Humanitarian Health Action

Purpose statements for panels and sessions

WHO Conference on the Health Aspects of the Tsunami Disaster in Asia

Panel 2.2: Surveillance, early warning alert and response


Over 2 million persons were displaced and health services disrupted in India, Indonesia, Maldives, Thailand, and Sri Lanka in the immediate aftermath of the Tsunami of 26 December 2004. The immediate health concern in such emergency situations with massive population displacement is the identification and control of potentially widespread outbreaks of communicable diseases. WHO staff, including Global Outbreak Alert and Response Network (GOARN) partners were deployed to Aceh Province in Indonesia, Sri Lanka and Maldives to assist the ministries of health (MOH) with the establishment of supplemental surveillance, early warning alert and response systems (EWARN). India and Thailand which were not as extensively affected and had more robust epidemic response capacities were supported by WHO country offices as needed. The principle objectives of these surveillance systems was to detect epidemic-prone diseases occurring in the population based on symptomatic diagnosis followed by laboratory confirmation, and to institute necessary interventions to contain further spread of disease to limit morbidity and mortality in affected populations.

Key questions

How effective was the surveillance, early warning alert and response system for communicable diseases in: establishing a sensitive and responsive surveillance system; ensuring good coordination of reporting by providing clinical care agencies (government, NGO, military); detecting and responding to alerts in a thorough and timely manner; outbreak investigations including: confirmation of potential pathogen by laboratory diagnosis, determination of the mode of transmission and identification of persons at risk; instituting necessary control measures and interventions; utilizing available resources to prepare for outbreak management and control; and in building local and national capacities?

What was done well - measured in terms of appropriateness, adequacy, effectiveness, efficiency, and connectedness - and what could have been done better? How can the lessons learnt be translated into future health response in surveillance, early warning alert and response system for communicable diseases? Would specific tools would be useful and, if so, what would these contain, and how could they be put into practice?

Some of the specific issues and challenges to be addressed include:

  • Establishing and sustaining early warning systems - should this be focused to affected localities or expanded to cover other areas in the country? Should the approach include all diseases under national surveillance or be limited to priority epidemic-prone and vaccine-preventable diseases? Should a syndromic approach be used? What was the importance of communication and feedback to partners?
  • Laboratory capacity and referral networking - what is the role of each level of public health labs? How does the current lab network function in the affected areas? What is required for laboratory strengthening (technical experts, guidelines, and procurement of reagents, supplies, referral network)?
  • Coordination of disease surveillance, early warning and response - what is the role of WHO, NGOs, militaries, national authorities and other partners such as private health care providers?
  • Health infrastructure rebuilding – based on the level of destruction, what are the needs that can and should be addressed?
  • The link to existing national surveillance plans for enhancing disease surveillance and early warning systems - Improving epidemic preparedness (development of plans, procurement of essential drugs and supplies-emergency health kits), outbreak verification, investigation and response.