Publications

Some important themes emerge in the White House Strategy. The first is the notion that the fundamental goal of the national biosurveillance enterprise should be to save lives by ensuring that leaders have the right information to make timely decisions during a public health emergency. This is an important development because few of the current public health surveillance systems that collect data to study long-term disease trends are equipped to aid in real-time decision-making during emergencies. For example, during the 2009 H1N1 pandemic, it was difficult for decision makers to gauge which disease mitigation strategies were appropriate for control of the epidemic because there was a lack of information about the severity of the epidemic.² Furthermore, response officials often had insufficient information about what medical resources (eg, vaccines, antivirals) were available and where. Thus it was difficult to know how to allocate resources in areas where demand outstripped supplies.³

The second important aspect of the Strategy is its call for an interdisciplinary approach to biosurveillance—one that incorporates information and knowledge from sectors beyond human health, such as law enforcement, intelligence, agriculture, the private sector, and others. Although there have been calls to better integrate existing federal biosurveillance efforts, there have been challenges in doing so. In 2007, Congress passed, and the President signed into law, the Implementing the Recommendations of the 9/11 Commission Act (PUBLIC LAW 110–53). This legislation calls on the federal government to improve integration and analysis of biosurveillance information, and effectively set up the National Biosurveillance Integration Center (NBIC) to be managed by the Department of Homeland Security. However, audits conducted by the GAO reveal that establishing the NBIC has not proceeded as planned.⁴ An articulation by the White House of the importance of sharing and integrating information across sectors may help to improve coordination and cooperation among agencies.

Guiding Principles

The Strategy outlines 4 guiding principles to serve as the foundation of efforts undertaken by the national biosurveillance enterprise.

1. Leverage Existing Capabilities – The National Enterprise should take full advantage of all existing biosurveillance resources—including tapping into existing efforts to expand reporting of electronic health information, and using social media and other available tools to improve sharing and integration of knowledge about human, animal, or plant health.
2. Embrace an All-of-Nation Approach – Biosurveillance will benefit by having a broader array of participants than just government entities. The strategy calls upon the national biosurveillance enterprise to embrace “novel community information sources.” It also calls for “prioritizing the development of a broader array of point-of-care diagnostics” to expand the number of “sentinels that may detect an incident of national significance.”
3. Add Value for Others – The Strategy acknowledges that effective biosurveillance requires the integration of information from a variety of arenas (eg, human, animal, plant, and environmental health; intelligence and law enforcement). Ensuring that data from these sources are accessible will require that the information providers see value in their sharing information with others in the biosurveillance community. To that end, the National Biosurveillance Enterprise should think broadly about what information and analyses may be useful to those collecting data and then develop ways to proactively share that information.
4. Maintain a Global Health Perspective – The Strategy emphasizes the importance of working with other countries to prepare and respond to health and security threats. It calls on the US to encourage other countries to integrate and share their biosurveillance and situational awareness information with the global community.

Core Functions

The Strategy states that the national biosurveillance enterprise should be able to meet the following core functions:

1. Scan and Discern the Environment – Systems should be able to detect events early on by routinely monitoring information and by looking at anomalous or concerning trends or patterns.
2. Identify and Integrate Essential Information – Biosurveillance efforts should be focused on ensuring rapid availability of information to answer/support the types of response questions and decisions that are most likely to emerge during any public health emergency. The Strategy recognizes that although public health emergencies can have unique attributes, there are likely to be aspects of response and decision making that are common to all emergencies. Ensuring coverage of these common elements should be a primary goal of biosurveillance efforts.
3. Alert and Inform Decision Makers – The national biosurveillance enterprise should be able to rapidly alert and inform decision makers of potential incidents of national significance and be able to continually provide critical updates as circumstances evolve. The strategy notes that because “tension often exists between certainty and timelines for action,” it will be necessary to find balance “among entities responsible for providing incident information and decisionmakers responsible for action regarding the information.”
4. Forecast and Advise Impacts – The White House Strategy also calls for the creation of a national biosurveillance enterprise that is capable of forecasting—that is, being able to access information that answers decision makers’ questions about probable impacts of an event and the consequences of action/inaction. The Strategy notes that forecasting does not necessarily require modeling, but will require the cultivation of “skills derived through experience and professional development.”

Prior to the release of the National Strategy for Biosurveillance there were a number of calls for greater oversight of ongoing biosurveillance efforts. Expert advisory group reviews of federal biosurveillance efforts, such as those conducted by the National Biosurveillance Advisory Subcommittee and the National Academies, have all concluded that national biosurveillance efforts suffer from lack of coordination and oversight. In 2010, the Government Accountability Office (GAO) recommended that a national strategy be created and a leader be appointed to oversee biosurveillance efforts.⁵ The GAO noted that many federal departments and agencies pursue missions and manage programs that could contribute to a national biosurveillance capability. To address this, the GAO recommended that the Administration designate a biosurveillance focal point to help agencies better define the “scope and purpose” of a national biosurveillance capability. This strategy seems poised to address some of the concerns noted in the GAO report.

The Strategy does not offer details on how the White House vision for biosurveillance will be implemented. It does, however, require that a plan to implement the Strategy be developed within 120 days.

References

1. White House. National Strategy for Biosurveillance. July 2012. https://obamawhitehouse.archives.gov/sites/default/files/National_Strategy_for_Biosurveillance_July_2012.pdf. Accessed August 1, 2012.
2. Lipsitch M, Finelli L, Heffernan RT, Leung GM, Redd SC, Group HnS. Improving the evidence base for decision making during a pandemic: the example of 2009 influenza A/H1N1. Biosecur Bioterror. Jun 2011;9(2):89-115.
3. Toner ES, Nuzzo JB, Watson M, Franco C, Sell TK, Cicero A, Inglesby TV. Biosurveillance where it happens: state and local capabilities and needs. Biosecur Bioterror. 2011 Dec;9(4):321-30.
4. US Government Accountability Office. Biosurveillance: Developing a Collaboration Strategy Is Essential to Fostering Interagency Data and Resource Sharing. December 2009. https://www.gao.gov/assets/300/299667.pdf. Accessed August 1, 2012.
5. US Government Accountability Office. Efforts to Develop a National Biosurveillance Capability Need a National Strategy and a Designated Leader. June 2010. https://www.gao.gov/assets/310/306362.pdf. Accessed August 1, 2012.