São Tomé and Príncipe: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 50

São Tomé and Príncipe has an AMR plan for the surveillance and detection of priority AMR pathogens. There is insufficient evidence that it covers reporting.

In 2022, the Ministry of Health and Social Issues published the National Plan to Combat Antimicrobial Resistance 2023–2025. The plan outlines the country’s sociodemographic, socioeconomic, and epidemiological context, identifying priority issues related to antimicrobial resistance (AMR). It proposes a set of actions grouped into eight types of interventions, including conducting surveillance of healthcare-associated infections, strengthening laboratory capacity, and training 40 technicians from various sectors to carry out control, inspection, and surveillance activities related to AMR. For each action, a responsible party, funders, involved ministries, partners, and a budget are specified (Pages 21 to 28). ¹

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national laboratory/laboratory system which tests for priority AMR pathogens.

According to the Tracking AMR Country Self-Assessment Survey 2022 Country Report, São Tomé and Príncipe does not have a reference lab/s performing susceptibility testing for any of the 11 bacteria covered by the survey. ²

The National Plan to Combat Antimicrobial Resistance 2023–2025, published in 2022, identifies the limited capacity of national laboratories in diagnosing and investigating AMR as one of its priority issues. As a result, strengthening laboratory capacity to respond to AMR is established as one of the intervention areas (Page 25). Proposed actions include acquiring technological equipment and training four laboratory technicians abroad in microbiology techniques for diagnosis and research (Page 25). ³

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that São Tomé and Príncipe conducts environmental detection or surveillance activities (e.g., in soil, waterways) for antimicrobial residues or AMR organisms. No evidence was found on the website of the Ministry of Health. ⁴ The Ministry of Environment, Youth and Sustainable Tourism does not have a website, only a Facebook page. ⁵

According to the Tracking AMR Country Self-Assessment Survey 2022 Country Report, São Tomé and Príncipe does not have a system for the regular monitoring of antimicrobial compounds and their metabolites (or residues), resistant bacteria, or antimicrobial resistance genes in water. ⁶ The National Plan to Combat Antimicrobial Resistance 2023–2025, published in 2022, does not include any actions addressing this issue. It only refers to the monitoring of resistant microorganisms and antimicrobial residues in food available in commercial establishments (page 26). ⁷

On the other hand, environmental surveillance for antimicrobial residues is currently being conducted in São Tomé, the country’s capital. However, this effort is part of a time-limited project funded by the Global Health Protection Programme (GHPP), an initiative of the German Federal Ministry of Health. According to the GHPP website, the project aims to strengthen local laboratory capacities in molecular diagnostics and genome sequencing for pathogens with epidemic or pandemic potential, including wastewater surveillance for the detection of antibiotic resistance. Within this framework, since late 2023, the National Reference Laboratory for Tuberculosis has been collecting environmental samples twice a month from six locations in São Tomé, including residential areas, the central market, and educational institutions. The project is scheduled to end in April 2026. ⁸

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has national legislation or regulation in place requiring prescriptions for antibiotic use for humans. No evidence was found on the website of the Ministry of Health. ⁹

The National Health Development Plan 2023-2032 acknowledges that medicines, including antibiotics, are easily accessible, even without a prescription, in high street pharmacies. ¹⁰

The National Pharmaceutical Policy (not available online) includes, as one of its actions, the implementation of a system to regulate the prescription of medicines and promote the rational use of medicines. ¹¹ However, no evidence has been found that this has been implemented. ¹² The Pharmaceutical Director Plan 2021–2025 does not address prescription regulations. Instead, it sets a goal of promoting the rational use of medication through the adoption of tools to support prescribing and dispensing, continuous staff training, and ongoing information campaigns targeting both professionals and the general population (page 12). ¹³

The National Plan to Combat Antimicrobial Resistance 2023–2025, published in 2022, identifies the indiscriminate sale of medicines without a prescription as one of the country’s key weaknesses (Page 14). In response, the plan sets a goal of promoting social mobilization against the sale of antimicrobials in inappropriate locations and without a prescription. This includes conducting workshops to raise awareness among street vendors about the dangers of illegally selling antimicrobials and recruiting a non-governmental organization to support social mobilization efforts (Page 21). ¹⁴

Additionally, according to the Tracking AMR Country Self-Assessment Survey 2022 Country Report, São Tomé and Príncipe does not have laws or regulations on prescription and sale of antimicrobials for human use. ¹⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has national legislation or regulation in place requiring prescriptions for antibiotic use for animals. No evidence was found on the website of the Ministry of Health and the Ministry of Agriculture and Rural Development. ¹⁶¹⁷

The National Plan to Combat Antimicrobial Resistance 2023–2025, published in 2022, identifies the implementation of prescription of veterinary medicines as one of the main actions for animal health (page 19). ¹⁸ Additionally, according to the Tracking AMR Country Self-Assessment Survey 2022 Country Report, São Tomé and Príncipe does not have laws or regulations on the prescription and sale of antimicrobials for animal use. ¹⁹

However, Decree No. 07/2019 of August 15, 2019, which regulates the provision of public and private veterinary services, prohibits ranchers, managers, guards, overseers, caretakers, and general workers from injecting or administering medications that have not been prescribed by a veterinarian or authorized technician (Article 35). ²⁰

1.2.1a Laws/plans on zoonotic disease

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has legislation, plans, or equivalent strategy documents on zoonotic disease. No evidence was found on the website of the Ministry of Health and the Ministry of Agriculture and Rural Development. ²¹²²

The National Action Plan for Health Security 2022–2026 acknowledges the lack of a zoonosis response plan but does not establish its creation as a goal (Page 20). ²³ The National Health Development Plan 2023–2032 also does not address legislation or planning related to zoonotic diseases. ²⁴ Furthermore, the plans available on the Ministry of Health's website cover only tuberculosis, HIV, malaria, STIs, and viral hepatitis. ²⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has national legislation, plans or equivalent strategy document which includes measures for risk identification and reduction for zoonotic disease spillover events from animals to humans. No evidence was found on the website of the Ministry of Health and the Ministry of Agriculture and Rural Development. ²⁶²⁷

The National Action Plan for Health Security 2022–2026 and the National Health Development Plan 2023–2032 do not include measures for risk identification and reduction for zoonotic disease spillover. ²⁸²⁹ Published in 2019, the National Technical Guide for Integrated Disease Surveillance and Response provides guidance on how to respond to outbreaks and other public health events. For example, for vector-borne diseases, it recommends indoor residual spraying, the use of locally available insecticide-treated mosquito nets, and other insecticide-treated materials. In the case of rodent-borne diseases, it advises avoiding contact with rodents and their urine, droppings, and other secretions; keeping food and water covered; maintaining a clean and tidy home and cooking area; and using chemicals (such as insecticides, rodenticides, and larvicides) and traps. ³⁰

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has legislation, plans, or guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern. No evidence was found on the website of the Ministry of Health and the Ministry of Agriculture and Rural Development. ³¹³²

The National Action Plan for Health Security 2022–2026 includes real-time surveillance as one of its technical areas but does not provide specific details on zoonotic pathogens. ³³ Although not limited to zoonotic diseases, the National Health Development Plan 2023–2032 sets out actions such as operationalizing surveillance based on community events in all areas of the health districts (page 81), and advocating for the integration of the health information system into planning and decision-making in health, epidemiological surveillance, and the evaluation of health interventions (page 98). ³⁴

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has legislation, plans, or guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern. No evidence was found on the website of the Ministry of Health and the Ministry of Agriculture and Rural Development. ³⁵³⁶

The National Health Development Plan 2023–2032 has as one of its goals to ensure that each inter-ministerial body actively participates in joint actions on health determinants, however, it does not mention any specific inter-ministerial body. ³⁷

World Health Organization's Joint External Evaluation Report for São Tomé & Príncipe, published in 2019, states that while there is some data sharing between the Ministry of Health and the Ministry of Agriculture on some zoonotic issues, such as rabies, ebola and avian flu, there is no systematic data sharing of reports and information between ministries. ³⁸

1.2.1e Presence of One Health strategic plan

Score: 0

São Tomé and Príncipe does not currently have a national One Health strategic plan in place. No evidence was found on the website of the Ministry of Health and the Ministry of Agriculture and Rural Development. ³⁹⁴⁰

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance. No evidence was found on the website of the Ministry of Health, the Ministry of Agriculture and Rural Development, and Food and Agriculture Organization. ⁴¹⁴²⁴³

However, according to the Livestock Code of 30 December 2005, for certain diseases – including vesicular stomatitis, avian influenza, and Newcastle disease – it is mandatory for the owner, keeper, or anyone with custody or responsibility for an animal, as well as anyone with knowledge of the disease, to report it as soon as possible, even if it is only a suspicion (Article 86). The law also states that a second list of notifiable diseases will be established in accordance with World Organisation for Animal Health standards, taking into account economic and health risks, as well as the serious dangers they may pose. For diseases on that list, notification must be made by the owner to local or national health authorities, regardless of whether a diagnosis has been confirmed or whether the animal is currently ill or has recovered (Article 87). ⁴⁴ No evidence of the list was found on the Ministry of Agriculture and Rural Development website. ⁴⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners). No evidence was found on the website of the Ministry of Health, the Ministry of Agriculture and Rural Development, and Food and Agriculture Organization. ⁴⁶⁴⁷⁴⁸

The Livestock Code of 30 December 2005 only establishes that veterinarians must maintain confidentiality in the exercise of their professional functions (Article 125). ⁴⁹ Likewise, the Personal Data Protection Law of 10 May 2016 grants provisions for data related to health, but does not cover animal health or reporting mechanisms. ⁵⁰

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no publicly available evidence that São Tomé and Príncipe conducts surveillance of zoonotic diseases in wildlife (e.g., wild animals, insects, other disease vectors), poultry and livestock. No evidence was found on the website of the Ministry of Health. ⁵¹ The Ministry of Agriculture's website is currently unavailable. ⁵²

Neither the National Health Development Plan 2023-2032 nor the National Action Plan for Health Security 2022-2026 refers to surveillance of zoonotic diseases. ⁵³⁵⁴

During the 2022 dengue outbreak, however, national health authorities carried out entomological investigations to identify breeding sites. ⁵⁵

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence that São Tomé and Príncipe has a mechanism for reporting notifiable diseases to the World Organisation for Animal Health (WOAH).

According to the World Health Organization’s Joint External Evaluation Report, conducted in 2019, the country has designated focal points within the Ministry of Agriculture for the WOAH and protocols are in place for notifying the organization. However, the mechanism for ensuring effective information exchange between the National IHR Focal Point and international bodies still requires strengthening. ⁵⁶ No additional information on the mechanism was available on the websites of the Ministry of Health and the Ministry of Agriculture, nor in the National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026. ^57585960

1.2.4a Number of veterinarians per 100,000 people

Score: 10.1

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

Score: 27.8

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national plan on zoonotic diseases or any related legislation regulations or plans; therefore, there cannot be any mechanism for working with the private sector in controlling or responding to zoonoses. No evidence was found on the website of the Ministry of Health, the Ministry of Agriculture and Rural Development, and Food and Agriculture Organization. ⁶¹⁶²⁶³

The National Health Development Plan 2023-2032 aims to promote intersectoral dialogue on health determinants by ensuring, among other things, the participation of the private sector in the context of its social responsibility in the health sector (page 85). However, it does not establish any mechanism to facilitate this participation. ⁶⁴ The National Action Plan for Health Security 2022-2026 does not include any actions addressing the private sector. ⁶⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a record, updated within the past five years, of the facilities in which especially dangerous pathogens and toxins are stored or processed, including details on inventories and inventory management systems of those facilities. No evidence was found on the websites of the Ministry of Health and Ministry of Agriculture. ⁶⁶⁶⁷

The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws regulations, or other measures have been found on the topic of registration requirements for individuals or facilities. ⁶⁸ The National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026 do not refer to dangerous pathogens and toxins. ⁶⁹⁷⁰

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has legislation and/or regulations related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems, and/or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed. No evidence was found on the websites of the Ministry of Health and Ministry of Agriculture. ⁷¹⁷²

The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws regulations, or other measures have been found on the topic of biosecurity requirements and cybersecurity measures. ⁷³ The National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026 do not refer to biosecurity regulations. ⁷⁴⁷⁵

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an established agency (or agencies) responsible for the enforcement of biosecurity legislation and regulations.

