GAO-01-722 Global Health: Challenges in Improving Infectious Disease Surveillance Systems

According to the World Health Organization, infectious diseases account for more than 13 million deaths every year, including nearly two-thirds of all deaths among children under age 5. Although the great majority of these deaths occur in developing countries, infectious diseases do not recognize international boundaries. They present a substantial threat to people in all parts of the world. In recent years, this threat has grown in volume and complexity. New diseases have emerged, others once viewed as declining in significance have resurged in importance, and many have developed substantial resistance to known antimicrobial drugs. This picture is complicated by the potential deployment of infectious disease pathogens as weapons of war or instruments of terror. Infectious disease surveillance provides national and international public health authorities with information that they need to plan and manage efforts to control these diseases. In the mid-1990s, public health experts in the United States and abroad determined that global infectious disease surveillance was inadequate, and both the World Health Assembly and the President of the United States called for concerted action to develop an effective global infectious disease surveillance and response system. 1 In response to your concern about current arrangements for infectious disease surveillance, we reported in July 2000 2 that global surveillance is carried out through a loose framework of formal, informal, and ad hoc arrangements that World Health Organization (WHO) officials characterize as a " network of networks. " In this second report, we (1) examine the framework's evolution and current operations, (2) identify factors that constrain its performance, and (3) assess several initiatives designed to improve global infectious disease surveillance and response. In doing this work, we collected data from and consulted with experts in the international public health community, including officials of WHO, the Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID), the World Bank, and prominent nongovernmental organizations in the health sector. As you requested, we emphasized surveillance operations in sub-Saharan Africa, visiting Malawi, Tanzania, Uganda, and Zimbabwe to discuss relevant issues with public health officials at every level. More detailed information about our scope and methodology is in appendix I. Information on each of the diseases mentioned in this report is in appendix II. The strongest influence on the evolution of the current global infectious disease surveillance framework has been the international community's focus on specific diseases or groups of diseases. The …