Biosurveillance: Efforts to Develop a National Biosurveillance Capability Need a National Strategy and a Designated Leader
Published: 2010-06-30T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The U.S. government has a history of employing health surveillance to help limit malady, loss of life, and economic impact of diseases. Recent legislation and presidential directives have called for a robust and integrated biosurveillance capability; that is, the ability to provide early detection and situational awareness of potentially catastrophic biological events. The Implementing Recommendations of the 9/11 Commission 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 addresses (1) federal efforts that support a national biosurveillance capability and (2) the extent to which mechanisms are in place to guide the development of a national biosurveillance capability. To conduct this work, GAO reviewed federal biosurveillance programs, plans, and strategies and interviewed agency officials from components of 12 federal departments with biosurveillance responsibilities.
section_title: What GAO Found
paragraphs: Federal agencies with biosurveillance responsibilities--including the Departments of Health and Human Services, Homeland Security, and Agriculture--have taken or plan to take actions to develop the skilled personnel, training, equipment, and systems that could support a national biosurveillance capability. GAO previously reported that as the threats to national security have evolved over the past decades, so have the skills needed to prepare for and respond to those threats. Centers for Disease Control and Prevention (CDC) officials stated that skilled personnel shortages threaten the capacity to detect potentially catastrophic biological events as they emerge in humans, animals, or plants. To address this issue, some federal agencies are planning or have taken actions to attract and maintain expertise using fellowships, incentives, and cooperative agreements. Moreover, CDC has called for the development of a national training and education framework to articulate professional roles and competencies necessary for biosurveillance. The Department of Agriculture has also developed training programs to help ensure that diseases and pests that could harm plants or animals can be identified. In addition, federal agencies have taken various actions designed to promote timely detection and situational awareness by developing (1) information sharing and analysis mechanisms, (2) laboratory networks to enhance diagnostic capacity, and (3) equipment and technologies to enhance early detection and situational awareness. While national biodefense strategies have been developed to address biological threats such as pandemic influenza, there is neither a comprehensive national strategy nor a focal point with the authority and resources to guide the effort to develop a national biosurveillance capability. For example, the National Security Council issued the National Strategy for Countering Biological Threats in November 2009. While this strategy calls for the development of a national strategy for situational awareness, it does not meet the need for a biosurveillance strategy. In addition, this strategy includes objectives that would be supported by a robust and integrated biosurveillance capability, such as obtaining timely and accurate insight on current and emerging risks, but it does not provide a framework to help identify and prioritize investments in a national biosurveillance capability. GAO previously reported that complex interagency efforts, such as developing a robust, integrated, national biosurveillance capability, could benefit from an effective national strategy and a focal point with sufficient time, responsibility, authority, and resources to lead the effort. Efforts to develop a national biosurveillance capability could benefit from a national biosurveillance strategy that guides federal agencies and other stakeholders to systematically identify risks, resources needed to address those risks, and investment priorities. Further, because the mission responsibilities and resources needed to develop a biosurveillance capability are dispersed across a number of federal agencies, efforts to develop a biosurveillance system could benefit from a focal point that provides leadership for the interagency community.
section_title: What GAO Recommends
paragraphs: GAO recommends that the Homeland Security Council direct the National Security Staff to identify, in consultation with relevant federal agencies, a focal point to lead the development of a national biosurveillance strategy to guide the capability's development. GAO provided a copy of this draft to the 12 federal departments and the National Security Staff.

section_title: Letter
paragraphs: A catastrophic biological event, such as a terrorist attack with a weapon of  mass destruction or a naturally occurring pandemic, could cause  thousands of casualties or more, weaken the economy, damage public  morale and confidence, and threaten national security. In January 2010,  the bipartisan Commission for the Prevention of Weapons of Mass  Destruction Proliferation and Terrorism, which was established by the  Implementing Recommendations of the 9/11 Commission Act to address  the threat that the proliferation of weapons of mass destruction poses to  the United States, gave the nation a failing grade in its efforts to enhance  capabilities for rapid response to prevent biological attacks from inflicting  mass casualties. The commission reported that unless the world  community acts, it is more likely than not that a weapon of mass  destruction will be used in a terrorist attack somewhere in the world by  the end of 2013. Further, the report stated that such a weapon is more  likely to be biological than nuclear.
The U.S. government has a long history of employing disease surveillance  activities to help limit malady, loss of life, and economic impact.  Traditional disease surveillance activities involve trained professionals  engaged in monitoring, investigation, confirmation, and reporting in an  effort to further various missions including, but not limited to, detecting  signs of pathogens in humans, animals, plants, food, and the environment.  However, in recent years experts and practitioners, reacting to an  increasing awareness of the speed and intensity with which a biological  weapon of mass destruction or highly pathogenic strain of emerging  infectious disease could affect the nation, have sought to augment the  traditional surveillance activities with biosurveillance programs and  systems. The dual purposes of biosurveillance are (1) to detect as early as  possible a potentially catastrophic biological event and (2) to enhance  situational awareness—including awareness, comprehension of meaning,  and projection into the near future about events—by improving the quality  of information available to support response and policy actions in the face  of such an event.
Since at least the 1990s, there has been an ongoing and evolving effort by  the federal government in conjunction with its partners to address the  need for a strategic approach to improving disease surveillance and  response. Recognizing the potentially devastating consequences that could  flow from biological events—both natural and intentional—responsible  federal officials and other experts have, in various formats, called for  better integration of multiple disparate surveillance and related mission  activities to help support a strong national biosurveillance capability. For  example, among the federal government’s initiatives to confront the threat  of biological events was a presidential directive that called for the  development of a national, robust, and integrated biosurveillance  capability that provides timely warning and ongoing characterization of  catastrophic biological events, drawing on the systems, resources, and  information from existing human, animal, plant, food, and environmental  surveillance activities. Ensuring the development of such a national  biosurveillance capability involves attention to the resources—personnel,  training, equipment, and systems—that underpin various surveillance  efforts across the federal government, as well as mechanisms to help  direct effective and efficient use of those resources to support the  capability.
Many federal departments and agencies pursue missions and manage  programs that might contribute to a national biosurveillance capability.
The Department of Health and Human Services (HHS) is the federal  agency with primary responsibility for disease surveillance—including  food-borne illnesses—in humans. The Department of Agriculture (USDA)  is the primary federal agency with responsibility for pest and disease  surveillance in animals and plants as well as food-borne illnesses within  the agricultural industries. As the agency with lead responsibility for  protecting against and responding to threats and hazards to the nation, the  Department of Homeland Security (DHS) is concerned with the prevention  of bioterrorist attacks as well as preparing the nation to respond to  biological events in order to minimize human and economic losses. In  addition, the Homeland Security Council was established by executive  order in 2001 to serve as a mechanism for ensuring coordination of  homeland security-related activities of executive departments and  agencies and effective development and implementation of homeland  security policies. The establishment of the Homeland Security Council  was subsequently codified in statute with the enactment of the Homeland  Security Act of 2002.
Around the same time that the President issued a directive calling for a  national biosurveillance capability, Congress articulated a similar goal  with respect to a biosurveillance capability in the Implementing  Recommendations of the 9/11 Commission Act of 2007 (9/11 Commission  Act)—to enhance the capability of the federal government to rapidly  identify, characterize, localize, and track biological events of national  concern by integrating and analyzing data relating to human, animal, plant,  food, and environmental surveillance. The 9/11 Commission Act also  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. This report  responds in part to that mandate by examining the extent to which a  national, robust, integrated biosurveillance capability has been  established. Specifically, the report examines the following: (1) federal  agency efforts to provide resources—personnel, training, equipment, and  systems—that support a national biosurveillance capability; and (2) the  extent to which mechanisms are in place to guide the development of a  national biosurveillance capability.
In December 2009, in response to the same mandate, we issued work  addressing the efforts of DHS’s National Biosurveillance Integration  Center (NBIC), which was established in the 9/11 Commission Act to  enhance federal biosurveillance capabilities. We also have ongoing work  on state, local, tribal, and territorial biosurveillance activities, from which  we expect to issue a report in winter 2011.
To address our objectives, we reviewed key legislation and presidential  directives related to biosurveillance, including the Homeland Security Act  of 2002, the Public Health Security and Bioterrorism Preparedness and  Response Act of 2002, the Pandemic and All Hazards Preparedness Act of  2006, and Homeland Security Presidential Directives (HSPD) 9, 10, and  21. This report focuses on surveillance efforts for one or more of the  following biosurveillance domains: human health, animal health, plant  health, food, and the environment (specifically, air and water). It focuses  primarily on seven federal departments that have key roles and  responsibilities—based on agency missions, statutory responsibilities,  presidential directives, or programmatic objectives—for biosurveillance  and related mission activities, including protecting public health,  agriculture, and national security. These departments are the Departments  of Agriculture, Defense (DOD), Homeland Security, Health and Human  Services, Interior (DOI), as well as the Environmental Protection Agency  (EPA) and the United States Postal Service (USPS). To understand how  federal agencies have planned or coordinated their biosurveillance efforts,  we reviewed key agency and interagency documents, including concepts  of operation, surveillance and implementation plans, and biodefense  strategies. For example, we reviewed NBIC’s Concept of Operations for  the National Biosurveillance Integration System, agency strategies and  plans for conducting surveillance, and the National Security Council’s  National Strategy for Countering Biological Threats. We conducted  interviews with officials and observed operations at federal agencies— particularly DHS, HHS, and USDA, which have the larger and more direct  mission responsibilities for biosurveillance and related mission  activities—to understand their roles and responsibilities and how their  activities support the national biosurveillance capability. We also collected  and analyzed information on the resources, systems, and equipment they  use; the other governmental and nongovernmental entities with whom  they partner; and the limitations they have encountered in conducting  their biosurveillance missions. We also reviewed reports published by  nongovernmental entities—for example, the National Academy of  Sciences’s Institute of Medicine and the Center for Biosecurity—related to  public health, disease detection, bioterrorism, biodefense, and emergency  management. We also reviewed our prior work on federal surveillance  activities, food safety, intergovernmental and interagency collaboration,  and national security issues. We compared information we collected from  agency documents and officials to our previous work related to national  strategies and focal points for leadership to identify mechanisms that  could help support crosscutting efforts to build and sustain a national  biosurveillance capability. More detailed information about our scope  and methods appears in appendix I.
We conducted this work from December 2008 through May 2010 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.
subsections: section_title: Background
paragraphs: As shown in figure 1, biosurveillance is a concept that emerged in  response to increased concern about biological threats from emerging  infectious diseases and bioterrorism. Biosurveillance is carried out by and  depends on a wide range of dispersed entities. Federal biosurveillance  responsibilities, likewise, are spread across an array of agencies and  provided for in multiple laws and presidential directives.
subsections: section_title: Social and Economic Conditions Contribute to the Threat of a Catastrophic Biological Event
paragraphs: In an era of rapid transit and global trade, the public health and  agricultural industries, as well as natural ecosystems including native  plants and wildlife, face increased threats of naturally occurring outbreaks  of infectious disease and accidental exposure to biological threats.  According to the World Health Organization (WHO), infectious diseases  are not only spreading faster, they appear to be emerging more quickly  than ever before. Since the 1970s, newly emerging diseases have been  identified at the unprecedented rate of one or more per year. There are  now nearly 40 diseases that were unknown a generation ago. In addition,  during the last 5 years, WHO has verified more than 1100 epidemic events  worldwide. Figure 2 shows select disease occurrences worldwide in  recent decades. Additional information about the occurrences is available  electronically in pop-up boxes on the map or in print in appendix II.  Examples of emerging infectious disease include Severe Acute  Respiratory Syndrome (SARS), H5N1 influenza (avian flu), and the H1N1  influenza that resulted in a global pandemic in 2009. The potential impact  of these events is not limited to public health. For example, the avian  influenza outbreaks in Asia and Eastern Europe were reminders that the  public health sector is intrinsically linked to the agriculture, trade,  tourism, economic, and political sectors.
Due to the rapid and constant movement of people and commodities— such as animals, plants, and food—biological agents can be carried by  passengers or containers on airplanes and boats and slip across national  borders unnoticed as infectious diseases are transferred from person to  person through close contact with one another. Ecological changes, such  as changes in land use, and the globalization of the food supply are also  associated with the emergence and spread of infectious disease. Animals  also face the threat of infectious disease, and in some cases diseases— known as zoonotic diseases—can be transferred between animals and  people. Zoonotic diseases represent at least 65 percent of newly emerging  and reemerging infectious diseases in recent decades. Many important  factors contribute to the proliferation of zoonotic diseases, including the  growth of human and domestic animal populations and the increasingly  close physical proximity within which humans and their domestic animals  live with wild animals.
Some disease agents can also be weaponized and used as weapons of mass  destruction to disrupt economies and endanger human, animal, and plant  health. Since the attacks of September 11, 2001, there has been concern  that another terrorist attack on U.S. soil could involve biological or other  weapons of mass destruction. Groups like the Center for  Counterproliferation Research at the National Defense University and the  Commission on the Prevention of Weapons of Mass Destruction  Proliferation and Terrorism (established by the 9/11 Commission Act)  have warned that the biological weapons threat is real, with evidence that  terror groups like Al Qaeda have had active biological weapons programs  in the past and approximately 12 countries are suspected of seeking  biological weapons.
Emerging disease and bioterrorism concerns also surround the nation’s  agriculture and food supply, as well. Plant resources in the United States,  including crops, rangelands, and forests, are vulnerable to endemic,  introduced, and emerging pathogens. More than 50,000 plant diseases  occur in the United States, caused by a variety of pathogens. Increasing  globalization and international trade activities create a likelihood that  many other exotic plant pathogens will arrive in the United States in the  coming years.
In addition, the United States faces growing food safety challenges from  fresh and processed foods that become contaminated well before they  reach the consumer, leading to outbreaks linked to foods that have not  previously been associated with foodborne illnesses. For example,  according to USDA, leafy greens are the category of produce most likely to  be associated with an outbreak. Recent outbreaks of foodborne illness  have also focused public attention on the increasing potential for  widespread dissemination of contaminated products. For example,  beginning in September 2006, the United States experienced an outbreak  of E. coli 0157:H7 associated with the consumption of tainted spinach  grown in California; this outbreak resulted in 205 victims in 26 states  suffering severe disease. Three people died. Widespread outbreaks of  other foodborne illnesses, such as Salmonella, have also occurred from  contaminated peanut butter and tomatoes.
