The Development and Growth of the English National Real-Time Syndromic Surveillance Program: Key Developments and Lessons Learned From the First Two Decades

Background:
Syndromic surveillance now forms an integral part of the surveillance for a wide range of hazards in many countries. Establishing syndromic surveillance systems can be difficult due to the many different sources of data which can be used, cost pressures, the importance of data security and different technologies.

Objective:
We describe major points in the development of the UK Health Security Agency (UKHSA) English real-time syndromic surveillance service over its first two decades (1998 to 2018) and key wider themes we believe are important in ensuring a sustainable and useful syndromic surveillance service.

Methods:
We conducted semi-structured interviews with current members of the UKHSA syndromic surveillance team who were involved from the earliest stages and previous senior colleagues who were supportive of the syndromic surveillance work during the early phases. We asked their views about the development of syndromic surveillance, the key drivers and the challenges.

Results:
Using the results of the discussions and our personal experience of running the syndromic surveillance service from inception and over decades, we summarise our recommendations for establishing and running sustainable syndromic surveillance systems.

Conclusions:
In this age of increased automation, with the ability to transfer data in real-time and to utilise machine learning and artificial intelligence, we are approaching a ‘new age of syndromic surveillance’. We consider the focus on the public health questions, relationships and collaboration, leadership and true teamwork should not be underestimated in the success of and usefulness of real-time syndromic surveillance systems.