them with opportunities to learn and work with each other, with career development opportunities, and so much more.

However, several participants commented that the human and animal health communities have not done a good job at demonstrating the return on investments for disease surveillance. It was noted that “Eventually the resource people are going to say, ‘What am I going to get out of this and what is at risk if I don’t do this?’” Demonstrating or documenting the benefits is complex and therefore is a challenge because the benefits are so complex. However, both the human and animal health communities need to make the case that the benefits of sustainable disease surveillance do not rest just in “a dollar return on investment, but in social, economic, and political stability.” Participants suggested that the justifications for funding must be framed carefully: “Say you had prevented SARS, how would you prove it? Even if you made a good case, somebody else would say you didn’t, that it would never have taken off and it was all a false alarm.” Other discussants agreed, noting that if the case for disease surveillance efforts were made on the basis of a single pathogen, for example, “You are in for a line item removal when [the disease] doesn’t happen.” The stronger argument is that an investment has made the country better prepared for a range of ongoing, unpredictable risks.

Gerald Keusch, one of the workshop convening co-chairs, closed the meeting with a few final observations:

  • Setting priorities for the expenditure of effort and resources is very important, but very difficult to do. In the case of HIV, for example, “the investments at the beginning were not consistent with the threat it actually became, but we weren’t smart enough to know when to push.”

  • “Gaming the system is a fact of life” when it comes to scrambling for resources, “but is it the best or only way to proceed?”

  • “With the exception of short-term threats from specific pathogens that are emerging, we have yet to figure out how to make a case for ongoing [disease] surveillance.”

On behalf of the committee, Keusch ended the meeting by thanking the workshop presenters and participants, noting that a wide range of pertinent and interesting information had been shared with the committee and guests to address this challenging human and animal health issue.



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