Introduction
At the December 2009 Meeting of States Parties of the Biological Weapons Convention
(BWC), U.S. Under Secretary of State Ellen Tauscher committed the U.S. Government
(USG) to engaging the global community to achieving and sustaining the capabilities
to combat infectious diseases and protect against biological threats. Specifically,
she committed the USG to a series of actions, including international meetings on
global disease surveillance and implementation of the International Health Regulations
(IHR[2005]), designed to enhance global cooperation and provide momentum for sustained
progress in this critical area. This journal supplement includes articles that capture
key presentations from two meetings: the June 2010 workshop on Comprehensive Global
Disease Surveillance held in Washington, D.C. and the August 2010 workshop on Implementation
of the IHR(2005) held in Geneva, Switzerland. The supplement also highlights efforts
underway to enhance disease surveillance and IHR(2005) implementation by global partners
and frames the current USG efforts to enhance global cooperation in disease surveillance,
capacity building, biothreat reduction, and IHR(2005) implementation.
The IHR(2005) provides a framework to promote global health security in the broadest
sense. Public health emergencies of international concern (PHEICs), by definition,
do not respect international boundaries, and the IHR(2005) articulates a vision of
solidarity that a common vulnerability to microbial and other threats should elicit.
A common interest exists for all countries to possess the capacities and capabilities
identified in the IHR(2005) to detect, assess, report, and respond to public health
threats, whether they are naturally occurring, accidental, or deliberate in origin.
This interest is neither solely a public health interest, nor a security interest,
but a human interest. Accordingly, the public health and security communities have
found it increasingly beneficial to work together to advance their shared objectives
in this particular area. While these two communities operate in distinct spheres,
there is an area where the public health and security spheres overlap. These workshops
brought the two communities together to clarify the connections between these spheres
and to promote and enhance cooperative efforts between them to advance IHR(2005) implementation
internationally in an effective, meaningful, and sustainable manner.
Working towards comprehensive global disease surveillance
On June 16th and 17th, 2010 more than 140 health and security experts from 30 countries
gathered in Washington, D.C. to discuss the fundamental components of comprehensive
disease surveillance, impediments to implementing efficient and effective systems,
and lessons and recommendations under the IHR(2005) that help build core disease surveillance
capacity. The meeting identified policy imperatives necessary to achieve functional,
comprehensive systems, particularly in low-resource settings and provided a venue
for funders and aid recipients to discuss the core capacities for surveillance, as
outlined in Annex 1 of the IHR(2005).
The June workshop included presentations from U.S. senior officials from Department
of State (DoS), Department of Health and Human Services (DHHS), and the Department
of Defense (DoD). The U.S. National Security Staff highlighted the political-level
commitment for increased coordination between the health and security communities.
Representatives from across the USG described their agencies’ efforts to build global
disease surveillance capacity, and global experts gave overviews of essential components
of effective surveillance; including human workforce development, commu-nications,
epidemiologic capacity, and the human/animal interface. The remainder of the workshop
was spent in break-out sessions, enabling participants to share national viewpoints,
experiences, and suggestions for cooperative efforts (see Figure 1).
Figure 1
Key themes from breakout sessions at the Workshop on Moving Towards Comprehensive
Global Disease Surveillance.
In this journal supplement, we include six articles drawn directly from this workshop.
Drs. McNabb and Chungong provide an overview of global surveillance elements, the
important scientific, political, and technologic drivers of public health surveillance,
and the surveillance core capacities required for compliance with the IHR(2005). Drs.
Kant and Krishnan describe how information and communication technology is being used
for disease surveillance in India. Mr. Johns and Dr. Blazes discuss how the Department
of Defense is helping nations building core capacities for IHR(2005). Dr. Nsubuga
from the Centers for Disease Control and Prevention (CDC), along with colleagues from
the U.S. Agency for International Development (USAID), the Africa Field Epidemiology
Network (AFENET) and CDC present mechanisms for strengthening surveillance and response
capacity using the health systems strengthening agenda for developing countries. Dr.
Andrus and colleagues from the Pan American Health Organization (PAHO) write about
global health security in the context of the IHR(2005), with specific examples of
how IHR(2005) guided the response to yellow fever in Paraguay and the H1N1 pandemic.
Also in this supplement is the overview of the USG agencies and offices engaged in
building global capacity for disease surveillance, as representatives presented it
at this meeting.
