Liberia: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

Liberia developed a multi sectoral National Action Plan on the Prevention and Containment of Antimicrobial Resistance 2018 to 2022, issued by the Ministry of Health, which includes specific objectives for strengthening surveillance, detection, and reporting of antimicrobial resistance across human and animal health sectors ¹. The plan expired in 2022 and no new national plan is publicly available or listed in the World Health Organization Library of National Action Plans ². In the absence of a current plan, Liberia has continued relevant activities. A national needs assessment of antimicrobial resistance capacity was conducted in July 2024 across 22 One Health laboratories in 12 counties, followed by a national Training of Trainers workshop in November 2024 to operationalize a newly developed surveillance strategy targeting professionals from 13 counties ³⁴. However, these efforts are externally funded and not formally adopted by the government. The 2023 Joint External Evaluation confirmed the absence of an updated national plan and recommended its finalization ⁵.

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

Score: 50

Liberia has demonstrated laboratory capacity to test for some, but not all, of the World Health Organization seven plus one priority antimicrobial resistance pathogens. The 2023 Joint External Evaluation of International Health Regulations Core Capacities, published by the World Health Organization, reports that five sentinel sites in five counties have designated staff trained to perform antimicrobial susceptibility testing, monitor resistance, and conduct surveillance for healthcare-associated infections ⁶. However, it does not specify which pathogens are tested. A 2024 report by the Food and Agriculture Organization confirms detection of Shigella, Salmonella Typhi, Salmonella Paratyphi A, Klebsiella, and non-typhoidal Salmonella in animal health surveillance under a One Health framework, with support from the United States Agency for International Development ⁷. The Institute for Health Metrics and Evaluation antimicrobial resistance country profile for Liberia reports resistance data for Klebsiella pneumoniae, Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa ⁸.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 100

Liberia conducts environmental surveillance for antimicrobial resistance (AMR) through its operational One Health framework. The National Action Plan on Prevention and Containment of Antimicrobial Resistance in Liberia (2018–2022), issued by the Ministry of Health, mandates that the Environmental Protection Agency and Ministry of Agriculture conduct surveillance of AMR in environmental matrices including soil, water, and food ⁹. Although the formal plan expired in 2022, implementation continued beyond its end date, as evidenced by intersectoral activities. In November 2024, the Ministry of Health, Environmental Protection Agency, Ministry of Agriculture, and National Public Health Institute of Liberia conducted a joint national Training of Trainers workshop on integrated AMR surveillance. This workshop specifically trained environmental-sector laboratory personnel in AMR detection protocols and environmental sample processing techniques ¹⁰.

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

Score: 0

There is no publicly available evidence that Liberia has national legislation or regulation in force requiring prescriptions for antibiotic use for humans. The Liberia Medicines and Health Products Regulatory Authority Act of 2010, enacted by the Republic of Liberia, establishes LMHRA’s authority to regulate medicines but does not mandate prescriptions for antibiotics ¹¹. The LMHRA’s “Regulations on the Registration of Medicines and Health Products,” issued on 6 January 2022, govern the registration, labeling, and importation of pharmaceuticals but do not contain enforceable provisions requiring prescriptions for human antibiotics ¹². The World Health Organization’s 2023 Joint External Evaluation explicitly states that “there is no national prescription policy for antibiotic use in Liberia” and highlights limited enforcement of antimicrobial regulations ¹³. Liberia’s “National Action Plan on Prevention and Containment of Antimicrobial Resistance 2018–2022,” developed by the Ministry of Health, promotes rational use and improved prescription practices but has no legal force ¹⁴. No legislation or regulatory text establishing a mandatory prescription requirement was found in LMHRA’s legal documents ¹⁵, the Ministry of Health’s publications ¹⁶, or the WHO Library of National Action Plans ¹⁷.

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

Score: 0

Liberia does not have national legislation or regulation requiring prescriptions for antibiotic use in animals. The World Health Organization (WHO) 2022 Tracking AMR Country Self-Assessment Survey (TrACSS) confirms that Liberia lacks a system to monitor the sale or use of antimicrobials in animals and does not have a regulatory authority for veterinary antimicrobial use ¹⁸. It further states that no surveillance system exists for antimicrobial resistance (AMR) in either terrestrial or aquatic animals ¹⁹. The 2023 Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities, published by the WHO Regional Office for Africa, does not mention any legislation or regulation requiring veterinary prescriptions for antimicrobials, nor does it describe enforcement mechanisms for such a policy ²⁰. A 2024 report by the Food and Agriculture Organization (FAO) outlines efforts to develop AMR surveillance in animals through training and laboratory support but makes no reference to any existing legal requirement for prescriptions in the veterinary sector ²¹.

1.2.1a Laws/plans on zoonotic disease

Score: 100

Liberia has national legislation and strategy documents that address zoonotic disease prioritization, detection, and reporting through a multi sectoral One Health approach. The National One Health Strategic Plan 2019–2023, issued by the Republic of Liberia and published with support from the Food and Agriculture Organization of the United Nations, identifies six priority zoonotic diseases: rabies, anthrax, brucellosis, Lassa fever, Ebola virus disease, and pandemic influenza. It outlines detection, surveillance, and coordination mechanisms across the human, animal, and environmental health sectors ²². In December 2022, Breakthrough ACTION Liberia published the National One Health Message Guide for Priority Zoonotic Diseases, which provides standardized public communication strategies for risk messaging, community engagement, and outbreak awareness aligned with the national strategic priorities ²³. In 2024, Liberia conducted a joint risk assessment for rabies, anthrax, and Lassa fever under the One Health framework, coordinated by the Ministry of Health and documented by the World Health Organization Regional Office for Africa ²⁴.

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

Score: 0

There is no publicly available evidence that Liberia has a national legislation, plan or equivalent strategy that explicitly includes measures for risk identification and reduction of zoonotic spillover from animals to humans. The National One Health Strategic Plan 2019–2023 sets broad pillars such as “Surveillance and Reporting” and describes integrated multi-sectoral data systems, but it does not contain explicit provisions on spillover risk detection or targeted risk-reduction actions ^{25, pp. 9–10, 30, Annex F, pp. 44–45}. The annex notes the absence of a veterinary law, livestock policy and routine animal health surveillance. The National Technical Guidelines for Integrated Disease Surveillance and Response (IDSR, 2021 edition) include protocols for reporting zoonoses such as rabies and Lassa fever, but these are operational disease surveillance guidelines rather than a national spillover risk plan ^{26, pp. 204–206}. The Community Event-Based Surveillance (CEBS) Manual, 2016 similarly sets out reporting triggers for events such as animal bites, unexplained animal deaths and suspected zoonotic outbreaks, but it is a technical implementation guide, not a national strategy ^{27, pp. 4–5, 19–20}. Finally, the Joint External Evaluation (JEE) of International Health Regulations (IHR) Core Capacities, 2023 highlights the continued absence of an animal health legislative framework and recommends strengthening zoonosis risk mapping and analyses, confirming that no explicit national spillover risk-identification and reduction strategy exists ^{28, pp. 9–10}.

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

Score: 100

Liberia has national guidelines in force that address the surveillance and control of multiple zoonotic pathogens of public health concern. The Ministry of Health and the National Public Health Institute of Liberia issued the National Technical Guidelines for Integrated Disease Surveillance and Response (Third Edition) in June 2021, adapted in November 2019. These guidelines include case definitions, reporting pathways, and laboratory procedures for zoonotic diseases such as anthrax, brucellosis, bovine tuberculosis, Ebola virus disease, human rabies, Lassa fever, Marburg virus disease, monkeypox, and yellow fever, listed as nationally notifiable conditions in Annex A ²⁹. The Ministry of Health’s Community Event-Based Surveillance Manual for Integrated Disease Surveillance and Response, published in May 2016, defines community-level alert categories for zoonotic threats such as unusual animal deaths, animal bites, and human cases linked to animal exposure, and establishes reporting protocols through trained community health volunteers ³⁰. The World Health Organization confirms in its 2023 Joint External Evaluation that these frameworks remain active and in use, including the Revised Community Event-Based Surveillance framework and Surveillance Contingency Plan (2023 to 2027), with specific zoonotic event triggers and response protocols ³¹. Additional 2024 and 2025 reports confirm active training, multi sectoral coordination, and field implementation of zoonotic surveillance in Liberia ³²³³.

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

Score: 100

Liberia maintains a functioning multi sectoral coordination mechanism dedicated to zoonotic diseases that operates across ministries. The Liberia One Health Coordination Platform, established in 2017, is governed by a secretariat within the Office of the Vice President and is chaired by the National Public Health Institute of Liberia (NPHIL) ³⁴. The platform includes formal representation from the Ministry of Health, Ministry of Agriculture, Environmental Protection Agency, Forestry Development Authority, and other relevant entities ³⁵. It facilitates collaborative activities such as joint risk assessments and the development of cross-sectoral communication tools. In 2023, the platform published the National One Health Message Guide for Priority Zoonotic Diseases, developed through joint efforts of stakeholders from human health, animal health, and environmental sectors ³⁶. In March 2023, Liberia also conducted a national Joint Risk Assessment for zoonotic threats under the leadership of the platform, with implementation support from the World Health Organization (WHO), Food and Agriculture Organization, and World Organisation for Animal Health ³⁷.

1.2.1e Presence of One Health strategic plan

Score: 100

Liberia has a One Health strategic plan in place, although it is out of date. The National One Health Strategic Plan was published in September 2018 by the Ministry of Health, Ministry of Agriculture, Forestry Development Authority, Environmental Protection Agency, Ministry of Commerce and Industry, National Disaster Management Agency, and the National Public Health Institute of Liberia. ³⁸

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

Score: 0

Liberia does not have a national mechanism, either voluntary or mandatory, for livestock owners to report disease surveillance directly to a central government agency. Instead, livestock surveillance is carried out by community animal health workers and district veterinary officers who collect information from owners and report to the Directorate of Veterinary Services at the Ministry of Agriculture ³⁹⁴⁰⁴¹. The 2023 Joint External Evaluation notes coordination of animal and zoonotic disease surveillance through the Veterinary Services Directorate but does not identify any owner-to-government reporting channel ^{42, p. 17}. Liberia’s Integrated Disease Surveillance and Response guidelines assign reporting roles to veterinary staff and community health volunteers, not to livestock owners ⁴³. The Community Event-Based Surveillance manual likewise assigns duties to community health volunteers and veterinary staff, with no direct reporting pathway from owners to a central authority ⁴⁴. The Food and Agriculture Organization’s Event Mobile Application (EMA-i/EMA-i+) supports real-time reporting by veterinary services and animal health workers, strengthening official reporting workflows, but it does not create a direct owner-to-government reporting mechanism ⁴⁵.

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

Score: 0

There is no publicly available legislation or regulation in Liberia that safeguards the confidentiality of surveillance data specifically related to animal owners. The 2023 Joint External Evaluation of International Health Regulations (IHR) Core Capacities reviewed Liberia’s surveillance systems but did not identify any legal framework protecting the confidentiality of animal owner–related surveillance information ⁴⁶. Liberia’s National Technical Guidelines for Integrated Disease Surveillance and Response contain confidentiality provisions for human health data but do not extend these protections to animal surveillance or data on livestock owners ⁴⁷. Similarly, the Community Event-Based Surveillance Manual includes operational guidance for data collection and community-level reporting but contains no clauses addressing the confidentiality of information linked to animal owners ⁴⁸. A review of publicly available documentation from the Ministry of Agriculture's Planning and Development Directorate did not reveal any applicable laws or regulatory instruments on this matter ⁴⁹.

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

Liberia conducts surveillance of zoonotic diseases in wildlife, poultry, and livestock through a multi sectoral, One Health–oriented approach. In October and November 2024, the Veterinary Services Directorate of the Ministry of Agriculture, in coordination with the Forestry Development Authority and supported by the Food and Agriculture Organization (FAO), trained wildlife officers, forest rangers, and community animal health workers in integrated disease surveillance and outbreak response for both wild and domestic animals ⁵⁰. In March 2025, the World Organisation for Animal Health and the International Union for Conservation of Nature led a workshop that introduced Liberia’s national Guidelines for Surveillance of Diseases, Pathogens and Toxic Agents in Wildlife and strengthened the country’s capacity to conduct environmental sampling and mobile diagnostics ⁵¹. The 2023 Joint External Evaluation confirms that Liberia conducts One Health surveillance of priority zoonotic diseases, including rabies, anthrax, bovine tuberculosis, Lassa fever, brucellosis, and mpox, across wildlife, poultry, and livestock populations ⁵². Additional FAO documentation from 2022 highlights field-level integration of surveillance across species, coordinated by the Emergency Centre for Transboundary Animal Diseases and implemented through joint veterinary and public health mechanisms ⁵³.

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

Liberia has a publicly accessible mechanism for reporting notifiable animal diseases to the World Organisation for Animal Health through the World Animal Health Information System. WOAH’s regional feed lists a Liberia notification dated 18 April 2025 for highly pathogenic avian influenza H5N1, demonstrating official submission via WAHIS ⁵⁴. A corresponding WAHIS event dashboard (Event ID 6673) shows a Liberia animal-health event with updates as of 21 June 2025, confirming active reporting by the national Veterinary Services to WOAH during 2025 ⁵⁵.

1.2.4a Number of veterinarians per 100,000 people

Score: 0

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

Score: 0

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

Score: 0

There is no public evidence that Liberia’s national zoonotic disease plan, legislation, regulation, or other official strategies include mechanisms for engaging the private sector in the control or response to zoonoses. Liberia’s National One Health Strategic Plan 2019–2023 involves public-sector coordination among the Ministries of Health, Agriculture, Commerce, Environmental Protection Agency, Forestry Development Authority, and the National Public Health Institute of Liberia but does not reference private veterinarians, private laboratories, animal health product suppliers, or other private–sector actors ⁵⁶. The National Technical Guidelines for Integrated Disease Surveillance & Response and the Community Event‑Based Surveillance Manual similarly outline roles for public veterinary and community health workers, with no mention of private‑sector involvement ⁵⁷⁵⁸. The 2023 Joint External Evaluation of International Health Regulations Core Capacities corroborates this absence, as it provides no indication that private‑sector engagement in zoonotic disease control or response is included within Liberia's national frameworks ⁵⁹.

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

Score: 0

There is no publicly available evidence that Liberia maintains 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. The 2023 Joint External Evaluation of International Health Regulations Core Capacities states that Liberia lacks monitoring and inventory systems for high-risk pathogens in public and private laboratories, donor-supported projects, and research facilities ⁶⁰. Liberia’s National Health Laboratory Strategic Plan 2023–2026 identifies the need to develop a national list of infectious agents and other dangerous materials, secure such materials at a limited number of designated laboratories, and create a tracking database for inventory monitoring ⁶¹.

