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• The network of public health laboratories, under the

coordination and supervision of the National Institute of Health,

is crucial

• Professional careers in public health for doctors and for

registered nurses, an internship in public health and graduate

programmes (MSc and PhD in Public Health and associate

domains) carried out by the National School of Public Health

and several universities, are relevant in influencing the practice,

namely the performance of any surveillance system.

The Director-General of Health is the Portuguese Chief Medical

Officer. The Directorate-General of Health (DGS), the technical entity

sponsoring the national health authority, is entitled to release guide-

lines aiming to assure preparedness and to control diseases, namely

to coordinate epidemiological surveillance. DGS is closely articulated

to European Centre for Disease Prevention and Control (ECDC),

being the Portuguese competent body for surveillance, health threat

preparedness and control, training, communication and scientific

advice.

Since 2005, DGS has developed a special unit aiming to support

public health emergencies. Its main objective is to detect signals

that may become, after proper validation, public health alerts. After

detection of the alerts, the DGS unit related to the specific alert trig-

gers the necessary measures for risk management. This Public

Health Emergency Unit (UESP) also helps to achieve effective means

of communication to enable adequate response, giving an essential

contribution to the development of the epidemic intelligence

concept and to the early detection of public health threats. This unit

ensures the management of the information system on the utiliza-

tion of emergency rooms, which has been developed since 2003.

International cooperation

During the last century and particularly after the Democratic

Revolution of 1974, Portuguese public health entities and profes-

sionals were entitled to receive relevant support, namely:

• Technical aid from WHO, particularly in the

implementation of primary health care policies and during the

organization of the NHS

• Participation in multi-centre research projects, networks and

working groups led by the European Commission

• Graduate programmes, platforms, study visits,

cooperation of consultants and auditors, provided

by the universities and public health agencies of

other countries.

Throughout the years, Portugal has developed

programmes of international cooperation within the

health domain, especially with Portuguese speaking

countries – Angola, Brazil, Cape Verde, Guine-Bissau,

Mozambique, São Tomé and East Timor. These agree-

ments include giving hospitals medical aid to evacuate

patients; technical missions to be carried out in the

respective countries by Portuguese health specialists (for

example in domains such as medical imaging, public

health, cardiology, paediatrics, pneumology and

immunoallergics); missions to support the organization

and operation of the health services in those countries;

training of the respective countries’ health profession-

als through training periods in Portuguese institutions;

and projects of scientific research.

Aiming to develop specific epidemiological surveil-

lance systems and to facilitate pandemic preparedness,

cooperation between Portugal and the Portuguese speak-

ing countries may be reinforced, in line with WHO

guidelines.

Final remarks

Epidemiological surveillance requires tools – from

adequate communication technology to laboratory facil-

ities, and appropriate and highly motivate professionals.

Pandemic preparedness requires political will and social

commitment, plus adequate epidemiological surveillance

system(s) and appropriate control mechanisms within a

context of effective public health leadership.

Arnaldo Sampaio, one of the most distinguished

Portuguese public health leaders, used to teach: “In

public health, do not adopt – adapt.” Not easy! One can

adopt guidelines and recommendations, case definitions

and technical procedures; one may even have a well-

made plan, developed with the support and expertize of

technical advisers. Probably, it will be almost nothing

without the expertize, practical experience, social

engagement and good will of professionals, particularly

at community level.

Being prepared to face a public health crisis, each

community – from local to national level – shall have

a global and integrated (public) health system. It is with

the

blood, sweat and tears

of professionals, mainly from

those who work in the community and with patients,

that the tasks and activities will be accomplished. From

the recognition of needs to evaluation, and the empha-

sis of actions to control problems, the most important

actors are the local people.

Pandemic preparedness cannot be reduced to a splen-

did discourse of politicians and public health officers.

‘Be prepared’ means motivation, competence and lead-

ership in community action to solve problems. Public

health is action, and requires social investments, sustain-

able efforts and continuous training.

Disease

Diphtheria

Polio

Tetanus

Whooping cough

Measles*

Mumps

Rubella

Hepatitis B

Haemophilus influenza type B

Number/Year

1,512 (1965)

297 (1965)

373 (1965)

858 (1965)

813 (1987)

2,197 (1987)

671 (1987)

1,234 (1993)

24 (1999)

Incidence of diseases prevented by vaccination in the first year of

vaccination and in 2007

2007

191

Source: Directorate-General of Health

*Vaccine introduced in 1974, but new cases known only since 1987