GAO 

United States Government Accountability Office

Report to Congressional Committees

BIOSURVEILLANCE

Developing a 

Collaboration Strategy 

Is Essential to 

Fostering Interagency 

Data and Resource 

Sharing 

December 2009 

GAO-10-171 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

December 2009

BIOSURVEILLANCE

Developing a Collaboration Strategy Is Essential to 

Fostering Interagency Data and Resource Sharing

Highlights of GAO-10-171, a report to 

Congressional Committees 

Recently, there has been an 

increased focus on developing the 

ability to provide early detection of 

and situational awareness during a 

disease outbreak. The 

Implementing Recommendations of 

the 9/11 Commission Act sought to 

enhance this capability, in part, by 

creating the National 

Biosurveillance Integration Center 

(NBIC) within the Department of 

Homeland Security. NBIC is to help 

provide early detection and 

situational awareness by 

integrating information and 

supporting an interagency 

biosurveillance community. The act 

directed GAO to report on the state 

of biosurveillance and resource use 

in federal, state, local, and tribal 

governments. This report is one in 

a series responding to that 

mandate. This report focuses on 

the actions taken by NBIC to (1) 

acquire resources to accomplish its 

mission and (2) effectively 

collaborate with its federal 

partners. To conduct this work, 

GAO reviewed documents, such as 

NBIC’s Concept of Operations, and 

interviewed officials at NBIC and 

11 federal partners. 

What GAO Recommends

To enhance collaboration, GAO 

recommends that NBIC work with 

its interagency advisory body to 

develop a strategy for addressing 

barriers to collaboration—such as 

the lack of clear mission, roles, and 

procedures—and to develop 

accountability mechanisms to 

monitor these efforts. We provided 

this draft to DHS and 11 federal 

partners. DHS concurred with our 

recommendations. 

To carry out its early detection and situational awareness mission, NBIC has 

made efforts to acquire data from the integration center’s community of 

federal partners, obtain analytical expertise from other agencies, establish 

governance bodies to develop and oversee the community of federal partners, 

and provide information technologies to support data collection, analysis, and 

communication.However, NBIC does not receive the kind of data it has 

identified as most critical for supporting its early detection mission—

particularly, data generated at the earliest stages of an event. In addition, 

NBIC has faced challenges leveraging the expertise of its federal partners. For 

example, NBIC officials have emphasized the importance of agencies 

temporarily assigning personnel to supplement the expertise at NBIC. 

However, only 2 of 11 partner agencies have assigned personnel to support 

the integration center. NBIC has developed governance bodies that provide 

oversight for the integration center and the interagency community. Although 

the integration center has also developed an information technology system, it 

is primarily used to help identify and collect publicly available Internet data 

because NBIC lacks data from federal partners that best support the early 

detection goal of biosurveillance. 

NBIC is not fully equipped to carry out its mission because it lacks key 

resources—data and personnel—from its partner agencies, which may be at 

least partially attributed to collaboration challenges it has faced. Integrating 

biosurveillance data is an inherently interagency enterprise, as reflected by 

both law and NBIC’s strategy for meeting its mission. NBIC is to help 

coordinate and support a community of federal partners for early detection 

and enhanced situational awareness. Consequently, for NBIC to obtain the 

resources it needs to meet its mission, it must effectively employ collaborative 

practices. However, in interviews with partner agencies, GAO encountered 

widespread confusion, uncertainty, and skepticism around the value of 

participation in the interagency community, as well as the mission and 

purpose of NBIC within that community. Further, interviews with agency 

officials demonstrated a lack of clarity about roles, responsibilities, joint 

strategies, policies, and procedures for operating across agency boundaries. 

We have previously reported on key practices that can help enhance and 

sustain collaboration among federal agencies. For collaborating agencies to 

overcome barriers to working together, they need to, among other things, (1) 

develop a clear and compelling rationale for working together by articulating 

a common federal outcome or purpose; (2) establish joint strategies, policies, 

and procedures to help align activities, core processes, and resources; (3) 

identify resources needed to initiate or sustain their collaborative effort; (4) 

work together to define and agree on their respective roles and 

responsibilities; and (5) develop accountability mechanisms to guide 

implementation and monitoring of their efforts to collaborate. Development of 

a strategy for collaboration and the use of these key collaboration practices 

could enhance NBIC’s ability to foster interagency data and resource sharing. View GAO-10-171 or key components.

For more information, contact William O. 

Jenkins at (202) 512-8777or 

jenkinswo@gao.gov. 
Page i GAO-10-171 

Contents 

Letter 1

Background 5 

NBIC Has Undertaken Efforts to Coordinate the NBIS and Acquire 

Resources, but Lacks Key Mission-Critical Elements 10 

Use of Key Collaboration Practices Could Help NBIC Strengthen 

Collaboration and Promote Fuller Participation 18 

Conclusions 27 

Recommendations for Executive Action 28 

Agency Comments and Our Evaluation 29 

Appendix I Comments from the Department of Homeland 

Security 31 

Appendix II GAO Contact and Staff Acknowledgements 33 

 

Tables 

Table 1: 9/11 Commission Act Requirements for NBIC and NBIC 

Member Agencies 7 

Table 2: Three Data Categories Collected by Federal Agencies 11 

 Biosurveillance Integration 
Abbreviations 

BCON Biosurveillance Common Operating Network 

BIWAC Biosurveillance Indications and Warnings Analytic Community 

DHS Department of Homeland Security 

HHS Department of Health and Human Services 

HSPD-9 Homeland Presidential Security Directive-9 

HSPD-10 Homeland Presidential Security Directive-10 

HSPD-21 Homeland Presidential Security Directive-21 

IAA interagency agreements 

ISA interagency security agreements 

IT information technology 

MOU memomorandum of understanding 

NBIC National Biosurveillance Integration Center 

NBIS National Biosurveillance Integration System 

NIOC NBIS Interagency Oversight Council 

NIWG NBIS Interagency Working Group 

NOC National Operations Center 

USDA United States Department of Agriculture 

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

copyrighted images or other material, permission from the copyright holder may be 

necessary if you wish to reproduce this material separately. 

Page ii GAO-10-171 Biosurveillance Integration
 

Page 1 GAO-10-171 

 

United States Government Accountability Office

Washington, DC 20548 

December 18, 2009 

The Honorable Joe Lieberman 

Chairman 

The Honorable Susan M. Collins 

Ranking Member 

Committee on Homeland Security and Governmental Affairs 

United States Senate 

The Honorable Bennie Thompson 

Chairman 

The Honorable Peter King 

Ranking Member 

Committee on Homeland Security 

House of Representatives 

In recent years, there has been an increasing awareness of the potential 

for biological agents to be used as weapons of mass destruction and of the 

threat of catastrophic effects arising from emerging strains of infectious 

disease. For example, the October 2001 anthrax attacks highlighted 

longstanding weaknesses in the current public health infrastructure and 

prompted efforts to improve the nation’s preparedness for and response to 

public health emergencies, including bioterrorism. In addition, the 2001 

accidental outbreak of foot-and-mouth disease in the United Kingdom 

caused approximately $5 billion dollars in losses to the food and 

agriculture sector, as well as comparable losses within the industry.1

 These 

events and others like them have underscored the importance of 

developing and maintaining a national biosurveillance capability—that is, 

the ability to detect biological events of national significance with the aim 

of providing earlier warning and better information to guide public health 

or other types of emergency response. 

Effective preparation for, detection of, and response to a major biological 

event requires effective pre- and postdisaster coordination and 

cooperation among different federal agencies, levels of government, 

nongovernmental organizations, and the private sector. In the case of 

1

GAO, Homeland Security: Much Is Being Done to Protect Agriculture from a Terrorist 

Attack, but Important Challenges Remain, GAO-05-214 (Washington, D.C.: Mar. 8, 2005). 

 Biosurveillance Integration 
 

biological threats, detection of biological agents is a first step in an 

effective response to a natural, accidental, or intentional outbreak of a 

biological event of national concern. The U.S. government has a long 

history of monitoring human, animal, and plant health—in some cases for 

more than a century—to help limit malady, loss of life, and economic 

impact. Although the United States has numerous surveillance programs 

and systems at various levels of government and in the private sector to 

monitor disease, these programs and systems were developed separately 

for a variety of mission objectives, and as such are relatively 

uncoordinated. 

Since at least the 1990s, there has been an ongoing and evolving effort by 

the federal government to address the need for a strategic approach to 

improving disease surveillance and response. Among numerous federal 

efforts to establish a coordinated national biosurveillance capability, a 

provision in the Implementing Recommendations of the 9/11 Commission 

Act of 2007 (9/11 Commission Act),2

 sought to enhance the capability of 

the federal government to rapidly identify, characterize, localize, and track 

biological events of national concern. The 9/11 Commission Act 

established, within the Department of Homeland Security (DHS), the 

National Biosurveillance Integration Center (NBIC), which was 

specifically tasked with fulfilling the biosurveillance objectives established 

in the act by integrating and analyzing information from surveillance 

systems across the federal government and disseminating alerts, if any 

biological events are detected. The federal partners that maintain these 

surveillance systems and those that may have information helpful for 

decisionmaking during an event are collectively known as the National 

Biosurveillance Integration System (NBIS). A central responsibility for 

NBIC is to further develop and oversee the NBIS with the goal of earlier 

detection of and enhanced information about potentially catastrophic 

biological events. 

