Brazil advances with the implementation of the Mosaic initiative at subnational level

Washington, D.C., October 6, 2025 (PAHO) - Through a successful partnership between the Ministry of Health, the National Council of State Health Secretaries (CONASS), the National Council of Municipal Health Secretaries (CONASS), the Pan American Health Organization, and the Todos pela Saúde Institute, Brazil is advancing in the implementation of the Mosaic initiative to strengthen respiratory virus surveillance across the country.

By September 2025, one national workshop and twenty-five subnational workshops had been conducted, with twenty-seven workshops scheduled to be completed by October 2025. The workshops are part of the CONASS-conceived Vigiares project which aims to strengthen surveillance, preparedness, and response capabilities for respiratory events with the potential to become public health emergencies. The Vigiares approach strives to use the lessons learned from dealing with influenza, COVID-19 and other respiratory disease emergencies.

The methodology consists of conducting case studies to identify the best surveillance approaches to respond to anticipated demands in the areas of detection, monitoring, and use of interventions, with the effective participation of epidemiological surveillance professionals, Strategic Information Center for Health Surveillance, the National Hospital Epidemiological Surveillance Network, laboratory, emergency management, occupational health, environmental surveillance, indigenous health, immunization, primary care, specialized care, regulation, communication, and professionals in the field of agriculture and livestock. At the end of the workshop, the State Mosaic Plan is presented, identifying opportunities for improvement and an action plan for the implementation and/or improvement of surveillance approaches, including the incorporation of innovations, with follow-up by professionals from the Ministry of Health and PAHO.

Throughout the process, the need to update national guidelines to support the implementation of state plans was identified, including for outbreak control in long-term care facilities, surveillance of unusual events caused by respiratory pathogens. These gaps required the formation of working groups to develop guidelines, manuals, and operational arrangements, and measures to strengthen sentinel surveillance of influenza-like illness across the country.

The workshops promoted various discussions including on the importance of identifying how health surveillance and clinical care teams can best work together, One Health, the role of health intelligence teams and integrated data analysis for decision-making; the use of clinical data in routine surveillance such as through syndromic surveillance, wastewater surveillance, the use of infection prevention and control measures, the organization of healthcare networks, the strengthening of immunization programs and the measurement of vaccination coverage for priority groups, actions to increase the use of pharmaceutical interventions, reporting of unusual events in health facilities and communities, expansion of partnerships to strengthen the laboratory networks, guidelines for the development contingency plans for respiratory viruses, and the need to develop a strategic risk assessments stratified by age group and health macro-regions.

The implementation model of the Mosaic initiative in Brazil is considered effective due to the creation of a steering group of key stakeholders and the integrated approach achieved in the States and Federal District. By harnessing new global guidelines for respiratory diseases, Brazil successfully conducted a participatory situational analysis, using a structured methodology, to develop a way forward for each State. These State Mosaic plans describe local needs to ensure sustainable programs for respiratory diseases across the country, considering the One Health approach. PAHO remains committed to continuing this collaboration to support the ongoing implementation of Mosaic in Brazil.