SS+Disease+surveillance+Aff

=For up-to- date team by team 1acs go here= = = =Draft Monday, July 23= = = =**Text: The United States federal government should expand the Center for Disease Control’s Global Disease Detection Program in Sub-Saharan Africa. We’ll clarify.**=

**Initially note, countries in Sub-Saharan Africa can’t afford cross-border disease surveillance technology – that means they misdiagnose diseases and perpetuate disease spread**
Jakob **Zinsstag et al**, Department of Public Health and Epidemiology at the Swiss Tropical Institute, **2007** [“Human benefits of animal interventions for zoonosis control,” U.S. National Center for Infectious Diseases, April 1, Lexis] Rein The spread of highly pathogenic avian influenza is a global threat to all countries that have a poultry industry, semicommercial poultry production, or backyard poultry operations and has already caused enormous economic losses (19). Moreover, the risk for human pandemic influenza originating from highly pathogenic avian influenza in conjunction with human influenza A virus is very high, with an estimate of >100,000 deaths for the United States alone (20). __To implement disease prevention and control measures, early identification of emerging patterns of disease is necessary and uses economic methods to determine which mix of measures is most cost-effective. Resource-limited countries in Africa are almost devoid of surveillance capacity and efficient early warning systems, which would be crucial. Surveillance of cross-border diseases cannot be restricted to countries that have the funds__. High-income countries would ultimately benefit by providing funding for surveillance and control to low-income countries. Comprehensive economic assessment of this issue are, however, lacking so far. Awareness, Knowledge, and Information __Many countries__, especially those with resource constraints and those __in sub Saharan Africa, lack information on the distribution of zoonotic diseases. Risks for zoonoses are considered negligible compared with those for diseases of higher consequence because the societal consequences of zoonoses are not recognized by the individual sectors__. For example, __outbreaks of Rift Valley fever in persons in Mauritania were mistakenly identified as yellow fever. The correct diagnosis was made only after public health services contacted livestock services__, which informed them of abortions in cattle (21). In resource limited and transitioning countries, __many zoonoses are not controlled effectively because adequate policies and funding are lacking__. However, __transmission of zoonoses to humans can already be greatly reduced by health information and behavior__. Authorities in Kyrgyzstan, for example, have started an information campaign to reduce brucellosis transmission to small-ruminant herders by encouraging them to wear gloves for lambing and to boil milk before consuming. Interventions in livestock should always be accompanied by mass information, education, and communication programs.

**New diseases are inevitable and are appearing constantly**
Declan **Butler**, Freelance Journalist, **2006** [“Disease Surveillance needs a revolution,” Nature, 3/1, [|http://www.nature.com/news /2006/060227/full/440006a.html]] Many hope that resources pumped into avian flu will benefit the surveillance of emerging diseases generally by strengthening infrastructure. But the money available so far is only a start. __And the rate at which new diseases appear — currently around one a year — is increasing__. Mark Woolhouse, __an epidemiologist at the University of Edinburgh__, UK, __has analysed all recognized human pathogens and he suggests that this rise is mainly due to changes in land use and the way that people live. Of the 117 emergent human diseases that he has studied, more than half jumped from animals. "The world has to get to grips with the fact that what is happening now is going to happen repeatedly," says Roeder. "We have to develop a global structure to tackle emerging diseases__.

**Ineffective surveillance in Africa prevents global understanding of future disease spread and current disease containment—accurate analysis allows for effective local response**
[“Challenges in Improving Infectious Disease Surveillance Systems,” August] __Weaknesses in developing country systems reduce the ability of public health authorities at every level to understand and control infectious disease threats. These shortcomings__ limit the success of ambitious international programs such as the polio eradication effort, and __impair the routine surveillance of other diseases and the identification and control of outbreaks, newly emerging diseases, and antimicrobial resistance. The surveillance achievements recorded by programs such as the polio eradication effort have been possible only because intensive international assistance has been given to developing countries so that they can participate in these programs. In spite of this assistance, poor surveillance in developing countries has continued to limit the ability of these programs to achieve their goals__. For example, according to CDC, four countries in southern Africa were unable to meet international expectations in 1999 for detecting cases of acute flaccid paralysis, a key indicator of polio surveillance quality. Seven countries in the region fell short of the targeted 80-percent rate for collecting stool samples from suspected cases. The African region as a whole performed more poorly than any other, detecting less than the target number of potential polio cases and attaining less than the 90-percent goal for completeness of reporting. According to CDC, __completing the global eradication effort is complicated by systemic weaknesses in the remaining endemic areas, which are located primarily in sub-Saharan Africa__ and South Asia.27 __Ineffective routine surveillance seriously compromises the international community’s ability to understand global disease burdens and trends. As already indicated with regard to yellow fever, cholera, and dengue, the global incidence of many diseases is unknown.__ One WHO official noted that health authorities in Equatorial Guinea, which lies within the yellow fever endemic zone of Africa, had informed him that their country has never experienced an outbreak of yellow fever. This statement cannot be disproved because no surveillance for yellow fever exists in Equatorial Guinea. __Even when adequate data exist to identify gross trends, the data generally are not adequate for in-depth analyses or informed decisions about targeting resources to achieve specific control objectives. Developing countries often cannot investigate or address outbreaks on their own.__ **__CDC’s investigative expertise, including laboratory support, is comparatively rare in the rest of the world.__** Many of the African surveillance assessments we reviewed indicated that outbreaks there are often not thoroughly investigated, if they are investigated at all. Health officials in countries we visited and at WHO headquarters in Geneva noted that serious outbreaks strain developing countries’ relatively weak public health systems, requiring them to request international assistance to cope. For example, India experienced an outbreak of plague in 1994 that resulted in hundreds of cases across the country, 56 deaths, and over a billion dollars in economic damage from the travel restrictions and trade embargoes imposed by other countries. The outbreak was severe in part because India had largely discontinued surveillance for plague. Health authorities did not respond to initial complaints of flea infestation and did not take appropriate measures to contain the outbreak. The disease spread to crowded urban slums where it progressed unchecked to its highly contagious, pneumonic form and became a serious national problem.
 * GAO**, United States General Accounting Office, **2001**

