Biosurveillance capability requirements for the global health security agenda: lessons from the 2009 H1N1 pandemic.

The biosurveillance capabilities needed to rapidly detect and characterize emerging biological threats are an essential part of the Global Health Security Agenda (GHSA). The analyses of the global public health system's functioning during the 2009 H1N1 pandemic suggest that while capacities such as those identified in the GHSA are essential building blocks, the global biosurveillance system must possess 3 critical capabilities: (1) the ability to detect outbreaks and determine whether they are of significant global concern, (2) the ability to describe the epidemiologic characteristics of the pathogen responsible, and (3) the ability to track the pathogen's spread through national populations and around the world and to measure the impact of control strategies. The GHSA capacities-laboratory and diagnostic capacity, reporting networks, and so on-were essential in 2009 and surely will be in future events. But the 2009 H1N1 experience reminds us that it is not just detection but epidemiologic characterization that is necessary. Similarly, real-time biosurveillance systems are important, but as the 2009 H1N1 experience shows, they may contain inaccurate information about epidemiologic risks. Rather, the ability of scientists in Mexico, the United States, and other countries to make sense of the emerging laboratory and epidemiologic information that was critical-an example of global social capital-enabled an effective global response. Thus, to ensure that it is meeting its goals, the GHSA must track capabilities as well as capacities.