Progress in Global Surveillance and Response Capacity 10 Years after Severe Acute Respiratory Syndrome

Christopher R. Braden, Scott F. Dowell, Daniel B. Jernigan, and James M. Hughes

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.R. Braden, S.F. Dowell, D.B. Jernigan); Emory University, Atlanta (J.M. Hughes)

Abstract

Ten years have elapsed since the World Health Organization issued its first global alert for an unexplained illness named severe acute respiratory syndrome (SARS). The anniversary provides an opportunity to reflect on the international response to this new global microbial threat. While global surveillance and response capacity for public health threats have been strengthened, critical gaps remain. Of 194 World Health Organization member states that signed on to the International Health Regulations (2005), <20 2012.="" 21st="" achieved="" address="" all="" and="" are="" available="" avoid="" by="" capacities="" capacity="" cause="" century="" challenges.="" complacency="" compliance="" core="" countermeasures="" deadline="" develop="" efforts="" from="" global="" had="" highlight="" improve="" in="" inequities="" insights="" june="" learned="" lessons="" many="" need="" new="" next="" of="" options="" outbreak="" p="" pandemic="" required="" research="" root="" sars="" strengthen="" striving="" support="" that="" the="" these="" to="" tools="" treatment="" using="" while="" with="">

Ten years have elapsed since the World Health Organization (WHO) issued its first global alert for an unexplained illness, which it named severe acute respiratory syndrome (SARS) (1). A few days later, the Institute of Medicine (IOM) released a report, Microbial Threats to Health, that highlighted many of the issues and challenges raised by SARS (2). This anniversary provides us with an opportunity to reflect on the international response led by WHO to this new global microbial threat, a response that resulted in control of the pandemic that resulted in >8,000 cases and nearly 800 deaths in >30 countries and had a large economic impact (3). The series of emerging and reemerging disease threats since 2003, from avian influenza (H5N1, H7N9) to extensively drug-resistant tuberculosis to the recently recognized novel coronavirus, reinforce the need to avoid the complacency that typically occurs in the aftermath of a successful response to a crisis resulting from an emerging microbial threat.

Lessons of SARS

Many features of the SARS epidemic and the public health response are worth recalling because they provide reminders of challenges posed by the emergence of a new disease that is transmissible from person to person. Some of these features include the initial lack of field investigative capacity, reference laboratory testing, and reporting transparency from southern China, which resulted in a 3-month delay in the reporting of the severe unexplained illness to WHO; the important role played by an alert clinician in Hanoi, Vietnam, in the initial recognition and response to the illness; the rapid spread of illness to >30 countries; and the effects on health care workers and family members, who were most at risk for person-to-person spread of the infection. Reviewing the events that occurred during the SARS epidemic is an opportunity to highlight the ultimate success of early patient isolation, contact tracing, quarantine, and infection control measures; the importance of rigorous attention to biosafety in laboratory settings; the effects of stigmatization of affected groups; the economic impact as a result of major disruptions in international travel and commerce; the identification of the mode and circumstances of cross-species transmission; and the role of “superspreaders” and superspreading events in the rapid dissemination of the illness.
In addition, during the epidemic, the leadership provided by WHO facilitated timely exchange of new information among clinicians, epidemiologists, and laboratory investigators around the world. These efforts included the formation of a global network (4) of virology and pathology laboratories that used modern diagnostic methods, which contributed to the rapid identification, characterization, and sequencing of the agent and the timely dissemination of critical information and guidance through agency reports, expedited peer-reviewed publications (5–9), lay media, and the Internet. These experiences exemplify the characteristic features of the global SARS outbreak.