Tunisia: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

There is evidence that Tunisia currently has an active national action plan for antimicrobial resistance (AMR) that covers the surveillance, detection, and reporting of priority AMR pathogens, albeit outdated. Tunisia’s National Action Plan to Combat Antimicrobial Resistance 2019–2023 (Plan national de lutte contre la résistance aux antimicrobiens 2019–2023) addressed surveillance, detection, and reporting across human and animal health with operational strategies and coordination mechanisms, but its term has ended and no extension or successor has been published ¹²³⁴. Checks of the official websites of the Ministry of Health, the Ministry of Agriculture, and the Ministry of Environment, as well as the World Health Organization’s (WHO) library of national AMR action plans, show no updated plan beyond 2019–2023 ⁵⁶⁷⁸. Recent implementation initiatives, such as the United Nations AMR-MPTF project (2023–2026) and the 2025 partnership with the International Centre for Antimicrobial Resistance Solutions (ICARS), demonstrate continued AMR activity but do not constitute a published national plan ⁹¹⁰.

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

Score: 100

Tunisia has established a national laboratory system that conducts testing for all 7 + 1 priority antimicrobial resistance (AMR) pathogens. Per the 2022 World Health Organization (WHO) Global Antimicrobial Resistance Surveillance System (GLASS), Tunisia is a participating country which reports on all common bacteria under GLASS. ¹¹ Reporting on the 2025 edition of GLASS confirms that Tunisia is among the contributing countries. ¹² The GLASS Dashboard shows coverage for all 8 priority pathogens in Tunisia's reporting. ¹³ The WHO Joint External Evaluation (JEE) of Tunisia's International Health Regulations (IHR) core capacities, conducted in 2016, notes that Tunisia's laboratory network was capable of conducting diagnostic tests for priority pathogens, including AMR-related organisms; it did note that "Capabilities for antimicrobial sensitivity testing using standardized methods are limited." ¹⁴

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no evidence that the Tunisian government conducts environmental detection or surveillance activities (e.g., in soil, waterways) for antimicrobial residues or AMR organisms.

Per its National Action Plan to Combat Antimicrobial Resistance 2019–2023 (Plan national de lutte contre la résistance aux antimicrobiens 2019–2023, NAP), jointly prepared by the Ministry of Health and the Ministry of Agriculture, Hydraulic Resources and Fisheries, Tunisia adopted a multisectoral approach to AMR that includes human, animal, and food security sectors. However, the NAP provides only limited reference to environmental dimensions of AMR and does not outline a comprehensive system for environmental detection or surveillance of antimicrobial residues or resistant organisms (p. 12–14) ¹⁵

In May 2025, the Ministry of Health signed a Memorandum of Understanding with the International Centre for Antimicrobial Resistance Solutions (ICARS) to launch the CARMA project (Constructed Wetlands for Mitigating Antimicrobial Resistance). This project aims to reduce AMR risks in reclaimed water used for agriculture by establishing nature-based constructed wetland systems to improve effluent quality and limit the spread of resistant pathogens. The initiative represents a government-supported pilot program for environmental AMR monitoring but does not constitute a nationwide surveillance system. ¹⁶ The ICARS project page, furthermore, highlights "a lack of robust environmental detection and surveillance systems" as part of the national AMR context. ¹⁷

The Pasteur Institute of Tunis (Institut Pasteur de Tunis, IPT), in collaboration with the Ministry of Health, has begun research on integrating artificial intelligence into wastewater quality monitoring. This work seeks to strengthen prediction and early warning capacity for infectious disease outbreaks, including those linked to AMR, by enhancing wastewater surveillance methods. ¹⁸ It does not, however, constitute a national environmental surveillance system for AMR.

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

Score: 50

Tunisia has national legislation and regulation in place requiring prescriptions for antibiotic use for humans, but there is evidence of gaps in enforcement.

According to the National Action Plan to Combat Antimicrobial Resistance 2019–2023 (Plan national de lutte contre la résistance aux antimicrobiens 2019–2023, NAP), jointly prepared by the Ministry of Health and the Ministry of Agriculture, Hydraulic Resources and Fisheries, Tunisia has national legislation and regulations requiring prescriptions for the use of antibiotics in humans. The plan highlights antimicrobial stewardship in the human health sector, including strengthening regulations to ensure that antimicrobials are dispensed only with a prescription, implementing stricter controls on pharmaceutical distribution, and promoting compliance with clinical treatment guidelines (p. 18–20). ¹⁹

The 2021 TrACSS Report – Tunisia (World Health Organization, 2021) confirms that prescription requirements are in place under Tunisian law, with oversight by the Ministry of Health through the Directorate of Medicine and Pharmacy. The report notes that antibiotics are legally restricted to prescription-only medicines. However, it does not provide detailed information on systematic enforcement mechanisms or data on compliance with prescription requirements (p. 3–4). ²⁰

A 2025 International Centre for Antimicrobial Resistance Solutions (ICARS) Tunisia project overview notes on the national AMR context that "Antibiotic consumption in the country ranked second globally between 2000 and 2015", and it highlights as issues "inappropriate antibiotic use in human and veterinary medicine, limited public awareness about responsible antibiotic consumption", indicating gaps in enforcement of the national legislation. ²¹

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

Score: 50

Tunisia has national legislation and regulation in place requiring prescriptions for antibiotic use for animals, but there is evidence of gaps in enforcement.

According to the National Action Plan to Combat Antimicrobial Resistance 2019–2023 (Plan national de lutte contre la résistance aux antimicrobiens 2019–2023, NAP), jointly prepared by the Ministry of Health and the Ministry of Agriculture, Hydraulic Resources and Fisheries, Tunisia has established national legislation and regulations requiring prescriptions for the use of antibiotics in animals. The plan specifies actions for veterinary antimicrobial stewardship, including strengthening controls over the distribution of veterinary medicines, reinforcing the prescription-only status of antimicrobials, and promoting awareness campaigns targeting veterinarians and farmers (p. 19–21). ²²

The 2021 TrACSS Report – Tunisia (World Health Organization, 2021) confirms that veterinary antimicrobials are legally restricted to prescription use under Tunisian law, with oversight provided by the Ministry of Agriculture through the General Directorate of Veterinary Services (DGSV). The report further notes that Tunisia has mechanisms in place for regulation of veterinary medicines and their use. However, it does not provide detailed information on systematic enforcement or data on compliance levels (p. 4). ²³

A 2025 International Centre for Antimicrobial Resistance Solutions (ICARS) Tunisia project overview highlights "inappropriate antibiotic use in human and veterinary medicine, limited public awareness about responsible antibiotic consumption" as issues contributing to AMR challenges in Tunisia. ²⁴

1.2.1a Laws/plans on zoonotic disease

Score: 0

There is insufficient evidence of national legislation, plans, or equivalent strategy documents for zoonotic disease prioritzation, detection and reporting.

According to the Joint External Evaluation of IHR Core Capacities of Tunisia: Mission Report (World Health Organization, 2017), Tunisia has established institutional mechanisms for zoonotic disease detection and reporting, primarily through the Ministry of Health and the Ministry of Agriculture (p. 35–36) ²⁵. The JEE highlights that zoonoses such as rabies, brucellosis, and avian influenza are reported between the animal health and human health sectors, and that coordination occurs through the National Observatory for New and Emerging Diseases (ONMNE) and the General Directorate of Veterinary Services. However, the JEE notes that while reporting channels exist, there is no evidence of a formal, published national zoonotic disease priority list ²⁶.

A 2023 One Health Roadmap, developed by the Ministries of Health, Agriculture, Water Resources and Fisheries, and Environment, confirms ongoing intersectoral collaboration on zoonotic disease detection and reporting. The roadmap identifies priority actions for zoonotic disease management, including strengthening data sharing between the ONMNE and the National Center for Animal Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), as well as joint outbreak investigation protocols (p. 5–7) ²⁷. These commitments reflect planning toward enhanced detection and reporting, but they do not provide requirements or plans for zoonotic disease prioritization ²⁸.

The World Organisation for Animal Health (WOAH) Bulletin (2019) records that Tunisia’s CNVZ was accredited as a WOAH Collaborating Centre for animal disease surveillance, affirming Tunisia’s technical capacity for veterinary disease detection and reporting. However, there is insufficient evidence of a prioritization mechanism with a government-mandated list of zoonotic diseases ²⁹³⁰.

Tunisia has received Pandemic Fund support for a World Bank–implemented project on pandemic preparedness and response using a One Health approach ³¹, but no national announcements or public project documents detail specific activities for zoonotic disease prioritization. As of September 2025, there is no publicly available evidence of a government-mandated list or statutory prioritization framework for zoonotic diseases.

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

Score: 0

There is no publicly available evidence that Tunisia has national legislation, plans, or equivalent strategy documents that explicitly include measures for risk identification and reduction of zoonotic disease spillover events from animals to humans. No such evidence was found on the websites of the Ministries of Health and Agriculture. ^{32 33} A 2024 study on One Health capacities for transboundary zoonotic diseases at the Libya–Tunisia border highlights that the National Center for Animal Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) conducts surveillance of priority zoonoses and implements interventions such as quarantine and animal movement controls. However, these activities are operational in nature and research-based, rather than codified within a national legislative or strategic framework. ³⁴

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

Score: 100

There is publicly available evidence that Tunisia has national legislation, plans, or guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern.

Tunisia’s Decree 2009-2200 of 14 July 2009 addresses zoonotic diseases and includes a list of specific diseases that should be monitored and reported due to their rapid spread, economic impact, and potential for human transmission. It prescribes control measures for a broad set of animal diseases with zoonotic potential ³⁵.

According to the Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, the country has an active epidemiological surveillance system for many zoonotic diseases including avian influenza, Zika virus, and Middle East respiratory syndrome coronavirus; the system functions at national, regional, and local levels. There are also regular and ad hoc control programs aiming at “helping communities control leishmaniosis in rural Tunisia” ³⁶.

Surveillance of some zoonotic pathogens is listed on the Pasteur Institute of Tunis (Institut Pasteur de Tunis, IPT) website, including public health programs on Newcastle disease, malaria, tuberculosis, rabies, spongiform encephalopathies, and sheep pox. However, there is no evidence of a single comprehensive law, plan, or set of guidelines consolidating these programs ³⁷.

The “Basic Health Care” section of the Ministry of Health website discusses monitoring epidemiological situations and readiness to respond to epidemics, but does not reference public health programs encompassing multiple zoonotic pathogens ³⁸. The Ministry of Agriculture, Hydraulic Resources and Fisheries website provides no reference to national laws or consolidated plans on zoonoses ³⁹.

A 2024 study on One Health capacities for transboundary zoonotic diseases at the Libya–Tunisia border identified brucellosis, Rift Valley fever, and avian influenza as priority zoonoses and highlighted the role of the National Center for Animal Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) in surveillance, early warning, and cross-border coordination. This demonstrates operational capacity for multiple zoonotic pathogens but remains primarily implemented through sectoral guidelines and disease-specific contingency measures ⁴⁰.

The website of the Institute of Veterinary Research of Tunisia provides technical resources, though it does not reference any overarching strategy for the surveillance and control of multiple zoonotic pathogens of public health concern ⁴¹.

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

Score: 100

Tunisia has established a multi-sectoral coordinating mechanism for zoonotic diseases that operates across ministries. The National Center for Animal Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) functions as the central platform for animal health surveillance and zoonotic disease control. According to its official mandate, the CNVZ is responsible for collecting epidemiological data on priority zoonotic pathogens, analyzing trends, and supporting early detection and rapid response across human and animal health sectors ⁴².

The CNVZ collaborates closely with the Ministry of Health and the Ministry of Agriculture to implement One Health approaches. Its mandate includes supporting inter-ministerial planning, coordinating multisectoral field investigations, and facilitating communication between veterinary services, public health authorities, and environmental health units ⁴³⁴⁴. In 2020, the World Organisation for Animal Health (WOAH) reported that CNVZ was accredited as a WOAH Collaborating Centre, further formalizing its role as Tunisia’s national coordination hub for zoonotic disease surveillance and response ⁴⁵.

1.2.1e Presence of One Health strategic plan

Score: 100

Tunisia developed a multisectoral roadmap (“Feuille de route ‘Une Santé’”) in December 2023, prepared during a workshop organised by the ministries of Health, Agriculture / Water Resources & Fisheries and Environment, in partnership with the World Health Organization (WHO), Food and Agriculture Organization (FAO), and United Nations Environment Programme (UNEP). ⁴⁶

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

Score: 100

Tunisia has a national mechanism through which livestock owners contribute to disease surveillance, coordinated by the Ministry of Agriculture, Hydraulic Resources and Fisheries. The National Center for Animal Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) serves as the central hub for collecting, verifying, and analyzing epidemiological data from the field, including information submitted by farmers and decentralized veterinary offices ⁴⁷. The CNVZ consolidates data from local Delegations of Agriculture and Livestock Services, providing guidance to regional veterinary authorities and facilitating timely notification to national and international stakeholders ⁴⁸.

The National Action Plan to Combat Antimicrobial Resistance 2019–2023 (Plan national de lutte contre la résistance aux antimicrobiens 2019–2023) reinforces the role of veterinary services in surveillance and mentions the National Animal Identification and Registration System (Système National d’Identification et d’Enregistrement des Animaux, SNIRA) as a tool for monitoring and reporting animal health events (Section II, p. 13) ⁴⁹. Through SNIRA, livestock owners are registered, herds are tracked, and disease events can be reported to local veterinary authorities.

Recent reports from the International Centre for Antimicrobial Resistance Solutions (ICARS) and the World Organization for Animal Health (WOAH) note improvements in coordination and data integration at CNVZ, which also enhance the mechanisms by which livestock owner reports are incorporated into the national surveillance system ^{50 51}.

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

Score: 0

There is no publicly available evidence of legislation or regulations safeguarding the confidentiality of information generated through surveillance activities for animals (for owners). According to Decree No. 2009-2200 of 14 July 2009, Tunisia requires animal owners to report instances of infected animals to relevant government authorities; however, the decree does not include provisions that safeguard the confidentiality of owners’ information ⁵². Similarly, Tunisia's Food and Feed Safety Law No. 25 of 2019 specifies professional secrecy for agents involved in inspections and violations, but these provisions apply to food safety activities rather than animal surveillance ⁵³. A review of the Ministry of Health “Legal Texts Portal” shows no legislation or regulations that address the confidentiality of information generated through animal disease surveillance ⁵⁴.

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

There is evidence that Tunisia conducts surveillance of zoonotic disease in wildlife (e.g., wild animals, insects, other disease vectors), poultry and livestock.

Tunisia's National Observatory for New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), housed under the Ministry of Health, reports in a January 2023 bulletin that a virus had been “detected in mosquitoes at active entomological surveillance sites starting in May (in Sousse, Monastir, Bizerte, Kairouan).” ⁵⁵ An ONMNE document of November 2023 further provides that “Entomological investigations carried out by the Pasteur Institute of Tunis (Institut Pasteur de Tunis, IPT) team showed that the drainage canals of the oases are the source of mosquito larval habitats.” ⁵⁶

Tunisia's National Center for Animal Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) publishes a weekly bulletin which in August 2025 states “Veterinary surveillance conducted on horses, mosquitoes, and resident and wild birds confirmed the circulation of WNV.” ⁵⁷ Per its website the CNZV also conducts surveillance of foot-and-mouth disease, bluetongue disease, and avian influenza. ⁵⁸⁵⁹⁶⁰

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

Tunisia has a mechanism to report notifiable animal diseases to the World Organization for Animal Health through the national Delegate at the Directorate General of Veterinary Services and the World Animal Health Information System (WAHIS) reporting platform. ^{61 62}

WOAH confirms that the National Center for Animal Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) supports Veterinary Services. “Its main missions are: to collect and catalogue epidemiological data… and to disseminate the related information… to assist the veterinary authorities in carrying out their missions.” ⁶³

1.2.4a Number of veterinarians per 100,000 people

Score: 20.45

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

Score: 5.11

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

Score: 0

There is insufficient publicly available evidence of a national plan on zoonotic disease or other legislation, regulations, or plans that include mechanisms for working with the private sector in controlling or responding to zoonoses ⁶⁴.

