The UNECE Protocol on Water and Health prioritises prevention and control of waterborne diseases in the European Region. In order to protect public health from water-related outbreaks, the Protocol mandates the Parties to establish, improve and maintain comprehensive national and local surveillance as well as early warning systems. It also promotes international cooperation among Member States and fosters the development of joint and coordinated action aimed to complement or strengthen national capacities of response. Coordination and liaison with competent international agencies and organisations acting in the field of public health and disease surveillance is instead almost completely neglected. Despite the gap in the agreement, the relevance to the Protocol of existing surveillance networks has increasingly been acknowledged. Following this trend, the Protocol Bodies are exploring the opportunities for a closer interaction with regional and global alert and response systems. This effort is commendable, but much more can be done to reach a more intense cooperation and achieve a globally integrated system of disease surveillance. Harmonisation of legal frameworks (in this case, the UNECE Protocol, the EU legislation and the IHR 2005) and a better synergy among relevant networks will enhance protection of global health security, avoid useless duplications of efforts, and ensure coherence of the whole body of international law on public health.