No evidence was found on the website of the Ministry of Health, the Ministry of Agriculture and Rural Development, and Food and Agriculture Organization. ⁷⁶⁷⁷⁷⁸ Neither the National Health Development Plan 2023-2032 nor the National Action Plan for Health Security 2022-2026 addresses biosecurity. ⁷⁹

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. No evidence was found on the websites of the Ministry of Health and Ministry of Agriculture. ⁸⁰⁸¹

The United Nations’ Biological Weapons Convention National Implementation Measures Database, the National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026 do not refer to dangerous pathogens and toxins inventories. ⁸²⁸³

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe requires biosecurity training. No evidence was found on the websites of the Ministry of Health and Ministry of Agriculture. ⁸⁴⁸⁵

Regarding the training of personnel on biosafety/biosecurity, the United Nations’ Biological Weapons Convention National Implementation Measures Database, points out the Law on Health No. 9/2018, of 2018. ⁸⁶ According to Article 26, the exercise of laboratory activity must, in all cases, safeguard the right to health, both of its beneficiaries and of the professionals themselves, providing for the provision of health care by those who have appropriate qualifications and qualifications and are accredited for that purpose. ⁸⁷

The National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026 do not refer to biosecurity training. ⁸⁸⁸⁹

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that São Tomé and Príncipe requires biosecurity training. No evidence was found on the websites of the Ministry of Health and Ministry of Agriculture. ⁹⁰⁹¹

Regarding the training of personnel on biosafety/biosecurity, the United Nations’ Biological Weapons Convention National Implementation Measures Database, points out the Law on Health No. 9/2018, of 2018. ⁹² According to Article 26, the exercise of laboratory activity must, in all cases, safeguard the right to health, both of its beneficiaries and of the professionals themselves, providing for the provision of health care by those who have appropriate qualifications and qualifications and are accredited for that purpose. ⁹³

The National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026 do not refer to biosecurity training. ⁹⁴⁹⁵

There is no publicly available evidence that São Tomé and Príncipe requires biosecurity training. No evidence was found on the websites of the Ministry of Health and Ministry of Agriculture. ⁹⁶⁹⁷

Regarding the training of personnel on biosafety/biosecurity, the United Nations’ Biological Weapons Convention National Implementation Measures Database, points out the Law on Health No. 9/2018, of 2018. ⁹⁸ According to Article 26, the exercise of laboratory activity must, in all cases, safeguard the right to health, both of its beneficiaries and of the professionals themselves, providing for the provision of health care by those who have appropriate qualifications and qualifications and are accredited for that purpose. ⁹⁹

The National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026 do not refer to biosecurity training. ¹⁰⁰¹⁰¹

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has regulations or licensing conditions that specify that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to checks. No evidence was found on the website of the Ministry of Health. ¹⁰²

The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws, regulations or other measures have been found on the topic of background checks for personnel. ¹⁰³ The Verification Research, Training and Information Centre (VERTIC) website lists key legislation for several countries, including São Tomé and Príncipe. However, none of the documents listed for the country mention checks for security and other personnel with access to pathogens, toxins, or biological materials. ¹⁰⁴

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has available information on national regulations on the safe and secure transport of infectious substances. No evidence was found on the website of the Ministry of Health. ¹⁰⁵

The National Action Plan for Health Security 2022–2026 highlights that assessments made in the country identified constraints in the transport of infectious substances. Such assessments emphasised the need to develop a plan to strengthen active surveillance of cases in terms of materials and transportation, find a lasting solution to international sample transport issues with carriers and airlines, and train and certify more technicians in the transport of infectious substances according to International Air Transport Association standards. ¹⁰⁶

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has legislation and/or regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. No evidence was found on the website of the Ministry of Health. ¹⁰⁷

The Environmental Law of 15 April 1999 prohibits the importation of any activities, products, or materials that cause serious environmental degradation or are potentially harmful to human health and ecosystems (Article 61). ¹⁰⁸ The Health Law of 06 June 2018 does not establish specific mechanisms to address this issue. It only states that it is the responsibility of the competent authorities to study, propose, implement, and enforce measures to prevent the import and export of diseases covered by the International Health Regulations, address the risk of spreading communicable diseases, and carry out all necessary health actions to protect global public health (Article 13). ¹⁰⁹

1.4.1a Biosafety laws/regulations

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has biosafety legislation, regulations, or a designated agency responsible for their enforcement.

No such evidence was found on the websites of the Ministry of Health, the Ministry of Agriculture and Rural Development. ¹¹⁰¹¹¹ Additionally, neither the National Health Development Plan 2023–2032 nor the National Action Plan for Health Security 2022–2026 addresses biosafety.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

No such evidence was found on the website of the Ministry of Health and the Ministry of Education’s Facebook page. ¹¹²¹¹³ Additionally, neither the National Health Development Plan 2023–2032 nor the National Action Plan for Health Security 2022–2026 addresses dual-use research. ¹¹⁴¹¹⁵

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence that São Tomé and Príncipe requires biosafety training. No evidence was found on the websites of the Ministry of Health and Ministry of Agriculture. ¹¹⁶¹¹⁷

Regarding the training of personnel on biosafety/biosecurity, the United Nations’ Biological Weapons Convention National Implementation Measures Database, points out the Law on Health No. 9/2018, of 2018. ¹¹⁸ According to Article 26, the exercise of laboratory activity must, in all cases, safeguard the right to health, both of its beneficiaries and of the professionals themselves, providing for the provision of health care by those who have appropriate qualifications and qualifications and are accredited for that purpose. ¹¹⁹

The National Health Development Plan 2023-2032 does not refer to biosafety training. ¹²⁰ The National Action Plan for Health Security 2022-2026 shows the estimated budget for biosecurity and biosafety under the plan (Page 33). The document also shows a list of IHR-2005 indicators and their scores in May 2019. One of the items is “Biosafety and biological security training and practice in all relevant sectors (including human, animal, and agricultural)”, which is scored 1 (Page 24). ¹²¹

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

No evidence was found on the website of the Ministry of Health and the Ministry of Education’s Facebook page. ¹²²¹²³ The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no information on the oversight of life sciences dual-use research has been found in publicly available sources. ¹²⁴

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

Score: 0

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

No evidence was found on the website of the Ministry of Health and the Ministry of Education’s Facebook page. ¹²⁵¹²⁶ The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no information on the oversight of life sciences dual-use research has been found in publicly available sources. ¹²⁷ The National Health Development Plan 2023-2032 notes that ethics must guide all health-related actions, from care provision to scientific research. Therefore, the Ministry of Health established the Health Ethics Committee for Scientific Research. However, given the expanding scope of health ethics, the committee should evolve into a body that informs decision-makers about ethical and bioethical issues, including those related to clinical trials and research. ¹²⁸

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. No evidence was found on the website of the Ministry of Health and the Ministry of Education’s Facebook page. ¹²⁹¹³⁰

The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no information on the oversight of life sciences dual-use research has been found in publicly available sources. ¹³¹ According to the National Health Development Plan 2023–2032, the Ministry of Health established the Health Ethics Committee for Scientific Research to evaluate the ethical aspects of all health research conducted in the country. However, the plan acknowledges that the committee still needs to grow and evolve into an institution capable of bringing ethical and bioethical challenges in health, such as those arising from clinical trials and other scientific research, to the attention of decision-makers and health authorities. ¹³² The committee was created in 2022 and, although no further information is available on the Ministry of Health website, it is actively involved in networks of ethics councils of Portuguese-speaking countries. ^133134135

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has legislation and/or regulation requiring the screening of synthesized DNA (deoxyribonucleic acid) against lists of known pathogens and toxins before it is sold.

No evidence was found on the website of the Ministry of Health. ¹³⁶ Additionally, neither the National Health Development Plan 2023–2032 nor the National Action Plan for Health Security 2022–2026 addresses the screening of synthesized DNA. ¹³⁷¹³⁸

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 100

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

Score: 0

There is no publicly available evidence that official foot-and-mouth disease (FMD) vaccination figures for livestock in São Tomé and Príncipe are available through the OIE database.

No evidence was found on the websites of the Ministry of Health and the World Organisation for Animal Health. ¹³⁹¹⁴⁰

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

São Tomé and Príncipe has a national immunization strategy that includes plans to ensure equitable distribution or strategies specifically aimed at addressing obstacles to vaccination.

The National Vaccination Strategy 2025–2029, published in 2024, lists among its strategic priorities the goal of ensuring the delivery of effective and accessible vaccination services for all, regardless of geographic location, age, socioeconomic status, or gender-related barriers (Page 26). To achieve this, it outlines several actions, including engaging communities and local administrative authorities in vaccination activities (planning, implementation, and evaluation) to provide services tailored to their needs; strengthening the implementation of fixed-site strategies and increasing mobile and door-to-door approaches targeting hard-to-reach populations; setting up vaccination services in markets or other public places with high population density; conducting intensive vaccination days on a quarterly basis in health zones with low coverage (high zero-dose and under-vaccinated populations) and organizing review meetings with all stakeholders; and establishing additional vaccination posts in underserved health zones (Pages 26 and 27). ¹⁴¹

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

Score: 100

São Tomé and Príncipe has a national immunization strategy that includes measures to address vaccine hesitancy and build public trust in vaccines.