Matthew **Carlberg**, Marine Corps Command And Staff Coll Quantico va, **2002** [July, [|http://stinet.dtic.mil/oai/oai ?&verb=getRecord&metadataPrefix �16�html&identifier�17�ADA403988]] __Epidemics threaten national security by impacting the economic, political, and social aspects of national power. The AIDS epidemic in Sub-Saharan Africa bears stark witness to the magnitude of this threat. It also offers the opportunity for prospective study of the relationship between epidemics, state failures, and wars. There are roughly 54 million deaths annually worldwide from infectious diseases. Half of these deaths occur in Sub-Saharan Africa. The litany of resurgent and emerging infectious diseases, coupled with the phenomenon of antibiotic resistance, bring to light the magnitude of the threat both to national security and deployed forces.__
 * Sub-Saharan epidemics kill 27 million annually**

**For example, surveillance in Sub-Saharan Africa is insufficient to contain the bird flu – Sub-Saharan Africa is a __critical__ region to prevent spread and mutation**
Tiaji **Salaam-Blyther**, Coordinator Foreign Affairs, Defense, and Trade Division of the Congressional Research Service, **2006** [U.S. and International Responses to the Global Spread of Avian Flu: Issues for Congress, 1/9, [|http://fpc.state.gov/documents /organization/59025.pdf]] Global Disease Surveillance A number of analysts have argued that __due to insufficient investment in disease surveillance and health care in many of the countries where H5N1 is endemic, a pandemic may progress before it is discovered. In this view, ill-equipped surveillance systems will be slow to determine the source of a pandemic, evaluate the rate of viral transmission, ascertain whether H5N1 has become efficiently transmissible among humans, or rate the effectiveness of anti-flu initiatives__. Senate Majority Leader Bill Frist has proposed $1 billion for a real-time international threat detection system.126 USAID and other U.S. government officials suspect that the lack of documented human cases of H5N1 in Laos has more to do with inadequate surveillance and reporting systems than an absence of infection.127 Some health experts believe that H5N1transmission could already be underway in Laos, since surrounding countries have already had human and animal outbreaks. Key U.S. agencies and international organizations have determined that Laos is a country that needs critical prevention, monitoring, and surveillance support in order to prevent full-blown human-to-human transmission of H5N1 that could emerge and sweep across the region without warning.128 Some experts have expressed increasing concern about the capacity of poorer countries that have not yet had H5N1 cases to effectively contain the spread of the virus and plan for pandemic influenza, particularly in sub-Saharan Africa. FAO has recently warned that the risk of H5N1 spreading to the Middle East and Africa has markedly increased. FAO is particularly wary of the virus reaching Eastern Africa, as the surveillance capacities and veterinary services in those countries are limited. According to Reuters, __a WHO representative declared that an H5N1 outbreak would likely be missed in Africa, as bird nutrition is poor and high mortality among poultry is common. Concurrently, human cluster cases are likely to be missed due to poor surveillance systems__. South Africa is reportedly the only country in sub-Saharan Africa to have drawn up a pandemic preparedness plan.129 __Some experts fear that an unabated H5N1 outbreak in East Africa could make the bird flu endemic there. “If the virus were to become endemic in eastern Africa, it could increase the risk that the virus would evolve through mutation or reassortment into a strain that could be transmitted to and between humans.__”130

**Mutation of bird flu is inevitable and a pandemic could be triggered at any moment**
Satish **Chandra**, Deputy National Security Advisor of India – Center for Strategic Decision Research, **2004** [Global Security: A broader Concept for the 21st Century, 5/7, [|http://www.csdr.org/2004book /chandra.htm]] If the possibility of the collapse of the thermohaline circulation system is alarming, __the possibility of a human-to-human transmittable bird flu pandemic is a nightmare. What makes it so frightening is the fact that it could happen at any time and that we are ill prepared to face it__. At current mortality rates, it could result in the sudden death of 15 to 20 percent of mankind. The most severe health crisis in recent years in terms of numbers of deaths was the 1918–1919 influenza epidemic, which in the space of one year caused an estimated 40 million deaths worldwide. Begun in Kansas in March 1918, the epidemic spread to Europe and then to India, Australia, and New Zealand. The virulence and mortality rate of the first wave of the disease, in the spring of 1918, was only slightly above normal levels but the second wave, which began in the fall of 1918, was extraordinarily deadly, with mortality rates of 5 to 20 percent above normal levels. It is believed that the fall strain of the virus came about through genetic mutation and that the genetic structure of the virus was a form of a swine and avian influenza strain. Since 1918, the world has seen several influenza outbreaks, most notably the 1957 Asian flu outbreak and the 1968 Hong Kong flu outbreak, each of which killed a million people. While WHO now has an Influenza Surveillance Program in place as well as an Influenza Pandemic Preparedness Plan, we still need to examine the possibility of the highly pathogenic H5N1 bird flu becoming transmittable from human to human, the outcome of such a situation, and what must be done to address the possibility. Since the end of 2003, outbreaks of the highly pathogenic H5N1 strain of avian influenza, or bird flu, have occurred in eight Asian countries, resulting in the loss of 100 million poultry birds. __The implications for human health are worrisome because of the extreme pathogenic nature of this virus—it has the capability to infect humans and cause severe illness, with mortality rates of 60 to 70 percent__. It has already infected humans three times in the recent past: In 1997 and 2003 in Hong Kong and in 2004 in Vietnam and Thailand. So far the disease has been transmitted only to humans who came in contact with dead or diseased poultry—it has not yet mutated to being capable of human-to-human transmission. The Likelihood of a Pandemic Since the H5N1 strain has not been eliminated from its avian hosts, it is obviously endemic. __The risk, therefore, that the virus could take on a new form that would make it capable of human-to- human transmission is considerable, especially because mass vaccinations of chickens, aimed at mitigating the disaster facing poultry farmers, has allowed the virus to continue to circulate among the vaccinated birds. It can thus linger indefinitely in poultry, making the gene mutation required to make it transmittable from human to human an even greater possibility. It could be said that there are three prerequisites for the start of a pandemic__: 1) a new virus must emerge against which the general population has little or no immunity; 2) the new virus must be able to replicate in humans and cause disease; and 3) the new virus must be efficiently transmitted from one human to another. Dr. Anarji Asamoa Baah, Assistant Director General, Communicable Diseases, WHO, asserts that, __regarding H5N1, the first two prerequisites have already been met, and it is known that the virus can become more transmittable via two mechanisms, “adaptive mutation” and “genetic re-assortment.”__ Dr. Baah has further contended that __re-assortment of H5N1 with a human influenza virus can take place in humans without prior adaptation in other species such as swine.__ It is clear, therefore, that 1) the H5N1 virus will continue to circulate for a very long time in poultry birds; 2) the threat to public health will be there as long as the virus continues to circulate in poultry birds; 3) should the virus become transmittable from human to human, the consequences for human health worldwide, in the words of Dr. Baah, “could be devastating;” and 4) the world needs to be prepared to respond to the next influenza outbreak. During an Influenza Pandemic Preparedness meeting in Geneva in March 2004, the head of the World Health Organization warned, “**__We know another pandemic is inevitable. It is coming__**…we also know that we are unlikely to have enough drugs, vaccines, healthcare workers, and hospital capacity to cope in an ideal way.” On the basis of an epidemiological model project, WHO scientists predict that an influenza pandemic will result in 57 million to 132 million outpatient hospital visits, 1 million to 2.3 million admissions, and between 280,000 and 650,000 deaths in less than two years. The impact on poor nations would be much greater. But I submit that these projections are gross underestimates given the fact that the 1918–1919 influenza epidemic, with mortality rates of a maximum of 20 percent above normal level, caused as many as 40 million deaths. With mortality rates in excess of 60 percent, the H5N1 virus is bound to be much more deadly, particularly because __in today’s world of air connectivity, the spread of H5N1 would be much more rapid than that of the 1918 influenza epidemic__. Indeed, __the death toll could run into hundreds of millions__. = =

