Prabhat Jha is director of the Centre for Global Health Research, St. Michael's Hospital; and professor of global health at University of Toronto's Dalla Lana School of Public Health.
Prime Minister Justin Trudeau's efforts to re-establish Canada's role in the world continues Friday when this country hosts the Montreal pledging conference for the Global Fund to fight AIDS, tuberculosis and malaria. His government has already pledged $785-million for 2017-2019 to the fund, which saves millions around the world.
Yet Canada can do more than contribute financially. Simply put, what gets measured gets done. The world needs accountable, evidence-based health surveillance. And Canada can provide leadership for this.
Various types of reliable, low-cost, long-term surveillance are vital in tracking trends in public health conditions, detecting new epidemics and outbreaks (such as SARS, Ebola and Zika), evaluating the success of control programs, and improving accountability for health expenditures (including the Global Fund). Routine vital statistics were crucial in documenting the large declines in tuberculosis and child mortality during the 20th century. They also sounded alarms about changing patterns and new threats; for example, the lung cancer increases among men beginning around the Second World War, which led to recognition of the tobacco epidemic. Subsequent action on smoking saved about 10 million lives in the United States and Canada alone. Routine deaths records found strange infections killing young men in San Francisco, heralding the AIDS pandemic.
Know that flu shot we should get every fall? The World Health Organization set up the Global Influenza Surveillance and Response System in 1952. About 150 national laboratories collect samples to develop global flu vaccines for the coming year, saving millions of lives.
Unfortunately, systems covering essential health surveillance are absent in most poor countries. Most don't have the benefit of the effective surveillance and response that Singapore, for example, is now employing against Zika and Dengue outbreaks.
However, successful and cheap solutions have been implemented. The Registrar General of India, for example, works with the University of Toronto on the "Million Death Study" which gathers cause-of-death data from 1.4 million homes. This project, which costs less than $1 per household annually, has transformed disease control in India. Another example: A simple radio network links field staff at more than 100 sites in South Sudan to report on eight infections. Prior to this system, an outbreak of relapsing fever in 1999 killed more than 2,600 people. After the system began, a second outbreak was held to 142 cases, with only 11 deaths.
How could Canada lead in this field of public health? The first step would be to convene donor countries, the private sector, NGOs and social-network groups around a global agenda for 21st-century surveillance. This would build on the international regulations of the World Health Organization, which unfortunately receive little funding.
Second, Canada could encourage donors to allocate about $1-billion of the $48-billion of developmental assistance in health to create a global health surveillance facility. This facility would monitor the performance of not only of countries, but also of international organizations such as the WHO, the World Bank and the Gates Foundation. It could, for example, support a few labs in each country to monitor drug resistance. It need not be another bureaucracy, but mostly a virtual network to mobilize technical support from universities, schools of public health, and international agencies.
Third, Canada could recommend a recurring "international health audit" day – one day every two years dedicated to providing simple facts and tracking trends over time. This would be marked at the highest level, increasing commitment to better health and to better data. Finally, Canada could apply a surveillance "litmus test" to assess candidates for the director-general of the World Health Organization. The world's top physician needs to be a capable disease detective.
Surveillance and data collection not only protects Canadians from global scourges, but also can provide road maps for every country to better health.
Few countries can match Canadian levels of achieving a 98-per-cent completion rates on census forms. If the world needs more Canada, it definitely needs better data.