day urgency. Noting that “society is healthier because more people understand health,” Karesh advocated greater information sharing by public health officials as a way to reduce, rather than increase, panic in response to disease threats, and also to increase popular support for funding public health. He envisioned a two-way exchange of surveillance information, with the global public both supplying essential data and receiving the benefits of its meaningful interpretation.

Panelist James LeDuc, Director for Global Health in the Institute of Human Infections and Immunity at University of Texas Medical Branch, offered a concrete example of the potential for such “grassroots” surveillance: In Cambodia, a network of “semitrained” villagers with cell phones and Mopeds swab sick chickens and ducks to check for avian influenza and alert the health community to suspected human cases. Multinational companies represent another newly tapped source of global surveillance information; LeDuc noted that the Centers for Disease Control and Prevention (CDC) has established collaborations with a number of major companies operating in China, encouraging them to share signs of unusual disease activity. He also identified two recent developments at the World Health Organization (WHO) as significant opportunities for global coordination in addressing infectious disease: the appointment to Director-General of Margaret Chan, who has extensive experience in this area, and the ratification of the revised International Health Regulations (IHRs; see Summary and Assessment).

On Location and in the Lab

In contrast to the global perspective taken by LeDuc, panelists Marci Layton, Fernando Guerra, and Frances Downes offered local viewpoints on infectious disease surveillance and detection. Layton, who had previously discussed local public health surveillance as conducted by the New York City Department of Health and Mental Hygiene (DOHMH; see Summary and Assessment and Chapter 1 overview), reemphasized that public health is an essentially local pursuit, and that its most important asset is its infrastructure, particularly its workforce. While acknowledging advantages in disease detection conferred by the increasing volume of surveillance information available at the local level, she stressed the importance of passing this inevitably noisy data through a “public health filter,” embodied in “an epidemiologist looking at the data, a physician interviewing other physicians to find out more deeply about a case, or field staff going out and investigating the case.” This process converts raw surveillance data into “trustable” intelligence that avoids being premature or panic inducing, Layton said.

Guerra, Director of Health for San Antonio and Bexar County, Texas, works with a population much smaller than that of New York City, but one that is similarly diverse and changeable. His experiences in building and using surveillance systems, such as an immunization registry and tracking program, reveal the profound influence of social circumstances on public health and their potential contribution to “situational awareness” of disease threats, as discussed in prior



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