Submission ID 131691
| Issue/Objective | Closing the Blind Spots: How Pakistan Built a National Early Warning System for Multi-Pathogen Threats Issue/Objective Pakistan entered the last decade with almost no capacity to detect outbreaks early. Reporting was absent, verification was ad-hoc, and surveillance relied on chance events. Multiple outbreaks-dengue, diphtheria, CCHF, and cholera-spread before the system could even recognize them. This resulted in preventable deaths, delayed responses, and overwhelmed hospitals. To close these dangerous blind spots, Pakistan introduced an all-hazards Integrated Disease Surveillance and Response (IDSR) system using existing government structures rather than creating parallel systems. The objective was simple: detect threats earlier, across all pathogens, at national scale, at minimal cost, and with government ownership from the start. |
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| Methodology/Approach | Methodology/Approach A Delphi process defined priority diseases in a data-poor environment, drawing on local epidemiological data and expert consensus. A national IDSR manual, standardized case definitions, evidence-based alert thresholds, outbreak investigation tools, and a national training curriculum were developed. Public health laboratories were established in key districts, creating lab-epidemiology fusion for the first time-enabling confirmation of suspected outbreaks rather than relying on clinical syndromic data alone. Over 14,000 government health workers were trained across 156 districts, embedding the system into routine primary care functions rather than vertical programs. |
| Results | Results IDSR shifted Pakistan from delayed, event-based notification to real-time early warning for 35 priority conditions. Routine aggregate data triggered earlier detection of dengue, diphtheria, cholera, CCHF, and mpox. Flexible case definitions enabled faster suspicion and reporting from peripheral facilities. Government ownership at federal and provincial levels ensured rapid scale-up without sustained external funding. |
| Discussion/Conclusion | Discussion/Conclusion Pakistan's IDSR demonstrates how a fragile, resource-limited country can close surveillance blind spots and build a functional, government-owned all-hazards early warning system. This directly aligns with Sub-theme 3-From evidence to impact-by showing translation of tools (case definitions, thresholds, lab networks) into measurable outcomes (earlier detection, national scale). The model is replicable for LMICs facing multi-pathogen risks, requiring minimal external funding and maximal use of existing workforce and infrastructure. |
| Presenters and Affiliations | Huma Khattak IDSRS-National Institution of Health (NIH), Islamabad Asif khan UKHSA Ali Rehman Khan National Institute of Health (NIH) |
