Academic journal article Bulletin of the World Health Organization

Impediments to Global Surveillance of Infectious Diseases: Consequences of Open Reporting in a Global Economy

Academic journal article Bulletin of the World Health Organization

Impediments to Global Surveillance of Infectious Diseases: Consequences of Open Reporting in a Global Economy

Article excerpt

Voit page 1365 le resume en francais. En la pagina 1366 figura un resumen en espanol.


Globalization has heightened the attention being paid to the international movement of people, goods, and information. In addition to expanding trade and travel, such movement accelerates the scale and speed of the transmission of infectious diseases. Most of these diseases are those once considered to be under control, ones that have emerged recently, or drug-resistant strains of existing pathogens. However, over the past two decades at least 30 new diseases have emerged, many with a potential for rapid spread across borders (/). The HIV/AIDS pandemic exemplifies the ease with which pathogens can spread in today's globalized society.

It is widely agreed that a global surveillance system for infectious diseases would help significantly to control their spread. Interest in disease surveillance dwindled between the late 1950s and the early 1990s because developed countries no longer perceived infectious diseases to be a serious threat. Such optimism resulted from advances made in vaccines and treatment, the eradication of smallpox, a preoccupation with chronic diseases, and a confidence among health leaders that infectious diseases were a problem of the past (2, 3). There were a few exceptions; for example, global influenza surveillance began in 1948 and led to the annual design of effective vaccines. Other comparable endeavours, however, were not sustained. In the absence of interest in global surveillance, the corresponding funds and infrastructure declined, together with the capacity to detect outbreaks. Inaccurate disease surveillance reports continue to be made by developing countries because of a fear of unduly harsh treatment from the world community (2, 3).

Global surveillance finds its beginnings in 1896 when it was agreed at the International Sanitary Conference that there was a need for international health surveillance (4). Before this date, individual countries had monitored and often contained cases through quarantine. The Organisation internationale d'Hygiene publique was established in Paris in 1907 to gather information on disease outbreaks for eventual distribution to participating countries. The reporting of cholera and plague was required initially, while yellow fever, typhus and relapsing fever were added later. European countries feared that these diseases would cross their borders from the poorer countries where they principally occurred (2). Some countries signed additional health treaties before the Second World War. Despite these efforts, international health legislation proved ineffective because the treaties did not keep pace with scientific advances, were not recognized by all countries, and failed to secure the compliance of the poorer countries, which did not report diseases for fear of possible repercussions (2).

After the Second World War the Organisation internationale d'Hygiene publique was replaced by the World Health Organization. In 1951, WHO issued the International Sanitary Regulations, which were renamed the International Health Regulations in 1969 and later revised in 1981. These regulations required Member States to notify WHO within 24 hours of outbreaks of cholera, yellow fever and plague. The aim was to achieve the greatest possible security against the spread of disease and minimal disruption of international traffic (3). WHO possessed no enforcement powers, and it was hoped that persuasion and recommendation would induce countries to comply. Unfortunately, they did not always do so, often fearing unwarranted reactions that would affect travel and trade (5). Non-reporting countries justified their fears in terms of the costly repercussions that reporting countries faced in the past. The present International Health Regulations cover only three diseases (cholera, plague, and yellow fever), failing to address all other re-emerging and emerging infectious diseases that may have a potential for international spread. …

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