We reported in March 2005 that although the United States has never  experienced a terrorist attack against agriculture, it is vulnerable for a  variety of reasons, including the relative ease with which causative agents  of diseases that could affect livestock and crops could be obtained and  disseminated. Many of these diseases are endemic in other parts of the  world and can be extracted from common materials, such as soil. Farms in  general are easily accessible because they are located in rural areas and  have minimal security, especially crop farms. Moreover, the highly  concentrated breeding and rearing practices of our livestock industry may  make it a vulnerable target for terrorists because diseases could spread  rapidly and be difficult to contain. For example, between 80 and 90  percent of grain-fed beef cattle production is concentrated in less than 5  percent of the nation’s feedlots. Therefore, the deliberate introduction of a  highly contagious animal disease in a single feedlot could have serious  economic consequences. In addition, a number of disease causing agents  can infect and be spread by wildlife. According to officials at DOI, it may  be difficult to control a novel pathogen if it is introduced into native  wildlife. These officials noted that the gregarious habits of many wildlife  species can enhance their susceptibility to catastrophic losses from select  diseases, and because of their mobility, there is potential for infectious  disease to spread quickly to new locations and populations.
Finally, pathogens can be carried through or introduced into the  environment, causing damage to health and economies. Drinking water  utilities across the country have long been recognized as potentially  vulnerable to terrorist attacks of various types, including physical  disruption, bioterrorism, chemical contamination, and cyber attack.  Damage or destruction by terrorists could disrupt not only the availability  of safe drinking water, but also the delivery of vital services that depend  on these water supplies, such as fire suppression. People and animals also  face the threat of becoming ill from inhaling certain biological agents,  some of which occur naturally in our environment and some that can be  weaponized and intentionally released to cause catastrophic disruption.  Concerns about weaponized airborne pathogens were amplified by the  anthrax attacks conducted through the mail a month after the September  11, 2001, attacks on the World Trade Center and the Pentagon.
section_title: Laws and Presidential Directives Direct Agencies to Strengthen Biosurveillance and HSPD- 21 Calls for an Integrated National Biosurveillance Capability
paragraphs: As figure 3 shows, federal laws and directives call for HHS, USDA, DHS,  and other federal agencies to take action to strengthen biosurveillance.  The most recent of these—Homeland Security Presidential Directive-21— synthesizes and reiterates actions in other laws and directives, explicitly  calling for a national biosurveillance capability. In calling for this national  capability, HSPD-21 discusses certain aspects related to the personnel,  training, equipment, and systems needed. For example, among the  elements it describes as necessary for a robust and integrated national  capability are enhanced clinician awareness, stronger laboratory  diagnostic capabilities, integrated biosurveillance data, and an  epidemiologic surveillance system with sufficient flexibility to tailor  analyses to new syndromes and emerging diseases.
In the case of biological threats, timely detection of biological agents is a  precursor to effective response; therefore, a national biosurveillance  capability like the one described in HSPD-21 is an essential tool in the  nation’s preparedness to confront catastrophic threats. Capabilities to  carry out any broad emergency management mission—like  biosurveillance—are made up of (1) planning, (2) organization and  leadership, (3) personnel, (4) equipment and systems, (5) training, and (6)  measurement/monitoring.
A national biosurveillance capability like the one described in HSPD-21  would largely rely on an interagency effort because the mission activities  and accompanying resources that support the capability—personnel,  training, equipment, and systems—are dispersed across a number of  federal agencies. For example, HHS’s Centers for Disease Control and  Prevention (CDC) has primary responsibility for human health and USDA  for plant and animal health. Responsibility for various food sources is split  between USDA and HHS’s Food and Drug Administration (FDA). DHS, as  the agency with primary responsibility for securing the homeland, is  responsible for coordinating efforts to prevent, protect against, respond  to, and recover from biological attacks. The resources—personnel,  training, equipment, and systems–that support a national biosurveillance  capability reside within the separate agencies that acquire and maintain  them in pursuit of their missions, which overlap with but are not wholly  focused on biosurveillance.
A national biosurveillance capability also depends upon participation from  state, local, and tribal governments. Few of the resources required to  support the capability are wholly owned by the federal government. The  responsibility and capacity for collecting most information related to  plant, animal and human health, food, and environmental monitoring  resides within state, local, and tribal governments, or private sector  entities—such as hospital and other private health care providers. In the  United States, state and local public health agencies have the authority  and responsibility for carrying out most public health actions, and the  federal government generally cannot compel state, local and tribal  governments, or private sector entities to provide information or  resources to support federal biosurveillance efforts. Instead, individual  federal agencies, in pursuit of their missions, attempt to build  relationships and offer incentives—like grants—to encourage voluntary  cooperation with specifi c federal efforts.
In addition, although traditional disease surveillance systems designed to  collect information on the health of humans, animals, and plants are the  backbone of biosurveillance—because they, among other things, provide  mechanisms for ongoing monitoring and specific information about  outbreaks to inform response—they also rely on time-intensive testing and  confirmation practices. The inherent time lag, combined with limitations  arising from reliance on data not owned by the federal government,  presents challenges that limit the promise of traditional disease  surveillance alone to provide the timely detection and situational  awareness that is the goal of a national biosurveillance capability. For  additional information on the contributions and associated challenges of  traditional federal surveillance activities to monitor for pathogens in  plants, animals, humans, and food see appendix III. For more information  on specific federal programs that can be used to support biosurveillance  see appendix IV.
section_title: Federal Agencies Have Taken Actions That Support a National Biosurveillance Capability
paragraphs: Federal agencies have taken or are planning some actions to improve the  personnel, training, and systems and equipment that support a national  biosurveillance capability, including, but not limited to, planning to assess  workforce needs, sponsoring recruitment and training efforts, seeking to  facilitate information sharing, and applying technologies to enhance  surveillance.
subsections: section_title: Federal Agencies Have Taken Actions to Help Ensure Availability of Personnel to Monitor Human, Animal, and Plant Health Domains for Biosurveillance Purposes
paragraphs: Some of the professions that underpin the surveillance mechanism for a  national biosurveillance capability currently face and are expected to  continue to confront workforce challenges—particularly workforce  shortages; however, some federal agencies with key biosurveillance  responsibilities have efforts underway to help confront those challenges.  We reported in September 2009 that as the threats to national security— which include the threat of bioterrorism and pandemic outbreak—have  evolved over the past decades, so have the skills needed to prepare for and  respond to those threats. We also found that like other federal efforts to  address modern national security challenges that require collaboration  among multiple agencies, an effective biosurveillance capability relies on  qualified, well-trained professionals with the right mix of skills and  experience. Figure 4 provides examples of the workforce involved with  detection and situational awareness activities that support biosurveillance.
The public health and health care workforce is expected to continue to  confront shortfalls in the coming years, which could threaten the federal  government’s ability to develop a national biosurveillance capability.  According to CDC officials, serious public health and health care  workforce shortages currently exist due to factors such as the exodus of  retiring workers, an insufficient supply of trained workers, inadequate  funding, and uncompetitive salaries and benefits. In discussing concerns  about looming workforce shortages, CDC officials pointed to a December  2008 Association of Schools of Public Health estimate that by 2020 the  nation will face a shortfall of over 250,000 public health workers. CDC  officials said that states and communities nationwide report needing more  public health nurses, informaticians, epidemiologists, laboratory workers,  statisticians, and environmental health experts. Moreover, the Institute of  Medicine stated in 2009 that the unevenness of organizational and  technical capacity at state and local levels across the public health system  weakens the nation’s preparedness to detect and, especially, to respond to  and manage the consequences of a major health emergency.
We also reported in February 2009 that the animal health field faces  workforce shortages that could affect the ability of professionals to be  prepared and enabled to detect and warn of biological events. For  example, USDA officials have expressed concern about the future size and  skills of the veterinarian workforce, particularly veterinary pathologists  who are integral to the work conducted in USDA’s diagnostic laboratories,  including work on diseases that threaten animal and human health.  Further, USDA officials have also expressed concern about the availability  of taxonomists, whose expertise is critical to characterizing threats and  providing warning of a potentially catastrophic biological event involving  plants.
Although the workforce shortages threaten to diminish capacity to detect  signals of potentially catastrophic biological events as they emerge, some  federal agencies are planning or have taken actions to help mitigate them.  In particular, in its National Biosurveillance Strategy for Human Health,  CDC named the biosurveillance workforce as one of its priority areas. To  enhance workforce capability, CDC’s strategy calls for assessing the  current biosurveillance workforce capability, identifying and addressing  gaps, ensuring the workforce is competent, developing recruitment and  retention strategies for professionals across diverse fields, and  establishing a national-level governance body for the biosurveillance  workforce across agency boundaries and disciplines. CDC has also taken  actions to help increase the number of public health workers, including  extending service and learning fellowships in epidemiology, informatics,  laboratory, and management.
Moreover, with respect to animal and plant workforce, the federal  government is implementing measures to help ensure an adequate  workforce. For example, we reported in February 2009 that USDA has set  a goal of recruiting at all veterinary colleges and universities. In addition,  USDA is using incentives, such as bonuses, to attract and maintain its  veterinarian workforce.  In addition, USDA has identified tactics to build  the capacity and retain the experience of taxonomists. USDA is also using  cooperative agreements and funding to enlist taxonomic services from  nonfederal institutions to identify and confirm identifications of exotic  plant pests. According to USDA officials, they have increased the number  and variety of these agreements in recent years, increased availability of  professionals who can help identify threats to plants by nearly 50 percent  in the past 20 years, and created a career ladder to retain experienced and  talented workers. Further, in response to recommendations we made in  February 2009 to address veterinarian shortages, in November 2009, the  Office of Personnel Management established the governmentwide  Veterinary Medical Officer Talent Management Advisory Council.  The  purpose of the council is to lead the design and implementation of a  governmentwide workforce strategy for federal veterinary medical  workers. The council held its first meeting in March 2010 and is in the  process of gathering workforce data from all federal agencies with  veterinarian medical officers.
section_title: Federal Agencies Have Supported or Implemented Training and Accreditation Programs
paragraphs: Federal agencies have supported programs to help with workforce  development at the state and local levels that respond partially to the  ongoing challenge of maintaining a trained cadre of professionals who  operate in fields where professional issues, systems, and technologies  continue to evolve over time. Training and accreditation programs are  essential to developing a knowledgeable workforce with the skills needed  to identify potential threats to human, animal, and plant health. An  effective medical response to a biological event would depend in part on  the ability of individual clinicians and other professionals to identify,  accurately diagnose, and effectively treat diseases, including many that  may be uncommon. The opportunity to evaluate signs and symptoms of  diseases of concern relies on trained professionals possessing the  knowledge needed to identify and order the right lab test to confirm a  diagnosis. In addition, detection and warning of a disease threat also relies  on these professionals knowing who to call to report the finding.
One challenge federal officials relayed to us is that because the concept of  biosurveillance is relatively new and has been evolving over the last  decade, there are few if any specialties or concentrations in  biosurveillance within epidemiology or other programs. They further  noted that while some university programs are beginning to address the  issues in their curricula, the general lack of biosurveillance or cross- domain specialties, curricula, and classes in these programs limits the  feedback loop between academics and practitioners that helps support  innovative solutions.
Another training challenge is keeping up with changes in issues,  technologies, and systems. CDC officials told us that public health workers  are always challenged with keeping abreast of developments. For  example, when a new laboratory tool or method is developed, public  health workers must be trained to use them. Epidemiologists also must be  trained and educated about new or emerging health issues, infections,  software, information technology systems, and tools. Clinicians require  continuing education to remain astute. These CDC officials noted that  maintaining expertise in a rapidly changing field is difficult, yet having  professionals with the right expertise is critical in protecting the public’s  health, as well as for emergency preparedness and response. For USDA,  the increased risks to animal and public health from animal diseases have  presented challenges because the expertise needed to identify and  respond to the risks of zoonotic diseases has not been defined.
Further, a DOI official expressed concern about maintaining skills and  expertise of wildlife health professionals. According to this official,  identifying, characterizing, and mitigating threats involving free ranging  fish and wildlife populations call for specific training and expertise in  wildlife epidemiology and wildlife disease ecology. These officials  expressed concern about whether federal inspectors receive sufficient  training or have sufficient resources to address disease in free-ranging  wildlife populations.
Federal agencies have taken actions to help respond to the challenges  arising from evolving fields of study and increased risks of outbreaks  impacting more than one domain. For example, in the National  Biosurveillance Strategy for Human Health, CDC has called for the  development of a national training and education framework to articulate  professional roles and competencies necessary for biosurveillance. The  strategy also noted that in addition to the traditional public health  professions trained in surveillance, there is a need to recruit professionals  from other diverse fields including informatics and computational  sciences to enhance data sharing, as well as the plant and veterinary  sciences to help understand how diseases flow among humans, animals,  and plants. Along these lines, CDC has developed a public health  informatics fellowship program, which is designed to help address the  need for practitioners with a mastery of sophisticated electronic systems  to facilitate communication and data exchange among public health  personnel at the local, state, and federal levels. Officials at HHS also noted  that the National Institute of Health’s National Library of Medicine has  funded 18 University-Based Biomedical Informatics Research Training  programs, of which 10 have special Public Health Informatics tracks.
USDA has also developed training programs to ensure their first detectors  are knowledgeable on diseases and pests of significance. For example,  USDA has an accreditation program for veterinarians and views the cadre  of veterinarians it has accredited as the front line of surveillance for  diseases of significance that are not specifically monitored through a  program. These accredited state and federal veterinary officials—as we  reported in 2005, approximately 80 percent of the veterinary workforce— are dispersed throughout the country and are trained to observe signs and  symptoms of diseases and unusual occurrences of illness or death in  animal populations. According to USDA, the United States depends  extensively on accredited veterinarians for official functions, such as  inspecting, testing, and certifying animal health. For plant surveillance,  USDA’s National Plant Diagnostic Network began the National First  Detector Training Program in 2003. The program offers training to aid  USDA’s surveillance of plants for pests and diseases. First detectors are  individuals who in the course of their activities are in a position to notice  an unusual plant pest outbreak, a pest of concern, or symptoms of a pest  of concern. The individuals may include growers, nursery producers, crop  consultants, pesticide applicators, and master gardeners, among others.  According to USDA officials, the training equips participants with the  knowledge to detect and report unusual exotic pest or disease activity,  which is key to initiating response and mitigation activities.
section_title: Federal Agencies Have Efforts Underway to Develop Equipment and Systems to Support Their Biosurveillance Missions
paragraphs: Our analysis of relevant presidential directives and our discussion with  federal officials with central responsibilities for monitoring disease and  protecting national security indicate that a national biosurveillance  capability depends upon systems and equipment that enable rapid  detection and communication of signals that might indicate a potentially  catastrophic biological event, quick and effective analysis of those signals,  and timely dissemination of high-quality and actionable information to  decision makers. In this vein, federal agencies have taken various actions  designed to promote timely detection and situational awareness by  developing (1) information sharing and analysis mechanisms, (2)  laboratory networks to enhance diagnostic capacity, and (3) equipment  and technologies to enhance early detection and situational awareness.
subsections: section_title: Information Sharing and Analysis Mechanisms
paragraphs: Because the data needed to detect an emerging infectious disease or  bioterrorism may come from a variety of sources, the ability to share and  analyze data from multiple sources may help officials better collaborate to  analyze data and quickly recognize the nature of a disease event and its  scope. As illustrated in figure 5, observing related symptoms in human  and animal populations, or cross-domain surveillance, may bring concerns  into focus more quickly than monitoring human symptoms alone. This may  be particularly important as many disease agents have the potential to be  weaponized and many of the recent emerging infectious diseases are  zoonotic.