The 2016 Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, discusses work plans and zoonotic committees of cooperation between human and animal health entities at both the regional and national levels ⁶⁵. However, it is unclear whether the private sector of either human or animal health agencies or actors are included in these entities. The JEE also notes that “the involvement of the (substantial and increasing) private veterinarian and medical sectors in active zoonosis surveillance and reporting should be improved (review the health delegation procedure for private veterinarians in order to increase the size of the field network)” ⁶⁶.

Further details on the content of these committees and forms of cooperation are not publicly available, and there is no evidence of such an entity on either the Ministry of Health ⁶⁷ or the Ministry of Agriculture, Water Resources, and Fisheries websites ⁶⁸.

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

Score: 50

Tunisia has a public record of biological laboratories which has been updated within the last three years. The National Accreditation Council (Conseil National d’Accréditation, TUNAC) maintains an online registry of accredited bodies with searchable entries showing current statuses and validity dates for medical biology laboratories, and the Ministry of Health hosts official laboratory directories ^{69 70}.

A webpage titled "Status report on the analysis and testing laboratories of the Ministry of Public Health and the Ministry of Agriculture and Water Resources" describes 22 regional laboratories and 4 central national labs, with general methods of operation but does not include inventory or chemical/biological stock records. ⁷¹

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is insufficient publicly available evidence that Tunisia has legislation or regulations on biosecurity that set requirements such as physical containment, operation practices, failure reporting systems, or cybersecurity of facilities ⁷²⁷³. 2016-2017 documents of the Pasteur Institute of Tunis and the World Health Organization reference the creation of technical committees and a draft legal framework, but there is no indication this was ratified into law ⁷⁴⁷⁵. Tunisia is a State Party to the Biological Weapons Convention and has submitted CBM reports, but these are not publicly accessible ⁷⁶. A review of the websites of the Ministry of Health, Ministry of Agriculture, Ministry of Defense, and UN databases did not identify new legislation addressing these requirements ⁷⁷⁷⁸⁷⁹. The United Nations Office for Disarmament AffairsBiological Weapons Convention National Implementation Measures Database page for Tunisia merely mentions that Law No. 2002-54 of 11 June 2002 on medical analysis laboratories requires an authorization for operation of medical analysis laboratories in article 8, and does not mention further or more recent laws having been published. ⁸⁰

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

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

Per 2019 Ministry of Local Affairs and Environment information, the Tunisian Association for Biosafety and Environmental Education (ATB2E) and other committees were cited as working to raise awareness on biosafety, biorisk management, and environmental education; however, it is not mentioned if they play any role in the enforcement of biosecurity legislation and regulations ⁸¹. ATB2E is a non-profit organization founded and operated by the scientific community, not a government body. ⁸²

Since 2021, official sources from the Ministry of Environment describe a consultative National Commission on Biosafety and ongoing efforts toward a national biosafety framework (including a draft biosafety law), but they do not evidence a legally established enforcement authority in force. ⁸³

Tunisia is a State Party to the Biological Weapons Convention (BWC) with Confidence-Building Measures (CBM) submitted annually through 2021-2025, but publicly available CBM postings do not identify a national agency legally responsible for domestic biosecurity enforcement ⁸⁴. According to an United Nations Institute for Disarmament Research (UNIDIR) BWC implementation overview page, "Tunisia has not established a National Contact Point for implementation of the BWC. However, other governmental departments are involved in the implementation of the Convention, including the Ministry of Defense, the Ministry of Health, the Ministry of Environment, the Ministry of Justice and the Ministry of Interior". ⁸⁵

Checks of the Ministry of Health legal texts portal and the Ministry of Agriculture website do not show legislation establishing an enforcement agency for biosecurity/biosafety or other mentions of such an agency ⁸⁶⁸⁷.

According to the Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, numerous ministries, institutes, and agencies are involved in biosafety and biosecurity management, including the Ministry of Health, Ministry of Agriculture, the Ministry of Local Affairs and Environment, and others; however, the management and enforcement role of each ministry and agency is not specified in the JEE ⁸⁸. A 2016 Pasteur Institute of Tunis (IPT) presentation noted a policy concept for a cross-ministry National Technical Commission on Biosafety, but it is unclear whether this was legally established or endowed with enforcement powers ⁸⁹.

The Verification Research, Training and Information Centre (VERTIC) BWC Legislation Database for Tunisia likewise does not provide evidence of such an agency ⁹⁰.

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

Score: 0

There is no publicly available evidence that Tunisia has undertaken national measures to consolidate inventories of especially dangerous pathogens and toxins into a minimum number of facilities. Tunisia has established and upgraded several high-containment laboratories, including a BSL-3 laboratory at the Pasteur Institute of Tunis (Institut Pasteur de Tunis, IPT) in 2021 ⁹¹, but there is no documentation that the government has acted to consolidate the number of facilities holding such materials available on the websites of the IPT, Ministry of Health, Ministry of Agriculture, Ministry of Defense. ^92939495

A webpage titled "Status report on the analysis and testing laboratories of the Ministry of Public Health and the Ministry of Agriculture and Water Resources" provides a mapping of 53 laboratories (27 under Agriculture and 26 under Health) conducting food, water, and microbiological analyses, but it does not reference consolidation of pathogen or toxin inventories ⁹⁶.

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

Score: 100

There is publicly available evidence of in-country capacity to conduct Polymerase Chain Reaction (PCR)–based diagnostic testing for anthrax, which would preclude culturing a live pathogen in Tunisia.

The Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, states that Tunisian laboratories have a demonstrated capacity for conducting PCR, culturing of bacteria and viruses, serology, and high-performance liquid chromatography (HPLC) ⁹⁷. The JEE, nonetheless, does not elaborate on whether PCR is conducted specifically for anthrax and/or Ebola. An article published in 2018 by the National Center for Biotechnology Information reports that the Laboratory of Hygiene of Sfax in southeast Tunisia uses PCR techniques in detecting Bacillus anthracis (anthrax). Samples are subsequently tested again in laboratories in the United Kingdom and France ⁹⁸.

The Pasteur Institute of Tunis (IPT) website does not provide information on the use of PCR in the monitoring activities for anthrax or Ebola ⁹⁹. The websites of the Ministry of Defense, the Ministry of Agriculture, Hydraulic Resources and Fisheries, and the Ministry of Health do not include any information on this topic ^100101102.

1.3.2a Biosecurity training using a standardised, required approach

Score: 33.33

Evidence indicates that biosecurity and biosafety trainings have been implemented in Tunisia through institutional and donor-led programs, but there is no evidene of a requirement for biosecurity training using a standardized, required approach for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The Institut Pasteur de Tunis operates a Regional Training Centre focused on quality assurance and good laboratory practices, although publicly available information does not detail a regular or standardized biosecurity training schedule tied to dangerous agents ¹⁰³. The Ministry of Health’s COVID-19 response documentation cites small-group biosafety trainings during the pandemic, which suggests ad hoc training rather than a mandated national system ¹⁰⁴.

Tunisia participated in the German-supported Biosecurity Project, initiated in 2017 under Germany's Enable & Enhance Initiative and integrated into the German Biosecurity Programme in 2023. This project included 'train-the-trainer' sessions and capacity-building on mobile diagnostics involving the Institut Pasteur Tunis (IPT) and the Directorate of Military Health ¹⁰⁵.

A BSL-3 lab was commissioned in 2021 at IPT ¹⁰⁶, but there is no documentation in ministry or institutional sources of a national requirement enforcing a common curriculum or periodic re-certification for labs working with high-consequence agents.

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

Score: 0

There is insufficient publicly available evidence of regulations or licensing conditions in Tunisia specifying that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to the following checks: drug testing, background checks, and psychological or mental fitness checks.

The Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, does not provide information on drug testing and background checks of any kind for personnel handling dangerous pathogens and toxins. The JEE does not mention that any of the relevant laws it describes, including one regarding a 1999 ad hoc committee on biosecurity, regarding a technical committee on biosecurity established in 2013 focused on the legal framework, and regarding a national committee that was planned to be finalized in 2017, mention drug testing, background checks, and psychological or mental fitness checks ¹⁰⁷.

Law 54-2002 of 11 June 2002 on laboratories of medical analysis of Tunisia, published on the Verification Research, Training and Information Centre (VERTIC) BWC Legislation Database for Tunisia, includes qualification requirements for laboratory staff, but it makes no mention of drug testing, background checks, and psychological or mental fitness checks ¹⁰⁸.

There is no information relevant to regulations or licensing conditions specifying that security and other personnel with access to especially dangerous pathogens are subject to drug testing, background checks, and psychological or mental fitness checks through the VERTIC database for Tunisia, or the websites of the Ministry of Agriculture, Hydraulic Resources and Fisheries, the Ministry of Health, the Pasteur Institute of Tunis (IPT), and the Ministry of Defence ^{109110111112113}.

Tunisia is a State Party to the Biological Weapons Convention (BWC) with Confidence-Building Measures (CBM) submitted annually through 2021-2025, but the reports are locked and not publicly available ¹¹⁴.

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

Score: 0

There is insufficient publicly available evidence that Tunisia has national regulations on the safe and secure transport of infectious substances explicitly covering Category A and Category B.

Law 97-37 of 2 June 1997 On the Transport of Dangerous Goods by Road defines hazardous substances and includes infectious substances under Class 6-2; however, the law does not reference Categories A or B as defined by WHO/IATA standards ¹¹⁵. The Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, similarly notes that Tunisian legislation addresses transport of dangerous goods but does not meet international standards on infectious substance transport, and recommends development of standard operating procedures (SOPs) for infectious substances under the International Health Regulations (IHR) ¹¹⁶.

The Ministry of Interior website lists two decrees linked to Law 97-37 — Decree No. 2002-2015 of 4 September 2002 and Decree No. 2005-3079 of 29 November 2005 — but neither explicitly addresses infectious substances Categories A or B ^117118119. The Verification Research, Training and Information Centre (VERTIC) legislation database for Tunisia does not list any relevant laws specific to Category A/B infectious substance transport ¹²⁰. The official websites of the Ministry of Agriculture, Hydraulic Resources and Fisheries ¹²¹, the Ministry of Health ¹²², the Pasteur Institute of Tunis (IPT) ¹²³, and the Ministry of Defence ¹²⁴ similarly provide no evidence of national regulations specific to the safe and secure transport of infectious substances by Category.

Tunisia is a State Party to the Biological Weapons Convention (BWC) with Confidence-Building Measures (CBM) submitted annually through 2021-2025, but publicly available CBM postings do not provide relevant details on national transport regulations ¹²⁵.

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

Score: 0

There is insufficient publicly available evidence of legislation and/or regulations in Tunisia to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential.

According to the Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, the Border Health Control Units, the Civil Aviation Authority at Airports (OACA), and the Ports and Merchant Navy Authority (OMMP) are in charge of addressing the security and health needs at points of entry; however, the JEE does not discuss transportation of pathogens or toxins explicitly ¹²⁶. Law 97-37 of 2 June 1997 On the Transport of Dangerous Goods by Road does not address transportation of dangerous pathogens, toxins, or pathogens with pandemic potential ¹²⁷. Decree No. 2002-2015 of 4 September 2002 and Decree No. 2005-3079 of 29 November 2005, both relating to the transportation of hazardous materials, do not specifically mention or address transportation of pathogens or toxins with pandemic potential ^128129130.

The “Safety, Security, and Environment” section of the Ports and Merchant Navy Authority (OMMP) website provides information on measures to mitigate the risk of transporting oil, chemical, and other dangerous products, but there is no information on the transportation of dangerous pathogens or toxins ¹³¹. The Tunisian Civil Aviation Authority (OACA) lists international aviation and transport safety measures, but none refer to pathogens or toxins ¹³². The official websites of the Ministry of Industry and Trade, the Ministry of Health, and the Ministry of Agriculture, Hydraulic Resources and Fisheries similarly do not provide evidence of legislation or regulations to oversee cross-border transfer and end-user screening of dangerous pathogens ^133134135.

Tunisia is a State Party to the Biological Weapons Convention (BWC) with Confidence-Building Measures (CBM) submitted annually through 2021-2025, but these are inaccessible to the public ¹³⁶. The Verification Research, Training and Information Centre (VERTIC) BWC Legislation Database for Tunisia notes customs controls under other laws (e.g., plant protection, customs code), but no legislation specific to oversight of the cross-border transfer and end-user screening of pathogens or toxins has been identified ¹³⁷.

1.4.1a Biosafety laws/regulations

Score: 0

There is insufficient publicly available evidence that Tunisia has in place national biosafety legislation and/or regulations.

The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, under the section on biosafety and biosecurity (safety and security of laboratories), refers to multiple committees and entities including the 1999 ad hoc committee on biosecurity, a technical committee on biosecurity established in 2013 focused on developing the legal framework, and a national committee that was planned to be finalized in 2017 ¹³⁸. However, the specific role of such committees is not outlined, and it is unclear if the biosafety legal framework was finalized and passed into law.

A 2016 Pasteur Institute of Tunis (IPT) presentation entitled “Current Regulation on Biosafety and Biosecurity in Tunisia” mentions the development of a National Legal Framework for Biosafety beginning in 1999, in accordance with the Cartagena Protocol; however, it is unclear if this framework is ratified into law ¹³⁹. The Verification Research, Training and Information Centre (VERTIC) database for Tunisia does not provide evidence of national biosafety legislation and/or regulations; neither do the websites of the Ministry of Health, Ministry of Agriculture, Hydraulic Resources and Fisheries, or the IPT ^140141142143.

As of May 2025 a draft biosafety law, drawn up with help of a consultative National Commission on Biosafety, was awaiting parliamentary approval and has not yet been enacted ¹⁴⁴¹⁴⁵. As such, no legally operative national biosafety law/regulation is in force yet.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is insufficient publicly available evidence of an established agency responsible for the enforcement of biosafety legislation and regulations.

Per 2019 Ministry of Local Affairs and Environment information, the Tunisian Association for Biosafety and Environmental Education (ATB2E) and other committees were cited as working to raise awareness on biosafety, biorisk management, and environmental education; however, it is not mentioned if they play any role in the enforcement of biosecurity legislation and regulations ¹⁴⁶. ATB2E is a non-profit organization founded and operated by the scientific community, not a government body. ¹⁴⁷

According to the World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, numerous ministries, institutes, and agencies are involved in biosafety and biosecurity management and enforcement, including but not limited to the Ministry of Health, Ministry of Agriculture, the Ministry of Local Affairs and Environment, and the Tunisian Association of Biosecurity. However, the management and enforcement role of each ministry and agency is not specified in the JEE ¹⁴⁸.

According to a document shared by the Pasteur Institute of Tunis (IPT) in 2016, there is a policy in place for establishing an inclusive, cross-ministry National Technical Commission on Biosafety that provides a mechanism for collaboration across government, private sector, and other entities. However, it is unclear if the policy creating the commission was ratified and what role each ministry plays in its implementation ¹⁴⁹.

