Biosrveillance Capabilities

8/10/2019 Biosrveillance Capabilities

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Recommendations for Action: Modernizing and Enhancing Our Nations

Biosurveillance Capabilities Report from the National Biodefense Science Board

EXECUTIVESUMMARY

The

United

States

Department

of

Health

and

Human

Services

(HHS)

Secretary,

through

the

Assistant

Secretary

for

Preparedness

and

Response

(ASPR),

directs

activities

related

to

the

nations

public

health

and

health

preparedness,

as

well

as

assuring

appropriate

national

response

capability

such

as

medical

countermeasures.TheNationalBiodefenseScienceBoard(NBSB)wastaskedwithprovidingguidelines

andrecommendationsforacoordinatedstrategytoassurethenationsbiosurveillancecapacityasit

contributes

to

situational

awareness

of

issues

potentially

and

actually

impacting

the

publics

health.1

1

The2013HHSPandemicandAllHazardsPreparednessReauthorizationAct(PAHPRA)HR307TitleIISec204,tasksthe

NBSBwithprovidingexpertadvice,includingrecommendations,regardingthemeasurablestepstheSecretary[HHS]

should

take

to

modernize

and

enhance

biosurveillance

activities

pursuant

to

the

efforts

of

the

HHS

to

ensure

comprehensive,

realtime,allhazardsbiosurveillancecapabilities.P.18

Abiosurveillancesystemincludesprograms,policies,procedures,workforce,andtechnologyrelated

to

biosurveillance

for

human

health.

Biosurveillance

is

an

important

component

of

public

health

and

healthcaresituationalawareness2butwouldnotinitselfincludeothercomponentsofsituational

awarenesssuchasinventoryandresourcemanagement.

2In

their

April

3 report,

the

NBSB

proposed

that

the

scope

of

public

health

situational

awareness

encompasses:

surveillanceforexistingandemergingpublichealththreats(biological,chemical,radiological)domesticallyandabroad,

whetherthroughmonitoringforchangesintrendsofcurrentdiseaseorsignalsofnewdiseases,andwhetheroriginatingin

human

health

or

elsewhere

(e.g.

animal

health);

and

realtimeawarenessofthecapacitytoprovideroutineaswellas

emergency

public

health

interventions.

The

scope

of

healthcare

situational

awareness

comprises

realtimeawarenessof

the

capacity

to

provide

routine

as

well

as

emergency

healthcare,

whether

in

regular

practice

or

during

a

crisis.

See

http://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/saevaluation.pdf

Biosurveillanceis,however,connectedtothe

publichealthandhealthcareresponsecomponentofsituationalawarenessbyensuringthemost

optimal

and

informed

decision

making

to

thereby

assure

our

national

health

security.

Effective

and

useful

biosurveillance

activities

and

systems

already

exist

to

fulfill

the

specific

needs

of

the

populationand/orareaforwhichtheyweredeveloped. However,theNBSBrecognizesthatthereare

1)duplicationinbiosurveillanceactivitiesacrosssystemsandagenciesresultinginsimilaroridentical

analysesandconsequentlyinefficientuseoflimitedresources,2)differingperspectivesandanalysesof

thesamerawinformationresultinginnonintegratedandpotentiallyconfusingorevenopposing

situational

perspectives,

requiring

better

correlation

and

reconciliation

across

the

US

Government

(USG)

agencies,and3)inadequateorlackofefficientandrelevantinformationsharingatandacrossalllevels

andareas. Inaddition,theNBSBagreesthat...developingarobust,integrated,nationalbiosurveillance

capabilitycouldbenefitfromaneffectivenationalstrategyandfocalpointwithsufficienttime,

responsibility,

authority,

and

resources

to

lead

the

effort.3

3U.S.GovernmentAccountabilityOffice.EffortstoDevelopaNationalBiosurveillanceCapabilityNeedaNationalStrategy

andaDesignatedLeader.Washington,D.C.:U.S.GAO,2010.http://www.gao.gov/assets/310/306362.pdf

Therefore,

the

NBSB

in

its

report

of

April

3,

2013,recommendedtheestablishmentofasinglecentralizedoversightauthority,hereafterreferredto

astheCentralExecutiveStrategicGroup(CESG):

TheNBSBstronglyemphasizestheneedtodesignateanoversightauthoritytoassurecompatibility,

consistency,continuity,coordination,andintegrationofallthedisparatesystemsanddata

rd

.

1
http://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.gao.gov/assets/310/306362.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.gao.gov/assets/310/306362.pdf


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requirements. Therefore,theNBSBrecommendsthattheSecretaryofHHSdesignateacentral

situationalawarenessauthorityforcoordinatingallpublichealthandhealthcaresituationalawareness

datathathavealreadybeencollected,processed,andanalyzedfromrespectiveagenciesonanational

level;theauthoritywillalsohavetheresponsibilitytorecommendcorrectiveactionstoimprove

situationalawareness,including,thestandardizationofcommonoperatingprocedures.4

4NationalBiodefenseScienceBoard.AnEvaluationofOurNationsPublicHealthandHealthcareSituationalAwareness:A

Brief

Report

from

the

National

Biodefense

Science

Board.

Washington

D.C.:

U.S.

DHHS,

2013.


The

NBSB

specifically

recommends

that

the

HHS

Secretary

invite

senior

representatives

from

the

multiple

federal

agencies

involved

in

public

health

and

healthcare

biosurveillance

to

comprise

this

executivegrouptoevaluateandcoordinatebiosurveillanceactivitiesacrossthefederalagenciesandits

partners.5

5

The

NBSB

recognizes

the

Department

of

Homeland

Security

National

Biosurveillance

Integration

Systems

(NBIS)

current

roleasaninteragencycommunityprovidingnationalbiosurveillanceandsituationalawarenessbyacquiring,integrating,

analyzing,anddisseminatinginformation,andrecommendsthatthecompositionoftheproposedCESG,initsmain

coordinationrole,utilizetheNBISinteragencyframeworkasamodelforinteragencyengagementandcollaboration.

TheCESGsroleistocoordinateanddevelopnationallevelstrategiesforimplementingan

integratednationwidebiosurveillancesystemthatprovidescontinuousandaccessiblesituational

awareness

to

decisionmakersatalllevels.

InitsApril3,2013,report,theNBSBproposedaseriesofactivitiestobeundertakenbytheCESG.In

additiontotheseactivities,theNBSBrecommendsthefollowingkeyactivity:

To

effectively

and

efficiently

establish

a

comprehensive,

realtime,andallhazardsbiosurveillance

system,theNBSBrecommendsthattheCESGdevelopadetailedstrategyforthedesignand

implementationofanintegratedanalyticalandinterpretivecapabilitythatwouldbeapplicableacross

theexistingpublichealthandhealthcarebiosurveillancesystems.

Thestrategyshouldincludeaformalassessmentofhumanhealthbiosurveillancesystemredundancies,

overlappingactivities,andbiosurveillanceinformationgaps. Inthiscontext,theCESGshouldconsider

thefollowing:

ThenewlydevelopedHHSCentersforDiseaseControlandPrevention(CDC)NationalPublicHealth

Surveillance

and

Biosurveillance

Advisory

Committee

(NPHSBAC)

mission

is

to

provide

recommendationsrelatedtobothtraditionalandinnovativesourcesofhumanhealthrelated

information

as

well

as

the

exchange

of

healthcare

and

public

health

information.

Therefore,

to

ensureintegrationandconsistencyinadviceandguidanceregardingbiosurveillanceactivitiesacross

USG

agencies,

NPHSBAC

recommendations

should

be

evaluated

for

inclusion

into

the

integration

strategy.

Thestrategyshouldrecognizethateffectivebiosurveillanceisnecessarilybroadinscope,monitoring

allthreatsnaturallyoccurringorintentionallyintroduced,andincludeanimal,plant,and

environmentalmonitoringtoidentifyallpotentialthreatstohumanhealth,domesticallyand

abroad. Humanskillandexperience(e.g.epidemiologistsandbiostatisticiansexperiencedin

biosurveillance

and

public

health

investigations),

as

much

as

information

collection

and

organization,areessentialtoprovideappropriatecontextandinterpretationforfullyinformed

2
http://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdf


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decisionsandrecommendations. Boththespecificinformationgleanedandderivedfromtraditional

surveillanceaswellasthepotentiallymeaningfuleventindicationsfromnontraditionalmethodsof

biosurveillancee.g.syndromicsurveillanceandsocialmediacouldenhancecurrent

biosurveillancewhenleveragedappropriately;furtherinvestigation,however,isrequiredto

understandtheirusefulnessfordecisionmaking. Anothernontraditionalsourceofinformationto

exploreforpotentialadditionalandcriticalinsightsisnationalsecurityinformationsuppliedbyUSG

agencies,includingfederallawenforcementandintelligenceagencies.6 Existinginternational

agreements

and

codes

of

conduct

(e.g.

International

Health

Regulations),7

in

addition

to

domestic

laws,regulations,

informationsharing,policiesandagreements,mustbeaccountedforand

integratedintoourbiosurveillanceefforts;ourfocusmustexpandbeyondourownbordersto

includeeventsthatmayimpactourcitizensathomeand/orabroad.

6Forexample,informationcollectedbytheNationalCenterforMedicalIntelligence(NCMI)NCMIdefinesmedical

intelligenceasthecategoryanalysisandinterpretationofforeignmedical,bioscientific,andenvironmentalinformation

that

is

of

interest

to

national

security

and

the

Homeland;

HHS

is

not

involved

in

the

gathering

or

dissemination

of

such

medical

intelligence.

