Carnegie Reporter, Vol. 1, No. 4 | Preventing “Dark Winter”— The Public Health System’s Role in Strengthening National Security, page 5 (low bandwidth)

CDC thinks it imperative that a national, online system be set up to monitor the earliest signs of a bioterrorism attack, and it is actively working toward that goal. The system would require that infection control professionals-usually a doctor or nurse who monitors anomalous infections within a hospital-be trained to spot unusual patterns of infection. They should have current telephone numbers for notifying other concerned professionals in the hospital and for contacting state and local health departments, the FBI's local office, and the CDC Emergency Response Office.

What else is needed? State health departments should provide information and reminders to healthcare providers and clinical laboratories. They should operate 24 hours a day, 7 days a week. They should immediately investigate unusual clusters of illness that suggest release of a bioterrorism agent and request CDC's assistance if necessary; implement a plan to access the Laboratory Response Network (which links public health, university and clinical laboratories in order to monitor and share information related to bioterrorism preparedness and response) to send and analyze specimens; and report immediately to CDC if the investigation suggests a bioterrorist attack. How long would it take to set up such a national system? Dr. Akhter says it depends on the amount of federal money made available because no locality could afford it. Even if all the funds needed were suddenly to materialize, Dr. Akhter estimates that it would still take two years to have an effective system up and running.

In this era of fast and popular international travel, an epidemic will not remain local for long, but international disease surveillance rests in the hands of individual nations, which have different concerns at different times. In the early days of the AIDS epidemic, many countries did not report AIDS cases for fear of the effect on business and tourism. The World Health Organization (WHO) set up the Global Outbreak and Alert Response Network in 2000 to link up 72 existing networks and institutions around the world. However, because the network depends on countries voluntarily reporting outbreaks, that may mean days of delay in areas with poor communication or even suppression of information that might be economically harmful.

In the U.S., in addition to the Laboratory Response Network, CDC has made headway in its efforts to develop a national alert, analysis and response system. Already in place is the Health Alert Network, designed to link local health departments to one another and to first responders, hospital and private laboratories, state health departments, CDC and other federal agencies. CDC is also implementing the National Electronic Data Surveillance System to electronically link a variety of disease surveillance activities, providing faster and more accurate reporting of information to the CDC and state and local health departments.

The European Union's 51 countries have national disease surveillance systems and there are plans to upgrade them. "Changes in social and physical environments have created a host of new threats of infectious disease," says Dr. Marc Danzon, WHO Regional Director for Europe. "Early detection and response are our best defense. Regional and global health and economic security depend on them."

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