Planning for Disease - An international disease response

by David Bradley

SARS appeared in a world that is plagued by many emerging and re-emerging diseases that occur on every continent not just the developing world, stated Dr David Heymann WHO's Executive Director of Communicable Diseases. Keep the map of global map of outbreaks current is challenging. For instance, at the time of the meeting there were outbreaks of a high-mortality respiratory syndrome in Afghanistan, acute diarrhoea in Mozambique/Burundi, H5N1 influenza A, meningitis, measles, acute respiratory syndrome in China, and cholera in Zambia.

There is great concern, said Heymann, that one day there may be deliberate use of microbiological agents to cause serious harm. Today, the agents that worrisome are bacterial, fungal and viral agents, and rickettsial agents that cause typhoid and fevers.

Our concerns are not new; there have been concern about infectious diseases for centuries, if not millennia. Efforts during the 19th and 20th centuries to control the spread of infection culminated in 1969 with the little-known International Health Regulations, which provide the framework for disease surveillance and response. They are endorsed by WHO member nations and the aim is to prevent the spread of disease with minimal interference to world traffic.

Recently, WHO has begun to network with research groups creating everything from formal collaborative links between laboratories around the world and informal internet discussion groups. Information is constantly being brought in through these routes to WHO, such active information exchange is in stark contrast to the passive system with only three diseases listed as there was in 1969 and where disease reporting was not even compulsory.

Information allows WHO to decide whether a reported disease outbreak is of urgent international health importance. If it is not, the nation will be asked to contain it. If it is, then a collaborative risk assessment is undertaken. This amounts, said Heymann, to a new and active approach to disease.

The SARS epidemic illustrated this new coordinated global response to disease, relying on the world's best laboratory scientists, clinicians, and epidemiologists to investigate and provide guidelines for care and containment. An extensive knowledge-base concerning SARS is now in the public domain, which will provide vital information for dealing with this and other diseases.