**Disease surveillance, labs, and CDC expertise are key to preventing the rapid spread of bird flu**
Stephen B. **Blount**, MD, MPH, Director – Office for Global Health, **2007** [5/2, [|http://www.hhs.gov/asl/testify /2007/05/t20070502a.html]] Currently, __the US and the rest of the world are facing a very real threat posed by the highly pathogenic H5N1 avian influenza virus. Our experience with SARS showed us how a highly infectious disease in a remote region of the world can__ **__spread in a matter of days__** __and weeks. Thanks to the rapid and constant movement of people and commodities, pathogens can hitch rides on airplanes and boats and slip across national borders unnoticed. The key to interrupting these pathogenic journeys is early detection as close to the source as possible.__ An estimated 60% of all known human infectious diseases and approximately 75% of all recently recognized emerging infectious diseases affecting humans are of animal origin. We witnessed sobering evidence of the health impact of the human-animal interface during our rapid multidisciplinary response to the large epidemic of potentially fatal Rift Valley fever virus earlier this year in east Africa. __Additional disease surveillance tools, laboratory capacity, and CDC expertise deployed abroad can rapidly improve our ability to recognize and intervene to contain emerging threats—including a possible avian influenza pandemic__—before they become significant problems within U.S. borders. To prepare for a pandemic of influenza, key issues __we need to address are appropriate training and exercising of rapid response teams to identify, investigate, and contain local outbreaks. We also need to be able to trust that we have the__ **__most accurate and reliable information__** __about influenza viruses and novel human influenza cases—through strong and established surveillance systems, laboratory capacity, and communication channels so we can respond effectively__.

**Bird flu transmissions spread globally, instantly killing a billion**
Satish **Chandra**, Center for Strategic Decision Research, **2004** [Global Security: A broader Concept for the 21st Century, May 7th [|http://www.csdr.org/2004book /chandra.htm]] __This scenario,__ as frightening as it is, __pales in comparison with what could overtake us by 2007 if the highly pathogenic form of bird flu__ “H5N1” __becomes transmittable human to human; all it would take for this to happen is a simple gene shift in the bird flu virus, which could happen any day. In a globalized world linked by rapid air travel, the disease would spread like a raging forest fire. If it did, it would overwhelm our public health system, cripple our economies,__ **__and wipe out a billion people__** **__within the space of a few months__**__—a 60 percent mortality rate is estimated.__

**Expanding human and animal disease surveillance is necessary to link the two together, improving the effectiveness of targeting and the containing disease**
T. **Kuiken**, Department of Virology, Erasmus MC, **2005** [“Pathogen Surveillance in Animals,” Science Magazine, Vol. 309. no. 5741, pp. 1680 – 1681, [|http://www.sciencemag.org/cgi /content/full/309/5741/1680 #AFF1]] Rein __The tasks of the expert working group should include identifying the largest gaps in current surveillance systems in humans, domestic animals, and wildlife and determining the most cost-effective methods to fill them__ (e.g., sampling of animals at live animal markets, game farms, and ports of entry; establishment of systems for adequate preservation of samples from site of collection to the laboratory); __identifying political barriers to effective surveillance__ (e.g., conflicting mandates of responsible authorities) __and determining methods to deal with them appropriately__ (e.g., an international program of insurance against economic losses that may be triggered by rapid and transparent reporting); __determining practical ways to integrate human and animal surveillance at the national and international level__ (including data management, communication networks, and regional laboratory networks); __facilitating development and distribution of validated diagnostic tests for rapid and sensitive screening of samples for zoonotic pathogens in the full range of potential host species; and encouraging scientists and funding agencies to study the underlying mechanisms of disease emergence in order to find new methods to deal with this problem__. We estimate the annual start-up costs for such a working group at US$4 to $5 million for the first 3 years, based on a core group of 10 people with broad knowledge of human, domestic animal, and wildlife health. Making use of the worldwide expertise in the relevant disciplines, this group would design and implement a global animal surveillance system for zoonotic pathogens. __The costs of this system would depend in part on the risk that human society is willing to take, but would be only a fraction of the savings made by early detection and rapid response to emerging pathogens. Zoonotic pathogens do not respect national borders, so it is in the best interests of wealthy nations to invest in improved animal surveillance programs in all parts of the world__. Emerging diseases are a major challenge to the biological safety of the world in the 21st century. Renewed effort, resources, and scientific innovations, as well as new degrees of integration are required to meet this challenge. __Linking comprehensive pathogen surveillance of wild and domestic animals--the principal source of emerging infections--with public health surveillance at the national and international level, and improving the quality and coverage of these surveillance programs, will make an important and essential contribution to the detection and control of emerging zoonotic infections__.

