A nation that "cannot detect and contain disease threats at their source," the letter states, cannot fully protect its people at home. The Detection Layer the Letter Points ToPAHO is headquartered in Washington, D.C., and was founded there in 1902. They support national surveillance systems, laboratory capacity and outbreak reporting in countries whose own public health infrastructure varies widely. Reasonable disagreement exists about multilateral health funding, including questions about organizational effectiveness, overlap with other agencies, and whether bilateral programs deliver comparable value. H5N1 avian influenza, dengue, Chagas disease, chikungunya and leishmaniasis as present in the U.S., plus the reemergence of New World screwworm.