In

addition,

the

Federal

Bureau

of

Investigation

(FBI)

is

involved

in

several

biosurveillance

activities

in

collaboration

with

other

agencies.

See

pgs.

2526forfurtherinformation.7

World

Health

Organization.

Alert,

Response,

and

Capacity

Building

Under

the

International

Health

Regulations

(IHR).

2013.http://www.healthit.gov/sites/default/files/utility/finalfederalhealthitstrategicplan0911.pdf

Finally,integrationstrategyinitiativesshouldrecommendongoingtransparencyandcommunication

effortswithrelevantagencypartners,thepursuitofstandardizationtoachievepublichealthand

healthcareinformationintegrationandsituationalawareness,andtheongoingconductofprogram

evaluations

to

ensure

that

the

needs

of

an

integrated

biosurveillance

network

are

continuously

addressedacrosstherelevantUSGagencies.

To

assure

the

implementation

and

management

of

the

integration

strategy,

the

NBSB

in

its

April

3,

2013

reportrecommendedtheestablishmentofacentralportfoliomanagementgroup,underthe

authority,thatwouldhelpcoordinatebetweenallbiosurveillanceactivitiesconductedbyvarious

agencies Inthepresentreport,theNBSBspecificallyrecommendstheestablishmentofaStrategic

IntegrationGroup(SIG)composedofappropriateprogrammanagementrepresentatives,including

leadbiosurveillancesubjectmatterexperts,fromeachoftheinvolvedfederalagencies.

TheSIGwillworkwiththeCESGtomanagetheimplementationoftheintegrationstrategyandassure

appropriatecoordinationamongtheagencies. TheSIGwillberesponsiblefortheinitialactivitiesofthe

strategy,includingtheassessmentofhumanhealthbiosurveillanceactivityredundanciesandgaps,and

the

development

of

critical

information

requirements

and

common

standards

for

data

collected

to

betterfacilitatethesustainabilityofsystemsandthealignmentofactivitiesacrossagencies. Asthe

implementationofthestrategyprogressesandevolves,theCESGwillassureappropriatecoordination

amongtherelevantagenciesand,importantly,willassurethattheeventualgoalofintegrated

informationandanalysis,resultingineffectivecontributionstopublichealthandhealthcaresituational

awareness,isachieved. TheintentoftheNBSBrecommendationisnottocreateyetanother

permanentagencyororganizationwithintheUSG,butrathertofillaperceivedneedforcoordination

amongallkeyplayersinvolvedinpublichealthandhealthcaresituationalawarenessactivities,including

biosurveillance. ThroughperiodicevaluationoftheCESGandSIGsprogress,theSecretaryofHHS,at

his/herdiscretion,willdeterminewhetherornotthatneedhasbeenfulfilled.

3
http://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdfhttp://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdf


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INTRODUCTION

On

April

3,

2013,

the

National

Biodefense

Science

Board

(NBSB)

transmitted

a

report

with

recommendationstotheDepartmentofHealthandHumanServices(HHS)SecretaryandAssistant

SecretaryforPreparednessandResponse(ASPR),entitled,AnEvaluationofOurNationsPublicHealth

andHealthcareSituationalAwareness,8offeringguidanceandrecommendationsonthemeasurable

steps

to

take

to

enhance

thenations

current

public

health

andhealthcare

situationalawareness

capabilities.

8National

Biodefense

Science

Board.

An

Evaluation

of

Our

Nations

Public

Health

and

Healthcare

Situational

Awareness:

A

BriefReportfromtheNationalBiodefenseScienceBoard.WashingtonD.C.:U.S.DHHS,2013.


The

NBSB

has

continued

its

work

on

this

topic

and

offers

this

report

with

recommendations

onthemeasurablestepstheHHSSecretaryshouldtaketoenhanceournationsbiosurveillance

capabilities,inresponsetoboththetaskfromtheASPR9anddirectivesinthe2013PandemicandAll

HazardsPreparednessReauthorizationAct(PAHPRA).10

9

See

Appendix

I

for

the

task

letter

from

the

ASPR.

10

Pandemic

and

All

Hazards

Preparedness

Reauthorization

Act.

13

March

2013.

See

pg.

178

http://www.gpo.gov/fdsys/pkg/PLAW113publ5/pdf/PLAW113publ5.pdf

TheNBSBwasaskedbytheASPRto...assesscurrentbiosurveillanceactivities,identifyefficiencies,and

makerecommendations,incoordinationwiththeapplicableexistingCentersforDiseaseControland

Prevention(CDC)advisorycommittees. Inaddition,the2013PAHPRAdirectives(HR307TitleIISec

204)specificallyaskstheNBSBtoidentifythestepsnecessarytoachieveanationalbiosurveillance

system

for

human

health

with

international

connectivity;

identify

any

duplicate

surveillance

programs

under

the

HHS,

or

changes

necessary

to

existing

programs

to

enhance

and

modernize

activities,

minimizeduplication,strengthenandstreamlineactivities,andachieverealtimedataforbothhuman

andzoonoticdiseaseactivity;and,tocoordinatewithapplicableexistingCDCadvisorycommittees.

IncoordinationwithCDC,theNBSBreconvenedandaugmentedmembershipontheSituational

Awareness(SA)StrategyandImplementationPlan(SIP)WorkingGroup(WG)toobtainarangeof

stakeholderviews.11

11See

Appendix

II

for

revised

SA

SIP

WG

Roster

Tothoroughly,thoughtfully,andeffectivelyrespondtothetaskanddirectives,the

WGfeltitwasnecessarytodevelopastrategicapproachaddressingthemainkeyissuesidentified

throughtheirresearch,deliberation,andcorrespondencewithseveralfederalentitiesinvolvedinpublic

health

and

healthcare

situational

awareness

and

human

health

biosurveillance

activities

across

the

US

Government

(USG).12

12TheWGheldaseriesofteleconferencesandwebinarstogatherfurtherdata,deliberate,andcommentonthisdraft

report,developedbytheWGChair,Dr.SarahPark,andCoChair,Dr.ManoharFurtado.

TheNBSBheldapublicmeetingviateleconferenceonOctober31,2013,toconsider,deliberate,and

voteontherecommendationspresentedbytheSASIPWG. Followingdiscussionbythemembersand

thepublic,theNBSBvotedon,andapprovedthetransmittaloftherecommendationsinthisreportto

theSecretaryofHHSandASPRforconsideration.

InresponsetothetaskfromtheASPRanddirectivesinthe2013PAHPRA,theNBSBoffersthisreport

with

recommendations

regarding

the

measurable

steps

the

HHS

Secretary

should

take

to

modernize

and

4
http://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-113publ5/pdf/PLAW-113publ5.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-113publ5/pdf/PLAW-113publ5.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-113publ5/pdf/PLAW-113publ5.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-113publ5/pdf/PLAW-113publ5.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-113publ5/pdf/PLAW-113publ5.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa-evaluation.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-113publ5/pdf/PLAW-113publ5.pdf


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enhancebiosurveillanceactivitiespursuanttotheeffortsofHHStoensurecomprehensive,realtime,all

hazardsbiosurveillancecapabilities.

5


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RECOMMENDATIONS

The2013PAHPRA(HR307TitleIISec204)taskedtheNBSBwithprovidingguidance,including

recommendations,regardingthestepstheSecretaryshouldtaketomodernizeandenhance

biosurveillanceactivitiespursuanttotheeffortsofHHS. TheNBSBhighlightsthatclarifyingthe

numerousgovernmentalandprivatesectorentitiesrolesandresponsibilitiesforleading,partnering,or

supportingbiosurveillanceactivitiescouldhelpensuretimelydiseasedetectionandpublic

health/healthcare

situational

awareness

across

these

multiple

domains

to

enhance

critical

decision

making, Clarifyingrolesandresponsibilitiescouldalsohelpidentifygapsorduplicationsin

biosurveillancecoveragewithinandacrossdomainsanddeterminewhethertheyshouldbe

addressed.13

13U.S.GovernmentAccountabilityOffice.EffortstoDevelopaNationalBiosurveillanceCapabilityNeedaNationalStrategy

andaDesignatedLeader.Washington,D.C.:U.S.GAO,2010.http://www.gao.gov/assets/310/306362.pdf

Tohelpachieveanationalbiosurveillancesystemforhumanhealthwithinternational

connectivity,andensurecomprehensive,realtime,allhazardsbiosurveillancecapabilities,theNBSBre

emphasizestheneedfortheHHSSecretarytoconveneaHHSledcentralizedpublichealthand

healthcaresituationalawarenessoversightauthoritywithinvitedfederalpartnerstoactasthecentral

focalpointtoassurethecompatibility,consistency,continuity,coordination,andintegrationofall

disparatesystems,andinformationrequirements,hereafter,referredtoastheCentralExecutive

StrategicGroup(CESG). AcentraltaskoftheCESGisthedevelopmentofastrategytocoordinatethe

effectiveintegrationofactivitiesacrossthefederalagencies(andpartners)currentlyengagedin

publichealthandhealthcaresituationalawareness,includinghumanhealthbiosurveillance. The

CESGsroleistocoordinateanddevelopnationallevelstrategiesforimplementinganintegrated

nationwidebiosurveillancesystemthatprovidescontinuousandaccessiblesituationalawarenessto

decisionmakersatalllevels.

Thestrategyshouldfocusonalignmentofkeybiosurveillancesystems,processes,andprotocolswith

thegoalofensuringthatthenecessaryinformationisavailabletothosewhoneeditfordecision

making.Indoingso,thestrategywouldidentifyanyoverlapofbiosurveillanceactivitiesandobjectives,

any

gaps

in

the

current

biosurveillance

network

and

activities

needed

to

fill

those

gaps,

and

develop

critical

information

requirements

and

common

standards

for

data

collection.