In reviewing the federal response, we reported that the analysis of the outbreak continued for weeks as  separate investigations of sick people and of dying birds. Only after the investigations converged, and  after several parties had independently explored other possible causes, was the link made and the virus  correctly identified.
section_title: June
paragraphs: We concluded that the time it took to connect the bird and human outbreaks signaled a need for better  coordination among public and animal health agencies.
One example of a federal initiative designed to improve sharing of  biosurveillance information is DHS’s National Biosurveillance Integration  Center’s (NBIC) Biological Common Operating Picture (BCOP), a  manually updated Google Maps application of current worldwide  biological events being tracked. Officials can view the BCOP on the  Homeland Security Information Network. The BCOP provides a  situational awareness tool for the National Biosurveillance Integration  System (NBIS)—the community of 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. NBIC supports the BCOP through a system—the  Biosurveillance Common Operating Network (BCON)—that monitors,  tracks, and disseminates available NBIS-partner information, but relies  largely on information from publicly available sources, such as news  articles. One of the primary data sources for BCON is 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.
A similar type of initiative underway at some federal agencies involves  developing and maintaining communication tools for information sharing  within specialized disciplines. These communication tools may include  functions that allow users to send and receive information or view the  status of ongoing events. One such tool is a Web-based forum that  provides a secure environment for the exchange of information on case  reports and allows users to request information or expertise from other  users. For example, one such communication tool developed by CDC,  known as Epi-X, provides a secure Web-based forum for public health  officials to post case reports of conditions and ask other health officials  whether they have also seen cases of the condition. The officials can also  discuss similarities in the cases that may indicate how the disease is  spreading and suggest mitigation measures—for example, product  recalls—that could be implemented. In this way, health officials can  leverage both information and analytical capacity across agencies, levels  of government, and different regions of the country to help support the  early detection and situational awareness goals of biosurveillance. For  example, the forum may help them to more quickly and comprehensively  determine whether diseases seem to be widespread and what caused them  and to discuss treatment options in a secure environment. For more  information on specific communication tools, see appendix IV.
In addition, we reported in May 2003 that electronic reporting of data can  facilitate data exchange among different databases and allow more rapid  and accurate analysis of information from multiple sources. CDC officials  noted that laboratory reports could be received by CDC in 72 hours if  exchanged through an electronic system, as opposed to the up to 2 weeks  it can take for laboratory report hard copies to be sent through the mail.  Further, because it facilitates data exchange, standardization can help  support the vision of integrated surveillance systems articulated in HSPD-9  and 21. According to CDC officials, the potential benefits of electronic  reporting of data in a standardized format are striking and can eliminate  the need for analysts to dedicate valuable time to processing and  translating data provided in different formats expressed using various  terminologies. For example, during the 2001 anthrax event, the results of  laboratory tests for anthrax were reported in different formats (e.g.,  emailed text, mailed hard copy, as attachments in different software  programs), and using different terminology, such as “Bacillus anthracis,”  “B. anthracis,” and “Anthrax.” These variations in report format and  language required analysts at CDC to spend time translating and compiling  the data into information that could inform decision making during the  event.
To support effective and efficient information sharing, some agencies have  efforts underway to promote electronic reporting of information in a  standardized format. For example, CDC’s Public Health Information  Network (PHIN) initiative aims to advance the development of  interoperable surveillance and other public health systems at federal,  state, and local levels. The initiative defines data and messaging standards  and provides guidance for public health entities to follow in building  systems that meet compatibility and interoperability standards for  enhanced electronic information sharing. Additionally, HHS, through  initiatives to support nationwide health information exchange, has defined  specific standards that promote the exchange of biosurveillance  information among health care providers and public health authorities.
Within CDC, several surveillance systems have been developed and  implemented in accordance with PHIN standards to promote electronic  information sharing. One of these is the National Electronic Disease  Surveillance System (NEDSS). A primary goal of NEDSS is the ongoing,  automatic capture and analysis of data that are already available  electronically to minimize the problems of fragmented, disease-specific  surveillance systems. The initiative is intended to promote efficient and  effective data management and information sharing by eventually  consolidating the data collection of CDC’s various programmatic disease  surveillance activities in one place. For more information on programs  that support standardization and electronic data exchange, see appendix  IV.
To further enhance and support biosurveillance activities, CDC, DHS and  other federal agencies have developed or taken action to gather electronic  data from syndromic surveillance systems. Syndromic surveillance uses  health-related data collected before diagnosis to look for signals or  clusters of similar illnesses that might indicate an outbreak. Examples of  syndromic surveillance data are prediagnostic health-related information  like patients’ chief complaints recorded by a health care worker at the  admissions desk of a hospital emergency room and information collected  on over-the-counter sales of antidiarrheal medicines that could indicate  gastrointestinal disease outbreaks. We reported in 2004 that because these  syndromic systems monitor symptoms and other signs of disease  outbreaks instead of waiting for clinically confirmed reports or diagnoses  of a disease, some experts believe they can increase the speed with which  outbreaks are identified. However, we also reported in September 2004  and November 2008 that the ability of syndromic surveillance to more  rapidly detect emerging diseases or bioterror events has not yet been  demonstrated, and questions about its cost-effectiveness arise. An  example of a syndromic surveillance system is CDC’s BioSense—another  CDC system that was developed and implemented in accordance with data  and message standards defined by the PHIN initiative. BioSense collects  electronic data that are voluntarily shared by participating state, local, and  other federal public health entities, including data related to infections,  injuries, and chronic diseases. Currently the system collects chief  complaint data from 570 hospitals and 1,100 federal clinics, and sales data  from over 10,000 pharmacies. Because the data and messages are sent and  received in standardized formats, the data are integrated into the BioSense  system, reducing the need for analysts to manually interpret or manipulate  data and are analyzed by the system to enhance the nationwide situational  awareness capabilities of public health analysts at CDC.
Even as standardization and data and information-sharing tools improve,  other challenges will likely impede information sharing for biosurveillance  purposes across federal, state, and local levels of government. We and  others have noted that numerous challenges have impeded efforts to  coordinate and collaborate across organizational boundaries to integrate  biosurveillance and other national security activities. Some such  challenges are inherently intergovernmental issues and arise because most  of the information needed for biosurveillance is generated and owned  outside of the federal government. Therefore, there is limited assurance  that state and local governments can or will fully participate in federal  information sharing and standardization initiatives like PHIN. CDC  officials expressed concern about the differing levels of capacity and  willingness among states to participate in data standardization and  electronic information-sharing initiatives.
Moreover, information-sharing challenges also occur among the federal  agencies. As we reported in December 2009, NBIC has faced collaboration  challenges and has been largely unsuccessful in obtaining from federal  partners key resources needed to support data integration and shared  analytical capacity. Federal officials from agencies participating in the  National Biosurveillance Integration System—such as CDC, USDA, and  FDA—described challenges to sharing such information, including  concerns about trust and control over sensitive information before it is  vetted and verified. In addition, NBIC officials told us and we previously  reported that much of the information available to help achieve  biosurveillance goals is unstructured and not readily processed by a  computer system; while, data that are more easily computer processed  often lack the context needed to make appropriate conclusions about  whether anomalies actually signal a potential problem.
section_title: Laboratory Networks to Enhance Laboratory Diagnostic Capacity
paragraphs: Over the past decade, the federal government has leveraged and enhanced  its laboratory capabilities, capacity, resources, and expertise for detecting  and warning about biological threat agents by developing and  implementing laboratory networks at the federal, state, and local level. In  addition, the federal government led an effort to establish a consortium of  laboratory networks that further integrates a number of these networks. In  June 2005, 10 federal agencies signed a Memorandum of Agreement  establishing the Integrated Consortium of Laboratory Networks (ICLN).  The purpose of this consortium is to establish a coordinated and  operational system of laboratory networks that provide timely, high- quality, and interpretable results for early detection of acts of terrorism  and other events that require integrated laboratory response capabilities.  ICLN’s individual laboratory networks focus on detecting biological threat  agents that affect humans, animals, or plants that contaminate the air,  water, or food supply. These laboratory networks which comprise the  ICLN are shown in table 1.
The federal government is developing and implementing equipment and  technologies that can provide additional information to support early  detection and situational awareness. For example, the federal government  is applying diagnostic technologies to help detect and monitor biological  events. Studying disease agents at the molecular level can provide  information for situational awareness. Techniques to determine and  attribute the source of biological events can be important for both natural  and intentional events. In a natural event—such as a foodborne illness—it  can help speed detection, focus the investigation, and characterize the  extent and severity of disease. For intentional events, it can provide  critical information to help determine the scope of the attack and  contribute to law enforcement investigations. One example of such a  system is CDC’s PulseNet, a national network of public health laboratories  that perform DNA “fingerprinting” as a means to help with early  identification of outbreaks of foodborne illness with a common source and  enhance situational awareness during an event. The PulseNet program  provides a tool for participating laboratories to upload and then compare  the genetic “fingerprints” of foodborne pathogens isolated from samples  taken from sick individuals. The network can identify and label each  fingerprint pattern to permit the rapid comparison of these patterns with  others in the PulseNet database. PulseNet officials told us that this process  can take roughly 2 weeks after receiving a sample. FDA, USDA, CDC, and  state public health officials have access to the PulseNet database. See  appendix IV for more information on foodborne disease monitoring  systems and diagnostic technologies.
Federal agencies have also developed technologies to detect biological  agents in drinking water and air. Drinking water utilities across the  country have long been recognized as potentially vulnerable to terrorist  attacks of various types, including physical disruption, bioterrorism,  chemical contamination, and cyber attack. People also face the threat of  becoming ill from inhaling certain biological agents—whether naturally  occurring or intentionally weaponized and released to cause disease and  disruption. EPA has developed a system to detect contamination of  drinking water and USPS, DOD, and DHS have developed sensor  technologies to detect aerosolized biological agents in the air. EPA’s Water  Security Initiative program developed a contamination warning system to  allow local water utilities to monitor drinking water for contamination by  chemical, biological, and radiological agents. The contamination warning  system has been designed to provide timely detection and appropriate  response to biological events.
The system, however, is not widely distributed. Currently, the Greater  Cincinnati Water Works in Cincinnati, Ohio is the only locality that has the  system fully operating. EPA is assisting local water districts in four other  locations—New York City, San Francisco, Dallas, and Philadelphia—with  implementation the contamination warning system as part of a five-city  pilot project each of which EPA officials stated is to last for four years and  be complete in 2012. Local water utilities are to implement this system on  a voluntary basis and operate it at their own expense. According to EPA  officials, no contamination warning systems has yet been proven to be  effective and sustainable for drinking water systems, but the Water  Security Initiative is attempting to design, deploy, and test an effective and  sustainable system. For more information on the Water Security Initiative,  see appendix IV.
USPS, DOD, and DHS have developed and implemented technologies to  sample the air and test for specific biological agents. One of these, DHS’s  Biowatch program, has been implemented in more than 30 metropolitan  areas and tests for the presence of multiple biological threat agents.  USPS has deployed an indoor monitoring system—Biohazard Detection  System—at mail distribution centers nationwide that automatically detects  and warns of the presence of the anthrax organism in the air surrounding  mail-sorting equipment. DOD has also developed indoor and outdoor  monitoring systems to detect airborne chemical, biological, radiological,  or nuclear agents in order to protect military interests.
However, these sensor technologies are limited in their ability to provide  early detection because there are constraints on the speed with which the  diagnostic testing can be performed. For example, DHS’ Biowatch sensor  technology depends on air filters which must be collected and transported  to a laboratory for diagnostic testing, which can take more than a day.  According to senior officials from the Office of Health Affairs and the  Science and Technology Directorate at DHS, research and development to  eliminate the need for manual collection of samples is underway, but the  science needed to do so may not yet be fully mature. Additional  information on the USPS, DOD, and DHS biodetection systems can be  found in appendix IV.
section_title: A National Strategy and a Focal Point Could Help Guide Development of a National Biosurveillance Capability
paragraphs: While some high-level biodefense strategies have been developed, there is  no broad, integrated national strategy that encompasses all stakeholders  with biosurveillance responsibilities that can be used to guide the  systematic identification of risk, assessment of resources needed to  address those risks, and the prioritization and allocation of investment  across the entire biosurveillance enterprise. Further, while numerous  agencies have biosurveillance responsibilities, a single focal point for this  effort has not been established. We have reported that developing effective  national strategies and establishing a focal point with sufficient time,  responsibility, authority, and resources can help ensure successful  implementation of complex interagency and intergovernmental  undertakings, such as providing a national biosurveillance capability.
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subsections: section_title: Establishing a Focal Point Could Help Ensure the Development and Implementation of a National Strategy
paragraphs: We reported in February 2004 that strategies themselves are not  endpoints, but rather, starting points, and, as with any strategic planning  effort, implementation is the key. This work also reported that the  ultimate measure of these strategies’ value will be the extent to which they  are useful as guidance for policy and decision makers in allocating  resources and priorities. However, for an undertaking such as developing  a national biosurveillance capability, those policy and decision makers are  spread across the interagency and intergovernmental network. In our  work related to combating terrorism, we reported that an interagency and  intergovernmental undertaking can benefit from the leadership of a single  entity with sufficient time, responsibility, authority, and resources needed  to provide assurance that the federal programs are based upon a coherent  strategy, are well coordinated, and that gaps and duplication in  capabilities are avoided.
According to our analysis of requirements in laws and presidential  directives related to biosurveillance, a focal point has not been established  with responsibility and authority for ensuring the development of a robust,  integrated, national biosurveillance capability. The mission responsibilities  and resources needed to develop a biosurveillance capability are dispersed  across a number of federal agencies, and, according to officials at a  number of federal agencies—CDC, USDA, and DHS—chief among them,  agencies have capabilities that could be leveraged to support a robust,  integrated, national biosurveillance capability. However, our analysis  indicates that no entity has the responsibility, authority, and accountability  for working across agency boundaries to guide and oversee the  development and implementation of a national effort that encompasses all  stakeholders with biosurveillance responsibilities. For example, CDC has  been given the operational lead for developing the vision of HSPD-21 for a  human health biosurveillance capability. However, according to CDC  officials, responsibility for developing a national biosurveillance capability  that includes human as well as animal, plant, food, and environmental  surveillance has not been assigned to a single entity such as an  intergovernmental council, a federal agency, or an individual official.
