Not surprisingly, prominent among the recommendations of the World at Risk report is a call for “global monitoring of infectious diseases”. “Crucial to mounting a defense against biological weapons development and attack is the early detection and reporting of outbreaks of infectious disease, a capability known as disease surveillance” (37). Moreover, World at Risk emphasizes the global geography and pre-diagnostic temporality of this future surveillance. “In addition, the United States should offer bilateral assistance to those developing countries at greatest risk of epidemics, helping them to establish surveillance networks for detecting and reporting both human and animal disease outbreaks prior to a confirmed laboratory diagnosis” (70). Doing so could provide, in their vision, an “’extended defense perimeter’ around the United States” (40).

It is striking to me that calls for enhancing “disease surveillance”—and in particular, global or international disease surveillance—have been appearing for at least fifteen years now. For example, the groundbreaking Institute of Medicine report Emerging Infections emphasized increasing ‘national and international disease surveillance’ as the key to preventing and mitigating emerging outbreaks of disease. “The key to recognizing new or emerging infectious diseases, and to tracking the prevalence of more established infectious diseases, is surveillance” (IOM 113). Yet in important ways these statements are not saying exactly the same thing. What has changed and what has stayed the same? In World at Risk the framing of the problem is “biological weapons development and attack” where for Emerging Infectious the problem is “new or emerging infections”. Certainly we can trace how these two problems have in the past fifteen years been correlated in such a way that they are seen to have sufficiently similar qualities and require similar technical approaches. In addition, there is a shift from the reference to “international” to “global” surveillance in the two reports. This is a shift in things as well as in words. As the World at Risk report notes, in the past few years a completely transformed International Health Regulations came into force (which shifts reporting requirements from only four diseases to any “public health event of international importance”) and the WHO constructed its Global Alert and Response Network (including surveillance of news reports culled through ProMED and the Global Public Health Information Network). As a number of commentators have argued, GPHIN epitomizes a surveillance infrastructure that is not merely international—it completely bypasses the sovereignty of national governments in the collection and distribution of information, providing the condition of possibility for a truly global public health geography. Despite these differences, both reports locate our weakness or risk in the face of biological threats as a problem of ‘too little information’. So to me it is somewhat troubling to see the World at Risk report call for increased surveillance, without acknowledging the trials and breakdowns that have accompanied the development of new disease surveillance systems. As I argued in my article “Redesigning Syndromic Surveillance for Biosecurity” in Collier and Lakoff, eds., Biosecurity Interventions, “More information means more interpretive work, without certain benefits; and more detected events requires more epidemiological responses, without (at this point) the necessary epidemiological resources to undertake them.” This is not to say that disease surveillance is not important or in fact essential to disease control. But the framing of the threat as a problem of recognition (rather than, for example, prevention, control or amelioration) assumes the existence of an effective response infrastructure that may not exist. And it also assumes that existing disease control practices could effectively control an outbreak if only we recognized it quickly, an assumption that, in the case of highly contagious viruses such as SARS, is not confidently known.