**Surveillance can halt the transformation of animal diseases to future human epidemics by catching the disease early and creating disease databases to better understand and diagnose future diseases**
Nathan D. **Wolfe et al**, Department of Epidemiology at UCLA, **2007** [“Origins of major human infectious diseases,” //Nature// 447, 279-283, May 17, [|http://www.nature.com/nature /journal/v447/n7142/full /nature05775.html#a1]] Rein __Most major human infectious diseases have animal origins, and we continue to be bombarded by novel animal pathogens__. Yet __there is no ongoing systematic global effort to monitor for pathogens emerging from animals to humans. Such an effort could help us to describe the diversity of microbial agents to which our species is exposed; to characterize animal pathogens that might threaten us in the future; and perhaps to detect and control a local human emergence before it has a chance to spread globally__. In our view, __monitoring should focus on people with high levels of exposure to wild animals, such as hunters, butchers of wild game, wildlife veterinarians, workers in the wildlife trade, and zoo workers__. Such people regularly become infected with animal viruses, and __their infections can be monitored over time and traced to other people in contact with them__. One of us (N.D.W.) has been working in Cameroon to monitor microbes in people who hunt wild game, in other people in their community, and in their animal prey15. The study is now expanding to other continents and to monitor domestic animals (such as dogs) that live in close proximity to humans but are exposed to wild animals through hunting and scavenging. __Monitoring of people, animals, and animal die-offs__16 __will serve as an early warning system for disease emergence, while also providing a unique archive of pathogens infecting humans and the animals to which we are exposed__. Specimens from such highly exposed human populations could be screened specifically for agents known to be present in the animals they hunt (for example, retroviruses among hunters of non-human primates), as well as generically using broad screening tools such as viral microarrays17 and random amplification polymerase chain reaction (PCR)18. __Such monitoring efforts also provide potentially invaluable repositories, which would be available for study after future outbreaks in order to reconstruct an outbreak's origin, and as a source of relevant reagents__.

**CDC is unique in its ability to solve these zoonotic diseases**
[“Protecting the Nation’s Health in an Era of Globalization: CDC’s Global Infectious Disease Strategy,” prepared by the Dept of Health and Human Services, [|http://www.cdc.gov/globalidplan /global_id_plan.pdf]] CDC can stimulate this process by providing technical assistance, evaluating regional progress, and working with WHO, other U.S. agencies, and other interested groups to strengthen the networks’ telecommunications capacities and encourage the use of common software tools and harmonized standards for disease reporting. CDC can also help revise the International Health Regulations, which describe internationally-reportable diseases and syndromes. In addition, __CDC will encourage linkages between regional networks and veterinary surveillance systems that monitor illnesses and epidemics among agricultural and feral animals. Several major outbreaks of zoonotic diseases__ (diseases __of animals that also affect humans) involving agricultural animals have occurred in recent years__ (Box 15). __CDC will also support disease surveillance efforts in tropical or heavily forested areas that are likely sources of human infection with unknown zoonotic or vectorborne diseases__.
 * DHHS**, Department of Health and Human Services, **2002**

Louis **Jacobson**, associate editor at National Journal, **1995** [“Disease Detectives,” National Journal, Government Executive, Section: Health, May, Lexis] __The U.S. governments disease-fighting forces__ have had some notable successes in the past, but they may __lack the resources to combat the enemy's increasing strength.__ As an outbreak of drug-resistant cholera began to spread in the small west African nation of Guinea-Bissau last fall, two young epidemiologists from the U.S. Centers for Disease Control and Prevention boarded a plane and began reading up, feverishly, on a disease they knew little about. Their mission was to size up the outbreak and advise local health officials on how to attack it. As they read, Alex Rowe and Fred Angulo, members of the CDC's elite Epidemic Intelligence Service, found hints that acidity could kill the cholera bacteria. When they arrived in Guinea-Bissau, they checked out a hunch -- and, sure enough, found that people who spritzed lemon in their water were less likely to become ill. Rowe and Angulo told the health ministry that adding lemon juice to water seemed to work just as well as boiling it, and was less expensive. Impressed, the government kicked off a big awareness campaign, and eventually the outbreak died down. It was a small victory in an exhausting fight. For most of this century, science made unswerving progress in controlling infections. But in the past decade or so, __previously unheard-of microscopic predators have begun to stalk humans with breathtaking impunity__. Some of these "emerging infections" are new strains of microbes, such as tuberculosis, that have become resistant to the drugs that had once nearly vanquished them. Others, such as the E. Coli O157:H7 that found its way into undercooked Jack-in-the-Box hamburgers in 1993, are mutated versions of ordinarily benign organisms. Still others, like the deer-tick-borne Lyme disease, became worrisome only when humans upset fragile ecosystems, presenting rare microbes with many new victims. Some, such as hantavirus, blossomed naturally, aided in 1993 by a rare bumper crop of pinon nuts and the resulting boom in virus-carrying mice. And many, like AIDS, traversed the globe, aided by modern-day travel. Indeed, because __any killer bug -- even a rare__, exotic __one from deepest Africa -- can immigrate to airports in New York or Dallas__ without presenting a passport or stopping at customs, agencies such as CDC now represent one of the last barriers between humans and the bugs that would infect them. __The U.S. government sends "disease cowboys"__ like Rowe and Angulo to places like Guinea-Bissau __out of self-interest as well as altruism. They__ test new treatments in the field, __watch for new strains and track the travels of microbes__ from one country to the next. This last mission -- known as __disease surveillance -- is especially vital__, as __it provides the United States and its neighbors with advance warning about disease threats. And it is in trouble. Systematic surveillance__, especially __on a global scale, has always been vexing.__ Findings are often haphazard: Not long ago, CDC learned of an outbreak of Lassa fever, an exotic, painful and often fatal virus, only because a supermarket pharmacist in Atlanta suggested that the agency check out an illness his brother was suffering in Nigeria. Today, though, __the world's surveillance network faces unprecedented troubles. Neglect and budget cuts have crippled__ some parts of __the safety net__, and __even CDC,__ the healthiest link, __could prove unequal to the rising tide of infections.__ While the public's attention has been focused on the dangers of emerging infections by the hit movie Outbreak and the publication last year of several popular books and countless articles on the subject, the __hype doesn't seem to be translating into real efforts to strengthen the ailing U.S. surveillance system.__ The Surveillance Challenge The need for good surveillance seems self-evident. "My main pitch," says Christopher H. Foreman Jr., author of Plagues, Products, and Politics (Brookings Institution, 1994), "is that __surveillance is the one element in all these hazards that is essential. Surveillance is the one stage where professionals run the show__ and where there's relatively little controversy about what is right to do." __Coordinating that surveillance__, however, __is a huge challenge.__ In the United States alone, __epidemiologists must rely on physicians to notify local authorities about patients with unusual or serious infections. Local officials pass information up the ladder to state officials, who then tell CDC__. Meanwhile, __CDC has to coordinate with other federal agencies__, notably the Agriculture Department (which handles animal and some food-borne diseases) __and the military__, whose far-flung outposts serve as sentinels for overseas outbreaks and whose research labs (thanks to longstanding concerns over biological warfare) rival and often surpass CDC's. Finally, __the United States has to work with foreign nations and such umbrella groups as the World Health Organization to track global disease movements. Even if all__ the __links were strong, creating a functioning whole would be challenging. But weaknesses abound.__ A study by Michael Osterholm, Minnesota's state epidemiologist, found that most states have no more than one person tracking all communicable diseases (excepting those whose tracking is supported by federal funds). Yet an association of state epidemiologists has just agreed to add half a dozen diseases to the list of roughly 50 upon which it is suggested that states report to the CDC.
 * Effective surveillance is key to detection and prevention of new super-diseases – the CDC is the only agency that can coordinate surveillance**