As of May 2025 a draft biosafety law, drawn up with help of a consultative National Commission on Biosafety, is awaiting parliamentary approval, but no enactment has occurred, nor any publicly declared agency has been assigned legal enforcement powers under the biosafety legislation ¹⁵⁰¹⁵¹.

A United Nations Institute for Disarmament Research (UNIDIR) BWC implementation overview page for Tunisia does not provide evidence of an established agency responsible for the enforcement of biosafety legislation and regulations; neither do the websites of the Ministry of Health, Ministry of Agriculture, Hydraulic Resources and Fisheries, or the IPT ^152153154.

1.4.2a Biosafety training using a standardised, required approach

Score: 33.33

There is no publicly available evidence that Tunisia requires a standardized biosafety training curriculum or national framework mandating periodic certification for personnel working with dangerous pathogens. However, there is evidence of ongoing institutional-level trainings.

The Institut Pasteur de Tunis (IPT) regularly organizes biosafety and biosecurity training workshops. In 2023, it held a biosafety awareness day on February 14 and organized several related activities through its Comité d'Éthique Biomédicale (CEBM) and biosafety projects in collaboration with international partners. IPT also participated in the 2022 IB-Biosafety project, which involved biosafety training sessions for trainers from Tunisia and Libya. During COVID-19, the Ministry of Health documented repeated small-group biosafety training as part of its pandemic response, but this initiative does not constitute a formalized, recurring national requirement with curriculum standardization or re-certification ^155156157.

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence suggesting that Tunisia 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.

The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, states that the country has begun a process of developing and monitoring a storage system for toxins and pathogens, but the report does not provide information on assessments conducted on the research that is occurring on dangerous pathogens, toxins, or other dual-use research ¹⁵⁸.

The Pasteur Institute of Tunis (IPT) website and publications poral include numerous research publications about pathogens and toxins; however, there is no mention of assessments of research that is occurring on dangerous pathogens, toxins, or other dual-use research ¹⁵⁹¹⁶⁰.

The Ministry of Health, the Ministry of Agriculture, Hydraulic Resources and Fisheries, and the Ministry of Defense websites contain no information on this matter ^161162163.

The National Agency for Sanitary and Environmental Control of Products (ANCSEP) published a document entitled “Overview of the Analysis and Testing Laboratories of the Ministry of Public Health & the Ministry of Agriculture and Hydraulic Resources” to understand the current system and create a plan of action; this was the only assessment of research capabilities available, but the assessment does not specifically address dangerous pathogens, toxins, pathogens with pandemic potential ¹⁶⁴.

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

Score: 0

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

A 2016 Pasteur Institute of Tunis (IPT) presentation titled “Current Regulation on Biosafety and Biosecurity in Tunisia” discusses the National Strategy and Action Plan on Biosafety and the proposed requirements on the use of pathogens. However, the document does not discuss the use of pathogens in research and it is unclear if this plan has been implemented or whether the proposed biosecurity law and related policies have officially been approved and passed into law ¹⁶⁵.

The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, states that a national policy on biosafety and biosecurity along with pathogen control measures are being developed ¹⁶⁶. However, there is no publicly available evidence to date suggesting that the policy or the control measures have been finalized and published. The Ministry of Health, the Ministry of Agriculture, Hydraulic Resources and Fisheries, and the Ministry of Defense websites contain no information on this matter ^167168169.

A review of official portals, including the Official Gazette of Tunisia (Journal Officiel de la République Tunisienne, JORT), the national legislation portal (legislation.tn), the Ministry of Health’s Legal Texts Portal, and the Verification Research, Training and Information Centre (VERTIC) database, similarly yielded no evidence of legislation or regulations requiring oversight of dual-use or high-risk pathogen research. ^170171172173.

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

Score: 0

There is no publicly available evidence of an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research in Tunisia.

The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, although states that a national policy on biosafety and biosecurity along with pathogen control measures are being developed, does not provide information on an agency responsible for oversight of research with especially dangerous pathogens or dual-use research ¹⁷⁴.

The Pasteur Institute of Tunis (IPT) published a slide deck in 2016 entitled “Current Regulation on Biosafety and Biosecurity in Tunisia”, which discusses the National Strategy and Action Plan on Biosafety. Although the slides mention the Ministry of the Environment and Sustainable Development and other relevant agencies as part of the framework, there is no mention of oversight of research on dangerous pathogens or dual-use research ¹⁷⁵.

The National Agency for Sanitary and Environmental Control of Products (ANCSEP), the Ministry of Health, the Ministry of Agriculture, Hydraulic Resources and Fisheries, and the Ministry of Defense websites contain no information on this matter ^176177178179.

A review of the Official Gazette of Tunisia (Journal Officiel de la République Tunisienne, JORT), the national legislation portal Legislation.tn, the Ministry of Health’s Legal Texts Portal, the Verification Research, Training and Information Centre (VERTIC) legislation database, the BWC eCBM portal, and a United Nations Institute for Disarmament Research (UNIDIR) BWC implementation overview page yielded no evidence of an agency assigned this oversight role. ^{180181182183184185}

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

Score: 0

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

The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published in 2017, mentions that the Cartagena Protocol on the prevention of biotechnological risks, which was ratified in 2002 by the Tunisian government, but does not provide information on legislation or regulation that requires the screening of synthesized DNA before it is sold ¹⁸⁶.

Tunisia is a party to the Convention on Biological Diversity since December 1993. The Cartagena Protocol is an international agreement that aims to ensure the safe handling, transport, and use of living modified organisms (LMOs); however, it does not mention regulations requiring screening of synthesized DNA before it is sold ¹⁸⁷.

The Draft Law on Biosecurity in Tunisia, meant to ratify and implement the National Biosafety Framework to fulfill Tunisia’s obligations under the Cartagena Protocol, discusses genetically modified organisms, pathogens, and invasive alien species, but does not mention synthetic DNA specifically ¹⁸⁸.

The websites of the Ministry of Health, the Ministry of Agriculture, Hydraulic Resources and Fisheries, and the Ministry of Defence contain no up-to-date information on this matter. ^189190191

Similarly, a review of the Official Gazette of Tunisia (Journal Officiel de la République Tunisienne, JORT), the national legislation portal, the Ministry of Health’s Legal Texts Portal, the Verification Research, Training and Information Centre (VERTIC) legislation database ¹⁹², and a United Nations Institute for Disarmament Research (UNIDIR) BWC implementation overview page yielded no evidence of a regulation requiring synthesized DNA screening prior to sale. ^{193194195196197}

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 50

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

Score: 100

Official foot-and-mouth disease (FMD) vaccination figures for livestock in Tunisia are publicly available through the OIE database. The World Organization for Animal Health (WOAH) World Animal Health Information System (WAHIS) database shows surveillance and control measures for Tunisia, and under "offical vaccination data" figures are displayed for FMD. ¹⁹⁸

1.6.1c Equitablenature of national immunization strategy/plan

Score: 0

Tunisia has a national immunization plan that ensures equitable distribution of vaccines, but there is no publicly available evidence that it includes specific strategies aimed at overcoming socioeconomic inequalities, geographic barriers, cultural or linguistic differences, or gender-related barriers to vaccination.

The Immunization Multiyear Plan 2019–2024 is referenced in the World Health Organization (WHO) Evaluation of the WHO Contribution in Tunisia 2019–2023 – Annexes, confirming the existence of a national immunization strategy supported by WHO and national health authorities [1]. The plan guides implementation of the Programme National de Vaccination (PNV), which is fully financed by the State and implemented through Tunisia’s network of primary health-care centers under the Basic Health Care Directorate (Direction des Soins de Santé de Base) [2–4. These arrangements demonstrate a system designed for equitable and free vaccine distribution across the country. UNICEF also reports that Tunisia's cold-chain system ensures safe and equitable access to immunization services nationwide [5].

There is no indication in WHO or Ministry of Health publications that a successor or follow-up plan beyond 2024 is currently in development or pending approval [1][5].

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

Score: 0

There is no publicly available evidence that Tunisia's national immunization strategy/plan includes measures to address vaccine hesitancy and build public trust in vaccines.

Tunisia undertook extensive risk communication and community engagement during the COVID-19 vaccination campaign, including communication strategies led by the Ministry of Health and partners ^{199 200}. There is no general immunization strategy document available on the website of the Ministry of Health, however, to show that the national immunization strategy/plan incorporates specific measures to address vaccine hesitancy and build public trust across all routine immunizations ²⁰¹. UNICEF in 2023 reported support to vaccination communication campaigns and community engagement to strengthen the immunization system, but these references do not demonstrate that such measures are embedded in the national routine immunization strategy/plan ²⁰².

There is no indication in World Health Organization or Ministry of Health publications that a successor immunization plan is under development that would incorporate explicit vaccine‑hesitancy or trust-building strategies. ^203204205

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Tunisia has a national advisory group that provides technical guidance and advice on the immunization strategy/plan to government.

A Ministerial Order of 4 May 2010 established the Comité technique de Vaccination as a technical advisory committee to the Ministry of Health with mandates to analyze adopted plans, propose strategies, follow the implementation of the Programme National de Vaccination, and provide scientific advice on vaccines. The committee must meet at least twice per year and submit minutes to the Minister of Health ²⁰⁶. Recent WHO documentation also shows active engagement of national immunization advisory groups in Tunisia through the Subregional Workshop for National Immunization Technical Advisory Group (NITAG) Chairs, EPI Managers and Influenza Focal Points on Influenza Vaccination Programmes, Policy and Evidence Review, hosted in Tunis from 12 to 14 February 2024 ²⁰⁷.

Tunisia self reported having a NITAG to the WHO. ²⁰⁸

1.6.1f Presence of an immunization programme for influenza

Score: 100

There is evidence that Tunisia has an immunization programme for influenza.

Tunisia conducts seasonal influenza vaccination campaigns each year as per Ministry of Health epidemiological bulletins documenting these campaigns ²⁰⁹. A 2022 Ministry presentation emphasizes vaccination of high-risk populations and health workers as part of seasonal prevention ²¹⁰. The Pasteur Institute of Tunis (Institut Pasteur de Tunis, IPT) also offers the seasonal influenza vaccines Fluarix and Vaxigrip with guidance that one dose is given and renewed annually ²¹¹. In February 2024, WHO and partners convened a workshop in Tunis with NITAG chairs and influenza focal points on influenza vaccination programmes and policy ²¹².

Availability and protocols: Seasonal influenza vaccines are available annually in Tunisia via public campaigns and through authorized providers such as the IPT; campaigns are directed at high-risk groups and health workers ^213214215. The 2022-2023 epidemiological bulletin noted slow campaign uptake due to vaccin hesitancy ²¹⁶.

1.7.1a Strategy/plan for resilience of health system

Score: 0

There is insufficient publicly available evidence that Tunisia has a strategy to develop a health system that is resilient to climate change and changing seasonal weather patterns, including the threat of infectious diseases.

Tunisia’s 2019 “National Adaptation Plan (NAP) Readiness” project, developed under the UNDP and Green Climate Fund framework, sets the groundwork for a full National Adaptation Plan and outlines actions to integrate climate risk into sectoral strategies including health. The NAP Readiness proposal includes specific commitments to enhance surveillance of climate-sensitive diseases, strengthen health infrastructure resilience, and incorporate adaptation into health system planning (page 4) ²¹⁷. A 2023 project summary published by the Green Climate Fund confirms that this process was initiated in 2019 and remained active, but no published strategy document was found ²¹⁸.

Tunisia’s Long-Term Carbon Neutral and Climate Resilient Development Strategy by 2050 identifies the health sector as one of the most vulnerable to climate impacts and emphasizes the need to reduce climate-related disease burdens, increase prevention capacity, and improve system resilience ²¹⁹. In parallel, the Ministry of Environment published a 2022 sectoral summary noting the health sector’s vulnerability to vectorborne and waterborne diseases and extreme heat events, and reaffirmed adaptation measures in health as a national priority ²²⁰. A July 2024 update from the Ministry of Environment confirms that the Ministry of Health is in the process of developing a new National Adaptation Plan for the health sector, which includes actions on surveillance, environmental exposure monitoring, and resilience integration ²²¹.

No published strategy document specific to health adaptation was identified on the websites of the Ministry of Health and the Ministry of Environment ²²²²²³.

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

Score: 0

There is insufficient publicly available evidence that Tunisia’s national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 core tests defined by the World Health Organization (WHO).

The 2025-published WHO evaluation “Evaluation of the WHO contribution in Tunisia 2019-2023 (Annexes)” includes that Tunisia has maintained capacity in its laboratories for priority disease diagnostics, including molecular methods and serological testing for diseases such as measles, polio, influenza (among core tests) ²²⁴. Additionally, the “Genome Tunisia Project” (2024) shows significant investment in sequencing capacity, infrastructure, and molecular diagnostics, which supports the ability to perform core tests that require molecular biology (e.g., PCR) ²²⁵.

According to Tunisia’s evaluation under the WHO’s Strategic Partnership for Health Security and Emergencies (SPAR) framework, as of 2024, the country scored 100% under Indicator C.5: Laboratory, suggesting sufficient capacity, but the evaluation does not mention a number of tests or name any of them. ²²⁶

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

There is evidence that Tunisia has a national plan for conducting testing during a public health emergency, but there is insufficient evidence that it includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated in June–July 2022, resulting in a revised NAPHS for 2022–2026. ²²⁷ However, there is no publicly available evidence that the NAPHS explicitly includes provisions for testing novel pathogens, scaling testing capacity, or defining testing goals: As of September 2025, no NAPHS document or equivalent testing plan is available on the websites of the Ministry of Health, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), the Ministry of Agriculture, or the Ministry of Environment, nor on the World Health Organization’s (WHO) NAPHS portal ^{228229230231232233}.

Tunisia has received Pandemic Fund support for a World Bank–implemented project launched in May 2025 that aims to strengthen surveillance and laboratory systems under a One Health approach ²³⁴²³⁵. Public project descriptions from the Pandemic Fund confirm activities such as “standardizing disease investigation systems, mapping disease vectors and public health threats, updating lists of notifiable diseases, and conducting simulation exercises for various outbreak scenarios” ²³⁶. A World Bank press release announcing the same project also highlights objectives of enhancing preparedness and response capacities ²³⁷. However, neither the Pandemic Fund project documents nor the World Bank announcement provide evidence of testing strategies for novel pathogens, defined testing goals, or explicit scaling provisions ²³⁸²³⁹.

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

Score: 0

There is no evidence that Tunisia has a national laboratory that serves as a reference facility which is accredited. Tunisia has an established accreditation system through the Tunisian Accreditation Council (TUNAC), which supports ISO 15189 accreditation for medical laboratories ²⁴⁰. However, although Tunisia has made arrangements and continues efforts toward ISO 15189 accreditation, no national reference laboratory is yet publicly documented as fully accredited under this standard. Notably, national media have reported that the Pasteur Institute of Tunis, which serves as the country’s main national reference laboratory, is actively pursuing ISO 15189 accreditation and is reportedly in the final phase of publishing its accreditation results ²⁴¹²⁴².

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

Score: 100

There is publicly available evidence that Tunisia has a national laboratory serving as a reference facility that is subject to external quality assurance review. The Proficiency Testing Tunisia (PTTn) program, accredited by the Tunisian Accreditation Council (TUNAC) under ISO/IEC 17043, organizes inter-laboratory comparisons and proficiency testing schemes for Tunisian laboratories, providing external quality assurance in compliance with international standards ²⁴³²⁴⁴. The Pasteur Institute of Tunis (Institut Pasteur de Tunis, IPT), which functions as Tunisia’s main national reference laboratory, is recognized as a central biomedical facility and has pursued ISO 15189 accreditation ^245246247.