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that Liberia has enacted biosecurity legislation or regulations that set facility requirements for physical containment, operational practices, failure or incident reporting, or cybersecurity for facilities that store or process especially dangerous pathogens and toxins. The 2023 Joint External Evaluation (JEE) of International Health Regulations (IHR) core capacities by the World Health Organization (WHO) reports a lack of laws establishing a biosafety and biosecurity program and a regulatory framework; it notes only a National Biosafety and Biosecurity Policy and a guide for laboratories and indicates that biosecurity legislation is in draft form ^{62, pp. 22, 23}. The National Health Laboratory Strategic Plan 2023 to 2026 by the National Public Health Institute of Liberia (NPHIL) states that up to date legislation defining minimal biosafety levels and requirements for operation of laboratories is not available, confirming the absence of enforceable facility biosecurity standards ^{63, p. 33}. Liberia’s Joint National Action Plan for Health Security records a baseline of zero for availability of biosafety and biosecurity legislation and sets an activity to develop and enact such legislation, which indicates no law is in force during the assessment period ^{64, pp. 46, 65, 66, 67}. The National Public Health Institute of Liberia has issued “Guidelines for the Safe Management of Healthcare Waste in Liberia 2020,” which provide procedural direction on waste segregation, collection, treatment, and disposal, but these remain technical guidelines and do not constitute statutory requirements for facility-level biosecurity, such as physical containment, incident reporting, or cybersecurity ^{65, p. VI}.

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence that Liberia has an established government agency with a legal mandate to enforce biosecurity legislation or regulations for facilities that handle dangerous pathogens. The World Health Organization’s Joint External Evaluation of International Health Regulations (IHR) Core Capacities: Liberia, 2023 (2nd edition) reports a lack of laws and a regulatory framework for biosafety and biosecurity, little oversight and monitoring of public and private sectors, no monitoring or inventory of high-level pathogens, and recommends establishing a national laboratory biosafety and biosecurity regulatory body, which indicates no enforcement authority exists at present ^{66, pp. 22–24}. The National Public Health Institute of Liberia’s National Health Laboratory Strategic Plan 2023-2026 states that up-to-date legislation defining minimal biosafety levels and operational requirements is not available, confirming the absence of enforceable standards that an agency could implement ^{67, p. 33}. The Ministry of Health’s National Technical Guidelines for Integrated Disease Surveillance and Response (IDSR) set out surveillance and reporting roles to guide public health action rather than any biosecurity regulatory powers ^{68, pp. 19, 32}. The Ministry of Health’s “Community Event-Based Surveillance Manual for Integrated Disease Surveillance and Response in Liberia” defines community alerting, escalation responsibilities, and a hotline, again without assigning biosecurity enforcement to any institution ^{69, pp. 7–10}.

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

Score: 50

Liberia has taken initial planning steps toward consolidating its inventory of especially dangerous pathogens but has not implemented measures to reduce the number of facilities authorized to hold such materials. The National Health Laboratory Strategic Plan 2023–2026 outlines an institutional objective to conduct a national mapping of facilities and establish a central inventory of pathogens, indicating intent to consolidate storage and improve biosafety governance ⁷⁰. However, there is no publicly available evidence that these objectives have been operationalized or that Liberia has taken active steps to reduce or restrict the number of facilities permitted to store these pathogens. The 2023 Joint External Evaluation of International Health Regulations Core Capacities confirms the absence of an existing national inventory and highlights limited biosafety and biosecurity development outside of the human health sector, particularly in veterinary and environmental domains ⁷¹. No relevant legislation or policies were identified through a review of official documents published by the Ministry of Health, the National Public Health Institute of Liberia, or the Strategic Partnership for Health Security portal ⁷²⁷³.

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

Score: 100

There is publicly available evidence that Liberia has in-country capacity to conduct Polymerase Chain Reaction (PCR) diagnostic testing for Ebola virus, which precludes the need to culture live pathogens. The Joint External Evaluation of International Health Regulations (IHR) Core Capacities: Liberia, 2023 confirms that human and animal health laboratories can perform PCR, and that the National Public Health Reference Laboratory (NPHRL) has diagnostic capacity for all priority diseases, including viral hemorrhagic fevers such as Ebola virus ^{74, pp. 9, 34, 48}. The National Health Laboratory Strategic Plan 2023–2026 further lists RT-PCR for Ebola virus at the NPHRL and shows GeneXpert sites at regional hospitals ^{75, pp. 14–15}. There is no publicly available evidence on whether Liberia conducts PCR testing for Bacillus anthracis (anthrax); a review of the national laboratory strategic plan, the Joint External Evaluation report, the World Health Organization Strategic Partnership for Health Security (SPH) country portal, and the National Public Health Institute of Liberia website did not identify any in-country anthrax PCR capability ^{76, p. 3477, pp. 14–15; 3; 4}.

1.3.2a Biosecurity training using a standardised, required approach

Score: 33.33

Liberia provides only ad hoc biosecurity training for personnel working in high-risk laboratories, with no evidence of a standardized, nationally required curriculum or recertification framework. The National Health Laboratory Strategic Plan 2023–2026 identifies the need to improve biosafety and biosecurity training as a strategic objective, referencing planned actions such as developing training modules, assessing training needs, and implementing a national curriculum, but it does not confirm that a mandatory system is currently in place ⁷⁸. The 2023 Joint External Evaluation of International Health Regulations Core Capacities for Liberia reports that biosecurity training is offered primarily through externally supported workshops and that implementation is variable and dependent on donor support ⁷⁹. These initiatives confirm the presence of training on an ad hoc basis but do not provide evidence of a required training program, a unified national curriculum, or a recurring recertification process. No documentation from the Ministry of Health, the World Health Organization Strategic Partnership Portal, or the Biological Weapons Convention implementation database contains evidence of mandated, systematic training across relevant facilities ⁸⁰⁸¹⁸².

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

Score: 0

There is no publicly available evidence that Liberia requires drug testing, background checks, or psychological or mental fitness assessments for personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential. The 2023 Joint External Evaluation of International Health Regulations Core Capacities of the Republic of Liberia does not mention any mandatory personnel screening procedures or vetting requirements related to biosafety or biosecurity facilities, including within the biosafety and biosecurity technical areas or laboratory workforce development frameworks ⁸³. No relevant provisions were identified in official documentation available on the Ministry of Health or Ministry of Agriculture websites ⁸⁴⁸⁵.

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

Score: 0

There is no publicly available evidence that Liberia has national regulations governing the safe and secure transport of infectious substances that explicitly include United Nations Category A or B agents. The Joint External Evaluation of IHR Core Capacities of the Republic of Liberia (2023) states that Riders for Health personnel are trained to transport specimens and that standard operating procedures are used by the National Reference Laboratory, but it also concludes that Liberia lacks biosafety and biosecurity laws and regulatory frameworks, including for the transport of infectious substances ⁸⁶. The Liberia Civil Aviation Authority’s 2021 Civil Aviation Regulations Part 15 adopts the International Civil Aviation Organization (ICAO) Technical Instructions for the transport of dangerous goods by air and references UN hazard Class 6.2 for infectious substances, which includes Categories A and B. However, the regulation does not explicitly identify Category A or B agents by name and is limited to air transport only, with no publicly available regulations covering road, sea, or rail transport ⁸⁷. No relevant legislation or regulatory framework was found on the websites of the Ministry of Health, Ministry of Agriculture, Ministry of Defense, Ministry of Transport, or the Environmental Protection Agency ^8889909192.

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

Score: 0

There is no publicly available legislation or regulation in Liberia that governs the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, or biological materials with pandemic potential. The 2023 Joint External Evaluation of International Health Regulations Core Capacities confirms that Liberia has no monitoring or inventory system for high-risk pathogens and lacks a national mechanism to identify or register them ⁹³. While a draft Biosafety and Biosecurity Policy was under development, the document notes that it had not been endorsed or implemented as of the evaluation period. It further clarifies that the draft National Public Health Law addresses issues related to antimicrobial use and resistance but does not contain provisions related to cross-border movement or end-user screening of dangerous biological materials ⁹⁴. The Environmental Protection Agency implements the Cartagena Protocol on Biosafety, but this treaty applies only to living modified organisms and does not provide regulatory coverage of dangerous pathogens or toxins ⁹⁵.

1.4.1a Biosafety laws/regulations

Score: 0

There is no publicly available evidence that Liberia has enacted national biosafety legislation as of 2025. The Environmental Protection Agency (EPA) of Liberia implements the National Biosafety Framework, originally established in 2004 and revised in 2012, with funding and technical support from the United Nations Environment Programme (UNEP) and the Global Environment Facility (GEF) ⁹⁶. While the framework outlines national procedures, institutional responsibilities, and risk assessment mechanisms aligned with the Cartagena Protocol on Biosafety, it does not constitute enforceable legislation. A draft National Biosafety Law was developed during the implementation period of the GEF-funded project and designates the EPA as the competent national authority, but the law remains unratified as of the project's terminal evaluation in 2018 ⁹⁷. The Food and Agriculture Organization (FAO) Global Platform on Genetically Modified Foods confirms that Liberia’s biosafety legislation is under development and not yet enacted ⁹⁸. The 2023 Joint External Evaluation of International Health Regulations (IHR) Core Capacities for Liberia does not report any existing national biosafety law, nor does the Biological Weapons Convention implementation database include biosafety legislation under Liberia’s profile ⁹⁹¹⁰⁰.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 100

The Environmental Protection Agency of Liberia (EPA) is the officially designated national authority responsible for the enforcement of biosafety regulatory functions. The Terminal Evaluation of the project “Support the Implementation of the National Biosafety Framework of Liberia,” published by the United Nations Environment Programme and Global Environment Facility, confirms that the EPA houses a Biosafety Unit that undertakes key enforcement activities including the issuance of biosafety permits, inspection of genetically modified organism (GMO) facilities, and monitoring of biosafety implementation under the National Biosafety Framework. The report explicitly states that the EPA was designated as the National Competent Authority for the Cartagena Protocol on Biosafety and leads national biosafety coordination and regulatory responsibilities ¹⁰¹. The Food and Agriculture Organization GM Foods Platform further confirms Liberia’s official designation of the EPA as the national authority for biosafety oversight and implementation of the Cartagena Protocol, including obligations for regulatory action ¹⁰². The EPA website is under maintenance and inoperational as of early August 2025 ¹⁰³.

1.4.2a Biosafety training using a standardised, required approach

Score: 33.33

There is only evidence of biosafety and biosecurity training being provided on an ad hoc basis in Liberia, rather than through a required, standardized approach. The 2023 Joint External Evaluation of International Health Regulations (IHR) Core Capacities reports that the National Public Health Institute of Liberia (NPHIL) conducts ad hoc biosafety and biosecurity training, primarily in the context of disease outbreaks or international technical support ¹⁰⁴. The document notes that no national policy mandates regular or standardized biosafety training for personnel handling especially dangerous pathogens or biological materials with pandemic potential, and no recertification system is described ¹⁰⁵. Similarly, the Terminal Evaluation of Liberia’s National Biosafety Framework project confirms that while the Environmental Protection Agency (EPA) and the Biosafety Unit offer periodic awareness sessions and training, these efforts lack a unified curriculum or institutionalized enforcement mechanism, and do not apply systematically across all relevant facilities or personnel ¹⁰⁶. The Food and Agriculture Organization of the United Nations (FAO) country legal profile for Liberia includes no enacted biosafety legislation or training mandates ¹⁰⁷.

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Liberia has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, or other forms of dual-use research. The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities: Liberia, 2023 (2nd edition) confirms that no monitoring or inventory system exists for such research and that the draft biosafety and biosecurity policy, which could potentially govern such oversight, remains unendorsed ¹⁰⁸. Liberia’s National Risk Assessment and Mapping Profile on the WHO Strategic Partnership for Health Security and Emergency Preparedness (SPH) portal contains no mention of dual-use research assessments or research inventories of high-risk biological agents ¹⁰⁹. No relevant documentation was found in the Biological Weapons Convention Confidence-Building Measures (CBMs) submissions, and no legal framework or national review body is documented in the VERTIC Biological Weapons Convention Legislation Database ¹¹⁰.

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

Score: 0

There is no publicly available legislation or regulation in Liberia that requires oversight of research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other forms of dual-use research. The 2023 Joint External Evaluation of International Health Regulations (IHR) Core Capacities for Liberia confirms that the country lacks policies, legislation, and a formalized review process to identify and manage dual-use research and the associated risks ¹¹¹. A search of the Biological Weapons Convention (BWC) State Party profile for Liberia reveals that the country has not submitted any Confidence-Building Measures indicating the existence of relevant legal instruments ¹¹². Furthermore, no applicable legislation is listed in the Liberia entry of the Biological Weapons Convention Legislation Database maintained by the Verification Research, Training and Information Centre (VERTIC), which also confirms that Liberia has not implemented specific laws addressing research oversight under the BWC framework ¹¹³.

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

Score: 0

There is no publicly available evidence that Liberia has designated an agency with legal authority to oversee research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. The 2023 Joint External Evaluation of International Health Regulations (IHR) Core Capacities does not identify any such agency under its indicators related to biosafety, biosecurity, or dual-use research oversight; the report explicitly states that Liberia lacks a system for identifying and registering high-risk biological agents and does not mention any institution tasked with regulating research on them ¹¹⁴. Similarly, the Terminal Evaluation of the Project: Development of the National Biosafety Framework for Liberia confirms that while the Environmental Protection Agency (EPA) is the designated authority for general biosafety matters under the Cartagena Protocol on Biosafety, it is not legally mandated to regulate dual-use or high-consequence pathogen research. The evaluation further highlights the absence of statutory authority to enforce biosafety compliance in research settings ¹¹⁵. Liberia’s State Party profile on the Biological Weapons Convention Implementation website also contains no reference to any institution responsible for dual-use research oversight or enforcement of biosafety mandates ¹¹⁶.

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

Score: 0

There is no publicly available evidence that Liberia has enacted legislation or regulation requiring the screening of synthesized deoxyribonucleic acid (DNA) against lists of known pathogens or toxins prior to sale. No such requirement is referenced in the official websites of the Ministry of Health, the Environmental Protection Agency, or the Liberia Medicines and Health Products Regulatory Authority, and no relevant national circulars or regulatory frameworks are publicly accessible ^117118119. The Joint External Evaluation of International Health Regulations (IHR) Core Capacities for Liberia, conducted in 2023 and published in 2024, makes no mention of synthetic DNA screening, gene synthesis oversight, or regulatory control of synthetic biology in its assessments of biosafety, biosecurity, or dual-use research controls ^{120, p. 36}. Liberia is a State Party to the Biological Weapons Convention; however, its profile in the VERTIC BWC legislation database confirms that Liberia has not established laws or regulations governing gene synthesis or the screening of dual-use genetic materials ¹²¹. Furthermore, no legislation related to DNA synthesis regulation is listed in the FAOLEX legal database for Liberia ¹²².