Officials in various agencies have taken the lead to fulfill their agencies’  biosurveillance missions, but they lack authority to direct other agencies  with whom they must partner to take specific action. For example, CDC  has undertaken some efforts to coordinate federal efforts relating to  human and zoonotic disease surveillance, but according to CDC officials,  it has limited authority to ensure the implementation of specific activities  at other agencies. According to CDC officials, an overarching  organizational mechanism and clearly articulated roles and responsibilities  across the separate surveillance programs that serve a range of purposes  could help address common surveillance issues within CDC and across the  biosurveillance enterprise by coordinating communication and planning.  Officials from CDC, DOD, DHS, USDA, and HHS stated that having a focal  point would help coordinate federal efforts to develop a national  biosurveillance capability. Because the mission responsibilities and  resources needed to develop a biosurveillance capability are dispersed  across a number of federal agencies, efforts to establish a national  biosurveillance capability could benefit from designated leadership—a  focal point—that provides leadership for the interagency community.
section_title: Conclusions
paragraphs: The report of the Commission on the Prevention of Weapons of Mass  Destruction Proliferation and Terrorism stated that an attempted  biological attack somewhere in the world is likely is likely within the next  few years and concluded that the nation was unprepared for such an  event. A key component of preparedness is the ability to detect a  dangerous pathogen early and assess its potential spread and effect.  Various federal statutes and presidential directives call for biosurveillance  actions, culminating with HSPD-2’s most recent call for a robust,  integrated national biosurveillance system that draws upon and  synthesizes the capabilities of multiple existing systems across a number  of federal departments and agencies. The challenges in achieving this  vision are many and difficult to successfully address, such as acquiring and  retaining staff with sophisticated skills and melding disparate information  and data systems. Biosurveillance must operate in a complex environment  of many players and an evolving threat. Because a biological incident,  originating from nature or deliberate acts, could emerge through any  number of means—plant, animal, air, and human transmission—it is  essential that federal agencies collaborate to leverage their capabilities  and find effective and efficient solutions and strategies for detection and  analysis. Although efforts like the National Biosurveillance Strategy for  Human Health, USDA’s Strategy for the National Animal Health  Surveillance System, and DHS’s National Biosurveillance Integration  Center are potentially useful steps in developing a robust, national  biosurveillance capability, they do not provide a unifying framework and  structure for integrating dispersed capabilities and responsibilities.  Further, none of the current players have the authority to guide and  oversee the development and implementation of a national effort that  encompasses all stakeholders with biosurveillance responsibilities.  Without a unifying framework, structure, and an entity with the authority,  resources, time, and responsibility for guiding its implementation, it will  be very difficult to create an integrated approach to building and  sustaining a national biosurveillance capability as envisioned in HSPD-21.
section_title: Recommendations for Executive Action
paragraphs: In order to help build and maintain a national biosurveillance capability— an inherently interagency enterprise—we recommend the Homeland  Security Council direct the National Security Staff to, in coordination with  relevant federal agencies, take the following two actions:  (1) Establish the appropriate leadership mechanism—such as an  interagency council or national biosurveillance director—to provide a  focal point with authority and accountability for developing a national  biosurveillance capability.  (2) Charge this focal point with the responsibility for developing, in  conjunction with relevant federal agencies, a national biosurveillance  strategy that:    defines the scope and purpose of a national capability;    provides goals, objectives and activities, priorities, milestones, and    assesses the costs and benefits associated with supporting and building  the capability and identifies the resource and investment needs, including  investment priorities;    clarifies roles and responsibilities of leading, partnering, and supporting a    articulates how the strategy is integrated with and supports other related  strategies’ goals, objectives, and activities.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report for review to the Departments of  Homeland Security (DHS), Health and Human Services (HHS), Agriculture  (USDA), Commerce (DOC), Defense (DOD), Interior (DOI), Justice (DOJ),  State (State), Transportation (DOT), and Veterans Affairs (VA); the  Environmental Protection Agency (EPA); the United States Postal Service  (USPS); and the National Security Council (NSC). DHS provided written  comments on the draft report, which are summarized below and presented  in their entirety in appendix V of this report. DOC, DOD, DOI, DOJ, HHS,  State, DOT, VA, EPA, USDA, USPS, and the NSC did not provide written  comments. We incorporated technical comments from DOC, DOD, DOI,  DOJ, HHS, State, DOT, VA, EPA, USDA, and the USPS where appropriate.
In written comments, DHS generally concurred with our findings and  recommendations. In particular, DHS noted that it is important to develop  a strategy that encompasses all biological domains. Further, DHS stated  that the department’s National Biosurveillance Integration Center in  conjunction with its NBIS partners, have identified strategic planning gaps  and could also be helpful in providing leadership for the strategic planning  effort. DHS also noted that the statutory responsibilities and expectations  assigned to NBIS federal participants could serve as guideposts for any  White House Homeland Security Council leadership mechanism.
We are sending copies of this report to the Special Assistant to the  President for National Security Affairs; the Attorney General; the  Secretaries of Homeland Security, Health Human and Services,  Agriculture, Commerce, Defense, Interior, State, Transportation, and  Veterans Affairs; the Administrator of the Environmental Protection  Agency; the Postmaster General; 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  listed in appendix VI.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: The Implementing Recommendations of the 9/11 Commission Act of 2007  required GAO to describe the state of federal, state, local, and tribal  government biosurveillance efforts, the duplication of biosurveillance  efforts, the integration of biosurveillance systems, and the effective use of  resources and expertise at these levels of governments. We are addressing  these questions in a series of three reports. The first of the series, issued in  December 2009, focused on the Department of Homeland Security’s (DHS)  National Biosurveillance Integration Center (NBIC). This report describes  domestic biosurveillance efforts at the federal level; we did not review  efforts by the federal government to create or improve on international  biosurveillance programs. A third report, which we expect to issue during  the Winter of 2011, will describe biosurveillance efforts at the state, local,  tribal, and territorial levels of government.
Specifically, this report examines the following: (1) federal agency efforts  to provide resources—personnel, training, equipment, and systems—that  support a national biosurveillance capability; and (2) the extent to which  mechanisms are in place to guide development of a national  biosurveillance capability.
To address these objectives, we reviewed key legislation, presidential  directives, and agency-issued policies related to biosurveillance.  Specifically, we reviewed the Homeland Security Act of 2002, the Public  Health Security and Bioterrorism Preparedness and Response Act of 2002,  the Pandemic and All Hazards Preparedness Act of 2006, the  Implementing Recommendations of the 9/11 Commission Act of 2007, and  Homeland Security Presidential Directives (HSPD) 5, 7, 8, 9, 10, and 21.  These laws and presidential directives task various federal agencies with  specific biosurveillance responsibilities and related mission activities,  describe biosurveillance activities that agencies are to perform, and define  key terms, among other things. To determine the elements of a capability,  we reviewed DHS’s Target Capability List, which specifies that capabilities  are made up of the personnel, training, equipment and systems, planning,  and leadership necessary to accomplish a mission. We consulted our prior  reports including reports on the public health system, emerging infectious  diseases, the use of information technology tools to support homeland  security and national security goals, protection of animal health and the  agriculture sector, food safety and defense, and combating terrorism. See  Related GAO Works for an expansive list.
We used the information in the laws and presidential directives, as well as  previous GAO work, to identify federal departments and agencies  responsible for biosurveillance. We also considered federal departments  and agencies that NBIC had included among its National Biosurveillance  Integration System (NBIS) partners. In addition to DHS, NBIC has  identified 11 NBIS-partner agencies, which it considers to be part of the  NBIS interagency community. Those departments and agencies are the  Departments of Agriculture (USDA), Commerce, Defense (DOD), Health  and Human Services (HHS), Interior, Justice, State, Transportation,  Veterans Affairs, as well as the Environmental Protection Agency (EPA)  and the United States Postal Service (USPS). We considered interviews we  conducted with officials with responsibilities for participating in the NBIC  community, as well as interviews with officials responsible for a number  of other biosurveillance-related mission activities to inform the findings  and underlying context of this report. Although we conducted interviews  at multiple components of 12 federal departments, we focused on  information collected at 7 federal departments that have key roles and  responsibilities—based on agency mission, statutory responsibilities,  presidential directives, or programmatic objectives—for biosurveillance  and related mission activities, including protection of public health,  agriculture, and national security. These departments are USDA, DOD,  DHS, HHS, DOI, EPA, and USPS. Further, as USDA, HHS, and DHS have  the larger and more direct mission responsibilities for biosurveillance and  related mission activities, we focused most heavily on the contributions of  their activities to support a national biosurveillance capability. For the  purposes of this review, we limited our evaluation to domestic  biosurveillance activities and how these domestic activities may  contribute to a national biosurveillance capability. We did not review  federal efforts to enhance international disease surveillance.
Specifically, we met with and reviewed documents from officials in the  agencies shown in table 1.
We reviewed publicly available documents, including organizational  charts, mission statements, memoranda of understanding, and program  descriptions from these agencies to identify programs which may  contribute to disease surveillance, early detection of biological events, or  improved situation-specific information during a biological event. We also  reviewed previously assembled lists of biosurveillance or disease  surveillance programs compiled in our prior reports and by other federal  agencies. These include a portfolio of biosurveillance programs completed  by CDC in October 2008 and the U.S. Animal Health and Productivity  Surveillance Inventory assembled by USDA. NBIC has a biosurveillance  mission specified in the Implementing Recommendations of the 9/11  Commission Act of 2007, which requires interagency coordination across  the federal government to detect and provide warning of biological events  of national concern. As such, we reviewed NBIC operational documents  that describe the federal agencies that participate in NBIC’s  biosurveillance activities.
To determine the extent to which mechanisms are in place to support a  national biosurveillance capability, we reviewed strategic plans issued for  supporting the nation’s biodefense goals—which includes  biosurveillance—for the extent to which these plans incorporated  biosurveillance objectives. These plans included the National Health  Security Strategy, the National Security Council’s National Strategy for  Countering Biological Threats, and the National Response Framework. We  also reviewed documents from individual agencies’ efforts to pursue their  biosurveillance mission, in order to determine the extent to which  individual agencies efforts may contribute to a national biosurveillance  capability. These documents include: The National Biosurveillance  Strategy for Human Health, NBIC’s Concept of Operations for the National  Biosurveillance Integration System, USDA’s National Animal Health  Surveillance System strategic plan, and FDA’s Food Protection Plan. We  also reviewed reports issued by the National Academies of Science’s  Institute of Medicine which analyzed the existing capacity of the United  States to detect and respond to emerging microbial threats, the limitations  of disease surveillance, and costs and benefits of existing biosurveillance  programs. We reviewed the approach used and the information provided  in the Institute of Medicine studies and found them to be credible for our  purposes.
We met with federal officials who had responsibility for specific disease  surveillance programs or were directly involved in other federal  biosurveillance activities, such as representing the department as part of  NBIC activities or having responsibility for implementing the department’s  responsibilities in relevant HSPDs. We interviewed these officials on the  function of the specific disease surveillance program, including the  process of detection, information-sharing mechanisms, and time frames in  which information is generated and shared. In addition, we interviewed  these officials on the degree to which the federal government has built a  national biosurveillance capability, how specific programs could  contribute to a national capability for early detection or situational  awareness of biological events, the degree to which federal programs are  integrated with each other, and the limitations of these programs in  supporting a national biosurveillance capability. We analyzed this  information to determine how individual agencies’ programs could  contribute to building the personnel, training, and equipment and systems  needed for a national biosurveillance capability. We also interviewed  agency officials from programs that have responsibilities for carrying out  the relevant HSPDs to determine the extent to which individual agencies  have created mechanisms for integrating data, information sharing, and  implementing new biosurveillance techniques. We also interviewed these  officials on the limitations individual agencies have in building this  capability and compared it to our previous work on identifying a focal  point. These officials included senior officials with CDC’s Biosurveillance  Coordination Unit, HHS’s Office of the Assistant Secretary for  Preparedness and Response, DHS’s NBIC, USDA’s Centers for  Epidemiology and Animal Health, and DOD’s National Center for Medical  Intelligence.
In addition, because public health activities are primarily administered at  the state and local levels of government, we met with representatives from  nonprofit and public health professional organizations that have  biodefense or disease surveillance-related missions, as well as state and  local organizations, in order to further identify federal programs or  initiatives that may contribute to biosurveillance. These include the  Association of State and Territorial Health Officials, the Council of State  and Territorial Health Epidemiologists, and the National Association of  County and City Health Officials. These organizations represent state and  local epidemiologists, public health organizations, and officials involved in  public health at the state and local levels. In particular, the Council of  State and Territorial Health Epidemiologists coordinates the development  of the National Notifiable Disease List. In addition, we met with experts  from research organizations that study biodefense issues, including the  University of Pittsburgh Center for Biosecurity, the Congressional  Research Service, and the National Academies’s Institute of Medicine.  These organizations identified biosurveillance efforts at the federal level,  discussed the status of the federal government’s efforts to build a national  biosurveillance capability, and described limitations on the federal  government’s biosurveillance efforts and efforts to build a robust and  integrated national biosurveillance capability.
During our review of documents and interviews with knowledgeable  officials, we compiled a list of more than 100 programs from across the  federal government which may be relevant to biosurveillance. We also  asked federal officials to explain how these programs may contribute to  detecting biological events or providing situation-specific information to  decision makers during an ongoing event, and to identify other programs  to consider for inclusion in our study. For each program identified, we  interviewed officials and requested descriptive information on their  program, such as the coverage and frequency of populations surveyed;  diseases on which data are collected by these biosurveillance efforts and  their characteristics; how data are used to conduct biosurveillance; how  information is reported to support early detection of a biological event or  improved information during an event; the status of these efforts; and  costs to operate these efforts. These programs were included in our  catalog because they may contribute to biosurveillance in one of the  following five ways:  1.  Provide information to establish disease baselines, such as infection  rates and geographical distribution of disease outbreaks.  2.  Provide opportunities for astute clinicians to detect outbreak signals,  such as collecting syndromic data that, when analyzed, may indicate  an emergent infectious disease.  3.  Provide disease-specific information to enhance response; for  instance, data which may be used to identify and trace sources of  detected outbreaks.  4.  Represent a surveillance effort designed to shorten the time to detect  disease outbreaks, such as environmental sensors designed to detect  specific biological agents.  5.  Provide tools to integrate data or coordinate information sharing; for  instance, communication platforms on which analysts can discuss  biosurveillance issues of concern.