2.2.1a Nationwide specimen transport system

Score: 100

There is publicly available evidence that Tunisia has a nationwide specimen transport system. In the WHO’s SPAR (State Party Self-Assessment Annual Reporting) submission for Tunisia in 2024, the capacity for specimen referral and transport system (Indicator C.5.1) is scored at 100%, indicating that the specimen transport/referral system is functioning at a national level ²⁴⁸. The World Health Organization's Joint External Evaluation (JEE) of Tunisia's International Health Regulations (IHR) core capacities, conducted in 2016, also shows sample transportation for measles, rubella, influenza, and polio covering more than 80% of the country ²⁴⁹.

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

Score: 0

There is no publicly available evidence of a plan to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale up testing during an outbreak in Tunisia. The Tunisian Accreditation Council (TUNAC) is a public body tasked with evaluating and accrediting laboratories, inspection, and certification bodies according to national and international standards, but its website does not provide evidence of an emergency mechanism for expedited authorization of laboratories during outbreaks ²⁵⁰. Regulations on the licensing of private medical laboratories exist, but they do not reference procedures for rapid authorization in the context of epidemics ²⁵¹.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the NAPHS document itself is not publicly accessible on the websites of the Ministry of Health, the Ministry of Agriculture, Hydraulic Resources and Fisheries, the Ministry of Environment, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ^{252253254255256257}, allowing no confirmation of whether the updated NAPHS includes a plan to rapidly authorize or license laboratories during outbreaks.

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

Score: 50

There is evidence that Tunisia conducts ongoing event-based surveillance and indicator-based surveillance, but there is insufficient publicly available evidence that data are analyzed on a daily basis.

According to the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), Tunisia’s integrated computerized epidemiological surveillance plan includes “intelligence épidémique” with integration of event-based surveillance (EBS) and WHO’s EIOS, and platforms such as SORMAS and SATURNE for collection, analysis and management of outbreak data (2023 presentation by the ONMNE Director General) ²⁵⁸. ONMNE’s publications show recurring surveillance bulletins (e.g., seasonal influenza and West Nile virus), indicating routine indicator-based monitoring and event verification; however, these sources do not specify daily analysis cadence ²⁵⁹.

A 2016 Ministry of Health influenza surveillance guide also describes the use of global electronic systems (FluNet/FluID), confirming structured indicator-based surveillance streams ²⁶⁰. In addition, a World Bank health system strengthening project document published in 2025, co-implemented with the Ministry of Health, refers to activities to strengthen event-based data collection and advanced data management under the section “Amélioration de la surveillance épidémiologique” ²⁶¹. In its 2024 State Party Annual Report (SPAR), Tunisia self-reported a score of 80 for indicator- and event-based surveillance.

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 Tunisia maintains an International Health Regulations (IHR) National Focal Point mechanism for reporting to WHO within required timelines. The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Tunisia (2016) indicates that Tunisia has an established “National IHR Focal Point (NFP)” and a functional mechanism for IHR coordination, communication, and reporting. ²⁶² WHO’s Eastern Mediterranean Regional Office reports on a national workshop where Tunisia’s National IHR Focal Point (Ministry of Health) participated, explicitly identifying the official as the National IHR Focal Point and describing actions to advance IHR implementation ²⁶³. In Tunisia's 2024 IHR States Parties Self-Assessment Annual Reporting Tool assessment, the indicator "National IHR Focal Point functions" received a score of 80%. ²⁶⁴

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 0

There is insufficient publicly available evidence that Tunisia operates a standardized electronic reporting surveillance system at both the national and sub-national levels that collects ongoing data and allows for disaggregation and analysis by variables such as age or ethnicity. The World Health Organization’s Joint External Evaluation (JEE) for Tunisia, conducted in 2016, noted the limited use of electronic reporting systems across health services and surveillance units, and did not provide evidence of nationally integrated or routinely disaggregated electronic surveillance outputs ²⁶⁵.

A 2023 presentation by the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE) confirms that Tunisia is in the process of deploying two separate electronic systems—SORMAS for case and contact management, and SATURNE for health monitoring and outbreak response—but does not indicate that either system is fully operational nationwide or extended to all sub-national levels (see pp. 13–19) ²⁶⁶.

No publicly available evidence has been found on the websites of the Ministry of Health, ONMNE, the National Center for Veterinary Health Surveillance (CNVZ), the Institut Pasteur de Tunis, or the Tunisian Accreditation Council confirming implementation of a standardized nationwide electronic reporting surveillance system that spans both central and local levels ^{267268269270271}.

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

Score: 0

There is publicly available evidence of national efforts to establish electronic surveillance platforms for collecting and managing outbreak data, but there is insufficient evidence that Tunisia’s systems currently ingest real-time laboratory data or allow nationwide disaggregation by age, ethnicity, or similar variables.

A 2023 presentation by the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE) states that Tunisia is working to implement an integrated computerized surveillance system using SATURNE (for health monitoring and response) and SORMAS (for case and contact management), with the aim of interoperability with laboratory networks; however, the slides refer to these features as part of an ongoing integration process rather than a fully operational national system (see pp. 13–19) ²⁷². The presentation discusses linking to “Réseaux de laboratoires,” but does not confirm active ingestion of real-time lab data or demographic disaggregation functionalities at the national level ²⁷³.

A 2016 Ministry of Health guide on influenza surveillance references the use of FluNet and FluID for electronic indicator-based data reporting, which confirms electronic data flows but not comprehensive laboratory data integration or disaggregated analysis capacities across diseases ²⁷⁴. Overall, Tunisia has laid the groundwork for electronic disease surveillance but lacks publicly available evidence of nationwide real-time lab data ingestion and routine disaggregation by age, ethnicity, or other criteria ²⁷⁵²⁷⁶.

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within Tunisia, although there is limited evidence on whether this is at the national level or ongoing.

The AI4PEP programme titled "A Responsible Artificial Intelligence-driven Initiative for Tackling Waterborne Pathogen (re)Emergence in Tunisia (INTERACT)" is aimed at: 1. Establishing a list of high-priority waterborne pathogens in tight coordination with the Ministry of Health, 2. Implementing guidelines for an efficient Data collection process for responsible AI implementation, 3. Building AI models that correlate disease cases with real-time Data / indicators and highlight possible hotspots, 4. Deploying validated models through a publicly available information platform, 5. Implementing on-the-ground validation to confirm risky regions or outbreaks, and 6. Getting insights about the efficacy of treatments employed in the studied wastewater plants against the selected waterborne pathogens, especially for agriculture water reuse.²⁷⁷

Moreover, the WHO states that at 12 national laboratories in Egypt, the Islamic Republic of Iran, Iraq, Jordan, Kuwait, Morocco, Oman, Pakistan, Saudi Arabia, Sudan, Syria and Tunisia, polioviruses isolated from fecal samples collected from AFP cases are tested using standardized procedures and reagents. However, it states that there are seven environment surveillance laboratories across the Region, in Egypt, Jordan, the Islamic Republic of Iran, Kuwait, Pakistan, Sudan and Syria, and does not name Tunisia as having an ES labs.²⁷⁸

A research paper from 2023, analysed 242 sewage samples that were collected between June 2019 and May 2020 from different lines of wastewater treatment procedures implemented in the five wastewater treatment plants investigated to detect enteroviruses and SARS-CoV-2. ²⁷⁹

The WHO EMR Polio Bulletin from May 2026 documents monitoring of polio in the country.²⁸⁰

Finally, in 2023, the French Development Agency (AFD) (coordinated by the Pasteur Institute in collaboration with the Obépine Scientific Interest Group (GIS)), launched the ATLANTES (Alliance for the Extension of Pathogen Surveillance in Wastewater) project. ²⁸¹ Phase one of the project focused on the design and preparation of wastewater sampling engineering system. Meanwhile, phase two focused on the operational implementation of wastewater monitoring, and is a pilot project for wastewater monitoring deployed in Guinea, Morocco, and Tunisia.

2.4.1a Common usage of electronic health records

Score: 50

There is publicly available evidence that electronic health records (EHRs) are in use in Tunisia, but they are not yet commonly used nationwide. The Ministy of Health's draft National Health Policy (Projet de Politique Nationale de Santé, PNS) 2023–2030 highlights digitalization of health services and includes commitments to introduce electronic medical records and hospital information systems. ²⁸² A 2022 United Nations Economic and Social Commission for Western Asia (UN ESCWA) National Digital Development Review Report (NDDR1) confirms that Tunisia’s digital health strategy includes deploying electronic medical records in some public health facilities and upgrading hospital information systems. ²⁸³

2.4.1b Public health system access to individual electronic health records

Score: 0

There is insufficient publicly available evidence that the national public health system in Tunisia has routine access to the electronic health records (EHRs) of individuals. The draft National Health Policy (Projet de Politique Nationale de Santé, PNS) 2023–2030 highlights digitalization of health services and introduces commitments to electronic medical records and hospital information systems, but does not confirm current access to EHRs ²⁸⁴. A 2022 United Nations Economic and Social Commission for Western Asia (UN ESCWA) National Digital Development Review Report (NDDR1) indicates that Tunisia’s digital health strategy includes deploying electronic medical records in some public health facilities and upgrading hospital information systems ²⁸⁵. However, these sources do not document nationwide public health system access to individual EHR data. No further evidence has been identified on the websites of the Ministry of Health of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), or the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) ^286287288.

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is insufficient publicly available evidence of nationally implemented health data standards in Tunisia that ensure comparability across electronic health systems. Tunisia participates in international standardization through the Institut National de la Normalisation et de la Propriété Industrielle (INNORPI), which represents Tunisia at ISO and oversees national adoption of standards ²⁸⁹. The draft National Health Policy (Projet de Politique Nationale de Santé, PNS) 2023–2030, however, acknowledges weaknesses in health information systems, including lack of interoperability, standardized data collection, and unified management, underscoring the absence of implemented national data standards ²⁹⁰. As of September 2025, no additional evidence has been identified on the websites of the Ministry of Health, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), or the Centre National de Veille Zoosanitaire (CNVZ) to confirm the application of data standards for comparability. ^291292293

2.4.2a Data sharing mechanisms

Score: 0

There is insufficient publicly available evidence of established mechanisms at the relevant Tunisian ministries for systematic data sharing across human, animal, and wildlife surveillance.

The World Health Organization (WHO) Joint External Evaluation (JEE) for Tunisia (2017) noted that information is exchanged between the Ministry of Health, the Ministry of Agriculture, and the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), or the Centre National de Veille Zoosanitaire (CNVZ) for diseases such as rabies, brucellosis, and avian influenza, but did not document formalized institutional mechanisms for data sharing (pp. 35–36) ²⁹⁴.

The WHO National Bridging Workshop (NBW) Tunisia Roadmap (2023) highlights multisectoral collaboration, including commitments to strengthen data sharing between ONMNE and the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ) and to establish joint outbreak investigation protocols (pp. 5–7) ²⁹⁵. Tunisia has also received Pandemic Fund financing for a World Bank-implemented One Health project to strengthen surveillance and laboratory systems ²⁹⁶. However, as of September 2025, no publicly available evidence has been identified on the websites of the Ministry of Health of Tunisia, the ONMNE, the CNVZ, the Institut Pasteur de Tunis (IPT), the Ministry of Agriculture, or the Ministry of Environment that confirms the existence of a formal, operational data-sharing mechanism covering human, animal, and wildlife surveillance ^{297298299300301}.

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

Score: 100

There is publicly available evidence that Tunisia makes de-identified health surveillance data on infectious diseases accessible through reports on government websites. The World Health Organization (WHO) Joint External Evaluation (JEE) for Tunisia (2016) references national surveillance systems, but did not specify public data publication ³⁰². However, the Ministry of Health of Tunisia publishes epidemiological bulletins that present aggregated infectious disease surveillance data, such as the Relevé Épidémiologique Décembre 2022–2023 ³⁰³. A review of the websites of the Ministry of Agriculture, Hydraulic Resources and Fisheries, and the Pasteur Institute of Tunis did not identify additional publicly available de-identified datasets or regular reports ³⁰⁴³⁰⁵.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is publicly available evidence of legislation and/or regulations that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities in Tunisia. Law No. 2004-63 of 27 July 2004 on the Protection of Personal Data is Tunisia's primary legislation governing the collection, processing, and safeguarding of personal data, including health data. Article 14 prohibits the processing of personal data revealing health status unless explicit consent is given, or the processing is necessary for public interest, scientific research, or protection of vital interests. Chapter V (Articles 53–74) applies specifically to personal data processed by public health institutions and public authorities when exercising public power ³⁰⁶.

In March 2022, Tunisia established the National Authority for the Protection of Personal Data (INPDP) as an independent regulatory body tasked with monitoring compliance with Law No. 2004-63 and strengthening enforcement mechanisms ³⁰⁷. The 2016 Joint External Evaluation of IHR Core Capacities of Tunisia: Mission Report, published by the World Health Organization in 2017, does not provide information on health data privacy, and no more recent evidence has been identified through the Ministry of Health or Pasteur Institute of Tunis websites as of 2025 ^308309310.

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

Score: 0

There is no publicly available evidence of legislation or regulations in Tunisia that specifically safeguard the confidentiality of identifiable health information generated through health surveillance activities, while also including protections from cyberattacks. Tunisia’s Law No. 2004-63 of 27 July 2004 on the Protection of Personal Data regulates the collection and processing of personal information, including health data, but does not include cybersecurity provisions ³¹¹. Tunisia has also enacted general cybersecurity laws, including Law No. 2004-5 of 3 February 2004 on the protection of computer systems and networks and Circular No. 19 of 11 April 2007 mandating cybersecurity measures in public institutions ³¹². In addition, Decree-Law No. 2022-54 on Cybercrime introduced new penalties and frameworks addressing cyberattacks and digital security ³¹³. However, these measures do not establish specific safeguards for health surveillance data. No further evidence has been identified on the websites of the Ministry of Health of Tunisia or the Institut Pasteur de Tunis ³¹⁴³¹⁵.

2.4.5a Cooperative commitments or agreements within regions

Score: 50

There is evidence of a commitment to share surveillance data for at least one disease, via participation in WHO’s global influenza surveillance platforms. The Ministry of Health’s influenza guidance describes use of WHO’s FluNet/FluID systems as part of national surveillance, which entail reporting surveillance data to the global network and, by extension, international partners during events of concern ³¹⁶. More recent National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE) materials emphasize the aim of integration with international networks and intelligence systems, but do not specify additional disease-specific data-sharing agreements beyond influenza ³¹⁷. In June 2024, Tunisia joined an Africa CDC initiative to pilot Geographic Information System (GIS) mapping for laboratory capacities among North African countries, which supports regional data sharing and strengthens cross-border cooperation in outbreak preparedness ³¹⁸. As a signatory of the International Health Regulations (IHR 2005), Tunisia is obligated to notify the World Health Organization (WHO) of public health events that may constitute a public health emergency of international concern. However, this legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries. ³¹⁹

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 of a national system in Tunisia that provides structured support at the sub-national level (e.g., training, metrics standardization, or financial resources) to conduct contact tracing in the event of an active or future public health emergency. While contact tracing was applied during outbreaks such as COVID-19 through ad hoc measures, no formalized nationwide framework has been identified to ensure sustained sub-national support. The World Health Organization Joint External Evaluation (JEE) for Tunisia (2016) does not provide information on contact tracing systems or national-level support mechanisms ³²⁰.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ^{321322323324325326327}, allowing no confirmation of whether the updated NAPHS includes provisions for supporting sub-national systems for contact tracing.