The National Vaccination Strategy 2025–2029, published in 2024, lists among its strategic priorities the goal of ensuring that all populations and communities value vaccination services and systematically seek them out (Page 31). To achieve this, it outlines several actions, including identifying and carrying out awareness-raising activities targeting hard-to-reach populations in urban and rural areas, including fishing communities; acquiring appropriate equipment and technologies for effective communication; involving NGOs, women’s and youth associations in raising community awareness through educational talks aimed at different target groups, including men, using tailored messages; and organizing vaccination awareness caravans through forum theatre performances (Page 31). ¹⁴²

1.6.1e National advisory group for immunization strategy/plan

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national advisory group that provides technical guidance and advice on the immunization strategy/plan to the government. No evidence was found on the website of the Ministry of Health. ¹⁴³

The National Vaccination Strategy 2025–2029, published in 2024, reports that the country does not have a National Immunization Advisory Group to initiate and scientifically support decision-making in the field of immunization, and identifies its establishment as one of the planned actions. ¹⁴⁴

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an immunization programme for influenza. No evidence was found on the website of the Ministry of Health. ¹⁴⁵

The National Health Development Plan 2023-2032, the National Action Plan for Health Security 2022-2026 and the National Vaccination Strategy 2025–2029 do not refer to influenza programmes. ^146147148

1.7.1a Strategy/plan for resilience of health system

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a strategy or plan to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose, that includes the threat of infectious diseases. No evidence was found on the website of the Ministry of Health. ¹⁴⁹

The National Health Development Plan 2023-2032 and the National Action Plan for Health Security 2022-2026 do not refer to health system resilience to climate change. ¹⁵⁰¹⁵¹ Although the Health and Climate Change Country Profile, published in 2021 by the World Health Organization, reported that the country was developing a climate change and health strategic action plan, no evidence of it was found on the website of the Ministry of Health. ¹⁵²¹⁵³

Furthermore, the country does not yet have a National Adaptation Plan. Although it has been in preparation since 2022, its launch is planned for 2026. ¹⁵⁴

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe’s laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests. No evidence was found on the website of the Ministry of Health. ¹⁵⁵

According to the National Health Development Plan 2023–2032, the country currently has laboratory capacity for the diagnosis of HIV, tuberculosis, and malaria. However, there is a need to expand diagnostic capabilities for influenza virus, salmonella, and polio, as well as for four additional priority diseases identified by the country: bacterial meningitis, viral haemorrhagic fever, viral hepatitis, and measles. ¹⁵⁶ The World Health Organization’s Country Cooperation Strategy 2023–2027 states that the country has a PCR diagnostic service capable of detecting the influenza virus. ¹⁵⁷

The National Technical Guide for Integrated Disease Surveillance and Response, published in 2019, notes that although laboratories in the country are able to meet the minimum conditions for performing some tests, they still lack adequate infrastructure, reagents, consumables, equipment, and trained personnel to carry out most of the tests required for priority diseases. It also identifies which laboratories would be most appropriate for testing specific priority diseases, including polio, measles, and typhoid fever. However, it is not clear whether the listed laboratories have the capacity to conduct diagnostic tests for these diseases. ¹⁵⁸

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national plan, strategy or similar document for conducting testing during a public health emergency. No evidence was found on the website of the Ministry of Health. ¹⁵⁹

The National Health Development Plan 2023–2032 identifies public health emergencies as one of its strategic axes, but it does not address diagnostic testing during emergencies. The document also acknowledges that the country lacks a National Emergency Plan. ¹⁶⁰ Similarly, although the National Action Plan for Health Security 2022–2026 was developed to strengthen capacities for implementing the International Health Regulations (2005), aiming to effectively prevent, detect, and respond to public health risks and threats, it also does not cover testing in emergency contexts. ¹⁶¹

The World Health Organization’s Joint External Evaluation (JEE) Report, published in 2019, do not refer to plans for conducting testing during a public health emergency. ¹⁶²

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an accredited laboratory. No evidence was found on the website of the Ministry of Health. ¹⁶³

According to the National Health Development Plan 2023–2032, the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) programme, initiated by the World Health Organization, is currently being implemented to monitor and enhance the quality and safety of clinical analysis laboratories, while also fostering national ownership and ensuring sustainability. In this context, one of the plan’s strategic interventions is to promote and allocate funding for all health laboratories to participate in the SLIPTA initiative, with the goal of gradually improving laboratory quality and achieving accreditation. ¹⁶⁴

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

Score: 100

São Tomé and Príncipe has a national laboratory that serves as a reference facility which is subject to external quality assurance review.

According to the World Health Organization’s (WHO) Joint External Evaluation Report, conducted in 2019, the laboratory at Hospital Dr. Ayres de Menezes and the national reference laboratory for tuberculosis are enrolled in Portugal’s external quality assessment programme for biochemistry, parasitology, coagulation, and certain tests in hematology and bacilloscopy (Page 32). ¹⁶⁵ WHO’s EMTCT Assessment Report, published in 2023, confirms that the reference laboratory conducts both internal and external quality assurance and participates in proficiency testing for HIV and tuberculosis only (Page 34). It remains unclear whether other laboratories in the country are involved in proficiency testing. ¹⁶⁶

2.2.1a Nationwide specimen transport system

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a nationwide specimen transport system.

No evidence was found on the website of the Ministry of Health. ¹⁶⁷ The National Health Development Plan 2023–2032 does not address specimen transport. ¹⁶⁸ The National Action Plan for Health Security 2022–2026 highlights that assessments made in the country identified constraints in the transport of infectious substances. Such assessments emphasised the need to develop a plan to strengthen active surveillance of cases in terms of materials and transportation, find a lasting solution to international sample transport issues with carriers and airlines, and train and certify more technicians in the transport of infectious substances according to International Air Transport Association standards. ¹⁶⁹

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. No evidence was found on the website of the Ministry of Health. ¹⁷⁰

The National Health Development Plan 2023–2032 highlights that there is no dedicated structure within the Ministry of Health responsible for organising, regulating, and managing laboratories. There is also a lack of validated policies to organise and regulate laboratories within a functional national network. The document adds that it is necessary to create a network of laboratories to decentralise the performance of clinical analyses across the country. In this context, it proposes the creation of a National Laboratory Policy and the establishment of a Directorate of Public Health Laboratories to organise, coordinate, monitor, and evaluate the entire laboratory system. ¹⁷¹

The National Action Plan for Health Security 2022–2026 does not address the issue. ¹⁷²

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

Score: 50

There is publicly available evidence that São Tomé and Príncipe conducts indicator-based surveillance (IBS) and analysis for notifiable diseases; however, there is no evidence that this applies to novel infectious diseases or that the country conducts event-based surveillance (EBS). No evidence was found on the Ministry of Health’s website. ¹⁷³

The World Health Organization’s Joint External Evaluation, published in 2019, reports that the information flow to the IBS system is well structured and has high completeness (Page 36). It also notes that there is a list of priority diseases for IBS, and that bulletins are sent digitally to the districts, although they are not available to the public (Pages 35 and 36). The document recommends establishing EBS in both the human and animal health sectors (Page 37). ¹⁷⁴

The National Health Development Plan 2023-2032 does not refer to IBS but sets as a priority intervention to operationalise surveillance based on community events in all areas of the health districts (Page 81). ¹⁷⁵ The National Action Plan for Health Security 2022-2026 does not cover IBS and EBS. ¹⁷⁶

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

Score: 100

There is publicly available evidence that São Tomé and Príncipe has a mechanism (such as IHR focal point) for reporting notifiable diseases to the World Health Organization (WHO), although there is no information on timeline.

According to the WHO’s Joint External Evaluation Report, conducted in 2019, the country has designated focal points within the Ministry of Health for the International Health Regulations (IHR), with protocols in place for notifying the organization (Page 38). However, the mechanism for ensuring effective information exchange between the National IHR Focal Point and international bodies still requires strengthening (Page 39). ¹⁷⁷

The disease notification system follows a structured reporting flow: on a weekly basis, health units send aggregated data to the district level, which then forwards it to the Epidemiology Department of the Ministry of Health’s Directorate of Health Care. Trend analyses of priority diseases and conditions are conducted at both district and central levels to determine whether established thresholds have been exceeded, allowing for timely prevention and control measures. For malaria, tuberculosis, and HIV, immediate reporting from health facilities to the Ministry of Health’s Directorate for Endemic Diseases is required (Page 38). ¹⁷⁸

The National Technical Guide for Integrated Disease Surveillance and Response, published in 2019, provides detailed instructions on how to report diseases, conditions, and priority events within the required timeframes (Section 2). It also includes guidance on the notification of a potential Public Health Emergency of International Concern under the IHR (2005), along with the relevant reporting forms (Annex D). ¹⁷⁹

According to the National Action Plan for Health Security 2022-2026, says that the IHR Focal Point Coordinator is the Director of Health Care, and further members include the Ministry of Health, Ministry of Agriculture, Ministry of the Environment, Ministry of Defense and Civil Protection, Ministry of Infrastructure, and Ministry of Finance (Page 30). ¹⁸⁰

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 0

There is no publicly available evidence that São Tomé and Príncipe operates an electronic reporting surveillance system at both the national and the sub-national level. No evidence was found on the website of the Ministry of Health. ¹⁸¹

Since 2020, the country has used the District Health Information Software version 2 (DHIS2). However, according to the National Health Development Plan 2023-2032, two years after its implementation, the use of DHIS2 was still limited, covering only vaccination, reproductive health, tuberculosis, HIV/AIDS and malaria programmes, and there was no official plan to operationalise the progressive implementation of the tool in order to allow for more widespread and optimal use (Page 50). ¹⁸²

According to World Health Organization’s EMTCT Assessment Report, most of the data collected via DHIS2 appears to be aggregated and the data is not comprehensive, besides is use is not efficient, as data sources are still record books and excel spreadsheets (Page 36). ¹⁸³

The National Action Plan for Health Security 2022-2026 does not address electronic reporting surveillance. ¹⁸⁴

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

Score: 0

There is limited publicly available evidence that São Tomé and Príncipe has an electronic reporting surveillance system that collects ongoing or real-time laboratory data.

According to World Health Organization’s EMTCT Assessment Report, published in 2023, the referral laboratory system has an electronic laboratory system called GesLab. This system is only available at the reference laboratory and not in the districts, due to the limited capacity of the server. The laboratory is in the process of identifying an appropriate server to expand the use of the laboratory information system. ¹⁸⁵ No further evidence was found on the website of the Ministry of Health. ¹⁸⁶

Since 2020, the country has used the District Health Information Software version 2 (DHIS2), which supports aggregated and individual data. However, according to the National Health Development Plan 2023-2032, two years after its implementation, the use of DHIS2 was still limited, covering only vaccination, reproductive health, tuberculosis, HIV/AIDS and malaria programmes, and there was no official plan to operationalise the progressive implementation of the tool in order to allow for more widespread and optimal use. ¹⁸⁷ Furthermore, the EMTCT Report says that most of the data collected via DHIS2 appears to be aggregated, although, at the district level, and depending on the services such as HIV and maternal and child health data, there is individual data. ¹⁸⁸

Neither the National Health Development Plan 2023-2032 nor the National Action Plan for Health Security 2022-2026 addresses electronic lab reporting. ¹⁸⁹¹⁹⁰

2.3.3a National wastewater surveillance programme or initiative

Score: 50

São Tomé and Príncipe currently operates an ongoing but pilot-scale wastewater surveillance initiative for detecting contaminants, particularly pathogens and antibiotic-resistant bacteria in the capital city. Since early 2023, the SURVIN‑STP (Surveillance in São Tomé and Príncipe) project – led by the Bernhard Nocht Institute for Tropical Medicine (BNITM) in collaboration with the Ministry of Health and the Laboratório Nacional de Referência da Tuberculose (LNR‑TB)—has established a wastewater-based surveillance system in the capital, São Tomé. ¹⁹¹ The SURVIN‑STP project runs through April 2026, with a budget of approximately €575,000, focusing on enhancing laboratory capacity, molecular diagnostics, genome sequencing, and surveillance especially for antibiotic resistance via wastewater sampling.

2.4.1a Common usage of electronic health records

Score: 50

São Tomé and Príncipr's electronic health records are not commonly in use, but there is evidence they are used.

The World Health Organization reported in 2021 that, since 2020, the District Health Information Software (DHIS2) individual tracker in São Tomé and Príncipe has enabled individual data reporting and patient registry for a wide range of areas. These include patient registration at primary healthcare facilities, emergency consultations, death registration, HIV testing and treatment, tuberculosis treatment and monitoring, malaria investigation, reproductive, maternal, infant, and adolescent health services, immunization, COVID-19 lab result reporting and vaccination, and monitoring of adverse events. ¹⁹²

However, the National Health Development Plan 2023–2032 highlights several constraints in the use of DHIS2 in the country. These include inadequate governance, limited adherence by health professionals even in programmes where DHIS2 is already available, fragmentation of health information systems, a shortage of human resources, insufficient digital infrastructure, weak coordination, and the absence of a robust national strategy. According to the Plan, the DHIS2 is effectively used only in specific programmes such as vaccination, reproductive health, tuberculosis, HIV/AIDS, and malaria (Page 50). Moreover, there is no official roadmap to progressively expand DHIS2 implementation to enable broader and more optimal use (Page 50). ¹⁹³

2.4.1b Public health system access to individual electronic health records

Score: 100

São Tomé and Príncipe’s public health system has access to the electronic health records of individuals in their country.