The

strategy

should

eventuallyincludespecificrecommendationsforremediatinganyredundanciesandgaps,shouldfocus

onthegoalofintegratingbiosurveillanceinformationandanalytics,andinclude:

Aprocessforevaluatingandselectingtheoptimalinformationcollectionandinformationreporting

systemsaswellastheidealcombinationsofsuchtoprovidedirectiontoHHSagenciesand

recommendations

to

all

USG

departments

involved

in

human

health

and

healthcarerelated

biosurveillanceactivities,andhencefillingapsininformationrequirementsandavoidoverlap,as

appropriate;

Periodic

monitoring

of

information

summaries

provided

by

various

agencies

and

sources

relevant

to

publichealthandhealthcaresituationalawareness(biosurveillance,publichealth,media,

intelligence,

etc.)

to

make

recommendations

regarding

gaps

in

critical

information,

areas

for

improvement,

and

confirm

that

critical

information

requirements

are

being

met;and

6
http://www.gao.gov/assets/310/306362.pdfhttp://www.gao.gov/assets/310/306362.pdf


7/31

Approaches

to

consolidate

and

reduce,

if

not

eliminate,

overlapping

and

redundant

methods

of

informationcollectionacrossagenciesdrawingfromseveraldiversesources(militarytocivilian)and

therebymaximizeefficiencywhileminimizingburdenonfrontlineinformationcollectionand

interpretation(i.e.,statesandlocals)forexample,DepartmentofDefense(DoD)separately

requestingthesameorsimilarinformationfromthesamesourceasCDC.

Aspartofthiseffort,theNBSBalsorecommendstheestablishmentofaStrategicIntegrationGroup

(SIG)composedofmanagementrepresentatives,includingleadbiosurveillancesubjectmatter

experts,fromtherelevantagencies. TheSIGisspecificallytaskedwithassuringtheimplementationof

theCESGsstrategywiththegoalofintegratingandcoordinatingbiosurveillanceactivitiesandanalyses.

Theinitialfocuswillnecessarilybeontheevaluationofexistingbiosurveillanceredundanciesandgaps.

Astheimplementationofthestrategyprogressesandevolves,theSIGwillassureappropriate

coordinationamongtherelevantagenciesand,importantly,willassurethattheeventualgoalof

integratedinformationandanalysis,resultingineffectivecontributionstopublichealthandhealthcare

situationalawareness,isachieved. UndertheguidanceoftheCESGsstrategy,theSIGwillalsoensure

closecollaborationandcommunicationamongtherelevantfederalpartneragenciesaswellasacross

state,local,tribal,andterritorial(SLTT)agencies,andincludinghealthcare,privateindustry,and

academiadisciplinesinvolvedinbiosurveillanceactivities.TheworkandaccomplishmentsoftheSIG

shouldberegularlyreviewedbytheCESG. TheintentofSIG,oreventheCESG,isnottocreateyet

anotherpermanentagencyororganizationwithintheUSG,butrathertofillaperceivedneedfor

coordinationamongallkeyplayersinvolvedinpublichealthandhealthcaresituationalawareness

activities,

including

biosurveillance.

Through

periodic

evaluation

of

the

CESG

and

SIGs

progress,

the

SecretaryofHHS,athis/herdiscretion,willdeterminewhetherornotthatneedhasbeenfulfilledby

standingdownoneorbothgroups.

Specifically,theNBSBrecommendsthattheCESGconsiderthefollowingasitdevisesitsstrategyfor

implementation

by

the

SIG:

IntegratedAdviceInvolvetheNationalPublicHealthSurveillanceandBiosurveillanceAdvisory

Committee(NPHSBAC)withtheCESGsActivities

Assuming

the

formation

of

a

CESG,

the

NPHSBAC

should

consider

the

CESGs

role

when

making

recommendations

for

public

health

biosurveillance

and

situational

awareness

activities

across

the

USG

on

a

consistent

and

ongoing

basis.

Such

recommendations

should

include

not

only

CDC

surveillance

activitiesbut,asneeded,activitiesundertakenbyotherfederalagenciestodeterminetheirusefulness,

potentialforcoordination,aswellasoverlap/redundancy,andeffortandresources

required/efficiencies.

Based

on

the

recommendations

from

the

NPHSBAC,

the

CESG

will

be

able

to

strategically

develop

focused

goals,

determine

a

set

of

critical

information

needs

among

all

stakeholders,

integrate

thinking,and

recognize

existing

as

well

as

cultivate

new

expertise

and

best

practiceswithregardtolimitedresourcestoensureatrulycoordinatedandintegratednational

biosurveillance

system

with

international

connectivity.

7


8/31

WithinthescopeoftheNPHSBACscharteredduties,theNBSBproposesthattheNPHSBACthoughtfully

considerandproviderecommendationsasitexecutesitschargebyansweringthefollowing

biosurveillancecenteredquestionsinanefforttoprovideafoundationfortheCESGsstrategy:

EnablingStateandlocalpublichealthbiosurveillancecapabilities: Whatdothefederalgovernment

and

its

state

and

local

partners

expect

of

biosurveillance?

This

requires

specific

articulation.

Effectiveness

of

electronic

health

information

exchange:

Are

the

existing

systems/methods

adequategiventhisexpectationandassociatedspecifictasks?

Innovativesourcesofbiosurveillanceinformationanditsintegration: Importantly,howcanthisbe

accomplishedinthemostefficientway,particularlywithregardtointegrationofinformationand

analysis?

Gapsinbiosurveillanceandpublichealthsurveillancecapabilities: Giventheimportanceof

integration,

how

should

biosurveillance

activities

that

occur

across

various

government

organizations(HHS,DOD,etc.)andaresynchronizedandcentrallycoordinatedcontinuetoidentify

andeliminategapsinbiosurveillanceinalongtermsustainablemanner?

Additional

FocusReview

and

Define

the

Utility

of

Non

Traditional

Information

Sources

to

Traditional

Ones

WithregardtothescopeofbiosurveillancethattheCESGsstrategymustconsider,theNBSB

recommendstheneedtoalsofocusoninformationfromenvironmental,chemical,and

radiological/nuclearsurveillancewhichfallwithinthedefinitionofbiosurveillanceasitrelatestohuman

health

and

safety.

Additionally,

a

careful

review

of

the

added

value

of

signals

from

these

types

of

surveillanceaswellasnontraditionalinformationsources,suchasactivesurveillanceofnewsandsocial

media,shouldbeevaluatedasacomplementtotraditionalspecific,sensitive,realornearrealtime,all

hazards,andflexiblecapabilities. TheutilityofnationalsecurityinformationtoHHScancomplement

the

full

spectrum

of

biosurveillance

from

early

warning

by

using

nontraditional

sources

to

enhance

the

traditional

biosurveillance

and

response

action

that

follows.

Finally,

agreements

and

information

sharingprocesseswithothercountriesshouldbeimprovedandenhancedtoensurethatcritical

biosurveillancedataareaccessibleandavailabletorecognizeinternationallyemergingdiseasesof

considerablenationalandglobalimpact.

Standardization

of

StrategiesAddress

the

Same

Baseline

Needs

for

Consistency

and

Continuity

Tofurtherthecoordinationofbiosurveillanceactivities,integrationinitiativesshouldcontinueongoing

transparencyandcommunicationeffortswithrelevantagencypartners,pursuestandardizationofdata

requirements

to

achieve

public

health

and

healthcare

information

integration

and

situational

awareness,androutinelyconductprogramevaluationtoensurethatthefollowingneedsare

continuouslyaddressedacrosstheUSG:

Considerationofessentialinformationneedsandadequateperformanceofthesystemsthat

supportthem.

ReducedandreasonableburdenonSLTTpartners.

8


9/31

Broader,costeffective,andmoresophisticateduseofinformationtechnology,includingincreased

useofelectronichealthrecords(EHRs).

Anintegratedapproachtoassuringinformationneedsforallinformationsharingpartnersaremet

whileidentifyingopportunitiesforcreatingefficiencies.

Consistentsupportfortraininganddevelopmentofacapable,multidisciplinarybiosurveillance

workforceacrosstheSLTTandfederalsystem.

Ultimately,

integration

through

the

synchronization

and

coordination

of

biosurveillance

efforts

will

enhancecriticaldecisionmakingtowardprotectingournationalhealthsecurity.

RelationshipsandResponsibilitiesOutlinedbyRecommendations

9


10/31

KEYSUPPORTINGINFORMATIONThefollowingsectionpresentselementsthatwereconsideredin

thedevelopmentoftheNBSBsrecommendations.

DefinitionandScopeofBiosurveillance

PAHPRA2013Biosurveillancemeanstheprocessofgatheringnearrealtimebiologicalinformation

thatrelatestohumanandzoonoticdiseaseactivityandthreatstohumanoranimalhealth,inorderto

achieve

early

warning

and

identification

of

such

health

threats,

early

detection

and

prompt

ongoing

traffickingonhealthevents,andoverallsituationalawarenessofdiseaseactivity. 14

14

Pandemic

and

All

Hazards

Preparedness

Reauthorization

Act.

24

April

2013.

http://www.gpo.gov/fdsys/pkg/PLAW

113publ5/pdf/PLAW113publ5.pdf

Optimalpublichealthbiosurveillancerequiresnotonlythecollectionandorganizationofinformation

elementsbut,especially,skilledandexperiencedpersonstoappropriatelyvalidate/verify,analyze,and

interprettheseelementsintheappropriatecontext. Informationalonewithoutthehumanelementto

verifyits

relevancewouldbemeaningless. With

this

inmind,

biosurveillance

is

the

scienceandpractice

ofmanagingandinterpretinghealthrelatedinformationwiththeprimarygoaloftimelyandaccurate

publichealthandhealthcaresituationalawarenessfor:15

15DefinitionofbiosurveillancetakenfromtheNationalBiosurveillanceStrategyforHumanHealth.ExecutiveSummary.

