Never mind vaccines — America can’t even track dangerous diseases

Pennsylvania recorded its first measles deaths in 35 years this week, and the national count of cases has passed 2,900 — more than in any year since the disease was declared eliminated in 2000.

The argument that followed was about vaccines, and they do matter, but that is yesterday’s fight. The failure that should keep Congress up at night is quieter: the U.S. still cannot see, in one place and in near real-time, what is happening biologically inside its own borders. 

I built disease detection systems for the Defense Threat Reduction Agency, ran hospital epidemiology at Michigan State University, and worked on national security problems at Sandia National Laboratories. The hardest problem was never the sequencing or the software. It was that no two data sources described the same disease the same way.  

Each state keeps its own list of reportable conditions and its own case definitions. Each laboratory and hospital keeps its own data format. Before a single alert can fire, someone must build a translation layer that aligns those schemas and vocabularies into one picture. In the Army, we called that a common operating picture. American public health does not have one, and no one oversees building it. 

This is not an attack on the Centers for Disease Control and Prevention — in fact, the agency says so itself. It “does not have direct authority to require data reporting,” according to its website, and receives data from 50 states and more than 3,000 local jurisdictions, each with its own data-sharing agreement. 

Case notification to the national system is voluntary, and national counts are provisional and revised weekly. Jurisdictions still send case reports in several technical standards; the CDC is still working toward a single one. The picture is scattered across the the Food and Drug Administration and the Departments of Health and Human Services, Homeland Security, Agriculture and........

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