For each agency in our review, we compiled the information on each  program into a standard profile and validated this information with  program officials. We asked these program officials to verify the accuracy  of the information, to add missing information, or make technical  comments, which we incorporated as appropriate. We also requested  officials to identify additional programs for us to consider including in this  review, which we added as appropriate.
These selected efforts do not represent the total universe of  biosurveillance efforts, nor does the catalog represent a statistically  representative sample of federal biosurveillance efforts. In addition, we  did not include programs or initiatives that are led by state, local,  international, or private entities; do not specifically support  biosurveillance activities; or are classified systems. Some programs or  initiatives may be used to support the nature and purposes of  biosurveillance on a case-by-case basis during a biological event, but may  not regularly be used to support biosurveillance. For example, some  systems we identified track weather patters or map transportation  infrastructures, which may be used to estimate the severity of an outbreak  or predict a disease’s epidemiology. These programs are not included in  the selected catalog. Because these efforts are not included in the selected  catalog, it does not represent the total universe of biosurveillance  capabilities nor does it represent a statistically significant sample of  biosurveillance efforts. Finally, we did not evaluate the efficiency or  effectiveness of the biosurveillance efforts that we identify in the catalog.
We conducted this work from December 2008 through June 2010 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.
section_title: Appendix II: Full Text for Figure 2 Select Worldwide Disease Occurrences in Recent Decades
paragraphs: The following information appears as interactive content in the body of  the report when viewed electronically. The content associated with each  point on the map describes a disease event and includes information on  the transmission and symptoms of the disease. The content appears in  print form below in alphabetical order by disease name.
section_title: Appendix III: Traditional Monitoring Systems Provide Important but Limited Contributions to a National Biosurveillance Capability
paragraphs: Traditional disease surveillance systems designed to collect information  on the health of humans, animals, and plants support biosurveillance  efforts by recording national health and disease trends and providing  specific information about the scope and projection of outbreaks to  inform response. Traditional systems, however, rely on time-intensive  testing and confirmation practices as well as data not owned by the federal  government, which present challenges that limit their ability to provide  timely detection and situational awareness.
Monitoring for disease at the national level establishes a baseline  understanding of disease characteristics that enables officials to recognize  anomalous disease occurrences within the United States. Detecting a  signal that warns of a potential or imminent biological threat of national  concern requires the ability to discern whether disease occurrence is  abnormal based on its general characteristics, as well as where, when, and  how severely the disease has historically occurred. This information is  also useful for projecting how an outbreak may progress during response  to a potentially catastrophic biological event.
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. Disease surveillance for human  health at the national level was established to assess the status of the  public’s health, develop policy to define public health priorities, and  provide assurance of the prevention and control of disease. The federal  government uses a nationally notifiable disease List as the foundation of  its human health surveillance efforts.
Fifty-seven jurisdictions, including state and local health departments,  voluntarily report cases of certain diseases named on the list of nationally  notifiable diseases to the CDC. CDC uses these reports from the states to  monitor national health trends, formulate and implement prevention  strategies, and evaluate state and federal disease prevention efforts. In  addition to the National Notifiable Disease Surveillance System, CDC  maintains programs aimed at detecting and preventing specific diseases,  such as influenza. (For more information on specific programs, see app.  IV.) In general, these programs rely on participating health providers to  send case reports to CDC on a periodic basis. According to CDC, the  timeliest of these disease-specific surveillance programs have participants  report the data weekly. Other programs may send information to the CDC  on a monthly or annual basis. CDC compiles the data, checks for accuracy,  clarifies inconsistencies, and reports national level data at regular  intervals. Information that is collected through the National Notifiable  Disease Surveillance System and other public health surveillance  programs can be applied to determine the scope and forecast the course of  an outbreak to enhance situational awareness to guide decision makers’  response efforts.
Similarly, to help protect the nation’s agricultural sector, USDA has  routine reporting systems and disease-specific surveillance programs for  domesticated animals and some wildlife that can provide information to  support the early detection goal of biosurveillance. Information gathered  through these efforts can also help characterize and project the nature and  scope of an outbreak—for example, by providing the number of infected  animals and where they are located—to enhance situational awareness.  For instance, state animal health officials obtain information on the  presence of specific, confirmed clinical diseases in livestock, poultry, and  aquaculture in the United States from multiple sources—including  veterinary laboratories, public health laboratories, and veterinarians—and  report this information to the USDA’s National Animal Health Reporting  System (for more information, see app. IV). USDA has also developed  control and eradication programs of specific diseases that threaten the  health of animals to reduce the incidence of disease and to provide timely  detection of some foreign animal diseases, resulting in smaller outbreaks.  These programs are carried out in targeted high-risk populations of  various animal and aquaculture species to identify cases of the disease,  stem the spread of disease, and take measures to ensure certain diseases  that are no longer common in the United States do not reemerge.
In addition, USDA coordinates with state departments of agriculture, state  foresters, universities, and industry partners to conduct pest detection  surveys of agricultural plants and forests annually. By working with states  to identify and prioritize pest threats of national interest and coordinate  pest surveys, USDA’s Pest Detection Program provides nationwide  information about the presence of select plant pests.
According to officials at DOI, currently there is no national reporting  system for diseases of wildlife, making it difficult to track national trends  in wildlife disease. DOI’s U.S. Geological Survey’s National Wildlife Health  Center is changed with addressing wildlife disease throughout the U.S.  This center provides disease diagnosis, field investigation, disease  management and research, and training. It also maintains a database on  disease findings in wild animals and on wildlife mortality events.
For foodborne illness, CDC, USDA, and FDA can partner to use their  traditional surveillance activities to enhance situational awareness during  outbreaks. First, CDC identifies an outbreak of foodborne illnesses based  on reports from state and local health care providers. Then, it works with  the other federal partners to characterize the extent of the illness and  identify its source, using a system called OutbreakNet (see app. IV for  more information). While CDC works with its external partners to collect  additional information about identified cases—such as characteristics of  the people affected, the types of food consumed, and the possible location  of the consumption—FDA and USDA work with state and local food safety  agencies to gather additional information about the source by conducting  inspections and testing food samples.
Although information provided by traditional surveillance activities is  essential for biosurveillance purposes, the nature of those systems  presents inherent challenges that prevent them from being wholly  sufficient as tools for timely detection and enhanced situational  awareness. We and others have reported that traditional disease reporting  has generally been slow and incomplete, and, therefore, not well suited to  provide early detection and warning of a disease outbreak or pest  infestation. For example, federal agencies collecting data from state,  local, and private-sector entities generally rely on voluntary participation,  which limits the federal government’s ability to institute controls at the  initial collection and data entry points to help ensure accuracy,  completeness, or timely reporting. As we reported in 2004, most states  maintain a modified version of the national notifiable disease list that  reflects the public health priorities of the particular state, but do not  consistently reflect CDC’s list of notifiable diseases. Therefore, some local  health care providers are not obligated to report diseases on the national  notifiable disease list. For instance, five states, including Alabama,  Nevada, New Hampshire, Oregon, and Washington do not require local  health care providers to report cases of smallpox—which could be used by  terrorists as a biological weapon—even though CDC requests this  information.
We also previously reported that state officials have experienced  significant underreporting by health care providers in their efforts to  collect disease data and underreporting can adversely affect public health  efforts by leading to erroneous conclusions about trends in incidence, risk  factors for contracting a disease, appropriate prevention and control  measures, and treatment effectiveness. According to the Institute of  Medicine, many health care providers do not fully understand their role in  infectious disease surveillance, including their role as a source of data.  Furthermore, despite the existence of state notifiable disease lists and  related laws, some providers may be unaware of basic reporting  requirements.
Also posing a challenge to timely detection and situational awareness is  the need for laboratory confirmation. Although mechanisms exist for  reporting suspected cases of disease, traditional public health systems rely  on laboratory-confirmed cases. Laboratory confirmation, while important  to establishing accurate information, adds up to 2 weeks to the reporting  process, as results are analyzed and communicated at the state and local  levels before they are reported to federal health officials. Officials from  CDC and USDA attribute this delay to the inability of labs to communicate  test results electronically.
Timely detection and situational awareness are also problems for livestock  biosurveillance. For example, we reported in 2005 that USDA does not  always use rapid diagnostic tools to test animals at the site of an outbreak.  Although, according to experts, on-site use of rapid diagnostic tools is  critical to speeding diagnosis, containing the disease, and minimizing the  number of animals that need to be slaughtered, USDA employd them only  within selected laboratories. DOD used rapid diagnostic tools to identify  disease agents on the battlefield, but USDA officials considered the  technology to be still under development. A 2002 USDA exercise  estimated that, under the current approach, a foreign animal disease such  as Foot and Mouth Disease would spread rapidly, necessitating the  slaughter of millions of animals and cause staggering financial losses— precisely the type of high-visibility destruction some experts told us  terrorists seek. In response to our recommendation, USDA is in the  process of evaluating the costs and benefits of using penside rapid  diagnostic tools. In addition, we reported that animal numbers and  locations are generally not known, and without a national animal  identification program, surveillance, trace back, and disease containment  is a challenge.
section_title: Appendix IV: Selected Systems Used in Federal Early Detection and Situational Awareness Activities
paragraphs: Below we describe selected systems owned or developed by federal  agencies which may be used to detect or provide enhanced information  about outbreaks relating to human, animal, and plant health, as well as  monitoring food and the environment. This list encompasses information  reported by federal agencies on electronic communications and  surveillance systems as well as networks of laboratories and health  officials engaged in disease surveillance.
Human Health, Animal, Plant, Food, Air, Water  The Integrated Consortium of Laboratory Networks is to facilitate the development and maintenance of a system of laboratory  networks that is built upon established laboratory networks such as the Food Emergency Response Network; the Laboratory  Response Network; the National Animal Health Laboratory Network; the National Plant Diagnostic Network; the Environmental  Response Laboratory Network; and other emerging networks within the federal government with responsibilities and authorities for  laboratory preparedness and response. These networks are to provide timely, high-quality, and interpretable results for the early  detection and effective consequence management of acts of terrorism and other events requiring an integrated laboratory response.  The Integrated Consortium of Laboratory Networks has created a capabilities assessment of member network laboratories and  established working groups to address deficiencies identified by member lab networks. Additionally, the Integrated Consortium of  Laboratory Networks provides a forum for laboratory network representatives to provide assistance in the event of a biological,  chemical, or radiological contamination emergency.
FY 2009 Costs (thousands)
In development since 2005 and  will be transitioned to the Office  of Health Affairs once  operational (currently targeted  for fiscal year 2011)
Diseases resulting from an act of terrorism involving a biological or chemical agent or toxin, radiological contamination, or a naturally  occurring outbreak of an infectious disease that may result in a national epidemic.
Laboratory networks have modeled threats posed by chemical, biological, and radiological agents and are developing the capability to  support characterization, containment, and recovery from such attacks.
The Department of Homeland Security’s BioWatch Program is an early warning system comprised of collectors capable of detecting  aerosol releases of select biological agents, natural and man-made. The Program develops and disseminates guidance and other  documents geared toward the public health community, which provide information necessary to prepare for and respond to the  detection of an agent of interest. The rogram also evaluates state and local implementation of guidance documents through an active  exercise program which serves to assure that BioWatch coverage areas have the capability to respond to a detection. According to  DHS, the combination of early warning and rapid public health response can substantially minimize the potentially catastrophic impact  on the population.
FY 2009 Costs (thousands)
System is operational.  BioWatch sensors were first  deployed to major urban areas  across the United States in  2003  DHS has identified scenarios involving the release of biological materials in urban areas that could result in significant casualties and  economic disruption.
Human Health, Animal, Plant, Food, Air, Water  The Implementing Recommendations of the 9/11 Commission Act (9/11 Commission Act) established, within the Department of  Homeland Security, the National Biosurveillance Integration Center. The center is tasked with enhancing the capability of the federal  government to rapidly identify, characterize, localize, and track biological events of national concern by integrating and analyzing data  related to human health, animal, plant, food, and environmental monitoring systems, and to disseminate alerts if any such events are  detected. A central responsibility is to develop and oversee the National Biosurveillance Integration System, a federal interagency  consortium and information management concept that was established to integrate and analyze biosurveillance-relevant information  to achieve earlier detection and enhanced situational awareness.
FY 2009 Costs (thousands)
NBIC has been operational  since 2007  Any bio-event involving the intentional use of biological agents as well as emergent biohazards, such as accidental release of  biological agents or natural disease outbreaks.
A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
Airbase/Port Detector System (Portal Shield)
The Portal Shield sensor system was developed to provide early warning of biological threats for high-value, fixed-site assets, such as  air bases and port facilities. Portal Shield can detect and identify up to 10 biological warfare agents simultaneously, within 25 minutes  of release.
FY 2009 Costs (thousands)
CBRNE operative personnel  managing the system  Biological agents could pose a threat to soldiers on the battlefield  Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE)
ESSENCE is used in the early detection of infectious disease outbreak and provides epidemiological tools that can be used to  investigate disease oubreaks. It utilizes ambulatory data from hospitals and clinics. Epidemiologists can track, in near real time,  symptoms being reported in a region through a daily feed of reported data (such as working diagnoses indicated by codes assigned  by local health care staff). ESSENCE uses the daily data downloads, along with traditional epidemiological analyses that use historical  data, for baseline comparisons in order to improve detection  FY 2009 Costs (thousands)
Health surveillance is critical to medical readiness and force health protection.
Armed Forces Health Surveillance Center  US Army Public Health Command (formerly known as US Army  Center for Health Promotion and Preventative Medicine)
The mission of the Armed Forces Health Surveillance center is to analyze, interpret, and disseminate information related to the status,  trends, and determinants of the health of the U.S. military service members and military-associated populations. The center identifies  obstacles to medical readiness by linking various databases that communicate information relevant to service member health and  fitness. The Armed Forces Health Surveillance Center maintains the Defense Medical Surveillance System, a database containing up- to-date and historical data on disease and medical events as well as longitudinal data on personnel and deployments. The Defense  Medical Surveillance System provides the data supporting the Department of Defense Serum Repository which as of Spring 2010  includes over 50 million serum specimens drawn from servicemembers (since the late 1980s) and used to perform longitudinal  analyses of service member health. The system also also supports the Defense Medical Epidemiology Database, an application that  provides remote user access to selected deidentified data (i.e., data with patient identifying characteristics removed). The Armed  Forces Health Surveillance Center also operates the Global Emerging Infectious Surveillance and Response System, a program that  conducts laboratory-based surveillance for emerging infectious diseases within the U.S. military and in foreign civilian populations  through leveraging a network of research and clinical laboratory partners in the United States and overseas.