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

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

Score: 0

There is no publicly available evidence that Liberia reports official foot-and-mouth disease (FMD) vaccination figures for livestock through the World Organisation for Animal Health (WOAH) database. Liberia is listed as a WOAH Member Country ¹²³ and is actively participating in the Performance of Veterinary Services (PVS) Pathway ¹²⁴. However, a detailed search of the World Animal Health Information System (WAHIS) database yielded no publicly available vaccination figures for FMD for Liberia ¹²⁵. The WOAH Regional Representation for Africa website also does not include any Liberia-specific updates on FMD vaccination ¹²⁶. No vaccination statistics are found on the official website of the Ministry of Agriculture of Liberia ¹²⁷. The 2023 Food and Agriculture Organization (FAO) country profile on Liberia similarly does not reference any national-level data on FMD vaccination coverage ¹²⁸. While Liberia’s National Agriculture Development Plan 2024–2030 outlines strategic objectives for improving livestock health and mentions general vaccination initiatives, it does not confirm the existence of any formal FMD vaccination campaign or WOAH reporting mechanism ¹²⁹.

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Liberia has a national immunization strategy that includes both a plan for equitable distribution and specific strategies to address social and geographic barriers to vaccination. The United Nations Children’s Fund 2023 Liberia Country Office Annual Report confirms that Liberia’s immunization programming in 2023 was guided by an updated national strategy that explicitly focused on equity of access ¹³⁰. The report states that the country targeted cross-border populations and informal settlements and deployed outreach services to increase coverage in hard-to-reach rural areas ¹³¹. It also describes tailored interventions to address gender-related and linguistic barriers by training female vaccinators and providing culturally appropriate messaging in local languages ¹³². In addition, the 2023 Joint External Evaluation of International Health Regulations Core Capacities affirms that Liberia has adopted an equitable approach to immunization delivery, including through strengthened data systems and expanded service access for marginalized groups ¹³³.

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

Score: 100

Liberia’s national immunization strategy includes explicit measures to address vaccine hesitancy and build public trust in vaccines. The 2023–2027 National Immunization Strategy, developed by the Ministry of Health with UNICEF support, incorporates social and behavioral change (SBC) efforts to improve vaccine acceptance, and was implemented throughout 2023 ¹³⁴. The strategy is supported by a dedicated Coverage and Equity Analysis (CEA) conducted in 2023, which identified communities with high numbers of zero-dose children and directed tailored outreach interventions ¹³⁵. Liberia’s 2023 Country Office Annual Report confirms that the SBC components were integrated into immunization programming, and community engagement activities were implemented to improve demand generation ¹³⁶. According to the World Health Organization’s 2023 Joint External Evaluation, Liberia has adopted a robust approach to vaccine confidence, including community mobilization and risk communication under the national immunization framework ¹³⁷.

1.6.1e National advisory group for immunization strategy/plan

Score: 100

A national immunization advisory group is active in Liberia and provides technical guidance to the government on immunization strategy. The 2023 Joint External Evaluation (JEE) explicitly confirms the existence and functionality of the Liberia Immunization Technical Advisory Group (LITAG), a standing national immunization advisory body that guides national immunization policy and strategic planning ¹³⁸. The JEE also highlights the regular engagement of the LITAG in national decision-making regarding immunization programs and confirms that the advisory group includes multi sectoral membership with the technical capacity to offer evidence-based recommendations ¹³⁹. Additionally, the 2023 UNICEF Country Office Annual Report notes that Liberia’s 2023–2027 National Immunization Strategy was developed and validated with technical inputs from advisory and coordinating structures, and that these were supported by UNICEF and other international partners through 2023 and early 2024 ¹⁴⁰.

1.6.1f Presence of an immunization programme for influenza

Score: 0

Liberia does not have an established national immunization program for influenza. According to the World Health Organization (WHO) WIISE Immunization Introduction Tracker, as of 2024, Liberia has not introduced a seasonal influenza vaccine into its national immunization schedule ¹⁴¹. This is further corroborated by the WHO Influenza Vaccination Coverage Dashboard, which reports no data for influenza vaccine coverage in Liberia for any age group, including healthcare workers or older adults ¹⁴². Additionally, the 2023 Joint External Evaluation of International Health Regulations (IHR) Core Capacities for Liberia makes no mention of a national influenza immunization program or any influenza vaccination implementation under the country’s Expanded Programme on Immunization (EPI) ¹⁴³. The 2023 UNICEF Liberia Country Office Annual Report also provides no evidence of any influenza-specific vaccine deployment or routine immunization support related to influenza ¹⁴⁴.

1.7.1a Strategy/plan for resilience of health system

Score: 100

There is evidence that Liberia has a national strategy that addresses health system resilience to climate change and explicitly incorporates the evolving threat of infectious diseases. The National Policy and Response Strategy on Climate Change, published by the Environmental Protection Agency of Liberia in 2018, includes a dedicated “Health” component as one of its thematic pillars and identifies infectious disease outbreaks as a priority vulnerability resulting from climate-sensitive risks such as floods, droughts, and heatwaves ¹⁴⁵. The strategy calls for strengthening early warning systems and public health services to respond to climate-induced disease outbreaks, particularly malaria and diarrheal diseases. Additionally, Liberia’s 2018 National Action Plan for Health Security (NAPHS), which remains the most recent publicly available version, outlines multi-sectoral preparedness actions for climate-sensitive and environmentally linked diseases such as cholera and yellow fever, including surveillance and emergency risk communication during climate events ¹⁴⁶. The 2023 National Emergency Preparedness and Response Plan for Public Health Threats further confirms that floods and other climate-related disasters are included in Liberia’s national risk profile and identifies climate variability as a trigger for infectious disease emergencies requiring health system response ¹⁴⁷.

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

Score: 100

Liberia’s national laboratory system conducts at least five of the ten World Health Organization (WHO)-defined core diagnostic tests. The 2023 Joint External Evaluation confirms that Liberia’s National Reference Laboratory has established diagnostic capacity for tuberculosis using both culture and GeneXpert, performs bacterial culture and antimicrobial susceptibility testing, and conducts real-time polymerase chain reaction (PCR) diagnostics for priority pathogens ¹⁴⁸. The Joint National Action Plan for Health Security (NAPHS) 2018–2022 explicitly documents the availability of laboratory capacity and reagents for measles IgM testing, yellow fever IgM, Ebola virus PCR, Lassa fever PCR, and dengue virus diagnostics, as well as monkeypox PCR through international partnerships ¹⁴⁹. The same plan highlights the use of malaria rapid diagnostic tests (RDTs) at health facility and community levels, and notes the nationwide distribution of GeneXpert machines as part of TB and emerging disease surveillance ¹⁵⁰. The diagnostic capacity spans both human and zoonotic pathogens and includes alignment with the national animal health laboratory system ¹⁵¹.

2.1.1b Plan to conduct testing during a public health emergency

Score: 100

Liberia has a formally endorsed national plan that includes comprehensive provisions for diagnostic testing during public health emergencies. The National Health Laboratory Strategic Plan 2023–2026, jointly developed by the Ministry of Health and the National Public Health Institute of Liberia, includes explicit provisions for testing novel pathogens such as Ebola, Marburg, Lassa, influenza, and dengue, and draws on lessons from previous outbreaks ¹⁵². The plan describes detailed surge-capacity mechanisms, including the introduction of multiplex molecular platforms at the National Public Health Reference Laboratory, expansion of bacteriology services to 15 county hospitals, and nationwide deployment of GeneXpert equipment to 20 additional sites ¹⁵³. Furthermore, the plan includes a four-year implementation matrix with clearly defined testing goals, performance indicators, responsible agencies, timelines, and budget lines, covering scale-up mechanisms and national diagnostic targets ¹⁵⁴.

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

Score: 0

Liberia does not have a nationally accredited reference laboratory. The National Health Laboratory Strategic Plan 2023–2026, issued by the Ministry of Health and the National Public Health Institute of Liberia (NPHIL), confirms that Liberia is pursuing international accreditation under the International Organization for Standardization (ISO) 15189 framework through the World Health Organization (WHO) Stepwise Laboratory Improvement Process Toward Accreditation (SLIPTA) but states to date, there are no accredited laboratories in the country ¹⁵⁵. A government-issued presentation on multi sectoral laboratory system coordination reiterates that the National Public Health Reference Laboratory is currently enrolled in the WHO Africa Region’s Strengthening Laboratory Management Toward Accreditation (SLMTA)/SLIPTA program and is working toward ISO 15189 compliance, indicating the effort remains in the pre-accreditation phase ¹⁵⁶.

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

Score: 0

There is no publicly available evidence that Liberia’s National Public Health Reference Laboratory currently participates in an external quality assurance (EQA) program. The National Health Laboratory Strategic Plan 2023–2026, issued by the Ministry of Health and the National Public Health Institute of Liberia (NPHIL), calls for laboratories to enroll in EQA schemes, but offers no documentation of any completed EQA rounds, evaluations, or panel results. It confirms that Liberia is still working toward Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) compliance under World Health Organization (WHO) guidance and notes quality management as a development area, not a completed process ¹⁵⁷. The joint 2023 briefing on multi sectoral laboratory coordination likewise refers to quality assurance as an ongoing need, without listing any laboratories that have completed or are currently participating in EQA schemes ¹⁵⁸. The 2023 Joint External Evaluation by WHO reiterates that while Liberia has adopted quality-management strategies, there is no evidence of active EQA participation, nor documented external assessments for diagnostic accuracy or performance standards at national-level facilities ¹⁵⁹.

2.2.1a Nationwide specimen transport system

Score: 100

Liberia has a nationwide specimen transport system for human health diagnostics. A multi sectoral coordination report issued jointly by the Ministry of Health and the National Public Health Institute of Liberia in November 2022 confirms that Riders for Health support the transportation of these samples from peripheral facilities to the National Public Health Reference Laboratory, explicitly naming this mechanism as part of the integrated public health laboratory network operating in all 15 counties ¹⁶⁰. The document further outlines the tiered referral structure comprising health center, county, regional, and national laboratories under the oversight of the National Diagnostics Division and NPHIL, reinforcing the national scope of the system ¹⁶¹. The 2023 Joint External Evaluation by the World Health Organization similarly affirms the existence of an effective sample referral mechanism, identifying the Riders for Health courier network as a key enabler of specimen referral for outbreak investigation and Integrated Disease Surveillance and Response testing ¹⁶².

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

Score: 0

Liberia does not currently have a published plan in place to authorize or license laboratories to supplement national capacity during a public health emergency. There is no public evidence of any policy or formal mechanism for rapid licensing or emergency authorization of public or private laboratories in outbreak situations. The 2023 Joint External Evaluation of the International Health Regulations Core Capacities for Liberia confirms that while efforts have been made to improve coordination and strengthen laboratory networks, there is no documented protocol for temporarily or rapidly approving additional laboratories for outbreak surge capacity ¹⁶³. The National Health Laboratory Strategic Plan 2023–2026, published by the National Public Health Institute of Liberia and the Ministry of Health, outlines strategic priorities for laboratory system expansion and emergency preparedness but does not contain any section indicating a regulatory or legal mechanism for rapid laboratory authorization during emergencies ¹⁶⁴. A briefing on multi sectoral coordination of laboratory systems, also issued by the Ministry of Health and the National Public Health Institute of Liberia, discusses system-wide goals and capacity-building but makes no mention of any legal or procedural plan to license laboratories under emergency conditions ¹⁶⁵.

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

Score: 50

Liberia is conducting ongoing event-based surveillance (EBS) for notifiable and novel infectious diseases, but there is no publicly available evidence that data from EBS or indicator-based surveillance (IBS) systems are analyzed on a daily basis. The World Health Organization’s Joint External Evaluation of IHR Core Capacities: Liberia, 2023 (2nd edition) confirms that Liberia implements EBS through community informants, the national 4455 hotline, and media scanning tools, coordinated by the National Public Health Institute of Liberia (NPHIL) and integrated into the country’s Integrated Disease Surveillance and Response (IDSR) platform ¹⁶⁶. EBS activities feed into Liberia’s Event Management System, which is used for validation and triage of public health signals and events. The report further states that signals collected through EBS are shared with designated surveillance officers via automated SMS alerts and dashboards, and that these alerts are reviewed by the National Surveillance Unit ¹⁶⁷. However, there is no explicit mention that the collected data are analyzed on a daily basis. The National Health Laboratory Strategic Plan 2023–2026 reiterates the integration of surveillance and laboratory confirmation efforts under IDSR, and highlights the need for real-time data visibility, but it does not reference daily data analysis practices for EBS or IBS ¹⁶⁸.

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

Score: 100

Liberia has a documented mechanism for reporting notifiable diseases to the World Health Organization (WHO) through its designated National IHR (International Health Regulations) Focal Point. The 2023 Joint External Evaluation of IHR Core Capacities confirms that Liberia’s National IHR Focal Point is operational, routinely engages in urgent communications with WHO, and serves as the national authority for IHR event notification ¹⁶⁹. The annex of the same report includes an excerpt from an official email submitted by Liberia’s IHR Focal Point to the WHO, dated October 2022, explicitly reporting a suspected yellow fever case under Article 6 of the IHR ¹⁷⁰.

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

Liberia operates an electronic surveillance reporting system at both the national and sub-national levels. The 2023 Joint External Evaluation of International Health Regulations Core Capacities, conducted by the World Health Organization (WHO), confirms that Liberia’s Integrated Disease Surveillance and Response (IDSR) system is fully implemented through the electronic platform DHIS2 (District Health Information Software 2). This system enables health facilities to report surveillance data electronically, which is then consolidated at the county and national levels for further analysis and action. The JEE report explicitly states that “all 15 counties in Liberia submit weekly IDSR reports through DHIS2,” verifying both nationwide coverage and sub-national implementation. The national public health system uses this platform to collect, monitor, and respond to signals related to notifiable diseases, including real-time alerts and case-based reporting. According to the same assessment, the system also supports event-based surveillance and has been adapted to accommodate alerts for priority conditions ¹⁷¹.

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

Score: 50

Liberia operates a real-time electronic surveillance system, but there is no publicly available evidence confirming that it supports routine data disaggregation by age, ethnicity, or other demographic characteristics. As of 2025, Liberia’s Electronic Integrated Disease Surveillance and Response (eIDSR) system, built on the District Health Information Software 2 (DHIS2) platform, is functional and nationally deployed. A September 2024 report confirms that the United States Agency for International Development (USAID) and the International Rescue Committee (IRC) formally transferred oversight of the eIDSR system to the Government of Liberia, with capabilities for real-time, case-based, and laboratory reporting in pilot counties and ongoing nationwide expansion ¹⁷². The 2023 Joint External Evaluation of International Health Regulations Core Capacities confirms the existence and rollout of the eIDSR system, highlighting real-time reporting from subnational levels ¹⁷³. However, Liberia’s 2021 National Technical Guidelines for Integrated Disease Surveillance and Response, which remain the most current public guidance, do not mandate or describe any functionality for demographic disaggregation of surveillance or laboratory data beyond basic sex and age breakdowns. There is no mention of ethnicity, geographic, or equity-focused variables in routine eIDSR datasets ¹⁷⁴. The World Health Organization’s 2024–2025 Results Report: Liberia Country Profile provides no indication that eIDSR supports demographic disaggregation beyond basic fields, and it does not document ethnicity or equity-focused variables in routine datasets ¹⁷⁵.