In the same title, the 9/11 Commission Act directed us to examine the state 

of federal, state, local, and tribal government biosurveillance efforts and 

the federal government’s use of resources to implement and execute 

biosurveillance systems.3

 This report responds in part to that mandate by 

examining actions that NBIC has taken to integrate and analyze data for 

the purposes of early detection and warning of biological events of 

 

2

Pub. L. No. 110-53 § 1101, 121 Stat. 266, 375-79 (2007) (codified at 6 U.S.C. § 316). 

3

§ 1102, 121 Stat. at 379. 

Page 2 GAO-10-171 Biosurveillance Integration
 

national concern. Specifically, this report addresses (1) what actions NBIC 

has taken to coordinate the NBIS and acquire essential resources; and (2) 

how effectively NBIC has employed collaborative practices with NBIS 

partners to help ensure that it acquires and develops essential resources.4

In summer 2008, we testified on the status of NBIC’s efforts to implement 

its 9/11 Commission Act responsibilities, particularly by entering into 

information-sharing and interagency personnel-assignment agreements 

with NBIS partners.5

 At that time, we noted that DHS faced difficulties 

completing some key tasks, such as defining what capabilities the center 

will provide once fully operational, formalizing agreements to obtain 

interagency coordination, and completing work related to information 

technology (IT) systems. In addition to this NBIC-specific report, we have 

ongoing work on biosurveillance activities throughout the federal 

government from which we expect to issue a report in early 2010, and a 

review of state, local, and tribal activities, which we expect to report on 

later in the year. 

To determine the extent of NBIC’s efforts to acquire the necessary data 

and resources, we reviewed documents including relevant laws and 

directives, operating documents, program guidance, program evaluation 

reports, and other documentation and interviewed officials at NBIC with 

knowledge of NBIC’s management and analytical activities. We visited 

NBIC facilities, specifically NBIC’s analysis center at DHS’s Nebraska 

Avenue Complex, DHS’s National Operations Center, and the 2009 H1N1 

Incident Management Cell at the Office of Health Affairs in Washington, 

D.C., where we observed key meetings, processes, and technologies. To 

identify the elements that are necessary for NBIC to achieve its mission, 

we analyzed the relevant provisions of the 9/11 Commission Act, the NBIS 

 

4

The 9/11 Commission Act defines an NBIS “Member Agency” as a federal department or 

agency that has signified its willingness to participate in the NBIS by signing a 

memorandum of understanding with NBIC. 6 U.S.C. § 316(j)(4). We use the term “NBIS 

partner” throughout this report to describe those federal departments and agencies and 

their related components that NBIC has identified as having potential to share relevant 

information and data with the NBIS community irrespective of whether the agency in 

question has entered into any interagency agreement. At least one such federal department, 

for example, told us that it does not plan to sign a memorandum of understanding to 

become a “Member Agency,” but participates with the NBIS community to some degree. 

5

GAO, Biosurveillance: Preliminary Observations on Department of Homeland Security’s 

Biosurveillance Initiatives, GAO-08-960T (Washington, D.C.: July 16, 2008). 

Page 3 GAO-10-171 Biosurveillance Integration
 

Concept of Operations, and interviews with NBIC officials.6 Once we 

identified these elements, we vetted them with NBIC officials who agreed 

they were accurate. To determine the extent to which NBIC and NBIS 

partners have collaborated to help ensure that NBIC acquires and 

develops essential resources, we reviewed existing federal interagency 

agreements and other documentation, such as the NBIS Concept of 

Operations, NBIC’s draft strategic plan, and post meeting reports from 

meetings of NBIS governance bodies. We also spoke with agency officials 

from the 11 NBIS partners—agencies NBIC has identified as having 

relevant data or resources to contribute to the biosurveillance objectives 

established in the 9/11 Commission Act.7

 We conducted semistructured 

interviews, based on our previous work describing practices to enhance 

and sustain collaboration in the federal government.8

 We conducted these 

interviews with 14 components of the 11 federal agencies that NBIC 

identified as NBIS partners. We identified the components to interview by 

contacting the 11 partner agencies to determine which had regular 

interaction with NBIC’s processes and products. We explored officials’ 

experiences working with NBIC and within the NBIS at all of the identified 

components. We asked these officials about their understanding of NBIC’s 

mission and purpose; the perceived value to their respective agencies of 

participation in the NBIS; the extent of and reasons for their agency’s level 

of participation; and the extent to which joint strategies, policies, and 

procedures have been established and are commonly understood and 

accepted between NBIC and individual agencies, as well as across the 

NBIS. We then analyzed the results of these interviews to identify 

recurrent themes. We provided these officials the opportunity to comment 

on a standard set of collaborative practices and provide examples from 

their experiences, and we analyzed the content of their responses to 

develop our findings. However, due to the semistructured nature of our 

interviews, different groups of officials focused on different aspects of 

their experiences with NBIC; therefore, not every theme identified in our 

analysis was explicitly discussed by every group of officials. 

 

6

NBIC issued the first version of the Concept of Operations in December 2007. 

Subsequently, NBIC created version 2.0 of the Concept of Operations, which has not yet 

been finalized. We reviewed both of these documents in the course of our work. 

7

NBIC has identified the following NBIS partners at the federal level—The Departments of 

Health and Human Services (HHS), Agriculture (USDA), Commerce, Defense, Interior, 

Justice, State, Transportation, and Veterans Affairs, as well as the Environmental 

Protection Agency and the United States Postal Service. 

8

GAO, Results-Oriented Government: Practices That Can Help Enhance and Sustain 

Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 21, 2005). 

Page 4 GAO-10-171 Biosurveillance Integration
 

This report is limited to the efforts NBIC has taken or planned to carry out 

related to its 9/11 Commission Act responsibilities. On the whole, federal 

biosurveillance efforts rely on state, local, and tribal biosurveillance 

efforts, and there are many federal efforts designed to collect and analyze 

biosurveillance data. However, this report focuses on NBIC’s integration 

efforts and not the effectiveness of the various federal systems the data of 

which NBIC would integrate. 

We conducted this performance audit from February 2008 through 

November 2009, in accordance with generally accepted government 

auditing standards. Those standards require that we plan and perform the 

audit to obtain sufficient, appropriate evidence to provide a reasonable 

basis for our findings and conclusions based on our audit objectives. We 

believe that the evidence obtained provides a reasonable basis for our 

findings and conclusions based on our audit objectives. 

Background 

NBIC Is Responsible for 

Facilitating Collaboration 

across Multiple Agencies 

to Enhance 

Biosurveillance 

Effectiveness by 

Integrating Data and 

Expert Analysis 

Biosurveillance is the process of gathering, analyzing, and interpreting 

data in order to achieve early detection and warning and overall 

situational awareness of biological events with the potential to have 

catastrophic human and economic consequences.9

 In August 2007, the 9/11 

Commission Act established NBIC to contribute to the nation’s 

biosurveillance capability by enhancing the ability of the federal 

government to rapidly identify, characterize, localize, and track biological 

events of national concern through integration and analysis of data 

relating to human health, animal, plant, food, and environmental 

monitoring systems (both national and international).10 Once a potential 

event is detected, NBIC is to disseminate alerts to enable response to a 

biological event of national concern. To achieve these objectives, NBIC is 

to coordinate with federal and other stakeholders that have information 

that can be used to enhance the safety and security of the United States 

against potential biological events of national significance. This 

community of federal stakeholders is known as the NBIS. 

 

9

Situational awareness, in the biosurveillance context, includes cognizance of the existence 

and meaning of a biological threat, as well as the ability to make projections regarding its 

probable status in the near future—for example, the likelihood of an emerging infectious 

disease becoming an epidemic. 

106 U.S.C. § 316. 

Page 5 GAO-10-171 Biosurveillance Integration
 

The NBIS community predated the enactment of the 9/11 Commission Act. 

Beginning in 2004, DHS managed the NBIS and developed an IT system to 

manage other agencies’ biosurveillance information, an effort that was 

moved among several DHS Directorates, including DHS’s Science and 

Technology Directorate and the Preparedness Directorate. In 2007, DHS 

created the Office of Health Affairs, headed by the DHS Chief Medical 

Officer, to lead DHS’s biodefense activities and provide timely incidentspecific management guidance for the medical consequences of disasters. 

At that time, DHS placed NBIS in the Office of Health Affairs.11 Shortly 

after that, the 9/11 Commission Act created NBIC and gave it responsibility 

for managing the NBIS, which has remained in the Office of Health Affairs. 

Since fiscal year 2008, NBIC has operated with an annual budget of $8 

million dollars. Biosurveillance activities at NBIC are carried out by its 

Operations Division, which is headed by the Deputy Director and Chief 

Scientist and supported by 10 contract employees that serve as the 

analytic core for NBIC’s daily operations. These staff members have 

various backgrounds related to biodefense, including public health, 

veterinary, environmental, and intelligence training. 

NBIC Draws Its Early 

Detection and Situational 

Awareness Missions from 

Multiple Presidential 

Directives, in Addition to 

the 9/11 Commission Act 

As shown in table 1, the 9/11 Commission Act outlines certain 

requirements for NBIC and NBIS member agencies, and most of these 

relate to how NBIC is to coordinate NBIS member agency data and 

information management resources. Generally, there are four elements 

that are critical for NBIC to achieve its early detection and situational 

awareness missions established in the 9/11 Commission Act: (1) acquire 

data from NBIS partners that can be analyzed for indications of new or 

ongoing biological events, (2) leverage scientific and event-specific 

expertise from across the NBIS, (3) obtain strategic and operational 

guidance from NBIS partners, and (4) develop and maintain information 

technologies to support data collection, analysis, and communication. 