2010.http://www.cdc.gov/osels/pdf/NBSHH_v2.pdf,andtheCDCBiosurveillanceUnitDefiningBiosurveillancefor

Human

Health

Fact

Sheet,

http://www.cdc.gov/osels/phsipo/pdf/Fact%20Sheet%20Biosurveillance.pdf

Earlydetectionofevents

Signalvalidation

Eventcharacterization

Event

monitoring

Alertandnotificationofresponsiblegovernmentalentities

Publicwarningand

protection

Effectiveresponsetomitigateadversehealtheffects

Thescopeandfunctionofpublichealthbiosurveillance:16

16

Ibid

Encompassesallhazards:includingbiological,chemical,radiological,nuclear,andexplosivessuch

that

animal

health,

plant/agricultural

issues,

microorganism

characteristics,

and

environmental

(artificial,manmade,andnatural)factorsimpactinghumanhealtharemonitored

Isdefinedbyurgencyandpotentialformultijurisdictionalinterest

Includesurgentnotifiableconditions17aswellasnonspecificandnovelhealthevents

Includesadhocinformationgathering,analysis,andapplicationofinformation

Includesthefollowingfunctions:casedetection,eventdetection,signalvalidation,event

characterization,projectionofeventimpact,notificationandcommunication,andqualitycontrol

andimprovement

17

The

Council

of

State

and

Territorial

Epidemiologists

(CSTE)

holds

the

responsibility

for

defining

and

recommending

which

diseasesandconditionsarereportablewithinstatesandwhichofthesediseasesandconditionswillbevoluntarily

reportedtoCDC. Alistingofcurrentlynationallynotifiablediseasescanbefoundat

http://wwwn.cdc.gov/nndss/script/conditionlist.aspx?type=0&yr=2013.

10
http://www.gpo.gov/fdsys/pkg/PLAWhttp://www.cdc.gov/osels/pdf/NBSHH_v2.pdfhttp://www.cdc.gov/osels/phsipo/pdf/Fact%20Sheet%20Biosurveillance.pdfhttp://wwwn.cdc.gov/nndss/script/conditionlist.aspx?type=0&yr=2013http://www.gpo.gov/fdsys/pkg/PLAWhttp://www.cdc.gov/osels/phsipo/pdf/Fact%20Sheet%20Biosurveillance.pdfhttp://wwwn.cdc.gov/nndss/script/conditionlist.aspx?type=0&yr=2013http://www.cdc.gov/osels/pdf/NBSHH_v2.pdfhttp://www.gpo.gov/fdsys/pkg/PLAWhttp://www.cdc.gov/osels/phsipo/pdf/Fact%20Sheet%20Biosurveillance.pdfhttp://wwwn.cdc.gov/nndss/script/conditionlist.aspx?type=0&yr=2013


11/31

Supports

rapid

and

efficient

discharge

of

responsibilities

related

to

the

International

Health

Regulations[IHR(2005)]andcoordinationwithUSNationalIHRFocalPoint.

EffortstoLeverageNontraditionalBiosurveillanceCapabilitiestoTraditionalOnes

Different

information

sources

can

be

utilized

for

biosurveillance.

Ideally,

monitoring

and

analysis

of

manydisparatetypesofreportscollectedcanallowgovernmenttoidentifypotentialthreatswithsome

advanceintervaltoreactwithappropriatecountermeasuresorotherpublichealthactionsasrequired;

thepotentialutilityofsyndromicsurveillanceisexemplifiedinFigure1onpage12. However,someof

thisinformationmustbecategorizedaspreliminaryandnotverifiedwhengatheredand/orused,and

detectioncouldoccuratanypointbasedonthesensitivity,specificity,andpositivepredictivevalueof

theinformationsource,whichcouldvarywidelyfromonetypetotheother. Today,ournations

biosurveillancecapabilityrestsprimarilyinourpublichealthsurveillancesystem. Traditional

biosurveillancesystemsincludethemonitoringandgatheringofinformationreceivedfromambulatory

care,hospital,laboratory,andepidemiologicalsources. Nontraditionalbiosurveillancecapabilities

includetheregionalandglobalmonitoringandgatheringofinformationwithhumanhealthrelevance

fortheemergenceandspreadofapathogenthatcouldentertheareaofconcern(e.g.theHomeland);

thisincludesglobalsyndromicsurveillanceincludingnationalsecurityinformationaswellasactive

surveillanceofnewsandsocialmedia. Suchsourcescouldcontributetoestablishingabaseline,inwhich

contextonemightthenassesseventsandidentifychangesthatcouldpotentiallyindicateanincidentof

publichealthimportance. Furtherinvestigationofsuchasignalcoulddeterminewhetheraresponseis

warranted

and

whether

assets

should

be

deployed.

Figure

2

demonstrates

the

hypothetical

timing

of

potentiallyusefulinformationavailablefromelectronicsourcesintheevolutionofadiseaseoutbreak.

Cautionmustbetakenwhenutilizingnontraditionalinformationfrominternationalaswellasdomestic

sources;thebalanceamongfindingnewsourcesofinformation,strengtheningtheuseoftraditional

biosurveillanceinformation,andadaptingtospecificneedscanvaryfromstatetostateandcountryto

country.

However,

given

the

trend

of

emerging

diseases

with

international

origins,

the

global

monitoringofbiologicalissuesofnationalsignificanceshouldbeprioritizedforthesurveillanceof

foreigndiseaseeventsthatcouldposedisastrouspublichealthandnonpublichealtheffectsonour

nationsinfrastructure.

PreviousWorktoDevelopStrategies/RecommendationstoImprovePublicHealthandHealthcare

SituationalAwarenessandOutlineOngoingNationwideBiosurveillanceCapabilityEfforts

Appendix

III

lists

selected

strategies

and

recommendations.

In

2011,

the

National

Biosurveillance

AdvisorySubcommittee(NBAS)submittedtheirsecondreportentitled,ImprovingtheNationsAbilityto

Detect

and

Respond

to

21st

Century

Urgent

Health

Threats.

The

NBSB

supports

the

recommendations

offeredbyNBASandfullyagreesthattheachievementofcomprehensive,effectivedomesticand

internationalbiosurveillanceiscompromisedbyjurisdictionalcomplexityandinefficiencies.18

18National

Biosurveillance

Advisory

Subcommittee.

Improving

the

Nations

Ability

to

Detect

and

Respond

to

21st

Century

UrgentHealthThreats:FirstReportoftheNationalBiosurveillanceAdvisorySubcommittee.Atlanta,2009.

http://www.cdc.gov/osels/pdf/NBAS%20Report%20%20Oct%202009.pdf

11
http://www.cdc.gov/osels/pdf/NBAS%20Report%20-%20Oct%202009.pdfhttp://www.cdc.gov/osels/pdf/NBAS%20Report%20-%20Oct%202009.pdfhttp://www.cdc.gov/osels/pdf/NBAS%20Report%20-%20Oct%202009.pdfhttp://www.cdc.gov/osels/pdf/NBAS%20Report%20-%20Oct%202009.pdf


12/31

ExistenceofOngoingIntegrationInitiativeswithinAgenciesandDepartmentsInvolvedinPublic

HealthandHealthcareBiosurveillanceandSituationalAwareness

AnexampleofcurrenteffortswithinanagencyisCDCsongoingefforttodevelopandimplementadraft

CDCSurveillanceStrategy.ThiseffortinvolvesworkingacrossCDCwithleadershipandprogramsto

establishpolicy,procedures,andparameterstoimproveefficienciesandmakedatamorereadily

availableinordertoenhancecurrentandfuturesurveillance/biosurveillanceactivities.Apartofthis

effort

is

focused

on

reducing

the

burden

of

SLTT

partners

and

enhancing

their

surveillance

capabilities.

ThiseffortalsoincludestheuseofEHRsasapartofthatstrategyforpublichealthsurveillance.The

goalsofthisinitiativeareto:

Improvesurveillanceefficiencythroughaprocessofidentifyingareaswherethereareopportunities

tostandardize,consolidate,oreliminateduplication;

AdvancetheuseofEHRinformation;and

Leveragenewtechnologiesthatwillenablesharedinfrastructureandservices.

DevelopmentofaNationalPublicHealthSurveillanceandBiosurveillanceAdvisoryCommittee

(NPHSBAC)

in

the

Fall

of

2013

19

19

Charter

of

the

National

Public

Health

Surveillance

and

Biosurveillance

Advisory

Committee.

Signed

August

2012.

http://www.cdc.gov/maso/FACM/pdfs/NPHSBAC/NPHSBAC_Charter.pdf

20AlsoseeFigure3onpage14foraGAOdiagramofUSGagencybiosurveillancerolesandresponsibilities

TheCDCsNPHSBACwillproviderecommendationsfocusedonensuringtheFederalGovernmentis

meetingthegoalofenablingStateandlocalgovernmentpublichealthsurveillancecapabilities.

Specifically,theseincluderecommendationsrelatedtobothtraditionalandinnovativesourcesof

humanhealthrelatedinformationaswellastheexchangeofpublichealthandhealthcareinformation.

