The Undefended Country…

A story in The Scientist by Katherine Eban about the woefully inadequate disease surveillance efforts in the USA. In particular, the media have started to play their necessary role, as discussed here.

In an earlier discussion I had started over at Freedom to Tinker about the lack of an effective syndromic surveillance system, it seemed that concern of most of the commentators to my post were centered on the privacy issues. But I am actually very little concerned with those issues, more concerned with the safety issues, and the intelligent design of such a system. Putting into place the necessary provisions so that if we had such a system and it worked, we would be able to address the disease that it might uncover is also neglected. Roger Brent had some very good ideas in his outlines of what a system should look like, and even more importantly, when such a system is needed (NOW)  That could be a separate post.

Biosense or Biononsense?
Years of development and hundreds of millions of dollars later, what has the CDC’s syndromic surveillance program accomplished?
By Katherine Eban

It was two days before Thanksgiving 2004, when an epidemiologist in New Jersey’s public health agency picked up a heart-stopping electronic message. The “Sentinel Infection Alert,” from a computer program run by the Centers for Disease Control and Prevention, had detected what appeared to be the beginning of a smallpox outbreak in the state. There, however, New Jersey’s public health officials were stuck. The alert, generated from deep within the CDC’s headquarters in Atlanta, didn’t clarify the data’s origin, what sparked it, or how state officials could respond.

Calling the CDC two days before Thanksgiving didn’t help. New Jersey’s frantic health officials found the CDC’s staffing and pace reminiscent of a sleepy, preterrorist agency. No one was in at the CDC’s Biointelligence Center, which is supposed to support the computer program. Even the CDC’s emergency operations center seemed unable to shed light on the warning. “We certainly were concerned,” says Christina Tan, deputy state epidemiologist for the New Jersey Department of Health and Senior Services, recalling how they called the CDC’s technical help desk and left a message.

An interesting fact is that some of the municipal syndromic surveillance efforts, particularly in New York City, are better than those of the Federal Government. Not surprising.

Last year, Congress passed the Pandemic and All Hazards Preparedness Act, which mandates the use of information technology to improve public health awareness. The need is clear, say some experts. “Surveillance capacity is no longer optional,” says Farzad Mostashari, assistant commissioner of New York City’s Department of Health and Mental Hygiene, who oversees the city’s highly praised syndromic surveillance efforts. “It’s necessary and critical for state and local health departments,” he says, but notes that a centralized Federal data system thousands of miles away from an incident cannot be a substitute for local officials having up-to-the-minute local information. “You wouldn’t do that with police. You wouldn’t do that with firemen,” he adds.

Congress has responded with funding. In 2002, it passed the Public Health Surveillance Act, which authorized $1 billion for the CDC to distribute to states for public health preparedness. Included was a mandate that states develop some kind of electronic means of monitoring emerging symptoms, but there were few guidelines and no national strategy.

Katherine Eban’s reporting was funded in part by The Nation Institute. Eban was a 2006 Alicia Patterson Fellow reporting on public health and homeland security.

Another article on a similar subject:

The Undefended Country…

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