Consent, confidentiality, and the threat to public health surveillance

Effective protection of public health requires direction from the information provided by disease surveillance1—for example, in the cases of AIDS and variant Creutzfeldt-Jakob disease surveillance data led to action that protected health. 2 3 Health surveillance relies entirely on prompt and accurate reporting of the occurrence of disease by doctors and other health professionals.1 Recently there has been increased concern in the United Kingdom about the need to maintain the confidentiality of information arising from consultations between doctor and patient. Documents have been issued regulating or advising on transfer of patient data. Some have argued that, unless needed for direct patient care, data should not be transferred to third parties without patients' explicit consent, or, alternatively, that all identifying information must first be removed.4 The difficulty in countering these arguments arises partly from the fact that health surveillance, including that for communicable diseases, has been neglected in official guidance on confidentiality.5 We and our colleagues are concerned that if some interpretations of this guidance were enforced they would impair or stop important surveillance activities and thus seriously prejudice public health.