TheserecommendationswillsupportCDCsongoingefforttoevaluatepublichealthandbiosurveillance

activitiesacrossCDC. Wherefeasible,theserecommendationscouldalsoincludeactivitiesoutsideCDC

astheyrelatetousefulness,potentialforcoordination,overlap/redundancy,andeffortandresources

required/efficiencies. TheNPHSBACrecommendationsmaybeimplementedinpartorintheirentirety

by

the

CESG

through

the

SIG

as

it

works

to

ensure

the

integrated

analysis

and

coordination

ofbiosurveillanceinformationandactivities.

ExistenceofMultipleCoordinatingBodiesInvolvedinPublicHealthandHealthcareBiosurveillance

ActivitiestowardNationalandInternationalSituationalAwareness

Biosurveillanceactivitiestovaryingdepthsandsuccessalreadyexistatmultiplelevels,vertically(i.e.,

local,state,regional,national)andhorizontally(e.g.acrossmultipleagenciesintheUSG). Examplesof

someexistingpublichealthandhealthcaresituationalawarenessandbiosurveillancecoordinating

entities

atthenational

andinternationallevelsareprovidedin

AppendixIV.20 Someagenciesalready

work

in

concert

with

each

other

to

varying

degrees,

while

others

are

siloed,

such

that

the

full

potential

anddimension

ofthevaluable

informationandanalysis

they

mightprovide

arenotrealizedforlack

of

applyingtoafullercontextthroughsharingacrossrelevantgroups.

12
http://www.cdc.gov/maso/FACM/pdfs/NPHSBAC/NPHSBAC_Charter.pdfhttp://www.cdc.gov/maso/FACM/pdfs/NPHSBAC/NPHSBAC_Charter.pdf


13/31

Figure1.Anexampleofthepotentialutilityofsyndromicsurveillancethroughthedemonstrationofa

progressionofdatasourcesasrelatedtotheunderlyinginfectionandassociatedbehaviors.

Mandl,etal."ImplementingSyndromicSurveillance:APracticalGuideInformedbytheEarly

Experience."

Journal

of

the

American

Medical

Association

(2004):

141150.DOI10.1197/jamia.M1356

13


14/31

Figure2.Hypotheticaltimingofinformalelectronicsourcesavailableduringadiseaseoutbreak.

Keller,

M,

et

al.

"Use

of

unstructured

eventbasedreportsforglobalinfectiousdiseasesurveillance."

EmergingInfectiousDisease(2009).http://wwwnc.cdc.gov/eid/article/15/5/081114.htm DOI:

10.3201/eid1505.081114

14
http://wwwnc.cdc.gov/eid/article/15/5/08-1114.htmhttp://wwwnc.cdc.gov/eid/article/15/5/08-1114.htmhttp://wwwnc.cdc.gov/eid/article/15/5/08-1114.htmhttp://wwwnc.cdc.gov/eid/article/15/5/08-1114.htm


15/31

Figure3.UnitedStatesGovernmentagencybiosurveillancerolesandresponsibilities

U.S.GovernmentAccountabilityOffice.EffortstoDevelopaNationalBiosurveillanceCapabilityNeeda

NationalStrategyandaDesignatedLeader.p.40. Washington,D.C.:U.S.GAO,2010

http://www.gao.gov/assets/310/306362.pdf

15
http://www.gao.gov/assets/310/306362.pdfhttp://www.gao.gov/assets/310/306362.pdf


16/31

APPENDIXI

TaskLetterfromASPRto

NBSB

15


17/31

DEPARTMENT OF HEALTH HUMAN SERVICES

Office o the Secretary

Assistant Secretary for

Preparedness Response

Washington

D C 20201

JUN - 7 2 12

John S. Parker, MD, Major General (Retired)

Chair, National Biodefense Science Board

Senior Vice President

Scientific Applications International Corporation

656 Lynn Shores Drive

Virginia Beach,

VA

23452

Dear Dr. Parker and Members ofthe National Biodefense Science Board (NBSB):

The Department

of

Health and Human Services has begun activities to develop a Public Health and

Healthcare Situational Awareness (SA) Strategy and Implementation Plan (SIP). The Public Health

and Healthcare

SA

SIP aims to strengthen our overall national health security

by

serving as a

comprehensive and national strategy and implementation plan, as called for

in

the current legislation

to reauthorize the Pandemic and All Hazards Preparedness Act

P

AHP A). The Public Health and

Healthcare SA SIP will provide a common approach to building SA capabilities, to ensure the early

detection

of

incidents with potential adverse health impacts, as well as effective decision making and

resource allocation during a response.

I would like the NBSB to review and evaluate the Public Health and Healthcare SA SIP during its

development to offer guidance, including recommendations, on the measurable steps to take to

enhance our current public health and healthcare situational awareness capabilities. Biosurveillance

is one

of

the major components

of

situational awareness, therefore, I would also like the NBSB to

assess current biosurveillance activities, identify efficiencies, and make recommendations, in

coordination with the applicable existing Centers for Disease Control and Prevention (CDC)

advisory committees. The Office

of

the Assistant Secretary for Preparedness and Response (ASPR)

and the CDC will lead the SA SIP development process.

Given the

NBSB s

demonstrated ability, experience, and expertise, your contributions towards the

development

of

this strategy and implementation plan are yet another critical step taken towards

ensuring the public health and healthcare preparedness

of

our nation.

In performing your deliberations, however, I encourage the NBSB to obtain stakeholder views on

this topic using whatever means is deemed most appropriate. I look forward to discussing your initial

thoughts on this topic at the June

26,2012,

NBSB public meeting.

The

timeline for completion will

he consistent with the timeline established

in

the final reauthorization

of

the P AHPA.

Thank you for your continued diligence in serving to strengthen our nation's resilience.

Sincerely,

Nicole Lurie, MD, MSPH

Assistant Secretary for Preparedness and Response


18/31

APPENDIXII

NationalBiodefenseScienceBoardSituationalAwarenessWorkingGroupRoster

VotingMembers

Chair,

Sarah

Y.

Park,

MD,

FAAP

State

Epidemiologist

and

Chief

Disease

Outbreak

Control

Division

Hawaii

Department

of

Health

Honolulu,HI

CoChair,ManoharR.Furtado,PhD

FounderandPresident

BiologyforGlobalGoodLLC

SanRamon,CA

GeorgesC.Benjamin,MD,FACP,FACEP(E),FNAPA,

Hon

FRSPH

ExecutiveDirector

AmericanPublicHealthAssociation

Washington,DC

NelsonJ.Chao,MD,MBA

Chief

Division

of

Hematological

Malignancies

and

Cellular

Therapy

DukeUniversity

Durham,NC

DavidJ.Ecker,PhD

DivisionalVicePresidentandGeneralManager

Ibis

Biosciences,

Inc.

Carlsbad,

CA

EmilioA.Emini,Ph.D.

ChiefScientificOfficer

VaccineResearch

Pfizer,Inc.

Collegeville,PA

John

S.

Parker,

MD,

Major

General

(Retired)

SeniorVicePresident

ScientificApplicationsInternationalCorporation

VirginiaBeach,VA

ExOfficioMembers

U.S.

Department

of

Agriculture

RandallL.Levings,DVM

ScientificAdvisor

National

Center

for

Animal

Health

U.S.

Department

of

Agriculture

Ames,

IA

U.S.DepartmentofVeteransAffairs

VictoriaJ.Davey,PhD,MPH

Chief,OfficeofPublicHealthandEnvironmental

Hazards

U.S.DepartmentofVeteransAffairs

Washington,DC

ExecutiveOfficeofthePresident

AndrewM.Hebbeler,PhD

SeniorPolicyAnalyst

NationalSecurityandInternationalAffairs

OfficeofScienceandTechnologyPolicy

ExecutiveOfficeofthePresident

Washington,

DC

InvitedFederalRepresentatives

JamesB.Daniel,MPH

PublicHealthCoordinator,OfficeofProviderAdoption

Support

Office

ofthe

NationalCoordinator

forHealthIT

US

DepartmentofHealth

andHumanServices

Washington,

DC

PamelaS.Diaz,MD

Director,

Biosurveillance

Coordination

Activity

PublicHealthSurveillanceandInformaticsProgram

Office

OfficeofSurveillance,EpidemiologyandLaboratory

Services

CentersforDiseaseControlandPrevention

Atlanta,GA

17


19/31

PamEvans,CEM

Acting,Director,Secretary'sOperationCenter

OfficeofEmergencyManagement

AssistantSecretaryforPreparednessandResponse

USDepartmentofHealthandHumanServices

Washington,DC

Efrain

E.

Garcia,

PhDChief,InternationalPartnerships

DivisionofInternationalHealthSecurity

OfficeofPolicyandPlanning

OfficeoftheAssistantSecretaryforPreparednessand

Response

Washington,DC

GlennDowling,MD,MPH

Director,MedicalPreparednessPolicy

NationalSecurityStaff

TheWhite

House

Executive

Office

of

the

President

Washington,

DC

TahaA.KassHout,MD,MS

FDAChiefHealthInformaticsOfficer

FDAChiefTechnologyOfficer(Acting)

FoodandDrugAdministration


SilverSpring,MD

MichaelW.Latham

Senior

Public

Health

Analyst

PolicyandCommunicationLead

BiosurveillanceCoordinationActivity


Services

CentersforDiseaseControlandPrevention

Atlanta,

GA

KathrynLMorici,MD,MPH

ChiefScientist

NationalCenterforMedicalIntelligence

Defense

Intelligence

Agency

DepartmentofDefense

Frederick,MD

CurtisWeaver

Senior

Advisor

to

the

Director

BiosurveillanceCoordinationActivity

PublicHealthSurveillanceandInformaticsProgram

Office


Services

Centers

for

Disease

Control

and

PreventionAtlanta,GA

OtherInvitedRepresentatives

CherylAusteinCasnoff,MPH

SeniorFellow,NationalOpinionResearchCenter

UniversityofChicago

Bethesda,MD

JanetJ.Hamilton,MPH

Manager,CommunicableDiseaseSurveillanceand

Reporting

Section

DiseaseControlandHealthProtection

BureauofEpidemiology

Florida

DepartmentofHealth

Tallahassee,

FL

PaulL.Hewett,Jr,PhD

DeputyDirector

CenterforIntegratedEmergencyPreparedness

DecisionandInformationSciencesDivision

ArgonneNationalLaboratory

Lemont,

IL

MaryKeating,RN,MA

HPPCoordinator

StateESARVHP/MRCCoordinator

PublicHealthPreparednessandResponseBranch

ConnecticutDepartmentofPublicHealth

Hartford,CT

JasMantero,MD,MPH,PhD

ExpertinEpidemicIntelligence

Doctors

with

Africa

CUAMM

ItalianDevelopmentCooperationHealth

WesternEquatoriaState

SouthSudan

18


20/31

AlonzoL.Plough,PhD,MPH

Director,EmergencyPreparednessandResponse

County

of

Los

Angeles

Department

of

Public

Health

Clinical

Professor,

Health

Services

UniversityofWashingtonSchoolofPublicHealth

LosAngeles,CA

Mark

S.

