specifically for animal health emergencies.

However, the country participates indirectly in regional animal health frameworks and collaborations, notably through the Regional Animal Health Center (RAHC) under the West African Health Organization (WAHO), which supports coordination and surveillance of transboundary animal diseases across ECOWAS member states. ⁴⁹⁶ The Gambia, like other ECOWAS countries, contributes to region-wide prioritization and response for zoonotic diseases—such as anthrax, Lassa fever, and rabies—under a One Health approach as outlined by ECOWAS member consensus on priority zoonotic threats. ⁴⁹⁷

The 2024 Joint External Evaluation (JEE) does not address animal health emergency agreements specifically, and the 2017 JEE mentions only that The Gambia’s national veterinary laboratory collaborates with a partner facility in Senegal (L'NERV), without providing details on any formal MOU or agreement. ⁴⁹⁸⁴⁹⁹ These arrangements appear to be part of broader surveillance and outbreak-response networks rather than country-level bilateral protocols governing animal health emergencies. Neither the Ministry of Health, the National Disaster Management Agency, nor the Ministry of Agriculture provide additional relevant information via public websites. ^500501502

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

The Gambia is a State Party to the Biological Weapons Convention (BWC), having deposited its instrument of ratification on 7 May 1997. This status grants it full rights and obligations under the treaty, identical in legal effect to both signature and ratification, in accordance with international law. ⁵⁰³

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

Score: 100

The Gambia has submitted Confidence-Building Measures (CBMs) annually since 2022 under the Biological Weapons Convention (BWC), reflecting a continued commitment to transparency and international cooperation. According to the official BWC CBM portal, The Gambia submitted reports in 2022, 2023, 2024, and most recently in 2025 (on 17 July 2025), demonstrating sustained engagement with the Convention’s reporting mechanisms. ⁵⁰⁴

5.3.1c Submission of UNSCR 1540 reports

Score: 0

There is no public evidence that The Gambia has submitted its required UNSCR 1540 National Report to the Security Council Committee established pursuant to Resolution 1540 (the 1540 Committee). The Office of Parliamentarians for Global Action (PGA) reported in October 2024 that The Gambia was among just eight UN Member States that had not yet submitted the mandatory national report under Resolution 1540 (2004). ⁵⁰⁵

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

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

Score: 0

The Gambia holds membership in the Proliferation Security Initiative (PSI) but is not a member of either the Australia Group (AG) or the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP). ^506507508

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

Score: 100

The Gambia has completed a Joint External Evaluation (JEE) within the last five years, with the most recent evaluation conducted between 9-13 September 2024 and the final report published in July 2025. ⁵⁰⁹

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

Score: 0

There is no evidence that The Gambia has completed and published a Performance of Veterinary Services (PVS) assessment or gap analysis in the past five years. According to the World Organisation for Animal Health (WOAH) database, the country’s most recent publicly available PVS Evaluation was conducted in 2009, with no subsequent PVS Evaluation, PVS Gap Analysis, or PVS Follow-up Mission report released since that time. ⁵¹⁰

However, in February 2021, The Gambia hosted a National Bridging Workshop on the International Health Regulations (IHR) and the Performance of Veterinary Services (PVS) Pathway in Banjul, co-organized with the World Health Organization (WHO) and WOAH. The workshop sought to strengthen coordination between human and animal health authorities, enhance understanding of respective mandates, and jointly identify priority actions for One Health implementation and national preparedness. ⁵¹¹ While this event demonstrated a continued commitment to intersectoral collaboration and to using the PVS framework as a planning tool, it does not constitute a new or published PVS assessment

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

Score: 0

There is no evidence that The Gambia has completed and published a Performance of Veterinary Services (PVS) assessment or gap analysis in the past five years. According to the World Health Organization for Animal Health (WOAH) data, the country’s most recent publicly available PVS evaluation occurred in 2009, with a subsequent gap analysis in 2012 and no follow-up assessment reported since then. ⁵¹²

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

Score: 0

There is limited evidence that The Gambia has allocated domestic government funding within the past three years specifically to strengthen capacity for addressing pandemic or epidemic threats

The most definitive financial response occurred during the COVID‑19 pandemic, when the government established a dedicated US $14.1 million COVID‑19 response fund, disbursing resources—including approximately US $5 million under the Pandemic Emergency Financing Facility—to procure laboratory equipment, diagnostics, and PPE. These expenditures were largely supported by donor funding, such as the World Bank's COVID‑19 Preparedness and Response Project and UNDP support programs. ⁵¹³⁵¹⁴

Government budget documents and independent reviews—including the 2022 national budget speech—do not reflect a ring-fenced or recurring national budget line for pandemic preparedness or public health emergency preparedness as of mid-2025. A 2023 capacity assessment likewise confirmed that The Gambia continues to lack a dedicated budget line for preparedness operations, which constrains sustained implementation of response plans. ⁵¹⁵⁵¹⁶

