National Strategy for Biosurveillance: Anything New?

Reviewed by Siddha Hover (GMU Biodefense PhD program)

The Obama administration published the National Strategy for Biosurveillance on July 31st of this year. The Strategy seeks to lay the foundation for the forthcoming biosurveillance strategic implementation plan, set to be published before the end of 2012.  The self-expressed goal of the Biosurveillance Strategy is to provide “a well-integrated national biosurveillance enterprise that saves lives by providing essential information for better decisionmaking at all levels”. Although official recognition of the need for effective biosurveillance is important, the strategy has two key flaws; a general lack of originality and an over-broadening of that which constitutes biosurveillance.

Before the flaws of the Biosurveillance Strategy can be examined, however, a cursory overview of its content is necessary. The Strategy employs rhetorical mechanisms of  “guiding principles”, “core functions” and “enablers” to present an introduction to US biosurveillance goals.  Emphasizing the use of “existing, multipurpose capabilities” the strategy presents four key national goals – discerning the environment, identifying essential information, alerting decision makers, and forecasting. These goals are enabled by the aptly titled “enablers”, which include the integration of capabilities, capacity building, encouraging innovation, and strengthening interactions across multiple sectors.

These concepts are indeed relevant. Cross-sector information sharing is indeed crucial to effective biosurveillance, as is innovation in detection technologies. However, these and similar suggestions have already been made reiteratively over the last decade, by almost all relevant stakeholders, in relation both to biological threats specifically and terrorism writ-large. Gregory Koblentz, in his book Living Weapons: Biological Warfare and International Security, published in 2009, calls explicitly for innovative “detection, protection, and treatment technologies”.  The 9/11 Commission Report, published in 2004, has entire sections dedicated to the need for increased cross-sector information sharing. The choice to pursue status-quo principles, core functions, and enablers of the Strategy is not a negative reflection on the content itself, and there is merit in the argument that these suggestions remain pertinent. However,  the lack of originality in the Strategy is nonetheless disheartening and concerning. Disheartening because the superficial treatment of the need for improvements in our national biosurveillance could be interpreted as official ambivalence. Concerning because the most virulent diseases, whether manufactured by terrorists or reassorted in pigs, are often characterized by a devastating aptitude for change.

The second flaw within the Strategy is the broadening of the concept of biosurveillance.  Biosurveillance is defined as “the process of gathering, integrating, interpreting, and communicating essential information related to all-hazard threats or disease activity affecting human, animal, or plant health…”, where all-hazard is associated with all chemical, biological, radiological and nuclear (CBRN) attacks.  This Strategy takes this definition of biosurveillance and broadens it to include “emerging infectious diseases, pandemics, agricultural threats, and food-borne illnesses”. By positing itself as a continuation of both the National Security Strategy and the National Strategy for Countering Biological Threats, the National Biosurveillance Strategy effectively securitizes all wide-scale health concerns.  This broadening is problematic for a number of reasons, the foremost being a dilution of that which constitutes a “threat” almost to the point of meaningless. Processing the vast amount of information  on intentional threats alone is already extremely challenging for the national security apparatus. The mandate to monitor all incidents of disease unnecessarily adds to this vast burden while expending limited security resources, leaving us less able to address immanent biological threats and exigencies.

The detrimental impact of this broadening is further visible when analyzing the Strategy’s policy suggestions. For instance, the aforementioned goal to “indentify and integrate essential information” encompasses within it the suggested development of a “discrete set of key questions to speed incident detection and awareness”. The 2001 anthrax letter attacks (Amerithrax) illustrate the difficulty in developing such a discreet set of questions. Despite occurring in the weeks following 9/11, and despite the staggered timing of the attacks, two of the latter Amerithrax victims still died due to misdiagnosis. Bacillus anthracis, like many of the other select agents, presents very similarly to pneumonia, making its initial diagnosis difficult. Thus, just as it remains difficult to synthesize a single set of questions to exclusively detect the symptoms of one, relatively uncommon disease, any set of questions which is expected to detect all potential effects from CBRN, emerging infectious diseases, pandemics, and food-bourne illnesses would be meaningless.

All criticisms aside, it should be kept in mind that the Biosurveillance Strategy is the first of its kind.  The lack of originality could be interpreted as a summation of past precedent. The broadening of the scope of biosurveillance  could be interpreted as recognition of the need for effective pandemic preparedness. As a first draft, then, while it definitely needs work, it’s very existence is a step in the right direction.

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