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Enhancing Nationwide Biosurveillance for Human Health

Biosurveillance Coordination Unit

Dan Sosin, M.D., M.P.H, F.A.C.P.(CDC/COTPER)

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Urgent Threats: Infectious Diseases

West Nile Virus

SARS

Foodborne Disease

Pandemic Influenza

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Urgent Threats: Terrorism

9/11 Anthrax

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Urgent Threats: Chemical Releases

Ammonia Leak

Chlorine Spill

Hazardous Materials

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Urgent Threats: Natural Disasters

Hurricanes

Wildfires

Floods

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Public Health Protection in a Small World

Requires:

Fast and accurate detection Fast and credible science Fast and effective communication Fast and effective coordination Fast and effective action

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National Biosurveillance Priority

Homeland Security Presidential Directives 9 and 10 Create new biological threat awareness capacity; Establish an integrated warning system

Pandemic and All-Hazards Preparedness Act of 2006

Homeland Security Presidential Directive-21 mandates the need to, “establish an operational national…[bio]surveillance system for human health” and a “Federal Advisory Committee … to ensure that the Federal Government is meeting the goal of enabling State and local government public health surveillance capabilities” Biosurveillance Coordination Unit (BCU) formed to lead

interagency efforts

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Scope of Biosurveillance

“active data-gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health --whether infectious, toxic, metabolic, or otherwise, and regardless or intentional or natural origin--in order to achieve early warning of health threats, early detection of health events, and overall situational awareness of disease activity” (HSPD-21, paragraph 2 a)

The science and practice of managing health-related data and information so that effective action can be taken to mitigate adverse health effects from urgent threats

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Biosurveillance Inputs

Skilled WorkforceSkilled Workforce

Surveillance ProgramsSurveillance Programs

Un-Structured SurveillanceUn-Structured SurveillanceNon-Public Health DataNon-Public Health Data

InvestigatingInvestigating

BiosurveillanceBiosurveillance

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Enhanced Biosurveillance: A Different Look

Situation awareness“The perception of elements in the environment within

a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future” -- Endsley

Critical information requirements -- Weaver How I see the enemy (threats)

How I see my myself (response assets)

How I prevent the enemy from seeing me (what makes me vulnerable)

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Enhanced Biosurveillance: What The Future Looks Like

All-source, relevant, accurate, timely, and actionable information for government, healthcare, business, and personal decision-making around health emergencies

Improved horizontal and vertical information sharing

Enhanced capability through shared responsibility

Related initiatives integrated and priorities set collaboratively for limited resources

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Enhanced Biosurveillance: What It Will Take

Workforce New skills Greater capacity

New Science Bridging of information and analytic fields Data and information safeguards Responsible application of new methods

Modified Workflows and Business Processes

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Enhanced Biosurveillance: Challenges

Workforce Limitations Capacity reductions at the most skilled end of the workforce

Lack of competencies, curriculum, and mechanisms to develop with biosurveillance workforce of the future

Duplication of Efforts Constrained data sharing

Limited interagency collaboration and visibility of relevant work

Unstable Funding Impedes research and development

Impedes recruitment, retention, and collaboration

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Enhanced Biosurveillance: The Way Forward

The National Biosurveillance Strategy for Human Health (NBSHH) Builds on the current capabilities and relationships

Respects multiorganizational and multidisciplinary perspectives

Ensures protection of rights and authorities

Serves as a reference point for the next generation biosurveillance capability

Version 1.0 was distributed on December 15, 2008

The National Biosurveillance Advisory Subcommittee

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The Strategy is a product of the collaborations of several multi-disciplinary working groups and engagements of additional biosurveillance stakeholders.

The network of stakeholders includes: Federal Agencies and State, Local, Territorial and Tribal

Governments The Healthcare Industry and International Partners Private Sector, Academia, and Community-based Organizations

While having broader missions, the professional communities protecting Animal, Plant and Environmental Health have direct impact on human health security and are stakeholders as well.

The Strategy: Collaborations

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The Strategy: Vision

An approach that addresses all-hazards and all-populations to mitigate the full spectrum of public health emergencies;

A vertically- and horizontally-networked enterprise of complementary systems which provides biosurveillance capability and multi-directional information exchanges between and among domestic and international stakeholders;

A dynamic situation awareness capability that meets the health-related needs appropriate for the roles, responsibilities, and assets of the stakeholders.

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The Strategy: Vision

An environment that enables both ongoing and ad hoc data collection, real-time analyses, and feedback processes to facilitate continuous evaluation and adaptation;

Enhanced case detection and disease reporting through electronic health and laboratory information;

Evaluation and judicious integration of newer sources of biosurveillance data;

Biosurveillance technology to support professional judgment; and

A strengthened and competent biosurveillance workforce.

