Concerns about the international spread of diseases are not new. What is new is: (1) the broader scope of identified ‘emerging’ or ‘re-emerging diseases’; (2) the extent of globalizing factors that unleash them; (3) the intrusion of new actors in the arena of public health surveillance, bringing economic or security concerns in; (4) the blurred limits between potential hazards of deliberate and natural outbreaks; and (5) the ever-increasing demand from the public and press agencies for real-time information.
These novelties have entertained the distorted view of global surveillance as an overwhelming and singular priority in health, a view that is now being embraced by major donor agencies. As shown in this paper, this phenomenon carries a risk of further disruption of fragile health systems, and of creating a new complex categorical (vertical) intervention with global dimensions and moving borderlines.
It is fortunate that the forces driving globalization (and its collateral effects on health and lifestyles) are providing at the same time communication instruments that enhance public health surveillance through universal access to informal information sources. But in this way, official health infrastructures are becoming marginal—if not dispensable—in their contribution to fuelling global ‘outbreak intelligence’.
As demonstrated by experience in southern India, the main characters to be empowered in surveillance programmes should be the front-line health care providers, who are entitled, in return for their participation, to expect more assistance in daily encounters with patients, and obviously during times of epidemics.
Likewise, communities can only be motivated to report on unusual events by the reward of free, accessible health care. This is to say that curative and public health sectors cannot be dissociated in this exercise, and that initiatives to fund surveillance programmes cannot work in abstraction from overall deficiencies of health systems.
At international level, it is not enough to acknowledge the global threat of emerging or re-emerging diseases and to focus on a strategy based on externally driven surveillance and response.
With equal urgency, preparedness for future epidemics has to include a parallel overhaul of health systems, including the essential issues of human resources development, governance and equity in access to care. Yielding and complacency toward multiple donor-driven initiatives result in further disruption of weak health systems and contradict the rhetoric of promoting integration in public health surveillance.
At a time when a clock predicting the next influenza pandemic seems to tick close to its detonation time, it is perhaps incongruous to advocate the revisiting of policies framing global public health surveillance. But if the main legacy of global surveillance policies consists merely of a summons to plug into a virtual ‘network of networks’, and to welcome foreign investigators donning bio-protective equipment, we will fail in our duty to protect the most vulnerable populations during a pandemic of some magnitude.
No developing country is currently in a position to absorb the shockwave of extra hospital-based care brought about by a pandemic of influenza, or to organize universal access to protective or preventive measures, should the latter become available. At this time, there is no escaping from the conclusion that the harvest of outbreak intelligence overseas is essentially geared to benefit wealthy nations.