**Finally, future diseases cause extinction**
Kavita **Daswani, 1996** [South China Morning Post, 1/4, Lexis] Despite the importance of the discovery of the "facilitating" cell, it is not what Dr Ben-Abraham wants to talk about. __There is__ a much more pressing medical crisis at hand - one he believes the world must be alerted to: __the possibility of a virus deadlier than HIV__. If this makes Dr Ben-Abraham sound like a prophet of doom, then he makes no apology for it. AIDS, the Ebola outbreak which killed more than 100 people in Africa last year, the flu epidemic that has now affected 200,000 in the former Soviet Union - they are all, according to Dr Ben-Abraham, the "tip of the iceberg". Two decades of intensive study and research in the field of virology have convinced him of one thing: in place of natural and man-made disasters or nuclear warfare, __humanity could__ **__face extinction__** __because of a single virus, deadlier than HIV. "An airborne virus__ is a lively, complex and dangerous organism," he said. "It __can come from a rare animal or from anywhere and can mutate constantly. If there is no cure, it affects one person and then there is a__ **__chain reaction and it is unstoppable__**__. It is a tragedy waiting to happen."__ That may sound like a far-fetched plot for a Hollywood film, but Dr Ben -Abraham said history has already proven his theory. Fifteen years ago, few could have predicted the impact of AIDS on the world. Ebola has had sporadic outbreaks over the past 20 years and the only way the deadly virus - which turns internal organs into liquid - could be contained was because it was killed before it had a chance to spread. Imagine, he says, if it was closer to home: an outbreak of that scale in London, New York or Hong Kong. It could happen anytime in the next 20 years - theoretically, it could happen tomorrow. The shock of the AIDS epidemic has prompted virus experts to admit "that __something new is indeed happening and that the threat of a deadly viral outbreak is__ **__imminent__**__"__, said Joshua Lederberg of the Rockefeller University in New York, at a recent conference. He added that the problem was "very serious and is getting worse". Dr Ben-Abraham said: "__Nature isn't benign. The survival of the human species is not a preordained evolutionary programme. Abundant sources of genetic variation exist for viruses to learn how to mutate and evade the immune system__." He cites the 1968 Hong Kong flu outbreak as an example of how viruses have outsmarted human intelligence. __And as new "mega-cities" are being developed in the Third World and rainforests are destroyed__, disease-carrying animals and insects are forced into areas of human habitation. "__This raises the very real possibility that lethal, mysterious viruses would,__ for the first time, __infect humanity at a large scale and__ **__imperil the survival of the human race__**," he said.