FY 2009 Costs (thousands)
Defense Medical Surveillance  System/DOD Serum  Repository/ Defense Medical  Epidemiology Database: $6,000 Global Emerging Infectious  Surveillance and Response  System: $52,000  All health threats to U.S. military personnel, including trauma, psychological stress, environmental hazards, and infectious diseases.  Laboratory network surveillance is focused on infectious diseases affecting humans, including some animal diseases that also affect  humans, as well as some pathogens that could contaminate food.
Health surveillance is critical to medical readiness and Force Health Protection.
Division of Migratory Bird Management  The Division of Migratory Bird Management is largely responsible for monitoring the health of migratory bird populations and issuing  guidelines for conservation and sustainable harvest. The Division of Migratory Bird Management program activities are restricted to  sampling migratory bird populations and testing those populations for indicators of diseases affecting birds or zoonotic diseases that  could affect human populations, such as avian (H5N1) influenza. The United States Geological Survey laboratory in Madison,  Wisconsin conducts laboratory analysis of submitted samples. The Division of Migratory Bird Management also collaborates with  USDA’s Animal and Plant Health Inspection Service to test bird samples and to survey bird populations.
FY 2009 Costs (thousands)
Infectious diseases affecting migratory birds  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
Fish and Wildlife Service inspectors work with public health officials and other federal inspectors at ports of entry to enforce wildlife  regulations and ensure compliance with international wildlife laws as they pertain to wild animal imports. Some inspections consist of  examinations of import paperwork, while others may consist of physical inspections of the animals being imported to confirm that the  shipment contents match corresponding documents. The decision to physically inspect a shipment could depend on the type of  commodity, country of origin, or importer history. Random physical inspections are also conducted.
FY 2009 Costs (thousands)
FWS inspectors stationed at  ports of entry  Diseases affecting animal populations are not the primary focus of the wildlife inspection program; although, if wildlife inspectors note  the presence or suspected presence of disease, they will notify the appropriate federal agency.
Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
The National Wild Fish Health Survey is an ongoing effort to sample and test wild fish for both specific diseases identified as key  threats and for emerging infectious diseases. Fish samples are collected by state and tribal governments for testing at one of Fish and  Wildlife Service’s nine regional laboratories. A national database collects and maintains all laboratory test results. Fish and Wildlife  Service inspectors also examine all federal fish hatcheries at least annually and some are examined biannually. States may also  request testing in the event of a major fish die-off or apparent disease outbreak.
FY 2009 Costs (thousands)
Infectious diseases affecting fish populations  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
Office of Ground Water and Drinking Water  The Water Security Initiative addresses the risk of intentional contamination of drinking water distribution systems by promoting the  voluntary adoption of online water quality monitoring, sampling and analysis, enhanced security monitoring, consumer complaint  surveillance, public health surveillance, and a consequence management plan at local water utilities. EPA is implementing the Water  Security Initiative by developing the conceptual design of a system for detection of and response to a contamination event;  demonstrating the viability of such a system through pilots in five cities; and developing guidance and outreach to promote voluntary  adoption of drinking water contamination warning systems. EPA has implemented a pilot drinking water contamination warning system  with the Cincinnati Water Works in Cincinnati, Ohio, and has funded pilots in San Francisco, New York City, Philadelphia, and Dallas,  all of which are underway.
FY 2009 Costs (thousands)
EPA provides guidance and  best practice standards to  facilitate the implementation of a  contamination warning system  in a drinking water utility, and  local water utilities operate the  system and respond to threats.
System is a pilot.
Chemical, biological, and radiological agents which could be present in drinking water  Drinking water utilities have been recognized as being potentially vulnerable to physical disruption, bioterrorism, chemical  contamination, and cyber attack. Damage or destruction of a water network could disrupt not only the availability of safe drinking water  but also the delivery of vital services that depend on these water supplies, like fire suppression.
The Environmental Response Laboratory Network serves as a ntaional network of labs that can be accessed as needed to support  large scal environmental responses by providing consistent analytical capabilities, capacities, and quality data in a systematic,  coordinated response.
FY 2009 Costs (thousands)
System can be accessed as  needed to support large-scale  environmental responses  Chemical, biological, and radiological agents present in air or water that can cause diseases resulting from a large-scale  environmental disaster  A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.  122 Cities Mortality Reporting System  As part of its national influenza surveillance effort, CDC receives weekly mortality reports from 122 cities and metropolitan areas in the  United States within 2-3 weeks from the date of death. These reports summarize the total number of deaths occurring in these  cities/areas each week due to pneumonia and influenza. This system provides CDC with the preliminary information with which to  evaluate the impact of influenza on mortality in the United States and the severity of the currently circulating virus strains.
FY 2009 Costs (thousands)
122 cities and metropolitan  areas contribute data to the  system  Influenza viruses are found in human and many different animals, including ducks, chickens, pigs, whales, horses and seals.  Seasonal Flu is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to  death. Pneumonia is an infection of the lungs that is usually caused by bacteria or viruses. Globally, pneumonia causes more deaths  than any other infectious disease, such as AIDS, malaria, or tuberculosis. However, it can often be prevented with vaccines and can  usually be treated with antibiotics or antiviral drugs.
Arboviral Surveillance System (ArboNet)
ArboNet is an internet-based national arboviral surveillance system developed by state health departments and CDC in 2000. ArboNet  collects reports of arboviral diseases and other data from all states and three local districts (New York City, Washington D.C, and  Puerto Rico). Data are reported by local health departments weekly for routine analysis and dissemination. These data are  summarized periodically in the Morbidity and Mortality Weekly Report and yearly in the MMWR Summary of Notifiable Diseases.
FY 2009 Costs (thousands)
Arboviruses, such as West Nile Virus, encephalitis, and yellow fever viruses  West Nile virus is a mosquito-borne viral disease that is transmitted to humans through infected mosquitoes. Many people infected  with the virus do not become ill or show symptoms. Symptoms that do appear may be limited to headache, sore throat, backache, or  fatigue. There is no vaccine for the West Nile virus, and no specific treatment besides supportive therapies. The disease occurs in  Africa, Eastern Europe, West Asia, and the Middle East. This disease appeared for the first time in the United States in 1999. Yellow  fever is a mosquito-borne viral disease that occurs in tropical and subtropical areas. The yellow fever virus is transmitted to humans  through a specific mosquito. Symptoms include fever, muscle pain, headache, loss of appetite, and nausea. There is no treatment for  yellow fever beyond supportive therapies. A vaccine for yellow fever is available.
BioSense is a national program intended to improve capabilities for rapid disease detection, monitoring, and real-time situation  awareness through access to specific health care data from participating organizations, including more than 500 acute-care hospitals,  commercial laboratories, as well as Department of Defense and Veterans Affairs health care facilities. BioSense enables local and  state public health departments to share and access data, providing a more complete picture of potential and actual health events  both locally and across jurisdictional boundaries. Data received into the system are available simultaneously to state and local health  departments, participating hospitals, and CDC through a Web-based application. BioSense securely processes, analyzes, and  visualizes data to help characterize and monitor outbreaks and enable appropriate and timely public health interventions. Based on  user feedback, BioSense is undergoing revision to deemphasize collection of detailed clinical data from hospitals at CDC and  emphasize greater dependence on collection of data from existing automated surveillance systems operated by state and local health  departments. The BioSense program also funds applied and developmental projects including Regional Surveillance collaboratives,  state-based health information exchanges, Centers of Excellence in Public Health Informatics, and BioSense evaluations.
FY 2009 Costs (thousands)
BioSense is operational across  the current participating health  care facilities, health systems,  and health department  surveillance systems. A contract  solicitation is underway to  support BioSense redesign to  enhance population coverage  and stakeholder engagement.
All-hazards (with a focus on infectious diseases) affecting human health  The BioSense program monitors 90 concepts (syndromes and sub-syndromes) that encompass infections, injuries, chronic diseases,  exposures, miscellaneous conditions, and specified codes, and free-text search terms corresponding to these concepts. In addition to  these health outcome data, patient demographics (age group, sex), date of diagnosis, and geographic location information is reported.
Human Health, Animal, Plant, Food, Air, Water as it relates to human  health  The mission of the Biosurveillance Coordination is to coordinate the development and support the implementation of an integrated,  national biosurveillance plan for human health. The plan, a requirement outlined in Homeland Security Presidential Directive 21,  includes the capacity to generate timely, comprehensive, and accessible information with proper context for public health decision  making. Biosurveillance Coordination has developed the National Biosurveillance Strategy for Human Health and a companion  document titled Concept Plan for Implementation of the National Biosurveillance Strategy for Human Health. Biosurveillance  Coordination has begun to compile an inventory of biosurveillance systems, tools, collaboratives, programs, and registries within CDC.  More information about these activities and final documents can be found at http://www.cdc.gov/osels/ph_surveillance/bc.html  FY 2009 Costs (thousands)
Biosurveillance Indications and Warning Analytic Community (BIWAC)
Human Health, Animal, Plant, Food, Air, Water  The Mission of the Biosurveillance Indications and Warning Analytic Community (BIWAC) is to provide a secure, interagency forum for  timely collaborative exchange of critical information regarding Indications and Warning (I&W) of Biological events that may threaten  U.S. National Interests. The BIWAC will conduct the collaborative exchange of critical Biosurveillance information through an  encrypted information-sharing portal called “Wildfire,” and also through meetings and teleconferences.
FY 2009 Costs (thousands)
BIWAC partners contribute data  to the system and share  information via an online portal  $801 (with additional in-kind  support from partners)
Diseases of concern to BIWAC members, including foreign animal and plant diseases and pathogens of national significance (priority  1 and 2), and zoonotic diseases, particularly those with pandemic potential.
Border Infectious Disease Surveillance Project  The Border Infectious Disease Surveillance Project serves as a binational early warning and active syndromic illness and disease  monitoring network operating in the United States (U.S.)-Mexico Border Region and targets approximately 12 million people. The  project conducts surveillance among residents of border states who visit participating clinics and hospitals. Using Web-based data  entry, the project provides timely data sharing through data system and Epi-X notifications dependent on state health department and  Mexican national policies.
FY 2009 Costs (thousands)
The Web-based system has  been operational since 2006  Infectious diseases affecting humans of mutual interest to the United States and Mexico including syndroms compatible with  bioterrorism agents  The Border Infectious Disease Surveillance Project conducts surveillance for viral hepatitis (A,B,C,D,E); fever and rash syndromes  (measles, rubella, dengue, flea-borne typhus, tick-borne ehrlichiosis); fever and neurologic illness/West Nile Virus; influenza;  undifferentiated fever/dengue/rickettsial disease; severe acute vesicular rash/varicella; community acquired  pneumonica/Coccioidomycosis; animal rabies; brucellosis; and foodborne infections such as Salmonella and E.coli 0157:H7.
The Early Aberration Reporting System provides a free-to-end-user analysis tool that allows state and local public health officials as  well as disaster and response agencies and organizations to quickly detect syndromes that might indicate a public health emergency  and to monitor progression and control. The Early Aberration Reporting System allows users to add anything that can be counted into  the software, and it will detect trends indicating something out of the ordinary. The tool may be downloaded from CDC’s Web site.  Unless a user initiates a submission, there is no link alerting CDC to investigate a potential public health emergency, and the user is  responsible for initiating investigation and incident response. According to CDC, a new version of the system is scheduled for release  in Summer 2010 and a version geared for local disaster management and monitoring organizations, both domestic and foreign, will be  developed and fielded prior to 2011.
FY 2009 Costs (thousands)
Users contribute and may  analyze only their own data.  CDC does not currently receive  data from the system, and the  data from end users vary  according to state regulations  and the data-sharing  agreements set up with data  reporters  A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause hundreds of thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten  national security. Being able to monitor extent and impact is valuable for response coordinators.
Early Warning Infectious Disease Surveillance  The Early Warning Infectious Disease Program is a collaboration of state, federal and international partners who are working to  provide rapid and effective laboratory confirmation of urgent infectious disease case reports in the border regions of the United States,  Canada, and Mexico. Activities include assessing surveillance and laboratory capacity on each side of the international border,  improving electronic sharing of laboratory information, maintaining a database of all sentinel/clinical labs, and working to develop and  agree on a list of notifiable conditions. The program was established in 2003 in order to enhance coordination between the United  States, Canada, and Mexico to provide early warning and cross-border capability in the event of a disease outbreak.
FY 2009 Costs (thousands)
The program was established in  2003  A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
The Electronic Disease Notification System is an electronic system used to notify state and local public health jurisdictions about  diseases and disease outbreaks occurring among refugees and immigrants entering the United States. The system has a module to  track tuberculosis and other quarantinable diseases in refugees and immigrants. CDC uses the system to electronically notify health  departments of arriving refugees and immigrants with Class A and Class B quarantinable conditions, provide an electronic  communication system for health departments to notify each other of persons with tuberculosis conditions who change jurisdictions,  and provide health departments with an electronic system to record and evaluate the outcome of domestic follow-up examinations.
FY 2009 Costs (thousands)
Panel Physicians using required  Department of State medical  examination forms  Quarantinable Diseases, as defined by executive order 13295, include cholera, diphtheria, infectious tuberculosis, plague, smallpox,  yellow fever, viral hemorrhagic fevers (such as Marburg, Ebola and Congo-Crimean disease), SARS (severe acute respiratory  syndrome), and influenza caused by novel or re-emergent influenza viruses that are causing or have the potential to cause a  pandemic.
Tuberculosis is a bacterial disease that is usually transmitted by contact with an infected person. People with healthy immune systems  can become infected but not ill. Symptoms include a bad cough, coughing up blood, pain in the chest, fatigue, weight loss, fever, and  chills. Several drugs can be used to treat tuberculosis, but the disease is becoming increasingly drug resistant.
The Emerging Infections Program is a network of CDC and 10 state health departments working with collaborators, including  academic institutions and other federal agencies. The network conducts active population-based surveillance and research for  emerging infectious diseases of public health importance. Examples of programs included in the Emerging Infections Program  network include Active Bacteria Core Surveillance (a program conducting laboratory-based surveillance for bacterial pathogens),  FoodNet (a program to monitor the incidence of foodborne and waterborne diseases), and Influenza Projects (a program that tracks  trends and characterizes outbreaks of severe influenza).
FY 2009 Costs (thousands)
Epidemic Information Exchange, Epi-X  Epi-X connects state and local public health officials so that they can share information about outbreaks and other acute health  events, including those possibly related to bioterrorism. It is intended to provide epidemiologists and others with a secure, Web-based  platform that can be used to instant emergency notification of outbreaks and requests for CDC assistance. Epi-X provides tools for  searching, tracking, and reporting on diseases.
