A common thread connects all preparedness and response processes and this is represented by an “all-hazards” outlook in the preparedness of the public health sector. A broad understanding of the problem makes it easier to focus on synergies instead of trade-offs between the partners and sectors involved. Currently the ECDC works following a matrix model which combines its four core vertical functions (surveillance, scientific advice, preparedness and response, and health communication) with programmes focused on priority areas of communicable diseases. This structure also facilitates the integration of the deliberate release perspective in the current ECDC work.

The most important differentiating factor in countering an incident of deliberate release as opposed to a naturally occurring epidemic is the need for collaboration with the security sector and the law enforcement authorities. In response to an incident of deliberate release, public health services continue to operate their surveillance systems and analyse case findings, investigate and test samples in diagnostic laboratories, give guidance for managing patients and propose public health measures for the control of the outbreak as in any other infectious disease emergency. In their relationship with security sector and law enforcement authorities, public health services stress the importance of keeping public health high on the agenda in cases of a deliberate release of biological agents. However, in response to a health crisis resulting from a deliberate release of a biological agent, EU coordination is faced with two contradicting forces in the communication with the member states: on the one hand some member states would be requesting urgent advice, guidance and possibly assistance, while on the other hand there will be marked reluctance by the security sector to discuss sensitive information.

Yet, public health systems can respond rapidly with effective containment measures only when the best evidence-based options are supported by early warnings and plausible information on the source of the outbreak, its characteristics, and the extent of its public health impact. Official notifications, as in routine surveillance, often are insufficient, belated and subject to a lengthy clearance, and are of little help when a rapid and effective response is necessary.

Modern technologies, mainly related to the development of information technology, with the internet being the backbone of it, are rapidly changing the way scientists and public health officials access health information. Online media, scientific fora and direct electronic communication are increasingly supplanting traditional reporting mechanisms through the various levels of public health administration. Health authorities are no longer in full control of an environment that puts journalists, politicians and the general public in direct contact with raw data.

This new information environment contributed to the revision of the International Health Regulations that was approved during the 2005 World Health Assembly. Member states of the World Health Organization (WHO) are legally bound to both notify cases on a preset list of diseases and all “public health events of international concern”.

Institutions in charge of health security no longer rely solely on traditional disease reporting mechanisms such as mandatory notification of diseases. While these systems can ensure appropriate public health response to identified risks, they cannot recognise the emergence of new threats such as SARS, human cases of avian influenza, or potential deliberate outbreaks. In order to overcome the limitations of traditional surveillance for the detection of previously unknown threats, new approaches have been developed, including the monitoring of syndromes, death rates, health services admissions, or drug prescriptions [11]. These new approaches contribute to enhance the performance of traditional surveillance systems.

Meanwhile, the media and other informal sources of information are increasingly recognised as valuable sources of public health alerts. Epidemic intelligence provides a conceptual framework into which countries may complete their public health surveillance system to meet new challenges [13]. This approach represents a new paradigm aiming at complementing traditional surveillance systems.