**African disease surveillance efforts are failing due to a lack of funding—this risks a global epidemic**
James Thuo **Njuguna**, completing his PhD in medical parasitology at the University of Bonn, International Livestock Research Institute in Nairobi, **2005** [African Security Review Vol 14 No 1, [|http://www.iss.co.za/index.php ?link_id=3&slink_id=1967&link _type=12&slink_type=12&tmpl_id =3]] Terrorist groups exist to promote religious, ethnic, political (ideological) or economic causes. __Acts of biological terrorism could__ therefore __have political, religious, ideological or criminal motives and could conceivably be planned by groups or a single individual or be part of state-sponsored terrorist activities The activities leading to the 1998 American embassy bombings in Kenya and Tanzania were well coordinated and planned.__ This trend has continued with most recent attacks across the world. Various attacks are timed to take place simultaneously and on multiple targets. This indicates that terrorist groups make extensive plans for these activities. __It is now known that the suspected perpetrators can be citizens of one or different countries, which demonstrates the capacity of these groups to successfully recruit members and execute plans undetected by law enforcement agencies.__ This was true of the events of 11 September 2001 in the United States. __When compared to other weapons, the acquisition, storage and transportation of -biological weapons could be considerably easier. Competent undergraduate students could readily master viral, bacterial culture methods and simple genetic engineering.__ It is possible that a group or individuals with appropriate training could produce lethal weapons in adequate amounts and then disseminate them in a manner that would result in thousands of casualties and widespread panic. __Outbreaks of infectious diseases are a common occurrence in eastern Africa and the region suffers from insecurity owing to countless conflicts. This makes the threat of the use of biological weapons in this region something that has to be considered by the relevant -government departments. In addition, the -distinction between national and global threats is artificial, as infectious agents do not observe the divide. Adequate public health surveillance and response are solutions to preparing for biological warfare events.__ Only long-term planning and funding can sustain such a global undertaking, which has to be internationally financed and managed. Infectious diseases with no known prophylactic remedies will continue to infect travellers and local people and remain a possible biological weapon.32 Infectious diseases can undermine the security of a country whether these diseases are deliberately inflicted by biological warfare or occur naturally. While the Biological and Toxins Weapons Convention (BTWC) prohibits the development and use of biological weapons, __the defence against a natural or intentional epidemic is the same: a robust global public health surveillance system and the ability to respond efficiently and effectively to disease outbreaks.__ The state has an important role in combating the threat of deliberate disease because it has the moral duty to protect its citizenry. An effective way of countering the threat of deliberate disease is to establish and maintain disease surveillance and control programmes. __Most of the publications on epidemics in eastern Africa indicate that very little disease surveillance is done at present__.33 Where gains were made in control and eradication, they were later lost through neglect of control protocols such as vaccinations and control of livestock movements between endemic and non-endemic areas. __There seems be unanimous agreement among observers that the main reason for the failure of surveillance and control systems is lack of funding. This is blamed on reduced funding for the responsible government organs and agencies owing to shrinking economies__. National governments and other interested stakeholders will have to find the required funds, for __if infectious diseases are not eradicated or at least maintained at minimum levels, an added threat will be their use as biological weapons, endangering people away from the endemic areas. Observers have expressed the view that disease surveillance should be intensified and coordinated beyond the divide of national boundaries__. Surveillance programmes should be part of the public health management systems. The ideal situation requires setting up local and international surveillance/response teams. Teams endowed with the necessary techniques and resources should be put in place so that they can deal with epidemics when they occur. This will ensure that expertise in dealing with these diseases is available uniformly throughout the region.35 It is also important to register the groups/individuals engaged in these emergencies to minimise chances of hazardous materials being acquired by groups whose intent would be to cause disease outbreaks. Vaccination programmes have to be maintained because failure to do so may lead to a loss of the gains previously achieved in terms of disease control. Besides, for every case of sickness encountered, prevention is cheaper than cure. __Some authors encourage joint veterinary and human disease surveillance as a way of cost cutting for zoonotic disease control and such a team can be schooled to monitor biological weapons as well__ (see the commentary by Dorothy Preslar in this issue of African Security Review).

**Numerous factors make a biological terror attack on the continent highly likely**
John **Bornie**, Leads a project on ‘Disarmament as Humanitarian Action’ at the UN Institute for Disarmament Affairs in Geneva, was New Zealand ’s deputy head of mission for disarmament in Geneva and working on biological disarmament issues, **and** Dominique **Loye**, Deputy Head of the Mines-Arms Unit of the International Committee of the Red Cross in Geneva, **2005** [“Why Preventing Hostile Use of the Life Sciences is Relevant to Africa,” African Security Review, Vol 14, No 1] But **//why//** would African populations or economies be targets for attacks with biological agents? __It is worth bearing in mind that African countries could be considered attractive targets for attack precisely because they are perceived__ (or these countries perceive themselves) __as non-strategic or unimportant. For example, those with hostile intent might carry out such attacks as a demonstration of their power to other countries perceived as ‘strategic’ or as a means of creating a regional or global pandemic, hoping to overwhelm the disease response resources of developed countries. The chances of being caught could be much lower in African countries than in those with greater public health and law enforcement capabilities, or there may be a lower perception of threat, accompanied by a lower level of vigilance. Those with hostile intent may simply wish to attack foreign populations in African countries without regard for ‘collateral damage’ to the local people or their environment, as happened in the truck bomb attacks on American embassies in Kenya and Tanzania on 7 August 1998__, which killed 225 people and injured more than 4 000. Sadly, __the use of poisoning and the deliberate spread of infectious disease as a method of warfare is not a new concept in Africa.__ Historical examples abound, for example infecting the tips of arrows and contaminating wells. Modern examples include the use of chemical weapons by Mussolini’s armies in the invasion and annexation of Abyssinia (now Ethiopia) in 1936. Libya’s offensive biological, chemical and nuclear weapon programmes are only now being dismantled. Moreover, the apartheid government’s clandestine programme to develop biological and chemical weapons (‘Project Coast’) in South Africa until the 1990s experimented with a number of agents intended to kill opponents of apartheid and to develop so-called non-lethal agents for use against demonstrators and other civilians.20 A leading expert on ‘Project Coast’ concluded that: __On a continent that has a great deal of experience of national conflicts, there is a potential incentive for acquiring [biological weapons].__ We therefore need to be aware of the danger posed by the development of biological agents that can be used to quell civilian uprisings against bad governments.21 Africa has witnessed many destructive conflicts in the last half-century, some of which simmer on. The prospect cannot be excluded that certain African governments will view biological agents as attractive weapons against each other, as has happened in the past. Unless norms against poison and the deliberate spread of disease are strongly embedded in the region’s political culture through adherence to the relevant international treaties and practical and transparent risk reduction measures to build mutual confidence, __the use of biological weapons is increasingly likely, as they are becoming cheaper and easier to develop.__