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 2 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.¹⁷⁶

An environmental surveillance system was established in February 2020 as part AFP surveillance strengthening in Liberia to enable early detection of possibly imported Vaccines-derived Polio Viruses (cVDPV2) before it spreads widely.¹⁷⁷ On February 23, 2024, Liberia's Ministry of Health declared the circulating variant type 2 poliovirus (cVDPV2) outbreak following the confirmation from environmental surveillance.¹⁷⁸ There is limited evidence of whether this ES is still ongoing.

In 2021, the United States Centers for Disease Control and Prevention (U.S. CDC) stated that it was supporting the Government of Liberia to improve surveillance and reporting of suspected polio cases in Nimba, Bong, Margibi, Maryland, River Cess, and River Gee counties. However, it is unclear whether this support is still ongoing. ¹⁷⁹

A pilot wastewater surveillance initiative was launched in April 2024 by the STOP Spillover Liberia Country Team. It focused on detecting Lassa virus RNA in wastewater at Phebe Hospital (Bong County) and Liberia Agriculture Company (LAC) Hospital (Grand Bassa County) – both of which manage Lassa isolation wards. ¹⁸⁰ The initiative involved twice-weekly passive sampling (cotton plugs in wastewater pipes), staff training (including proper PPE use), and analysis at the National Reference Laboratory (NRL). It was a 12‑week pilot aimed at validating protocols that could serve as an early warning surveillance system for Lassa fever in the future.

During 2019–2020, poliovirus was isolated in a sewage sample before (or in the absence of) a confirmed AFP case in Afghanistan, Cameroon, Chad, Côte d'Ivoire, Egypt, Ghana, Iran, Kenya, Liberia, Senegal (all cVDPV2), Philippines (cVDPV1), and Malaysia (cVDPV1 and cVDPV2). However it is unclear whether this was at a national level or if it still ongoing.¹⁸¹

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records (EHRs) are not commonly in use across Liberia, but there is publicly available evidence confirming pilot-level implementation in both facility-based and community health settings. In 2020, Partners In Health launched an electronic medical records system at J.J. Dossen Hospital in Maryland County to support improved documentation and continuity of care ¹⁸². In 2023, Last Mile Health and the Ministry of Health jointly piloted an electronic community-based information system aimed at digitizing frontline health service delivery and data collection in rural areas ¹⁸³. Liberia is also listed by OneHealth, a private-sector African EHR platform, as one of its target countries, but there is no evidence that this system is integrated or scaled nationally ¹⁸⁴.

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no publicly available evidence that Liberia’s national public health system has access to individual-level electronic health records (EHRs). While donor-supported EHR pilots exist, such as the 2020 deployment of electronic medical records by Partners In Health at J.J. Dossen Hospital in Maryland County, these are facility-specific and not connected to a centralized public health platform ¹⁸⁵. Similarly, the 2023 pilot of an electronic community-based information system by the Ministry of Health and Last Mile Health supports frontline health workers but does not provide national-level access to individual records ¹⁸⁶. Although Liberia is listed on the website of the private-sector OneHealth EHR platform, there is no evidence that its services are in use by the government or that national public health institutions can access the data ¹⁸⁷.

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that Liberia has adopted national or international data standards to ensure the comparability or interoperability of health data. The 2021 National Technical Guidelines for Integrated Disease Surveillance and Response, issued by the Ministry of Health and the National Public Health Institute of Liberia, outline disease reporting structures and case definitions but do not reference the use of global standards such as ISO, HL7, SNOMED, LOINC, or ICD coding frameworks in the collection, exchange, or management of surveillance data ¹⁸⁸. No evidence of health information architecture, standardized data dictionaries, or interoperable system protocols is provided. Similarly, the 2023 Joint External Evaluation of International Health Regulations Core Capacities for Liberia, conducted by the World Health Organization and national authorities, does not mention any data comparability frameworks, interoperability standards, or technical governance of health data infrastructure ¹⁸⁹.

2.4.2a Data sharing mechanisms

Score: 100

Liberia has formal mechanisms in place for sharing surveillance data among the ministries responsible for animal, human, and environmental health, supported through a national One Health framework. The Joint External Evaluation of International Health Regulations Core Capacities for Liberia, conducted in 2023 by the World Health Organization and national authorities, confirms systematic surveillance data exchange, including routine joint risk assessments across the Ministry of Health, Ministry of Agriculture, and Environmental Protection Agency. The report states that Liberia has a functioning One Health platform with multi sectoral coordination, formal data sharing channels, and consistent technical collaboration between sectors ¹⁹⁰. In parallel, the National Public Health Institute of Liberia’s National Health Laboratory Strategic Plan 2023–2026 identifies a One Health specimen referral and management system involving the National Public Health Reference Laboratory, Central Veterinary Laboratory, and Environmental Health Laboratory. The plan documents inter-ministerial linkages for laboratory sample management and coordination under shared surveillance objectives ¹⁹¹.

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

Score: 100

Liberia makes de-identified health surveillance data on infectious diseases publicly available via weekly epidemiological bulletins published on the website of the National Public Health Institute of Liberia (NPHIL) ¹⁹². The “Epidemiology Bulletin” section of the NPHIL portal includes weekly reports for 2025, with publication dates ranging from March to May 2025. These bulletins are labeled by epidemiologic week and made publicly accessible on a rolling basis through the government site ¹⁹³. Each bulletin includes county-level case counts of priority notifiable diseases such as measles, Lassa fever, monkeypox, and rabies exposure, and presents data in the form of aggregated tables, maps, and charts with no personally identifiable information ¹⁹⁴.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Liberia has legislation that safeguards the confidentiality of identifiable health information. Section 18.23 “Confidentiality” in the Public Health Law was enacted in 2010; it creates a statutory duty of non-disclosure for identifiable patient information in the context of human immunodeficiency virus test results ^{195, p. 11}. The Act establishing the Liberia Institute of Statistics and Geo-Information Services was enacted in 2004; Annex Three imposes an oath of confidentiality on statistical personnel, protecting individual-level data handled by the national statistics system ^{196, p. 17}. The Telecommunications Act was enacted in 2007; Sections 49–51 require confidentiality of customer information and communications and set protections for personal information, demonstrating additional statutory privacy obligations relevant to data generated by health services and related systems ^{197, pp. 38–39}.

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

Score: 0

Liberia lacks any enacted legislation or formal regulation designed to safeguard identifiable health information by addressing protections against cyber‑attacks such as ransomware or other digital threats. The Republic of Liberia’s “Act to Amend the Public Health Law, Title 33,” Section 18.23, explicitly prohibits unauthorized disclosure of HIV test results but contains no provisions regarding cybersecurity or the confidentiality of digital health surveillance data ¹⁹⁸. Liberia has not adopted a general data protection law, and the draft Cybersecurity and Cybercrime Bill remains unpassed as of mid‑2025 ¹⁹⁹. There are no binding legal requirements for breach notification, data security obligations, encryption standards, or digital risk mitigation in health data handling. The DLA Piper “Data Protection Laws of the World: Liberia” summary confirms that Liberia has no breach notification mandates or cybersecurity-driven data security obligations in place ²⁰⁰. Analyses from the Council of Europe’s Octopus Cybercrime database underscore that Liberia’s Penal Code contains no cybercrime provisions, and there is no national cybersecurity legislation in force ²⁰¹.

2.4.5a Cooperative commitments or agreements within regions

Score: 100

Liberia has made formal commitments to share surveillance data with other countries during public health emergencies for more than one disease. The World Health Organization (WHO) confirms that Liberia continues to implement the International Health Regulations (2005), which mandate real-time data sharing with international partners during outbreaks of public health concern, including COVID-19, mpox, and Lassa fever ²⁰². Liberia’s Ministry of Agriculture published the Integrated Animal Disease Surveillance and Response System in Liberia, Second Edition in 2023, which establishes multisectoral data exchange protocols for over twenty priority zoonoses and explicitly references obligations under the One Health framework for regional data sharing ²⁰³. In 2025, the Liberian government operationalized a USAID- and International Rescue Committee-supported digital surveillance platform to improve regional coordination and transnational data flow in health emergencies ²⁰⁴. The same year, the National Public Health Institute of Liberia (NPHIL), in collaboration with Africa Centres for Disease Control and Prevention (Africa CDC) and the Ministry of Health, launched new Event-Based Surveillance Guidelines to formalize mechanisms for information dissemination during health threats, including commitments to alert neighboring countries and global stakeholders ²⁰⁵.

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

Score: 100

Liberia maintains a standing national system that supports sub‑national contact tracing capacity well before the onset of public health emergencies. The Ministry of Agriculture’s Integrated Animal Disease Surveillance and Response System in Liberia, Second Edition (2023) prescribes that County Health Teams and community surveillance officers conduct contact tracing duties, use standardized case investigation forms and definitions, and receive routine training and supervisory follow‑ups to sustain preparedness ²⁰⁶. CDC Liberia, working with the Government of Liberia, provides ongoing Integrated Disease Surveillance and Response training, tools for data management, and logistical support to County Health Teams for contact and case tracing; a clear example of pre‑crisis national support ²⁰⁷. The World Health Organization’s 2025 Liberia Annual Report confirms rapid activation of contact tracing teams for mpox and Lassa fever outbreaks using pre‑existing protocols, indicating that these capacities were established before crisis onset at district and regional levels ²⁰⁸.

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

Score: 50

Liberia provides medical attention to individuals in isolation through community-based health teams, but there is no evidence of national economic support such as income replacement or job security guarantees for those under quarantine. According to the World Health Organization (WHO), Liberia’s surveillance framework includes home-based monitoring by County Health Teams (CHTs), clinical assessments, and distribution of isolation kits with thermometers, pulse oximeters, masks, hand sanitizer, and educational leaflets to support home care ²⁰⁹. A WHO bulletin further confirms that this medical support is routinely deployed to households under investigation during disease outbreaks, including COVID-19 and Lassa fever ²¹⁰. However, the World Bank’s Environmental and Social Management Framework for Liberia’s COVID-19 Emergency Response Project specifies only public health interventions and risk communication, with no mention of financial compensation, paid leave, food stipends, or employment guarantees for isolated individuals ²¹¹. Similarly, World Food Programme (WFP) relief programs were aimed at broad food insecurity and not specifically tied to isolation or contact tracing compliance ²¹².

2.5.2a Strategy for tracing and quarantining international travelers

Score: 100

Liberia has a standing national framework that formally links public health and border control authorities to detect, trace, and quarantine suspected cases among international travelers in future public health emergencies. The “Standard Operating Procedures for Points of Entry (Air, Sea, and Ground Crossings)” issued by the Ministry of Health and the National Public Health Institute of Liberia in March 2020 and validated by the Liberia Immigration Service, Customs, Coast Guard, and Port Health Officers, assigns each agency clearly delineated roles for entry screening, referral, contact tracing, isolation, and quarantine at all border points. These procedures are applicable “during and after the pandemic period” and are designed to remain active beyond COVID-19 ²¹³. The document explicitly outlines multi sectoral workflows, simulation training, and mentorship for border personnel in non-outbreak periods, indicating preparedness in advance of future crises ²¹⁴. In addition, the World Health Organization’s 2023 Joint External Evaluation confirms that Liberia maintains eight designated points of entry with clearly defined standard operating procedures, sector-specific responsibilities, and cross-agency coordination mechanisms among the Ministry of Health, National Public Health Institute, Liberia Immigration Service, and other stakeholders ²¹⁵.

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

Score: 100

Liberia has access to prominent applied epidemiology training programs, including both a government-supported intermediate Field Epidemiology Training Program (FETP) and a One Health Field Epidemiology Training Program. In October 2024, the National Public Health Institute of Liberia (NPHIL), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFENET), issued a public call for applications to the ninth cohort of its Liberia Intermediate Field Epidemiology Training Program (LFETP‑I), which runs seven to nine months and places trainees in surveillance and outbreak response roles across the country ²¹⁶. In January 2025, Liberia launched its first One Health Field Epidemiology Training Program cohort, enrolling participants from the human, animal, and environmental health sectors to strengthen multi sectoral outbreak preparedness ²¹⁷.

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

Liberia offers a field epidemiology training program that explicitly includes animal health professionals. In January 2025, the Government of Liberia launched the first national One Health Field Epidemiology Training Program cohort. The program’s official announcement confirms that it is multi sectoral by design, enrolling participants from the human, animal, and environmental health sectors to strengthen coordinated detection, investigation, and response to zoonotic and other health threats ²¹⁸.

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

Score: 100

Liberia meets the minimum workforce density requirement of one trained field epidemiologist per 200,000 population. The 2023 Joint External Evaluation of IHR Core Capacities, published by the World Health Organization, confirms that the Liberia Field Epidemiology Training Program (FETP) has graduated more than 200 individuals with competencies in public health and veterinary epidemiology, outbreak investigation, and response ²¹⁹. According to the World Bank’s 2024 population estimate, Liberia has a total population of approximately 5.5 million, yielding a ratio of one trained field epidemiologist per 27,500 people ²²⁰.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 66.67

Liberia has an overarching national public health emergency response plan that is publicly available and addresses multiple communicable diseases with epidemic or pandemic potential, including Ebola virus disease, Lassa fever, cholera, measles, coronavirus disease, and monkeypox, while defining national coordination, alert levels, and Public Health Emergency Operations Center activation ^{221, pp. 8–9, 26}. The National Emergency Preparedness and Response Plan 2023 covers a five year implementation timeframe of 2023 to 2027 ^{222, p. 11}. Section 6 presents budget templates by technical pillar but contains no figures or totals, and the plan shows no confirmed government or partner allocations for implementation ^{223, pp. 69–71}. The 2023 Joint External Evaluation reports no dedicated national budget lines for International Health Regulations implementation and a reliance on external donor financing, and it recommends establishing specific funding mechanisms ^{224, pp. 22–25}.