The country uses the District Health Information Software (DHIS2) to collect, validate, analyse, and share health data. However, its coverage remains limited, and challenges persist regarding the quality of data collection at health facilities, as well as in data analysis, utilisation, and communication, factors that, according to the National Health Development Plan 2023-2032, continue to compromise effective health planning and decision-making (Page 50). ¹⁹⁴ Despite these limitations, the Ministry of Health has published the Health Statistics Yearbook annually since 2020, and since 2022, it has relied on data sourced from the DHIS2 platform. ¹⁹⁵

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has data standards to ensure data is comparable. No evidence was found on the website of the Ministry of Health. ¹⁹⁶

The National Health Development Plan 2023–2032 recognises that data quality remains a challenge in São Tomé and Príncipe. As a result, it identifies as a high-priority intervention the establishment of data quality control mechanisms, including timeliness of entry, completeness, accuracy, and data sharing (p. 98). Another high-priority intervention outlined in the plan is the identification and harmonisation of indicators and data collection forms, both electronic and paper-based, to support integrated data gathering and the creation of user-friendly databases that are widely accepted by health professionals (p. 100). ¹⁹⁷

2.4.2a Data sharing mechanisms

Score: 0

There is no publicly available evidence that São Tomé and Príncipe have mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data. No evidence was found on the website of the Ministry of Health. ¹⁹⁸ The Ministry of Agriculture's website is currently unavailable. ¹⁹⁹

Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 mentions the existence of such a mechanism. ²⁰⁰²⁰¹ Furthermore, the PNDS identifies as priority interventions for strengthening the health information system the establishment of partnerships with other national institutions and the reinforcement of information dissemination and sharing between institutions (page 100). ²⁰²

According to the World Health Organization’s (WHO) Joint External Evaluation Report, conducted in 2019, there is information sharing between the Ministry of Health and the Ministry of Agriculture in certain cases, such as rabies, Ebola, and highly pathogenic avian influenza. However, outside of these situations, there is no systematic sharing of reports and information between the sectors that deal with zoonoses. ²⁰³

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

Score: 100

São Tomé and Príncipe makes de-identified health surveillance data on infectious diseases publicly available via reports on government websites.

Since 2020, the Ministry of Health has published the Health Statistics Yearbook annually. One of its chapters focuses on epidemiological surveillance, reporting the incidence of diseases such as typhoid fever, acute respiratory infections, dysentery, influenza, and chickenpox. Although the chapter number may change from year to year, they are always called "Epidemiological Surveillance", except in 2021, when each disease had a section on the issue. ²⁰⁴ In 2024, the Ministry also released 16 epidemiological bulletins covering notifiable diseases, including malaria, yellow fever, influenza, and viral haemorrhagic fever. ²⁰⁵

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is evidence of laws that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities in São Tomé and Príncipe.

The Personal Data Protection Law of 2016 prohibits the processing of data related to health and sexual life, including genetic data, except when necessary for purposes such as preventive medicine, medical diagnosis, the provision of care or medical treatment, or the management of healthcare services. In such cases, the data must be processed by a healthcare professional bound by confidentiality or by another individual also subject to professional secrecy (Article 7). The law also stipulates that systems must ensure a logical separation between data related to health and sexual life, including genetic data, and other personal data (Article 16). ²⁰⁶

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

Score: 100

There is limited publicly available evidence that São Tomé and Príncipe has legislation and/or regulations safeguarding the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities, including protections from cyber-attacks.

The Personal Data Protection Law of 2016 prohibits the processing of data related to health and sexual life, including genetic data, except when necessary for purposes such as preventive medicine, medical diagnosis, the provision of care or medical treatment, or the management of healthcare services. In such cases, the data must be processed by a healthcare professional bound by confidentiality or by another individual also subject to professional secrecy (Article 7). The law also stipulates that systems must ensure a logical separation between data related to health and sexual life, including genetic data, and other personal data (Article 16). ²⁰⁷

The law includes measures against cyber-attacks. Article 15 establishes that the data controller must implement appropriate technical and organisational measures to protect personal data against accidental or unlawful destruction, accidental loss, alteration, unauthorised disclosure, or access, especially when data processing involves transmission over a network. These measures should ensure a level of security appropriate to the risks posed by the processing and the nature of the data to be protected. The law also provides for imprisonment of up to one year or a fine of up to 120 days for unauthorised access to personal data. The penalty is increased to double its limits if the access is achieved by breaching technical security measures, enables the offender or third parties to become aware of the personal data, or provides the offender or third parties with a financial benefit or advantage (Article 37). ²⁰⁸

2.4.5a Cooperative commitments or agreements within regions

Score: 0

There is little publicly available evidence that São Tomé and Príncipe has committed via public statements, legislation and/or a cooperative agreement to share surveillance data during a public health emergency with other countries.

Besides being a State Party to the IHR ²⁰⁹, in 2025, according to the Africa Centres for Diseases Control and Prevention, São Tomé and Príncipe is one of 12 countries that have joined together in collaboration to respond, prevent and control disease outbreaks, especially the recent monkeypox outbreaks, which includes "data-sharing mechanisms". It is unclear whether this is just for one or multiple diseases, and there is no evidence of any implementation of mechanisms. ²¹⁰

No further evidence was found on the websites of the Ministry of Health. ²¹¹ The National Health Development Plan 2023–2032 mentions only agreements for the provision of health professionals and training. ²¹² According to the World Health Organization’s Joint External Evaluation Report, conducted in 2019, the country needs to develop protocols and procedures to strengthen multisectoral, regional and/or international collaboration with neighbouring countries regarding disease notification. ²¹³

Published in 2019, the National Technical Guide for Integrated Disease Surveillance and Response provides guidance on how to respond to outbreaks and other public health events. According to the document, during emergencies or outbreaks, the coordination with countries in the African sub-region should include, among others, meeting partners as soon as the epidemic or event is recognised; regular meetings to assess the status of the outbreak or epidemic; regular sharing of surveillance data, addressing case counts (and contact tracing status; and sharing information on the travel history of identified cases and contacts to facilitate a coordinated response with countries in the sub-region. ²¹⁴

Lastly, São Tomé and Príncipe is a member of the Community of Portuguese Language Countries (CPLP), which adopted a Strategic Health Cooperation Plan for 2023–2027. The plan reflects a collective commitment among CPLP Member States to collaborate in the health sector, including in areas such as public health emergency preparedness and health information and communication. However, it does not explicitly address the sharing of surveillance data, establishing only actions such as cooperating bilaterally and/or multilaterally in strengthening capacities for surveillance and response to public health emergencies and creating a training program on communication in health emergencies. ²¹⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national system in place to provide support at the sub-national level to conduct contact tracing in the event of a public health emergency. No evidence was found on the Ministry of Health's website. ²¹⁶

Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses tracing. ²¹⁷²¹⁸

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support and medical attention. No evidence was found on the Ministry of Health's website. ²¹⁹

During the COVID-19 pandemic, the country provided economic support such as four-month payments to vulnerable families and wage subsidy schemes. However, these initiatives were broader in scope and not specifically tied to self-isolation or quarantine status. ²²⁰

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence that there is a joint plan or cooperative agreement between the public health system and border control authorities in São Tomé and Príncipe. No evidence was found on the Ministry of Health's website. ²²¹

According to the National Health Development Plan 2023–2032, São Tomé and Príncipe has improved surveillance at points of entry, with a focus on Integrated Disease Surveillance and Response (IDSR) at both district and community levels, including the establishment of focal points. ²²² Furthermore, the National Action Plan for Health Security 2022–2026 also sets as a strategic objective the strengthening of capacity for early detection and management of public health events at points of entry (page 27). ²²³ However, neither document refers to specific mechanisms or cooperative agreements with border control authorities.

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an applied epidemiology training program or that resources are provided by the government to send citizens to another country to participate in applied epidemiology training programs. No evidence was found on the Ministry of Health's website. ²²⁴

Although there is currently no operational epidemiology training program in São Tomé and Príncipe, the country implemented the Field Epidemiology Training Program (EpiSTP) between 2021 and 2022. This initiative was supported by multiple partners, including the Brazilian Association of Field Epidemiology Professionals, the Ministry of Health, the World Bank, and the United Nations Development Programme. EpiSTP trained a total of 42 field epidemiologists across three cohorts. ^225226227 The National Health Development Plan 2023–2032 identifies the permanent implementation of the Field Epidemiology Training Program (FETP) as a strategic action (page 147). ²²⁸

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has field epidemiology training program. No evidence was found on the Ministry of Health's website. ²²⁹

Although there is currently no operational epidemiology training program in São Tomé and Príncipe, the country implemented the Field Epidemiology Training Program (EpiSTP) between 2021 and 2023. According to one of the program’s main partners, the Brazilian Association of Field Epidemiology Professionals, the initiative aimed to build a network of field epidemiologists, promote integration between human and animal health sectors, enhance the use of data for public health decision-making, and improve the frequency and quality of case and outbreak investigations. Publicly available information on the trainees’ backgrounds exists only for one of the cohorts, which included one veterinarian among the 16 participants. ^{230231232233234}

Although there is no epidemiology training program specific to animal health, the World Health Organization’s 2022–2023 report on São Tomé and Príncipe states that the program follows a One Health approach, covering human, animal, and environmental health. ²³⁵

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

Score: 100

São Tomé and Príncipe has at least one trained field epidemiologist per 200,000 people.

São Tomé and Príncipe has 42 field epidemiologists and a population of 230,871; therefore, it has approximately 36 field epidemiologists per 200,000 people. ²³⁶²³⁷

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential.

No evidence was found on the Ministry of Health's website. ²³⁸ Additionally, the National Health Development Plan 2023–2032 identifies the development and operationalization of a National Emergency Plan as one of its monitoring indicators, suggesting that such a plan is still pending, and establishes the training of technicians from the National Centre for Health Education in risk communication and community engagement as one of its interventions (page 147). ²³⁹

The National Action Plan for Health Security 2022–2026 does not reference a national emergency plan but cites the existence of a National Strategy for Disaster Risk Management (2010). ²⁴⁰ However, the document was not found online.

According to the WHO Joint External Evaluation (JEE) Report for São Tomé and Príncipe (May 2019), the only contingency plan the country has developed is one for Ebola in 2014 (page 35). However, the actual Ebola plan could not be found online, and there is no indication that it covers other or multiple communicable diseases. The JEE also notes that the country’s National Council for Preparation and Response to Catastrophes (CONPREC) developed the National Contingency Plan 2016–2018 to support operations in the event of a serious accident or catastrophe (page 13). Although the plan could not be found online, the JEE highlights that it addresses potential epidemics and other health threats from different sources in a succinct way (page 13). Additionally, the JEE (page 47) states that the National Health Service of São Tomé and Príncipe has developed a contingency plan to respond to health emergencies; however, this document was also not found online. ²⁴¹

According to the Ministry of Health's Facebook page, the country published in 2020 a Contingency Plan for the COVID-19 Epidemic. ²⁴² However, it was not found online.

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential.

No evidence was found on the Ministry of Health's website. ²⁴³ Additionally, the National Health Development Plan 2023–2032 identifies the development and operationalization of a National Emergency Plan as one of its monitoring indicators, suggesting that such a plan is still pending, and establishes the training of technicians from the National Centre for Health Education in risk communication and community engagement as one of its interventions (page 147). ²⁴⁴

The National Action Plan for Health Security 2022–2026 does not reference a national emergency plan but cites the existence of a National Strategy for Disaster Risk Management (2010). ²⁴⁵ However, the document was not found online.

