Catching outbreaks wherever they occur

Abstract

Communicable diseases have no respect for boundaries. As pandemic influenza A (H1N1) swept the globe this year, WHO's Member States could take comfort in the legal requirements of the International Health Regulations (IHR), which were updated in 2005 to require countries to report certain disease outbreaks to the World Health Organization (WHO). not all parts of the world are or may be parties to the IHR, and where there is a gap in surveillance there is always the possibility that an outbreak can slip through the net. For example, the West Bank and the Gaza Strip--though not party to the IHR--are covered by the Middle East Consortium on Infectious Disease Surveillance (MECIDS). This coordination mechanism of Israeli, Jordanian and Palestinian health officials shares information and takes coordinated action to help detect and respond to infectious disease outbreaks. It is one example of how regional disease surveillance can be achieved in difficult political environments, and also of how such cooperation works to implement the requirements of the IHR. When WHO declared Phase 6 of the A (H1N1) virus in June, we found we needed an urgent meeting, says Dr Bassam al-Hijawi, head of the Disease Control Directorate at Jordan's Ministry of Health. Increasing the capabilities of laboratories in the region posed one challenge for which it was necessary to hold face-to-face talks, even if it meant travelling to a third location because of political tensions between the sides. But we succeeded in going to Jerusalem to discuss it, says al-Hijawi, an epidemiologist, who serves on the executive board of MECIDS. We started [working according to] the same rules together, even though Israel reported the first A (H1N1) case. This was in compliance with the International Health Regulations, he says. MECIDS was established in 2003, when nongovernmental organizations Search for Common Ground and Washington-based Nuclear Threat Initiative began facilitating regional cooperation in public health. MECIDS was established as part of those efforts, in which the Ministry of Health of Israel, the Palestinian Authority, and Jordan were initially sharing data on foodborne disease outbreaks. Since then, data sharing has expanded to other disease areas, including vector-borne diseases and pandemic influenza. MECIDS partners have protocols for cross-border collaboration for investigating infectious disease outbreaks, including a bird culling radius across the borders, an automatic system for notifying each and tested collaboration for general preparedness for pandemic influenza. [ILLUSTRATION OMITTED] Harmonizing diagnostic and reporting methodologies, sharing training programmes and facilitating cross-border communication between laboratory technicians and public health officials are other important activities. It's just not a talking organization. This is a direct action organization, says Terence Taylor, who is vice-president of Global Health and Security, at the Nuclear Threat Initiative, that is helping MECIDS implement its plans. idea behind MECIDS is that everybody is equal, says Dr Alex Leventhal, the director of Israel's Health Ministry Department of International Relations and the consortium's first chair. Leventhal is joined by Dr Adel Belbesi, assistant secretary-general for primary health care at Jordan's Ministry of Health. Dr Assad Ramlawi, the Palestinian Authority Ministry of Healths director of primary care and public health, is the third principal and currently holds the year-long rotating post. The three principals are the heads of their respective delegations to MECIDS and they take turns in occupying the rotating chair. We have to exchange information and support each other, Ramlawi says of the need for health professionals to protect their respective communities from the outbreak of infectious diseases. …