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

Score: 0

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

The Ministry of Health’s COVID-19 portal, the Institut Pasteur de Tunis, and the Ministry of Defense provided information on health measures and quarantine protocols during the COVID-19 pandemic, but no evidence of sustained nationwide policies guaranteeing economic support or combined medical and economic wraparound services has been identified ^328329330.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ^{331332333334335336337338}, allowing no confirmation of whether the updated NAPHS includes provisions for wraparound services.

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence of a joint plan or cooperative agreement between the public health system and border control authorities in Tunisia to identify suspected and potential cases in international travelers and to trace and quarantine their contacts in the event of a public health emergency. During the COVID-19 pandemic, Tunisia introduced ad hoc measures for international travelers, including requirements for negative PCR tests and mandatory quarantine, but these were not part of a formalized cooperative framework between health and border authorities ³³⁹³⁴⁰.

The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published 2017, also does not reference such arrangements ³⁴¹. A review of the Ministry of Health, Pasteur Institute of Tunis, Ministry of Defense, and Ministry of Transport websites provides no additional evidence of a joint plan or agreement ^342343344345.

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

Score: 100

There is evidence that Tunisia operates an applied epidemiology training program, but no evidence that resources are provided by the government to send citizens to another country to participate in applied epidemiology training programs.

The 2016 Joint External Evaluation (JEE) for Tunisia, published 2017, noted Tunisia’s engagement with MediPIET, FETP Morocco, and universities in Belgium, France, and the United Kingdom during the establishment of its program (pp. 34–35) ³⁴⁶. The Ministry of Health of Tunisia and the National Observatory for New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), with support from the Eastern Mediterranean Public Health Network (EMPHNET), launched the Tunisia FETP in 2017 ³⁴⁷. EMPHNET reports and communications from 2023 confirm that the program remains active with intermediate and basic level cohorts, contributing to outbreak investigations and field epidemiology training in Tunisia ³⁴⁸³⁴⁹.

Tunisia is among the countries to which Morocco’s FETP is offerd, but there is no evidence that the Tunisian government provides resources to send citizens to this program ³⁵⁰. As of September 2025, the Ministry of Health of Tunisia and the Pasteur Institute of Tunis do not provide additional updates on their websites ³⁵¹³⁵².

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is evidence that the Tunisia Field Epidemiology Training Program (T-FETP) is inclusive of animal health professionals. The first T-FETP cohort, launched in 2017 by the Ministry of Health in collaboration with the National Observatory for New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE) and the Eastern Mediterranean Public Health Network (EMPHNET), included 14 physicians and 1 veterinarian ³⁵³. EMPHNET reports that subsequent cohorts have continued to include veterinarians and other animal health sector professionals, reflecting a multisectoral One Health approach ³⁵⁴. EMPHNET announcements confirm that the program remains active, with basic and intermediate-level training and participation of veterinary professionals ³⁵⁵³⁵⁶.

In addition, Tunisian veterinarians are eligible to participate in the Morocco Field Epidemiology Training Program, which is open to professionals from across the region ³⁵⁷. The Ministry of Health and the Pasteur Institute of Tunis do not provide additional information on veterinary participation ³⁵⁸³⁵⁹.

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

Score: 0

There is no publicly available evidence confirming that Tunisia has at least 1 trained field epidemiologist per 200,000 people. The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published 2017, documented plans to expand epidemiology training but did not provide workforce ratios ³⁶⁰. The Tunisia Field Epidemiology Training Program (T-FETP), launched in 2017, enrolled 15 participants in its first cohort, including 14 physicians and 1 veterinarian ³⁶¹. EMPHNET reports that additional cohorts have been trained since then, at both basic and intermediate levels ³⁶², and recent updates confirm continued activity but without mentioning numbers of graduates ³⁶³³⁶⁴.

Per its population of around 12 million people Tunisia would require 60 trained field epidemiologist to have 1 field epidemiologist per 200,000 people. However, no official source provides aggregate numbers of graduates or workforce density figures, and reviews of Ministry of Health and Pasteur Institute websites show no data on the total epidemiology workforce ³⁶⁵³⁶⁶.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

There is evidence of an overarching national public health emergency response plan in Tunisia, but the plan is not publicly available.

The World Health Organization (WHO) Joint External Evaluation (JEE) for Tunisia, published 2016, referenced the National Plan for Preparedness, Response, and Resilience for Diseases with Epidemic Potential and other related frameworks, but did not provide access to the plan itself ³⁶⁷.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), nor on the WHO NAPHS portal ^{368369370371372373374}. This does not allow confirmation of whether the updated NAPHS includes planning for multiple communicable diseases with epidemic or pandemic potential.

Tunisia has received external funding for pandemic preparedness and response. The World Bank’s Pandemic Fund lists Tunisia as a beneficiary under the project “Implementing Pandemic Preparedness, Prevention and Response (PPR) – One Health Approach” ³⁷⁵, and GHScosting confirms allocations for health security activities ³⁷⁶.

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

Score: 100

Tunisia’s overarching national public health emergency response plan has been updated in the last three years.

According to the World Health Organization, Tunisia reviewed and updated its National Action Plan for Health Security (NAPHS) for 2022–2026 in collaboration with national authorities and international partners ³⁷⁷. This plan functions as a multisectoral framework for epidemic preparedness, detection, and response, covering surveillance, laboratory capacity, risk communication, workforce, and One Health coordination. However, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), nor on the WHO NAPHS portal ^{378379380381382383}.

3.1.1c One health principles by covering multiple threat types

Score: 0

There is evidence that Tunisia has an overarching national public health emergency response plan, but the plan itself is not publicly available. The World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, published 2017, referenced the National Plan for Preparedness, Response, and Resilience for Diseases with Epidemic Potential and related frameworks, though it did not provide access to the plan ³⁸⁴. The National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop, but the updated document is not accessible on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Water Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), or the WHO NAPHS portal ^{385386387388389390391}. This lack of access does not allow confirmation of whether the plan explicitly applies One Health principles by covering multiple threat types.

Tunisia has received external funding for pandemic preparedness and response, with the World Bank’s Pandemic Fund listing the country as a beneficiary under the project “Implementing Pandemic Preparedness, Prevention and Response (PPR) – One Health Approach”, but the project description does not mention aims to prevent antimicrobial resistance, zoonotic disease spillover, biological accidents or deliberate acts. ³⁹²

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

There is evidence that Tunisia has an overarching national public health emergency response plan, but the plan itself is not publicly available. The 2016 World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia referenced the National Plan for Preparedness, Response, and Resilience for Diseases with Epidemic Potential and related frameworks, though it did not provide access to the plan ³⁹³. The National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop, but the updated document is not accessible on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Water Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), or the WHO NAPHS portal ^{394395396397398399400}. This lack of access does not allow confirmation of whether the plan explicitly includes health equity considerations or mechanisms to identify and address the needs of vulnerable populations.

Tunisia has received external funding for pandemic preparedness and response, with the World Bank’s Pandemic Fund listing the country as a beneficiary under the project “Implementing Pandemic Preparedness, Prevention and Response (PPR) – One Health Approach” ⁴⁰¹, and GHScosting confirming allocations for health security activities ⁴⁰².

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

Score: 0

There is no publicly available evidence that Tunisia has specific mechanisms for engaging with the private sector to assist with outbreak emergency preparedness and response. The 2016 World Health Organization (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia discussed multisectoral collaboration but did not reference formalized private sector engagement mechanisms ⁴⁰³. The Ministry of Health website outlines its roles and functions, including coordination with the private sector, but does not specify structured mechanisms related to outbreak preparedness or response ⁴⁰⁴.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ^{405406407408409410}. This does not allow confirmation of whether the updated NAPHS details specific mechanism(s) for engaging with the private sector to assist with outbreak emergency preparedness and response.

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

Score: 0

There is no publicly available evidence of a policy, plan, or guidelines in Tunisia for the systematic implementation of non-pharmaceutical interventions (NPIs) during an epidemic or pandemic for one or more diseases. Manuals published by the Ministry of Health during the COVID-19 pandemic, such as the Manual for Health Isolation Centers and Health Isolation for COVID-19 Patients, describe procedures for isolation and quarantine but do not constitute broader NPI guidelines ⁴¹¹⁴¹². The Ministry of Health’s COVID-19 portal and official website provide epidemiological updates and technical documents but no evidence of comprehensive NPI planning ⁴¹³⁴¹⁴. Neither the Pasteur Institute of Tunis nor the Ministry of Defence websites provide evidence of a formal national policy or guidelines on NPIs ⁴¹⁵⁴¹⁶.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ^{417418419420421422}. This does not allow confirmation of whether the updated NAPHS details information about implementing non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

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

Score: 0

There is no publicly available evidence that Tunisia has activated its national emergency response plan for an infectious disease outbreak in the past year, nor that it has completed a national-level biological threat-focused exercise. The World Health Organization (WHO) Disease Outbreak News archive shows no Tunisia-specific activation notices in the last 12 months ⁴²³. WHO’s Simulation Exercise (SimEx) portal lists activities but does not show a Tunisia national-level biological threat-focused exercise within the past year ⁴²⁴.

Tunisia participated in a WHO/International Organization for Migration (IOM) regional table-top simulation exercise on cross-border public health preparedness in August 2025, but this was regional rather than national in scope ⁴²⁵. A review of Tunisian media, including a November 2024 news article on rising tuberculosis cases, did not identify evidence of national plan activation in 2025 ⁴²⁶. No further evidence is provided on the websites of the Ministry of Health of Tunisia, the Pasteur Institute of Tunis, or the Ministry of Defense (Direction Générale de la Santé Militaire) ^427428429.

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

Score: 0

There is insufficient publicly available evidence that Tunisia has identified gaps and best practices in infectious disease response in the past year through an after-action review, simulation exercise, or related evaluation, and developed a plan to improve response capacity. WHO reports that Tunisia finalized a draft National Action Plan for Health Security in 2023 to address system-wide gaps, but the plan itself is not publicly available and there is no documentation of published corrective action plans in 2024–2025 ⁴³⁰. The WHO Strategic Partnership Portal lists Tunisia under “Simulation Exercise Activities” and “After Action Review Activities,” but no recent activities are recorded for 2024–2025 ⁴³¹⁴³². Checks of the Ministry of Health and the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE) portals similarly did not identify lessons-learned reports or improvement plans ⁴³³⁴³⁴.

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

Score: 0

There is no publicly available evidence that Tunisia has undergone a national-level biological threat-focused exercise in the past year that included private sector representatives. WHO’s Simulation Exercise (SimEx) portal shows that Tunisia last conducted a national-level biological threat-focused exercise in 2017 and does not list more recent national-level exercises ⁴³⁵.

While Tunisia participated in a WHO/IOM regional table-top simulation exercise on cross-border preparedness in August 2025, this was regional in scope and did not provide evidence of structured private sector involvement ⁴³⁶.

No further information on such an exercise is available through the websites of the Ministry of Health of Tunisia, the Pasteur Institute of Tunis, or the Ministry of Defense (Direction Générale de la Santé Militaire) ^437438439.

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

There is evidence that Tunisia has an Emergency Operations Center (EOC) in place. According to the 2016 World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia, the EOC covers public health science functions (epidemiology, medical and other subject-matter expertise), public communications, and partner liaison ⁴⁴⁰. The Ministry of Health established the Strategic Health Operations Center (SHOC room) in 2009 during the H1N1 pandemic, and it has since been referenced in contingency planning for Ebola (2014) and the management of refugees and migrants in southern Tunisia (2014–2016) ⁴⁴¹.

The Ministry of Health website provides SHOC contact details, confirming that the structure is in place as of 2025 ⁴⁴². In addition, a World Bank project appraisal document published in 2025 on pandemic preparedness in Tunisia confirms the ongoing existence of the SHOC, describing it as the country’s national Emergency Operations Center for coordination of public health response ⁴⁴³.

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

Score: 0

There is no publicly available evidence that Tunisia’s Emergency Operations Center (EOC), the Strategic Health Operations Center (SHOC room), is required to conduct a drill for a public health emergency scenario at least once per year or that it conducts such drills on an annual basis. The 2016 World Health Organization Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia referenced the SHOC’s role in contingency planning for H1N1 influenza (2009), Ebola (2014), and the management of refugee and migrant influxes (2014–2016), noting that simulations had taken place but without specifying their frequency ⁴⁴⁴.

Tunisia participated in broader regional and international disaster preparedness activities, such as the Africa-Arab Platform on Disaster Risk Reduction in 2018 ⁴⁴⁵⁴⁴⁶, but there is no indication that these included annual EOC-specific drills. The Ministry of Health of Tunisia and the Ministry of Environment of Tunisia do not provide any evidence of such drills on their official websites ⁴⁴⁷⁴⁴⁸.

A World Bank project appraisal document published in 2025 confirms the ongoing existence of the SHOC as Tunisia’s national Emergency Operations Center ⁴⁴⁹. However, this source does not mention requirements for annual drills or evidence that such drills are conducted on a yearly basis.

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

Score: 0

There is no publicly available evidence that, in the past year, Tunisia’s Emergency Operations Center (EOC), the Strategic Health Operations Center (SHOC room), conducted a coordinated emergency response or emergency response exercise activated within 120 minutes of identifying a public health emergency or scenario. As of September 2025, neither the Ministry of Health of Tunisia nor the World Health Organization Strategic Partnership Portal provide activation or after-action reports that meet the 120-minute criterion ⁴⁵⁰⁴⁵¹. The 2016 WHO Joint External Evaluation (JEE) of IHR Core Capacities of Tunisia describes the SHOC but does not evidence timed activations ⁴⁵².

A World Bank project appraisal document (2025) confirms that the SHOC functions as Tunisia’s national Emergency Operations Center and has been engaged in previous outbreak responses ⁴⁵³. Media reporting also documents recent epidemic responses, such as the rise of tuberculosis cases in 2024 where public health authorities mobilized resources to address outbreaks ⁴⁵⁴. However, neither of these sources provides evidence of an EOC-specific activation within 120 minutes in the past year. Checks with the Ministry of Defense (military health), the Ministry of Agriculture (for One Health events), and the Institut Pasteur de Tunis similarly yielded no evidence of timed activations ^455456457.

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is insufficient publicly available evidence that Tunisia has conducted a multisectoral exercise involving public health, animal health, the private sector, and national security authorities to respond to a deliberate biological event. WHO’s Simulation Exercise (SimEx) portal shows that Tunisia last conducted a national-level biological-threat-focused exercise in 2017 and does not list more recent national-level simulations ⁴⁵⁸⁴⁵⁹. Tunisia is a State Party to the Biological Weapons Convention (BWC) and has participated in regional implementation meetings under the UN Office for Disarmament Affairs, but no documentation indicates that these activities have translated into domestic intersectoral response exercises or frameworks ⁴⁶⁰. Tunisia has also implemented biosafety and biosecurity capacity-building efforts, including a German-supported Biosecurity Project initiated in 2017, and the establishment of a BSL-3 laboratory at the Institut Pasteur de Tunis in 2021 ⁴⁶¹⁴⁶². However, no publicly available standard operating procedures, memorandums of understanding, or other agreements between health, agriculture, defense, or private-sector authorities addressing deliberate biological threats were identified on official websites ^{463464465466467}.

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

Score: 0

There is no publicly available evidence that Tunisia has, within national public health emergency response documents, a dedicated risk communication plan or guidelines specifically intended for use during a public health emergency. No risk communication plan or section is posted on the Ministry of Health website or the World Health Organization (WHO) SPH country page; the WHO Joint External Evaluation (JEE) of Tunisia’s International Health Regulations (IHR) core capacities, conducted in 2016, notes protocols and SOPs but these are not publicly available online ^468469470.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ^{471472473474475476}. This does not allow confirmation of whether the NAPHS includes a section detailing a risk communication plan specifically intended for use during a public health emergency.

