These regulations, designed to protect against global public health emergencies like SARS, influenza outbreaks and others, became binding international law in June 2007.

However, the absence of an integrated national health surveillance system in Canada with smooth information flow between the provinces, territories and the federal governments, as well as the lack of timely reporting mechanisms are key hindrances in complying with the regulations.

The Auditor General of Canada has warned 3 times, most recently in May, 2008, that Canada's failure to develop surveillance systems puts Canadians at risk.

Globally, a lack of capacity in developing countries, the risk of unilateral actions by developed countries to protect their own populations, and poor coordination between federal and regional governments in decentralized countries are challenges for successful implementation.

In an accompanying editorial www.cmaj.ca/cgi/rapidpdf/cmaj.080818, Dr. Amir Attaran (Dr. Amir Attaran, Canada Research Chair in Law, Population Health and Global Development Policy, University of Ottawa, 613-562-5800 x 2015, aattaran@uottawa.ca) for CMAJ's editorial team calls upon the federal government to "legislate a way past the jurisdictional schisms" and make information regarding health epidemics readily available. Currently, "12 of 13 provinces are under no obligation to share information with the federal government or the rest of Canada during an outbreak," writes Dr. Attaran. "We at CMAJ believe this is a national embarrassment."-Canadian Medical Association Journal