Biological and other disaster threats – whether accidental, driven by forces of nature, or intentional – pose fairly grave risks to the United States and the world. Situational awareness has been a conspicuous topic ever since the 9/11 attacks and the anthrax scare that followed shortly thereafter. Since then we have experienced numerous disasters: health impacts of major weather events such as hurricanes and earthquakes, new virus outbreaks like Ebola in Africa, raging wildfires on the West Coast (I live in California), and the ever-present threat of pandemic flu which a hundred years ago infected some 500 million people across the globe and killed an estimated 50 million people worldwide, according to the Center for Disease Control and Preparedness (CDC).
But since the initial flurry of public health preparedness funds in the ensuing several years after the 9/11 attacks, this topic has not had a high priority at CDC nor the funding necessary to implement it successfully.
Many of these issues came to a head with the formation of a Bipartisan Blue Ribbon Study Panel on Biodefense in 2014 which released its National Blueprint for Biodefense in October, 2015. This exhaustive study contains numerous recommendations related to the leadership, funding, and tactical shortcomings of US preparedness and response.
The publication of this report was followed by a September 2017 Government Accountability Office (GAO) report, Public Health Information Technology: HHS Has Made Little Progress toward Implementing Enhanced Situational Awareness Network Capabilities. Of particular interest to the informatics community, GAO pointed out lapses in completing Congressionally-mandated requirements for this area including the definition of minimal data elements required and collaboration with state, local, and tribal public health officials on the development of standards and procedures to ensure proper data collection. Despite limited investments over the years, the lack of progress has been apparent.
More recently the Blue Ribbon Study Panel on Biodefense held a meeting in Washington last week that focused on assessing progress on implementing key elements of their 2015 report. I can’t say I felt encouraged by the testimony which continued to lament the chronic under funding and lack of coordinated leadership at all levels of government. Dr. Anne Schuchat, Principal Deputy Director and former Acting Director of the CDC, gave a well-received report about real-time syndromic surveillance (SS) reporting in the United States from hospital emergency departments. In fact, her entire testimony was about work CDC is doing to strengthen its information systems, and in addition to SS reporting she called out mortality reporting, electronic lab reporting, and flu surveillance.
I find the current situation distressing. Responsibility for public health emergency preparedness and response has moved from CDC to the Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR). In fact, my colleagues and friends at CDC, the Office of the National Coordinator for Health Information Technology (ONC), and other offices within HHS do not even seem to have this issue on their radar. Projects we are supporting, including the open source Reportable Condition Knowledge Management System (RCKMS) which underpins the national Electronic Case Reporting initiative, continue to scrape by with minimal funding.
But there may be some hope in sight. The Pandemic and All Hazards Preparedness Act (PAHPA) is in the midst of reauthorization by Congress (to date it has passed the House and awaits passage in the Senate). This legislation reauthorizes and provides continuing funding for a number of biodefense programs and agencies.
In October, the White House released the National Biodefense Strategy, a concise document that defines a broad strategy for preventing, preparing for, and responding to natural, accidental, or deliberate biological threats. From a public health standpoint, this strategy is light on details but that is probably by design. The CDC – cornerstone of public health preparedness in the United States – is not even mentioned.
Hopefully, final passage of PAHPA will bring increased funding and focus to biodefense activities. It will likely bring increased reorganization and renewed focus within the Federal government, but hopefully we won’t find the baby thrown out with the bath water: new agencies have a tendency to want to do things their way and ignore years of institutional experience and talent that exists in other parts of government. Public health agencies at all levels – and professional associations – need to be ready to re-engage on biodefense-related issues as they emerge. It is important to recognize that infrastructure for biopreparedness and defense can often be put to good use for other initiatives, and in many way can be better justified through this “double duty” of supporting both biodefense and conventional activities.
As described in last week’s Blue Ribbon Panel meeting, the Federal government is working hard on developing new partnerships to not only try to address biodefense risks at their source, and also to engage the private sector in planning both preventative and reactive strategies. In testimony at the meeting, Tim Morrison, senior director for weapons of mass destruction and biodefense at the National Security Council (NSC) who played a critical role in the drafting of the White House’s National Biodefense Strategy said that one of the elements of the new biodefense strategy “that sets this strategy apart from some of the prior work, is the reliance on innovation; engaging the private sector in harnessing what technology can do to help the United States deal with biodefense challenges.” Open source software can play a key role in this strategy by providing scalable, high-quality, and innovative solutions to keep the United States ahead of the threats.
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