ISSUES ACROSS THE INTERNATIONAL

Integration of disease surveillance efforts across the international borders of the United States presents complex challenges and significant implications for national security against both natural epidemics and biological attack. To explore these issues, we conducted qualitative studies of surveillance of communicable diseases across the Mexico /Texas border and the Michigan/Canada border. We conducted a series of semi-structured interviews with public health officials and physicians responsible for surveillance along these borders. The interviews were audio- taped, transcribed, and then coded for themes that emerged from these data. The findings for the Mexico border indicate that the most important issues are differences in standards of health care (including diagnostic tests and treatment protocols), communication pathways, and information technology between the two countries. Accurate communication about diseases cannot take place while standards are different. Another key finding was the importance of bi-national organizations in coordinating a variety of health issues across these complex borders. Although bi-national organizations have functioned for a numbe