With 194 member states scattered across 6 WHO regions, widely varying levels of resources and/or political will, literally hundreds of language barriers, and a myriad of (sometimes conflicting) societal, cultural, and religious beliefs, the assemblage of a good and consistent global disease surveillance and reporting network remains an unmet goal.
In 2005 the World Health Organization adopted the IHR (International Health Regulations) that – among other things - requires countries to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO.
Although the agreement went into force in 2007, member states had until mid- 2012 to meet core surveillance and response requirements. Most nations failed to meet that deadline, and four years later, another extension seems inevitable.
As the WHO says in their IHR graphic: Until all countries are on board with IHR, no country is ready.
It is against this fragmented background, and the rising threat from a still poorly understood Zika Virus threat, that the World Health Organization has published an interim surveillance and reporting system for Zika, Microcephaly, and GBS.
OverviewThis document provides interim WHO recommendations for the surveillance of Zika virus and potentially related complications. It has been developed in consideration of the declaration on 1 February 2016 by the WHO Director-General of a Public Health Emergency of International Concern with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus.
This document provides interim recommendations for the surveillance of Zika virus infection, microcephaly and Guillain-Barré syndrome, in four different contexts and describes reporting requirements to WHO.
Transmission refers to vector-borne transmission, unless specified differently. Autochthonous infection is considered to be an infection acquired in-country, i.e. among patients with no history of travel during the incubation period or who have travelled exclusively to non-affected areas during the incubation period. This document does not provide guidance on laboratory investigation or vector surveillance.
Although Zika is the disease du jour, the problems of inconsistent (and sometimes, nonexistent) surveillance and reporting around the world extends far beyond the current crisis (see Libya's Under Reported Burden Of H5N1 (FAO Workshop and WHO Scales Up Influenza Surveillance In Africa).
Sometimes these surveillance gaps are due to a genuine lack of resources or political instability, but in far too many cases it appears to be more a matter of political expediency.
One of the big lessons of the 21st century is that oceans and borders are no longer protection against emerging infectious diseases. The next big global health threat could appear at any time and from anywhere on earth.
Implementing the IHR might not stop that from happening, but having it in place, and in full operation, might give us enough of a head's up to do something about it.