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The Mekong Basin Disease Surveillance (MBDS) consortium comprises six participating countries: Cambodia, China (Yunnan and Guangxi Provinces), Lao PDR, Myanmar, Thailand and Vietnam and a growing number of development partners who together seek to reduce morbidity and mortality caused by outbreak-prone diseases in the sub-region.MBDS countries have been working together since 2001to progressively build local capacity, share information, and cooperate in outbreak response and pandemic influenza preparedness. The MBDS structure and governance include the Executive Board, comprised of a senior health official from each member country to provide guidance and oversight; Country Coordinators, who provide operational oversight; and the MBDS Coordinator, who coordinates communications and operations and manages administrative elements.MBDS has built its work on the core values of mutual trust, transparency and cooperation. These core values have evolved over time to include greater attention to accountability, innovation, and learning based on incorporation of lessons from past experiences. In May 2007, Ministers of Health of the six participating countries signed a new Memorandum of Understanding to continue MBDS cooperation indefinitely. At approximately the same time, the World Health Organization’s (WHO) revised International Health Regulations (IHR) came into effect. These regulations specify the obligations of countries to develop and maintain capabilities to detect, respond to and communicate about public health emergencies of international concern (PHEIC); thus, they provide additional context for MBDS cooperation.MBDS is a pioneer of self-organized sub-regional disease surveillance networking and cooperation: The 2006-2007 MBDS multi-sector influenza country-level and regional pandemic preparedness exercises were the first of their kind in the world and drew attention to the emerging nature of sub-regional cooperation; a subsequent conference in Bellagio led to a Call for Action related to sub-regional surveillance networking, and a newer initiative that began in 2009, Connecting Health Organizations for Regional Disease Surveillance, seeks to further strengthen sub-regional surveillance cooperation. MBDS has been an active participant in all of these efforts.