Firstly, HCWs were concerned the lack of experience and low perceived risks of exposure to new pathogens would minimise awareness among hospital staff, leading to reduced suspicion and increased delay to the recognition of a new pathogen. Specialist input would be required for the monitoring process, introducing further labour and financial burdens on hospitals. In addition, the need for HCWs to be discriminating as to which symptoms to report, could result in wide variation in reporting practice, again potentially undermining the validity of the system. With EIDs viewed as rare events, participants felt that if the detection of EIDs was the sole rationale for reporting, adherence could decline as HCWs might question the usefulness of such a system.