Conference organized by:

Center for Biosecurity of UPMC

World Health Organization Communicable Disease Surveillance and Response Office

Conference sponsored by:

The Nuclear Threat Initiative

The Global Outbreak Alert and Response Network (GOARN)
Presenter: Dr. May C. Chu

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In its Communicable Disease Surveillance and Response activities, the WHO seeks to detect global disease outbreaks and to provide a rapid response in order to reduce suffering of infected populations, contain the international spread of disease, and minimize impact on travel and trade that could result from international efforts to control a disease outbreak.

At the WHO, the Assessment and Field Operations Unit (AFO) scans incoming disease outbreak reports from both official and nonofficial sources to detect potential epidemics of global public health significance. Non-official sources of information, such as reports from the Global Public Health Intelligence Network (GPHIN), ProMED, and NGOs play a major role in the detection of disease. During the period from 2000 to 2004, 61% of all events were reported through these nonofficial sources. When the WHO detects a potential disease outbreak, it will work with member countries to verify the event. Once the event has been verified, the WHO may be invited by affected member countries to assist in responding to the epidemic, or if it is not invited, the WHO may advocate for permission from member countries to assist in the response.

Instrumental in responding to global epidemics is the Global Outbreak Alert and Response Network (GOARN), a voluntary technical partnership of more than 120 members coordinated by WHO to provide multi-disciplinary technical support to countries for outbreak response. In this capacity, GOARN serves as the operational arm of the WHO that can be mobilized to assist countries with disease control efforts by providing technical support.

GOARN team members deployed in the field and those that offer professional guidance from their home countries communicate with each other and with the WHO through teleconference. The recently constructed Strategic Health Operation Center at WHO provides added functionality for this process, but according to Dr. Chu "[it] doesn't really change what we do."

In the 2000 to 2004 period, GOARN responded successfully to more than 36 outbreaks worldwide, such as the 2003 SARS outbreak in Asia. Despite these successes, the network is continually challenged by resource limitations. Although most GOARN members self-fund their participation in the network, it can be very costly for the WHO to coordinate the deployed teams. The WHO does not have a budget for GOARN activities and therefore must solicit external funds for coordinating GOARN teams each time they are mobilized. The most recent example of this is the 2005 outbreak of plague (one of the three diseases that are reportable under the current International Health Regulations) in the Democratic Republic of Congo, in which WHO was faced with the challenge of simultaneously planning its response to the outbreak while raising nearly $400,000 USD to ensure the safety and transportation of the responding GOARN team. These resource limitations raise questions about the WHO's capacity to respond to large disease epidemics that are occurring in multiple locations or that require sustained responses.

- Summary by Jennifer Nuzzo, M.S.  

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