One major technological advance is the spread of DNA fingerprinting beyond crime-fighting into the tracking and detection of potentially harmful strains in bacteria, plants and animals. DNA fingerprinting is, for example, now part of the screening process for fish catches to ensure that potentially dangerous bacteria like E. coli are not present. It is also being used to identify antibiotic-resistant strains to help doctors either to select an antibiotic other than the one to which the bacteria are resistant, or to consider chosing alternative treatments.

Although less sophisticated than the systems being run by the CDC, the World Health Organization a decade ago had a similar ambition for its Integrated Disease Surveillance Programme, which strengthened disease surveillance capacity in over forty African countries. Looking ahead, a major challenge lies in creating a global bio-surveillance system that will work equally well around the world. According to workshop participants, collecting reliable data from the field and connecting the sources in an effective manner itself requires ‘a significant change in the current surveillance paradigm’. Add on the levels of intelligence required to be built into and support data mining of such a wide range of information and the barriers are clear. ‘Integrated systems that use new data systems, analysis, visualisation and modelling as well as decision analysis tools are clearly required,’ many of which are now in development.

At the same time, more open human-to-human communication is also a key ingredient for global bio-surveillance, and this is one aspect that is now more or less sufficiently advanced to have an impact. As the Chatham House Centre on Global Health Security puts it: ‘With the advent of the internet and the blogosphere, there have been radical changes in the ways that public health risks are communicated by and to the public. These changes can influence national and international health policies that are designed to respond to threats to our collective health.’ Non-traditional sources of health data such as news stories, unstructured real-time text messages between healthcare professionals and animal health reports can, if properly integrated, provide core elements of an effective system.

Looking ahead to 2020, the ambition of an international system that links together relevant sources of dispersed data from such sources as hospitals, animal health centres, local monitoring of water sources for biological agents and even remote monitoring of people and animals from space seems to be increasingly realisable. International agreements, legacy system integrations and open communication of data are already in place. Once these are matched up with the data analysis and visualisation software already in use in other sectors, the anticipated changes, it is argued, will occur. An increasing number of healthcare experts can see just over the horizon a future where ‘as soon as an outbreak of disease occurs, whether in humans or animals, it can be rapidly tracked and analysed so that the appropriate responses can be activated.’ With this, not only will we have faster early warning, detection, and situational awareness of threats to public health, but we will also have the means to better plan for future disease scenarios from multiple sources. Whether responding to ebola, avian flu or bio-terrorism, it is anticipated that ‘linked overt and covert surveillance will protect the populous – ideally as well in the southern hemisphere as is likely in the North.’ If everything goes to plan, whether you live in New York or the Rift Valley, improved public health will be underpinned by this type of global monitoring.