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The author is Professor John Snow of Epidemiology and director of the Infectious Immunology Center at the School of Public Health at Columbia University.
Get off the curb at a busy intersection without scanning traffic? Of course it’s not. But we do the same thing every day by ignoring infectious disease surveillance.
Our collective awareness of emerging infectious diseases began decades ago with HIV/AIDS, Ebola and the West Nile virus. These diseases, along with SARS, MERS, Zika, MPox and novel influenza, originate from animals before jumping into humans. It continues.
However, zoonotic diseases are not the only threat. The number of high-heating labs handling dangerous pathogens has exploded. In the 1980s, fewer than 10 fatal threats were found, such as Ebola and Marburg, which had no effective drugs. Today there are at least 69. There is no official registration of the type of lab used to study deadly aerial viruses such as SARS and SARS-COV-2. However, in the US alone, there are 1,300 people, with an estimated value of several thousand.
This research is essential, but it is risky. Between 2000 and 2021, 309 reported lab-accumulated infections worldwide, with eight deaths. Worse, some countries are currently weaponized pathogens. Russia reportedly revitalized Sergiev POSAD-6, a Soviet-era biological facility near Moscow. North Korea’s program is also active. Non-state actors also pose risks. Viruses can be built from scratch using a sequence from a public database. Additionally, companies that integrate viral genes monitor requests, but anyone can buy used previous generations of equipment online and produce whatever they need without monitoring.
We live in a world where new threats can arise from being exposed to infected animals, lab accidents, or deliberate efforts by terrorists and fraudulent states. And it’s not just exotic infectious diseases that worry us. Antibiotic resistance can derail recovery from routine hip or knee surgery. The introduction of viruses like H5N1 (Avian influenza) can also cause economic disruption.
You may not be able to control wildlife markets, fraudulent laboratories, or overuse of antibiotics. But we can and must stop blind flights.
The term surveillance comes from the French sur (over) and Baylor (keeping awake). The term surveillance refers to active, continuing comprehensive vigilance to spot potential threats. However, there are no national or international organizations to perform this function.
Furthermore, given the withdrawal of financial and political support for organizations like the global health organizations and ministries, the limited capacity of surveillance that we had is rapidly fading.
Nowadays, surveillance is mostly passive. The general population relies on the health department to voluntarily provide information. This can be as accurate as the government is to obtain that information and how transparent it is when it comes to sharing it. A more aggressive surveillance system is needed that can identify infectious threats.
I was an early developer of diagnostic tools for detecting infectious agents. Over the past 40 years, we have seen tools become more sensitive and cheaper. It is now possible to take samples from air or wastewater, extract and sequence genetic material, flag known or novel pathogens, and build portable devices that are naturally or manipulated.
Such equipment can be located at ports of entry for tourists and trade and can be used to continuously screen for infectious threats to public health and agriculture. It can be deployed especially if there is a burst of activity that coincides with the emergence of a new infectious disease. It can also be used in clinics and hospitals with regulatory approval to enable accurate diagnosis of infectious diseases, better clinical outcomes, and cost reductions.
However, surveillance cannot stop at the border. The best defense is to find an outbreak in their sources. The easiest way to do this is to train and equip local scientists in high-risk areas with the temptation of wildlife, high-level biointake facilities, population centers, or mass gatherings. Such support should be linked to data transparency.
Pandemic fatigue is real, but self-completion is fatal. The next threat can appear anytime, anywhere. Investing in smart and scalable surveillance is not a warning. It’s pragmatism.