Checks of the Presidency of Government communication portal and the Ministry of Environment did not yield a risk communication plan ⁴⁷⁷.

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

Score: 0

There is no publicly available evidence that Tunisia has a risk communication plan or related policy document outlining how messages will reach populations and sectors with different communication needs, such as by language, geography, media access, or vulnerability status. No such plan or section is available on the Ministry of Health website or the WHO Strategic Partnership Portal (SPH) country page ⁴⁷⁸⁴⁷⁹. The WHO Joint External Evaluation (JEE) of Tunisia’s International Health Regulations (IHR) core capacities, conducted in 2016, referenced risk communication structures and standard operating procedures but did not describe strategies addressing diverse population groups, and the relevant documents are not publicly available ⁴⁸⁰.

The National Action Plan for Health Security (NAPHS) for 2022–2026 was reviewed and updated through a WHO-led workshop, yet the updated version is not accessible on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Water Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), or on the WHO NAPHS portal ^{481482483484485486}.

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

Score: 0

There is no publicly available evidence that a risk communication plan or equivalent policy formally designates a single spokesperson to the public during a public health emergency. Searches of the Ministry of Health website, the Presidency of Government communication portal, and the WHO SPH country page did not identify a plan or decree naming an official spokesperson for emergency risk communication ^487488489. The World Health Organization’s Joint External Evaluation (JEE) of Tunisia’s International Health Regulations (IHR) core capacities, conducted in 2016, notes protocols and SOPs but these are not publicly available online ⁴⁹⁰.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ^{491492493494495496}. This does not allow confirmation of whether the NAPHS designates a specific position within the government to serve as the primary spokesperson to the public during a public health emergency.

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

Score: 100

There is evidence that Tunisia’s public health system has actively shared messages via online media platforms in the past year to inform the public about ongoing health concerns and to dispel misinformation during emergencies. The Ministry of Health maintains a website that posts advisories and updates ⁴⁹⁷. In addition, the Ministry of Health’s official Facebook page has been used throughout 2025 to disseminate preventive health messages beyond active emergencies, including seasonal prevention advice, a national rabies vaccination campaign, and awareness on leishmaniasis and other conditions ^498499500.

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

Score: 100

There is no verifiable public evidence that senior leaders in Tunisia (President or Ministers) have disseminated misinformation or disinformation related specifically to infectious diseases in the past two years (2023–2025). While broader analyses point to presidential use of conspiracy rhetoric and disinformation tactics more generally, none of the instances identified relate directly to infectious disease topics such as COVID-19, epidemics, transmission, vaccines, or treatments. ^{501 502 503}

3.6.1a Percentage of households with Internet

Score: 58.97

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 72.54

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

Score: 76.67

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

Score: 79.17

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 Tunisia imposed restrictions on the export or import of medical goods such as medicines, oxygen, PPE, or other supplies in the past year due to an infectious disease outbreak. No relevant announcements were found on the websites of the Ministry of Health, Ministry of Trade and Export Development, or World Health Organization regarding such measures implemented in 2024–2025 ^504505506.

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

Score: 100

There is no publicly available evidence that Tunisia imposed restrictions on the export or import of non-medical goods such as food or textiles in the past year due to an infectious disease outbreak. Searches of the Ministry of Health, Ministry of Trade and Export Development, and FAO/WOAH sources did not reveal any relevant restrictions applied in 2024–2025 ^507508509.

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

Score: 100

There is no publicly available evidence that Tunisia imposed inbound or outbound travel restrictions in the past year due to an infectious disease outbreak. The Ministry of Health and Ministry of Transport portals, as well as the World Health Organization country information page, show no announcements of health-related travel restrictions during 2024–2025 ^510511512. Media reporting confirms that Tunisia lifted all remaining COVID-19 restrictions in February 2023 ⁵¹³.

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

Score: 100

There is publicly available evidence that Tunisia uses an IHR-aligned risk assessment approach for international travel. The WHO evaluation of its contribution in Tunisia (2019–2023) describes activities under the “Pillar 4: Points of Entry, International Travel and Transport,” including risk assessment of traveler flows, health screening protocols, and coordination functions tied to IHR obligations ⁵¹⁴.

Regional WHO progress reports and documents for the Eastern Mediterranean Region note that member states, including Tunisia, participate in regional risk assessment frameworks and adjust travel and cross-border measures on that basis, using event and signal monitoring systems and rapid risk assessments. ⁵¹⁵⁵¹⁶

4.1.1a Doctors per 100,000 people

Score: 19.47

4.1.1b Nurses and midwives per 100,000 people

Score: 28.11

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

There is no publicly available evidence that Tunisia has, in the past five years, updated a comprehensive national health workforce strategy that identifies shortages and sets strategies to address them. The World Health Organization’s Joint External Evaluation (JEE) of Tunisia’s International Health Regulations (IHR) core capacities, conducted in 2016, noted persistent gaps in veterinary health, field epidemiology, and information systems, and that the workforce strategy had not been updated ⁵¹⁷. As of September 2025, no standalone workforce strategy is available on the Ministry of Health website ⁵¹⁸.

Tunisia's draft National Health Policy (Projet de Politique Nationale de Santé, PNS) 2023–2030 outlines broad national health priorities and goals; however, while it refers to improving human resources for health, it does not function as a dedicated workforce strategy that systematically maps shortages and defines strategies to address them ⁵¹⁹. The WHO evaluation of its country cooperation in Tunisia (2023) similarly confirms support for strengthening the health workforce but does not reference an updated national workforce strategy ⁵²⁰.

4.1.1d Health system capacity for essential health services

Score: 0

There is no publicly available evidence demonstrating that Tunisia currently has sufficient capacity to deliver essential health services.

The World Health Organization (WHO) Evaluation of WHO’s Contribution in Tunisia (2019–2023) report, published in 2025, as well as recent partner briefs discuss ongoing reforms and projects to strengthen health service delivery and system resilience, but they do not provide an official assessment that essential services capacity is sufficient nationwide ⁵²¹⁵²². Checks of the Ministry of Health portal did not identify an assessment confirming sufficiency either ⁵²³. Life expectancy in Tunisia "has worsened by 0.233 years from 74.3 [73.8 – 74.9] years in 2000 to 74.1 [73.6 – 74.7] years in 2021" whereas in the Eastern Medditeranean region it has "improved by 3.03 years from 65.5 [64.8 – 66] years in 2000 to 68.5 years in 2021." ⁵²⁴

The 2016 WHO Joint External Evaluation of IHR Core Capacities of Tunisia states in section D4 that "Multisectoral, skilled and competent, workforce at governorate and local levels is not always available" and that "the national health workforce strategy is not regularly reviewed and updated to suit the evolving country, regional and global context as well as country needs and priorities in IHR". ⁵²⁵ Section R1 notes that no sufficent surge capacity to respond to a PHEIC is available. ⁵²⁶

4.1.1e Essential health services continuity plan for public health emergencies

Score: 100

There is publicly available evidence of a national plan that sets out continuity of essential health services during public health emergencies.

The 2025 World Bank-funded Tunisia Health System Strengthening Project has the objective to improve pandemic preparedness and emergency care, modernize primary healthcare services, and strengthen governance and digitalization in the public health system. ⁵²⁷ Its components 2 (on primary health care services) and 3 (on emergency medical services) concern continuity of essential health services during emergencies. Component 3 should "enhance all phases of emergency care including pre-hospitalization, hospitalization and discharge", and "focus on the hospitalization phase by enhancing triage systems and ensuring efficient patient transfers and address the post-hospitalization phase by establishing a referral network to connect discharged patients with primary care and intensive care services." ⁵²⁸

A Ministry of Health announcement issued on 21 March 2020 addresses continuity of hospital activity, but does not mention a comprehensive continuity plan for essential services ⁵²⁹. The Ministry's draft National Health Policy (Projet de Politique Nationale de Santé, PNS 2023–2030) sets strategic objectives for equitable access and quality service delivery ⁵³⁰.

4.1.2a Hospital beds per 100,000 people

Score: 63.16

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

Score: 0

There is insufficient publicly available evidence that Tunisia maintains 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. Tunisia did receive two mobile negative-pressure isolation hospitals (30 beds each) donated by the U.S. Embassy in 2021 to Mongi Slim Hospital in La Marsa, but these are temporary, external assets, not evidence of permanent biocontainment infrastructure ⁵³¹. A 2023 multicenter study of Tunisian medical intensive care units (MICUs) reported that most ICU facilities did not adhere to standards such as negative-pressure rooms or individual isolation rooms, indicating gaps in fixed isolation infrastructure ⁵³². Neither the Ministry of Health’s website, the Directorate of Military Health under the Ministry of National Defense, nor the Pasteur Institute of Tunis publish detailed technical documentation confirming that Tunisia has the capacity to isolate patients with highly communicable diseases in permanent biocontainment units or patient isolation rooms ^533534535.

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

Score: 0

There is no publicly available evidence that Tunisia has expanded isolation capacity in response to an infectious disease outbreak in the past two years.

The World Health Organization (WHO) Joint External Evaluation (JEE) mission report for Tunisia, published in 2017, notes that isolation wards exist in selected hospitals and that contingency planning for surge capacity was limited, with the need to strengthen infrastructure and operational readiness for scaling up patient isolation during outbreaks ⁵³⁶. Tunisia’s Strategic Health Operations Center (SHOC), established in 2009 within the Ministry of Health, provides national-level coordination for outbreak response and real-time information sharing, but there is no accessible documentation that this system has been used in 2024–2025 to expand isolation units or beds ⁵³⁷.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), nor on the WHO NAPHS portal ^{538539540541542}. This does not allow confirmation of whether the revised plan includes strategies or tested mechanisms for rapidly expanding isolation capacity. Checks of the Ministry of Health portal and WHO’s Strategic Partnership for IHR and Health Security (SPH) platform similarly did not show announcements of isolation facility expansion during 2024–2025 ⁵⁴³⁵⁴⁴.

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

Score: 100

There is publicly available evidence of a national procurement protocol and contract framework that ministries can use for routine acquisition of laboratory and medical supplies, and it explicitly covers these product categories.

Tunisia’s public procurement regime (Decree No. 2014-1039) establishes procedures and allows centralized purchasing; procurement is executed via the national e-procurement system TUNEPS which is available to all ministries, including Health and Agriculture ^545546547548. For medicines, medical devices, and reagents, the Central Pharmacy of Tunisia (Pharmacie Centrale de Tunisie, PCT) acts as the statutory purchasing body and runs competitive tenders and direct-award procedures; PCT’s published notices include international tenders for laboratory reagents (e.g., HIV diagnostics) ^549550551552.

The draft National Health Policy (Projet de Politique Nationale de Santé, PNS 2023–2030) aims to reinforce transparency and governance principles related to procurement oversight but does not itself establish a procurement framework ⁵⁵³.

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

Score: 0

There is no publicly available evidence that Tunisia maintains a defined national stockpile of medical supplies for public health emergencies, nor a published plan to ensure equitable distribution. The Joint External Evaluation (JEE) of 2016 highlighted the absence of a mapped national stockpile of medical countermeasures and recommended establishing a management and distribution plan ⁵⁵⁴. The Ministry of Health established the Strategic Health Operations Center (SHOC) room in 2009 to coordinate epidemic response, and it is referenced in the Tunisia COVID-19 Response Project as a national focal point, but this facility is not described as managing a stockpile ⁵⁵⁵.

In 2023, the World Health Organization (WHO) Eastern Mediterranean Regional Office reported that Tunisia finalized a draft National Action Plan for Health Security (NAPHS) to improve health security; however, the document is not publicly available, and there is no evidence that it includes provisions for a national stockpile or an equitable distribution mechanism ⁵⁵⁶. A review of the Ministry of Health website confirms the absence of any official policy or inventory ⁵⁵⁷.

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

Score: 0

There is no publicly available evidence that Tunisia maintains a national stockpile of laboratory supplies (e.g., reagents, media, kits) for use during a public health emergency. Reviews of the official websites of the Ministry of Health, the Ministry of Agriculture, Hydraulic Resources and Fisheries, and the Institut Pasteur de Tunis did not identify a national laboratory supplies stockpile policy, inventory, or governance framework.

The Joint External Evaluation (JEE) mission report for Tunisia, published in 2017, discusses laboratory capacities and priority actions but does not document a national stockpile of laboratory supplies ⁵⁵⁸. In addition, Tunisia’s Strategic Health Operations Center (SHOC) within the Ministry of Health is referenced in government and partner sources as part of emergency coordination, yet available materials do not indicate that the SHOC manages or oversees a national laboratory supplies stockpile ⁵⁵⁹⁵⁶⁰.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), nor on the WHO NAPHS portal ⁵⁶¹. This does not allow confirmation of whether the plan establishes (or mandates) a national stockpile of laboratory supplies for public health emergencies.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available evidence that Tunisia conducts or requires an annual review of the national stockpile of medical and laboratory supplies to ensure sufficiency for a public health emergency. Reviews of the official websites of the Ministry of Health, the Institut Pasteur de Tunis, and the World Health Organization (WHO) Strategic Partnership for IHR and Health Security (SPH) portal show no documentation of regular review or audit of supply stockpiles ^562563564.

The Joint External Evaluation (JEE) mission report for Tunisia (28 November–2 December 2016) discusses laboratory capacities and highlights gaps in preparedness but does not reference any requirement for annual reviews of national laboratory stockpiles ⁵⁶⁵. Tunisia’s Strategic Health Operations Center (SHOC), established within the Ministry of Health as an emergency coordination hub, is noted in World Bank and UNDRR materials; however, there is no indication that it oversees annual reviews of stockpiles ⁵⁶⁶⁵⁶⁷.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Health Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal ⁵⁶⁸⁵⁶⁹. This does not allow confirmation of whether the plan includes provisions for annual review of stockpiles.

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

Score: 0

There is no publicly available evidence of a national public procurement framework and e-procurement system that can be applied to medical supplies (e.g. MCMs, medicines, vaccines, equipment, PPE).

According to Decree No. 2014-1039 (as amended) and the TUNEPS e-procurement system, ministries procure goods and services through standardized e-bidding and e-catalog/e-shopping modules, which can also be used for health sector supplies ^570571572. The Ministry of Health’s Environmental and Social Management Framework (CGES 2021) references the pharmaceutical system, reagents, and inputs, confirming the use of this procurement framework for health supplies ⁵⁷³.

There is no publicly available evidence of a national plan or agreement to leverage domestic or regional manufacturing capacity for emergency production of medical supplies, nor of a formal mechanism to expedite medical supplies through points of entry. The Joint External Evaluation (2016) noted reliance on importation and the need for stronger logistics systems, but did not document emergency procurement or customs fast-tracking ⁵⁷⁴. The Strategic Health Operations Center (SHOC), established in 2009 to coordinate outbreak response, facilitates operational communication but is not a procurement authority and does not publish procedures for expedited customs clearance ⁵⁷⁵.