 

11In July 2007 the DHS Office of Inspector General reported that the program lacked 

sustained program leadership and was not a priority, because ownership of the program 

shifted among department organizations numerous times, with corresponding fluctuations 

in the program approach, priority, and accomplishments. According to the DHS Inspector 

General, despite the changes in program focus, the program benefited from increased 

senior-level support and priority under the Office of the Chief Medical Officer. DHS OIG 

Report, Better Management Needed for the National Bio-Surveillance Integration System 

Program, OIG-07-61 (July 26, 2007). 

Page 6 GAO-10-171 Biosurveillance Integration
 

Table 1: 9/11 Commission Act Requirements for NBIC and NBIC Member Agencies 

Requirements for NBIC • Consolidate data from all relevant surveillance systems maintained by member 

agencies across human, animal, and plant domains 

• Seek private sources of surveillance when such sources would enhance coverage of 

gaps 

• Use an IT system with the best available statistical and other analytical tools to 

identify and characterize biological events of national concern in as close to real time 

as practical 

• Provide the infrastructure for integration including IT systems and space, and support 

for personnel from member agencies with sufficient expertise to analyze and interpret 

data 

• Work with member agencies to create IT systems that use the minimum amount of 

patient data necessary and consider patient confidentiality and privacy in all stages of 

development 

• Alert member agencies as well as public health agencies of state, local, and tribal 

governments (in coordination with or through member agencies) of incidents that 

could develop into a biological event of national concern 

Requirements for NBIC member agencies • Use best efforts to integrate biosurveillance information into the NBIC, with the goal of 

promoting information sharing between federal, state, local, and tribal governments to 

detect biological events of national concern 

• Provide timely information to assist the NBIC in maintaining biological situational 

awareness for accurate detection and response purposes 

• Enable the NBIC to receive and use biosurveillance information from member 

agencies to carry out its requirements 

• Connect the biosurveillance data systems of that member agency to the NBIC data 

system under mutually agreed protocols 

• Participate in the formation of strategy and policy for the operation of the NBIC and its 

information sharing 

• Provide personnel to the NBIC under an interagency personnel agreement and 

consider the qualifications of such personnel necessary to provide human, animal, 

and environmental data analysis and interpretation support to the NBIC; and retain 

responsibility for the surveillance and intelligence systems of that department or 

agency, if applicable 

Source: Pub. L. No. 110-53, § 1101, 121 Stat. 266, 375-79 (2007) (codified at 6 U.S.C. § 316). 

Although the act does not specify any member agency that must 

participate in the NBIS, it defines a member agency as any agency that 

signifies agreement to participate by signing a memorandum of 

understanding (MOU) and establishes for them specific requirements—

generally related to sharing information and human assets. For example, 

as shown in table 1, the act provides that each member agency shall use its 

best efforts to integrate biosurveillance information into the NBIC, with 

the goal of promoting information sharing between federal, state, local, 

and tribal governments to detect biological events of national concern. 

NBIC has identified 11 NBIS partners at the federal level—the 

Departments of Health and Human Services (HHS), Agriculture (USDA), 

Page 7 GAO-10-171 Biosurveillance Integration
 

Commerce, Defense, Interior, Justice, State, Transportation, and Veterans 

Affairs, as well as the Environmental Protection Agency and the United 

States Postal Service. In some departments, more than one component has 

been identified for participation. Some of these departments, such as HHS 

and USDA, have major mission responsibilities for collecting health data 

that may indicate an outbreak of a disease or other biological event. Other 

departments may collect data or have subject matter expertise that may be 

used during the course of a biological event. For example, the National 

Oceanic and Atmospheric Agency within the Department of Commerce 

collects meteorological data that may be used by NBIC to help inform the 

progression of an outbreak based on weather patterns. 

Around the same time as the enactment of the 9/11 Commission Act, the 

President issued Homeland Security Presidential Directive-21 (HSPD-21), 

as a high-level biodefense strategy. HSPD-21 is built on the principles of 

earlier directives—HSPD-9 and HSPD-10—which collectively describe the 

role of the federal government in building a national capability to detect a 

biological event. For example, HSPD-21 lays out goals for addressing each 

of four biodefense elements for human health,12 one of which is 

surveillance. In this respect, HSPD-21 calls for the United States to 

develop a nationwide, robust, and integrated biosurveillance capability to 

provide early warning and ongoing characterization of disease outbreaks 

in near real-time. Consistent with this goal, HSPD-21 directs the Secretary 

of Health and Human Services to establish a national epidemiologic 

surveillance system for human health, in part, to integrate federal, state, 

and local data into a national biosurveillance common operating picture. 

Although HSPD-21 does not specify a role for DHS in biosurveillance, the 

earlier directives did, and creation and maintenance of an electronic 

biosurveillance common operating picture has been an NBIS goal since its 

inception. 

 

12HSPD-10, also called Biodefense for the 21st Century, describes four “pillars” of 

biodefense: (1) threat awareness, (2) prevention and protection, (3) surveillance and 

detection, and (4) response and recovery. 

Page 8 GAO-10-171 Biosurveillance Integration
 

The data needed to detect an infectious disease outbreak or bioterrorism 

may come from a variety of sources, and aggregating and integrating data 

across multiple sources is intended to help recognize the nature of a 

disease event or understand its scope. Combining and comparing data 

streams from different sectors to detect or interpret indications of a 

potential health emergency is called biosurveillance integration. Both 

HSPD-21 and the 9/11 Commission Act seek enhanced integration of 

disparate systems and programs that collect data with the aim of providing 

early warning and ongoing characterization of biological events. HSPD-21 

and the 9/11 Commission Act each also seek to enhance the situational 

awareness for the detection of and response to biological events. Much of 

the information gathered for these biosurveillance purposes is generated 

at the state government level. For example, state health departments 

collect and analyze data on notifiable diseases submitted by health care 

providers and others.13 In addition, state-run laboratories conduct testing 

of samples for clinical diagnosis and participate in special clinical or 

epidemiologic studies. Finally, state public health departments verify cases 

of notifiable diseases, monitor disease incidence, and identify possible 

outbreaks within their states. At the federal level, agencies and 

departments generally collect and analyze surveillance data gathered from 

the states and from international sources, although some federal agencies 

and departments also support their own national surveillance systems and 

laboratory networks. 

Biosurveillance Involves 

Data Gathering and 

Analysis at Multiple Levels 

of Government for the 

Purposes of Earlier 

Warning and Enhanced 

Situational Awareness 

When an issue crosses federal agency lines, as biosurveillance integration 

does, the agencies involved must collaborate to deliver results more 

efficiently and effectively. Due to NBIC’s role as an integrator of 

information across the biosurveillance community, it is important for 

NBIC to ensure that it effectively collaborates with the NBIS to obtain the 

cooperation of this interagency community. One reason that it is important 

that NBIC effectively collaborate with federal partners is that agencies are 

not required by law to support NBIC or participate in the NBIS 

community. We have previously reported that for collaborating agencies to 

enhance and sustain collaboration, they need to, among other things, (1) 

have a clear and compelling rationale for working together; (2) establish 

joint strategies, policies, and procedures for aligning core processes and 

 

13Most states use a national list of notifiable diseases maintained and revised by the Council 

of State and Territorial Epidemiologists in collaboration with HHS’s Centers for Disease 

Control and Prevention. This national list is reviewed annually and revised periodically. 

However, each state adapts this list such that the diseases considered notifiable and the 

requirements for reporting them vary by state. 

Page 9 GAO-10-171 Biosurveillance Integration
 

resources; (3) identify resources needed to initiate or sustain their 

collaborative effort; (4) work together to define and agree on their 

respective roles and responsibilities; and (5) develop accountability 

mechanisms to help implement and monitor their efforts to achieve 

collaborative results.14

NBIC has made some efforts to put mission-critical elements in place, such 

as requesting data from other federal partners, initiating relationshipbuilding activities among NBIC analysts and subject matter experts at 

other agencies, and establishing governance bodies to oversee and guide 

the NBIS. However, NBIC currently relies on publicly available data 

because it receives limited data from NBIS partners and generally lacks 

assignments of personnel from other agencies to leverage analytical 

expertise from across the NBIS partners. 

NBIC Has Undertaken 

Efforts to Coordinate 

the NBIS and Acquire 

Resources, but Lacks 

Key Mission-Critical 

Elements 

NBIC Generally Has Not 

Acquired Data from Other 

Agencies to Support the 

Early Detection Mission 

and Instead Relies on 

Nonfederal, Open-Source 

Data 

NBIC’s ability to acquire and consolidate data from NBIS partners as well 

as from nonfederal sources is central to achieving its mission. Current and 

initial drafts of the NBIS Concept of Operations reinforce this notion,15

noting that the identification of relevant and timely data sources, which 

act in combination to provide actionable information for decisionmaking, 

is essential to accomplishing early detection. NBIC has taken some action 

to acquire these types of data from NBIS partners, for instance, by 

requesting that NBIS partners identify the types of data they collect or 

generate that might aid in NBIC’s early detection mission. However, as of 

October 2009, NBIC was generally not receiving the types of data best 

suited to early detection of biological events of national concern. NBIC 

officials acknowledge that they lack key data, and NBIC and other NBIS 

member officials described numerous challenges to sharing such 

information, including but not limited to scant availability of such data 

throughout the federal government and concerns about trust and control 

over sensitive information before it is vetted and verified. 

