Exploring the international arena of global public health surveillance

Abstract

Threats posed by new, emerging or re-emerging communicable diseases are taking a global dimension, to which the World Health Organization (WHO) Secretariat has been responding with determination since 1995. Key to the global strategy for tackling epidemics across borders is the concept of global public health surveillance, which has been expanded and formalized by WHO and its technical partners through a number of recently developed instruments and initiatives. The adoption by the 58th World Health Assembly of the revised (2005) International Health Regulations provides the legal framework for mandating countries to link and coordinate their action through a universal network of surveillance networks. While novel environmental threats and outbreak-prone diseases have been increasingly identified during the past three decades, new processes of influence have appeared more recently, driven by the real or perceived threats of bio-terrorism and disruption of the global economy. Accordingly, the global surveillance agenda is being endorsed, and to some extent seized upon by new actors representing security and economic interests. This paper explores external factors influencing political commitment to comply with international health regulations and it illustrates adverse effects generated by: perceived threats to sovereignty, blurred international health agendas, lack of internationally recognized codes of conduct for outbreak investigations, and erosion of the impartiality and independence of international agencies. A companion paper (published in this issue) addresses the intrinsic difficulties that health systems of low-income countries are facing when submitted to the ever-increasing pressure to upgrade their public health surveillance capacity.

Avian influenza, ‘viral sovereignty’, and the politics of health security in Indonesia

“…Many now note that some public health issues, mainly rapidly spreading infectious diseases, have come to be seen as 'pressing existential threats that require urgent and extraordinary international policy responses', thus 'abandoning the decades-old convention of equating security with the absence of armed conflict between states' (Elbe 2009: 2). The securitisation of infectious disease has undoubtedly led to an increasing emphasis upon, and rising funding allocated by the governments of richer countries towards, programs aimed at improving the capacities of developing countries for surveillance of and response to emerging infectious diseases (Calain 2007;Smith 2012;Lakoff 2008). …”

“…It is often argued that following a brief 'post-Westphalian' moment, resulting from the SARS shock, states have reasserted their national sovereignty over the WHO's supranational authority, with detrimental consequences to global efforts to deal with the threat of infectious disease (Calain 2007;Stevenson and Cooper 2009;Kamradt-Scott 2011;Smith 2012). Siti's virus-sharing dispute is viewed as the most significant manifestation of this nationalist backlash, as she was seen to challenge even her country's basic responsibility to cooperate with the WHO (Fidler 2010).…”

“…Another explanation, provided most explicitly by Stefan Elbe (2010;also Forster 2010;Calain 2007), is that Siti was reacting to the 'securitisation' of H5N1 by the WHO and Western governments:…”

Global eHealth

“…The deepening enmeshment of ICTs and global health is also reflected in a sharp increase in the number of digital networks aimed at public health surveillance (Calain 2007). From the seasonal flu to the Ebola epidemic outbreak, networks aimed at monitoring population health have been multiplying at a rapid rate over the past decade.…”

“…In natural disaster and war zones, in humanitarian settings, or as part of broader development policies, eHealth networks are being implemented. Networks provide services such as remote diagnostic solutions (Nsehe 2012), health information to patients and lay persons (WHO 2011b), teleconsultations between practitioners (Wootton 2008), and text-message reminders of follow-up medical appointments (Liew et al 2009;WHO 2011b).The deepening enmeshment of ICTs and global health is also reflected in a sharp increase in the number of digital networks aimed at public health surveillance (Calain 2007). From the seasonal flu to the Ebola epidemic outbreak, networks aimed at monitoring population health have been multiplying at a rapid rate over the past decade.…”