{"id":4274,"date":"2023-08-08T15:18:53","date_gmt":"2023-08-08T20:18:53","guid":{"rendered":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/?p=4274"},"modified":"2023-08-08T15:19:02","modified_gmt":"2023-08-08T20:19:02","slug":"a-crucial-early-warning-system-for-disease-outbreaks-is-in-jeopardy","status":"publish","type":"post","link":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/2023\/08\/08\/a-crucial-early-warning-system-for-disease-outbreaks-is-in-jeopardy\/","title":{"rendered":"A Crucial Early Warning System for Disease Outbreaks Is in Jeopardy"},"content":{"rendered":"
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Wired<\/a> Internal dissent within\u00a0the mostly volunteer disease-news network known as ProMED\u2014which\u00a0alerted the world<\/a>\u00a0to the earliest cases of\u00a0Covid<\/a>, Middle East Respiratory Syndrome (MERS), and SARS\u2014has broken out into the open and threatens to take down the internationally treasured network unless an external sponsor can be found.<\/p>\n\n\n\n

The struggle for the future of the low-tech site, which also sends out each piece of content on a no-reply email list with 20,000 subscribers, has been captured in dueling posts to its front page. On\u00a0July 14, a post<\/a>\u00a0by ProMED\u2019s chief content officer, a veterinarian and infectious-disease expert named\u00a0Jarod Hanson<\/a>, announced that ProMED is running out of money. Because it is being undermined by data-scraping and reselling of its content, Hanson wrote, ProMED would turn off its RSS and Twitter feeds, limit access to its decades of archives to the previous 30 days, and introduce paid subscriptions. <\/p>\n\n\n\n

Hanson is at the top of ProMED\u2019s masthead<\/a>, and the post was signed \u201cthe ProMED team,\u201d which gave the announced changes the feeling of a united action. That turned out not to be the case. Very early on August 3, a post addressing \u201cDear friends and readers of ProMED\u201d appeared on the site\u2019s front page. The open letter was signed by 21 of its volunteer and minimally paid moderators and editors, all prominent physicians and researchers, and it makes clear that no unity existed.<\/p>\n\n\n\n

\u201cAlthough the [July post] was signed by \u2018The ProMED Team,\u2019 we the undersigned want to assure you that we had no prior knowledge,\u201d the open letter stated. \u201cWith great sadness and regret \u2026 we, the undersigned, are hereby suspending our work for ProMED.\u201d<\/p>\n\n\n\n

The letter was taken off the site within a few hours, but the text had already been pushed to email subscribers. (WIRED\u2019s copy\u00a0is here<\/a>.) On Friday, signers of the open letter said they had been locked out of the site\u2019s internal dashboard. The site\u2019s regular rate of posting slowed Friday and Saturday, but appeared to pick up again on Sunday. <\/p>\n\n\n\n

Maybe this sounds like a small squabble in a legacy corner of the internet\u2014but to public health and medical people, ProMED falling silent is deeply unnerving. For more than 20 years, it has been an unmissable daily read, ever since it received an emailed query in February 2003 about chat-room rumors of illnesses near Hong Kong. As is the site\u2019s practice, that initial piece of intel was examined by several volunteer experts and cross-checked against a separate piece of news they found online. In its post, which is not currently accessible, ProMED reproduced both the email query and the corroborating information, along with a commentary. That post became the first news published outside China of the burgeoning epidemic of SARS viral pneumonia, which would go on to sweep the world that spring and summer\u2014and which was acknowledged by the regional government less than 24 hours afterward.<\/p>\n\n\n\n

Using the same system of tips and local news sources, combined with careful evaluation, ProMED published the first alerts of a number of other outbreaks, including two more caused by novel coronaviruses: MERS and Covid, which was detected via\u00a0two online articles<\/a>\u00a0published by media in China on December 30, 2019. Such alerts also led the World Health Organization to reconsider what it will accept as a trustworthy notice of the emergence of epidemics. When the organization rewrote the International Health Regulations in the wake of SARS, committing member nations to a public health code of conduct, it included \u201cepidemic intelligence from open sources\u201d for the first time. On the surface, the dispute between ProMED\u2019s moderators and its leadership team\u2014backed by the professional organization that hosts the project, the\u00a0International Society for Infectious Diseases<\/a>\u00a0(ISID)\u2014looks like another iteration of a discussion that has played out online for years: how to keep publishing news if no one wants to pay for it. But while that is an enduring problem, the question posed by the pause in ProMED\u2019s operations is bigger than subscriptions. It looks more like this: How do you make a case for the value of human-curated intelligence in a world that prefers to pour billions into\u00a0AI<\/a>? \u201cProMED might not always be the fastest, but it always provides important context that would not come through a news report,\u201d says John Brownstein, an epidemiologist and chief innovation officer at Boston Children\u2019s Hospital, who cofounded the automated online outbreaks database\u00a0HealthMap<\/a>\u00a0and has collaborated with ProMED. \u201cIt\u2019s the anti-social media, in a way. It\u2019s a trusted voice.\u201d <\/p>\n\n\n\n