 

14GAO-06-15. 

15NBIC issued the first version of the NBIS Concept of Operations—version 1.0—in 

December 2007. Subsequently, NBIC issued version 1.1 of the Concept of Operations in 

October 2008 and created version 2.0 of the Concept of Operations to incorporate NBIS 

member comments regarding the earlier versions. NBIC shared the latest version with 

NBIS member agencies for review in August 2009 and it is currently undergoing 

interagency review. 

Page 10 GAO-10-171 Biosurveillance Integration
 

Based on our discussions with NBIS agency officials and review of NBIC 

documents, we have defined and verified with NBIC officials three 

categories of electronic data that are critical for NBIC to achieve its 

mission and might be available from federal agencies or other sources. As 

described in table 2, these data categories are (1) raw structured data, (2) 

raw unstructured data, and (3) final products which are typically briefings 

produced by other agencies in the course of monitoring routine and 

emerging disease. As of October 2009, NBIC was receiving some final 

products from NBIS partners, but was not receiving any raw data—

particularly data that are generated at the earliest stages of a biological 

event. 

Table 2: Three Data Categories Collected by Federal Agencies 

Data Category Description Example 

Raw structured Data that have been collected in an electronic format 

that can be automatically processed by a computer but 

have not been analyzed to reach conclusions about 

their meaning, such as whether the data are signs of a 

potentially catastrophic infectious disease outbreak. 

These data may frequently be expressed in quantitative 

terms. 

Codes that represent chief complaints reported by 

patients and entered into a hospital emergency room 

medical database or test results from health 

laboratories. 

Raw unstructured Data that requires manual review or manipulation and 

are not structured for automatic processing by a 

computer system. Data is often qualitative rather than 

quantitative. 

Media reports of disease outbreaks, gathered from free 

and subscription Internet sites. 

Final products A final written product that contains an analysis and 

interpretation of data to provide contextual meaning. 

Products have been reviewed and approved by the 

leadership of the agency that created them before they 

are shared. 

A written report that is issued after raw or unstructured 

data have been analyzed and interpreted to identify a 

disease cluster. 

Source: GAO analysis and verification with NBIC officials responsible for acquiring and using data. 

According to officials, receipt of all three types of electronic data is 

important to help NBIC achieve its mission of detecting and warning of a 

biological event because detection of events that are novel, from multiple 

sources, or widespread requires analysis of multiple independent data 

streams. However, the officials told us that they do not receive from NBIS 

partners the raw structured or unstructured data that best support the 

early detection goal of biosurveillance. In particular, NBIC identified data 

that are generated at the earliest stages of a biological event—which can 

include raw data collected by federal agencies as part of their 

biosurveillance responsibilities—as being among the highest value for 

enabling the earlier detection of biological events of national concern. For 

instance, structured data, such as medical codes corresponding to 

Page 11 GAO-10-171 Biosurveillance Integration
 

diagnoses that are entered into databases, as well as some sources of 

unstructured data, such as written observations noted on medical forms, 

are generated at the earliest stages of a biological event and have been 

identified by NBIC as a high priority for early detection. These data can be 

collected or generated by federal agencies with responsibilities for 

biosurveillance and which are participating in NBIS. For example, HHS 

has developed a surveillance system that collects data on symptoms of 

patients entering emergency departments, that when analyzed with 

statistical tools, may be able to indicate the presence of an outbreak in less 

time than it takes to perform diagnostic lab tests. 

NBIC seeks to finalize three types of agreements with NBIS partners to 

articulate and establish protocols and legal authority for resource sharing: 

(1) MOUs, (2) interagency agreements (IAA), and (3) interagency security 

agreements (ISA).16 To date, 7 of the 11 agencies have signed MOUs,17 but 

only 1 has a finalized ISA in place for data sharing, according to NBIC 

officials. As of October 2009, the federal agency that signed an ISA agreed 

to provide a single data source related to food safety. NBIC officials told 

us that although the agreement and the technology allowing the electronic 

data exchange are in place, the agency has not yet begun transferring the 

data to NBIC, and they did not know when to expect the transfer to begin. 

NBIC’s inability to finalize agreements can be attributed in part to 

challenges it faces in ensuring effective collaboration, which will be 

discussed later in this report. 

Five NBIS partners provide NBIC with written final products, such as 

briefings produced on a routine basis that provide information on 

outbreaks of diseases or special alerts of potentially dangerous biological 

events issued as needed. However, NBIC officials noted that there are 

limitations on the value of final reports for supporting early detection. 

These finished products represent the agency’s final analysis and 

 

16The MOU is a general agreement to participate in NBIC. The IAA is a more specific 

agreement that outlines how personnel will be shared. The ISA, which ultimately must be 

finalized for data to be shared, addresses security and privacy issues related to the handling 

of the data. 

17The number of MOUs signed does not directly reflect the level of agency participation in 

the NBIS. In the absence of an MOU outlining agencies’ agreement to participate in the 

NBIS, NBIC and other NBIS officials told us that federal agencies may still take part in 

NBIS activities. For example, three of the federal agencies that have not signed an MOU 

participate in key NBIS processes and meetings while some agencies have not provided 

data or personnel to NBIC even though they have signed an MOU. 

Page 12 GAO-10-171 Biosurveillance Integration
 

interpretation of the raw data that it collects and have been reviewed and 

approved by the agency leadership for general dissemination to interested 

parties. According to NBIC officials, these products are generally useful 

for providing context but not for early detection of a biological event 

because they are not generated in a timely enough fashion to be valuable 

for detecting new biological events and focus on biological events that 

have already been detected. 

In the absence of proprietary information from NBIS partners, NBIC relies 

on mostly nonfederal sources of data, such as media reports of illness, to 

attempt to identify biological events. The bulk of data—according to NBIC 

officials more than 98 percent—NBIC currently uses to pursue its mission 

is unstructured and comes from nonfederal, open sources, including an 

international information gathering service called Global Argus, a 

federally-funded program in partnership with Georgetown University. The 

service searches and filters over 13,000 overseas media sources, in more 

than 34 languages. The practice of monitoring and translating local news 

articles has the potential to provide information about undiagnosed and 

other suspicious disease activity before it is reported through more official 

channels. NBIC officials stated that continuous monitoring of global news 

media sources and publicly available Web sites would be important to 

round out potential gaps in coverage, even if other data are available from 

federal agencies. 

NBIC Has Had Limited 

Success Obtaining 

Expertise from NBIS 

Partners through 

Interagency Personnel 

Assignments 

NBIC officials told us that regardless of the quantity and quality of data 

types shared by collaborating agencies, effective biosurveillance depends 

on human analysts to interpret events and place them in context. For 

example, determining whether an outbreak of a new emerging infectious 

disease has occurred and further assessing whether this event is one of 

national concern are analytic judgments that require not only data but also 

the expertise of an experienced, knowledgeable analyst. According to 

these officials, analyst-to-analyst communication in a trusted environment 

is absolutely essential for rapid vetting, verification, and contextualization 

of events. 

The 9/11 Commission Act calls for member agencies to provide personnel 

to NBIC under an interagency personnel agreement and consider the 

qualifications of such personnel necessary to provide human, animal, and 

environmental data analysis and interpretation support.18 However, for the 

 

186 U.S.C. § 316(e)(1)(F). 

Page 13 GAO-10-171 Biosurveillance Integration
 

most part, NBIC has not consistently received this kind of support from 

NBIS partners. Personnel detailed (that is, personnel employed by a 

federal agency and temporarily assigned to NBIC for a specified period of 

time) from other federal agencies enable analysis and interpretation of 

data by serving as subject matter experts for specific issues that are part 

of their home agencies’ missions and as conduits of information from their 

respective home agencies. NBIC has signed MOUs with seven agencies, 

but only two have provided a personnel detail to the NBIC headquarters in 

Washington, D.C., and as of October 2009, only one of those personnel 

details was active, because one of those agencies did not replace 

personnel after the initial detail ended. NBIC officials told us that daily 

interaction with officials who had been on detail at NBIC not only 

enhanced their ability to interpret the information immediately on hand 

but also contributed to ongoing contextual learning for NBIC’s analytical 

corps. 

Although most of the NBIS partners have not detailed their subject matter 

experts to NBIC, the integration center officials have used other means to 

obtain expertise and information from other agency analysts. NBIC 

officials told us that they have co-located the NBIC analysts at other 

collaborating agencies where they spend up to 2 weeks working with 

analysts from these other agencies both to learn more about their 

operations and to help forge ongoing relationships. NBIC officials stated 

they have also established a daily process to engage the NBIS in sharing 

information and analytic insights with each other. During this process—

which NBIC calls the daily production process—NBIC analysts compile 

information on reports of outbreaks that may be of concern, and then this 

information is disseminated to the NBIS community for discussion at a 

daily teleconference. The participants in the teleconference determine 

whether the events merit further monitoring or evaluation and share any 

relevant information they may have about the event. NBIC analysts then 

use the information gathered, as refined by the daily teleconference, to 

finalize NBIC daily reports and update its electronic Biosurveillance 

Common Operating Picture, which is a manually updated electronic 

picture of current worldwide biological events being tracked. 