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

Score: 0

There is no publicly available evidence of national mechanisms to procure laboratory supplies (e.g. reagents, media) for national use during a public health emergency. Tunisia’s public procurement framework (Decree No. 2014-1039) and the national e-procurement platform (TUNEPS) establish procedures usable by ministries to acquire laboratory reagents and consumables ^576577578. The Pharmacie Centrale de Tunisie (PCT), established by Decree-Law No. 61-2 of 1961, acts as the statutory purchasing body and runs regular tenders for laboratory reagents ⁵⁷⁹. However, these mechanisms operate under routine procurement rules, and there is no publicly available evidence of emergency-specific accelerated processes or exemptions ^580581582583. The Ministry of Health’s Environmental and Social Management Framework (CGES 2021) references the pharmaceutical system and laboratory reagents, confirming their governance within this procurement framework, but also does not mention a plan/mechanism to procure laboratory supplies for national use during a public health emergency ⁵⁸⁴.

There is no evidence of a national plan or agreement to leverage domestic or regional manufacturing capacity for laboratory supplies during emergencies. Neither the World Health Organization's Joint External Evaluation (2016) nor recent Ministry of Health or Observatoire National des Maladies Nouvelles et Émergentes (ONMNE) publications document mechanisms to expedite laboratory supplies through customs or points of entry ⁵⁸⁵. Tunisia’s Strategic Health Operations Center (SHOC), established in 2009 and referenced as the focal point for outbreak response, coordinates emergency operations but does not publish evidence of authority over expedited importation of laboratory supplies ⁵⁸⁶.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

There is publicly available evidence that Tunisia has a system or mechanism for national and subnational levels for emergency logistics and supply chain management, and that this system includes cold chain management and covers both the public and private sectors.

The Central Pharmacy of Tunisia (Pharmacie Centrale de Tunisie, PCT), operating under the Ministry of Health, oversees the national procurement, storage, and distribution of medicines and medical supplies, including during public health emergencies. The PCT has issued tenders for essential supplies such as reagents and diagnostic kits ⁵⁸⁷. Cold chain management is addressed in Tunisia’s Environmental and Social Management Framework (Cadre de Gestion Environnemental et Social, CGES 2021), which outlines infection prevention and control, biomedical waste handling, and maintenance of cold chain systems during emergencies and routine operations ⁵⁸⁸. The national immunization program (Programme National de Vaccination, PNV) is implemented through a network of public health centers under the Direction des Soins de Santé de Base and includes coordination with private and non-governmental partners, indicating a multisectoral approach to vaccine logistics. ⁵⁸⁹⁵⁹⁰. A 2013 report published by World Health Organization (WHO) and PATH, titled Optimize: Immunization Systems and Technologies for Tomorrow, shows how vaccine logistics were integrated into Tunisia's national supply system under PCT oversight, with use of computerized tracking (LMIS), solar-powered cold stores, and temperature monitoring mechanisms ⁵⁹¹.

There is no publicly available evidence that the national emergency logistics or supply chain system is regularly exercised, reviewed, evaluated, or updated. No documentation of simulation exercises, formal evaluations, or system-wide after-action reviews was located on the websites of the Ministry of Health, the PCT, or among major international partner reports. ^592593594595 The CGES and Optimize documents set infrastructure and performance standards but do not publish assessments of actual readiness or periodic updates. ⁵⁹⁶⁵⁹⁷

During the COVID‑19 response, a logistics and support committee was formed to manage distribution of personal protective equipment, indicating coordination at national and subnational levels ⁵⁹⁸. The Joint External Evaluation (2016) noted that Tunisia had logistics systems already in place but recommended strengthening stockpile management and rapid deployment capability ⁵⁹⁹. Tunisia’s Strategic Health Operations Center (SHOC), established in 2009, serves as the national focal point for outbreak coordination and is mentioned in project documents, but no public record confirms it runs routine logistics drills or evaluations ⁶⁰⁰. The updated National Action Plan for Health Security (NAPHS) 2022–2026 was developed in a WHO-led workshop, but the plan is not publicly accessible, preventing confirmation of whether it institutionally incorporates mechanisms for periodic logistics review or private sector integration ⁶⁰¹.

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

Score: 0

There is no publicly available evidence that Tunisia has a plan, program, or guidelines in place for dispensing medical countermeasures (MCMs) for national use during a public health emergency (e.g., antibiotics, vaccines, therapeutics, and diagnostics). Reviews of the official websites of the Ministry of Health of Tunisia and the World Health Organization (WHO) Strategic Partnership for IHR and Health Security (SPH) portal do not identify dispensing guidelines or frameworks ⁶⁰²⁶⁰³.

The Joint External Evaluation (JEE) mission report for Tunisia (28 November–2 December 2016) does not reference any system for dispensing medical countermeasures ⁶⁰⁴. Tunisia’s Strategic Health Operations Center (SHOC), established within the Ministry of Health, is referenced in World Bank and UNDRR sources as a coordination hub during emergencies; however, available documentation does not mention whether the SHOC is responsible for planning or implementing the dispensing of MCMs ⁶⁰⁵⁶⁰⁶.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), nor on the WHO NAPHS portal ⁶⁰⁷⁶⁰⁸. This does not allow confirmation of whether the updated NAPHS includes provisions for dispensing medical countermeasures during public health emergencies.

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

Score: 0

There is no publicly available evidence of a plan in place to facilitate workforce surge in an emergency.

Tunisia's national COVID-19 vaccination strategy and program describe governance structures, deployment procedures, and training of additional staff ⁶⁰⁹⁶¹⁰. Guidance for vaccination delivery in community pharmacies further operationalized surge capacity by defining roles and procedures for additional vaccinators ⁶¹¹. However, this workforce surge framework is specific to the COVID-19 vaccination response, and there is insufficient evidence that it has been integrated into a broader national health emergency policy.

Tunisia is a beneficiary of the World Bank Pandemic Fund project “Implementing Pandemic Preparedness, Prevention and Response (PPR) – One Health Approach,” which includes workforce-development aims, but these do not constitute a national plan to facilitate workforce surge in an emergency .

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence of a public plan in Tunisia for receiving health personnel from other countries to respond to a public health emergency. Reviews of the official website of the Ministry of Health of Tunisia and the World Health Organization (WHO) Strategic Partnership for IHR and Health Security (SPH) portal do not show such a plan ⁶¹²⁶¹³.

The WHO Joint External Evaluation (JEE) mission report for Tunisia (28 November–2 December 2016) describes coordination mechanisms and international collaboration but does not reference a public plan for the reception of foreign medical personnel ⁶¹⁴. Tunisia’s Strategic Health Operations Center (SHOC), established within the Ministry of Health, is noted in World Bank and UNDRR documents as an emergency coordination hub; however, these materials do not indicate that the SHOC is mandated to manage or host incoming international health personnel ⁶¹⁵⁶¹⁶.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health of Tunisia, the Ministry of Agriculture, Hydraulic Resources and Fisheries of Tunisia, the Ministry of Environment of Tunisia, the Observatoire National des Maladies Nouvelles et Émergentes (ONMNE), the Centre National de Veille Zoosanitaire (CNVZ), nor on the WHO NAPHS portal ⁶¹⁷⁶¹⁸. This does not allow confirmation of whether the updated NAPHS includes provisions for receiving foreign health personnel during public health emergencies.

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no publicly available evidence of planning that provides for mobilization and augmentation of human resources during emergencies.

Tunisia's national COVID-19 vaccination strategy and program describe governance structures, deployment procedures, and training of additional staff ⁶¹⁹⁶²⁰. Guidance for community pharmacies further operationalized surge capacity by defining roles and procedures for additional vaccinators ⁶²¹. However, this workforce surge framework is specific to the COVID-19 vaccination response and there is insufficient evidence that it has been integrated into a broader national health emergency policy.

Tunisia is a beneficiary of the World Bank Pandemic Fund project “Implementing Pandemic Preparedness, Prevention and Response (PPR) – One Health Approach,” which includes workforce development aims, but these do not amount to a public plan to redeploy existing health personnel within the country ⁶²².

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

The Constitution of Tunisia (2022) explicitly guarantees citizens’ right to medical care, but without guaranteeing free medical care. Article 43 states: “Health is the right of every human being. The state guarantees prevention and health care for every citizen, and provides the necessary capabilities to ensure the safety and quality of health services. The state guarantees free treatment for the bondless and for those with limited income. It guarantees the right to social coverage according to what is regulated by law.” ⁶²³

The earlier 2014 Constitution similarly guaranteed this right under Article 38, affirming that “Health is a right for every human being” and that the state shall provide preventive health care, treatment, and ensure free care for those without means and those with limited income ⁶²⁴⁶²⁵.

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

Score: 97.06

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

Score: 56.83

4.4.1d Coverage of essential health services through universal health coverage

Score: 83.33

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: 52.64

4.4.1f Rate of mortality amenable to health care

Score: 3.24

4.4.2a Guaranteed paid sick leave

Score: 66.67

Tunisian workers are guaranteed paid sick leave but there is no evidence that such leave is available for mental health problems. There is publicly available evidence that paid sick leave is guaranteed through the National Health Insurance Fund (Caisse Nationale d’Assurance Maladie, CNAM), which provides daily cash benefits upon medical certification ^626627628. CNAM materials and Tunisian social security references set out eligibility and payment rules (e.g., medical certificate P-61 and indemnity forms), confirming the paid sick leave entitlement framework nationwide ⁶²⁹⁶³⁰. There is insufficient publicly available evidence specifying whether sick leave coverage is explicitly guaranteed for mental health conditions as a distinct category beyond general illness ⁶³¹⁶³².

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that Tunisia 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. Reviews of the Ministry of Health of Tunisia website and the World Health Organization (WHO) Strategic Partnership for IHR and Health Security (SPH) portal show no such commitments ⁶³³⁶³⁴.

The draft National Health Policy (Projet de Politique Nationale de Santé, PNS) 2023–2030 outlines Tunisia’s general health sector priorities, including workforce development and system strengthening; however, it does not provide evidence of commitments to prioritized healthcare services for healthcare workers specifically in the context of public health emergencies ⁶³⁵. Similarly, WHO’s 2025 evaluation of its contributions in Tunisia emphasizes support for primary care, universal health coverage, and pandemic response, but does not reference dedicated provisions for healthcare workers’ access to prioritized care if they fall ill during emergency response ⁶³⁶.

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

Score: 0

There is no publicly available evidence of a formalized system in Tunisia for public health officials and healthcare workers to communicate during a public health emergency. Reviews of the Ministry of Health of Tunisia website and the WHO Strategic Partnership for IHR and Health Security (SPH) portal do not show any structured mechanisms for communication beyond ad hoc coordination ⁶³⁷⁶³⁸.

The 2016 Joint External Evaluation (JEE) mission report for Tunisia, published 2017, highlights gaps in communication and coordination capacities and does not reference a formalized system dedicated to linking public health officials and healthcare workers during emergencies ⁶³⁹. Tunisia’s Strategic Health Operations Center (SHOC), established in 2009 within the Ministry of Health, is referenced in World Bank and UNDRR materials as an emergency coordination hub; however, available sources do not specify that it operates a system for routine communication with frontline healthcare workers ⁶⁴⁰⁶⁴¹.

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

Score: 0

There is no publicly available evidence that Tunisia’s communication system for health emergencies formally encompasses healthcare workers in both the public and private sectors. Reviews of the Ministry of Health of Tunisia website and the World Health Organization (WHO) Strategic Partnership for IHR and Health Security (SPH) portal do not identify such a system ⁶⁴²⁶⁴³.

The WHO Joint External Evaluation (JEE) mission report for Tunisia (28 November–2 December 2016) describes weaknesses in coordination and communication and does not provide evidence of a structured mechanism that links public and private sector healthcare workers during emergencies ⁶⁴⁴. Tunisia’s Strategic Health Operations Center (SHOC), established in 2009 within the Ministry of Health, is referenced in World Bank and UNDRR sources as a coordination hub; however, available materials do not indicate that the SHOC maintains a communication system covering both public and private sector healthcare providers ⁶⁴⁵⁶⁴⁶.

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

Score: 0

There is insufficient publicly available evidence that Tunisia monitors or tracks healthcare-associated infections (HCAIs) in healthcare facilities at the national level. Reviews of the Ministry of Health of Tunisia website and the WHO Strategic Partnership for IHR and Health Security (SPH) portal do not show evidence of systematic national HCAI surveillance ⁶⁴⁷⁶⁴⁸. Tunisia’s draft National Health Policy (Projet de Politique Nationale de Santé, PNS) 2023–2030 outlines strategic health priorities and goals for strengthening the health system, but it does not provide evidence of a structured national surveillance system for HCAIs in healthcare facilities ⁶⁴⁹. The Ministry of Health’s Environmental and Social Management Framework (Cadre de Gestion Environnemental et Social, CGES 2021) outlines measures for infection prevention and control and occupational health, but it does not mention monitoring for and tracking the number of HCAIs that take place in healthcare facilities ⁶⁵⁰.

4.6.1b Infection prevention and control programme

Score: 0

There is insufficient publicly available evidence that Tunisia has a comprehensive national infection prevention and control (IPC) program in place. The Joint External Evaluation (JEE) mission report for Tunisia (2016) scored the IPC core capacity at 40 percent, citing limited implementation and coordination of national IPC activities ⁶⁵¹. While the draft National Health Policy (Politique Nationale de Santé, PNS) 2023–2030 emphasizes quality of care and patient safety, it does not provide evidence of a dedicated, operational IPC program ⁶⁵².

Similarly, the National Action Plan for Health Security (NAPHS) was updated for 2022–2026 in a WHO-led workshop, but the updated document is not publicly available, preventing confirmation of whether it includes an IPC program ⁶⁵³. Checks of the Ministry of Health portal, the National Observatory of New and Emerging Diseases and WHO’s Strategic Partnership Portal did not identify a national IPC program or related operational plan ^654655656.

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

Score: 100

There is evidence of a national framework to ensure a safe environment in health facilities.

The Ministry of Health’s Environmental and Social Management Framework (Cadre de Gestion Environnemental et Social, CGES 2021) outlines measures for infection prevention and control, biomedical waste management, occupational health, and facility safety during both routine operations and emergencies ⁶⁵⁷. The framework sets concrete aims to strengthen waste handling systems, reduce environmental risks, and improve safety for health workers and patients. However, no updated or follow-up framework has been published since 2021. ⁶⁵⁸

The Ministry of Health has a Department of Environmental Health and Protection (Direction de l’Hygiène du Milieu et de la Protection de l’Environnement) which has the mandate to ensure a safe environment in health facilities, as among its main missions are listed "Hygiene control in establishments open to the public; Hygiene control in public and private hospitals; Controlling the fight against disease-carrying insects." ⁶⁵⁹ The Department, together with Tunisia's National Waste Management Agency, has published a manual titled Framework Of Procedures For The Management Of Hazardous Healthcare Waste. ⁶⁶⁰

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is publicly available evidence that Tunisia requires ethical review before the initiation of clinical trials. The Institut Pasteur de Tunis confirms that it has a Comité d’Éthique Bio-Médicale which reviews protocols involving human subjects. ⁶⁶¹ Procedural overviews of clinical trials in Tunisia note that protocols must receive approval from ethics committees (Comités de Protection des Personnes) as well as the Directorate of Pharmacy and Medicines. ⁶⁶² In addition, the Health Research Web Africa portal lists a Comité National d’Éthique Médicale (CNEM) as a national ethics body in Tunisia. ⁶⁶³

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

Score: 0

There is insufficient publicly available evidence of an expedited process for approving clinical trials of unregistered medical countermeasures or for mutual recognition of trial results conducted abroad. The National Observatory of New and Emerging Diseases and the Pasteur Institute of Tunis provide information on research and ethics approvals, but no documentation specifies accelerated mechanisms for MCM trials during pandemics or epidemics ⁶⁶⁴⁶⁶⁵. Searches of the Ministry of Health website did not identify relevant legislation or guidelines ⁶⁶⁶.

