Lots of Scientists Write a Letter About Infectious Disease Surveillance

One of the most important things in public health is surveillance. While it's not sexy, you can't solve health problems if you don't have good data. Recently, many professional societies sent a joint letter to several representatives asking their support for the National Integrated Public Health Surveillance Systems and Reportable Conditions Act which will be submitted to committee (the full text of the letter is at the end of the post).

The primary goal of the NIPHSSRCA (try saying that ten times fast....) is to modernize our surveillance infrastructure. When I would argue for electronic antibiotic resistance surveillance, I always told audiences that something is very wrong when CVS Pharmacy knows more about the birthday cards I buy for my mother than the State of Massachusetts knows about the problem of antibiotic resistance. We definitely need electronic surveillance, as the letter claims (italics mine):

Many parts of the local-state-federal disease surveillance system remain fragmented and paper-based, and have not fully benefited from new technologies that could improve the completeness and timeliness of reporting. A 2007 survey of barriers states report in achieving electronic laboratory reporting shows that 20 states are still using web-based manual reporting and 16 are completely paper-based. Only two state public health laboratories have bidirectional data flow and can both send and receive laboratory messages, the gold standard for disease reporting....

The bill also focuses on improving electronic disease surveillance and reporting by requiring the Secretary, acting through the Director of the Centers for Disease Control to adopt, within 180 days of enactment, guidelines for public health entities to ensure that all State and local health departments and public health laboratories have access to receive, monitor, and report infectious diseases and other urgent conditions of public health importance. Grant mechanisms for achieving complete, and updated electronic disease reporting by state and local health departments, and public health laboratories are delineated and modestly enhanced to ensure the nation has a seamless, rapid information flow for disease detection and reporting.

Importantly, the legislation focuses on improving two areas of surveillance--genetic fingerprinting and emerging infectious diseases, including antibiotic resistant organisms. The legislation would also establish a uniform list of notifiable diseases that all laboratories would be required to report. It would also map diseases using GIS technology. The total price tag would only be $164 million per year, which when spread across 50 states isn't that much money, considering the amount of work to be done.

It's a very good piece of legislation; ask your representative to support this bill.

The full text of the letter:

September 10, 2008

The Honorable Lee Terry
1524 Longworth House Office Building
Washington, D.C. 20515

The Honorable Tammy Baldwin
2446 Rayburn House Office Building
Washington, D.C. 20515

The Honorable Edolphus Towns
2232 Rayburn House Office Building
Washington, D.C. 20515

Dear Representatives Terry, Baldwin and Towns:

The undersigned organizations join in supporting your introduction of the "National Integrated Public Health Surveillance Systems and Reportable Conditions Act." This important legislation addresses a critical aspect of our public health system in the United States: the science infrastructure at all levels of government. That infrastructure, primarily applied epidemiology, laboratory science, and public health informatics, has greatly improved since the mid-1990's, but has not kept pace with the challenges we face today: increased foodborne disease outbreaks, emerging infections such as West Nile Virus, growing antimicrobial resistance, pandemic flu, and environmental health threats, particularly to clean air and water.

Many parts of the local-state-federal disease surveillance system remain fragmented and paper-based, and have not fully benefited from new technologies that could improve the completeness and timeliness of reporting. A 2007 survey of barriers states report in achieving electronic laboratory reporting shows that 20 states are still using web-based manual reporting and 16 are completely paper-based. Only two state public health laboratories have bidirectional data flow and can both send and receive laboratory messages, the gold standard for disease reporting. The potential for new pathogen discovery, rapid electronic exchange of public health information, national bacterial and viral databases for DNA "fingerprinting" of infectious disease organisms has not been fully realized.

We need a robust, complete, 21st century public health infrastructure that is strengthened at all levels of government to meet these challenges.

The "National Integrated Public Health Surveillance Systems and Reportable Conditions Act" will achieve that goal. It will accomplish this by providing a very modest expansion of resources, renewed focus and mission, and new areas of special emphasis for several existing programs within the Centers for Disease Control and Prevention, which have never before been authorized. These programs support public health capacity to identify and monitor the occurrence of infectious diseases and other conditions of public health importance; detect new and emerging infectious disease threats, including laboratory capacity to detect antimicrobial resistant infections; identify and respond to disease outbreaks; and hire and train necessary professional staff.

The bill also focuses on improving electronic disease surveillance and reporting by requiring the Secretary, acting through the Director of the Centers for Disease Control to adopt, within 180 days of enactment, guidelines for public health entities to ensure that all State and local health departments and public health laboratories have access to receive, monitor, and report infectious diseases and other urgent conditions of public health importance. Grant mechanisms for achieving complete, and updated electronic disease reporting by state and local health departments, and public health laboratories are delineated and modestly enhanced to ensure the nation has a seamless, rapid information flow for disease detection and reporting.

Fellowship training for key elements of the public health workforce, applied epidemiologists, laboratory scientists and public health informaticians, is authorized and modest funding targets provided. We are facing workforce shortages in many areas of our health and public health system. The need to increase, well-trained, core public health science professionals is addressed in this bill.

The bill also authorizes, for the first time, a process for determining a list of nationally notifiable diseases and conditions. The provisions are modeled on the existing process of collaboration between the States and the Centers for Disease Control and Prevention, but provide clarity and structure that enables Congress to monitor and support improvements as events and technology require.

We greatly appreciate your leadership in introducing this legislation and look forward to working with you on its enactment.

Sincerely,

American Association of Public Health Veterinarians
American Public Health Association
American Society for Microbiology
Association for Professionals in Infection Control & Epidemiology
Association of Public Health Laboratories
Association of State and Territorial Health Officials
Center for Infectious Disease Research and Policy
Council of State and Territorial Epidemiologists
Infectious Diseases Society of America
National Association of State and Territorial AIDS Directors
National Association of State Public Health Veterinarians
National Public Health Information Coalition
Society for Healthcare Epidemiology of America
Trust for America's Health