For example, NBIC analysts might identify local news reports that suggest 

food contamination in a region. During the daily conference call, one or 

more of the agencies with responsibility for monitoring food safety or 

foodborne illness might contribute more information, such as a history of 

similar issues in the same geographical region, that gives more context to 

the reports. Then, collectively, the responsible agencies might decide that 

the event, first uncovered in open source media, warrants further 

Page 14 GAO-10-171 Biosurveillance Integration
 

investigation and monitoring. NBIC analysts would then post all known 

information to its electronic Biosurveillance Common Operating Picture 

for all interested parties to follow. Meanwhile, the agencies with missions 

of jurisdiction would conduct their investigations and report any new 

findings during the following day’s teleconference. NBIC officials told us 

that this process requires a wide range of expertise from across the 

agencies. These officials said that they may also communicate directly 

with an agency prior to the daily teleconference if NBIC plans to discuss 

an item relevant to the agency’s mission at the meeting. 

Another means NBIC uses to obtain expertise and information from other 

agency analysts is through participation in the Biosurveillance Indications 

and Warnings Analytic Community (BIWAC). The BIWAC is a selfgoverning interagency body composed of federal officials who are actively 

responsible for pursuing a biosurveillance mission. The agencies 

represented include: the Department of Defense, HHS’s Centers for 

Disease Control and Prevention, USDA, DHS, and the intelligence 

community. The mission of the BIWAC is to provide a secure, interagency 

forum for the collaborative exchange of critical information regarding 

biological events that may threaten U.S. national interests. On behalf of the 

BIWAC, the Department of Defense’s National Center for Medical 

Intelligence hosts an encrypted information sharing portal called Wildfire. 

According to NBIC’s Chief Scientist and Deputy Director, in addition to 

engaging in the information exchange through Wildfire, she is an active 

supporter and participant in BIWAC meetings and teleconferences. 

According to NBIC officials, although these efforts to obtain the analytical 

insights of subject matter experts from collaborating agencies may be 

valuable, they do not provide a substitute for personnel details to the 

integration center itself. For example, with the daily teleconference, NBIC 

may have limited access to NBIS agency subject matter experts because 

analysts from only a few of the various agencies may be available for 

immediate communication on any given day, and not all agencies regularly 

participate in the daily teleconference. In addition, apart from the daily 

teleconference, NBIC officials said that agencies may limit NBIC’s ability 

to communicate with their subject matter experts, particularly in the early 

stages of responding to a biological event when the agency is prioritizing 

its response needs. Finally, NBIC analysts may also communicate through 

federal agencies’ operations centers during the course of an ongoing 

biological event, but NBIC officials noted that this channel of 

communication is not always an effective means to get meaningful input 

from agencies’ subject matter experts. The lack of sustained personnel 

detailed to NBIC from other NBIS partner agencies can be attributed, in 

Page 15 GAO-10-171 Biosurveillance Integration
 

part, to challenges it faces with ensuring effective interagency 

collaboration, which will be discussed later in this report. 

NBIC Established 

Governance Structures to 

Develop and Oversee the 

NBIS 

In order to support the ability for NBIS partners to engage in overseeing 

and guiding the NBIS, NBIC has established and administers two 

governance bodies. NBIC sponsors meetings of the two groups on a 

regular basis. The NBIS Interagency Oversight Council (NIOC) is 

composed of representatives at the assistant secretary level from each 

NBIS agency. The NIOC is to act as the senior oversight body to provide 

guidance and direction for the operation, implementation, and 

maintenance of the NBIS, as well as to resolve interagency or 

intradepartmental issues that cannot be resolved at lower levels. The NBIS 

Interagency Working Group (NIWG) is a senior, director-level working 

body created to share information on NBIC activities, such as the status of 

developing draft documents and standard operating procedures including 

procedures undertaken during ongoing biological events of national 

concern. The NIWG can also establish sub-working groups to conduct 

specific work as necessary to provide support to the NBIC and the NIOC. 

For example, NIWG established a sub-working group to propose 

procedures for resolving conflict during the daily production cycle. 

NBIC Uses an IT System to 

Manage Publicly Available 

Data and to Communicate 

Alerts, but Generally Lacks 

the Ability to Apply 

Analytical Tools to Data 

One of the elements that is critical for NBIC to carry out its mission is 

development and maintenance of information technologies to support data 

collection, analysis, and communication of alerts. The 9/11 Commission 

Act also specifically mentions the need for statistical tools to analyze data 

to identify and characterize trends of biological events of national 

concern.19 NBIC has taken steps to develop an IT system that can manage 

data from NBIS partners and can help identify open source reports of 

potential biological events, but NBIC largely lacks data from federal 

agencies. Given this condition, rather than a system designed to 

electronically process structured data received directly from NBIS 

partners, NBIC has configured its IT system—the Biosurveillance 

Common Operating Network (BCON)—primarily to identify and assemble 

unstructured data from public sources on the Internet that it will later vet 

 

196 U.S.C. § 316(c)(3). 

Page 16 GAO-10-171 Biosurveillance Integration
 

with other NBIS analysts in the daily production process.20 Therefore, 

NBIC relies on the NBIS community and member agency subject matter 

experts for analysis and interpretation of publicly available data rather 

than providing the NBIS community with an analysis of integrated, raw, 

structured data from the NBIS partners. According to NBIC officials, they 

anticipate using BCON to manage any agency data streams that they may 

eventually acquire. 

BCON is a system of systems that is built on multiple commercial-off-theshelf software packages. Currently, the central feature of BCON is its use 

of a set of keywords within a language algorithm to search the Internet for 

media articles that may contain biosurveillance-relevant information and 

compile them for NBIC analysts to review. As part of this function, BCON 

also flags events for immediate analyst attention. Additionally, the 

information from BCON is the basis for the NBIC Biosurveillance Common 

Operating Picture, which is a manually updated Google Maps application 

of current worldwide biological events being tracked. NBIS agency 

officials can view the Biosurveillance Common Operating Picture on the 

Homeland Security Information Network.21 According to NBIC officials, in 

the future NBIS agency officials will also have the ability to create and 

update event information. 

Although NBIC generally lacks direct-feed, raw, structured data from NBIS 

partners to apply statistical and analytical tools, according to our 

observations and review of documents supporting the development of the 

system, BCON is designed to locate and log information associated with 

the events contained in the open source media that it searches. This 

information includes the geographic coordinates and the date and time of 

occurrence for each event. This data is archived and, according to NBIC 

officials, can be used to conduct cross-domain analysis for trends, 

historical context, associated events, anomaly detection, and hypothesis 

generation. Among the applications planned for inclusion in BCON is a 

 

20The early version of the information management system was called NBIS 2.0, but it is 

currently known as the Biosurveillance Common Operating Network. For the purposes of 

this report, we use the current NBIC nomenclature, where NBIS refers to a community of 

stakeholders and the Biosurveillance Common Operating Network is the technology 

management system. 

21The Homeland Security Information Network is a comprehensive, nationally secure and 

trusted Web-based platform able to facilitate Sensitive but Unclassified information sharing 

and collaboration among federal, state, local, tribal, private sector, and international 

partners. 

Page 17 GAO-10-171 Biosurveillance Integration
 

tool that is designed to perform historical analysis of this archived data to 

help monitor and refine the effectiveness of the algorithm. According to 

NBIC officials, the goal of this analysis is to help ensure that NBIC analysts 

will be able to identify events that merit attention by refining the algorithm 

to limit results that are less relevant for monitoring for biological events of 

national concern. However, these officials told us that this aspect of BCON 

has been put on hold due to budget constraints. 

To advance information sharing among federal agencies, NBIC is also 

pursuing $90 million dollars in supplemental funding for a broader 

information sharing initiative. This initiative is intended to enable greater 

information sharing capabilities among federal, state, and local agencies 

and to have the necessary data security to house classified data. According 

to NBIC officials, this initiative is being led by the National Security 

Council. 

To communicate alerts to member agencies and the larger NBIS 

community regarding any incident that could develop into a biological 

event of national concern, NBIC has developed an IT system to provide 

alerts and warnings, based on an existing system that had been developed 

for another DHS component. However, according to NBIC officials, the 

system has not yet been fully implemented because they recently acquired 

it, and NBIC is still testing protocols for using it. According to our 

observations of the system and review of operational protocols, the 

system provides NBIC with the capability to tailor alerts and warnings to 

specific recipients via distribution lists. These officials said that in spring 

2008 the protocols were approved by the NIWG and briefed to the NIOC. 

NBIC officials said they are currently testing the protocols but have not yet 

needed to employ the system during a biological event. 

Our analysis and interviews with NBIS partners suggest that NBIC could 

strengthen its use of collaborative practices. Because participation in the 

NBIS is voluntary, effective use of collaborative practices is essential to 

NBIC’s ability to successfully develop and oversee the NBIS in a way that 

enhances federal biosurveillance capabilities. However, we found (1) 

widespread uncertainty and skepticism around the value of participating 

in the NBIS and the purpose of NBIC; (2) incomplete joint strategies, 

policies, and procedures for operating across agency boundaries; (3) an 

inability or unwillingness of NBIS members to respond to plans for 

leveraging resources; (4) confusion and dissatisfaction around the 

definitions of mission, roles, and responsibilities of NBIC and its NBIS 

Use of Key 

Collaboration 

Practices Could Help 

NBIC Strengthen 

Collaboration and 

Promote Fuller 

Participation 

Page 18 GAO-10-171 Biosurveillance Integration
 

partners; and (5) a lack of mechanisms to monitor and account for 

collaborative results. 

