tious diseases that builds on the current global capacity of infectious disease monitoring. This effort, of necessity, will be multinational and will require regional and global coordination, advice, and resources from participating nations. A comprehensive system is needed to accurately assess the burden of infectious diseases in developing countries, detect the emergence of new microbial threats, and direct prevention and control efforts. To this end, CDC should enhance its regional infectious disease surveillance; DOD should expand and increase in number its Global Emerging Infections Surveillance (GEIS) overseas program sites; and NIH should increase its global surveillance research. In addition, CDC, DOD, and NIH should increase efforts to develop and arrange for the distribution of laboratory diagnostic reagents needed for global surveillance, transferring technology to other nations where feasible to ensure self-sufficiency and sustainable surveillance capacity. The overseas disease surveillance activities of the relevant U.S. agencies (e.g., CDC, DOD, NIH, USAID, USDA) should be coordinated by a single federal agency, such as CDC. Sustainable progress and ultimate success in these efforts will require health agencies to broaden partnerships to include nonhealth agencies and institutions, such as the World Bank.

Rebuilding Domestic Public Health Capacity

Strong and well-functioning local, state, and federal public health agencies working together represent the backbone of an effective response to infectious diseases. The U.S. capacity to respond to microbial threats is contingent upon a public health infrastructure that has suffered years of neglect. Upgrading current public health capacities will require considerably increased, sustained investments.

U.S. federal, state, and local governments should direct the appropriate resources to rebuild and sustain the public health capacity necessary to respond to microbial threats to health, both naturally occurring and intentional. The public health capacity in the United States must be sufficient to respond quickly to emerging microbial threats and monitor infectious disease trends. Prevention and control measures in response to microbial threats must be expanded at the local, state, and national levels and be executed by an adequately trained and competent workforce. Examples of such measures include surveillance (medical, veterinary, and entomological); laboratory facilities and capacity; epidemiological, statistical, and communication skills; and systems to ensure the rapid utility and sharing of information.



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