Written Assignment, Unit 7

Epidemiology

HS 3311-01 - AY2022-T5

Mehrnaz Siavoshi
(Instructor)

Global Health Surveillance System

As the world witnessed, the COVID-19 pandemic affected more than 180 countries, emerged

rather quickly and spread very fast, which created a global health and economic crisis. The

pandemic has overwhelmed health care systems and forced hospitals, health authorities and

facilities to find effective ways to share data. (Lee, H. A. et al. 2020) Information flow was

slow, often cases were under-reported and treatments for infection weren’t effectively

controlled or prevented. How to prevent a similar infectious case to occur from becoming

global again? Surveillance is a fundamental role of public health. Much of the information

about morbidity and mortality comes out of systematic disease surveillance. Epidemiologic

surveillance maintains an “ongoing systematic collection, analysis and interpretation of

health data essential to the countries and rural areas, surveying to detect cases either

periodically on a routine basis or after an index case has been reported.” (Leon Gordis. 2014)

A global public health surveillance is thus critical for the identification and prevention of

emerging and reemerging diseases, both for infectious and noncommunicable diseases that

account for the greatest burden of diseases, even in very poor countries. (Michael St. Louis.

CDC. 2012)

Discussion

Studies on infectious disease surveillance has highlighted 2 major issues with the current

global surveillance systems. Either some systems “have the function of being a static

continuous spatial map of infectious disease risk, while others have the function of

continuously updating the reporting of infectious diseases, but there is still no system that

combines these two functions.” (Lee, H. A. et al. 2020) Moreover, since SARS-Cov2 was a

new virus, no specific treatments were available, which meant a discrepancy between the

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development of a treatment and the exchanging of treatment results and case experiences.

(Lee, H. A. et al. 2020) A functional and effective global network surveillance system should

then be designed, that may learn from past mistakes and errors, thus updating new capabilities.

A surveillance system that shares information of the movement and tracking of cases, that

may include linkage and correlation between each case and infectious disease control in

various countries. It should also provide health information in a timely manner so that

countries have the information that they need to fight epidemics now or to plan for the future.

Several public health problems have been addressed effectively by the development and

maintenance of surveillance systems. One example is smallpox, which was eradicated

through a switch in strategy from mass vaccination to surveillance with rapid response.

(Michael St. Louis. CDC. 2012) In terms of global health protection and security, the

International Health Regulations (IHR) is a legally binding agreement “of 196 countries to

build the capability to detect and report potential public health emergencies worldwide”.

(CDC.2022) The IHR “require that all countries have the ability to detect, assess, report, and

respond to public health events.” (CDC.2022) Unfortunately, only 1/3 of the countries in the

world currently have these capabilities, thus such limits may render a total global coverage

wanting. (CDC.2022) Remote areas, in need of surveillance may be difficult to reach, thus

maintaining communication from such places to health authorities that may act and make

policy for prevention, disease control and resource allocation are still an issue. (Leon Gordis.

2014) Moreover, these places might also underreport observed clinical cases due to a

different understanding of disease definitions or methodology, thus lacking laboratory or

other sophisticated diagnostic tools and or resources to conduct better evaluations of

suspected cases. (Leon Gordis. 2014) Disparities in estimates are also problem. Malaria

control illustrate this issue well, where mortality cases peaked in 2004, only to gradually

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decrease a few years later, attributed to successful control activities, insecticide-treated

bednets to prevent infection and improved treatment of those already infected. (Leon Gordis.

2014)

Conclusion

In order for a global health threat to be detained its crucial to understand that surveillance in

low-resource countries is not the same as in highly industrialized ones. It’s necessary to do

more with less. Ongoing surveillance is difficult and sustainability is challenging. (Michael

St. Louis. CDC. 2012) In such countries a more voluntary based surveillance, integrating

communities, that may be connected and share data may be enough to keep a true flow of

information over health and disease. Resource allocation for laboratory upgrading, testing

and analysis should be allocated on a global basis through different programs, since many

low-resource countries might not have a fund base to maintain such upkeeping.

Surveillance, in global terms needs to be integrated, in cases decentralized (low-resource

countries) and mainly voluntary. Its data sharing ought to assume a minimalistic and

functional approach to data interpretation, it should be timely, regularly disseminated and

connected online.

A global approach needs a convergence and standardization for a better disease interpretation,

international medical forms, simpler formats and a better training needed for clinical,

laboratory, informatics, and public health agents to implement all such practices. (Michael

St. Louis. CDC. 2012)

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References:

Michael St. Louis. CDC. (2012). Global Health Surveillance. Retrieved from:

https://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a4.htm

Lee, H. A., Kung, H. H., Lee, Y. J., Chao, J. C., Udayasankaran, J. G., Fan, H. C., Ng, K. K.,

Chang, Y. K., Kijsanayotin, B., Marcelo, A. B., & Hsu, C. Y. (2020). Global Infectious

Disease Surveillance and Case Tracking System for COVID-19: Development Study. JMIR

medical informatics, 8(12), e20567. https://doi.org/10.2196/20567

CDC. (2022). Global Health Protection and Security. International Health Regulations (IHR).

Retrieved from: https://www.cdc.gov/globalhealth/healthprotection/ghs/ihr/index.html

Leon Gordis. (2014). Epidemiology. Fifth edition. Elselvier. Philadelphia. USA