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

There is publicly available evidence that Tunisia has a government agency responsible for approving new medical countermeasures (MCMs) for humans. The Directorate of Pharmacy and Medicines (Direction de la Pharmacie et du Médicament, DPM), under the Ministry of Health, is mandated to regulate the registration, marketing authorization, and quality oversight of medicines and vaccines in Tunisia. ⁶⁶⁷ Official descriptions from the Ministry of Health and regulatory analyses published in 2021 and 2022 confirm the DPM’s role as the national authority for the approval of pharmaceutical products ^668669670.

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

There is evidence of an expedited process for approving medical countermeasures for human use during public health emergencies in Tunisia. The Directorate of Pharmacy and Medicines (Direction de la Pharmacie et du Médicament, DPM) under the Ministry of Health is mandated to regulate the registration, marketing authorization, and quality oversight of medicines and vaccines in Tunisia. ⁶⁷¹ A 2022 research article details how the DPM expedited the process for approving anti-COVID-19 vaccines in Tunisia. The DPM allowed submission of files online and with a lighter administrative module; it "adopted the rolling review procedure by processing the data submitted by manufacturers in real time"; and it held several meetings in a few months as opposed to its regular annual schedule; and "the documentary evaluation of the quality file was done by the LNCM and required an exceptional mobilization of human resources, which shortened their evaluation time from 782 days to 21 days". ⁶⁷²

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

Score: 100

Tunisia has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁶⁷³

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

Score: 0

There is insufficient publicly available evidence that epidemics and pandemics are integrated into Tunisia’s national risk reduction strategy or that a standalone national disaster risk reduction strategy specific to epidemics and pandemics exists. The National Strategy for Disaster Risk Reduction by 2030 (Stratégie nationale de réduction des risques de catastrophe à l’horizon 2030) outlines Tunisia’s disaster risk reduction priorities across sectors but does not provide specific measures addressing epidemics and pandemics ⁶⁷⁴. Similarly, Tunisia’s Voluntary National Report for the Midterm Review of the Sendai Framework highlights progress in multisectoral disaster management under the Ministry of Interior’s General Directorate of Civil Protection (Direction Générale de la Protection Civile), yet it does not document the integration of epidemic or pandemic risks into the national DRR framework ⁶⁷⁵.

Reviews of the Ministry of Health of Tunisia and the Institut Pasteur de Tunis provide no additional evidence of national DRR strategy directly addressing epidemics and pandemics ⁶⁷⁶⁶⁷⁷.

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 0

There is insufficient publicly available evidence of cross‑border agreements, protocols, or memoranda of understanding with neighboring countries (or regional groups) specifically addressing public health emergencies. Tunisia participates in regional public health cooperation initiatives (e.g., Eastern Mediterranean Public Health Network; historical EpiSouth network), but no formal cross‑border public health emergency agreement is publicly posted on their websites; recent checks of the Ministry of Health and Food and Agriculture Organization North Africa profiles provide no evidence of such agreements either. ^678679680681

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Tunisia participates in formal regional cooperation mechanisms addressing animal health emergencies through the Cooperation Framework between the Chief Veterinary Officers of Algeria, Egypt, France, Italy, Libya, Mauritania, Morocco, Portugal, Spain, and Tunisia for the creation and development of the Mediterranean Animal Health Network (REMESA) ⁶⁸². The framework, established under the coordination of the World Organisation for Animal Health (WOAH) and the Food and Agriculture Organization (FAO), provides joint mechanisms for outbreak information exchange and coordinated preparedness and response to transboundary animal diseases, including zoonoses. This demonstrates Tunisia’s participation in a structured regional agreement that facilitates communication and technical collaboration during animal health emergencies.

Tunisia also hosts the WOAH Sub-Regional Representation for North Africa in Tunis, which strengthens coordination among neighboring countries on animal disease surveillance and response ⁶⁸³. In addition, the Tunisian Institute for Veterinary Research (Institut de la Recherche Vétérinaire de Tunisie, IRVT) maintains bilateral technical cooperation agreements, including with Italy’s Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise (IZSAM), which enhance regional laboratory and surveillance collaboration ⁶⁸⁴.

However, there is limited publicly available evidence of national-level mechanisms for monitoring implementation or evaluating operational effectiveness of these cooperative frameworks.

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Tunisia is a State Party to the Biological Weapons Convention (BWC). According to the United Nations Office for Disarmament Affairs, Tunisia ratified the Convention on 18 May 1973, thereby holding full legal effect under the treaty. ⁶⁸⁵

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

Score: 100

There is publicly available evidence that Tunisia has submitted Confidence-Building Measures (CBMs) for the Biological Weapons Convention within the past three years. According to the BWC Implementation Support Unit/United Nations Office for Disarmament Affairs, Tunisia most recently submitted its CBM on 30 July 2025, and it appears in the official list of recent CBM submissions. ⁶⁸⁶

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Tunisia has provided the required UNSCR 1540 report by submitting its revised national implementation matrix to the 1540 Committee. The approved matrix is publicly available on the official UN Security Council website. ⁶⁸⁷

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

Tunisia does not meet at least two of the criteria. The Proliferation Security Initiative (PSI) website lists Tunisia as one of the endorsing states ⁶⁸⁸. However, publicly available membership lists show that Tunisia is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction ⁶⁸⁹ nor of the Australia Group ⁶⁹⁰.

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

Score: 0

Tunisia has not completed a Joint External Evaluation (JEE) or precursor external evaluation in the last five years. The most recent JEE was conducted in November–December 2016, with the full report published in 2017 by the World Health Organization (WHO) ⁶⁹¹. According to the WHO Strategic Partnership for IHR and Health Security (SPH) portal, Tunisia is listed as having a new JEE “in pipeline,” but as of September 2025 the updated evaluation has not yet been conducted or published ⁶⁹².

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

Score: 0

There is no publicly available evidence that Tunisia has completed and published a Performance of Veterinary Services (PVS) assessment in the last five years. A review of the World Organisation for Animal Health (WOAH) PVS library confirms that no recent PVS evaluation for Tunisia is listed during the reference period ⁶⁹³. However, the PVS database does record a national workshop held in Tunisia in 2023, which indicates engagement with the PVS pathway but does not constitute a full PVS assessment ⁶⁹⁴.

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

Score: 0

There is no publicly available evidence that Tunisia has completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. A review of the World Organisation for Animal Health (WOAH) PVS library shows no record of a gap analysis for Tunisia during the reference period ⁶⁹⁵. The database does list a PVS national workshop held in 2023 ⁶⁹⁶.

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

Score: 100

There is publicly available evidence that Tunisia has allocated national funds within the past three years to strengthen capacity to address epidemic and pandemic threats.

The World Bank Pandemic Fund project page for Tunisia reports a US$ 25 million grant that “leveraged… co-investment from the government” (listed as US$ 870.9 million) and additional co-financing ⁶⁹⁷. The World Bank approved the Tunisia Health System Strengthening Project on 28 May 2025 for USD 125.16 million, including a USD 17.16 million grant from the Pandemic Fund, with objectives that explicitly include improving pandemic preparedness, laboratories, surveillance, and emergency care ⁶⁹⁸.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available ⁶⁹⁹. Tunisia’s national budget documentation for 2024 (Ministry of Health mission budget) is publicly posted by the Ministry of Finance, confirming domestic health allocations during the assessment period, even though publicly available summaries do not always present a discrete line titled “epidemic preparedness” ⁷⁰⁰. The WHO evaluation of WHO’s contribution in Tunisia (2019–2023) also documents the significant use of the Emergency Fund for Outbreak and Crisis Response (OCR) during COVID-19 (59 percent of executed funding), evidencing sustained pandemic-related financing alongside domestic allocations ⁷⁰¹.

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

Score: 0

There is no publicly available evidence that Tunisia’s Joint External Evaluation (JEE), National Action Plan for Health Security (NAPHS), or a Global Health Security Agenda (GHSA) roadmap allocate or describe specific national budget funding to address identified gaps. The JEE conducted in 2016 identified priority areas but did not reference national budget allocations ⁷⁰². Tunisia’s NAPHS was reviewed and updated for 2022–2026 during a WHO-led workshop; however, the updated document is not publicly available on WHO NAPHS portal, preventing confirmation of any financial commitments ⁷⁰³. In addition, no evidence of a Tunisian GHSA roadmap has been identified in WHO or GHSA sources ⁷⁰⁴.

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

Score: 0

There is no publicly available evidence that a Performance of Veterinary Services (PVS) assessment or PVS gap analysis allocates or describes specific funding from the national budget to address identified gaps in Tunisia. A review of the World Organisation for Animal Health (WOAH) PVS library shows no recent PVS assessments or gap analyses for Tunisia during the reference period ⁷⁰⁵. The PVS national workshop recorded for Tunisia in 2023 confirms engagement with the PVS pathway but does not provide evidence of specific budgetary allocations or national funding commitments linked to identified veterinary service gaps ⁷⁰⁶.

5.5.3a Emergency public financing during a public health emergency

Score: 0

There is no publicly available evidence that Tunisia has a nationally designated special emergency public financing mechanism or reserve fund for public health emergencies. Reviews of the Ministry of Finance of Tunisia and Ministry of Health of Tunisia websites do not identify a standing mechanism specified in statute or a public health emergency act ⁷⁰⁷⁷⁰⁸.

Tunisia has, however, received international financing for emergency response operations. The GHScosting database lists Tunisia as a recipient of external funding allocations for preparedness and emergency response across IHR core capacities ⁷⁰⁹. In addition, the World Bank’s Pandemic Fund identifies Tunisia as a beneficiary under the project “Implementing Pandemic Preparedness, Prevention and Response (PPR) – One Health Approach”, which supports national capacity building for health security ⁷¹⁰. While these allocations confirm access to international mechanisms, they do not constitute a publicly identified national emergency financing mechanism.

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

Score: 100

There is evidence that Tunisian senior leaders have made public commitments in the past three years to strengthen domestic capacity for epidemic preparedness by requesting support to improve capacity. In May 2025, the Minister of Health and other government representatives officially launched a Pandemic Fund–supported project with the World Bank, Food and Agriculture Organization, and World Health Organization to reinforce Tunisia’s prevention, preparedness, and response (PPR) capacities under a One Health approach. Pandemic Fund grants are awarded based on proposals submitted by requesting countries; public announcements of Tunisia's project state it has collaborated with international partners to secure the financing. ⁷¹¹⁷¹² However, no recent evidence was found in Tunisian or international news media of commitments by Tunisian leaders to provide financing or support to other countries.

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

Score: 100

There is evidence that Tunisia has requested and received financing and technical support from international donors in the past three years to strengthen domestic epidemic preparedness and response. The GHScosting database lists Tunisia as a recipient of external funding for activities related to International Health Regulations (IHR) core capacities, including biosafety, zoonotic disease surveillance, and laboratory capacity ⁷¹³. The WHO Strategic Partnership Portal (SPH) also compiles records of international support projects directed to Tunisia’s health security system ⁷¹⁴. The WHO Regional Office for the Eastern Mediterranean (WHO EMRO) further reports Tunisia’s participation in donor-supported programs such as the Pandemic Fund project and regional One Health initiatives ⁷¹⁵.

However, there is no publicly available evidence that Tunisia has provided financing or technical support to other countries in this period. Reviews of the Ministry of Health of Tunisia website and the Ministry of Foreign Affairs of Tunisia portal did not show any record of outbound financial or technical assistance for epidemic preparedness ^716717718.

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

Score: 100

There is publicly available evidence that Tunisia has fulfilled its assessed contributions to the World Health Organization (WHO) within the past two years. WHO’s official Statement of Account for February 2025 confirms that Tunisia has paid its full assessed contributions in 2023 and 2024, while USD 80,380 of its total contribution for 2025 of USD 109,090 remains to be paid ⁷¹⁹.

The Evaluation of the WHO Contribution in Tunisia (2019–2023) highlights ongoing collaboration with WHO and regular participation in its country cooperation strategy, with no mention of payment delays ⁷²⁰. Similarly, WHO’s Tunisia Results Report 2020–2021 reflects continued contributions to WHO’s core funding and national programme implementation ⁷²¹.

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

Score: 0

There is no publicly available evidence that Tunisia has a national plan or policy for sharing genetic data, clinical specimens, or isolated biological materials beyond influenza with international organizations or other countries. Checks of the Ministry of Health of Tunisia, the Ministry of Higher Education and Scientific Research of Tunisia, and the Pasteur Institute of Tunis did not identify such a policy ^722723724.

Tunisia’s National Action Plan for Health Security (NAPHS) was reviewed and updated for 2022–2026 in a WHO-led workshop; however, the updated NAPHS document is not publicly available on the websites of the Ministry of Health, the Ministry of Agriculture, Hydraulic Resources and Fisheries, the Ministry of Environment, the National Observatory of New and Emerging Diseases (Observatoire National des Maladies Nouvelles et Émergentes, ONMNE), the National Center for Veterinary Surveillance (Centre National de Veille Zoosanitaire, CNVZ), nor on the WHO NAPHS portal, which prevents confirmation of whether it includes provisions for specimen and data sharing ^{725726727728729730}.

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

Score: 100

Tunisia has not failed to share samples in accordance with the Pandemic Influenza Preparedness (PIP) Framework in the past two years. WHO EMRO influenza reports confirm Tunisia’s regular reporting to FluNet/EMFLU, consistent with its PIP obligations. ^{731 732}

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

Score: 100

There is no publicly available evidence that Tunisia has refused to share pandemic pathogen samples during an outbreak in the past two years. As of September 2025, WHO Disease Outbreak News and academic/public databases reflect ongoing data and sequence sharing involving Tunisia (e.g., SARS‑CoV‑2 genomic sequences and recent influenza submissions), and there are no official notices of refusal to share outbreak samples. ⁷³³

Checks of the Ministry of Health identified no documented instances of non‑sharing. ⁷³⁴

6.1.1a Policy formation

Score: 50

6.1.1b Quality of bureaucracy

Score: 50

6.1.1c Excessive bureaucracy/red tape

Score: 50

6.1.1d Vested interests/cronyism

Score: 50

6.1.1e Corruption

Score: 39

6.1.1f Accountability of public officials

Score: 50

6.1.1g Human rights risk

Score: 50

6.1.2a Orderly transfers of power

Score: 25

6.1.3a Risk of social unrest

Score: 0

6.1.4a Risk of terrorism

Score: 25

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 50

6.1.5a Presence or risk of armed conflict

Score: 75

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 25

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

Score: 91.48

6.2.2a UNDP Gender Inequality Index score

Score: 100

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

Score: 97.52

6.2.3b Share of employment in the informal sector

Score: 50

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

Score: 0

6.2.4a Public confidence in government

Score: 100

6.2.5a Robust, open, diverse local media and reporting

Score: 100

6.2.6a Gini coefficient

Score: 66.3

6.3.1a Adequacy of road network

Score: 50

6.3.2a Adequacy of airports

Score: 75

6.3.3a Adequacy of power network

Score: 50

6.4.1a Urban population (% of total population)

Score: 26.83

6.4.2a Change in forest area (percentage points)

Score: 77.5

6.4.3a Natural disaster risk

Score: 75

6.5.1a Total life expectancy (years)

Score: 100

6.5.1b NCD mortality rate

Score: 100

6.5.1c Population aged 65+

Score: 34.51

6.5.1d Tobacco use (% of adults)

Score: 23.58

6.5.1e Level of adult obesity (%)

Score: 38.2

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

Score: 0

6.5.2a Access to potable water

Score: 97

6.5.2b Access to at least basic sanitation facilities

Score: 99

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: 43.33

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