3.1.1c One health principles by covering multiple threat types

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national public health emergency response plan in place.

No evidence was found on the Ministry of Health's website. ²⁴⁶ Additionally, the National Health Development Plan 2023–2032 identifies the development and operationalization of a National Emergency Plan as one of its monitoring indicators, suggesting that such a plan is still pending. ²⁴⁷

The National Action Plan for Health Security 2022–2026 does not reference a national emergency plan. Instead, it cites the existence of a COVID-19 Contingency Plan (2020), an Ebola Contingency Plan (2014), and a National Strategy for Disaster Risk Management (2010). None is currently available online. ²⁴⁸²⁴⁹ There is available online, however, a Contingency Plan for Dengue, published in 2022. ²⁵⁰

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national public health emergency response plan in place.

No evidence was found on the Ministry of Health's website. ²⁵¹ Additionally, the National Health Development Plan 2023–2032 identifies the development and operationalization of a National Emergency Plan as one of its monitoring indicators, suggesting that such a plan is still pending. ²⁵²

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has mechanisms for engaging with the private sector to assist with outbreak emergency preparedness and response. No evidence was found on the Ministry of Health's website. ²⁵³

The National Health Development Plan 2023-2032 aims to promote intersectoral dialogue on health determinants by ensuring, among other things, the participation of the private sector in the context of its social responsibility in the health sector (page 85). However, it does not establish any mechanism to facilitate this participation. ²⁵⁴ The National Action Plan for Health Security 2022-2026 does not include any actions addressing the private sector. ²⁵⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic. No evidence was found on the Ministry of Health's website. ²⁵⁶

The National Health Development Plan 2023–2032 and the National Action Plan for Health Security 2022–2026 do not address NPIs. ²⁵⁷²⁵⁸

Although there is no evidence of a formal NPI plan, the country has implemented non-pharmaceutical interventions during recent health emergencies. During the COVID-19 pandemic, measures such as school closures, teleworking, remote meetings, and the reduction or cancellation of mass gatherings were adopted ²⁵⁹. In 2022, during the dengue outbreak, the country implemented fogging and source reduction measures in some affected areas ²⁶⁰.

The WHO's Joint External Evaluation Report for São Tomé and Príncipe of May 2019 does not mention NPIs. ²⁶¹

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national emergency response plan in place. No evidence was found on the Ministry of Health's website. ²⁶²

The most recent outbreak reported in São Tomé and Príncipe occurred in 2022, with 103 confirmed cases of dengue fever. At the time, the country lacked both an overarching national public health emergency response plan and a disease-specific plan for dengue. In response to the outbreak, authorities developed, validated, and disseminated a dedicated Dengue Contingency Plan. ²⁶³

Regarding threat-focused exercises, the World Health Organization (WHO) reports that the most recent simulation exercise involving São Tomé and Príncipe took place in 2020. ²⁶⁴ However, the National Health Development Plan 2023–2032 indicates that a large-scale simulation exercise for an Ebola outbreak, supported by WHO, was conducted in 2022. ²⁶⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has, in the past year, identified a list of gaps and best practices in response and developed a plan to improve response capabilities. No evidence was found on the Ministry of Health's website. ²⁶⁶

The country conducted an After-Action Review (AAR) in 2019 following an outbreak of necrotizing cellulitis, and an Intra-Action Review (IAR) in 2021 during the COVID-19 response. ^267268269 However, no evidence was found indicating that these reviews resulted in a formal plan to enhance response capabilities. ²⁷⁰

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has, in the past year, undergone a national-level biological threat-focused exercise that has included private sector representatives.

No evidence was found on the Ministry of Health's website. ²⁷¹ Furthermore, according to the World Health Organization, the most recent simulation exercises involving the country were conducted in 2020 and 2022. ²⁷²²⁷³

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

There is publicly available evidence that São Tomé and Príncipe has an Emergency Operations Center (EOC)

According to the National Health Development Plan 2023–2032, one of the measures taken by São Tomé and Príncipe to strengthen the country’s capacities was the establishment of the EOC team. This included appointing a coordinator and training the team in 2021 with support from the World Health Organization (WHO), and designating a physical space for the EOC’s installation and operation, which was scheduled to be rehabilitated by 2022. ²⁷⁴ In 2024, the Ministry of Health reported the official inauguration of the EOC building. ²⁷⁵

Additionally, members of the EOC team participated in 2024 in a training organized by the East, Central, and Southern Africa Health Community (ECSA-HC) and WHO. The training covered foundational EOC principles and included practical emergency simulation exercises. ²⁷⁶

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe’s Emergency Operations Center (EOC) is required to conduct a drill for a public health emergency scenario at least once per year or that it conducts a drill at least once per year. No evidence was found on the Ministry of Health's website. ²⁷⁷

The National Health Development Plan 2023–2032 and the National Action Plan for Health Security 2022–2026 do not address such a requirement. ²⁷⁸²⁷⁹

However, the EOC team has participated in simulation exercises. In 2024, it took part in a training organized by the East, Central, and Southern Africa Health Community (ECSA-HC) and the World Health Organization (WHO) in Ethiopia. The training included practical emergency simulation exercises, allowing participants to apply theoretical knowledge to real-world scenarios. ²⁸⁰ Also in 2024, the team joined a simulation exercise organized by the Global Network of Public Health Emergency Operations Centers (EOC-NET), established by the WHO. The main objective of this exercise was to test the capacities of Emergency Operations Centers in Member States across the six WHO regions. Additionally, the exercise helped identify key strengths and areas needing improvement to enhance the functionality of Public Health Emergency Operations Centers. ²⁸¹

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has, in the past year, conducted a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario. No evidence was found on the Ministry of Health's website. ²⁸²

There is evidence that members of the Emergency Operations Center (EOC) team participated in a training organized by the East, Central, and Southern Africa Health Community (ECSA-HC) and the World Health Organization (WHO) in 2024 in Ethiopia. The training included practical emergency simulation exercises, allowing participants to apply theoretical knowledge to real-world scenarios. However, it is unclear whether this included an emergency response exercise activated within 120 minutes. ²⁸³

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has, in the past year, identified a list of gaps and best practices in response and developed a plan to improve response capabilities. No evidence was found on the Ministry of Health's website. ²⁸⁴

Furthermore, the World Health Organization's Joint External Evaluation Report, the National Action Plan for Health Security 2022–2026 and the National Health Development Plan 2023–2032 do not refer to deliberate biological events. ^285286287

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan or legislation detailing a risk communication plan that is specifically intended for use during a public health emergency.

No evidence was found on the Ministry of Health's website. ²⁸⁸ Additionally, the National Health Development Plan 2023–2032 identifies the development and operationalization of a National Emergency Plan as one of its monitoring indicators, suggesting that such a plan is still pending, and establishes the training of technicians from the National Centre for Health Education in risk communication and community engagement as one of its interventions (page 147). ²⁸⁹

The National Action Plan for Health Security 2022–2026 does not reference a national emergency plan but cites the existence of a National Strategy for Disaster Risk Management (2010). ²⁹⁰ However, the document was not found online.

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a risk communication plan or similar document.

No evidence was found on the Ministry of Health's website. ²⁹¹ Additionally, the National Health Development Plan 2023–2032 identifies the development and operationalization of a National Emergency Plan as one of its monitoring indicators, suggesting that such a plan is still pending, and establishes the training of technicians from the National Centre for Health Education in risk communication and community engagement as one of its interventions (page 147). ²⁹²

The National Action Plan for Health Security 2022–2026 does not reference a national emergency plan but cites the existence of a National Strategy for Disaster Risk Management (2010). ²⁹³ However, the document was not found online.

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

Score: 100

There is publicly available evidence that São Tomé and Príncipe designate a specific position within the government to serve as the primary spokesperson to the public during a public health emergency.

The WHO's Joint External Evaluation Report for São Tomé and Príncipe of May 2019 notes that one of the country's strengths in the area is the existence of a designated government spokesperson to communicate with the public during an emergency, the Directorate of Health Care (page 57). However, it does not note the existence of any plan, legislation, regulation or strategy document where such practice is explicitly stated. The JEE states that the country does not have a risk communication plan or section in another larger plan (page 55). ²⁹⁴ No other evidence was found on the website of the Ministry of Health. ²⁹⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe’s public health system has actively shared messages via online media platforms to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation. No evidence was found on the Ministry of Health's website and Facebook. ²⁹⁶²⁹⁷

The Ministry of Health uses Facebook to share epidemiological information on dengue and COVID-19; however, since the last outbreak of either disease occurred in 2022, it is unclear whether they remain ongoing public health concerns. ²⁹⁸²⁹⁹

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

Score: 100

There is no publicly available evidence that São Tomé and Príncipe’s senior leaders (president or ministers) have shared misinformation or disinformation on infectious diseases in the past two years. No evidence was found on the official websites and Facebook pages. ^300301302303

3.6.1a Percentage of households with Internet

Score: 0

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 34.32

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

Score: 66.67

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

Score: 58.33

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

Score: 100

There is no publicly available evidence that São Tomé and Príncipe has implemented restrictions on export/import of medical goods (e.g. medicines, oxygen, medical supplies, PPE) due to an infectious disease outbreak. No evidence was found on the Ministry of Health's website. ³⁰⁴

The National Action Plan for Health Security 2022-2026 and the National Health Development Plan 2023-2032 do not address restrictions on export/import of medical goods. ³⁰⁵³⁰⁶

The most recent outbreak reported in São Tomé and Príncipe occurred in 2022, with 103 confirmed cases of dengue fever. No evidence was found that the country implemented restrictions on export/import of medical goods during the outbreak. ³⁰⁷

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

Score: 100

There is no publicly available evidence that São Tomé and Príncipe has implemented restrictions on export/import of non-medical goods (e.g. food, textiles, etc) due to an infectious disease outbreak. No evidence was found on the Ministry of Health and the Ministry of Agriculture and Rural Development's websites. ³⁰⁸³⁰⁹

The National Action Plan for Health Security 2022-2026 and the National Health Development Plan 2023-2032 do not address restrictions on export/import of non-medical goods. ³¹⁰³¹¹

The most recent outbreak reported in São Tomé and Príncipe occurred in 2022, with 103 confirmed cases of dengue fever. No evidence was found that the country implemented restrictions on export/import of non-medical goods during the outbreak. ³¹²

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

Score: 100

There is no publicly available evidence that São Tomé and Príncipe has implemented inbound or outbound travel restrictions due to an infectious disease outbreak in the past year. No evidence was found on the Ministry of Health's website. ³¹³

The National Action Plan for Health Security 2022-2026 and the National Health Development Plan 2023-2032 do not address travel restrictions. ³¹⁴³¹⁵

The most recent outbreak reported in São Tomé and Príncipe occurred in 2022, with 103 confirmed cases of dengue fever. No evidence was found that the country implemented restrictions on travel during the outbreak. ³¹⁶

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe uses a risk-based approach to international travel-related measures. No evidence was found on the Ministry of Health's website. ³¹⁷

The National Action Plan for Health Security 2022-2026 and the National Health Development Plan 2023-2032 do not address travel-related measures. ³¹⁸³¹⁹

The most recent outbreak reported in São Tomé and Príncipe occurred in 2022, with 103 confirmed cases of dengue fever. No evidence was found that the country implemented travel-related measures during the outbreak. ³²⁰

4.1.1a Doctors per 100,000 people

Score: 6.49

4.1.1b Nurses and midwives per 100,000 people

Score: 28.49

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

There is publicly available evidence that São Tomé and Príncipe has a health workforce strategy in place (which has been updated in the past five years) to identify fields where there is an insufficient workforce and strategies to address these shortcomings.

