Strengthening National Disease Surveillance and Response—Haiti, 2010–2015

Emerging pathogens and infectious diseases continue to cause significant morbidity and mortality around the world; increasing global travel and changing environmental conditions compound new developing health threats.1 From the Ebola outbreak in West Africa to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), infectious agents demonstrate the ability to adapt and spread with the potential to affect large and often vulnerable populations. In 2015, the World Health Organization (WHO) recorded more than 150 outbreak reports from 36 countries across all the continents with Zika virus and MERS-CoV as the most commonly reported infections.2 With expanding international travel, a local epidemic has the potential to spread quickly across borders.1 Thus, it is critical for countries to have well established systems to prevent, detect, and respond to any public health threat. The International Health Regulations (IHR), revised and adopted in 2005 by the World Health Assembly, were designed to help the international community deal with the risk posed by emerging and reemerging infectious diseases and other health threats.2–5,6 As part of their commitment to the IHR, participating countries agreed to comply with these rules by 2012. However, this binding document signed by 196 countries has been difficult to implement as fewer than 20% of countries had met IHR goals.5–7 By 2014, only about one-third of participating countries (64 countries) reported fully achieving the core capacities.8 The Global Health Security Agenda (GHSA), which includes 55 countries and stakeholder organizations, was launched in 2014 to help nations meet IHR requirements and promote global health security as an international priority.9 Priorities under GHSA include assisting countries to develop national infectious disease laboratories, electronic public health reporting systems, emergency operations centers, and effectively trained workforce.7 In 2015, Haiti was approved as a Phase 2 GHSA country providing impetus to examine and build Haiti’s disease surveillance systems and preparedness to face new global disease threats. In January 2010, Haiti’s already fragile health infrastructure was further impacted, after the country experienced a devastating 7.0 magnitude earthquake. Within 2 weeks of the earthquake, the U.S. Centers for Disease Control and Prevention (CDC), the Pan American Health Organization (PAHO) and other national and international agencies began working with Haiti’s Ministry of Public Health and Population (MSPP) to improve disease surveillance in the country.10,11 This article will describe Haiti’s progress in disease surveillance, document the lessons learned from the implementation of systems, and inform future investment in public health in Haiti in the context of the GHSA.