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

Score: 100

Liberia has a publicly available, funded national emergency preparedness and response plan that addresses multiple communicable diseases with epidemic or pandemic potential. The National Emergency Preparedness and Response Plan 2023, developed jointly by the Ministry of Health and the National Public Health Institute of Liberia, specifies a five-year implementation period from 2023 to 2027 ^{225, pp. 1, 7}. The document defines multi sectoral roles for the Ministry of Health, the National Public Health Institute, the National Disaster Management Agency, the Ministry of Agriculture, the Environmental Protection Agency, and the Liberia National Police ^{226, pp. 3, 6–7}. It further establishes operational mechanisms including Public Health Emergency Operations Center alert levels, Incident Management System activation criteria and phases, and hazard-specific annexes covering epidemic-prone diseases such as Ebola virus disease, Lassa fever, cholera, measles, meningitis, yellow fever, and COVID-19 ^{227, pp. 26, 31–33}. The WHO Liberia Country Annual Report 2023 confirms implementation, citing development of fifteen county preparedness and response plans, a national measles preparedness plan, and integration of COVID-19 response into routine services ^{228, pp. 12–13}.

3.1.1c One health principles by covering multiple threat types

Score: 100

Liberia’s national public health emergency response plan follows One Health principles by covering multiple threat types, including zoonotic spillover, antimicrobial resistance, and deliberate or accidental biological events. The National Emergency Preparedness and Response Plan 2023, issued by the Ministry of Health and the National Public Health Institute of Liberia, establishes a five-year implementation period from 2023 to 2027 and defines the roles of multi sectoral actors such as the National Disaster Management Agency, the Ministry of Agriculture, the Environmental Protection Agency, and the Liberia National Police ^{229, pp. i, 4, 6–7}. Its scope lists immediate notifiable conditions that include both human and animal events, and its policy framework references the One Health Governance Manual and the Animal Disease Surveillance and Response Plan, confirming alignment across human, animal, and environmental health sectors ^{230, pp. 5–6}. The World Health Organization National Action Plan for Health Security (NAPHS) for All: A Strategic Framework for Operational Planning further defines national action plans as multi sectoral, all-hazards, and One Health in scope, listing antimicrobial resistance and chemical hazards among the core priorities ^{231, pp. 1, 3–5}.

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 100

Liberia’s overarching national public health emergency response plan includes mechanisms for identifying and considering the needs of vulnerable populations ^{232, p. 44}. The plan directs coordination to be contextualized with a focus on vulnerable communities and requires mapping of vulnerable populations when sharing data and risk assessment findings, establishing a concrete mechanism to identify and consider their needs during preparedness and response ^{233, p. 44}. It further instructs planners to tailor risk communication and community engagement actions toward specific population groups and settings, reinforcing attention to vulnerable and hard-to-reach communities ^{234, p. 44}. The plan also recognizes gender dynamics in protecting the predominantly female health workforce during emergencies, indicating consideration of equity within workforce protection measures ^{235, p. 12}. In addition, vaccination guidance calls for targeted booster strategies to protect vulnerable groups during upsurges, which operationalizes attention to at-risk populations within response actions ^{236, pp. 53–54}. The World Health Organization’s 2023 Liberia Annual Report also confirms the existence of a national EPR plan and county EPR plans ^{237, pp. 12–13, 15}.

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

Score: 0

There is no publicly available evidence that Liberia has a specific, institutionalized mechanism for engaging the private sector to assist with outbreak emergency preparedness and response. The World Health Organization (WHO) describes monthly One Health technical working groups and weekly National Emergency Preparedness and Response meetings, but it does not cite any standing public private platform for outbreak operations ^{238, p. 26}. The Republic of Liberia Supply Chain Master Plan records that warehouse and transport functions are outsourced to the World Food Programme under contract, and it plans procurement of an outsourcing partner for end to end logistics, which are logistics arrangements rather than a national mechanism for private sector engagement in emergency preparedness or response ^{239, p. 40}. During COVID 19, the Healthcare Federation of Liberia coordinated private health stakeholders alongside the Ministry of Health, but this was an emergency context activity rather than a permanent government mechanism for outbreak preparedness or response ²⁴⁰.

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

Score: 0

Liberia does not have a publicly available national policy, plan, or guideline for implementing non-pharmaceutical interventions that applies to more than one disease. During the COVID-19 pandemic, Liberia implemented curfews, school closures, physical distancing, travel restrictions, hand hygiene protocols, and mask use to contain virus transmission ²⁴¹. These were described as part of its emergency operations and Incident Management System (IMS) under presidential directives, and not guided by any pre-existing cross-disease strategy ²⁴². The World Bank project appraisal document confirms that such measures were developed and deployed in response to COVID-19 under time-limited emergency frameworks ²⁴³. The 2023 Joint External Evaluation independently verifies that Liberia lacks documented national guidance for applying non-pharmaceutical interventions across multiple disease threats. The JEE report notes that a national multi-hazard plan exists, but it does not contain standard guidance or policy on when or how to implement NPIs such as gathering bans or school closures for diseases other than COVID-19 ²⁴⁴.

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

Score: 100

There is publicly available evidence that Liberia activated its national emergency response plan for an infectious disease outbreak within the past year. In December 2024, the National Public Health Institute of Liberia confirmed activation of surveillance and coordination mechanisms in response to a suspected viral haemorrhagic fever case in Sierra Leone, including heightened monitoring at points of entry and in counties near the border ²⁴⁵. Earlier that year, Liberia activated its public health emergency coordination structures in response to Mpox, following the World Health Organization’s designation of Mpox as a Public Health Emergency of International Concern, as documented by One Health Liberia ²⁴⁶. In 2025, the Liberia Early Warning Disease Surveillance Bulletin reported the country’s emergency response to a Lassa fever outbreak, with evidence of weekly situation reporting, case investigations, contact tracing, and Emergency Operations Center engagement ²⁴⁷.

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

Score: 50

There is publicly available evidence that Liberia has developed, but not published, a plan to improve outbreak response capacity in the past year. The Liberia Early Warning Disease Surveillance Bulletin for epidemiological week 41 of 2024 confirms that the National Public Health Institute of Liberia revised its Mpox Incident Action Plan in December 2024 using templates from the World Health Organization and Africa Centres for Disease Control and Prevention ²⁴⁸. However, there is no publicly available After-Action Review, Intra-Action Review, biological-threat-focused exercise report, or comprehensive national improvement plan published during 2024 or 2025. Searches conducted on the official websites of the National Public Health Institute of Liberia, One Health Liberia, the World Health Organization Regional Office for Africa, and ReliefWeb confirm that no updated national plan to improve response capacity was published during this period ^249250251252.

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

Score: 0

There is no publicly available evidence that Liberia conducted a national-level biological threat-focused exercise in the past year that included private-sector representatives. In February 2025, the European Union supported a Chemical, Biological, Radiological and Nuclear (CBRN) preparedness exercise in Sierra Leone and Liberia; participants from Liberia included ministries of Health, Defence, Agriculture, and national security agencies, but no private-sector actors such as airlines, logistics firms, port operators, hospital networks, or other businesses were reported ²⁵³. A review of the National Public Health Institute of Liberia’s publications page found no after-action reports, press releases, or bulletins indicating private-sector participation in any biological threat exercise during 2024–2025 ²⁵⁴. Likewise, searches of One Health Liberia’s emergency preparedness and response documentation and the World Health Organization Regional Office for Africa country publications portal for Liberia revealed no evidence of private-sector engagement in any national simulation or exercise ²⁵⁵²⁵⁶.

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

There is publicly available evidence that Liberia maintains a national Emergency Operations Center (EOC) and operates EOCs in all 15 counties. The National Public Health Institute of Liberia states that it leads the country’s Incident Management System and EOC coordination for health emergencies at national, county, district, and community levels ²⁵⁷. In 2021, the World Health Organization reported that Liberia commissioned its first National Polio EOC to strengthen outbreak coordination infrastructure ²⁵⁸. A 2024 report from eHealth Africa confirms that all 15 counties maintain functional EOCs that are integrated with the national-level system. It further documents Liberia’s transition from Ebola-specific response functions to an all-hazards emergency coordination approach through continued engagement with the Ministry of Health ²⁵⁹.

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

Score: 0

There is no publicly available evidence that Liberia’s Emergency Operations Center is legally required to conduct, or has conducted, a public health emergency drill within the past twelve months. The U.S. Department of State’s 2024 Global Health Security country profile confirms that Liberia maintains a national EOC along with county-level EOCs supported by the central EOC, but it does not indicate any regular simulation, drill requirement, or evidence of such an exercise in 2024 or 2025 ²⁶⁰. A detailed search of the National Public Health Institute of Liberia’s publications archive did not identify any notification, press release, report, or after-action summary describing a national-level EOC drill or simulation during this period ²⁶¹. Similarly, neither the One Health Liberia emergency preparedness documentation nor the World Health Organization’s Regional Office for Africa country portal for Liberia provide proof of any recent exercise involving the national EOC ²⁶²²⁶³.

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

Score: 0

There is no publicly available evidence from 2024 or 2025 that Liberia’s Emergency Operations Center (EOC) was activated within 120 minutes of detecting a public health emergency or during a national-level exercise. The Africa Centres for Disease Control and Prevention (Africa CDC) reported five confirmed mpox cases in Liberia in 2024, but provided no details on EOC response timing or emergency coordination measures in-country ²⁶⁴. A review of all National Public Health Institute of Liberia (NPHIL) press releases and disease surveillance bulletins published between January 2024 and July 2025 revealed no situation reports, operational timelines, or response logs confirming that the national EOC was activated within two hours of threat detection ²⁶⁵. One Health Liberia’s emergency preparedness and news updates likewise contain no documented instance of a rapid EOC activation ²⁶⁶. The World Health Organization (WHO) Africa Regional Office country portal for Liberia lists outbreak-related publications, but none include timestamped evidence of an EOC deployment within 120 minutes ²⁶⁷. Similarly, ReliefWeb archives contain public health and humanitarian response documents for Liberia, but no after-action reports, exercise summaries, or activation briefings from 2024–2025 mention this threshold ²⁶⁸.

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence from 2024 or 2025 that Liberia carried out a coordinated multi-sector exercise simulating a deliberate biological event involving public health, animal health, national security, and private-sector actors, and no publicly released standard operating procedures, memoranda of understanding, or guidelines exist that link those sectors for biothreat response. A European Union Chemical, Biological, Radiological and Nuclear (CBRN) Centres of Excellence exercise held in February 2025 did involve Liberian ministries of Health, Agriculture, Defence, and security agencies, but there is no indication that private-sector entities participated ²⁶⁹. Structured searches of the National Public Health Institute of Liberia publications archive ²⁷⁰, One Health Liberia emergency preparedness pages ²⁷¹, the World Health Organization Regional Office for Africa publication listings for Liberia ²⁷², and ReliefWeb updates on Liberia ²⁷³ found no record of relevant interagency SOPs, MOUs, or joint simulation exercises.

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

Score: 100

Liberia has a formal risk communication plan intended for use during public health emergencies, as documented in national policy and validated implementation reports. The Liberia National Action Plan for Health Security 2019–2023, issued by the Ministry of Health, outlines a multi sectoral objective to establish and implement a national risk communication framework for health threats, with coordinated responsibilities across One Health institutions ²⁷⁴. The 2023 Joint External Evaluation by the World Health Organization confirms that risk communication and community engagement activities are embedded in Liberia’s Public Health Emergency Response Plan and are operational through functional technical working groups at national and subnational levels. These mechanisms are tasked with media coordination, rumor management, and community engagement during health emergencies ²⁷⁵. A 2024 technical brief from Breakthrough ACTION Liberia provides evidence of continued implementation, citing the nationwide adoption of a One Health Message Guide and the active functioning of risk communication structures across all fifteen counties, especially in the context of zoonotic and pandemic threats ²⁷⁶.

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

Score: 100

Liberia’s national risk communication strategies include defined procedures for tailoring and disseminating emergency messages to communities with diverse communication needs. The 2023 Joint External Evaluation confirms that Liberia conducts assessments of target populations and produces materials in multiple formats to ensure accessibility for vulnerable and geographically isolated populations ²⁷⁷. A 2023 technical brief published by Breakthrough ACTION Liberia provides operational details on the use of county-level Risk Communication and Community Engagement (RCCE) Technical Working Groups in all 15 counties. These groups disseminate information using digital platforms, such as county-specific messaging groups, and draw content from a standardized National One Health Message Guide designed for multi-audience adaptation ²⁷⁸. Additionally, the 2019–2023 National One Health Strategic Plan includes a policy objective requiring the creation of communication methods that are appropriate for different audiences and regions, ensuring emergency health messages reach populations with varied needs across the country ²⁷⁹.

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

Score: 0

There is no publicly available evidence that Liberia’s risk communication framework designates a specific position within the government to serve as the primary spokesperson to the public during public health emergencies. The 2023 National Emergency Preparedness and Response Plan, issued by the Ministry of Health, outlines governance and coordination mechanisms under the Risk Communication, Community Engagement, and Infodemic Management pillar, but it only identifies functional units and technical working group structures without assigning formal spokesperson duties to any specific officeholder ²⁸⁰. Liberia’s COVID-19 Risk Communication Standard Operating Procedures from 2020 assign general responsibilities to media focal persons at national and county levels but do not designate a specific spokesperson post such as the Minister of Health or Chief Medical Officer ²⁸¹. The 2023 Joint External Evaluation by the World Health Organization confirms the presence of risk communication and community engagement systems and the existence of RCCE technical working groups but does not mention any officially appointed spokesperson for health emergencies ²⁸². A review of the National Public Health Emergency Operations Center guidelines portal also found no relevant documentation identifying a designated spokesperson ²⁸³.

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

Score: 100

Liberia’s public health system actively uses online media platforms to disseminate health information and counter misinformation. The Ministry of Health’s Facebook page has published verified health content throughout the year, including a February 2 post titled “Don't Be Fooled: Get the Facts on COVID-19 Vaccines,” which directly counters false information circulating in communities ²⁸⁴. On March 24, the Ministry shared graphics and prevention tips for tuberculosis in recognition of World TB Day, reinforcing health education campaigns across digital channels ²⁸⁵. Additionally, the National Public Health Institute of Liberia’s official website hosts regular updates through its “Surveillance Bulletins” and “Publications” tabs, where it disseminates weekly epidemiological reports covering notifiable diseases, outbreak alerts, and risk communication guidance ²⁸⁶. The 2024 Breakthrough ACTION Liberia technical brief confirms that Risk Communication and Community Engagement (RCCE) structures in all fifteen counties maintained online presence through platforms like WhatsApp, allowing timely dissemination of updates to rural and urban populations alike ²⁸⁷. The 2023 Joint External Evaluation conducted by the World Health Organization supports this assessment, stating that social media and official web portals are used as part of Liberia’s integrated emergency communication strategy ²⁸⁸.

