BioWatch and Public Health Surveillance Evaluating Systems for the Early Detection of Biological Threats: Abbreviated Version (2011) / Chapter Skim
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BioWatch program has air samplers deployed in more than 30 major u.S. cities intended to swiftly detect the presence of certain aerosolized biological agents to help local and state health officials respond promptly.
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given the BioWatch system's serious technical and operational challenges and its costs, dHS should assess its effectiveness and frame program goals from a risk-management perspective; conduct systematic operational testing of current and proposed BioWatch technologies; establish an external advisory panel with technical and operational expertise; and strengthen collaboration and coordination with public health officials in BioWatch jurisdictions. Infectious disease surveillance through the public health and health care systems is broader and more flexible than BioWatch, having the potential to detect infectious diseases resulting from various exposures.
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. In response to congressional direction, DHS asked the National Academies to evaluate the current and potential capabilities of BioWatch in detecting biological threats; examine the capabilities of the current and an enhanced surveillance system that relies on hospitals and public health agencies to detect biological threats; examine the costs of BioWatch and surveillance based in public health and health care; and consider whether BioWatch and traditional surveillance are redundant or complementary.
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The evaluation will consider biosurveillance framework that will help provide state and local public health authorities, in collaboration with the health care system, with the information they need to determine the appropriate response to a possible or confirmed attack or disease outbreak. SCOPE OF THE STUDY The study committee was asked to evaluate the effectiveness of BioWatch and compare it to an enhanced national surveillance system that relies on the health care and public health systems (see Box S-1)
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Bioterrorism, as the primary context for the BioWatch program, was the principal focus of attention.2 2 This study focused on the detection of biological threats to the civilian population in the United States. While recognizing the need to monitor and potentially respond to international disease activity, the committee did not examine disease surveillance systems in other countries or ones operated by international organizations.
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EVALUATING BIOWATCH BioWatch is a federal program led by DHS that operates in collaboration with federal partners and with the states and localities where BioWatch air samplers are deployed. The federal partners include the Centers for Disease Control and Prevention (CDC)
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As validated methodologies are developed, situational awareness and decision support systems with analytical tools to facilitate analysis of critical information needed to inform decisions in response to a BAR should be developed; • preparing detailed guidance for local and state public health of ficials with specific recommendations on public health measures and decisions following a BAR; • ensuring that a team, with specific training in reacting to BARs and relevant subject matter expertise (e.g., infectious disease epidemiol ogy, laboratory science, environmental assessment, risk communication) , would be available to provide around-the-clock expert federal assistance following a BAR; and • developing a formal mechanism for reviewing and sharing the "lessons learned" from the operation of BioWatch, including all BARs and interagency exercises.
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Moreover, the operational test results must be evaluated against measures of effectiveness that should be developed through a genuine collaboration between the BioWatch program office and the public health community. The results of this and other BioWatch testing should be made available to public health stakeholders, with appropriate provisions for security requirements.
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RECOMMENDATION 4: DHS should improve the level of coopera tion and collaboration between its Office of Health Affairs and its Science and Technology Directorate to promote effective research and technology development in support of the BioWatch program. Opportunities to Advance Future Biodetection Systems A continuing research and development effort is needed to provide the technology and knowledge for effective and sustainable outdoor and indoor environmental monitoring in urban environments.
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But the program should operate from the perspective of a more complete system that includes not only its detector technology and equipment and associated assays, but also the responsibilities that fall to state and local public health officials for additional information gathering to confirm and characterize a BAR; for communication with varied federal, state, and local authorities and with the public; and for response planning and training. DHS should emphasize its stated goal of timely response to mitigate illness and deaths from a biological attack, not just successful detection of genetic material that may indicate a terrorist event, and should collaborate with federal, state, and local stakeholders to develop BioWatch program objectives.
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Advisors should include state and local public health officials with decision-making roles in response to a BAR. Areas of expertise should include epidemiology, environmental health, public health laboratory systems, infectious diseases, biochemistry, genetics, law enforcement, emergency management, detection technology, meteorology, systems engineering, decision and information science, and operations research.
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Investments, especially increases in federal funding since 2001, have brought improvements; but further improvements are needed and federal funding covering all aspects of preparedness has declined since the initial post2001 increases. Develop and Evaluate New Opportunities in Infectious Disease Surveillance and Detection Detecting and responding to infectious disease threats is a core function for the public health and health care systems.
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HHS should assign this leader ship role to those responsible for the prevention and control programs these surveillance systems are intended to serve, and it should rigor ously evaluate these surveillance efforts. Achieve Better Information Sharing and Situational Awareness Much of the information that enables detection, characterization, and ongoing management and mitigation of natural and bioterrorism-related infectious disease outbreaks is generated by health care providers and laboratories, collected at the local or regional level, assembled at a statewide level, and then reported to CDC at the federal level.
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Develop and Evaluate Decision Support for Clinical Case Recognition and Reporting by Health Care Providers Early detection of a bioterrorism event or the emergence of a naturally occurring disease threat may depend on the ability of astute clinicians to diagnose the first few cases, or recognize suspicious clinical presentations that require special scrutiny by experts in infectious diseases. However, this requires busy clinicians to recognize a rare disease they may well be seeing for the first time -- a challenging prospect in the best of circumstances.
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But BioWatch is specialized, and it does not eliminate the need for the broader and more flexible surveillance activities of the public health and health care systems, either in their current forms or with various enhancements. Infectious disease surveillance is an essential part of daily activities at local, state, and federal levels to protect the public's health from various threats, including bioterrorism or naturally occurring infectious disease.
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Generation 2, with goal of including additional agents; environmental presence of airborne pathogens Public Health and Health Care Systems Disease recognition All human health Entire country, Not readily and reporting hazards (e.g., reports of quantified; varies by health care biologic, chemical, uneven quality by disease, providers and environmental) submitted to provider, location, laboratories that result nearly 3,000 local reporting system, to health in clinically and state health epidemiologic departments recognized disease departments expertise, and or injury other resources
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changes not must be overcome included to achieve desired system capabilities May depend Provide ongoing Unknown; data Need for additional on disease, detection of necessary to integration and skill of health intentional estimate costs information sharing care provider, and naturally of disease across federal, state, availability of occurring surveillance and local levels; appropriate outbreaks for systems or need for evaluation analysis tools, prevention or marginal cost and incorporation of scale of pathogen treatment of surveillance new techniques exposure, for significant reporting system; infectious disease depends on threats not evidence of available infection, so not likely to detect before environmental surveillance continued
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Annual governmental expenditures on all public health activities are estimated at approximately $64 billion. But the committee was unable to obtain information that would allow a determination of the portion of these costs attributable to infectious disease surveillance.
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At present, the nation lacks a clear, overarching architecture of interlocking interagency goals, metrics, and accountability to assure a seamless process from detection of biological threats through response and recovery.
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With reductions in federal funds and financial challenges facing state and local governments in 2009, these weaknesses may worsen. Federal assistance is needed to achieve the desired minimum state and local capacities for surveillance for bioterrorism and infectious disease threats, but the task will be challenging, requiring effective coordination and collaboration in state and local public health systems and in the complexities of both state and federal relationships and federal interagency action.
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It is essential that policy makers recognize that the benefits of any form of infectious disease surveillance will not be realized if states and communities do not also have the capability to respond effectively to a public health emergency. Despite the substantial progress that many localities have made in advancing mass dispensing capacity, having the ability to administer antibiotic prophylaxis to hundreds of thousands, if not several million, urban area residents within a few days following detection of a bioterrorist attack remains challenging.
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