Smolinski,

MD,

MPHDirector,GlobalHealthThreats

SkollGlobalThreatsFund

San

Francisco,

CA

CherylStroud,DVM,PhD

Chair,NorthCarolinaOneHealthCollaborative

AVMARepresentative,OneHealthCommission

Chair,OneHealthIntellectualExchangeGroup

DiscussionSeries

Raleigh,NC

JohnWandelt

Chief,InformationExchangeandArchitectureDivision

ExecutiveDirector,NationalInformationExchange

Federation

GeorgiaTechResearchInstitute

Atlanta,GA

ExecutiveSecretariat

JomanaMusmar,MS,PhDc

Biotechnology

Policy

Analyst

OfficeofPolicyandPlanning

OfficeoftheAssistantSecretaryforPreparednessand

Response


Washington,DC

19


21/31

APPENDIXIII

SelectedStrategies,Recommendations,andInternationalAgreementsforImprovingSituationalAwareness:

USDepartmentofHealthandHumanServicesNationalHealthSecurityStrategyoftheUnitedStatesofAmerica

(December2009).(NHSS):21

21U.S.DepartmentofHealthandHumanServices.NationalHealthSeecurityStrategyoftheUnitedStatesofAmerica.Washington

D.C.:U.S.DHHS,2009.http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhssfinal.pdf

o

Informed

and

empowered

individuals,

communities

o Nationalhealthsecurityworkforce

o Integrated,scalablehealthcaredeliverysystems

o Situationalawareness

o Timelyandeffectivecommunications

o Effectivecountermeasuresenterprise

o Prevention/mitigationofenvironmental,otherhealththreats

o Postincidenthealthrecoveryinplanningandresponse

o Crossborderandglobalpartnerships

o Science,evaluation,qualityimprovement

ImplementationPlanfortheNationalHealthSecurityStrategyoftheUnitedStatesofAmerica(May2012).

(NHSS

IP:

Objective

3

outcomes

of

the

2009

NHSSSituational

Awareness):22

22U.S.DepartmentofHealthandHumanServices.ImplementationPlanfortheNationalHealthSecurityStrategyoftheUnited

StatesofAmerica.Washington,D.C.:U.S.DHHS,2012.

http://www.phe.gov/Preparedness/planning/authority/nhss/ip/Documents/nhssip.pdf

CDC.2010.http://www.cdc.gov/osels/pdf/NBSHH_v2.pdf

o Commonnationalapproachtopublichealthandhealthcaresituationalawarenessfornationalhealth

security

o Nearrealtimeawarenessofevolvingincidentswithpotentiallynegativehealthconsequences

o Nearrealtimeawarenessofavailabilityandlocationofresources(bothpersonnelandother)beforeand

duringincidentswithpotentiallynegativehealthconsequences

o Effectivecoordinationofhealthrelatedsituationalawareness,includingscalabilityfromlocal,national,and

internationallevels,involvingbothprivateandpublicsectors

20

USDepartmentofHealthandHumanServicesNationalBiosurveillanceStrategyforHumanHealthVersion2.0

(February2010).(NBSHH):23

23

Centers

for

Disease

Control

and

Prevention.NationalBiosurveillanceStrategyforHumanHealth.ExecutiveSummary.Atlanta:

o ElectronicHealthInformationExchange

o ElectronicLaboratoryInformationExchange

o UnstructuredInformation

o IntegratedBiosurveillanceInformation

o GlobalDiseaseDetectionandCollaboration

o BiosurveillanceWorkforceoftheFuture
http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/ip/Documents/nhss-ip.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/ip/Documents/nhss-ip.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/ip/Documents/nhss-ip.pdfhttp://www.cdc.gov/osels/pdf/NBSHH_v2.pdfhttp://www.cdc.gov/osels/pdf/NBSHH_v2.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/ip/Documents/nhss-ip.pdfhttp://www.cdc.gov/osels/pdf/NBSHH_v2.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdfhttp://www.phe.gov/Preparedness/planning/authority/nhss/ip/Documents/nhss-ip.pdfhttp://www.cdc.gov/osels/pdf/NBSHH_v2.pdf


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ConceptplanforImplementationoftheNationalBiosurveillanceStrategyforHumanHealth(January2010):24

24CentersforDiseaseControlandPrevention.ConceptPlanFortheImplementationoftheNationalBiosurveillanceStrategyfor

HumanHealth.Atlanta:CDC,2010.http://www.cdc.gov/osels/pdf/Concept_Plan_V1+5+final+for+print+KMD.PDF

o Governancemodelforenhancingcollaborationbetweenstakeholders

o Approachtoassessexistingbiosurveillanceactivitiesthatcompriseourcollectiveinvestmentinnational

biosurveillanceforhumanhealth

o Approachtocommunicatingtheeffortsofthisnationwideenterprisetoawideraudienceofpolicymakers

andhealthprofessionals.

National

Strategic

Plan

for

Public

Health

Preparedness

and

Response

(September

2011).

(NSPPHPR):25

25OfficeofPublicHealthPreparednessandResponse,CDC.ANationalStrategicPlanforPublicHealthPreparedness andResponse.

Atlanta:CDC,2011.http://www.cdc.gov/phpr/publications/2011/A_Natl_Strategic_Plan_for_Preparedness_20110901A.pdf

o Preventand/ormitigatethreatstothepublicshealth

o Integratepublichealth,thehealthcaresystem,andemergencymanagement

o Promoteresilientindividualsandcommunities

o Advancesurveillance,epidemiology,andlaboratoryscienceandservicepractice

o Increasetheapplicationofsciencetopreparednessandresponsepractice

o Strengthenpublicpreparednessandresponseinfrastructure

o Enhancestewardshipofpublichealthpreparednessfunds

o Improvetheabilityofthepublichealthworkforcetorespondtohealththreats

National

Strategy

for

Biosurveillance

(July

2012)

(NSB):

26

26ThePresidentoftheUnitedStatesofAmerica.NationalStrategyforBiosurveillance.Washington,DC:TheWhiteHouse,2012.

http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Biosurveillance_July_2012.pdf

o ScanandDiscerntheEnvironment

o IdentifyandIntegrateEssentialInformation

o AlertandInformDecisionMakers

o ForecastandAdviseImpacts

NationalSecurityCouncil,NationalStrategyforCounteringBiologicalThreats(November2009),Objectives:27

27

National

Security

Council.NationalStrategyforCounteringBiologicalThreats.Washington,DC:TheWhiteHouse,2009.

http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Countering_BioThreats.pdf

o Promoteglobalhealthsecurity

o Reinforcenormsofsafeandresponsibleconduct

o Obtaintimelyandaccurateinsightoncurrentandemergingrisks

o

Take

reasonable

steps

to

reduce

the

potential

for

exploitation

o Expandourcurrentcapabilitytoprevent,attribute,andapprehend

o Communicateeffectivelywithallstakeholders

o Transformtheinternationaldialogueonbiologicalthreats

21
http://www.cdc.gov/osels/pdf/Concept_Plan_V1+5+final+for+print+KMD.PDFhttp://www.cdc.gov/osels/pdf/Concept_Plan_V1+5+final+for+print+KMD.PDFhttp://www.cdc.gov/phpr/publications/2011/A_Natl_Strategic_Plan_for_Preparedness_20110901A.pdfhttp://www.cdc.gov/phpr/publications/2011/A_Natl_Strategic_Plan_for_Preparedness_20110901A.pdfhttp://www.whitehouse.gov/sites/default/files/National_Strategy_for_Biosurveillance_July_2012.pdfhttp://www.whitehouse.gov/sites/default/files/National_Strategy_for_Countering_BioThreats.pdfhttp://www.whitehouse.gov/sites/default/files/National_Strategy_for_Countering_BioThreats.pdfhttp://www.whitehouse.gov/sites/default/files/National_Strategy_for_Biosurveillance_July_2012.pdfhttp://www.cdc.gov/phpr/publications/2011/A_Natl_Strategic_Plan_for_Preparedness_20110901A.pdfhttp://www.cdc.gov/osels/pdf/Concept_Plan_V1+5+final+for+print+KMD.PDF


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NationalBiosurveillanceScienceandTechnologyRoadmap(June2013)identifieshighpriorityresearchand

developmentobjectivestobeprioritizedtoenablethecorefunctionsoftheNSB2012:28

28NationalScienceandTechnologyCouncil.NationalBiosurveillanceScienceandTechnologyRoadmap.WashingtonDC: Executive

OfficeofthePresident.17June2013.

http://www.whitehouse.gov/sites/default/files/microsites/ostp/biosurveillance roadmap 2013.pdf

o Establishbaselinelevelsofcommunityandecosystemrisks,threats,andhealth;

o Identifycausesofaberrationsfromnormalattheecosystem,organism,reservoir,vector,andhostnexus;

o Identifyindicatorsthatareassociatedwithpotentialoutbreaksanddevelopmodelsusingtheseindicatorsto

assistinbetterdecisionmakingatalllevels;

o Enhance

information

integration,

analysis,

and

sharing

platforms

for

improved

situational

awareness

ofbiosurveillanceinformationatalllevels,includingwithinternationalpartners,asappropriate;

o Furtherdeveloptechnologicalsolutionsthatintegrateandanalyzeelectronichealthinformation,while

protectingprivateinformation,tobetterinformhealthdecisionmaking;

o Identifyandevaluatetheutilityofnovelsourcesofbiosurveillanceinformation,suchassocialmedia;

o Improveexposureassessmentanddiagnosticcapability,especiallyatthepointofcare,toenableaccurate

and

timely

collection

of

information

for

early

detection

and

situational

awareness

throughout

an

incident,

and;

o Improveidentificationandcharacterizationofknownandunknownhealththreats.