According to the National Health Development Plan (PNDS) 2023–2032, São Tomé and Príncipe had a National Human Resources for Health (HRH) Policy covering the period 2019–2023. This policy aimed to ensure the availability of health professionals in adequate numbers and with appropriate qualifications, distributed according to the needs of the health system, and motivated to perform their duties with rigour, ethics, and professionalism. ³²¹ However, the document is not publicly available on the Ministry of Health’s website. ³²²

The PNDS also notes that the country lacks a survey and analysis of the needs for health professionals, by category and level of specialisation, which would be necessary to effectively plan training and meet the health system’s demands. ³²³

Although the country does not currently have a dedicated HRH strategy, human resources for health are addressed as one of the core areas of the PNDS, structured around three axes: strengthening HRH governance and leadership capacity; promoting the training of human resources and improving their competency levels; and ensuring the adequate availability and equitable distribution of health professionals. ³²⁴

Planned interventions include: increasing the production of health professionals (including community health workers, nurses, doctors, and health technicians) across relevant areas of competence to better meet population needs and improve the quality of service delivery; ensuring that the education sector aligns with healthcare delivery strategies; creating incentives (such as housing loans, education for children, healthcare guarantees, continuous training, and insurance) to boost productivity and encourage staff retention, especially in remote and isolated areas; and strengthening cooperation agreements with other countries for HRH training in priority areas, alongside mechanisms to ensure the return and reintegration of trained professionals to serve the country. ³²⁵

The PNDS also set as intervention the mapping of the distribution of resources (human and equipment) and care units in the national health system, by geographical area and type. It further calls for the development and implementation of a human resources plan aimed at increasing the overall workforce, addressing gaps in clinical specialisation, and adapting both technical and behavioural skills to meet the evolving demands of healthcare delivery and organisational management. ³²⁶

4.1.1d Health system capacity for essential health services

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has sufficient capacity within the health system to deliver essential health services.

According to the National Health Development Plan 2023–2032, health centres across the country face serious limitations. Infrastructure and equipment are outdated or inadequate, power outages are frequent and often damage medical equipment, and there are persistent deficiencies in water supply, sanitation, and hygiene. Human resources are also insufficient to meet the level of intervention required to achieve Universal Health Coverage, with the ratio of doctors and nurses/1,000 inhabitants being below the values recommended by the World Health Organization’s (WHO). The country relies on international cooperation to deliver some services. For instance, the shortage of specialist doctors in tertiary care is addressed through regular medical missions, and when local capacity for diagnosis or treatment is exceeded, particularly in the case of cancer, patients may be evacuated to Portugal. ³²⁷

The WHO Country Cooperation Strategy 2023–2027 identifies as challenges to São Tomé and Príncipe, limited access to and quality of healthcare services, as well as critical gaps in water supply, hygiene, sanitation, and electricity in health facilities, all of which affect the functioning and capacity of health services. ³²⁸

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan to ensure continuity of essential health services during a public health emergency. No evidence was found on the Ministry of Health's website. ³²⁹

Additionally, the National Health Development Plan 2023–2032 identifies the development and operationalization of a National Emergency Plan as one of its monitoring indicators, suggesting that such a plan is still pending. ³³⁰

The National Action Plan for Health Security 2022–2026 does not reference a national emergency plan. Instead, it cites the existence of a COVID-19 Contingency Plan (2020), an Ebola Contingency Plan (2014), and a National Strategy for Disaster Risk Management (2010). None is currently available online. ³³¹³³² There is available online, however, a Contingency Plan for Dengue, published in 2022, which does not address continuity of essential health services. ³³³

The WHO's Joint External Evaluation Report for São Tomé and Príncipe of May 2019 does not refer to plans to ensure continuity of essential health services during a public health emergency. ³³⁴

4.1.2a Hospital beds per 100,000 people

Score: 76.81

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

Score: 100

There is publicly available evidence that São Tomé and Príncipe has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit and/or patient isolation room/unit located within the country.

The World Health Organization's Joint External Evaluation Report for São Tomé and Príncipe, published in 2019, states that the country has the infrastructure to impose quarantine and isolation at times of public health emergencies. ³³⁵

A 2023 Additional Financing document submitted to the World Bank describes that one of the actions planned under the ongoing World Bank-supported project is the rehabilitation of the ground floor of the Isolation Center at the country’s main hospital, Hospital Aires de Menezes, as well as the remodeling of its upper floor. ³³⁶

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has demonstrated the capacity to expand isolation facilities in response to an infectious disease outbreak within the past two years, nor that it has developed, updated, or tested a corresponding plan.

The most recent reported outbreak in the country occurred in 2022, with 103 confirmed cases of dengue fever. As dengue is not transmitted from person to person, there was no requirement for patient isolation. ³³⁷

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

Score: 100

There is publicly available evidence that São Tomé and Príncipe has a national and/or international procurement protocol or contract framework in place which can be utilized by the Ministries of Health and Agriculture for the acquisition of laboratory supplies (e.g. equipment, reagents and media) and medical supplies (e.g. equipment, PPE) for routine needs.

The 2009 Regulation on Bids and Public Procurement establishes the rules applicable to the procurement and contracting of public works, the supply of goods, and the provision of services to the State and other public entities. Although it does not specifically refer to laboratory and medical supplies, the law applies to procurement and contracting conducted by bodies and entities of the Central State Administration, including Public Institutes, National Agencies, State-Owned Enterprises or those with majority public ownership, Local Authorities, and the Autonomous Region of Príncipe. ³³⁸ Besides, the Ministry of Health publishes this law on its website under the Contracting and Procurement section. ³³⁹

According to the World Health Organization’s EMTCT Assessment Report, published in 2023, the National Medicines Fund (FNM) is responsible for procuring all pharmaceuticals and medical supplies for the Ministry of Health, including clinics and hospitals. ³⁴⁰ Decree No. 52/1998 (not available online) establishes the FNM’s responsibility to ensure the national supply of medicines, consumables, reagents, and hospital goods. ³⁴¹ The National Health Development Plan 2017–2021 also states that the FNM's mission is to guarantee equitable access to essential medical products that are safe, effective, high-quality, and cost-efficient. ³⁴² Furthermore, Service Order No. 02/DCS/2024, of 16 February 2024, requires that all public health units wishing to import essential medicines and health products must do so through the FNM, the only authorized public institution for this purpose, in accordance with Decree No. 52/98 (rule 4). ³⁴³

On the other hand, the National Health Development Plan 2023–2032 does not include laboratory or medical supplies under the FNM’s remit. It describes the FNM as operating through two main activities: direct sales of pharmaceutical products to health institutions and patients, and management of pharmaceutical stocks acquired by third parties, such as medicines for hospitalisation and emergencies funded by the Ministry of Health and epidemic-related and reproductive health products provided by WHO. A 2022 assessment found that FNM’s current level of management is a barrier to fulfilling its intended role. Accordingly, the Plan sets out the restructuring of the FNM as a necessary intervention (page 108). It also references the existence of National Purchasing Centres, though no further information about them was found. ³⁴⁴

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a stockpile of medical supplies for national use during a public health emergency. No evidence was found on the Ministry of Health’s website. ³⁴⁵

The National Health Development Plan 2023–2032 reports that the country faces stock-outs of essential medicines and inaccessibility to medical equipment. Furthermore, the Plan sets as a high-level priority intervention to support the acquisition of a reserve stock of medicines, vaccines and other health products in emergency situations. ³⁴⁶ The National Action Plan for Health Security 2022-2026 does not refer to a medical supplies stockpile. ³⁴⁷

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a stockpile of laboratory supplies for national use during a public health emergency. No evidence was found on the Ministry of Health’s website. ³⁴⁸

The National Health Development Plan 2023–2032 reports that laboratory consumables and reagents are often in short supply or even missing. Furthermore, the Plan sets as a high-level priority intervention to support the acquisition of a reserve stock of medicines, vaccines and other health products in emergencies. ³⁴⁹ The National Action Plan for Health Security 2022-2026 does not refer to a laboratory supplies stockpile. ³⁵⁰

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available evidence that São Tomé and Príncipe country conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency. No evidence was found on the Ministry of Health’s website. ³⁵¹

The National Health Development Plan 2023–2032 reports that the country faces frequent stock-outs of essential medicines, limited access to medical equipment, and shortages of laboratory consumables and reagents. As a high-level priority, the Plan proposes supporting the acquisition of a reserve stock of medicines, vaccines, and other health products for use in emergencies. In addition, it outlines several actions to ensure efficient planning, management, and supply of medicines and other health technologies. These include implementing a stock management system, organising regular meetings to review stock levels, planning and acquisitions, and training professionals in stock management. ³⁵²

The National Action Plan for Health Security 2022-2026 does not refer to an annual review of the national stockpile. ³⁵³

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has plan/agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce medical supplies for national use during a public health emergency. However, the country has a mechanism to procure and expedite the import of medical supplies through points of entry in such situations.

The National Pharmaceutical Policy 2019–2029 includes the promotion of national pharmaceutical production as one of its key guidelines. In this context, efforts will focus on creating and/or updating legislation related to the national production of medicines listed on the National Essential Medicines List, as well as herbal medicines. To support this goal, other efforts include building capacity in pharmaceutical laboratories, promoting the production of both generic medicines and the raw materials and inputs necessary for their manufacture, and identification and implementation of mechanisms to reduce reliance on international procurement. ³⁵⁴ However, the National Health Development Plan 2023–2032 notes that the country depends on imports of pharmaceutical specialities and medical devices, and that its insularity and low procurement volumes result in high purchase prices. The plan identifies as a priority intervention the establishment of a reserve stock of medicines, vaccines, and other health products for emergency situations, as well as the creation of collaborative mechanisms with other countries in the region to purchase or receive donations of these products during emergencies (page 110). ³⁵⁵
Additionally, the Analysis of the Pharmaceutical Sector, published by the Ministry of Health in 2022, states that there is no national manufacturer of pharmaceutical products and does not mention any plans to procure or expedite medical supplies during emergencies. ³⁵⁶ The National Action Plan for Health Security 2022–2026 also does not address this issue. ³⁵⁷

The Ministry of Health’s Ordinance No. 02 of 2024, which regulates the import and customs clearance of medicines and health products, establishes that any importation of such products, whether retail or wholesale, must be carried out exclusively by duly authorized importers. It also sets out the deadlines and required documentation for import procedures. However, the ordinance does not establish any mechanisms to expedite the import of medical supplies. ³⁵⁸

Regarding the mechanism to procure medical supplies, according to the COVID-19 Vaccine Introduction Plan, healthcare professionals, health programme managers, hospital pharmacy and therapeutics committees may submit special or emergency requests for medicines pharmaceutical products not on the national essential medicines list. The document also outlines the procedures for the urgent import and customs clearance of medicines and medical devices. It explains that the Pharmaceutical Department (DF), is part of the Single Window for Foreign Trade (GUCE), which plays a key role in facilitating the customs clearance process. In this sense, the DF recommends that, three days prior to the arrival of the goods, the official broker or importer submit some information on the invoice and packing list along with the expected date of arrival in São Tomé and Príncipe. Upon receipt of this documentation, the DF conducts a documentary review that must be completed within 48 hours. ³⁵⁹

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

Score: 0

There is no evidence that São Tomé and Príncipe has a plan/agreement/mechanism to leverage domestic manufacturing capacity to produce laboratory supplies, nor to procure/expedite laboratory supplies. No evidence was found on the Ministry of Health’s website. ³⁶⁰

The National Pharmaceutical Policy 2019–2029 includes laboratory reagents in its definition of pharmaceutical products. The Policy has the promotion of national pharmaceutical production as one of its key guidelines. To support this goal, efforts include building capacity in pharmaceutical laboratories, promoting the production of both generic medicines and the raw materials and inputs necessary for their manufacture, and identifying and implementing mechanisms to reduce reliance on international procurement. ³⁶¹

However, the National Health Development Plan 2023–2032 notes that the country depends on imports of pharmaceutical specialities and medical devices, and that its insularity and low procurement volumes result in high purchase prices. It adds laboratory consumables and reagents are often in short supply or even missing ³⁶² Additionally, the Analysis of the Pharmaceutical Sector, published by the Ministry of Health in 2022, states that there is no national manufacturer of pharmaceutical products and does not mention any plans to procure or expedite medical supplies during emergencies. ³⁶³ The National Action Plan for Health Security 2022–2026 also does not address these issues. ³⁶⁴

The Ministry of Health’s Ordinance No. 02 of 2024, which regulates the import and customs clearance of medicines and health products, establishes that any importation of such products, whether retail or wholesale, must be carried out exclusively by duly authorized importers. It also sets out the deadlines and required documentation for import procedures. However, the ordinance does not establish any mechanisms to expedite the import of laboratory supplies. ³⁶⁵

According to the COVID-19 Vaccine Introduction Plan, healthcare professionals, health programme managers, hospital pharmacy and therapeutics committees may submit special or emergency requests for medicines or pharmaceutical products not on the national essential medicines list. It is not clear whether this includes laboratory supplies. ³⁶⁶

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a system or mechanism for national and subnational levels for emergency logistics and supply chain management.