FY 2009 Costs (thousands)
Epi-X has over 5,000 users who  have the capability to provide  data, including all state  epidemiologists and local health  officers from more than 150  major metropolitan cities or  counties that can post data to  the system. Epi-X scientific staff  are available 24 hours a day, 7  days a week to post reports and  notify users of urgent health  events.
A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
Foodborne Disease Active Surveillance Network (FoodNet)
As part of CDC’s Emerging Infections Program, FoodNet provides a network for responding to new and emerging foodborne diseases  of national importance, monitoring the burden of foodborne disease, and identifying the sources of specific foodborne diseases. It  consists of active surveillance and related epidemiological studies, which help public health officials better understand the  epidemiology of foodborne diseases in the United States. Participating FoodNet sites may also be employed to coordinate enhanced  surveillance and epidemiologic investigation if a novel foodborne disease threat is suspected in order to more rapidly identify the  source and extent of the threat.
FY 2009 Costs (thousands)
Public health and food safety  officials in the 10 FoodNet sites  Foodborne illness harms human health, and outbreaks undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance, the 2006 outbreak of E. coli O157:H7 linked to bagged spinach resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
The Global Disease Detection program focuses on gathering, analyzing, and sharing global information to identify and respond to  emerging health threats. The program has three mechanisms to accomplish this focus: regional centers that are placed around the  world and are concerned with the detection and control of emerging infectious disease; CDC staff placed overseas to support CDC’s  mission; and the Global Disease Detection program operations center, which serves as the central clearinghouse focused on early  detection of international events to which CDC may be asked to respond.
FY 2009 Costs (thousands)
The program began operating in  2004  A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
Global Emerging Infections Sentinel Network (GeoSentinel)
GeoSentinel is a Web- and provider-based sentinel network. It consists of travel/tropical medical clinics around the world that  participate in surveillance to monitor geographic and temporal trends in morbidity among travelers and other globally mobile  populations. Passive surveillance and response capabilities are also extended to a broader network of GeoSentinel Network  members.
FY 2009 Costs (thousands)
GeoSentinel was established in  1995 and is operational  A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
The Health Alert Network is a nationwide system serving as a platform for the distribution of health alerts, dissemination of prevention  guidelines and other information, distance learning, national disease surveillance, and electronic laboratory reporting, as well as for  CDC’s bioterrorism and related initiatives to strengthen preparedness at the local and state levels. Among other things, the Health  Alert Network is to provide early warning alerts and to secure capability to securely transmit surveillance, laboratory, and other  sensitive data.
FY 2009 Costs (thousands)
Not available  The objective of influenza surveillance is to monitor the timing, geographic extent, and severity of influenza activity in the United  States and its impact on the U.S. population over time. The system consists of nine complementary surveillance components, which  include data on laboratory-based data describing the number and percentage of positive tests from laboratories across the country;  the percentage of doctor visits for flu-like symptoms; the percentage of deaths reported to be caused by pneumonia and influenza in  122 U.S. cities; state and territorial epidemiologist reports of influenza activity; influenza-associated pediatric mortality; and reported  pediatric influenza hospitalizations.
FY 2009 Costs (thousands)
Data on influenza are  contributed by more than 120  laboratories, more than 2,400  sentinel health care providers,  vital statistics in 122 cities,  research and health care  personnel at the Emerging  Infections Program and  influenza surveillance  coordinators and state  epidemiologists for 50 state  health departments, New York  City and the District of Columbia Influenza viruses are found in human and many different animals, including ducks, chickens, pigs, whales, horses, and seals.  Seasonal flu is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to  death.
The Laboratory Response Network is an integrated network of 165 public health and clinical laboratories that provide laboratory  diagnostics and disseminated testing capability for public health preparedness and response. It ensures that all member laboratories  collectively maintain current biological detection and diagnostic capabilities, as well as surge capacity for all biological and chemical  agents likely to be used by terrorists. The network is based on the use of standard protocols and reagents, integrated data  management, and secure communications.
FY 2009 Costs (thousands)
Members share data with each  other  A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
Morbidity and Mortality Weekly Report  The Morbidity and Mortality Weekly Report is the nation’s leading public health bulletin and the flagship publication of CDC. The  Morbidity and Mortality Weekly Report includes reports on disease epidemics, trends, prevention and control of illness, injuries, and  deaths. This information represents the primary manner that state and local public health officials, the media, and the public are  informed of public health issues from CDC. The Morbidity and Mortality Weekly Report publishes data from the National Notifiable  Disease Surveillance System each week and in an annual Summary of Notifiable Diseases. These data are the official statistics, in  tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States.
FY 2009 Costs (thousands)
International and U.S. public  health officials and scientists  submit epidemiological and  surveillance data about  outbreaks or other health  events. Other federal agencies,  such as USDA, FDA, and EPA  produce public health  information for publication. The  publication is also integrated  with the Epi-X and National  Notifiable Diseases Surveillance  System, both of which  contribute data for publication.
The Morbidity and Mortality  Weekly Report published its first  issue in 1961. The publication is  updated weekly and monthly.
Not available  The National Botulism Surveillance System compiles information on botulism cases that occur in the United States. CDC provides  clinical, epidemiological, and laboratory consultation and testing services for suspected botulism cases 24 hours a day and is the only  source for antitoxin in the US. CDC alerts other federal agencies concerning botulism outbreaks associated with commercially  produced and distributed food products. Also, CDC conducts a yearly survey of state and territorial epidemiologists and of state public  health laboratory directors to identify and compile all botulism cases that occurred in the previous year.
FY 2009 Costs (thousands)
Federal public health officials;  annual report is compiled from  data provided by state health  departments  Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by theneurotoxin producing Clostridia. There  are four types of botulism. Foodborne botulism is caused by eating foods that contain the botulinum toxin. Wound botulism is caused  by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the  botulinum bacteria, which then grow in the intestines and release toxin. Finally, Adult Colonization is a rare form of botulism, similar to  Infant Botulism, and results from ingestion of spores by susceptable persons and subsequent growth and toxin production in the  intestines. All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially  dangerous because many people can be poisoned by eating a contaminated food.
National Notifiable Diseases Surveillance System  CDC has responsibility for the collection and publication of data concerning nationally notifiable diseases. All 50 states, 5 territories,  the District of Columbia, and New York City participate in the National Notifiable Diseases Surveillance System. The Council of State  and Territorial Epidemiologists, with input from CDC, makes recommendations annually for additions and deletions to the list of  nationally notifiable diseases. Reporting of nationally notifiable diseases to CDC by the states is voluntary. Reporting is currently  mandated (i.e., by state legislation or regulation) only at the state level. The list of diseases that are considered notifiable, therefore,  varies slightly by state. All states generally report the internationally quarantinable diseases (i.e., cholera, plague, and yellow fever) in  compliance with the World Health Organization’s International Health Regulations.
FY 2009 Costs (thousands)
Public health officials in 50  states, 5 territories, the District  of Columbia and New York City  Most states have a list of notifiable diseases that approximates a national list of notifiable diseases maintained by the Council of State  and Territorial Epidemiologists. This national list is reviewed and revised annually with input from CDC. States may modify their list of  notifiable diseases to reflect the public health needs of their region.
National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet)
PulseNet is an early warning system for outbreaks of foodborne diseases. The network has participants from public health  laboratories in all 50 states, federal regulatory agencies, and some state agricultural laboratories and is coordinated by CDC.  PulseNet contributes to the identification and investigation of outbreaks of foodborne and bacterial diseases through comparison of  the molecular “fingerprints” of foodborne pathogens from patients and their food, water, and animal sources. Once an outbreak is  detected, PulseNet identifies patients who are infected with isolates that have the outbreak DNA “fingerprint” and thus are likely to be  part of the outbreak. If a foodborne pathogen is isolated from a suspected vehicle, PulseNet also links it to the outbreak if it displays  the outbreak “fingerprint.” Finally, PulseNet provides leadership, expertise, training, and education in the field of foodborne and  bacterial diseases.
FY 2009 Costs (thousands)
PulseNet participants enter data  into the system using  standardized equipment and  methods  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For example, the 2006 outbreak of E. coli O157:H7 linked to bagged spinach resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
Human Health, Animals, Food, Water  The National Outbreak Reporting System is a Web-based application for states to report foodborne, waterborne, and other outbreaks  electronically. Information collected includes the number ill, dates and places of outbreak, percent of cases by age group and gender,  symptoms, incubation period and duration of illness, implicated food or water item, contributing factors leading to food or water  contamination, source of implicated food or water, and food recall or other public health response. Data are used for annual summary  reports of foodborne illness as well as for the monitoring of multistate outbreaks. The National Outbreak Reporting System was  developed by CDC as a successor system to the Electronic Foodborne Outbreak Reporting System.
FY 2009 Costs (thousands)
50 state and 15 territorial  reporting areas provide  information on the number and  characteristics of foodborne,  waterborne and other enteric  disease outbreaks in their area  Foodborne, waterborne and other enteric disease outbreaks  Foodborne, waterborne and other enteric disease outbreaks have myriad causes (e.g., bacteria, viruses, parasites, toxins and  chemicals). These agents cause a range of human illnesses through toxicity (toxins or chemicals) or by infection (pathogens).
National Respiratory and Enteric Virus Surveillance System  The National Respiratory and Enteric Virus Surveillance System is a laboratory-based system that monitors temporal and geographic  patterns associated with the detection of respiratory viruses including respiratory synctial virus, human parainfluenza viruses,  respiratory and enteric adenoviruses, and rotaviruses. Influenza detections are also reported to the system, but are integrated with  CDC influenza surveillance. Users upload data to the National Respiratory and Enteric Virus Surveillance System through a Web- based or telephone dial-in system.
FY 2009 Costs (thousands)
Commercial, public health, and  clinical laboratories  Respiratory viruses tracked in the system are generally transmitted through direct or close contact with contaminated secretions that  are spread through droplets in the air or by contact with contaminated environmental surfaces. Enteric infections tracked in the system  enter the body through the mouth and intestinal tract and are usually spread through contaminated food and water or by contact with  vomit or feces.
OutbreakNet is a national network of epidemiologists and other public health officials coordinated by CDC who investigate outbreaks  of foodborne, waterborne, and other enteric illnesses in the United States. OutbreakNet ensures rapid, coordinated detection and  response to multistate outbreaks of foodborne illness and to promote more comprehensive outbreak surveillance. OutbreakNet seeks  to improve the collaboration and partnership among officials in local, state, and federal agencies who work with foodborne and  diarrheal disease outbreak surveillance and response. OutbreakNet works in partnership with U.S. state and local health departments,  USDA, FDA, and PulseNet (a national surveillance network made up of state and local public health laboratories and federal food  regulatory agency laboratories).
FY 2009 Costs (thousands)
Foodborne, waterborne and other enteric diseases  Foodborne, waterborne and other enteric disease outbreaks have myriad causes (e.g., bacteria, viruses, parasites, toxins and  chemicals). These agents cause a range of human illnesses through toxicity (toxins or chemicals) or by infection (pathogens).
The Public Health Information Network is an effort initiated by CDC to provide interoperability across public health functions and  organizations, such as state and federal agencies, local health departments, public health labs, vaccine clinics, clinical care, and first  responders. It is intended to, among other things, (1) deliver industry standard data to public health, (2) investigate bioterrorism  detection, (3) provide disease tracking analysis and response, and (4) support local, state, and national data needs. It builds on  existing CDC investments in other surveillance systems. The Public Health Information Network will not replace any of these systems  but will provide an “umbrella” to support the interoperability of existing CDC surveillance, communications, and reporting systems.
FY 2009 Costs (thousands)
Not available  CDC’S United States Quarantine Stations seek to limit the importation of infectious diseases into the United States by working with  key partners to identify ill persons and potentially infectious items. Quarantine Stations enter reports into the Quarantine Activity  Reporting System in real time to CDC-Atlanta that summarizes port activities at 20 ports of entry and land-border crossings where  international travelers arrive. The reports are analyzed and evaluated daily and relevant information is captured and disseminated as  part of a Disease and Activity Report which is sent to CDC leadership and relevant external partners. During 2009 Quarantine Station  staff reported 3, 847 illnesses and 125 deaths, conducted 122 airline contact investigations involving 95 index cases, forwarded 9,778  migrant packets, processed 205 non-human primate shipments, released 125 drug shipments, and participated in 1,510 activities with  external partners.
FY 2009 Costs (thousands)
CDC’s Quarantine Stations  report data gathered from airline  staff, state and local health  departments, Customs and  Border Protection personnel,  emergency responders, and  other first responders to  infectious disease outbreaks  A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
Unexplained Deaths and Critical Illnesses Surveillance System  As part of CDC’s Emerging Infections Program, the Unexplained Deaths and Critical Illnesses Surveillance System is expected to  contain limited epidemiological and clinical information on previously healthy persons aged 1 to 49 years who have illnesses with  possible infectious causes. It is also expected to provide active population-based surveillance through coroners and medical  examiners at limited sites. National and international surveillance will be passive for clusters of unexplained deaths and illnesses.
FY 2009 Costs (thousands)
A catastrophic biological event, such as a terrorist attack with a weapon of mass destruction or a naturally occurring pandemic could  cause thousands of casualties or more, weaken the economy, damage public morale and confidence, and threaten national security.
Electronic Laboratory Exchange Network, (eLEXNET)  eLEXNET provides a Web-based system for real-time sharing of food safety laboratory data among federal, state, and local agencies.  It allows public health officials at multiple government agencies engaged in food safety activities to compare and coordinate laboratory  analysis findings in a secure setting. eLEXNET captures food safety sample and test result data from participating laboratories and  uses them for risk assessment and decision support purposes, improving the early detection of problem products.
FY 2009 Costs (thousands)
FDA’s Center for Food Safety  and Applied Nutrition manages  eLEXNET, which has 1,800  users including 203 participating  labs, 150 of which are FERN  labs  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance, the 2006 outbreak of E. coli O157:H7 linked to bagged spinach resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
FDA and the Food Safety and Inspection Service at USDA  The Food Emergency Response Network is a coordinated initiative between USDA’s Food Safety and Inspection Service and FDA to  develop an integrated laboratory network capable of responding to national emergences. Laboratories participating in the network are  responsible for detecting and identifying biological, chemical, and radiological agents in food. The primary objectives of the Food  Emergency Response Network are to prevent attacks on the food supply through surveillance; to prepare for emergencies by  strengthening lab capabilities; to respond to threats, attacks, and emergencies in the food supply; and to assist in recovery.  Participating laboratories conduct investigations of terrorism-related events involving food and play a major role in method  development and validation for detecting foodborne contamination.