The Recovery Focused National Development Plan 2023–2027 acknowledges the disruption caused by COVID‑19 and outlines commitments to strengthen epidemic preparedness, including the operationalization of a Public Health Emergency Preparedness and Response system, enhancement of surveillance and laboratory capacity, use of a One Health approach, and improved compliance with the International Health Regulations (IHR 2005). However, publicly available budget documents do not provide clear evidence that these strategic priorities have been accompanied by concrete or recurring domestic financial commitments. ⁵¹⁷

The 2024 Joint External Evaluation (JEE) further confirms that domestic budget allocation for IHR implementation and public health emergency response remains inadequate, with The Gambia allocating only 7.95% of its national budget to health in 2024—well below the 15% target set by the Abuja Declaration. While a contingency budget line managed by the Ministry of Finance provides a degree of flexibility for reallocating funds during emergencies, this mechanism is described as slow and cumbersome, contributing to delays in emergency response. The JEE also highlights limited political prioritization and public awareness of health security, and assigns a low score (1 out of 5) for public health emergency financing, indicating major constraints in both planning and operational execution. ⁵¹⁸

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

Score: 0

The Gambia has developed a National Action Plan for Health Security (NAPHS) covering the period 2022–2026, and while the plan identifies priority activities and resource needs, there is limited evidence of specific national budget allocations dedicated to its implementation—and the NAPHS document itself is not publicly available. ⁵¹⁹

In October 2022, the Gambian Ministry of Health, in collaboration with the World Health Organization (WHO), conducted a resource mapping workshop using WHO’s REMAP tool to assess financial and technical support for implementing the NAPHS. The exercise identified more than $28 million in partner funding for general health security activities, but very little of this was earmarked directly for NAPHS activities. Domestic contributions—mainly in the form of salary and infrastructure support—were acknowledged, but no ring-fenced national budget line for NAPHS implementation was confirmed. Major funding gaps were highlighted in key areas such as medical countermeasures, real-time surveillance, antimicrobial resistance, and workforce development. Although the NAPHS had not been officially launched at the time of the workshop, implementation had reportedly begun in select areas such as legislation, food safety, and immunization. The 2024 Joint External Evaluation (JEE) also confirms that domestic funding for International Health Regulations (IHR) implementation remains inadequate, with a slow and cumbersome process for accessing emergency public health funds and a continued reliance on donor financing. ⁵²⁰⁵²¹

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

Score: 0

The Gambia has not completed a Performance of Veterinary Services (PVS) assessment or PVS Gap Analysis in the past five years; as such, there is no public documentation identifying or allocating specific national budget resources to address veterinary service capacity gaps. ⁵²²

5.5.3a Emergency public financing during a public health emergency

Score: 100

There are publicly identified special emergency public financing mechanisms that The Gambia can access during a public health emergency. These include eligibility for borrowing from the World Bank’s International Development Association (IDA) and access to the Pandemic Emergency Financing Facility (PEF). ⁵²³⁵²⁴ During the COVID‑19 pandemic, The Gambia mobilized resources through the PEF and the World Bank’s COVID‑19 Preparedness and Response Project, using these funds to procure diagnostics, personal protective equipment (PPE), and to strengthen laboratory and surveillance systems. ⁵²⁵ While there is no national reserve fund exclusively dedicated to health emergencies, the Ministry of Finance maintains a flexible contingency budget line that allows reallocation of funds across sectors in times of crisis. However, according to the 2024 Joint External Evaluation (JEE), this process is non-transparent, slow, and inefficient—leading to delays in emergency response—and underscores the country’s ongoing reliance on external donor support rather than sustained, ring-fenced domestic financing. ⁵²⁶

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

Score: 0

In the past three years, there is no evidence that senior leaders in The Gambia—such as the President or Ministers—have made public commitments to support other countries in strengthening their capacity to address pandemic or epidemic threats, either through financing or other forms of assistance. While The Gambia has engaged in regional collaborations with entities like the Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organization (WHO), and the West African Health Organization (WAHO), these efforts have focused on domestic preparedness and multilateral coordination, not on providing bilateral support. Regarding domestic capacity, there is limited evidence of public commitments from senior leadership to expand financing or request external support for epidemic preparedness. For example, following the confirmation of a monkeypox (mpox) case, the Ministry of Health publicly announced national-level actions such as surveillance strengthening, contact tracing, and collaboration with international agencies. However, these responses were operational and technical in nature, with no accompanying political statements or pledges by senior leaders committing national resources or advocating for expanded funding or donor support to improve The Gambia’s epidemic response capacity. Neither the Ministry of Health; the Ministry of Foreign Affairs, International Cooperation and Gambians Abroad; nor the Office of the President shares additional relevant information via public websites. ^527528529 The Global Health Security Tracking Dashboard does not report any financing geared toward improving The Gambia's capacity to address epidemic threats in the past three years. ⁵³⁰

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

Score: 100

There is evidence that The Gambia has requested and received technical and financial support from international partners within the past three years to strengthen its capacity to address epidemic threats.

