Cultivation of an Adaptive Domestic Network for Surveillance and Evaluation of Emerging Infections

The best time to plant a tree was 20 years ago; the second best time is now."-Chinese Proverb T hrough the metaphor of an adaptive, organic entity-a tree with roots, a trunk, large limbs and smaller branches, fruits, and seeds (Figure 1)-this article describes the Emerging Infections Program (EIP), reflects on this network's accomplishments over the past 20 years, and considers opportunities and challenges for the future.Other articles in this 2015 20th anniversary issue of Emerging Infectious Diseases focusing on the EIP expand on many of the ideas introduced here, providing additional discussion, details, and references. RootsThe concepts of emerging infectious diseases are now familiar to the scientific community and the public.However, it took a 1992 Institute of Medicine report to emphasize the dynamic and modern factors that cause infectious diseases to emerge and re-emerge and to put to rest the idea of infectious diseases as a solved problem, a worry for earlier times (1).The Centers for Disease Control and Prevention (CDC) Plan to Address Emerging Infections, released in April 1994, provided recommendations for action by CDC and other public health agencies (2).The CDC Plan highlighted the foundational role of surveillance and included in the recommendations creation of a network comprising state public health agencies, academic institutions, and CDC for special surveillance and applied public health research.The EIP sprang from these recommendations.Even before that time, active, population-based surveillance projects dating to the 1970s had provided a general

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