No evidence was found on the Ministry of Health’s website. ³⁶⁷ Neither the National Health Development Plan 2023–2032 nor the National Action Plan for Health Security 2022–2026 addresses this issue. ³⁶⁸³⁶⁹ Additionally, the 2022 Analysis of the Pharmaceutical Sector, published by the Ministry of Health, does not report the existence of such a mechanism. ³⁷⁰

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan, program, or guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency (i.e., antibiotics, vaccines, therapeutics and diagnostics). No evidence was found on the Ministry of Health’s website. ³⁷¹

Neither the National Health Development Plan 2023–2032, the Pharmaceutical Master Plan 2021–2025, nor the National Action Plan for Health Security 2022–2026 addresses this issue. ^372373374

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan in place to facilitate workforce surge in an emergency.

No evidence was found on the Ministry of Health’s website. ³⁷⁵ Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses this issue. ³⁷⁶³⁷⁷ The PNDS mentions partnerships and bilateral cooperation agreements with some countries to provide health professionals and mitigate human resource shortages, but these are not framed in the context of emergency situations. ³⁷⁸

During the COVID-19 pandemic, the country received health professionals from the European Union and Cuba. ³⁷⁹³⁸⁰

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a public plan in place to receive health personnel from other countries to respond to a public health emergency. No evidence was found on the Ministry of Health’s website. ³⁸¹

Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses this issue. ³⁸²³⁸³ The PNDS mentions partnerships and bilateral cooperation agreements with some countries to provide health professionals and mitigate human resource shortages, but these are not framed in the context of emergencies. ³⁸⁴ No information on such agreements was found on the Ministry of Health’s website. ³⁸⁵

During the COVID-19 pandemic, the country received health professionals from the European Union and Cuba. ³⁸⁶³⁸⁷

There are reports of bilateral agreements regarding the strengthening of the health system, but there is not enough information to assess whether it covers the receiving of health personnel. ^388389390

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan in place to redeploy existing health personnel within the country.

No evidence was found on the Ministry of Health’s website. ³⁹¹ Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses this issue. ³⁹²³⁹³ According to the World Health Organization’s Country Cooperation Strategy 2023–2027, during COVID-19, however, there was a need to divert human resources to the pandemic response, impacting the continuity of essential health services, quality of care and health outcomes. ³⁹⁴

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

There is publicly available evidence that São Tomé and Príncipe guarantees citizens’ right to medical care.

According to Article 50, everyone has the right to health protection and the duty to defend it. For its part, the State is responsible for promoting Public Health, which aims to ensure the physical and mental well-being of the population and their balanced integration into the socio-ecological environment in which they live, in accordance with the National Health System. ³⁹⁵ Although not explicitly, the constitutional guarantee of the right to health protection, along with the State’s duty to promote public health, implies a right to access medical care as part of that protection.

According to the National Health Development Plan 2023–2032, “Health is a constitutionally recognised social good. It is the state's responsibility to guarantee the right to and promotion of public health for all São Toméans and all those who have chosen São Tomé and Príncipe to live in.” ³⁹⁶

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

Score: 95.59

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

Score: 95.77

4.4.1d Coverage of essential health services through universal health coverage

Score: 66.67

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: 78.67

4.4.1f Rate of mortality amenable to health care

Score: 60.57

4.4.2a Guaranteed paid sick leave

Score: 33.33

São Tomé and Príncipe guarantees paid sick leave for workers.

The Labor Code, of 11 April 2019, establishes that a worker may lose wages in case of absence due to illness, unless they benefit from a social security scheme for protection against illness (Article 211). ³⁹⁷ There is no evidence that mental health problems are covered.

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has issued legislation, a policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency. No evidence was found on the Ministry of Health’s website. ³⁹⁸

Neither the National Health Development Plan 2023–2032 nor the National Action Plan for Health Security 2022–2026 addresses this issue. ³⁹⁹⁴⁰⁰

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a system in place for public health officials and healthcare workers to communicate during a public health emergency. No evidence was found on the Ministry of Health’s website. ⁴⁰¹

Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses this issue. ⁴⁰²⁴⁰³ The PNDS only refer to the communication within the Ministry of Health. According to the document, there is an urgent need to rethink the mechanisms of communication and transversal collaboration between the different directorates, offices, sections and departments that make up the Ministry (namely the Directorate of Health Care, the National Endemic Diseases Centre, the Directorate of Financial Administration, the Central Hospital and the National Medicines Fund), to enable a clear and concerted definition of health priorities, to promote strategic and coordinated planning, and to improve the quality of health. ⁴⁰⁴

However, the country has a Public Health Emergency Operations Center and in 2024 its team it took part in a training organized by the East, Central, and Southern Africa Health Community (ECSA-HC) and the World Health Organization (WHO) in Ethiopia. The training included practical emergency simulation exercises, allowing participants to apply theoretical knowledge to real-world scenarios. The training also emphasized the importance of multi-sectoral coordination. ⁴⁰⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe’s system for public health officials and healthcare workers to communicate during an emergency encompass healthcare workers in both the public and private sector.

No evidence was found on the Ministry of Health’s website. ⁴⁰⁶ Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses this issue. ⁴⁰⁷⁴⁰⁸

However, the country has a Public Health Emergency Operations Center and in 2024 its team it took part in a training organized by the East, Central, and Southern Africa Health Community (ECSA-HC) and the World Health Organization (WHO) in Ethiopia. The training included practical emergency simulation exercises, allowing participants to apply theoretical knowledge to real-world scenarios. The training also emphasized the importance of multi-sectoral coordination. ⁴⁰⁹

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe’s public health system is monitoring for and tracking the number of healthcare-associated infections (HCAI) that take place in healthcare facilities.

According to the World Health Organization’s (WHO) Joint External Evaluation Report, conducted in 2019, the main hospital in the capital city of São Tomé, Ayres de Menezes Hospital (HAM), has a Hospital Infection Control Committee and a surveillance system with an active prospective search for healthcare-associated infections (HCAIs). The report also notes that the country has an action plan for the prevention and control of HCAIs. ⁴¹⁰ However, neither the action plan nor further information on the HCAI framework at HAM was found online. ⁴¹¹

The National Plan to Combat Antimicrobial Resistance 2023–2025 outlines specific goals to address HCAIs. These include formally establishing a national branch of the Hospital Infection Control Committee; conducting a workshop to assess and update HAM’s 2019–2021 action plan for HCAI prevention and control; and promoting the implementation of an infection prevention and control programme across health facilities (page 23). ⁴¹²

4.6.1b Infection prevention and control programme

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an infection prevention and control (IPC) programme in place nationally. No evidence was found on the Ministry of Health’s website. ⁴¹³

The National Plan to Combat Antimicrobial Resistance 2023–2025 sets a series of goals, including reducing the incidence of infections through effective sanitation, hygiene, and infection prevention measures. In this sense, it establishes actions such as promoting the implementation of an IPC programme in health facilities, focusing on hand hygiene, environmental decontamination, and precautions for healthcare workers and patients; formally establishing a national body for the Hospital Infection Control Committee; and evaluating the Hospital Ayres de Menezes action plan for the prevention and control of healthcare-associated infections (2019–2021) and updating it. ⁴¹⁴ No evidence was found on the Ministry of Health’s website that these measures were implemented. ⁴¹⁵

In 2025, the Ministry of Health, with technical assistance from the World Health Organization, organized training on “hospital cleaning and disinfection” for 180 cleaning assistants across all health units in the country. The training aimed to update and enhance the knowledge of these professionals regarding hygiene processes in hospitals. ⁴¹⁶

Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses this issue. ⁴¹⁷⁴¹⁸

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan to ensure a safe environment in health facilities nationally. No evidence was found on the Ministry of Health’s website. ⁴¹⁹

The National Plan to Combat Antimicrobial Resistance 2023–2025 includes measures to support effective sanitation, hygiene, and infection prevention in health facilities. In this sense, it establishes actions such as promoting the implementation of an infection prevention and control programme in health facilities, focusing on hand hygiene, environmental decontamination, and precautions for healthcare workers and patients; formally establishing a national body for the Hospital Infection Control Committee; and evaluating the Hospital Ayres de Menezes action plan for the prevention and control of healthcare-associated infections (2019–2021) and updating it. ⁴²⁰ No evidence was found on the Ministry of Health’s website that these measures were implemented. ⁴²¹

In 2025, the Ministry of Health, with technical assistance from the World Health Organization, organized training on “hospital cleaning and disinfection” for 180 cleaning assistants across all health units in the country. The training aimed to update and enhance the knowledge of these professionals regarding hygiene processes in hospitals. ⁴²²

Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 refer to a plan to ensure a safe environment. ⁴²³⁴²⁴

The PNDS reports that health centres in the country experience frequent power outages, inadequate access to water and sanitation, and infrastructure and equipment that are either dilapidated or inadequate. According to the document, these conditions negatively affect the quality of care provided (including patient safety, confidentiality, dignity, and privacy) as well as the working conditions of healthcare professionals. ⁴²⁵

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national requirement for ethical review (e.g., from an ethics committee or via Institutional Review Board approval) before beginning a clinical trial. No evidence was found on the website of the Ministry of Health. ⁴²⁶

Although there is no evidence of such a requirement, the country has a Health Ethics Committee for Scientific Research. According to the National Health Development Plan 2023–2032, the Ministry of Health established the committee to evaluate the ethical aspects of all health research conducted in the country. However, the plan acknowledges that the committee still needs to grow and evolve into an institution capable of bringing ethical and bioethical challenges in health, such as those arising from clinical trials and other scientific research, to the attention of decision-makers and health authorities. ⁴²⁷ The committee was created in 2022 and, although no further information is available on the Ministry of Health website, it is actively involved in networks of ethics councils of Portuguese-speaking countries. ^428429430

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics. No evidence was found on the Ministry of Health’s website. ⁴³¹

According to the Pharmaceutical Master Plan 2021–2025, the country lacks standards and procedures for drug registration, quality control, import control, post-marketing surveillance, inspection, pharmacovigilance, and regulation of clinical trials. ⁴³² The National Health Development Plan 2023–2032 includes the creation and adoption of new legal and regulatory proposals for the pharmaceutical sector as a strategic intervention, including regulation to conduct clinical trials (page 109). ⁴³³ The Basic Health Law of 2018 merely states that clinical trials must always be conducted under medical supervision and responsibility, and with the patient’s consent (Article 25). ⁴³⁴