**Disease surveillance is essential to the prevention and containment of bioterror outbreaks—local health workers alone lack necessary skills**
James Thuo **Njuguna**, completing his PhD in medical parasitology at the University of Bonn, International Livestock Research Institute in Nairobi, **2005** [African Security Review Vol 14 No 1, [|http://www.iss.co.za/index.php ?link_id=3&slink_id=1967&link _type=12&slink_type=12&tmpl_id =3]] Ministries of health (MoHs) across Africa are mandated to deal with all health issues -including budgetary allocations to deal with infectious disease outbreaks. They are -responsible for -containing disease outbreaks wherever they occur in a country. Hospitals and care-giving institutions have a core function owing to their being in a special position to recognise an emerging outbreak of a given disease.24 __Early detection of a biological agent attack or a natural outbreak depends on epidemiological warning networks and the individual clinical/laboratory expertise of medical personnel, because diagnostic procedures are the same for disease that is caused deliberately and for infections that occur naturally__.25 During a crisis or outbreak an MoH may involve the services of its internal agencies or refer the matter to international organisations such as World Health Organisation (WHO) or non-governmental organisations (NGOs) for relevant action and to obtain support. __Outbreaks of rare diseases are unpredictable and local health personnel may fail to recognise the early signs at the onset of a major epidemic, mostly because of lack of relevant skills. When this happens, people with contagious infections are allowed to move freely, putting others at risk. Corpses may be released for burial without a public health caution. When field workers in remote locations suspect a rare infectious disease, the referral/reference centres in the cities may not always have the facilities and reagents for some required tests. Samples then have to be sent abroad for testing to positively identify the infecting agents. This takes time and makes the management of the disease outbreak even more challenging as medical personnel have to deal blindly with unknown agents until identification details come from abroad. Consultation between operators is complicated by distance__. Epidemic situations are always of concern to the members of public as well as the health professionals. __The ministry of health is usually under pressure to do its best, a task made more difficult by the lack of resources in many -developing countries.__

**Effective surveillance provides valuable experience to contain and deter bioterror attacks**
James Thuo **Njuguna**, completing his PhD in medical parasitology at the University of Bonn, International Livestock Research Institute in Nairobi, **2005** [African Security Review Vol 14 No 1, [|http://www.iss.co.za/index.php ?link_id=3&slink_id=1967&link _type=12&slink_type=12&tmpl_id =3]] __The recent outbreaks of SARS and the continuing AIDS epidemic have demonstrated critical weaknesses in global public health infrastructure in the face of a threat from a novel pathogen__.40 __The international community must continue to learn from the experience of natural outbreaks to improve early detection and effective response to emerging disease on a global basis. Minimising the impact of disease, of natural or deliberate origin, will save countless lives as well as deter future bio-terrorist acts__.41 States parties to the BTWC are due to meet in 2006 for the Sixth Review Conference to review the convention. It is important that the ideals of 1972 BTWC should be retained, that the convention be reinterpreted in the light of recent scientific developments, and that states parties find a way to strengthen the BTWC through the adoption of measures to monitor and verify treaty compliance.

**Bioweapons cause extinction**
Richard **Ochs**, Freelance Journalist, **2002** [“Biological Weapons must be Abolished Immediately,” June 9, [|http://www.freefromterror.net /other_articles/abolish.html]] Rein __Of all the weapons of mass destruction, the genetically engineered biological weapons, many without a known cure or vaccine, are an extreme__ **__danger to the continued survival of life on earth__**__. Any perceived military value or deterrence__ **__pales in comparison__** __to the great risk these weapons pose just sitting in vials in laboratories. While a "nuclear winter," resulting from a massive exchange of nuclear weapons, could also kill off most of life on earth and severely compromise the health of future generations, they are easier to control. Biological weapons__, on the other hand, __can get out of control very easily__, as the recent anthrax attacks has demonstrated. __There is no way to guarantee the security of these doomsday weapons because very tiny amounts can be stolen or accidentally released and then grow or be grown to horrendous proportions. The Black Death of the Middle Ages would be small in comparison to the potential damage bioweapons could cause__. Abolition of chemical weapons is less of a priority because, while they can also kill millions of people outright, their persistence in the environment would be less than nuclear or biological agents or more localized. Hence, chemical weapons would have a lesser effect on future generations of innocent people and the natural environment. Like the Holocaust, once a localized chemical extermination is over, it is over. __With__ nuclear and __biological weapons, the killing will probably never end__. Radioactive elements last tens of thousands of years and will keep causing cancers virtually forever. Potentially worse than that, __bio-engineered agents by the hundreds with no known cure could wreck even greater calamity on the human race than could persistent radiation. AIDS and ebola viruses are just a small example of recently emerging plagues with no known cure or vaccine. Can we imagine hundreds of such plagues?__ **__HUMAN EXTINCTION IS NOW POSSIBLE__**.

**The CDC must expand its Global Disease Detection program to ensure effective global disease surveillance**
CDC is a major partner in our nation’s frontline against emerging international health threats. __CDC’s Global Disease Detection program__, in partnership with host country governments and the WHO, __is a__ **__key component__** __of this effort and forms the foundation of a transnational detection, prevention and response network to address emerging health threats__ including pandemic influenza. __With current funding levels, CDC has established 5 regional response Centers, but needs 18 – three in each WHO region - to complete the network and properly protect the nation. The existing Centers have already proven their effectiveness and impact on detecting and responding to outbreaks__ including avian influenza, aflatoxin poisoning, Rift Valley fever, Ebola and Marburg virus outbreaks, and many other serious infectious diseases and environmental health threats. __The Centers__ also __provide a platform for__ regional __training, surveillance, research, and health diplomacy activities that help promote sustainable health development in the targeted regions. CDC is a major global source of technical and scientific support to categorical disease control programs__ supported by USG, WHO, health ministries, PEPFAR, the Global Fund, and many other health organizations. __Our investment is modest and highly leveraged, but our capacity in most critical areas has been eroded by budget attrition and increases in the costs__ of science, travel, and infrastructure support __in the past few years. We need to continue and expand operational research to assure that investments__ the USG and others are making in international health __are state-of-the science and optimized to achieve results in the field.__ Critical areas that urgently need support include:
 * Center for Disease Control, 2007**
 * [**“Professional judgment for fiscal year 2008”, developed in response to a request by the chairman, during the house appropriation Subcommittee on labor, health and human services, 4-20, [|http://www.fundcdc.org/document s/CDCFY2008PJ_000.pdf], p. 6]

