ProMED

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ProMED

ProMED-mail, to give it its baptismal name, or ProMED, as everyone now calls it, was a happy accident. Barbara Hatch Rosenberg of the Federation of American Scientists organized a meeting in 1993 in Geneva, Switzerland, co-sponsored by the World Health Organization (WHO), to float the idea of a world-girdling chain of institutes capable of sending out teams to the site of any unusual disease outbreak in their neighborhood. The objective would be to determine whether it was of natural or unnatural origin. The conference itself was unusual in bringing together experts on not only human, but also animal and plant diseases, and on bioterrorism, which at the time was not high on anyone's priority list.

There were some 60 participants from 15 countries. The conclusion was that such a chain was highly desirable from the point of view of human health and food security. At a follow-up conference in the United States in 1994, further steps were outlined, and the late Dr. Robert Shope suggested the name ProMED, for Program for Monitoring Emerging Diseases. It was decided that an e-mail list be set up to enable discussion among the participating institutions. Charles Clemens of SatelLife offered to host the e-mail list, and I offered to run it, with the assistance of Stephen Morse, then of Rockefeller University. I was working for the New York State Health Department in Albany, New York, at the time, and was one of only a few of the conference participants who had access to e-mail then. Thus ProMED-mail, so called to distinguish it from its parent program, was launched in August 1994.

It turned out that absolutely no one in the program had anything to say to each other, so as we were supposed to be monitoring outbreaks, Steve and I started posting outbreak reports from the media. Then in May 1995, the Ebola epidemic in Kikwit, Zaire, hit the media, and people surfing the Web discovered that ProMED was posting information about it. I well remember the thrill when our mailing list, which had begun with 40 members in seven countries, hit 250. Later we were written up in the Wall Street Journal and our numbers went overnight to 500. Today, in mid-2007, we stand at over 40,000 in at least 180 countries, with many more accessing our Web site at <www.promedmail.org>. And, thanks to foundations and donations we still provide worldwide coverage, 7/365, without fee.

The uniqueness of ProMED is its stable of experts in the fields of clinical and veterinary medicine, microbiology, and plant pathology, all of whom serve on a part-time basis. It is the only free disease reporting system to cover human, livestock, wildlife, and food and feed crop diseases in one place, the latter because of the potential impact of animal and vegetable diseases on nutrition and therefore on human health. Since 2000, ProMED has been a program of the International Society of Infectious Diseases, which guarantees its freedom from political constraints that often cause delays in outbreak reporting. In fact, WHO has said that it uses ProMED reports to convince recalcitrant countries to report outbreaks officially, in view of the fact that a report has already appeared on ProMED.

During the anthrax-by-mail episode in the United States in 2001, the Science Advisor to the President told us that the White House's main sources of updates on the situation were CNN and ProMED. The Chief Veterinary Officers of Australia and New Zealand routinely copy livestock outbreak reports to ProMED at the same time as they send them to the World Animal Health Organization, and we get reports directly from hospitals and research institutes involved in outbreaks. We emphasize reports on outbreaks caused by select agents from the bioterrorism A list, such as anthrax and botulinum toxin, so that our readership understands that such natural outbreaks are not uncommon in some countries. We cover outbreaks due to biological toxins. Otherwise, we report on emerging diseases such as bird flu, using a rather broad definition of emerging that includes dengue but excludes most tuberculosis and HIV/AIDS reports.

ProMED has parallel lists in Spanish, Portuguese, and Russian, with a French version scheduled to launch shortly. These are not straight translations of the English reports, but are mainly reports of regional interest. Chinese and Japanese translations of many ProMED reports are found on the travel health Web sites of Hong Kong and Tokyo International Airport.