Cooperation Between Countries Can Improve Disease Surveillance, Experts Say | Best Countries

As the world faces yet another surge in COVID-19 cases, experts say countries have the opportunity to improve disease surveillance systems to better prepare for the next pandemic, but it will require global cooperation.

An October report by the Council on Foreign Relations found that the world was “caught unprepared” by the coronavirus crisis “despite decades of warnings of the threat of global pandemics and years of international planning.” The report notes that the pandemic has revealed the limitations of existing epidemic threat surveillance systems, which “left public health officials and researchers without access to timely data.”

One of those limitations is that disease surveillance “fundamentally relies on the transparency and self-reporting of directly affected states,” says Thomas Bollyky, the director of the global health program at the Council on Foreign Relations.

“That system has broken down,” Bollyky says. “The world’s safety from pandemic threats can no longer rely on the transparency and self-reporting of nations.”

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There is one existing surveillance system, however, that played a key role in the initial discovery of COVID-19. The Program for Monitoring Emerging Diseases, which is part of the nonprofit International Society for Infectious Diseases and also known as ProMED, is described as the largest publicly available system that conducts “global reporting of infectious diseases outbreaks.” The program has been the first to report on many major outbreaks such as the Severe Acute Respiratory Syndrome, or SARS, crisis and, most recently, identified the “first more detailed report” on the novel coronavirus, according to Linda MacKinnon, the executive director of the International Society for Infectious Diseases.

“I don’t really know what we could have done that much quicker, in terms of surveillance providing a mechanism by which a novel pathogen can be flagged of importance to everyone,” says David Pigott, an assistant professor of health metrics sciences at the University of Washington’s Institute for Health Metrics and Evaluation.

Pigott adds that ProMED is a “great example of surveying both rumor and health professionals to determine their signal from the noise.” Even so, Bollyky argues that “earlier notice really could have made a huge difference in the containment of this pandemic.” He says the Council on Foreign Relations’ task force found that China was “slow to notify” the world about COVID-19 and was also “slow to share material information” about the disease, especially in January. Bollyky acknowledges the role ProMED played at the outset of the pandemic but notes that it’s open-sourced.

“We need something more than that,” he says. (MacKinnon says ProMED data is “always validated and reviewed through an extensive process” before it is distributed.)

Bollyky, however, is optimistic, describing pandemic surveillance as a “fixable problem.” The council’s report recommends that the United States work with other governments and partners to “build and integrate national and global epidemic surveillance systems.” The task force argues that health care facilities should be incentivized to regularly share hospitalization data into a new global assessment platform.

Pigott says “there’s a lot more to be done than just the flagging of events of high concern.” He argues for more global standardization of reported metrics and definitions related to emerging diseases. While this would be “tough to coordinate,” such broad coordination is “not unprecedented.” He notes, for example, the process for death certification, which is standardized by a centralized organization with countries agreeing to use those benchmarks in their systems.

“To be honest, the COVID pandemic has highlighted, from my perspective, a need for that way of thinking about these problems. And if I can’t convince people to be thinking about that right now, I don’t think I ever will,” Pigott says. “I think this is one of the real paradoxes about emerging infectious disease surveillance, that you hope that it’s a rare occurrence, and therefore, you need to kind of maintain the quality of a system that is infrequently challenged. I think we should kind of consider that as like a ramping up of surveillance.”

Pigott adds that the world should be considering how to build a system that can also adapt with health care workers, rather than burdening them with an “extensive manual transfer” of data that has them filling out hundreds of fields when, in reality, they are going to “prioritize things that matter to the day-to-day survival of their patients.” Therefore, he says, it’s important to routinely prepare data reporting systems for a future multinational scale, rather than “always playing catch-up” and doing it “as a knee-jerk to a one-off pathogen response.”

MacKinnon agrees that a “more global, systematic approach” to disease surveillance would be ideal. She said achieving such a system will require leadership and the appropriate level of funding. Bollyky adds that he’s hopeful, noting that U.S. President-elect Joe Biden has talked about disease surveillance generally in his plans for attacking the COVID-19 pandemic once he assumes office. Biden has said he will reverse President Donald Trump’s decision to withdraw the U.S. from the World Health Organization, which would not be complete until next July.

MacKinnon says she is “always hopeful,” and that the lessons learned from this current crisis will help everyone “do a little bit better next time.”

“I think people might have taken things for granted,” she says. “And sometimes it’s like, ‘Oh, it’s not in my backyard,’ but it’s everywhere now. So I think it’s sort of a wake-up call for us to work together and make strides to bring this to fruition.”

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