Global efforts to improve disease surveillance have historically focused on  specific diseases or groups of diseases. For example, as we reported in  2001, the international community has set up surveillance systems for  smallpox, polio, influenza, HIV/AIDS, tuberculosis, and malaria, among  others, with the goal of eradicating (in the case of smallpox and polio) or  controlling these diseases. Four U.S.–funded Programs Help Build Capacity for Overseas Infectious Disease Surveillance

U.S. agencies operate or support four key programs aimed at building  overseas surveillance capacity for infectious diseases: Global Disease  Detection (GDD), operated by CDC; Field Epidemiology Training  Programs (FETP), supported by CDC and USAID; Integrated Disease  Surveillance and Response (IDSR), supported by CDC and USAID; and  Global Emerging Infections Surveillance and Response System (GEIS),  operated by DOD. USAID also supports additional capacity-building  projects. In 2004-2006, the U.S. government obligated about $84 million for these  four programs (see table 1). Funding for these programs is obligated to  support the ability of laboratories to confirm diagnosis of disease as well  as the training of public health professionals who will work in their  countries to improve capacity to detect, confirm, and respond to the  outbreak of infectious diseases. Collectively, these four programs operate in 26 developing countries. Global Disease Detection

GDD is CDC’s primary effort to build public health capacity to detect and  respond to existing and emerging infectious diseases in developing  countries, according to CDC officials. Integrated Disease Surveillance and Response

USAID has supported CDC in (1) designing and implementing IDSR, with  WHO/AFRO, in 46 African countries and (2) providing technical assistance  to 8 of these countries. In 2005-2006, DOD obligated approximately $8 million  through GEIS to build capacity for infectious disease surveillance. Agencies Monitor Surveillance Capacity- Building Activities and Have Begun to Evaluate Programs’ Impact

The U.S. agencies operating or supporting the disease surveillance  capacity building programs collect data to monitor the programs’  activities. CDC and USAID also recently began systematic efforts to  evaluate program impact, but it is too early to assess whether the  evaluations will demonstrate progress in building surveillance capacity. However, as of July 2007, the agency had not collected data on the two  surveillance indicators to evaluate the program’s contribution to  improved surveillance. CDC has collected data such as the numbers of FETP trainees  and graduates, the numbers of FETP graduates hired by public health  ministries, the number of outbreak investigations conducted, and the  number of surveillance evaluations conducted. This is a work of the U.S. government and is not subject to copyright protection in the  United States.
Why GAO Did This Study

The rapid spread of severe acute respiratory syndrome (SARS) in 2003 showed that disease outbreaks pose a threat beyond the borders of the country where they originate. The United States has initiated a broad effort to ensure that countries can detect outbreaks that may constitute a public health emergency of international concern. Three U.S. agencies--the Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID), and the Department of Defense (DOD)--support programs aimed at building this broader capacity to detect a variety of infectious diseases. This testimony describes (1) the obligations, goals, and activities of these programs and (2) the U.S. agencies' monitoring of the programs' progress. To address these objectives, GAO reviewed budgets and other funding documents, examined strategic plans and program monitoring and progress reports, and interviewed U.S. agency officials. GAO did not review capacity-building efforts in programs that focus on specific diseases, namely polio, tuberculosis, malaria, avian influenza, or HIV/AIDS. This testimony is based on a report (GAO-07-1186), which is being released with this testimoy. GAO did not make recommendations. The agencies whose programs we describe reviewed our report and generally concurred with our findings. We incorporated their technical comments as appropriate.

What GAO Found

The U.S. government operates or supports four key programs aimed at building overseas surveillance capacity for infectious diseases. In fiscal years 2004-2006, U.S. agencies obligated approximately $84 million for these programs, which operate in developing countries around the world. Global Disease Detection is CDC's main effort to help build capacity for infectious disease surveillance in developing countries. The Field Epidemiology Training Programs, which CDC and USAID support, are another tool used to help build infectious disease surveillance capacity worldwide. Additionally, USAID supports CDC and the World Health Organization's Regional Office for Africa in designing and implementing Integrated Disease Surveillance and Response in 46 countries in Africa, with additional technical assistance to 8 African countries. DOD's Global Emerging Infections Surveillance and Response System also contributes to capacity building through projects undertaken at DOD overseas research laboratories. USAID supports additional capacity-building projects in various developing countries. For each of the four key surveillance capacity-building programs, the U.S. agencies monitor activities such as the number of epidemiologists trained, the number of outbreak investigations conducted, and types of laboratory training completed. In addition, CDC and USAID recently began systematic efforts to evaluate the impact of their programs; however, because no evaluations had been completed as of July 2007, it is too early to assess whether these evaluation efforts will demonstrate progress in building surveillance capacity.