Implementation of the IHR(2005)
On August 20th, 2010 a follow-on workshop was held at the Palais des Nations in Geneva,
Switzerland co-hosted by the BWC Implementation Support Unit. This workshop again
brought more than 100 experts from around the world together for detailed discussion
of lessons learned from national experiences implementing the IHR(2005) and regional
efforts to support capacity building. The aim of this workshop was to share insights
into the practical implementation of the IHR(2005), to identify and address obstacles,
and to facilitate sustainable, long-term collaborations. Speakers representing four
WHO regions delivered national presentations, including Uganda, represented in the
article by Wamala, et al. WHO representatives spoke about international collaboration
efforts necessary for IHR(2005) implementation and representatives from the AFENET
and the American Society for Microbiology (ASM) spoke about capacity building efforts.
These presentations are represented by articles by Dr. Specter and colleagues from
ASM, and by Dr. Musenero and colleagues from AFENET.
Several major themes emerged from the meeting (see Figure 2), as well as specific
challenges identified by participants. Some of the specific challenges to successful
IHR(2005) implementation include:
• Some countries struggle with gaps in resources, particularly human resources. Participants
emphasized the importance of regional training centers to address workforce shortages
and training gaps.
• Meeting IHR(2005) obligations at Points of Entry is a universal challenge, involving
human resources and multi-sectoral engagement and communication.
• The safe and effective transportation of specimens and samples remains difficult
in many parts of the world.
• There is a need for better laboratory infrastructure. Specifically, labs need broad
spectrum diagnostics for rare diseases and common reagents.
• Some countries have had success in developing core capacities at the national level,
but found it challenging to make substantial progress in developing capacity at the
local level.
• Some countries are focused on building basic public health infrastructure to address
endemic health needs, and must prioritize developing this basic infrastructure before
focusing specifically on IHR(2005) compliance.
Figure 2
Key themes, concerns and suggestions from participants at the Meeting on Implementation
of the IHR(2005).
Workshop participants discussed a set of eight draft principles for capacity building
and global cooperation for implementing IHR(2005). They include:
1. In today’s interdependent and interconnected world, health security requires coordinated
action and cooperation among members of the international community.
2. No single institution or country has all the capacities needed to effectively respond
to international public health emergencies. An effective response to these events
requires cooperation among multiple sectors and multiple partner countries, as well
as the WHO.
3. The IHR(2005) provide a critical and universal framework for promoting global health
security.
4. Early detection, rapid reporting, and effective response are critical to prevent
or halt the international spread of disease.
5. Rapid and timely communications between countries and with the WHO is critical
for the response to international public health emergencies.
6. Strong health systems are critical to each country’s ability to prepare for and
respond to both routine public health events and public health emergencies with international
impact.
7. Capacity-building must be practical, sustainable, collaborative, and based on the
needs of each country. In this regard, these efforts must contribute to the strengthening
of each country’s day-to-day capacities to detect and respond to public health events.
8. The development and maintenance of the IHR(2005) core capacities require a significant
investment on the part of all countries. To maximize the effectiveness and efficiency
of these capacity-building activities, it is important to take full advantage of opportunities
for collaboration and coordination among partners.
Additional policy issues
Several active participants in the summer meetings have articles in this supplement
relevant to IHR(2005), disease surveillance and capacity building. Dr. Bakanidze from
Georgia and her co-authors write about biosafety and biosecurity as pillars of international
health security, and discuss how Georgia is building a biosafety regime using the
international guidelines provided by IHR(2005), the BWC and United Nations Security
Council Resolution 1540. Dr. Sobers and her colleagues from Barbados detail the island
nation’s experience with H1N1 and the actions taken by the government to mitigate
the consequences of the disease on their country. Finally, colleagues from the CDC
the Defense Threat Reduction Agency (DTRA) collaborate on a paper that provides a
systems approach to strengthening national surveillance and detection of events of
public health importance.
Conclusions
Representing the desire to foster global collaboration and find both a common political
and technical vision for full implementation of the IHR(2005), the representatives
at the June and August meetings, as well as a growing network of international partners
are achieving important consensus, activities, and outputs. Countries recognize gaps
in disease surveillance capacity and needs for intra-country and inter-sector collaboration.
They also face challenges in specific technical areas and in building leadership,
communication, and collaboration. The platform for discussion and planning provided
in June and August generated enthusiasm and targeted areas for intervention. The contributors
to this supplement are codifying the vision for global disease surveillance and IHR(2005)
implementation, and collectively, planning the future.
Abbreviations
AFENET: Africa Field Epidemiology Network; BWC: Biological Weapons Convention; CDC:
Centers for Disease Control and Prevention; DHHS: Department of Health and Human Services;
DoD: Department of Defense; DoS: Department of State; DTRA: Defense Threat Reduction
Agency; IHR: International Health Regulations; PAHO: Pan American Health Organization;
PHEIC: Public health emergency of international concern; USAID: United State Agency
for International Development; USG: United States Government.
Competing interests
No competing interests to declare.
Authors’ contributions
All authors contributed equally to the text.