OfficeoftheNationalCoordinatorforHealthInformationTechnologyCoordinatedFederalHealthInformation

TechnologyStrategicPlan:20082012(June2008).(ONCHIT2008):29

29

OfficeoftheNationalCoordinatorforHealthInformationTechnology.TheONCCoordinatedFederalHealthInformation

TechnologyStrategicPlan:20082012.Synopsis.Washington,DC:DepartmentofHealthandHumanServices,2008.

http://dhhs.nv.gov/HOLD/HIT/docs/ONC20082012HITStrategicPlanSummary.pdf

o PrivacyandSecurity:Facilitateelectronicexchange,access,anduseofelectronichealthinformationwhile

protectingtheprivacyandsecurityofpatientshealthinformation

o Interoperability:Enablethemovementofelectronichealthinformationtowhereandwhenitisneededto

supportindividualhealthandcareneeds

o Adoption:PromotenationwidedeploymentofEHRsandpersonalhealthrecordsthatputinformationtouse

insupportofhealthandcare

o CollaborativeGovernance:Establishmechanismsformultistakeholderprioritysettinganddecisionmaking

toguidedevelopmentofthenationshealthITinfrastructure

o PrivacyandSecurity:Advanceprivacyandsecuritypolicies,principles,procedures,andprotectionsfor

informationaccessanduseinpopulationhealth

o Interoperability:

Enable

the

mobility

of

health

information

to

support

populationoriented

uses

o Adoption:Promotenationwideadoptionoftechnologiesandtechnicalfunctionsthatwillimprove

populationandindividualhealth

o CollaborativeGovernance:Establishcoordinatedorganizationalprocessessupportinginformationusefor

populationhealth

OfficeoftheNationalCoordinatorforHealthInformationTechnologyFederalHealthInformationTechnology

StrategicPlan:20112015(September2011).(ONCHITPerformancemeasuresavailablepg49AppendixA):30

30

Office

of

the

National

Coordinator

for

Health

Information

Technology.FederalHealthInformationTechnologyStrategicPlan:

20112015.Washington,DC:DepartmentofHealthandHumanServiceshttp://www.healthit.gov/sites/default/files/utility/final

federalhealthitstrategicplan0911.pdf

o AchieveAdoptionandInformationExchangethroughMeaningfulUseofHealthIT

o ImproveCare,ImprovePopulationHealth,andReduceHealthCareCoststhroughtheUseofHealthIT

22
http://www.whitehouse.gov/sites/default/files/microsites/ostp/biosurveillance_roadmap_2013.pdfhttp://dhhs.nv.gov/HOLD/HIT/docs/ONC2008%E2%80%902012HITStrategicPlanSummary.pdfhttp://dhhs.nv.gov/HOLD/HIT/docs/ONC2008%E2%80%902012HITStrategicPlanSummary.pdfhttp://dhhs.nv.gov/HOLD/HIT/docs/ONC2008%E2%80%902012HITStrategicPlanSummary.pdfhttp://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://www.healthit.gov/sites/default/files/utility/finalfederal%E2%80%90http://dhhs.nv.gov/HOLD/HIT/docs/ONC2008%E2%80%902012HITStrategicPlanSummary.pdfhttp://www.whitehouse.gov/sites/default/files/microsites/ostp/biosurveillance_roadmap_2013.pdf


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o InspireConfidenceandTrustinHealthIT

o EmpowerIndividualswithHealthITtoImprovetheirHealthandtheHealthCareSystem

o AchieveRapidLearningandTechnologicalAdvancement

NationalBiosurveillanceIntegrationCenterStrategicPlanDHS(November2012).CorePrinciples:31

31U.S.DepartmentofHomelandSecurity,NationalBiosurveillanceIntegrationCenterStrategicPlan.November2012

http://www.dhs.gov/sites/default/files/publications/nbicstrategicplanpublic2012.pdf

o InteragencycollaborationthroughtheNationalBiosurveillanceIntegrationSystem,wherenew

communicationprocessesandpolicieswillbepursued

o Information

integration

and

sharing,

from

NBIS

partner

surveillance

systems,

in

which

appropriate

information

technology

(IT)

systems,

business

rules,

and

partner

information

management/ownership

verification

will

be

a

priority;

o Analysis,whichrequiresmultidisciplinary,crosscutting,andindepthanalyticsupporttoprovidetimelyand

relevantinformationtosupportdecisions;

o Userdefinedreporting,recognizingthatallaspectsofNBICsanalysisandproductsmustbetailoredand

customerfocused.

o Effectivedisseminationofinformationinatimelyfashionwithimprovedrealtimecommunicationmethods

withNBSIpartners,andenhancedICinformationsharing.

ImprovingtheNationsAbilitytoDetectandRespondto21stCenturyUrgentHealthThreats: FirstReportofthe

National

Biosurveillance

Advisory

Subcommittee

(April

2009).

(NBAS

1):32

32

NationalBiosurveillanceAdvisorySubcommittee.ImprovingtheNationsAbilitytoDetectandRespondto21stCenturyUrgent

HealthThreats:FirstReportoftheNationalBiosurveillanceAdvisorySubcommittee.Atlanta,2009.

http://www.cdc.gov/osels/pdf/NBAS%20Report%20%20Oct%202009.pdf

o StrongExecutiveBranchleadershipincoordinationofnationalbiosurveillance

o Dueconsiderationofglobalhealththreats

o Adequatefundingforpersonnelforbiosurveillanceprograms

o InvestmentinEHRsandlabinformation

o Strategicinvestmentsinnewtechnologies

Improving

the

Nations

Ability

to

Detect

and

Respond

to

21st

Century

Urgent

Health

Threats:

Second

Report

of

the

National

Biosurveillance

Advisory

Subcommittee

(April

2011).

(NBAS

2):33

33

National

Biosurveillance

Advisory

Subcommittee.ImprovingtheNationsAbilitytoDetectandRespondto21stCenturyUrgent

HealthThreats:SecondReportoftheNationalBiosurveillanceAdvisorySubcommittee.April2011.

http://www.cdc.gov/about/advisory/pdf/NBASFinalReport April2011.pdf

o GovernanceestablishpolicyoversightofthebiosurveillanceenterprisethroughtheExecutiveOfficeofthe

Presidents

National

Security

Staff,

with

a

lead

advisory

group

established

to

provide

ongoing

input

on

biosurveillanceevents

o InformationExchangeneedforanimprovedlegalframeworktobetterenablestatefederalinformation

sharingtobeintegratedintoasystemofbiosurveillanceforhumanhealth,inharmonywiththe

InternationalHealthRegulations.

o Workforceaddresswideninggaps,keyprofessionsinpublichealthneedenhancement;modern

workforces

should

crosstrainandcollaboratewithcliniciansandbasicscientistsinhumanandanimal

health.

o ResearchandDevelopmentshouldfocusonrealtimeinformationcollection,easilydeployabledetection

methods,andstreamlinedassayvalidationtobettersurveyforpathogensandbiomarkersofhealthand

disease.

23
http://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdfhttp://www.cdc.gov/osels/pdf/NBAS%20Report%20%E2%80%90%20Oct%202009.pdfhttp://www.cdc.gov/osels/pdf/NBAS%20Report%20%E2%80%90%20Oct%202009.pdfhttp://www.cdc.gov/osels/pdf/NBAS%20Report%20%E2%80%90%20Oct%202009.pdfhttp://www.cdc.gov/about/advisory/pdf/NBASFinalReportApril2011.pdfhttp://www.cdc.gov/about/advisory/pdf/NBASFinalReportApril2011.pdfhttp://www.cdc.gov/osels/pdf/NBAS%20Report%20%E2%80%90%20Oct%202009.pdfhttp://www.dhs.gov/sites/default/files/publications/nbic%E2%80%90strategic%E2%80%90plan%E2%80%90public%E2%80%902012.pdf


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24

):34

AnEvaluationofourNationsPublicHealthandHealthcareSituationalAwareness:ABriefReportoftheNational

BiodefenseScienceBoard(April2013

34NationalBiodefenseScienceBoard.AnEvaluationofOurNationsPublicHealthandHealthcareSituationalAwareness:ABrief

ReportfromtheNationalBiodefenseScienceBoard.WashingtonDC:U.S.DHHS,2013.


o SecretaryofHHSdesignateacentralsituationalawarenessoversightauthorityforcoordinatingallpublic

healthandhealthcaresituationalawarenessinformationthathavealreadybeencollected,processed,and

analyzedfromrespectiveagenciesonanationallevel.

o Assuranceofacommonandunifiedstrategyamongallstakeholdersinvolvedinpublichealthand

healthcare

situational

awareness

efforts,

with

the

scopes

of

both

public

health

and

healthcare

situationalawarenesstobeexplicitlydefined.

o Identificationofthespecificquestionstobeansweredinsupportofbothpublichealthandhealthcare

situationalawareness.

o Recognitionthatthesystemforinformationcoordinationmustintegratetheexpertiseandexperiencefrom

across

all

levels

and

sectors.

o Bidirectionalcommunicationofgovernmentagencieswithallstakeholders,publicandprivate.

o Cautionindevelopingcommontechnologicalsystemsforsituationalawarenessandbiosurveillancesuch

that

the

valuable

complexities

of

some

existing

systems

are

not

reduced

or

lost.

o Establishmentoffunctionalstandardsforinformationreportingtopromoteacommonunderstandingofthe

targetsystemsandcapabilities.