\u201cProMED possesses trained scientists that are able to discern what is really a problem and what is fake news,\u201d says Scott J. N. McNabb, a research professor at Emory University\u2019s Rollins School of Public Health and a former chief of public health surveillance at the US Centers for Disease Control and Prevention. \u201cThat’s a tremendous advantage. So the reports are not coming from uninformed individuals, they’re coming from professionals that have the medical expertise and public health expertise to really discern: \u2018Is this genuine or not?\u2019\u201d<\/p>\n\n\n\n

To understand why the fate of ProMED feels momentous, it helps to know a little bit about its history. The deliberately Web 1.0 site\u2014it has no comment section and runs no graphics, so as not to stress the bandwidth in low-income nations\u2014was created in 1994 and began being hosted by ISID in 1999. Its chief founder was the late John Payne Woodall, an entomologist and virologist who had a hand in most of the post-World War II build-up of global public health infrastructure, working for the Rockefeller Foundation, the WHO, and the CDC. (Cofounders were Stephen Morse, a professor of epidemiology at Columbia University\u2019s Mailman School of Public Health, and Barbara Hatch Rosenberg, a biological weapons expert and former professor of microbiology at SUNY Purchase.)<\/p>\n\n\n\n

Woodall believed that everyday people\u2019s reports of events could constitute important early warnings of looming problems. The value of open source intelligence might seem obvious today, with every movement of the war in Ukraine<\/a>, for instance, tracked on Twitter. But at the time, Woodall was challenging the accepted view that official public health surveillance data, gathered by governments and nongovernmental entities, was the key to understanding the havoc diseases can create. And he was leveraging early civilian access to the internet to do it. The site was established and scored its momentous early success exposing SARS all before Twitter launched and Facebook opened to the general public in 2006, and before the first iPhone went on sale in 2007.<\/p>\n\n\n\n

The arrival of social media made it possible to instantly share information on all kinds of emergencies, from the Arab Spring to the Fukushima nuclear disaster to the Ebola<\/a> epidemic in West Africa, and many accounts built audiences and monetization by conveying real-time alerts on arrays of subjects, often with no sourcing attached. The speed of Twitter<\/a> (now known as X<\/a>) could make ProMED\u2019s careful verification look slow; though the organization pushed its content to its own Twitter account, those posts would often arrive after a breaking-news account got there first.<\/p>\n\n\n\n

That left the site in a battle for funding. Its online host ISID lost revenue during the pandemic, as professionals stayed home from the conferences it had hosted. Internally, money began to dry up. One of the complaints aired in the open letter is that payments to the moderators, who receive a small stipend, are already in arrears and will be delayed for two more months. <\/p>\n\n\n\n

\u201cWe are really up against a challenge of long-term, sustainable funding for operating ProMED,\u201d says ISID\u2019s CEO, Linda MacKinnon, who described the organization as sipping from project grants to keep core operations going on a budget of about $1 million a year. (MacKinnon spoke after the July 14 announcement but before the open letter was published.) \u201cWe have sort of grown organically over the years, from project to project that were all cobbled together, but not stepping back and putting together a business case of how to sustain, how to innovate. We have found ourselves partnering or collaborating with hospitals and academic institutions, but [not finding a] long-term home.\u201d<\/p>\n\n\n\n

Hanson, who published the post outlining the changes, told WIRED by email Friday evening: \u201cNot a single entity has stepped forward with any type of funding to allow ProMED to continue to operate as it has for 28 years, which is to say open and free to the public. We have diligently pursued funding and messaged our plan for the past year and made our financial situation widely known.\u201d He added, \u201cFunders are primarily interested in the latest and greatest tools, so from their strategic perspective there’s little value in ProMED\u2014an aging but highly effective email surveillance system\u2014to show to their leadership\/benefactors.\u201d<\/p>\n\n\n\n

A deeper look at recent history shows that the battle over ProMED is not only about money, no matter how critical that might be. After Woodall, ProMED was led for years by Larry Madoff, an infectious disease physician and professor at the University of Massachusetts Medical School who built a wide network of collaborators. Madoff was abruptly dismissed by ISID two years ago, and both he and moderators who worked with him say they do not know why. MacKinnon will only say the action was \u201ca board decision.\u201d Madoff held the title of editor in chief; according to the site\u2019s team listings<\/a>, that title is not now in use.<\/p>\nCUNOgsHT d<\/a><\/div><\/div>","protected":false},"excerpt":{"rendered":"

Wired Internal dissent within\u00a0the mostly volunteer disease-news network known as ProMED\u2014which\u00a0alerted the world\u00a0to the earliest cases of\u00a0Covid, Middle East Respiratory Syndrome (MERS), and SARS\u2014has broken out into the open and threatens to take down the internationally treasured network unless an external sponsor can be found. The struggle for the future of the low-tech site, which […]<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[21],"tags":[],"class_list":["post-4274","post","type-post","status-publish","format-standard","hentry","category-featured"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/posts\/4274","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/comments?post=4274"}],"version-history":[{"count":1,"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/posts\/4274\/revisions"}],"predecessor-version":[{"id":4275,"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/posts\/4274\/revisions\/4275"}],"wp:attachment":[{"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/media?parent=4274"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/categories?post=4274"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.unmc.edu\/healthsecurity\/transmission\/wp-json\/wp\/v2\/tags?post=4274"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}