Emerging infectious disease and bioterrorism concerns surround the nation’s public health, agriculture, and food supply. The World Health Organization (WHO) reports that, since the 1970s, newly emerging diseases have appeared at the rate of one or more per year. There are now nearly 40 diseases that were unknown 20 years ago and, during the past 5 years, WHO has verified 1,100 epidemics worldwide. In 2003, Severe Acute Respiratory Syndrome (SARS) amply demonstrated how rapidly an emerging disease can spread, with 37 countries reporting and confirming outbreaks within a three-week period. More recently, in 2009, H1N1 influenza was a largely unexpected global pandemic.
Against this background, in 2007, Homeland Security Presidential Directive-21 was published establishing, among other things, a requirement for a national biosurveillance capability. In 2009, in the immediate wake of the H1N1 pandemic, Presidential Policy Directive 2, The National Strategy for Countering the Proliferation of Biological Threats, was published as implementing guidance. This policy again directed the establishment of a worldwide biosurveillance program. The federal government’s intent was, and still is, clear: develop a nationwide, robust, and integrated biosurveillance capability, with connections to international disease surveillance systems, in order to provide early warning of deliberate or emerging biological threats, and ongoing characterization of disease outbreaks in near real-time.
Both presidential directives called for interagency cooperation across federal, state, and local governments. Both recognized the challenges and need for more personnel, better training, and new equipment and systems. Yet, as the Government Accountability Office (GAO) noted in June 2010, neither presidential directive established an appropriate leadership mechanism – e.g., an interagency council or national biosurveillance director – to provide a focal point with authority and accountability for developing a national biosurveillance capability. At present, primary responsibility is given to the U.S. Department of Health & Human Services’ (HHS) Centers for Disease Control and Prevention (CDC) for human health, the U.S. Department of Agriculture (USDA) for plant and animal health, USDA and HHS’s Food and Drug Administration (FDA) for food responsibilities, and the U.S. Department of Homeland Security (DHS) for a reporting responsibility under its charter for securing the homeland.
The present U.S. biosurveillance system is highly dependent on state and local public health officials, veterinarians, and agricultural agents to voluntarily report diseases and crop infections. In addition to challenges in both the speed of reporting and dealing with volumes of unstructured data, there is also an issue of training in a rapidly evolving field as well as available personnel. In December 2008, the Association of Schools of Public Health estimated that by 2020 the nation would face a shortfall of over 250,000 public health workers. The USDA likewise has reported expected nationwide veterinarian shortages.
Finally, there is the issue of what really constitutes biosurveillance. Traditional disease and biological threat surveillance relies on vigilant healthcare providers, public health agencies, veterinarians, and agricultural agents to report suspicious outbreaks. In most cases, reporting is slow, which is largely due to a reliance on scientific certainty and sophisticated laboratory testing. In contrast, biosurveillance uses actionable information from both medical and nonmedical sources – both domestically and internationally – in the shortest possible time.
- The majority of respondents agree that biosurveillance is an important part of state and local emergency planning, but many state and local biosurveillance programs are currently inadequate.
- The vast majority of respondents believe that additional investments are needed in developing interoperability between public health and healthcare institutions, in addition to better point-of-care diagnostics and attribution methodologies.
- Roughly half of respondents believe that what constitutes an “actionable” biosurveillance report differs depending on the subject of the threat, thus reflecting additional challenges that decision makers face when analyzing the reports.
- The vast majority of respondents were unaware of the fact that there are many agencies, each of which holds primary responsibility and authority for biosurveillance activities, depending on whether it covers human, animal, plant, food, or environmental surveillance.
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Major General Stephen Reeves, USA (Ret.), is a highly accomplished senior executive and an internationally recognized expert on chemical and biological defense as well as defense acquisition. He has testified as an expert witness on multiple occasions before the U.S. Congress and has been interviewed numerous times by the national and international print and television press. He also is a frequent speaker at both national and international defense and homeland security conferences. Experienced in leading and managing large, diverse, global, multi-billion dollar organizations, he established, and for seven years led, the first DoD Joint Program Executive Office for Chemical and Biological Defense.