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a government agency responsible for approving new medical countermeasures (MCM) for humans. No evidence was found on the Ministry of Health’s website. ⁴³⁵

The Pharmaceutical Master Plan 2021–2025 proposes the creation of the Regulatory Authority for Pharmacy, Medicines and Medical Devices (ARFAMED), which would be responsible for overseeing and processing authorizations for the introduction of medicines into the market. ⁴³⁶ According to the National Health Development Plan 2023–2032, in the absence of a formal regulatory authority, the Pharmaceutical Department within the Ministry of Health currently performs regulatory functions for certain pharmaceutical activities. The Plan identifies approval of the draft law establishing ARFAMED as a strategic intervention (page 109). ⁴³⁷

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has an expedited process for approving medical countermeasures (MCM) for human use or recognition of approval decisions taking place elsewhere during public health emergencies. No evidence was found on the Ministry of Health’s website. ⁴³⁸

According to the Pharmaceutical Master Plan 2021–2025, the country lacks standards and procedures for drug registration, quality control, import control, post-marketing surveillance, inspection, pharmacovigilance, and regulation of clinical trials. ⁴³⁹ Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses this issue. ⁴⁴⁰⁴⁴¹

However, according to the COVID-19 Vaccine Introduction Plan, during the COVID-19 pandemic, given that the country did not have a quality control laboratory, and that vaccine testing requires properly equipped laboratories, complex analytical methods, and qualified personnel, the Pharmaceutical Department opted to recognize the results of vaccines prequalified by the WHO and those registered or approved for emergency use in the European Union. For this process, the applicant needed only to submit the technical evaluation report issued by the WHO or its regulatory authorities in the European Union. The external labeling of the vaccines was required to include the statement: “For Emergency Use”. ⁴⁴² There is no information on the Ministry of Health’s website indicating whether this was an ad hoc measure or an established mechanism. ⁴⁴³

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

Score: 100

São Tomé and Príncipe has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁴⁴⁴

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a national risk reduction strategy.

No evidence was found on the Ministry of Health’s website. ⁴⁴⁵ Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses risk reduction. ⁴⁴⁶⁴⁴⁷

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

There is evidence that São Tomé and Príncipe has a cross-border agreements, protocols, or MOUs with neighbouring countries, or as part of a regional group, with regards to public health emergencies.

In 2025, São Tomé and Príncipe joined 11 other African countries in a commitment to strengthen cross-border collaboration for the prevention, control, and response to disease outbreaks. The agreement, developed alongside development partners, civil society organizations, and health experts from across the continent, focuses on Mpox and other health emergencies. It aims to address challenges related to cross-border transmission, improve data-sharing mechanisms between countries, and facilitate coordinated management of population movements. Additionally, it is expected to mobilize financial and technical resources to support sustainable response strategies for Mpox. ⁴⁴⁸

Furthermore, as a member of the African Union, the country is a signatory to the Revised Statute of the Africa CDC and its Framework of Operation, which promotes partnership and collaboration among Member States. ⁴⁴⁹ However, this does not necessarily mean that there are specific agreements in place in the event of a public health emergency.

No further evidence was found on the Ministry of Health’s website. ⁴⁵⁰ The National Health Development Plan 2023–2032 mentions agreements with other countries that are not specifically within the scope of public health emergencies. For example, the shortage of specialist doctors in tertiary care is addressed through regular medical missions, and when local capacity for diagnosis or treatment is exceeded, particularly in cancer cases, patients may be evacuated to Portugal. However, the Plan identifies as a priority intervention, within the strategic axis for combating public health emergencies, the creation of collaborative mechanisms with other countries in the region to purchase or receive donations of medicines and other health products (page 110). ⁴⁵¹

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 0

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

No such evidence was found on the Ministry of Health’s website and Ministry of Agriculture’s Facebook. ⁴⁵²⁴⁵³ While the National Health Development Plan 2023–2032 references agreements with other countries, these do not fall within the scope of animal health emergencies. ⁴⁵⁴ Similarly, the National Action Plan for Health Security 2022–2026 does not mention any agreements of this nature. ⁴⁵⁵

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

São Tomé and Príncipe acceded to the Biological Weapons Convention on 24 August 1979. ⁴⁵⁶

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

Score: 100

São Tomé and Príncipe has submitted confidence-building measures (CBM) for the Biological Weapons Convention (CBM) in 2024 and 2025. ⁴⁵⁷

5.3.1c Submission of UNSCR 1540 reports

Score: 100

São Tomé and Príncipe submitted a United Nations Security Council Resolution (UNSCR) 1540 report in 2015. ⁴⁵⁸

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe is a member of any of these initiatives. ^459460461

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has completed a Joint External Evaluation and published a full public report in the last five years. No evidence was found on the websites of the Ministry of Health and World Health Organization (WHO). ⁴⁶²⁴⁶³

According to the WHO, the country’s most recent Joint External Evaluation dates back to 2019. ⁴⁶⁴

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe completed and published a Performance of Veterinary Services (PVS) assessment in the last five years.

There is no record for São Tomé and Príncipe on the PVS Reports database of the World Organization for Animal Health (WOAH). ⁴⁶⁵ The organization indicates that the country made an initial PVS Evaluation in 2013. ⁴⁶⁶ The evaluation is not available online.

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years.

There is no record for São Tomé and Príncipe on the PVS Reports database of the World Organization for Animal Health (WOAH). ⁴⁶⁷ The organization indicates that the country only made an initial PVS Evaluation in 2013. ⁴⁶⁸ The evaluation is not available online.

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

Score: 100

There is publicly available evidence that São Tomé and Príncipe has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.

The State Budget allocated to epidemiological surveillance STD 10.1 million (USD 481) in 2024, being STD 10 million from external funds and STD 1.1 million from internal funds. ⁴⁶⁹ In 2023, it allocated STD 4.1 million (USD 195), being STD 3 million from external funds and STD 1.1 million from internal funds. ⁴⁷⁰ In 2022, it allocated STD 7.1 million (USD 338), being STD 5.3 million from external funds and STD 1.7 million from internal funds. ⁴⁷¹

However, the Ministry of Finance's website is down at time of research.

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe’s Joint External Evaluation (JEE) report, National Action Plan for Health Security (NAPHS), or national GHSA roadmap allocate or describe specific funding from the national budget (covering either a future period or the past five years) to address identified gaps.

No such evidence was found on the Ministry of Health’s website or in the aforementioned documents. ^472473474 The NAPHS includes annual cost estimates for each technical area but does not specify national budget allocations to cover these costs. Instead, it states that advocacy for resource mobilization will be conducted with stakeholders under the "One Health" approach, and that the plan will be financed through the national budget, national partners, and international partners. ⁴⁷⁵

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has conducted a Performance of Veterinary Services (PVS) gap analysis and/or PVS assessment.

There is no record for São Tomé and Príncipe on the PVS Reports database of the World Organization for Animal Health (WOAH). ⁴⁷⁶ The organization indicates that the country only made an initial PVS Evaluation in 2013. ⁴⁷⁷ The evaluation is not available online.

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is evidence that São Tomé and Príncipe can access a publicly identified special emergency public financing mechanism and funds in the face of a public health emergency.

São Tomé and Príncipe is listed as an International Development Association (IDA) eligible borrowing country and therefore is eligible for World Bank initiatives like the pandemic financing facility, the Crisis Response Window, and the Global Crisis Management Platform, which brings together a range of crisis support instruments to IDA-eligible countries that face an outbreak. ^478479480

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

Score: 0

There is no evidence that any senior leader in São Tomé and Príncipe, in the past three years, has made a public commitment to either support other countries to improve capacity to address epidemic threats by providing financing or support or to improve the country's domestic capacity to address epidemic threats by expanding financing or requesting support to improve capacity.

There are no reports of such kind in any news outlet or on the websites and Facebook pages of the Ministry of Health or the Ministry of Foreign Affairs, Cooperation and Communities. ⁴⁸¹⁴⁸² However, while there is no public evidence that the senior leaders made a public commitment by expanding domestic financing or formally requesting support, São Tomé and Príncipe published the National Health Development Plan 2023–2032 in September 2022, which includes measures related to public health emergencies. ⁴⁸³ In addition, in 2023, the World Health Organization handed over to the São Toméan Government a new strategy, valued at €9 million, aimed at improving the quality and accessibility of health services and strengthening human resource capacities by 2027. This strategy also addresses public health emergencies and was praised by the Minister of Health. ⁴⁸⁴ The agreement was signed in September 2023. ⁴⁸⁵

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

Score: 100

There is evidence that São Tomé and Príncipe has requested financing or technical support from donors to improve the country's domestic capacity to address epidemic threats. There is no evidence that it has provided other countries with financing or technical support to improve capacity to address epidemic threats in the past three years.

According to the Global Health Security Funding Tracking Dashboard, São Tomé and Príncipe received USD 60m from 2014 to 2022. For the COVID-19 pandemic, the country received USD 20m from 2019 to 2023. ⁴⁸⁶ The Global Fund to Fight AIDS, Tuberculosis and Malaria shows that the country requested additional COVID funding in 2023, besides funding for tuberculosis, malaria and HIV. ⁴⁸⁷

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

Score: 0

There is no publicly evidence that São Tomé and Príncipe has fulfilled its full contribution to the WHO within the past two years.

According to data from 2022 and 2023, the country has a balance outstanding of USD 17,152. ⁴⁸⁸

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

Score: 0

There is no publicly available evidence that São Tomé and Príncipe has a plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with the associated epidemiological data with international organizations and/or other countries that goes beyond influenza.

No evidence was found on the Ministry of Health’s website. ⁴⁸⁹ Neither the National Health Development Plan 2023–2032 (PNDS) nor the National Action Plan for Health Security 2022–2026 addresses risk reduction. ⁴⁹⁰⁴⁹¹

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

Score: 100

There is no publicly available evidence that São Tomé and Príncipe has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years.

No evidence was found on the Ministry of Health’s website. ⁴⁹² There have not been any reports of the country not sharing samples, according to the World Health Organisation. ⁴⁹³⁴⁹⁴

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

Score: 100

There is no publicly available evidence that São Tomé and Príncipe has not shared pandemic pathogen samples during an outbreak in the past two years.

The World Health Organisation Disease Outbreak News site reports no recent outbreaks in the country, the most recent outbreak being in 2022, with 103 confirmed cases of dengue fever. At the time, a subset of 30 samples confirmed by rapid diagnostic tests were sent to an international reference laboratory in Lisbon, Portugal, for further analysis.

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 45

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 75

6.1.2a Orderly transfers of power

Score: 25

6.1.3a Risk of social unrest

Score: 50

6.1.4a Risk of terrorism

Score: 100

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 75

6.1.5a Presence or risk of armed conflict

Score: 100

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: 92.69

6.2.2a UNDP Gender Inequality Index score

Score: 42.14

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

Score: 58.44

6.2.3b Share of employment in the informal sector

Score: 0

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

Score: 66.67

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 59.3

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 50

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 18.77

6.4.2a Change in forest area (percentage points)

Score: 0

6.4.3a Natural disaster risk

Score: 25

6.5.1a Total life expectancy (years)

Score: 69.2

6.5.1b NCD mortality rate

Score: 74.68

6.5.1c Population aged 65+

Score: 83.13

6.5.1d Tobacco use (% of adults)

Score: 71.11

6.5.1e Level of adult obesity (%)

Score: 64.59

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

Score: 96.2

6.5.2a Access to potable water

Score: 0

6.5.2b Access to at least basic sanitation facilities

Score: 0

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

Score: 0

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

Score: 14.36

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