Clearly Defining the 

Mission and Purpose, the 

Value of Participation, and 

Joint Strategies and 

Procedures Could Promote 

More Effective Interagency 

Cooperation 

Biosurveillance integration is an inherently interagency enterprise, 

requiring expertise and resources from various federal agencies, such as 

information on human and zoonotic diseases monitored by HHS and 

USDA.22 Indeed, NBIC officials acknowledged that NBIC cannot provide 

national-level capability for cross-domain biosurveillance relying solely on 

DHS resources. As a result, it is crucial for NBIC to ensure stakeholder 

buy-in and participation in clearly defining the value of NBIS participation 

and NBIC’s mission or purpose, as well as establishing the strategies and 

procedures for how the partners will work together. Our prior work states 

that effective collaboration requires agencies to have a clear and 

compelling rationale for working together, which can be achieved by 

defining and articulating a common federal outcome or purpose.23 The 

rationale can be imposed externally through legislation or other directives 

or can come from the agencies’ own perceptions of the value of working 

together. In either case, agency staff can accomplish this by working 

across agency lines to define and articulate the common purpose they are 

seeking to achieve that is consistent with their respective agency goals and 

mission. Because there is no legal requirement for agencies to participate 

in NBIS, agencies must have a clear and compelling rationale to work 

together as a community of federal partners by joining the NBIS and 

providing data and personnel to the integration center. In the case of an 

agency like NBIC, for which collaboration is essential, clearly defining and 

communicating its purpose and mission can help to ensure that partners 

share a vision of the desired outcomes.24 In addition, our work has shown 

that to enhance and sustain collaboration, it is important to establish joint 

strategies, policies, and procedures for operating across agency 

boundaries. Establishing joint strategies and compatible policies and 

procedures helps align collaborating agencies’ activities, processes, and 

 

22Zoonotic diseases are those that can be transmitted from animals to humans. 

23GAO-06-15. 

24In addition to our call for agencies to clearly define common outcomes to support 

collaborative efforts, we have also recommended clearly defined mission statements to 

keep agency objectives in focus. In prior work on strategic planning and management, we 

have reported that statements that clearly define the mission of an organization are 

important because they bring the agency into focus, explain why the agency exists, and 

tells what it does. GAO, Agencies’ Strategic Plans under GPRA: Key Questions to 

Facilitate Congressional Review, GAO/GGD-10.1.16 (Washington, D.C.: May 1997). 

Page 19 GAO-10-171 Biosurveillance Integration
 

resources to, among other things, bring together diverse organizational 

cultures to enable a cohesive working relationship across agency 

boundaries and create the mutual trust required to sustain the 

collaborative effort. 

However, we found in interviews with agency officials from 14 

components of the 11 NBIS partners,25 widespread uncertainty and 

skepticism around the value of and rationale for participation in the NBIS 

and incomplete strategies, policies, and procedures for operating across 

agency boundaries that lack key stakeholder buy-in. Twelve of the 14 

NBIS-partner components expressed uncertainty about the value of 

participating in the NBIS community or confusion about the purpose of 

NBIC. For example, officials from one component stated that they were 

uncertain whether sharing resources with the integration center, 

something that is required of members of the NBIS community, would 

further their agency’s missions. Officials from another component 

expressed concerns about the rationale for participating in the NBIS and 

supporting the integration center, stating they were unsure whether NBIC 

contributed anything to the federal biosurveillance community that other 

agencies were not already accomplishing in the course of carrying out 

their biosurveillance-relevant missions. Officials from five of these 

components noted that their uncertainty about the value of participation 

in the NBIS was a factor in not assigning personnel to NBIC. Further, 

officials from 7 of the 14 components we interviewed indicated that their 

experience with a recent tabletop exercise and real life events had 

contributed to their concerns about the value of participating in NBIS and 

the purpose of NBIC. For example, officials from one component said that 

the tabletop exercise showcased agencies’ reluctance to share information 

and underscored that there was no role for NBIC; while officials from 

another component said that during 2009 H1N1 activities, NBIC was not 

able to demonstrate that it had unique value to add. Officials from seven of 

the components indicated that they lacked a concrete understanding of 

the purpose for which NBIC was requesting their agencies’ data, which 

 

25At HHS, we interviewed a group of officials from the Office of the Assistant Secretary for 

Preparedness and Response, groups of officials at the Centers for Disease Control and 

Prevention, and a group of officials from the Food and Drug Administration. At USDA, we 

interviewed officials from the Animal and Plant Health Inspection Service and the Food 

Safety Inspection Service. At the Department of Defense, we interviewed a group of 

officials responsible for medical force readiness and a group of officials at the National 

Medical Intelligence Center. Although DHS is a member of the NBIS, we excluded DHS 

from our analysis of these 14 components from 11 federal agencies because it houses the 

program. 

Page 20 GAO-10-171 Biosurveillance Integration
 

was, in part, the reason they had not been able to identify appropriate data 

sources or to work out data sharing agreements with NBIC. 

NBIC officials told us that they regularly reminded NBIS partners of 

NBIC’s mission as the coordinator of the NBIS and the value of sharing 

data and personnel to achieve the goal of earlier detection and enhanced 

situational awareness. However, officials from 8 of the 14 components told 

us that during negotiations with NBIC, they had raised concerns about the 

purpose of the data or the value of detailing personnel to NBIC, and NBIC 

had not followed up in a timely and consistent manner to resolve those 

concerns. NBIC officials also stated that they have taken actions to 

demonstrate the value of participating in NBIS and of sharing resources 

with the integration center. For example, NBIC co-located the integration 

center’s analysts with analysts at other agencies, such as the Centers for 

Disease Control and Prevention, for brief periods of time to enhance 

mutual understanding between NBIC and NBIS partner agencies. Further, 

NBIC officials have attempted to demonstrate the value of participating in 

NBIS and supporting the integration center by encouraging agencies to 

participate in NBIC’s daily production process. NBIC officials said that 

through daily engagement in the production process and during recent real 

life events like food borne illness outbreaks they have been able to 

demonstrate the value of NBIC. However, agency officials told us that 

their experiences with NBIC during real life events and the tabletop 

exercise created questions about the value of participating in the NBIS and 

NBIC’s purpose. 

NBIC officials have drafted but not completed a strategic plan for NBIC 

that includes a mission statement, which could help clarify NBIC’s 

purpose. The plan is also to provide strategic and operational guidance to 

NBIC officials for achieving that mission. According to NBIC officials, 

however, they have not shared the draft strategic plan with NBIS officials 

or solicited their input, and it is not currently their plan to do so because it 

is an internal document. Officials have not set a deadline for completing 

the NBIC strategic plan because they are still in the process of vetting the 

initial draft internally. 

In addition to uncertainty about the value of participating in the NBIS and 

the purpose of NBIC, we also found that NBIC has not completed and 

achieved buy-in for joint strategies, policies, and procedures for operating 

across agency boundaries. NBIC has drafted a Concept of Operations, 

which is intended to communicate joint strategies, policies, and 

procedures for operating across the NBIS. According to NBIC officials, 

they have solicited and considered comments from NBIS partners as they 

Page 21 GAO-10-171 Biosurveillance Integration
 

developed the draft, which is currently on its third version. However, 

NBIC has not yet achieved agreement around strategies, policies, and 

procedures that would support effective collaboration across the NBIS. 

For example, one key partner agency—one for which biosurveillance is a 

mission critical function and is thus essential to a strong and effective 

NBIS—shared with us a memo they had written to NBIC expressing their 

lack of concurrence with the current Concept of Operations. The memo 

cited several concerns that related largely to lack of clarity in the 

document about the desired common federal outcome and the role of the 

different partners in achieving it. NBIC officials told us they plan to 

finalize the Concept of Operations by the end of 2009. 

Clearly defining its mission, as well as articulating the value of 

participation in the NBIS, could help NBIC overcome challenges 

convincing agencies to work collectively as part of the NBIS. In addition, 

establishing and clarifying joint strategies, policies, and procedures with 

buy-in across the NBIS, could help address barriers to collaboration. 

NBIC Has Not Clearly 

Identified How to Leverage 

Resources or Effectively 

Defined Roles and 

Responsibilities with NBIS 

Partners 

Two of the collaborative practices we recommend speak to how agencies 

will share human and other assets to achieve the desired outcomes—

identifying and addressing needs by leveraging resources and agreeing on 

roles and responsibilities.26 According to NBIC officials, the concept of a 

national center for integrating biosurveillance data from multiple agencies 

depends on the willingness of the collaborating agencies to detail their 

experts to the center for a period of time to interpret the data for signs of 

an outbreak or biological attack; consequently, effectively identifying what 

resources are available and how to leverage them is important. 

In our work on practices to enhance and sustain collaboration, we call for 

agencies to assess relative strengths and weaknesses to identify 

opportunities to leverage each other’s resources, thus obtaining additional 

benefits that would not be available were the agencies working separately. 

