Diseases once regarded as declining in significance have also reemerged in recent years to once again become major global health threats. The emergence of previously unknown diseases and the development of disease strains resistant to antimicrobial drugs further complicate international disease control efforts. Surveillance provides information for action against infectious disease threats. Multiple Surveillance Systems Created to Support Disease-Specific Control Programs

The strongest influence on the evolution of the existing surveillance framework has been the collaboration among medical professionals, national governments, and foreign assistance agencies to develop control programs and associated surveillance efforts that focus on specific diseases or groups of diseases. For example, the 1918 to 1919 influenza pandemic killed more than 20 million people in locations as diverse as China, Spain, the United States, and Samoa. Surveillance systems in industrialized and developing countries suffer from a number of common constraints, including a lack of human and material resources, weak infrastructure, poor coordination, and uncertain linkages between surveillance and response. For example, total health care spending per capita in low income countries amounts to about 3 percent of per capita spending in high income countries. Impact of Improvement Initiatives Remains to Be Demonstrated

The international community has recently launched a number of initiatives that may improve global surveillance. All three diseases have their most severe impacts in sub-Saharan Africa. However, the most recent report on the project’s results includes data from geographic areas that include only about 28 percent of the reported tuberculosis cases in the world and two-thirds of the 23 high-burden countries targeted by the Stop TB campaign. Broader Initiatives Aimed at Strengthening Global Surveillance

The international community has introduced a number of initiatives to strengthen overall global capacity for surveillance of infectious diseases as a group. These include efforts to improve laboratory and epidemiological capacity and to increase disease-mapping capability. International public health officials concerned about the overall threat of infectious disease are seeking to take advantage of the global community’s apparent willingness to commit itself to achieving measurable progress against three major disease threats—HIV/AIDS, tuberculosis, and malaria—to support broader systemic improvements in developing country surveillance and response capacity. However, given the need to demonstrate progress against these three diseases in particular, the extent to which the global public health community can manage the new disease-specific initiatives in a manner that significantly improves surveillance for all infectious disease threats, remains to be demonstrated. Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS), a disease of the immune system.
What GAO Found

According to the World Health Organization, infectious diseases account for more than 13 million deaths every year, including nearly two-thirds of all deaths among children under age 5. Infectious diseases present a substantial threat to people in all parts of the world, and this threat has grown in volume and complexity. New diseases have emerged, others once viewed as declining in significance have resurged in importance, and many have developed substantial resistance to known antimicrobial drugs. Infectious disease surveillance provides national and international public health authorities with information that they need to plan and manage efforts to control these diseases. In the mid-1990s, public health experts in the United States and abroad determined that global infectious disease surveillance was inadequate, and both the World Health Assembly and the President of the United States called for the development of an effective global infectious disease surveillance and response system. The strongest influence on the evolution of the current global infectious disease surveillance framework has been the international community's focus on specific diseases or groups of diseases. The international community has created diverse surveillance programs to support global and regional efforts to control particular diseases. Surveillance systems in all countries suffer from a number of common constraints. However, these constraints have their greatest impact in the poorest countries, where per capita expenditure on all aspects of health care amounts to only about three percent of expenditures in high-income countries. Surveillance in developing countries is often impaired by shortages of human and material resources. The international community recently launched several initiatives that may improve global surveillance. The community has committed itself to reducing the global burdens imposed by three diseases--tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome, and malaria. The community has also begun more broadly targeted initiatives to upgrade laboratories, strengthen epidemiological capacity, and otherwise improve surveillance for infectious diseases as a whole.