region. (This program is discussed in greater detail in the research and training section later in this chapter.)

  • USAID's Program in Worldwide Control of Sexually Transmitted Diseases (STD)/HIV. This is a single-source contract to Family Health International, a non-profit organization committed to family planning; contraceptive safety, acceptability, effectiveness, and ease of use; maternal and child health; interventions to reduce the transmission of STDs; and other related issues.

Although the CDC appears to have a mandate for U.S. disease surveillance, other government agencies (e.g., the NIAID, U.S. Department of Agriculture [USDA], DoD, and USAID), private foundations, and universities may also independently play major or minor roles. Currently, there is little coordination among these agencies and organizations regarding infectious disease surveillance. The committee concludes that the effectiveness of their surveillance activities, particularly those pertaining to recognition of and response to emerging microbial threats, could be greatly improved by designating a central focus for such efforts.

The committee recommends that international infectious disease surveillance activities of U.S. government agencies be coordinated by the Centers for Disease Control (CDC). To provide the necessary link between U.S. domestic and international surveillance efforts, the body that is established for this purpose should be the same as that suggested earlier in the recommendation on domestic surveillance. Alternatively, a federal coordinating body (e.g., a subcommittee of the Federal Coordinating Council for Science, Engineering, and Technology's [FCCSET] Committee on Life Sciences and Health, specifically constituted to address this issue) could be assigned the coordinating function. Implementation of surveillance activities, however, should remain with the appropriate federal agencies (e.g., the CDC, Department of Defense, National Institutes of Health, U.S. Department of Agriculture).

Multilateral International Surveillance Efforts

The coordination efforts of multilateral international organizations, such as the WHO, are critical to infectious disease surveillance. Without these organizations, programs such as the successful worldwide eradication of smallpox and the interruption of polio transmission in the Americas would be little more than dreams. Any implementation of a global surveillance system for emerging infectious diseases must draw upon the capabilities of such organizations. Some of the ongoing and past programs of two of these bodies are discussed below.

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