Essentially all the public health surveillance activities in the United States are managed by state and local governments. This local responsibility in the United States may limit the possibility of establishing official relationships between experts in the two countries.

Moreover, Keene noted that surveillance activities and outbreak investigations involve many practical problems—problems that may be peculiar to the particular state or country in question. One such problem in the United States relates to the various options that telephone customers have to limit their accessibility via phone. A growing number of telephone customers, for example, are choosing to have unlisted telephone numbers, and many of them also use call-screening methods to decide which calls they will answer. Such options make it more difficult to reach patients in order to collect necessary information for studies. Because legal authority and various practical matters differ from one country to the other, surveillance systems that work well in many American states may need to be adapted considerably if they are to fit with approaches of Iranian institutions and social customs.

Iranian participants indicated that among the steps they might be able to take to strengthen field laboratories would be a series of training workshops and the outfitting of facilities so that they will meet the minimum requirements of surveillance systems.


On behalf of the Iranian scientists, Mohammad Reza Zali expressed sincere appreciation for the opportunity to meet with U.S. colleagues. Recognizing that both countries have many problems, he said that he views the establishment and expansion of scientific relationships to be an important step for scientists and also for the general populations in both countries. Doyle expressed appreciation to all those involved in carrying out an excellent workshop. He said that the presentations had been of high quality and commended the Iranians for the excellent research they are conducting. Both moderators expressed the hope that collaborations between scientists in the two countries may flourish, resulting in improved science and improved health.

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