[Congressional Record (Bound Edition), Volume 146 (2000), Part 11]
[Senate]
[Pages 16344-16345]
[From the U.S. Government Publishing Office, www.gpo.gov]



                    INFECTIOUS DISEASE SURVEILLANCE

  Mr. LEAHY. Mr. President, I want to briefly discuss a GAO report that 
was released earlier this week to be sure that other Senators are aware 
of.
  The report, entitled ``Global Health: Framework for Infectious 
Disease Surveillance,'' was commissioned by Senator McConnell and 
myself, and Senators Frist and Feingold. It investigates the existing 
global system, or network, of infectious disease surveillance, and will 
be followed by a second report which analyzes the strengths and 
weaknesses of this network and make recommendations for strengthening 
it.
  We requested this report in response to a growing concern among 
public health officials about the inability of many countries to 
identify and track infectious diseases and respond promptly and 
effectively to disease outbreaks. In fact, the World Health Assembly 
determined in 1995 that the existing surveillance networks could not be 
considered adequate.
  By way of background, the term ``surveillance'' covers four types of 
activities: detecting and reporting diseases; analyzing and confirming 
reports; responding to epidemics; and reassessing longer-term policies 
and programs. I will touch on these categories in a bit more detail, as 
they illustrate the need for reform.
  In the detection and reporting phase, local health care providers 
diagnose diseases and then report the existence of pre-determined 
``notifiable'' diseases to national or regional authorities. The 
accurate diagnosis of patients is obviously crucial, but it can be very 
difficult as many diseases share symptoms. It is even more difficult in 
developing countries, where public health professionals have less 
access to the newest information on diseases.
  In the next stage of surveillance, disease patterns are analyzed and 
reported diseases are confirmed. This process occurs at a regional or 
national level, and usually involves lab work to confirm a doctor's 
diagnosis. From the resulting data, a response plan is devised. 
Officials must determine a number of other factors as well, such as the 
capability of a doctor to make an accurate diagnosis. Unfortunately, in 
many developing countries this process can take weeks, while the 
disease continues to spread.
  When an epidemic is identified, various organizations must determine 
how to contain the disease, how to treat the infected persons, and how 
to inform the public about the problem without causing panic. Forty-
nine percent of internationally significant epidemics occur in complex 
emergency situations, such as overcrowded refugee camps. Challenges in 
responding to epidemics are mainly logistical--getting the necessary 
treatment to those in need.

[[Page 16345]]

  Finally, in assessing the longer-term health policies and programs, 
surveillance teams can provide information on disease patterns, health 
care priorities, and the allocation of resources. However, information 
from developing countries is often unreliable.
  I want to emphasize two points. The first is that all the activities 
that I have just described are done by what WHO calls a ``network of 
networks.'' There is, in fact, no global system for infectious disease 
surveillance. Let me repeat, for anyone who thinks there is some 
centrally-managed, well-organized global system, there is not. Rather, 
what exists is a loose network, a patch-work quilt of sorts, involving 
the UN, non-governmental organizations, national health facilities, 
military laboratories, and many other organizations, all of which 
depend upon each other for information, but with no standardized 
procedures.
  The second point is that in countries where a tropical climate 
fosters many infectious diseases, one also finds the least amount of 
reliable data. If we as a country, or we as a global community, are 
committed to eradicating the deadliest diseases, building the capacity 
for effective surveillance in the developing countries is where we need 
to focus our attention.
  The sequel to this report is due to be released by the GAO in a few 
months. It will assess the strengths and weaknesses of this loosely-
organized surveillance system, and make recommendations for 
strengthening it. We need to be able to accurately diagnose diseases, 
and quickly transmit the information to the global health community.
  I urge other Senators to read this first report. This is an issue 
that has received far too little attention, and which directly affects 
the health of every American. Any disease, whether HIV/AIDS, malaria, 
TB, or others as yet unknown, which could infect and kill millions or 
tens of millions of people, is only an airplane flight away.
  Accurate surveillance, which is the first step to an effective 
response, is critical. Yet today we are relying on a haphazard network 
of public, private, official, and unofficial components of varying 
degrees of reliability, patched together over time. It is a lot better 
than nothing, but the world needs a uniformly reliable, coordinated 
system with effective procedures that apply the highest standards. I 
look forward to GAO's next report, and its recommendations for action.

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