**CDC's unique research and expertise means that the best and essential public health tools are used**
[“Protecting the Nation’s Health in an Era of Globalization: CDC’s Global Infectious Disease Strategy,” prepared by the Dept of Health and Human Services, [|http://www.cdc.gov/globalidplan /global_id_plan.pdf]] __Another major priority for CDC is to translate research innovations into practical public health tools and ensure that they are disseminated widely and rapidly for the benefit of people all over the world. Examples of public health tools that have had a major impact on global infectious disease control are antibiotics, childhood vaccines, oral rehydration therapy, and vitamin supplements. There is often a long delay between the development of a new public health tool and its widespread implementation__. A country may lack the means to buy a new medical product or it may lack a public health delivery system and trained workers to administer it. __There may be__ low demand, because the public is not informed about a new drug or vaccine, or __low political interest, because the national government is not convinced that the drug or vaccine will be cost-effective. CDC can use its experience in disease surveillance to demonstrate the value of public health tools to ministries of health and finance and to the public, using pilot studies, demonstration projects, and health education campaigns__ (Box 19). For example, __CDC will continue to work with USAID, WHO, and other partners to demonstrate that mechanisms for the prevention or control of malaria__ (via vector control, chemotherapy, and insecticide-treated bednets) __are ready for national or regional implementation, pending the availability of resources and political commitment__(see Priority Area 5). CDC can also help development agencies, NGOs, and other partners address problems related to public health training and to drug or vaccine delivery (see also Priority Area 6). As part of the global strategy, __CDC will intensify efforts to couple applied research with research on ways to promote the use of newly developed tools for disease control__ (“implementation research”). __CDC will help identify the most effective tools and actively encourage their international use, applying expertise and resources in laboratory research__, public health policy, program management, __and health communications to overcome scientific, financial, and cultural barriers. Examples of new tools with the potential for significant worldwide impact include point-of-use disinfection and safe water storage to prevent waterborne diseases__; auto-disable (one-use) syringes to prevent bloodborne transmission of hepatitis B and C viruses and HIV; and diethylcarbamazine and albendazole therapy to eliminate lymphatic filariasis.
 * DHHS**, Department of Health and Human Services, **2002**

**The US is uniquely capable of surveillance – they have the best research and scientists and other countries will follow US leadership**
[“The National Science and Technology Council on Emerging and Re-emerging Infectious Diseases,” Population and Development Review, Vol. 22, No. 1, Match, JSTOR] Thus, the effort to build a global surveillance and response system is in accord with the national security and foreign policy goals of the United States. Moreover, __leadership in global infectious disease surveillance and control is a natural role for the United States. American business leaders and scientists are__ **__in the forefront__** __of the computer communications and biomedical research communities__ (both public and private sector) __that provide the technical and scientific underpinning for disease surveillance__. Furthermore, __American scientists and public health professionals have been among the most important contributors to the international efforts to eradicate smallpox and polio__. The challenge ahead outstrips the means available to any one country or to international organizations. __The U.S. Government must__ not only improve its capacity to meet the growing threat of emerging infectious diseases, but also __work in concert with other nations and international bodies.__ Although international efforts must be coordinated to prevent global pandemics, disease surveillance must be the responsibility of each sovereign nation. However, __individual governments may not easily share national disease surveillance information, fearing losses in trade, tourism and national prestige__. Nevertheless, __because U.S. experts are often consulted on problems of infectious disease recognition and control, the U.S. Government is usually informed about major disease outbreaks in other countries__, although not always in an official or timely fashion. __To ensure that we continue to be notified when an unusual outbreak occurs, we must encourage and support other countries' efforts in national disease surveillance and respond when asked for assistance__. We must strive to develop a sense of shared responsibility and mutual confidence in the international effort to combat infectious diseases. There is much room for optimism. **__If the United States takes the lead, we can expect that other nations will contribute resources to a global surveillance system__**. Both Canada and the European Union have recently decided- in spite of tight budgets-to provide substantial funds ($7 and $10 million per year, respectively) to strengthen infectious disease surveillance and control. __It is also absolutely critical that developing nations be engaged in an international effort that is in their own interests__. In May 1995, WHO passed a resolution urging member states "to strengthen national and local programmes of surveillance for infectious diseases, ensuring that outbreaks of new, emerging, and reemerging infectious diseases are identified." Soon after the resolution was drafted, WHO issued a report urging the strengthening of global disease surveillance and control, and encouraging greater use of WHO Collaborating Centers in this endeavor. = =
 * Population Council, 1996**

**Disease surveillance is a prerequisite to all other forms of disease care – only disease surveillance can get at the problem quickly and provide information for treatment and containment**
Mac W. **Otten**, Jr., MD, MPH, Medical Epidemiologist, African Regional Office (WHO) **and** Helen **Perry**, MA, Educational Design Specialist, Division of International Health (CDC), **2001** [“Technical Guidelines for Integrated Disease Surveillance and Response in the African Region,”6/01, [|http://www.cdc.gov/idsr/focus /surv_sys_strengthening/tech _guidelines-integrated-diseaseE NG.pdf]] Communicable diseases are the most common causes of death, disability and illness in the African region. While these diseases present a large threat to the well-being of African communities, there are well-known interventions that are available for controlling and preventing them. __Surveillance data can guide health personnel in the decision making needed to implement the proper strategies for disease control and lead to activities for preventing future cases__. Surveillance is a watchful, vigilant approach to information gathering that serves to improve or maintain the health of the population. __A functional disease surveillance system is essential for defining problems and taking action. Using epidemiological methods in the service of surveillance equips district and local health teams to set priorities, plan interventions, mobilize and allocate resources and predict or provide early detection of outbreaks.__ Depending on the goal of the disease prevention programme, __the surveillance activity objectives guides programme managers towards selecting data that would be the most useful to collect and use for making evidenced-based decisions for public health actions__. A disease control program may want to know what progress is being made with its prevention activities. __The program collects age and vaccination statues for cases of vaccine-preventable diseases__. If the program’s goal is to prevent outbreaks, __the surveillance unit can monitor the epidemiology of a particular disease so that the program can more accurately identify where the next cases might occur or the populations at highest risk__. In addition, __improving laboratory support for disease surveillance is essential for confirming causes of illness and early detection of outbreaks. Casebased investigation and laboratory confirmation provide the most precise__ 2 __information about where action must be taken to achieve an elimination target. Monitoring populations at highest risk for a particular disease can help to predict future outbreaks and focus prevention activities in the areas where they are most needed__.