However, agency officials we met with stated that NBIC did not recognize 

the different levels of resources and capacities that each agency brought 

to this effort. Seven of the 14 groups of agency officials we interviewed 

noted that the NBIC made personnel requests that were not compatible 

with the resources agencies had available. For example, one of the 

comments officials made to us regarding NBIC’s request for personnel 

 

26GAO-06-15. 

Page 22 GAO-10-171 Biosurveillance Integration
 

details was that they did not have available or could not spare personnel 

that matched NBIC’s request for senior-level officials with sufficient 

analytical knowledge and authority to make immediate decisions about 

sharing information across the NBIS. Officials from one of the components 

without a direct biosurveillance mission told us that they only have one 

such person on staff and needed to keep that person in house to be able to 

carry out their mission-critical activities. Officials at two agencies 

described methods they had devised for human-resource sharing 

arrangements that did not involve locating senior staff at NBIC for several 

months. However, NBIC officials told us that this is no substitute for the 

value of a member agency personnel detail that is physically located at 

NBIC. NBIC officials noted that the Secretary of Homeland Security had 

sent a memo to other NBIS agency leadership requesting help in securing 

personnel details on May 23, 2008. In addition, they stated that the issue is 

regularly addressed in NIWG and NIOC meetings. The officials also 

provided several examples of outreach to NBIS officials at all 11 agencies, 

such as through discussions with NBIS partner agency representatives at 

NIWG meetings. 

Similarly, 5 of 14 groups of officials we interviewed reported that they had 

experienced confusion about how NBIC planned to use personnel details 

if they were provided. For example, one such agency expressing this 

confusion said that NBIC’s guidance on what it is looking for in a 

personnel detail had changed frequently. NBIC officials told us that 

initially they requested individuals with strong scientific backgrounds to 

assist with data analysis and interpretation (analyst model). However, they 

later determined that they could use senior-level agency officials who 

were knowledgeable about their home organization to act as liaisons by 

identifying specific subject matter experts to consult with NBIC, as needed 

(liaison model). According to these NBIC officials, they have 

communicated to the NBIS partners that if they detail personnel to NBIC, 

they can follow either the analyst model or the liaison model. 

Nevertheless, during our interviews a lack of clarity about personnel detail 

roles and responsibilities was among the reasons cited for not finalizing 

MOUs or interagency agreements for personnel details. 

Of the two NBIS partners that placed personnel at NBIC, officials from one 

agency told us that although they still were not entirely clear on NBIC’s 

needs, they were committed to the NBIS concept. Therefore, they 

committed to send two half-time detailees each fitting one of the two types 

of detailees NBIC had alternately requested. These personnel details were 

ongoing as of October 2009. According to agency officials, they committed 

to a shorter detail than NBIC requested because they intend to use the 

Page 23 GAO-10-171 Biosurveillance Integration
 

current detail placement to help clarify for themselves what NBIC’s needs 

are and the extent to which the detail arrangement might be valuable to 

their agency. However, officials at the only other agency that had detailed 

personnel to NBIC told us that they had not renewed the detail agreement 

when it ended, in part because of budgetary challenges, but also because 

of a general perception at their agency that the detail had not been 

particularly valuable for the individual or for their agency. According to 

NBIC officials, the personnel details from this agency assisted NBIC 

immeasurably in both the analysis work and in thinking through how to 

grow and shape the personnel detail program. 

We also discuss in our work on practices for enhancing and sustaining 

collaboration the importance of defining and agreeing on roles and 

responsibilities, to allow each agency to clarify who will do what, organize 

their joint and individual efforts, and facilitate decision making.27 Our 

analysis of NIOC and NIWG post meeting reports, NBIS tabletop exercise 

results, and interviews with NBIS agency officials reveals some ambiguity 

about NBIC’s mission, roles, and responsibilities, particularly during a 

crisis. Officials from 8 of 14 components we interviewed expressed 

uncertainty about NBIC’s role during a response relative to the 

biosurveillance capability provided by other agencies in the course of their 

routine, mission-critical duties. In large part, these officials said that if they 

had information to share that might involve a biological emergency, they 

would be more likely to interact with DHS’s National Operations Center 

(NOC), at which NBIC has representation, than directly with NBIC.28 The 

after action report, as well as comments from these officials, show that 

such questions about NBIC’s response role manifested during a recent 

tabletop exercise. In our interviews, officials from seven components 

expressed concerns about NBIC’s role in the exercise or real life events, 

ranging from lack of clarity about what role NBIC played or should play to 

statements that the exercise showed clearly that NBIC has no proper role 

in event response. According to the memo that the moderator prepared 

after the tabletop exercise, although the NOC did not participate, some 

participants thought NBIC would have been bypassed in favor of the NOC. 

 

27GAO-06-15. 

28DHS’s NOC is to provide real-time situational awareness and monitoring, coordinate 

incidents and response activities, and, in conjunction with the Office of Intelligence and 

Analysis, issue advisories and bulletins concerning threats to homeland security, as well as 

specific protective measures. The NOC operates 24 hours a day, 7 days a week, 365 days a 

year. Information on domestic incident management is shared with Emergency Operations 

Centers at all levels through the Homeland Security Information Network. 

Page 24 GAO-10-171 Biosurveillance Integration
 

They said the NOC would perform the essential biosurveillance integration 

roles of coordinating and disseminating information across agencies, 

states, and the private sector. In addition, the memo notes that exercise 

participants were not in agreement about the proper role for NBIC in 

ongoing collection and dissemination of data specific to an identified 

event. Among the recommendations in the after-action memo was for 

NBIC to work internally with the appropriate DHS parties, including the 

NOC, to write protocols defining the NBIC role inside DHS. According to 

NBIC officials, they have followed up on this recommendation, by among 

other things, exploring it through the NIWG. Additionally, NBIC, the NOC, 

and other stakeholders have initiated discussions about how to develop 

appropriate protocols. 

A related issue that came to light during the tabletop exercise and was a 

theme in interviews with NBIS officials is the extent to which NBIS 

partners trust NBIC to use their information and resources appropriately. 

According to the exercise after-action memo, participants repeatedly 

raised concerns about trusting NBIC with data, and participants also 

expressed concern that NBIC would reach the wrong conclusions or 

disseminate erroneous data or reports. Similarly, in our semistructured 

interviews, officials from 5 of 14 components said they were cautious 

about sharing data or information with NBIC because they lack confidence 

that NBIC will either interpret it in the appropriate context or reach back 

to the agency to clarify before sharing the data across the whole 

interagency community. These comments generally noted concerns that 

NBIC’s lack of contextual sophistication could lead to confusion, a greater 

volume of unnecessary communication in the biosurveillance 

environment, or even panic. NBIC officials acknowledged that subject 

matter expertise from the agencies with frontline responsibility for disease 

surveillance is essential for drawing appropriate conclusions about 

emerging situations. However, they also noted that analysts at NBIC have 

experience with public health and have been building their expertise as 

the program matures. Clearly identifying how NBIS resources, including 

personnel details, will be leveraged and establishing institutional roles and 

responsibilities, could strengthen NBIC’s efforts to obtain buy-in for 

agencies to fully participate in the NBIS, including by committing to 

personnel detail arrangements. 

Page 25 GAO-10-171 Biosurveillance Integration
 

We have previously reported that federal agencies can use their strategic 

and annual performance plans as tools to drive collaboration with other 

agencies and partners.29 Such plans can also reinforce accountability for 

collaboration by establishing performance measures and aligning agency 

goals and strategies with those of the collaborative efforts. Using 

established performance measures to evaluate and report on the 

effectiveness of collaboration could identify ways to improve it. NBIC’s 

draft strategic plan outlines milestones, goals, objectives, and key tasks 

needed for NBIC to meet its mission. These tasks include, among other 

things, defining an information-sharing strategy among its stakeholders, 

deploying IT to support its mission, and establishing standard operating 

procedures. However, despite acknowledging that interagency 

cooperation and collaboration remain a concern to resolve, the strategic 

plan does not address how NBIC will improve collaboration among 

current and potential NBIS member agencies or how it will measure 

collaborative results. NBIC’s draft strategic plan includes one proposed 

performance metric related to collaboration with NBIS partners—to 

assess current collaboration activities for relevance and contribution to 

NBIS mission requirements. However, the plan lacks a discussion of 

strategic objectives to achieve collaboration and, correspondingly, lacks 

associated measures and targets to monitor efforts to achieve 

collaborative results. Strategic objectives for collaboration and associated 

targets and measures could provide NBIC with a critical tool to help 

ensure that it appropriately focuses its efforts on enhancing collaboration 

with NBIS members and that the desired results are achieved. 

Creating a Mechanism to 

Monitor Performance and 

Accountability Could Help 

NBIC Enhance and Sustain 

Collaboration 

Leveraging NBIS 

Governing Bodies to 

Develop a Strategy for 

Collaboration Could Help 

NBIC More Effectively 

Meet Its Mission 

NBIC has the means to engage NBIS partners through the organizations 

that help organize and manage the NBIS community—the NIOC and the 

NIWG—but our analysis shows the integration center has not yet fully 

leveraged these groups to develop effective collaboration strategies. The 

purpose of the NIOC and NIWG governance bodies is to provide strategy 

and policy advice on the operation of the NBIS. Information on the status 

of NBIC’s efforts to achieve its mission has been provided to the NIOC, an 

oversight council serving the NBIS community, but substantive discussion 

of strategies for overcoming barriers to collaboration that impact NBIC’s 

execution of its mission did not occur during meetings with the NIOC. For 

example, post meeting reports from the NIOC—the higher level strategic 

governance body for the community of NBIS partners—show that the 

 

29GAO-06-15. 

