We must strengthen public health surveillance to stop disease outbreaks

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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

The writer is president and chief executive of Resolve to Save Lives and a former director of the US Centers for Disease Control and Prevention

The Covid pandemic, which killed close to 20mn people and cost more than $20tn globally, exposed weaknesses in disease tracking in nearly all countries. But we’re still flying blind and remain unprepared for — and unprotected from — significant health threats.

To protect people and improve health, it’s essential to have accurate, real-time data. We take for granted local weather reports, air quality alerts and traffic updates that keep us informed, ready and safe. So, too, public health surveillance can allow us to foretell health disasters, find invisible poisons and see trends in diseases and health programmes to save lives. Surveillance is the public health superpower: it can empower individuals, families, countries and the world. 

There have been some exciting technological advances in health surveillance but the secret to success is simply getting the basics right. Surveillance systems need to collect appropriate data and analyse it quickly and accurately to enable action. Strong laboratory systems are essential to confirm which pathogens are responsible. Thoughtful analysis is also important, to ensure disease prevention and control reaches the right communities at the right time. And long-term investment is critical to build systems and the capacity to save lives.

However, one health minister in Africa told me: “We’re drowning in data and starving for information.” What’s needed is effective surveillance that can quickly collect the minimum amount of data needed to detect a potential disease outbreak. Then, leaders must focus on how this data is used — prioritising systems that generate the most actionable insights.

Better information won’t come from overseas academic institutions that swoop in, vacuum up data and tell countries what they think is happening based on models or other methods. The best approach to health surveillance is to build local and national systems and capacity. People in each country will be best equipped to make the steady improvements in data quality and systems needed for timely analysis.

Traditional surveillance methods — such as case and death reporting, hospital and laboratory reporting and case and outbreak investigation — remain essential. Newer technologies can build on these strong basics.

Better information won’t come from overseas academic institutions . . . the best approach to health surveillance is to build local and national systems and capacity

Wastewater testing has long been used to detect polio outbreaks and is now a good early warning marker for the spread of Covid, influenza and other diseases. Genomic surveillance can improve detection of new disease variants or novel strains so we can adapt to stay a step ahead and develop and deploy countermeasures. Non-traditional data sources — such as social and news media, weather, population movements and historical disease trends — can be used, as well, and artificial intelligence may improve the utility of large and complex data sets.

Outbreak detection depends on effective surveillance and is critical to public safety. The “7-1-7” target for outbreak detection, notification and response sets achievable standards: seven days to find every outbreak; one day to report to public health authorities; seven days to have all essential control measures in place.

But the current fragmentation of, and under-investment in, core surveillance systems at national, regional and global levels means we under-leverage data in decision-making. This can be addressed only in part through advances in technology. Better sharing of data on human and animal health will help curb the H5N1 influenza outbreak in US cattle. Turning data into information and then into action requires transparent collaboration, thoughtful leadership and effective governance. 

There are already some bright spots in global collaboration, including progress in lower-income countries.

$20tnThe Covid pandemic has cost more than $20tn globally

For decades, a global influenza laboratory network has tracked the evolution of the virus as it spreads around the world, enabling manufacturers to make vaccine formulations more likely to work against each season’s strain. Now, the organisation I lead, Resolve to Save Lives, has partnered with countries which have made impressive progress: Nigeria has accelerated outbreak detection and response; Sierra Leone has engaged community health facilities to more rapidly detect outbreaks; and Mozambique has combined multiple surveillance programs to accelerate action on a broad range of health issues.

The world’s financial markets have long had early warning systems to spot potential problems, enabling policymakers to intervene before a crisis expands. We need a similar approach to health. New financing from the Pandemic Fund, World Bank, Global Fund, the US government and others is important in establishing such an early-warning system but there will not be a quick, one-time or technological fix.

Funding needs to be sustained to build strong surveillance systems within strong institutions. Accomplishing this will provide each country’s public health system with the tools needed to get the basics right and stop potential disease threats before they grow and spread.