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The Strategy: Priorities

Electronic Health Information Exchange Create nationwide capability for health information exchange Strengthen surveillance processes and notifiable disease

reporting mechanisms, including electronic laboratory reporting Electronic Laboratory Information Exchange

Create a governance structure for electronic laboratory information exchange

Ensure interoperability and collaboration across human health-relevant laboratory domains

Unstructured Data Identify options for the use and management of unstructured

data Develop the capacity to collect and utilize unstructured data for

biosurveillance for human health purposes

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The Strategy: Priorities

Integrated Biosurveillance Information Establish a nationwide capability for integrated biosurveillance

information management and exchange Create a collaborative environment for sharing of situation

awareness information and health intelligence Global Disease Detection and Collaboration

Strengthen Partnerships and leverage resources of U.S. Government (USG) and Non-USG partners

Support efforts to connect the worldwide “network of networks” to foster more rapid information sharing and earlier detection

Biosurveillance Workforce of the Future Assess current biosurveillance workforce capability – Identify

numbers, composition and gaps Ensure a competent biosurveillance workforce through a

continuous learning system

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The Strategy: Phase II Interagency Concept Plan (CONPLAN)

Concept Plan encourages interagency collaboration and more effective data sharing

Cataloging Biosurveillance Activities Internal CDC registry Intergovernmental registry

Governance Component

Draft version of the CONPLAN is due no later than June 30, 2009

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National Biosurveillance Advisory Subcommittee (NBAS)

“To ensure that the Federal Government is meeting the goal of enabling state and local government public health surveillance capabilities” (HSPD-21)

To review, research, guide, and endorse the National Biosurveillance Strategy for Human Health on an annual basis

To serve as an innovative engine for advancing nationwide biosurveillance capability

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NBAS Facts

Created by the Advisory Committee to the CDC Director on May 1, 2008

Comprised of 33 prominent public and private biosurveillance stakeholders and contributors

Independent advisors for the development of the next generation biosurveillance capability

Chaired by Dr. Larry Brilliant, Exec. Dir. Google.org

Supported by Federal agencies : HHS– ASPR,CDC, FDA, ONC; DHS; DoD; VA; USDA; FBI; and EPA

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NBAS Task Force CompositionDiagnostics and Laboratory Information Exchange

Steve Hinrichs (Champion)Ruth CarricoScott LayneBill Stephens

Consultant: Beth Seidenberg

Biosurveillance Workforce of the Future

Jim Hadler (Champion)

Sanford Climan

Tomas Aragon

Suzanne Delbanco

Global Disease Detection and Collaboration

Peggy Hamburg (Champion)

David Heymann (Champion)

Rajeev Venkayya

Denis Coulombier

Jonathan LordConsultants: Mark Smolinski, Jarvis Barbosa da Silva, David Paul Fidler, Louise Gresham, Jim Hughes, Patrick Kelley, Stephen Morse, Melinda Moore, Mike Ryan

Cross-Sector Collaborations for Biosurveillance Strategies

Tara O’Toole (Champion)Greg PolandPaul JarrisConsultants: Eric Rasmussen, Jeff Levi

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NBAS Task Force CompositionIntegrating Clinical and Public Health Reporting

Farzhad Mostashari (Champion)

Cecil Lynch

Gregg Istre

Chris Ross

Consultant: Art Davidson

Animal, Food, and Vectors

Art Reingold (Champion)Heather CaseJeff Engel

Michael Williams

Consultants: Tracey McNamara

Genomic Epidemiology and Digital Technologies

Ian Lipkin (Champion)

Ron Brookmeyer

James Heywood

John Russell

Ken MandlConsultant: David Relman

Environmental Monitoring

Linda McCauley (Champion)

Al Bronstein

Erica Pan

Consultants: Paul Epstein

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NBAS Steering Committee

Animal Foods and Vectors Arthur Reingold

Integrating Clinical and Public Health Reporting Farzad Mostashari

Genomic Epidemiology and Digital Technologies W. Ian Lipkin

Biosurveillance Workforce of the Future James Hadler

Cross Sector Collaborations

Tara O'Toole

Environmental Monitoring

Linda McCauley

Global Disease Detection and Collaboration

Peggy Hamburg and David Heymann

Diagnostics and Laboratory Information Exchange

Steven Hinrichs

Dr. Larry Brilliant, Chair

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NBAS Time Line

Aug 08 – Full Subcommittee convened

Sept 08 – Task Forces convened

Dec 08 – Task Force recommendations received

Jan 09 - NBAS Steering Committee Meeting Set 5 priority themes and writing process

Secretary’s Interim Letter Report

Stimulus/recovery package-ready recommendations

Mar 09 – NBAS Report and 2009 workplans

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Enhanced Biosurveillance:What You Can Do

Learn more about BCU activities http://intra-apps.cdc.gov/od/otper/bcu/default.asp

Contribute to current activities Open dialogue forums: BAT, SLTT Concept Plan Team

Improve the National Biosurveillance Strategy for Human Health, V1.0 - Comments Blog http://nbshh10.blogspot.com/

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Current BCU Detailees

Pam Diaz (NCPDCID)- Director Curtis Weaver (DSNS)– Deputy Director

Christine Bradshaw (DSLR)Medical Officer

Jennifer McGehee (NCPHI)Public Health Informatician

Gail Williams (NCHM)Communications Lead

Cathy Chow (COTPER) NBAS Scientist

Helen Schurz Rogers (NCEH)NBAS Scientist

Laura Conn (NCPHI)NBAS Scientist

Yoon Miller (DSAT)NBAS Scientist

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Current BCU Openings

BCU Director Policy/Communications Lead Epidemiology Lead Informatics Health Scientist Sr. Public Health Advisor

Apply and find job descriptions at: http://www.usajobs.gov

For additional questions contact:Curtis Weaver (BCU) – atr8@cdc.gov

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Biosurveillance Coordination Unit

For more information contact:

Biosurveillance Coordination Unit

Centers for Disease Control and Prevention

1600 Clifton Rd., NE, MS:K-72

Atlanta, GA 30333

Phone: 770-488-8806

bcucomments@cdc.gov

http://intra-apps.cdc.gov/od/otper/bcu/default.asp

Thank you!