Page 26 GAO-10-171 Biosurveillance Integration
 

NBIC director routinely gave a status update of the MOUs and interagency 

agreements for each agency, during which agencies report the status from 

their perspective. However, in these segments of the NIOC meetings, the 

post meeting reports reflect little, if any, discussion of the reasons NBIS 

agency officials cited in our interviews for not finalizing the agreements. 

Neither do the reports show any focused effort to discuss barriers to 

participation or solutions to working across agency boundaries. 

The NIWG—operational level working group—post meeting reports 

between March 2008 and May 2009 reflect only one discussion during 

which the need to finalize agreements was addressed. Although the NIWG 

has formed a sub-working group specifically to address collaboration, our 

review of the post meeting reports shows that neither the full NIWG nor 

the sub-working group has been effectively engaged in a focused effort to 

identify, discuss, and address challenges to working across agency 

boundaries. According to NBIC officials, they place contentious issues 

before the NBIS governance structure in a way that may not be clearly 

captured in post meeting reports. NBIC officials noted that the post 

meeting reports do not clearly reflect the numerous times they have made 

proposals for solutions to problems and have been met with silence from 

the attendees. However, they acknowledge that they have approached the 

NBIS governance bodies seeking buy-in for their proposals for tactical and 

operational approaches rather than an open-ended discussion seeking 

strategic solutions to the broader barriers to information and resource 

sharing. Leveraging these bodies to get meaningful input from NBISpartner leadership could help NBIC ensure that it is able to identify 

commonly accepted solutions to working across agency boundaries. 

Enhancing the federal government’s ability to detect and warn of 

biological events of national concern and to provide better situational 

awareness for response to those events depends on multiple actors inside 

and outside the federal government to work together effectively. The 9/11 

Commission Act charged NBIC with early detection and situational 

awareness, but both the act and the operational guidance NBIC has 

developed acknowledges that this is to be done, in large part, through the 

NBIS—a multi-agency collaborative community. Despite the critical role of 

this collaborative community in achieving the act’s charge, the act does 

not require any specific agency to participate in the NBIS or to support the 

integration center. Therefore, it is imperative that NBIC employ 

collaborative practices to enhance and sustain collaboration across the 

NBIS so that this community of federal partners are fully and effectively 

engaged in pursuit of the overarching missions of early detection and 

enhanced situational awareness. 

Conclusions 

Page 27 GAO-10-171 Biosurveillance Integration
 

Although NBIC has made some efforts to strengthen relationships with 

and solicit participation from NBIS partners, working with the NBIS to 

develop a strategy for collaboration that includes key collaboration 

practices identified in our previous work could help the integration center 

promote more effective collaboration. During the course of our review, 

officials from the NBIS community recounted a number of constraints on 

their participation, including concerns about the clarity of NBIC’s mission 

and the ends to which shared information and resources would be used. 

We have previously reported that having a mission statement helps to 

clarify an agency’s focus and purpose. Moreover, our prior work on 

enhancing and sustaining collaboration in the federal government advises 

that practices such as articulating common outcomes, identifying 

appropriate resources to be shared, clarifying roles and responsibilities, 

and developing mechanisms to monitor performance and accountability 

could help NBIC address barriers to collaboration. However, NBIC has not 

formulated goals and objectives for overcoming barriers to collaboration 

and has no supporting performance and accountability mechanisms—such 

as performance measures—to help ensure that they are pursuing those 

goals effectively. In addition, although NBIC has created the NIOC and 

NIWG to provide strategic and operational advice on how the NBIS should 

function, NBIC had not effectively engaged them in a focused effort to 

identify shared solutions for overcoming barriers to collaboration and 

creating buy-in for joint strategies, policies, procedures, roles, and 

responsibilities. A strategy for helping ensure that NBIC applies key 

collaborative practices effectively and consistently, that draws on the 

existing intellectual resources of its strategic partners in the NIOC, and 

that includes mechanisms to monitor performance and accountability for 

collaborative results, may help NBIC and NBIS partners to identify and 

overcome challenges to sharing data and personnel for the purposes of 

earlier detection and enhanced situational awareness of potentially 

catastrophic biological events. 

In order to help NBIC ensure that it effectively applies practices to 

enhance and sustain collaboration, including the provision of data, 

personnel, and other resources, we are making the following two 

recommendations to the Director of NBIC: 

Recommendations for 

Executive Action 

• In conjunction with the NIOC, finalize a strategy for more effectively 

collaborating with current and potential NBIS members, by (1) clearly 

defining NBIC’s mission and purpose, along with the value of NBIS 

membership for each agency; (2) addressing challenges to sharing data 

and personnel, including clearly and properly defining roles and 

Page 28 GAO-10-171 Biosurveillance Integration
 

responsibilities in accordance with the unique skills and assets of each 

agency; (3) developing and achieving buy-in for joint strategies, 

procedures, and policies for working across agency boundaries. 

• Establish and use performance measures to monitor and evaluate the 

effectiveness of collaboration with current and potential NBIS partners. 

We provided a draft of this report for review and comment to the following 

agencies: DHS, HHS, USDA, and the Departments of Commerce, Defense, 

Interior, Justice, State, Transportation, and Veterans Affairs, as well as the 

Environmental Protection Agency and the United States Postal Service. 

DHS provided written comments on December 10, 2009, which are 

summarized below and presented in their entirety in appendix I of this 

report. HHS, USDA, and the Departments of Commerce, Defense, Interior, 

Justice, Transportation, and Veterans Affairs, as well as the Environmental 

Protection Agency and the United States Postal Service did not provide 

written comments. We incorporated technical comments from DHS, 

USDA, and the United States Postal Service where appropriate. 

Agency Comments 

and Our Evaluation 

DHS generally concurred with our findings and recommendations and 

stated that NBIC will work with the NIOC and all NBIS partners to develop 

a collaboration strategy to clarify both the mission space and roles and 

responsibilities of all NBIS partners. DHS has taken initial steps to 

implement our recommendations. For example, DHS noted that at the 

December 9, 2009, quarterly NIOC meeting, the Assistant Secretary of 

Health Affairs and Chief Medical Officer for DHS, Dr. Alex Garza, 

referenced this report’s findings and challenged NIOC members to work to 

resolve and address confusion regarding NBIS and NBIC. We are 

encouraged by DHS’s efforts to engage the NIOC to identify and overcome 

barriers to collaboration; continuing to work with the NIOC to develop 

and finalize a strategy for collaboration could help NBIC overcome 

challenges to sharing data and personnel. In addition, monitoring the 

effectiveness of collaboration through the use of performance metrics 

could help NBIC ensure they are progressing towards their goal of 

obtaining the resources necessary to accomplish its mission of early 

detection and situational awareness of biological events of national 

concern. 

While DHS stated that we clearly identify the challenges faced by NBIC in 

carrying out its mission, the department also commented that the lack of a 

legal requirement for other federal agencies to participate in the NBIS 

Page 29 GAO-10-171 Biosurveillance Integration
 

prevents DHS from compelling the cooperation that is needed to ensure 

success of the NBIC mission. As we noted in our report, the lack of a legal 

requirement is what makes the effective use of collaboration best 

practices crucial for NBIC to be successful. 

We are sending copies of this report to the Secretary of Homeland 

Security, Secretary of Health Human and Services, Secretary of 

Agriculture, Secretary of Commerce, Secretary of Defense, Secretary of 

Interior, Attorney General, Secretary of State, Secretary of Transportation, 

and the Secretary of Veterans Affairs, as well as the Administrator of the 

Environmental Protection Agency, the Postmaster General, the Director of 

NBIC, and interested congressional committees. The report is also 

available at no charge on GAO’s Web site at http://www.gao.gov. 

If you or your staff have any questions about this report please contact me 

at (202) 512-8777 or JenkinsWO@gao.gov. Contact points for our Offices of 

Congressional Relations and Public Affairs may be found on the last page 

of this report. GAO staff who made major contributions to this report are 

William O. Jenkins, Jr

listed in appendix II. 

. 

Director, Homeland Security 

and Justice Issues 

Page 30 GAO-10-171 Biosurveillance Integration
Appendix I: Comments from the Department Appendix I: Comments from the Department of Homeland Security 

of Homeland Security 

Page 31 GAO-10-171 Biosurveillance Integration 
Appendix I: Comments from the Department 

of Homeland Security 

Page 32 GAO-10-171 Biosurveillance Integration
Appendix II: GAO Contact and Staff Acknowledgments 

Page 33 GAO-10-171 

Appendix II: GAO Contact and Staff 

Acknowledgments 

William O. Jenkins, Jr., (202) 512-8777 or jenkinswo@gao.gov 

In addition to the contact named above, Anne Laffoon, Assistant Director; 

Michelle Cooper; Clare Dowdle; Kathryn Godfrey; and Andrea Yohe made 

significant contributions to the work. Keira Dembowski, Susanna Kuebler, 

Alberto Leff, and Juan Tapiavidela also provided support. Amanda Miller 

assisted with design, methodology, and analysis. Tracey King provided 

legal support. Linda Miller provided communications expertise. 

 Biosurveillance Integration 

GAO Contact 

Acknowledgments 

(440777) 
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