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

Score: 100

There is no publicly available evidence that senior leaders in Liberia, including the President or Ministers, have shared misinformation or disinformation on infectious diseases in the past two years. A review of official government communications found that the Ministry of Health issued a formal press statement in February 2025 to explicitly denounce false information circulating online about disease outbreaks, reinforcing its commitment to scientifically accurate messaging during public health emergencies ²⁸⁹. In June 2025, both the Ministry of Health and Ministry of Education publicly denied and clarified misinformation published by external sources, further demonstrating a coordinated approach to countering disinformation at the ministerial level ²⁹⁰. The 2023 Joint External Evaluation conducted by the World Health Organization did not identify any instances of inappropriate or misleading public statements by Liberia’s senior political leadership regarding infectious diseases ²⁹¹. Additionally, updates from the One Health Liberia platform in 2025 reflect continued institutional alignment between government agencies and technical partners in promoting accurate risk communication practices ²⁹².

3.6.1a Percentage of households with Internet

Score: 46.16

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: 25

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

Score: 100

There is no publicly available evidence that Liberia implemented restrictions on the export or import of medical goods due to an infectious disease outbreak in the past year. The 2024 World Health Organization (WHO) Liberia Annual Report contains no mention of trade-based interventions, nor does it reference any structured decision mechanism or international guidance leading to such actions ²⁹³. A confirmed outbreak of highly pathogenic avian influenza (H5N1) was reported in Liberia in April 2024; however, trade-related responses involved only poultry, and there is no evidence that Liberia imposed any restrictions on medical goods, such as personal protective equipment (PPE), therapeutics, or oxygen, in connection with the event ²⁹⁴. Additionally, no government decree, emergency order, or regulatory action by the Liberia Medicines and Health Products Regulatory Authority (LMHRA) or Ministry of Health was published in relation to infectious disease-related trade restrictions during this period ²⁹⁵²⁹⁶.

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

Score: 100

There is no public evidence that Liberia imposed restrictions on the export or import of non‑medical goods (such as food or textiles) due to any infectious disease outbreak in 2024–2025; no structured decision protocol or international recommendation triggered such measures. The 2024 WHO Liberia Annual Report provides detailed information on outbreak responses and surveillance without referencing any trade restrictions on non‑medical commodities ²⁹⁷. The WTO Trade Policy Review of Liberia similarly reports Liberia’s overall trade regime and domestic pandemic-related responses with zero mention of bans or restrictions targeting food, textiles, or other non‑medical goods ²⁹⁸. Liberia’s Ministry of Commerce and Industry website contains no outbreak-linked notices for non‑medical items, and neither FAO nor WHO Disease Outbreak News issues include Liberia-specific trade restrictions on such goods ²⁹⁹.

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

Score: 100

There is no publicly available evidence that Liberia implemented inbound or outbound travel restrictions, such as flight bans, international border closures, or quarantine requirements, due to an infectious disease outbreak in 2024 or 2025. The 2024 WHO Liberia Annual Report outlines Liberia’s response to mpox, Lassa fever, and other notifiable diseases but contains no reference to government-imposed international travel restrictions or actions guided by international recommendations or published scientific evidence ^{300, pp. 14–16}. The United States Centers for Disease Control and Prevention issued a Level 2 Travel Health Notice for mpox in Liberia and Sierra Leone in July 2025, advising travelers to take precautions; however, this advisory was issued by a foreign institution and does not reflect any official policy adopted by Liberia ³⁰¹. Similarly, official travel advisories from the governments of Canada and Australia did not report any Liberian-imposed international travel restrictions during this period ³⁰²³⁰³.

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

Score: 0

There is no publicly available evidence that Liberia uses a structured, risk-based approach to international travel-related measures in response to infectious disease threats. The 2024 WHO Liberia Annual Report outlines Liberia’s surveillance and outbreak response activities for mpox, Lassa fever, measles, and other conditions, but includes no reference to any risk assessment models, tiered entry protocols, or decision frameworks used to guide international travel restrictions or screening procedures ³⁰⁴. Although Liberia previously implemented general airport screening procedures during past outbreaks, such as temperature checks and symptom questionnaires at Roberts International Airport, these were not embedded in a formally documented risk-based strategy ³⁰⁵. Liberia is also not identified as employing such an approach on the Strategic Partnership for Health Security portal maintained by the World Health Organization ³⁰⁶. Additionally, official travel advisories from the governments of Canada and Australia make no reference to Liberia using risk-based international travel policies ³⁰⁷³⁰⁸.

4.1.1a Doctors per 100,000 people

Score: 2.13

4.1.1b Nurses and midwives per 100,000 people

Score: 9.5

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

Liberia does not have a national health workforce strategy that has been updated in the past five years to identify workforce shortages and outline corrective measures. The country’s most recent national-level health workforce plan, the “Health Workforce Program Strategy 2015–2021,” concluded in 2021 and has not been replaced by an updated nationwide strategy ³⁰⁹. The “National Community Health Program Policy 2023–2032,” published by the Ministry of Health, outlines goals specific to community health workers but does not serve as a comprehensive health workforce strategy addressing shortages across all cadres or system levels ³¹⁰. The Staffing Norms for the Health Sector in Liberia are minimum facility-level staffing standards within the national service package that specify required numbers and types of health workers by facility type for planning and accreditation; these norms are not a nationwide workforce strategy that diagnoses shortages across cadres and prescribes system-wide remedies ^{311, p. 12}. Additionally, the World Health Organization’s 2023 Country Cooperation Strategy for Liberia, which summarizes key national health strategies and priorities, does not list or reference any updated or ongoing national health workforce strategy ³¹².

4.1.1d Health system capacity for essential health services

Score: 100

Liberia has sufficient capacity within its health system to deliver the full range of essential health services. The 2023 Joint External Evaluation conducted by the World Health Organization gives Liberia a score of 4, the highest possible, for this measure. The JEE states that there is a defined package of Essential Health Services (EHS), there are plan/guidelines on continuity of EHS in emergencies developed during COVID-19. A survey has been conducted to monitor service continuity at the national, intermediate and primary public health levels during COVID-19. Moreover, mechanisms for monitoring service continuity during emergencies are in place at the national, intermediate and primary levels. However, mechanisms for monitoring service continuity based on existing guidelines are defined and functional at all levels but have not yet been exercised, reviewed, evaluated and updated with improvements based on simulation exercises and lessons learned from real-world events-e.g., IAR (Intra-Action Reviews) or AAR (After Action Review).³¹³

The Ministry of Health’s 2022 Essential Package of Health Services explicitly confirms that nationwide delivery of services is being rolled out incrementally due to fiscal constraints and operational limitations, noting that full coverage remains aspirational ³¹⁴. The United Nations Development Programme’s 2024 annual report for Liberia further highlights persistent underperformance in rural service delivery, strained infrastructure, and inconsistent availability of qualified personnel, with geographic disparities in care delivery continuing to widen ³¹⁵. The 2024 Global Health Supply Chain Program country profile for Liberia reports systemic challenges in health commodity logistics, cold chain management, and facility readiness to provide basic services ³¹⁶. No Service Availability and Readiness Assessment (SARA) has been published for Liberia in 2024 or 2025, as confirmed by the official SARA-related links maintained by the World Health Organization ³¹⁷.

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

Liberia does not have a publicly available, government-approved plan, guideline, or annex that explicitly ensures the continuity of essential health services during a public health emergency. A full review of the Ministry of Health’s digital strategy library confirmed that no such plan exists in its listed national strategies or operational documents ³¹⁸. The National Public Health Institute of Liberia publishes outbreak reports, risk assessments, and surveillance updates, but there is no mention of a continuity framework or emergency service maintenance plan ³¹⁹. The country profile for Liberia on the World Health Organization’s Strategic Partnership for Health Security (SPH) platform includes Joint External Evaluations and preparedness plans, but it does not list or link to any continuity plan ³²⁰. Although the 2024 WHO Liberia Annual Report describes WHO’s support for emergency health services, such as burn management and blood transfusion readiness, it does not reference a government-endorsed continuity framework or operational guidance for maintaining essential services during emergencies ³²¹. A search of the validated 2023 National Emergency Preparedness and Response Plan confirms the absence of a dedicated annex or protocol for ensuring service continuity, with no section identifying routine service maintenance during emergencies ³²².

4.1.2a Hospital beds per 100,000 people

Score: 39.66

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

Score: 0

Liberia does not have publicly documented operational capacity to isolate patients with highly communicable diseases in a biocontainment-level patient care unit or dedicated isolation room. A 2024 peer-reviewed assessment of the John F. Kennedy Medical Center, the country’s only tertiary referral facility, reports that while an eight-bed holding unit adjacent to the emergency department was planned, it remains non-functional and lacks the laboratory infrastructure, infection control systems, and pressure-regulated ventilation necessary for biocontainment ³²³. Similarly, although health infrastructure improvements have continued into 2025, such as the recent renovation of the maternity ward at Tubmanburg Government Hospital, these upgrades do not involve the creation or retrofitting of isolation or biocontainment-capable units ³²⁴.

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

Score: 100

Liberia meets the criteria for this indicator based on current, publicly available government policy to expand isolation capacity during infectious disease outbreaks. The Liberia National Infection Prevention and Control Strategy 2022–2027, officially published by the Ministry of Health in March 2023, includes specific, time-bound directives to improve and expand isolation capacity across all health facility levels. The strategy mandates the review and revision of emergency preparedness plans by 2024 to incorporate surge capacity for isolation infrastructure in accordance with global IPC minimum requirements ³²⁵. It also calls for the engagement of IPC focal persons to provide technical guidance on the construction and modification of triage and isolation structures during outbreaks ³²⁶. Additionally, the strategy requires facilities to ensure adequate and functional isolation rooms with appropriate utilities, including water supply and waste disposal, to accommodate suspected or confirmed infectious cases ³²⁷.

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

Score: 100

Liberia maintains national procurement protocols that the Ministry of Health and the Ministry of Agriculture routinely use to acquire laboratory and medical supplies. For the health sector, the Liberia Supply Chain Master Plan 2023–2028 assigns the National Drug Service responsibility for quantification, tendering, and framework agreements for laboratory reagents, medical equipment, and personal protective equipment across all public facilities ³²⁸. For the agriculture sector, the Ministry of Agriculture’s official procurement unit confirms that all procurements, including for laboratories, must follow the Public Procurement and Concessions Act (PPCA), which requires ministries to prepare annual procurement plans and comply with competitive tendering rules ³²⁹. These national rules are legally codified in the amended Public Procurement and Concessions Act of 2010, which outlines mandatory procurement procedures for all public entities, including ministries of health and agriculture ³³⁰. A government-issued letter of invitation for bids published on 27 August 2024 by the Ministry of Agriculture specifically calls for the procurement of crop-science laboratory equipment and reagents, demonstrating the active use of this framework for laboratory supply acquisition ³³¹.

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

Score: 100

Liberia maintains a national stockpile of medical supplies for use during public health emergencies and has an official plan to ensure equitable distribution. The National Emergency Preparedness and Response Plan (2023) directs that medical countermeasures, including personal protective equipment (PPE), vaccines, laboratory supplies, and medicines, be stocked and strategically positioned for emergency readiness ³³². The Liberia Supply Chain Master Plan 2023–2028, developed by the Ministry of Health with VillageReach, operationalizes emergency stock holdings and equitable distribution through quantification, warehousing, regional hubs, and last-mile delivery, with roles and protocols defined, including buffer stocks managed by the National Drug Service ^{333, p. 57}.

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

Score: 100

Liberia maintains a national stockpile of laboratory supplies for public health emergency use and has formally integrated this capability into national logistics planning. The Liberia Supply Chain Master Plan 2023–2028 confirms that the Ministry of Health, through the National Drug Service, manages a designated emergency stock of critical laboratory commodities, including rapid diagnostic tests, sample collection kits, reagents, and consumables. The plan defines target levels of coverage and restocking thresholds to ensure continuous readiness during outbreak response ³³⁴. Additionally, Liberia’s National Emergency Preparedness and Response Plan, validated in 2023, mandates the positioning of emergency laboratory supplies in strategic locations across the country. The plan specifically requires the availability of laboratory kits and reagents to be maintained at pre-identified points for rapid deployment during emergencies, aligning with the country’s overall surge and deployment framework ³³⁵.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 100

Liberia conducts an annual review of its national stockpile to ensure the adequacy of supplies for public health emergencies. The Liberia Supply Chain Master Plan 2023 to 2028, jointly issued by VillageReach and the Ministry of Health, assigns the National Drug Service the responsibility for conducting “annual quantification” of medical commodities, including emergency stocks such as personal protective equipment (PPE), essential medicines, and laboratory reagents ³³⁶. This quantification process is formally incorporated into the broader supply chain management strategy and is explicitly referenced as a recurring requirement, confirming ongoing implementation. In parallel, the 2023 National Emergency Preparedness and Response Plan, validated by the Republic of Liberia Ministry of Health, mandates stockpile maintenance and outlines procedures to ensure readiness of strategic medical resources during outbreaks, with oversight mechanisms to align supplies with projected emergency needs ³³⁷.

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

Score: 100

Liberia has multiple operational mechanisms in place for procuring and expediting medical supplies during public health emergencies. The “Liberia Supply Chain Master Plan 2023 to 2028,” issued by the Ministry of Health and VillageReach, assigns the Logistics Pillar of the Incident Management System responsibility for rapid procurement, buffer stock activation, and national distribution of emergency medical commodities, including vaccines and PPE, during crises ³³⁸. The 2023 Joint External Evaluation confirms that Liberia has a documented medical countermeasures plan and an exercised emergency logistics and supply chain management system ³³⁹. In 2025, the National Public Health Institute of Liberia implemented a “Procurement and Supply Chain Management Improvement Plan,” which operationalizes and aligns emergency procurement and inventory systems with the 2023 master plan, ensuring continuity of procedures during the assessment year ³⁴⁰. In addition, the Liberia Revenue Authority’s official standard operating procedures outline a pre-established mechanism for fast-tracking medical supplies at points of entry, including duty-free waivers and prioritized customs processing during declared national emergencies ³⁴¹.

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

Score: 100

Liberia maintains formal mechanisms to procure and expedite laboratory supplies for national use during a public health emergency. The Liberia Supply Chain Master Plan 2023 to 2028, published by the Ministry of Health and VillageReach, delegates to the logistics pillar of the Incident Management System the responsibility to procure and distribute laboratory commodities in emergencies, including through buffer stock mobilization and activation of prequalified suppliers ³⁴². This is operationalized in 2025 through the National Public Health Institute of Liberia’s Completed Procurement and Supply-Chain Improvement Plan, which standardizes procurement and distribution procedures for laboratory reagents and diagnostics in alignment with the master plan ³⁴³. In parallel, the Liberia Revenue Authority’s official Standard Operating Procedures from 2018, which remain in force, establish fast-track customs clearance and duty-free import waivers for laboratory materials during declared emergencies ³⁴⁴.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

There is no publicly available evidence that Liberia has a functional system or mechanism at the national and subnational levels for emergency logistics and supply chain management, nor that such a system is regularly exercised, reviewed, evaluated, or updated. The 2023 Joint External Evaluation of International Health Regulations (IHR) core capacities assigns Liberia a Level 1 score for logistics and supply chain management and confirms that a formal system remains under development and is not operational ³⁴⁵. The report does not validate the existence of an institutionalized process for cold chain integration within an emergency context, and while cold chain infrastructure exists for routine immunization, it is not described as part of a coordinated emergency mechanism ³⁴⁶. The 2024 after-action review of Liberia’s COVID-19 response highlights critical delays in last-mile distribution of oxygen and personal protective equipment due to the absence of an institutional emergency logistics mechanism ³⁴⁷.

