Tracking Infectious Disease Across Borders

Lessons learned from the 2003 SARS epidemic highlight our need for effective working relationships and systems that cross all borders — local, state, provincial, and international. In the age of terrorism, it is essential to have the ability to track and quickly respond to infectious disease outbreaks whether from bioterrorism or natural emerging pathogen events. Such events do not recognize borders, so we must closely coordinate with our cross-border public health partners to navigate the maze of different governments, laws, and organizational structures—a task that is often easier said than done.

Recognizing this need, the Washington State Department of Health, funded by US Department of Health and Human Services (HHS), held a workshop in August 2004 in Bellingham, Washington, entitled Emerging Public Health Threats: Tracking Infectious Disease Across Borders. The goal was to begin establishing a seamless, cross-jurisdictional public health infectious disease surveillance network. This network must quickly and efficiently track acts of bioterrorism and emerging pathogen threats across local, state, provincial, and the United States/Canada international borders. More than 200 professionals in the fields of epidemiology, public health laboratories, emergency management, and law came from Alaska, Alberta, British Columbia, Idaho, Montana, North Dakota, Oregon, Washington, Yukon Territories, and tribes. Speakers provided attendees with insights into the many challenges of preparedness and the need for compatible detection and response efforts within the Northwest.

This was truly a working conference. Participants were charged with: 1) building and strengthening strong professional relationships across our borders; 2) developing a framework for formal agreements in tracking infectious disease across borders; and 3) developing a work plan that describes next steps to complete and execute the agreements. Using two separate tabletop exercises, participants helped identify policy issues that are critical for successfully developing cross-border infectious disease tracking. The leading five priority issues identified at the workshop were communication (initial and ongoing), jurisdictional issues, surveillance system compatibility, resources (human and material), and legal issues. Frameworks for future memoranda of understanding to help guide this work among partners were also developed.

Although the workshop represented a solid starting point for this effort, attendees recognized that much work remains to be done. To maintain their momentum, participants committed to five immediate initiatives: 1) formalizing workgroups and timelines; 2) developing a 24/7 contact list/directory; 3) planning and executing cross-border exercises, joint training, and systems of continuous improvement; 4) advocating for public health preparedness at appropriate policy levels; and 5) planning the next annual conference on cross-border preparedness. Attendees then signed on to actively participate in these initiatives, and the group is working to assure follow-through over the next several months. Additional funding from HHS has been earmarked for the Washington State Department of Health to continue strengthening cross-border infectious disease collaboration.

Authors
Wayne Turnberg, RS, MSPH, is cross-border surveillance workshop coordinator in the Washington State Department of Health, and Paul Wiesner, MD, is assistant clinical professor at the Northwest Center for Public Health Practice and senior associate with Milne and Associates, LLC.

New Environmental Health Training Module Now Available

A training module on essential services of environmental health, developed by Carl Osaki and pilot tested during the past year, is now available on CD-ROM from the Northwest Center for Public Health Practice. The module can be used by local health departments to increase their staff's understanding of how the ten essential services apply to the practice of environmental health, as well as how to write performance standards relevant to local projects for each of the essential services.

The CD contains a fully narrated version of the training presentations and a customizable PowerPoint® version, with an instructor's manual and supporting training materials. For more information about the module or to order the CD-ROM, visit or call 206-685-1130.

Hot Topics in Preparedness

New from the Northwest Center for Public Health Practice is a monthly interactive online forum. Past topics include: preparing for SARS, current issues in West Nile virus infection, mental health and preparedness, mass dispensing, children, and pandemic influenza. The past forums are archived at http://www.nwcphp.org/training/hot-topics.