From Blind Spots to Early Warning: Building an Inclusive, Sustainable National IDSR for Multi-Pathogen Threats in Pakistan
1
Health, United Kingdom Health Security Agency, Islamabad, Pakistan
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Many low and middle-income countries (LMICs) experience repeated outbreaks not because threats are rare, but because early warning systems are weak. Surveillance is fragmented, verification is ad hoc, and detection depends on chance signals. These gaps create avoidable inequities, with remote and underserved populations experiencing delayed recognition and response. Pakistan addressed these challenges by establishing an all-hazards Integrated Disease Surveillance and Response (IDSR) system through existing government structures.
METHODS:
In a data-poor context, a Delphi process prioritised notifiable diseases and supported standardisation of case definitions, alert thresholds, and outbreak investigation tools. A national IDSR manual and training curriculum were implemented through routine government channels to ensure sustainability. Public health laboratory functions were strengthened to enable routine laboratory&epidemiology linkage. A national cascade approach trained government health staff across the country.
RESULTS:
IDSR operationalised routine surveillance for 35 priority diseases and shifted detection from delayed event-based notification to earlier warning triggered by routine data. In multiple instances, routine IDSR alerts preceded formal outbreak declaration, enabling earlier local verification and response. Over 14,000 government health workers were trained across 156 districts, extending early warning capacity to underserved areas. The system supported earlier suspicion and response for dengue, diphtheria, cholera, Crimean-Congo haemorrhagic fever, and mpox through standardised alerts and flexible case definitions. Government ownership enabled rapid scale-up and continuity.
CONCLUSIONS:
Pakistan’s IDSR offers a pragmatic, transferable pathway for LMICs to close surveillance blind spots at national scale using existing structures. By reducing time to suspicion and narrowing detection delays across populations and geographies, the model strengthens equitable, inclusive preparedness and supports sustainable early warning for health threats that cross borders.
Many low and middle-income countries (LMICs) experience repeated outbreaks not because threats are rare, but because early warning systems are weak. Surveillance is fragmented, verification is ad hoc, and detection depends on chance signals. These gaps create avoidable inequities, with remote and underserved populations experiencing delayed recognition and response. Pakistan addressed these challenges by establishing an all-hazards Integrated Disease Surveillance and Response (IDSR) system through existing government structures.
METHODS:
In a data-poor context, a Delphi process prioritised notifiable diseases and supported standardisation of case definitions, alert thresholds, and outbreak investigation tools. A national IDSR manual and training curriculum were implemented through routine government channels to ensure sustainability. Public health laboratory functions were strengthened to enable routine laboratory&epidemiology linkage. A national cascade approach trained government health staff across the country.
RESULTS:
IDSR operationalised routine surveillance for 35 priority diseases and shifted detection from delayed event-based notification to earlier warning triggered by routine data. In multiple instances, routine IDSR alerts preceded formal outbreak declaration, enabling earlier local verification and response. Over 14,000 government health workers were trained across 156 districts, extending early warning capacity to underserved areas. The system supported earlier suspicion and response for dengue, diphtheria, cholera, Crimean-Congo haemorrhagic fever, and mpox through standardised alerts and flexible case definitions. Government ownership enabled rapid scale-up and continuity.
CONCLUSIONS:
Pakistan’s IDSR offers a pragmatic, transferable pathway for LMICs to close surveillance blind spots at national scale using existing structures. By reducing time to suspicion and narrowing detection delays across populations and geographies, the model strengthens equitable, inclusive preparedness and supports sustainable early warning for health threats that cross borders.
| eISSN: | 2654-1459 |
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