World

Health

Organization

(WHO)

International

Health

Regulations

(IHR)

2005

(Revised)35

35

International

Health

Regulations

(2005).

Switzerland:

World

Health

Organization,

2008.

http://www.who.int/ihr/9789241596664/en/

o TheformalIHRnotificationprocesshasa72hourtimelineandconsistsofmanybidirectionalinformaland

formal

information

sharing

pathways

leading

up

to,

during,

and

after

an

IHR

event

notification

to

the

WHO,

whichenhancesthecollaborationandcoordinationrequiredduringapublichealtheventresponse.

o Specifically,theIHRnotificationprocesscontributestobiosurveillanceactivitiesby:

o Providinginternationalcriticalinformationcommunicationrequirementsandastandarddecisionmatrixfor

usebyallmembersoftheWHO.

o Providingafunctionalnationalfederalpointofcontactwithdirectresponsibilityforcommunicatingand

receivinginformationfrominternalandexternalstakeholders.

o IntegratesIHRsubjectmatterexpertsintodomesticeventinformationcommunicationpathwaystoensure

that

obligation

under

the

IHR

(2005)

are

maintained.

o Enablestheestablishmentofformal/informalrelationshipsthatimprovecoordinationandcollaboration

duringemergencies

Gorgas

Memorial

Institute

(Panama)

Cooperative

Agreement

o HHSASPRispartneredwiththeGorgasMemorialInstituteofHealthStudies(GMI)tostrengthenPanamas

laboratorydiagnosticcapacitytorapidlydetect,communicate,andcontrolthespreadofselectbiological

threatagentsandpandemicinfluenza.

o TheprojectaimstosupportGMItomeetthestandardsforinternationalmembershipandadmissioninto

theU.S.LaboratoryResponseNetwork(LRN)atHHSCDC.

o ThisprojectispartofanoverallHHSefforttobuildcapacityabroadwiththeultimateintentofdetecting,

stopping

or

limiting

the

threat

or

spread

of

bioterrorism

agents

and

pandemics

to

the

United

States,

thus

enhancingthehealthsecurityoftheAmericanpopulation.
http://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa%E2%80%90evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa%E2%80%90evaluation.pdfhttp://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa%E2%80%90evaluation.pdfhttp://www.who.int/ihr/9789241596664/en/http://www.who.int/ihr/9789241596664/en/http://www.phe.gov/Preparedness/legal/boards/nbsb/Documents/sa%E2%80%90evaluation.pdf


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ASPRPartnershipwiththeInstitutePasteurandFUMEC(Mxico)specificregionalpartnerships

o ASPRsDivisionofInternationalHealthSecurity(DIHS)supportsglobalbiosurveillanceeffortsbypartnering

withscientific,publichealth,andbiomedicalinstitutionsthroughtheprovisionofprogrammaticfundingand

expertiseforcertaincountries(e.g.Mexico,Cambodia,Senegal,Cameroon,andtheCentralAfrican

Republic)tobuild,maintain,andenhanceinfluenzaandotherrespiratoryinfectiousdiseasesurveillance.

o Mainbiosurveillanceactivitiesincludesentinelandlaboratorysurveillanceforbothinfluenzalikeillnessand

severe

acute

respiratory

illnesses

in

African

countries;

human,

animal,

and

environmental

laboratory

surveillanceforH5N1inCambodia;andestablishmentoftheBiosafetyLevel(BSL)3laboratoryandtraining

onbioterrorismagentsaswellasdevelopmentoftheAlertaMexsystem,anautomateddiseaseanalysisand

earlywarningsysteminMexico.

25


27/31

APPENDIXIV

ExamplesofFederalSituationalAwarenessandBiosurveillanceCoordinatingEfforts:

CDCBiosurveillanceCoordinationActivity(BCA):36

36PublicHealthSurveillanceandInformaticsProgramOffice.BiosurveillanceCoordinationActivityCoordinatingBiosurveillance

Efforts

for

CDC.2012Atlanta:CentersforDiseaseControlandPrevention.

http://www.cdc.gov/osels/phsipo/docs/pdf/factsheets/BCA_Overview_12_232372_O_remediated_10_26_2012.pdf

BCAcoordinatesthedevelopmentofstrategies,initiatives,andactionstointegratehumanhealthinformation

intoacomprehensivenationalbiosurveillanceenterprisetoimprovetheUnitedStatesabilitytorespondto

publichealthemergencies. Theoverarchinggoalistoprovidedecisionmakerswiththeessentialinformation

neededfortheearlydetection,rapidresponse,management,andmitigationofthesepotentiallycatastrophic

events. BCAcollaboratesacrossCDCwithfederaldepartmentsandotherpartnerstostrengthentheenterprise

byworkingtointegratecurrentactivitiesandsystemswhileleveragingnewandpromisingtechnologies.

CDCNationalCenterforEmergingandZoonoticInfectiousDiseases(NCEZID)37

37

About

the

National

Center

for

Emerging

and

Zoonotic

Infectious

Diseases,

CDC.June9,2011.

http://www.cdc.gov/ncezid/aboutncezid.html

NCEZIDiscomposedofsevendivisionsthatworkwithpartnersthroughouttheUnitedStatesandaroundthe

world

to

prevent

illness,

disability,

and

death

caused

by

a

wide

range

of

infectious

diseasesfrom

the

rare

but

deadly,

like

anthrax

and

Ebola

hemorrhagic

fever,

to

the

more

common,

like

foodborne

disease

and

healthcare

associatedinfections. NCEZIDsworkoveralldirectlyreflectscurrentCDCprioritiestostrengthensurveillance

and

epidemiology,

enhance

the

agencys

ability

to

support

state

and

local

public

health,

provide

leadership

in

globalhealth,promoteeffectivepublichealthpolicy,andaddresstheleadingcausesofdeath,illness,and

disability.

CDCOfficeofPublicHealthPreparednessandResponse,DivisionofEmergencyOperations(DEO),Emergency

OperationsCenter38

38

Office

of

Public

Health

Preparedness

and

Response,

N.D http://www.cdc.gov/about/organization/ophpr.htm

DEOisresponsibleforoverallcoordinationofCDCspreparedness,assessment,response,recovery,and

evaluationpriortoandduringpublichealthemergencies. DEOisalsoresponsiblefortheCDCEmergency

OperationsCenter,whichmaintainssituationalawarenessofpotentialhealththreats24hoursaday,7daysa

week,365daysayear,andisthecentralizedlocationforeventmanagementwhenactivated. TheSituational

Awareness

Section

in

the

EOC

applies

knowledge

management

and

information

technologies

to

define

andcollectrelevantsocialdemographic,criticalinfrastructure,physical/environmental,andpublichealthdatato

informscienceandimproveallocationandapportionmentofcriticalresourcesduringemergencies.

Coordinatingwithincidentmanagementandscientificresponsestaff,thesectionproducesanalyticalproducts,

reports,databases,andgeospatialvisualizationstosupportallhazardssituationawarenessandenhance

decisionsandunityofeffort.

DHSNationalNetworkofFusionCenters39

39

National

Network

of

Fusion

Centers

Fact

Sheet.N.D.http://www.dhs.gov/nationalnetworkfusioncentersfactsheet

FusionCentersserveasprimaryfocalpointswithinthestateandlocalenvironmentforthereceipt,analysis,

gathering,andsharingofthreatrelatedinformationamongfederal,SLTTpartners. FusionCenterseffectively

andefficientlyutilizemultipleinternalandexternalinformationsourcestoconductanalysisforsituational

awareness,

provide

rapid

decision

support,

and

remain

on

the

forefront

of

indicators

and

warnings

of

public

.

26
http://www.cdc.gov/osels/phsipo/docs/pdf/factsheets/BCA_Overview_12_232372_O_remediated_10_26_2012.pdfhttp://www.cdc.gov/ncezid/about%E2%80%90ncezid.htmlhttp://www.cdc.gov/ncezid/about%E2%80%90ncezid.htmlhttp://www.cdc.gov/ncezid/about%E2%80%90ncezid.htmlhttp://www.cdc.gov/about/organization/ophpr.htmhttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.dhs.gov/national%E2%80%90network%E2%80%90fusion%E2%80%90centers%E2%80%90fact%E2%80%90sheethttp://www.cdc.gov/about/organization/ophpr.htmhttp://www.cdc.gov/ncezid/about%E2%80%90ncezid.htmlhttp://www.cdc.gov/osels/phsipo/docs/pdf/factsheets/BCA_Overview_12_232372_O_remediated_10_26_2012.pdf

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