In June 2023, the World Bank approved a US $4.33 million grant for The Gambia under the Health Emergency Preparedness and Response (HEPR) Program. This funding was provided in response to a government request for assistance to improve the country’s domestic capacity for early detection, laboratory readiness, and rapid response to health emergencies. The project specifically supports the Ministry of Health in developing integrated surveillance systems, enhancing emergency coordination mechanisms, and strengthening cross-sectoral preparedness aligned with the One Health framework. ⁵³¹

In parallel, under the World Health Organization (WHO) Country Cooperation Strategy (CCS) 2024–2028, The Gambia is classified as a Category D country, designating it to receive comprehensive technical support for emergency preparedness, health-system strengthening, and equitable access to essential services. While this classification reflects WHO’s strategic commitment rather than a specific request by the government, it complements The Gambia’s broader engagement with donors and partners to close preparedness gaps and align domestic priorities with global health-security objectives. ⁵³²

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

Score: 0

There is no publicly cited evidence that The Gambia has fully paid its assessed contributions to the World Health Organization (WHO) in the past two years (2023–2024) or into 2025. WHO’s assessed contributions are published and The Gambia is listed under assessed contributions for 2024–2025 with an amount figure of US $11,480. However, no specific notice or report confirms whether The Gambia actually remitted these payments in full within the timeframes in question. Typically, WHO releases member-specific Statements of Account or Notices of Assessment, but these documents for The Gambia in those years are not publicly accessible or highlighted in available reports. ⁵³³

Additionally, the Seventy-eighth World Health Assembly (WHA78) report on the Status of Collection of Assessed Contributions, published in May 2025, confirms that The Gambia had an outstanding balance as of 31 December 2024, indicating that the country had not fully settled its assessed contributions by year-end. ⁵³⁴ Absent explicit confirmation from WHO’s financial dashboards or official statements verifying full payment, The Gambia cannot be confirmed as having fulfilled its assessed contribution obligations in full for the past two years.

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

Score: 0

There is no publicly available plan or policy for sharing genetic data, epidemiological data, clinical specimens, or isolated specimens (biological materials) with international organisations and/or other countries that goes beyond influenza.
The Gambia National Health Sector Strategic Plan (2014-2020) mentions the data sharing capabilities of the country’s Health Management Information System (HMIS), but does not go into detail nor mention pathogens with pandemic potential. ⁵³⁵ Neither the Ministry of Health, the Ministry of Higher Education, Research, Science and Technology, nor the Ministry of Agriculture share relevant information via public websites. ^536537538 The Joint External Evaluation (JEE) report for The Gambia, published in September 2024, does not provide information on the existence of relevant policies.⁵³⁹

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

Score: 100

There is no public evidence that The Gambia has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past year. There is no reference to sharing influenza data on the Ministry of Health website and there have not been any reports of The Gambia not sharing samples in either national or international media. ⁵⁴⁰ The latest External Evaluation of the Pandemic Influenza Preparedness Partnership Contribution, published in 2016, does not refer to The Gambia not sharing samples, nor does it list The Gambia as a priority country for improving the "national ability to detect, monitor and share novel influenza viruses". ⁵⁴¹

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

Score: 100

There is no public evidence that The Gambia has not shared pandemic pathogen samples during an outbreak in the past two years. There is no reference to not sharing pandemic pathogen data on the Ministry of Social Health and Welfare website and there have not been any reports of The Gambia not sharing samples in either national and international media. ⁵⁴² The Ministry of Health and Social Welfare shares daily updates on the status of the COVID-19 pandemic in The Gambia, but these do not indicate if samples are not being shared. ⁵⁴³ There is no record of The Gambia participating in the World Health Organization's Global Influenza Surveillance and Response System (GISRS). ⁵⁴⁴

6.1.1a Policy formation

Score: 50

6.1.1b Quality of bureaucracy

Score: 0

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 38

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 25

6.1.2a Orderly transfers of power

Score: 50

6.1.3a Risk of social unrest

Score: 0

6.1.4a Risk of terrorism

Score: 50

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 50

6.1.5a Presence or risk of armed conflict

Score: 75

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 50

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

Score: 54.54

6.2.2a UNDP Gender Inequality Index score

Score: 22.55

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

Score: 87.07

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: 100

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 61.2

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 0

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 34.44

6.4.2a Change in forest area (percentage points)

Score: 9.37

6.4.3a Natural disaster risk

Score: 50

6.5.1a Total life expectancy (years)

Score: 51.7

6.5.1b NCD mortality rate

Score: 64.56

6.5.1c Population aged 65+

Score: 90.23

6.5.1d Tobacco use (% of adults)

Score: 61

6.5.1e Level of adult obesity (%)

Score: 71.22

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

Score: 64.42

6.5.2a Access to potable water

Score: 86.98

6.5.2b Access to at least basic sanitation facilities

Score: 47.93

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: 3.19

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: 100