The Chicken and the Egg: The Growth and Development of the World Health Organization’s Influenza Surveillance Network

From its modest beginnings in 1948 in borrowed laboratory space at the National Institute for Medical Research, London, the World Health Organization’s (WHO) Influenza Surveillance System has grown to a network comprising four collaborating centers and one hundred and twenty one institutions in ninety three nations that share in the collection and evaluation of influenza strains. While the WHO influenza surveillance network has successfully expanded in scale and scope, it has done so despite a host of difficulties including technological, institutional, economic, cultural, and diplomatic disputes. To a large extent, the challenges the surveillance network faced historically, and in the present day, derive from the fact that the system is global in mandate but reliant upon national health systems to achieve its goals. The sheer number of infections caused by this highly transmissible and ubiquitous virus presents enormous difficulties in quickly identifying and tracking novel strains, a problem further exacerbated by the uneven mix of technology and health care infrastructure among nations. Drawing upon medical and scientific literature, archival information from the WHO and United States Public Health Service, and personal interviews, this paper examines the founding and expansion of the WHO influenza surveillance network. The history of the WHO’s successes and failures in identifying novel influenza strains and outbreaks illustrate the tensions manifest in global health programs operating in nation-states.