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

Score: 100

Liberia has a documented national framework for the dispensing of medical countermeasures during a public health emergency. The “Liberia Supply Chain Master Plan 2023 to 2028”, issued by the Ministry of Health and VillageReach, outlines protocols for deploying medical countermeasures such as antibiotics, vaccines, diagnostics, and other emergency health commodities during outbreaks. It assigns responsibility for activation to the logistics pillar of the Incident Management System, and details prepositioning, last-mile delivery, and public health emergency distribution strategies under both centralized and county-level authority ³⁴⁸. The Joint External Evaluation of IHR Core Capacities, published by the World Health Organization and the Government of Liberia in 2023, affirms the existence of a medical countermeasure plan and notes that this plan has been exercised during simulation exercises and past emergencies ³⁴⁹. Further operationalization is provided in the “Procurement and Supply Chain Management Improvement Plan”, issued in 2025 by the National Public Health Institute of Liberia, which confirms the alignment of national procurement and distribution procedures with emergency needs and the master plan framework ³⁵⁰.

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

Score: 0

Liberia does not have a publicly available plan to facilitate the mobilization of additional healthcare personnel during public health emergencies. The World Health Organization (WHO) Joint External Evaluation of International Health Regulations (IHR) Core Capacities, conducted in 2023 and published in 2024, assigns Liberia Level 1 capacity for the workforce surge function and states explicitly that “there is no national personnel surge plan that has been drafted or is under development” ³⁵¹. Additionally, a comprehensive review of the WHO Strategic Partnership for Health Security (SPH) portal confirms that Liberia has not submitted a public workforce surge framework or surge staffing plan in any version of its National Action Plan for Health Security or related emergency preparedness documentation ³⁵².

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

Liberia does not have a publicly available plan for receiving foreign health personnel to support national response efforts during a public health emergency. The 2023 Joint External Evaluation of International Health Regulations core capacities confirms that there is no plan to receive foreign medical teams during public health emergencies and assigns Liberia a Level 1 capacity score for this function, indicating that the requirement is neither met nor under development ^{353, p. 65}. A comprehensive review of documents on the World Health Organization Strategic Partnership for Health Security and Emergency Preparedness portal, including Liberia’s National Action Plan for Health Security and supporting materials, yielded no evidence of procedures, protocols, or agreements for international surge staff deployment or reception ³⁵⁴. The National Emergency Preparedness and Response Plan 2023–2027 outlines surge workforce measures and names relevant ministries and services among implementers, but it does not specify procedures to request, receive, process, license, or integrate foreign health personnel during emergencies ^{355, pp. 74–75}.

4.3.2c Plan to redeploy existing health personnel within the country

Score: 100

A publicly available national plan outlines procedures for redeploying existing health personnel during public health emergencies. The 2023 National Emergency Preparedness and Response Plan, jointly issued by the Ministry of Health and the National Public Health Institute of Liberia, states that human resource requirements and personnel deployment are adjusted based on predefined triggers linked to the severity of an outbreak. The plan specifies that this includes the reallocation of clinical and support staff to locations with elevated caseloads. It also assigns the Incident Manager and relevant response pillars the responsibility of determining deployment needs in collaboration with county health teams. Furthermore, the plan mandates maintaining a national roster of responders and pre-identifying surge capacity staff to ensure workforce mobilization within affected regions ³⁵⁶.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 0

Liberia’s constitution does not include any enforceable provision guaranteeing citizens the right to medical care. Article 8, located in the National Policies section, directs the state to promote safety, health, and welfare within the context of employment, but does not create an individual entitlement ³⁵⁷. Chapter III on Fundamental Rights contains no reference to health, medical care, or public health as a protected or universally guaranteed right ³⁵⁸. The WORLD Policy Analysis Center independently categorizes Liberia’s Constitution as having no specific provision for the right to public health or medical care, consistent with this legal assessment ³⁵⁹.

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: 80.51

4.4.1d Coverage of essential health services through universal health coverage

Score: 37.5

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

Score: 61.25

4.4.1f Rate of mortality amenable to health care

Score: 74.1

4.4.2a Guaranteed paid sick leave

Score: 66.67

Liberian labor legislation guarantees paid sick leave but does not explicitly extend this benefit to cover mental health conditions. Section 19.2 of the Decent Work Act 2015 entitles every employee to ten days of paid sick leave per year at full ordinary remuneration, based on a certificate issued by a licensed medical practitioner ³⁶⁰. Additionally, Section 66.28 of the Civil Service Act 1973 grants up to fifteen days of paid sick leave annually for full-time civil servants, citing eligibility only in cases of personal illness or legal quarantine, with no reference to psychological or psychiatric conditions ³⁶¹. A full review of the 2017 Mental Health Act, as summarized by the World Health Organization in a service provider handbook, indicates that while the law addresses access to mental health services, anti-discrimination, and rights to treatment, it does not include any provision for employment-related benefits such as paid sick leave ³⁶².

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that the government of Liberia has issued legislation, a formal policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency. The 2023 National Public Health Emergency Preparedness and Response Plan outlines general surge response mechanisms and resource coordination but does not specify priority medical treatment for infected frontline workers ³⁶³. The 2023 Joint External Evaluation of International Health Regulations Core Capacities for Liberia references challenges in occupational safety and infection prevention for health workers but does not indicate any formal government commitment to prioritized care in emergencies ³⁶⁴. The Decent Work Act 2015 and Civil Service Act 1973 guarantee paid sick leave but do not address emergency-related prioritization ³⁶⁵³⁶⁶. The Mental Health Act 2017, as summarized in a legislative appendix by the World Health Organization, includes provisions for service access and nondiscrimination but does not mention prioritization of healthcare workers during public health emergencies ³⁶⁷.

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

Score: 100

Liberia has a national system that enables communication between public health officials and healthcare workers during public health emergencies. The 2023 Joint External Evaluation states that the Public Health Emergency Operations Center (PHEOC), managed by the National Public Health Institute of Liberia (NPHIL), operates under an Incident Management System (IMS) that includes mechanisms for coordination and information sharing across all response pillars, including coordination with frontline health workers ³⁶⁸. The 2023 National Emergency Preparedness and Response Plan outlines the IMS structure and identifies communication protocols between the Ministry of Health, NPHIL, and healthcare providers. The plan specifies procedures for disseminating emergency alerts, mobilizing Rapid Response Teams, and delivering technical guidance and updates to operational personnel through the PHEOC ³⁶⁹.

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

Score: 100

A national emergency communication system exists in Liberia that includes both public and private healthcare workers. The 2021 National Technical Guidelines for Integrated Disease Surveillance and Response (IDSR) explicitly state that all public and private health facilities must use standard IDSR forms to report alerts and weekly data, establishing two-way communication with district, county, and national authorities during public health emergencies ³⁷⁰. The 2023 National Emergency Preparedness and Response (EPR) Plan includes “private clinics and hospitals” in its contact matrix of stakeholders for information dissemination by the Incident Management System (IMS), confirming their inclusion in emergency advisories and situation updates ³⁷¹. Real-time participation of private facilities is demonstrated in the 2025 Early Warning Disease Surveillance Bulletin for Epi-week 2, which reports 99% IDSR reporting timeliness and completeness from 938 health facilities nationwide, including those in counties like Montserrado where many private providers operate ³⁷².

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

Score: 0

Liberia does not have a functioning national system to monitor or track healthcare-associated infections (HCAIs) in healthcare facilities. The Liberia National Infection Prevention and Control (IPC) Strategy 2022–2027 confirms that baseline HAI surveillance coverage is 0 percent and prioritizes the establishment of an HAI surveillance system as a future goal under strategic objective 2.4.3. It outlines plans to incorporate HAI indicators into the District Health Information Software 2 (DHIS2) and delegate analysis responsibilities to the national IPC Unit, but no nationwide implementation had occurred by 2025 ³⁷³. The 2023 Joint External Evaluation of IHR Core Capacities corroborates this, explicitly stating that Liberia lacks a national system for HAI surveillance and that existing IPC monitoring is limited to assessing adherence to guidelines, not tracking actual infection rates ³⁷⁴.

4.6.1b Infection prevention and control programme

Score: 100

Liberia has a national infection prevention and control (IPC) program formally outlined in the Liberia National IPC Strategy 2022–2027, issued by the Ministry of Health and National Public Health Institute of Liberia in March 2023 ³⁷⁵. The strategy defines the national IPC program as comprising governance structures, standards for health facilities, integration with water, sanitation, and hygiene (WASH) systems, and active surveillance of healthcare-associated infections. It assigns operational responsibilities to the national IPC Unit, county IPC focal persons, and facility IPC teams ³⁷⁶. The implementation framework includes annual operational plans, a costing matrix, and a performance-based monitoring and evaluation system ³⁷⁷. Implementation of the strategy is ongoing in 2025 and identifies real-time coordination with stakeholders including government, donors, and implementing partners ³⁷⁸. The program is funded and linked with quality assurance and antimicrobial resistance efforts. This confirms that a functioning national IPC program is in place with institutional oversight, implementation activity, and funding in 2025 ³⁷⁹.

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

Score: 100

Liberia has a publicly available national plan to ensure a safe environment in health facilities. The Liberia National Infection Prevention and Control (IPC) Strategic Plan 2023–2027 outlines structured actions to improve safety in health facilities nationwide. Strategic Direction 4 specifically addresses facility safety through interventions to: (1) strengthen involvement of IPC specialists in planning and designing infrastructure, (2) improve WASH services in all facilities, (3) improve waste management systems, and (4) enhance sterilization and decontamination services for equipment and materials ³⁸⁰. The plan is anchored in detailed IPC assessments from 255 health facilities, includes a full implementation matrix by IPC core components, and is costed with targets through 2027 ³⁸¹. It was developed by the Ministry of Health with support from WHO and CDC, and is referenced as Liberia’s first-ever dedicated national IPC strategy ³⁸². The 2023 Joint External Evaluation additionally notes that this IPC strategy is aligned with the broader National Action Plan for Health Security and is under implementation ³⁸³.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

Liberia has a national legal requirement for ethical review prior to the start of any clinical trial. The Liberia Medicines and Health Products Regulatory Authority (LMHRA) issued the Regulations on Clinical Trials in June 2022, which remain in force ³⁸⁴. These regulations require all human clinical trials to obtain both LMHRA authorization and ethical approval from a recognized Research Ethics Committee before implementation, and state that clinical trials must receive ethical clearance before initiation ³⁸⁵. The LMHRA’s legal authority to issue these requirements is derived from the Medicines and Health Products Regulatory Authority Act of 2010 ³⁸⁶. The African Medicines Regulatory Harmonization (AMRH) initiative lists LMHRA as the designated national regulatory authority and affirms that ethics review is a mandatory component of clinical trial approval in Liberia ³⁸⁷. Additionally, the National Research Ethics Board of Liberia (NREBL) confirms its role in independently reviewing human research protocols and outlines its responsibility to ensure participant protection before research begins ³⁸⁸.

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

Score: 100

Liberia has a publicly documented, legally valid process for expedited review of clinical trials involving unregistered medical countermeasures (MCMs) during emergencies. The Regulations on Clinical Trials, issued by the Liberia Medicines and Health Products Regulatory Authority (LMHRA) in June 2022 and currently in effect, authorize the Authority to implement special procedures during emergency situations. Section 15.1 of the regulation states that in emergencies, the LMHRA may apply an expedited application and review process for clinical trials and may grant exemptions to the usual documentation requirements ³⁸⁹. This regulatory mechanism provides a structured pathway to accelerate trials involving unregistered products in response to epidemics or public health crises. The ClinRegs portal, maintained by the U.S. National Institute of Allergy and Infectious Diseases, affirms that Liberian law permits expedited clinical trial review and documentation flexibility when public health interests are at stake ³⁹⁰.

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

Liberia has a designated national authority with the legal mandate to approve new medical countermeasures (MCMs) for human use. The Liberia Medicines and Health Products Regulatory Authority (LMHRA) was established by the “An Act to Amend the Public Health Law, Chapter 54A – Establishing the Liberia Medicines and Health Products Regulatory Authority,” enacted in 2010. The Act empowers LMHRA to regulate the registration, licensing, import, manufacture, distribution, and clinical evaluation of all medicines and health products in the country ³⁹¹. Specifically, Part V, Section 1 of the Act states that no medicine or health product, whether imported or manufactured locally, can be used in Liberia without registration by LMHRA, and Section 5 affirms that clinical studies cannot be conducted without the agency’s prior authorization, confirming its authority over investigational products ³⁹². Further confirmation is provided by the 2022 LMHRA “Regulations on Clinical Trials,” which state that clinical trials involving investigational products cannot proceed without LMHRA’s written approval and must comply with regulatory timelines and safety standards ³⁹³. An independent regulatory review from the U.S. National Institute of Allergy and Infectious Diseases ClinRegs database also identifies LMHRA as Liberia’s national regulatory authority for the approval of clinical trials and marketing authorization of medical products, confirming implementation of this mandate as of 2025 ³⁹⁴.

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

Liberia has an expedited pathway for enabling medical countermeasures during public health emergencies. The Liberia Medicines and Health Products Regulatory Authority allowed emergency market use during COVID-19; the World Bank project paper records that the LMHRA Managing Director granted an official waiver for the use of the AstraZeneca vaccine in Liberia upon submission of supporting documentation (2021), demonstrating the emergency mechanism in practice ^{395, p. 17}. In addition, LMHRA guidance permits importation of unregistered in-vitro diagnostics when cleared by recognized external assessments, including World Health Organization processes and expert review panels, which evidences a reliance approach that recognizes approval decisions made elsewhere ^{396, Section 1.6.1, p. 9}.

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

Score: 100

Liberia has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.³⁹⁷

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

Score: 100

Liberia has a national disaster risk reduction strategy that integrates epidemic and pandemic threats. According to a 2025 press release from the United Nations Development Programme (UNDP), the National Disaster Management Agency (NDMA) is implementing the national disaster risk reduction (DRR) strategy in alignment with the Sendai Framework, with targeted support to improve early warning systems and strengthen county-level DRR coordination structures ³⁹⁸. The International Federation of Red Cross and Red Crescent Societies (IFRC) 2025 Liberia Country Plan identifies epidemics among the most common national hazards and confirms that Liberia’s national risk governance includes the National Disaster Preparedness and Response Plan and the National Multi-Hazard Contingency Plan, both of which include epidemic scenarios. The same plan outlines that epidemic preparedness and response are strategic priorities for Liberia’s emergency readiness and response systems ³⁹⁹. In April 2024, the World Health Organization (WHO) led a Joint Risk Assessment (JRA) in Liberia, involving the NDMA and Ministry of Health, which assessed risks such as Lassa fever, rabies, and anthrax, confirming national-level multi sectoral planning for biological events ⁴⁰⁰.

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

Liberia maintains active cross-border and regional arrangements concerning public health emergencies, but evidence of implementation gaps persists. In June 2025, Liberia participated in the launch of the West Africa Risk Communication and Community Engagement Network’s 2025–2026 Action Plan under the Economic Community of West African States (ECOWAS), supporting coordinated outbreak preparedness, joint response protocols, and cross-border risk communication efforts ⁴⁰¹. In February 2025, the National Public Health Institute of Liberia co-organized a bilateral symposium with Côte d’Ivoire focused on Mpox preparedness and response, during which both countries committed to strengthening surveillance, information sharing, and collaborative emergency readiness ⁴⁰². The World Health Organization’s 2023 Joint External Evaluation highlights weaknesses in operational cross-border coordination and recommends that Liberia enhance collaborative public health planning with neighboring countries through formal frameworks and shared protocols ⁴⁰³.

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Liberia is a member of multiple regional frameworks for animal health emergency coordination, but 2025 evidence indicates that implementation remains partial. ECOWAS' Regional Animal Health Centre, a specialized agency to coordinate policies for transboundary animal diseases among member states, includes Liberia as a member state ⁴⁰⁴⁴⁰⁵. The Centre convenes the ECOWAS Regional Animal Health Networks, with documented annual meetings that operationalize regional coordination and planning for animal health emergencies ⁴⁰⁶. However, program monitoring for the Health Security Program in Western and Central Africa shows that by 31 May 2025 regional signed agreements for cross-border information sharing and routine multi sectoral cross-border investigations remained at zero, and multiple veterinary capacity indicators also remained at baseline across participating countries that include Liberia ^{407, pp. 4-7}.

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Liberia has signed and ratified the Biological Weapons Convention (BWC), fulfilling the criteria for full membership. The United Nations Office for Disarmament Affairs, “Biological Weapons Convention: Participants” (2025), lists Liberia as a State Party and records deposit of its instrument of ratification on 4 November 2016 ⁴⁰⁸. The United Nations Office for Disarmament Affairs, “Update on preparations for the Eighth BWC Review Conference, Number 6” dated 4 November 2016, reports that Liberia deposited its instrument in Washington, D.C. on 4 November 2016 and became the 176th State Party ^{409, p. 1}.

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

Score: 0

There is no publicly available evidence that Liberia has submitted any Confidence-Building Measures (CBMs) to the Biological Weapons Convention (BWC) within the past three years. The official BWC CBM portal maintained by the United Nations Office for Disarmament Affairs (UNODA) lists Liberia as having submitted zero CBMs since becoming a State Party in 2016, and the country profile shows no years of submission and a total submission count of zero ⁴¹⁰.

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Liberia has submitted the required national report to the United Nations Security Council Committee established pursuant to resolution 1540. The report, dated 15 July 2013 and issued under document number S/AC.44/2013/11, was submitted by Liberia’s Permanent Representative to the United Nations and confirms national measures to criminalize the financing of activities involving radioactive, chemical, or biological agents through the Anti-Money Laundering and Terrorist Financing Act ⁴¹¹. It also outlines intentions to introduce further legislation prohibiting the proliferation of nuclear weapons and designates three focal officials to support implementation. This report remains publicly available through the United Nations documentation system ⁴¹². The 1540 Committee continues to list this 2013 report as Liberia’s official national submission, with no subsequent updates or requests for revision ⁴¹³.

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

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

Score: 0

Liberia is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction ⁴¹⁴ or the Australia Group ⁴¹⁵. Liberia is listed as an endorsing state of the Proliferation Security Initiative ⁴¹⁶.

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

Score: 100

Liberia completed a Joint External Evaluation of its International Health Regulations core capacities in September 2023, and the full report is publicly available. The evaluation was conducted by the World Health Organization Regional Office for Africa in collaboration with Liberia’s Ministry of Health and the National Public Health Institute of Liberia. The report is titled “Joint External Evaluation of IHR Core Capacities: Liberia, 2023 (2nd edition)” and includes detailed assessments across all technical areas. It is published on the World Health Organization Regional Office for Africa website and confirms completion of the JEE process within the five-year timeframe required for this indicator ⁴¹⁷.

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

Score: 0

There is no publicly available evidence that Liberia has completed and published a full Performance of Veterinary Services evaluation within the past five years. The World Organisation for Animal Health (WOAH) Africa regional status tracker shows Liberia’s most recent full PVS evaluation follow‑up mission occurred in 2019, with the initial evaluation in 2013 and the PVS gap analysis in 2016 ⁴¹⁸. In 2021 Liberia participated in a virtual PVS Sustainable Laboratories mission focused solely on veterinary laboratory capacity ⁴¹⁹.

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

Score: 0

There is no publicly available evidence that Liberia has completed and published a full PVS Gap Analysis within the last five years. The World Organisation for Animal Health (WOAH) Africa “Performance of veterinary services (PVS) Pathway missions: status of implementation in Africa” lists Liberia’s most recent PVS Gap Analysis as 2016 ⁴²⁰. A 2021 Liberia activity documented by WOAH was a PVS Sustainable Laboratories mission conducted fully virtually to assess and support veterinary laboratory capacity; WOAH defines a PVS Gap Analysis as a distinct PVS Pathway output that develops a national, costed plan and investment priorities for Veterinary Services based on a PVS Evaluation, which the 2021 laboratory-focused mission is not ⁴²¹.

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

Score: 100

Liberia has allocated national funds within the past three years to improve capacity to address pandemic or epidemic threats. The approved National Budget for Fiscal Year 2025 includes direct allocations to the National Public Health Institute of Liberia (NPHIL), the Ministry of Health, and the Liberia Medicines and Health Products Regulatory Authority (LMHRA), with budget codes 439, 160, and 452, respectively. These allocations support disease surveillance, emergency preparedness, and regulation of pharmaceuticals ⁴²².

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

Score: 0

There is no publicly available evidence that Liberia’s Joint External Evaluation (JEE), National Action Plan for Health Security (NAPHS), or Global Health Security Agenda (GHSA) roadmap include specific national budget allocations or describe domestic funding commitments to fill identified health security gaps. The 2023 JEE report underscores the need to establish dedicated budget lines for International Health Regulations implementation, but does not present any current or planned national budget figures or earmarked funding ⁴²³. Liberia’s NAPHS (2018–2022) features costed activity matrices, yet consistently marks government contributions as “TBD” or leaves them blank, indicating no confirmed financing from national sources ⁴²⁴.

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

Score: 0

There is no publicly available evidence that Liberia’s Performance of Veterinary Services (PVS) Gap Analysis or PVS Evaluation includes specific funding allocations from the national budget to address identified gaps. According to the World Organisation for Animal Health (WOAH) Africa Region PVS Pathway mission tracker, Liberia’s most recent PVS Gap Analysis was conducted in 2016 and does not include national budget lines or committed domestic allocations ⁴²⁵. Liberia also participated in a virtual PVS Sustainable Laboratories mission in 2021, which provided technical support for laboratory strengthening but did not replace a full PVS Evaluation or Gap Analysis and did not describe national budgetary commitments ⁴²⁶. No references to national budget allocations linked to PVS activities were found in the WOAH PVS documents for Liberia, the Ministry of Agriculture website, or Liberia’s FY2024 or FY2025 approved national budgets ^427428429.

5.5.3a Emergency public financing during a public health emergency

Score: 0

Liberia does not have a publicly identified national reserve fund or special emergency financing mechanism that can be rapidly activated for public health emergencies. The 2025 Approved National Budget contains no contingency line, national reserve fund, or dedicated emergency response financing under the Ministry of Health or any central mechanism; all allocations are structured as routine programmatic spending and project-based aid, without flexible, rapid-release reserves ⁴³⁰. The 2023 Joint External Evaluation confirms that Liberia lacks dedicated budget lines for the International Health Regulations (IHR) core capacities or for emergency preparedness and response ⁴³¹. While Liberia received US$1 million from the World Bank’s Health Emergency Preparedness and Response Trust Fund (HEPR TF) in 2021, the support was tied specifically to COVID-19 vaccine rollout under a one-time emergency financing window, not an established standing mechanism ⁴³². Similarly, follow-on funding through the Liberia COVID-19 Emergency Response Project (P173812) closed in September 2024 and was structured as disease-specific project financing, not a multi sectoral or reusable emergency platform ⁴³³.

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

Score: 100

Senior Liberian leaders have made publicly verifiable commitments within the past three years to improve domestic pandemic and epidemic preparedness by securing financial support and proposing increased domestic financing. In his official Annual Message to the Legislature on 27 January 2025, President Joseph Nyuma Boakai confirmed that a National Health Equity Fund Bill would be submitted to the National Legislature and announced that the Government of Liberia had secured US $20 million in financing from the World Bank for the Special Disaster Fund to support epidemic response efforts ⁴³⁴. Separately, a World Bank restructuring document for the Liberia COVID-19 Emergency Response Project (P173812), publicly disclosed in December 2023, confirms that Liberia’s Minister of Health sent two formal letters in December 2023 requesting financial support and a project restructuring to allow the use of remaining project funds for the procurement of routine childhood vaccines. The document explicitly states that these letters were dated 12 December 2023 and 18 December 2023, and that the request was accepted and implemented in 2024 under revised project terms ⁴³⁵.

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

Score: 100

Liberia requested international donor financing in 2023 to strengthen its domestic capacity to address epidemic threats. A formal letter dated December 12, 2023, submitted by the Government of Liberia (GoL), requested financial support from the World Bank to procure routine childhood vaccines due to the country’s inability to meet immunization targets following COVID-19–related disruptions ⁴³⁶. The World Bank approved this request and restructured the Liberia COVID-19 Emergency Response Project (P173812) to include procurement of these vaccines under Component 1.2, thereby expanding the project scope to support broader public health preparedness goals ⁴³⁷. This activity is funded through IDA Credit 71990-LR and Grant E1140-LR, and implementation is ongoing as of 2025 ⁴³⁸. The Government’s December 18, 2023, follow-up letter formally requested restructuring of the project to include this new eligible expenditure category ⁴³⁹.

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

Score: 100

Liberia has fulfilled its assessed contributions to the World Health Organization (WHO) for the most recent two-year period. The WHO report on “Assessed Contributions Payable by Member States and Associate Members in 2024–2025” confirms that Liberia’s assessed contributions for 2024–2025 were fully paid, with a recorded balance of zero in both the “Total Outstanding” and “Balance Due” columns for the country ⁴⁴⁰.

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

Score: 0

Liberia does not maintain a publicly accessible national policy or plan for sharing genetic data, clinical specimens, or other biological materials with international organizations or other countries for pathogens beyond influenza. Participation in the Pandemic Influenza Preparedness Framework is facilitated through Liberia’s National Public Health Institute, which is confirmed operational as a WHO‑certified National Influenza Center, but this mechanism is strictly influenza‑specific and does not extend to other pathogens ⁴⁴¹. The 2023 Joint External Evaluation expressly states that Liberia lacks a formal mechanism for sharing specimens for diseases other than influenza with international stakeholders ⁴⁴². Searches of the WHO Strategic Partnership for Health Security Web Portal (SPH) yielded no evidence of any cross-pathogen specimen- or data-sharing policy ⁴⁴³. Liberia’s National Action Plan for Health Security (2019–2023) includes objectives on strengthening laboratory biosafety and national specimen transport but contains no guidance for international sharing beyond influenza ⁴⁴⁴.

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

Score: 100

Liberia is not publicly identified as non-compliant with the World Health Organization (WHO) Pandemic Influenza Preparedness (PIP) Framework sample-sharing requirements in the past two years. The WHO Pandemic Influenza Preparedness Framework Six-Month Progress Report for 1 January to 30 June 2024 describes ongoing sharing of biological materials through the Influenza Virus Traceability Mechanism and collaborative surveillance via the Global Influenza Surveillance and Response System, and it does not list Liberia among countries failing to share samples ^{445, pp. 2–3, 10–12}. The annexed tables list Member States participating under the High-Level Implementation Plan III and contain no indication of Liberia being recorded as non-compliant during this period ^{446, pp. 32–33}. In addition, WHO’s results reporting portal provides no public indication of Liberia’s non-compliance with Pandemic Influenza Preparedness Framework sample sharing in the past two years ⁴⁴⁷.

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

Score: 100

Liberia is not publicly identified as having failed to share pandemic pathogen samples during an outbreak. In 2024, Liberia reported five confirmed mpox cases and zero deaths in Africa Centres for Disease Control and Prevention reporting, which reflects outbreak detection with confirmed laboratory diagnosis, and the report does not note specimen withholding by Liberia ^{448, pp. 1–2}. The World Health Organization Disease Outbreak News archive for 2024–2025 contains no notices that flag Liberia for non-sharing of outbreak specimens ⁴⁴⁹. Liberia Ministry of Health news releases from January 2024 through July 2025 contain no statements indicating refusal or delay in sharing pandemic pathogen samples ⁴⁵⁰.

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: 0

6.1.1e Corruption

Score: 27

6.1.1f Accountability of public officials

Score: 50

6.1.1g Human rights risk

Score: 50

6.1.2a Orderly transfers of power

Score: 75

6.1.3a Risk of social unrest

Score: 25

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: 75

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

Score: 0

6.2.2a UNDP Gender Inequality Index score

Score: 7.06

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

Score: 50.31

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: 50

6.2.5a Robust, open, diverse local media and reporting

Score: 100

6.2.6a Gini coefficient

Score: 64.7

6.3.1a Adequacy of road network

Score: 0

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: 48.89

6.4.2a Change in forest area (percentage points)

Score: 39.2

6.4.3a Natural disaster risk

Score: 75

6.5.1a Total life expectancy (years)

Score: 34.93

6.5.1b NCD mortality rate

Score: 73.42

6.5.1c Population aged 65+

Score: 88.27

6.5.1d Tobacco use (% of adults)

Score: 69.61

6.5.1e Level of adult obesity (%)

Score: 87.7

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

Score: 79.87

6.5.2a Access to potable water

Score: 78.97

6.5.2b Access to at least basic sanitation facilities

Score: 22.89

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

Score: 85.42

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

Score: 1.61

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50