FY 2009 Costs (thousands)
State food testing laboratories  are the primary providers of  data. Some federal, local, and  county food testing laboratories  also provide data  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance, the 2006 outbreak of E. coli O157:H7 linked to bagged spinach resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
Center for Animal Health Information and Analysis  Animal and Plant Health Inspection Service  The Center for Animal Health Information and Analysis analyzes biosurveillance data on animal diseases by conducting all-source  intelligence and issue assessment of threats, identification of the hazards posed by animal diseases, analysis of risk and modeling of  the spread of an animal disease, and the issuance of recommendations to target surveillance resources to animal threats. The center  is organized into three teams: Global Intelligence and Forecasting focuses on improving animal health through intelligence and  analysis; Risk Analysis identifies methods and approaches for estimating risks of animal disease outbreaks; and Spatial Epidemiology  develops geospatial methods to collect and analyze data on farm animal locations and livestock concentration.
FY 2009 Costs (thousands)
Officials from the center analyze  data from a variety of sources  and issue alerts  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
Animal and Plant Health Inspection Service  The Emergency Management Response System is used to manage investigations of outbreaks of animal diseases in the United  States. This Web-based task management system was designed to automate many of the tasks that are routinely associated with  disease outbreaks and animal emergencies. The Emergency Management Response System is used for routine reporting of foreign  investigations of animal disease, state-specific disease outbreaks or control programs, national responses, or natural disasters  involving animals. The system also has a mapping feature, which allows for real-time identification of outbreaks to enable responders  to respond more quickly by providing high-resolution maps to decision makers, government agencies, and the public. The system  interfaces with state and federal diagnostic laboratories for reporting test results.
FY 2009 Costs (thousands)
State and federal animal health  officials  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
The emerging Veterinary event database  Animal and Plant Health Inspection Service  The emerging Veterinary event database stores syndromic surveillance information regarding adverse animal health events. USDA’s  Center for Animal Health Information and Analysis uses publicly available information sources to gather information on these events.  The database is used to establish a baseline for animal disease and catalog reports of adverse animal health events. Analysts use  this information to produce reports on emerging disease. Access to the database is not restricted to personnel from the Center for  Animal Health Information and Analysis.
FY 2009 Costs (thousands)
Minimal costs associated with  employee time for maintenance  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
National Agriculture Pest Information System  Animal and Plant Health Inspection Service  The National Agricultural Pest Information System is a database for collection, summarization, and standardized information on plant  pests such as insects, diseases, weeds, and nematodes. Data are gathered by each of the states and by USDA’s Plant Protection  and Quarantine. Emphasis is given to surveys for exotic pests, pests that may impact export of U.S. agricultural products, as well as  pest and biological control agents identified by Plant Protection and Quarantine progam officials. The National Agricultural Pest  Information System facilitates data management coordination for the plant pest survey data gathered on a national, regional, and/or  state scale as part of the Cooperative Agricultural Pest Survey program sponsored by USDA.
FY 2009 Costs (thousands)
States participating in the  Cooperaive Agricultural Pest  Survey enter data into the  system  Plant resources in the United States, inlcluding crops, rangelands, and forests, are vulnerable to endemic, introduced, and emerging  pathogens. More than 50,000 plant diseases occur in the United States, caused by a variety of pathogens. Increasing globalization  and international trade activities create a strong likelihood that many other exotic plant pathogens will arrive in the United States in the  coming years.
National Animal Health Laboratories Network  Animal and Plant Health Inspection Service  National Institute of Food and Agriculture  The National Animal Health Laboratories Network was established as part of a strategy to coordinate and network the diagnostic  testing capabilities of federal veterinary diagnostic laboratories with state and university diagnostic laboratories to improve early  detection of, response to, and recovery from animal health emergencies, including bioterrorist events, newly emerging diseases, and  foreign animal disease agents. The network is composed of 58 laboratories in 45 states. Current activities include a training program  for technicians who test for certain high-risk diseases such as food and mouth disease and conducting surveillance for animal  diseases, such as swine influenza virus and pseudorabies.
FY 2009 Costs (thousands)
State and university veterinary  diagnostic labs  (excludes funding provided to  labs for testing, sample  collection, or training)
Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
National Animal Health Monitoring System  Animal and Plant Health Inspection Service  The mission of the National Animal Health Monitoring System is to deliver information and knowledge about animal health by  conducting studies that generally focus on food animals, dairy, livestock, and poultry commodities. The studies are designed to gather  information about industry practices, biosecurity, and prevalence of endemic diseases. The studies are conducted about every 5 years  or more depending on budget/resources and needs of commodity stakeholders, and the results are published in an annual Animal  Health Report. This information is used for surveillance planning to identify risk factors, so that surveillance can be targeted to key  areas of concern.
FY 2009 Costs (thousands)
Data is provided by industries  that are selected through the  National Agricultural Statistics  Service  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
National Animal Health Reporting System  Animal and Plant Health Inspection Service  The National Animal Health Reporting System was designed to provide data from chief State animal health officials on the presence  or absence of confirmed World Organization for Animal Health reportable diseases in specific commercial livestock, poultry, and  aquaculture species in the United States. Within a state, data about animal disease occurrence are gathered from as many verifiable  sources as possible and consolidated into a monthly report submitted to the National Surveillance Unit, where the information is  verified, summarized, and compiled into a national report. The commodities currently covered are cattle, sheep, goats, equine, swine,  commercial poultry, and commercial food fish. The National Animal Health Reporting System is a joint effort of the U.S. Animal Health  Association, American Association of Veterinary Laboratory Diagnosticians, and USDA’s Animal and Plant Health Inspection Service.
FY 2009 Costs (thousands)
Federal cost is a portion of the  overall budget of the National  Surveillance Unit  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
Animal and Plant Health Inspection Service  The objective of the National Surveillance Unit includes developing and improving methods for surveillance and analysis of animal  health related data; analyze surveillance data to provide actionable information; designing and evaluating national animal health  surveillance systems; and communicating surveillance information to key partners. The National Surveillance Unit is the coordinating  entity for the National Animal Health Surveillance System. The goal of the unit is to create a comprehensive, integrated national  surveillance system for animal health. The National Surveillance Unit has created an inventory of biosurveillance systems focused on  animal health which allows users to search for animal health surveillance systems by species, disease, source of data, sample type,  category of system, and agency administering the system.
FY 2009 Costs (thousands)
NSU was founded in 2003 and  is operational  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
Animal and Plant Health Inspection Service  The Offshore Pest Information System is a Web-based information-sharing tool that allows users to communicate in an organized  manner about offshore animal and plant health events and issues. The system is a key instrument used to meet the goals of the  International Safeguarding Information Program. This program is risk-focused and designed to collect, synthesize/analyze,  communicate, and utilize relevant offshore animal and plant disease or pest information. The Offshore Pest Information System is  secure and enables multiple users to access, respond to, and act upon information about international events that affect animal and  plant health. Weekly reports are generated from events in the system’s database that are distributed to the system’s users and  stakeholders.
FY 2009 Costs (thousands)
Animal and plant emerging diseases and pests  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies. Plant resources in the United States, including crops, rangelands, and forests,  are vulnerable to endemic, introduced, and emerging pathogens. More than 50,000 plant diseases occur in the United States, caused  by a variety of pathogens. Increasing globalization and international trade activities create a strong likelihood that many other exotic  plant pathogens will arrive in the United States in the coming years.
Rapid Syndrome Validation Project for Animals (RSVP-A)
Animal and Plant Health Inspection Service  Rapid Syndrome Validation Project for Animals is a syndromic surveillance system to facilitate the early detection, reporting, and  response to an infectious disease outbreak in animals. Veterinarians collect syndromic data on animals—such as neurologic  dysfunction, birth defects, or unexpected death—on hand-held computers and send the data to a central database. USDA officials and  other practitioners analyze the data and create alerts of a disease outbreak or summarize normal disease occurrence.
FY 2009 Costs (thousands)
Operational in pilot project  phase  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
Integrated Pest Management Pest Information Platform for Extension and Education  National Institute of Food and Agriculture  The Integrated Pest Management Pest Information Platform for Extension and Education is a system to analyze threats to plant  health. The system utilizes modeling technology that allows stakeholders to access data online for the location of plant threats, as well  as their severity, distribution, forecasting, and state-specific control recommendations. Data included are all hazards, and include  weather patterns, observations of plant disease occurrences, and the results of sample testing that are contributed by the system’s  users. The system is active in 41 states, 5 Canadian provinces, and Mexico.
FY 2009 Costs (thousands)
System has been operating  since 2005  Plant resources in the United States, including crops, rangelands, and forests, are vulnerable to endemic, introduced, and emerging  pathogens. More than 50,000 plant diseases occur in the United States, caused by a variety of pathogens. Increasing globalization  and international trade activities create a strong liklihood that many other exotic plant pathogens will arrive in the United States in the  coming years.
National Institute of Food and Agriculture  The mission of the National Plant Diagnostic Network is to safeguard U.S. plant agriculture against introduced pests and pathogens  by enhancing diagnostic and detection capabilities; improving communication among federal, state, and local agencies involved in  monitoring for plant pests and pathogens; and delivering educational programs regarding the threats posed by their introduction. A  single database captures data from voluntary information given to laboratories, such as from grower samples, bugs brought into  laboratories, or from citizen complaints. The network, for example, funds diagnostic labs in all 50 states and sponsors training for  individuals in the plant industry (from nursery owners to home gardeners). The National Plant Diagnostic Network also maintains a  national database with plant disease reports, charts, and mapping tools.
FY 2009 Costs (thousands)
System has been operating  since 2002  Plant resources in the United States, including crops, rangelands, and forests, are vulnerable to endemic, introduced, and emerging  pathogens. More than 50,000 plant diseases occur in the United States, caused by a variety of pathogens. Increasing globalization  and international trade activities create a strong liklihood that many other exotic plant pathogens will arrive in the United States in the  coming years.
Upon arrival at a U.S. port-of-entry, all meat and poultry shipments must be reinspected by a Food Safety and Inspection Service  import inspector before they are allowed into this country. Every lot of product is given a visual inspection for appearance and  condition, and checked for certification and label compliance. In addition, the Automated Import Information System assigns various  other types of inspection including product examinations and microbial and chemical laboratory analysis based on statistical and trend  analysis of the product’s origin.
FY 2009 Costs (thousands)
Importers of meat and poultry  products submit reports to the  system  Biological agents that can contaminate meat and poultry products  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance the 2006 outbreak of E. coli O157:H7 linked to bagged spinach resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
Food Safety and Inspection Service Incident Management System  The Food Safety and Inspection Service’s Incident Management System is a web-based common operating platform that, according  to USDA officials, allows program managers and users to rapidly identify, respond to, and track the agency’s response to significant  incidents such as suspected tampering of products, threats to facilities, natural disasters, and Class 1 recalls with illness.
FY 2009 Costs (thousands)
Food Safety and Insepction  Service Emergency  Management Committee  members and personnel  granted access to the system  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance the 2006 outbreak of E. coli O157:H7 linked to bagged spinach resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
In April 2008, the Food Safety and Inspection Service implemented the Import Alert Tracking System, an automated data system that  allows field employees to record information related to ineligible, illegal, or smuggled shipments of imported meat, poultry, or egg  products found in commerce. The system enables better coordination in enforcement actions through quicker access to information  collected on illegal entries. The system has been designed to automate the processes of incident notifications between Food Safety  and Inspection Service program areas and creation of an incident report when appropriate.
FY 2009 Costs (thousands)
System is operational since  2005.
No direct costs - costs are  included under the Food Safety  and Inspection Service’s  Incident Management System  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance the 2006 outbreak of E. coli O157:H7 linked to bagged spinach, resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
Laboratory Electronic Application for Results Notification  The Laboratory Electronic Application for Results Notification program provides Food Safety and Inspection Service personnel,  establishments, and state officials with reports on the status of meat, poultry, and egg product test samples. The application is an  automated process that tracks each sample as it is received, analyzed, and results are reported. The Laboratory Electronic  Application for Results Notification program allows field inspectors and agency staff to check on the status of individual samples or  view circuit, district, and management summaries of results. Establishment and state officials will not have access to the intranet site,  but they may receive e-mail reports on the status of individual samples.
FY 2009 Costs (thousands)
Food Safety and Insepction  Service Laboratories  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance the 2006 outbreak of E. coli O157:H7 linked to bagged spinach, resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
Microbiological and Residue Computer Information System  The Microbiological and Residue Computer Information System contains sample identification information and results for analyses  submitted by inspection personnel to laboratories. These samples consist of meat, poultry, and egg products; and they are analyzed  to ensure that they are safe, wholesome, unadulterated, and properly labeled. The samples are tested because they bear or contain  residues of drugs, pesticides, other chemicals, or microbiological pathogens. Test results are used to alert agency personnel and the  industry of contaminations and threats to consumer health and the need for protective actions such as product recalls. The  Microbiological and Residue Computer Information System is also used for risk assessment and decision support purposes, improving  early detection of problem products, enabling active food safety surveillance, and evaluating potential threats to the food supply.
FY 2009 Costs (thousands)
Food Safety and Insepction  Service Laboratories  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance the 2006 outbreak of E. coli O157:H7 linked to bagged spinach, resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
The Pathogen Reduction Enforcement Program schedules tests, tracks food samples, and generates a series of reports concerning  food testing eligibility and the status of food sample testing results. It collects and stores food manufacturing establishment addresses  and product information, as well as the establishment’s performance in previous food safety tests. It uses this information to schedule  and request the collection of food samples for testing. These tests results are used to alert agency personnel and the industry of  contaminations, so an appropriate response can be issued. The Pathogen Reduction Enforcement Program is also used for risk  assessment and decision support purposes, improving early detection of problem products, enabling active food safety surveillance,  and evaluating potential threats to the U.S. food supply.
FY 2009 Costs (thousands)
Food Safety and Insepction  Service Laboratories  Outbreaks of foodborne illness can harm human health, undermine consumer confidence in the safety of the nation’s food supply, and  have serious economic consequences. For instance the 2006 outbreak of E. coli O157:H7 linked to bagged spinach, resulted in 205  confirmed illnesses, 3 deaths, and an estimated $100 million loss to industry.
The Agriculture Quarantine Inspection Program partners with Customs and Border Protection to conduct hands-on inspection of  agricultural commodities entering the United States to confirm that imports are free of pests and disease. Specifically, Customs and  Border Protection officers inspect any incoming agricultural commodities, including plants, animals, food, or other miscellaneous  goods—such as automobile parts where pests might hide and enter the United States—for the presence of pests. The Agriculture  Quarantine Inspection Program operates Plant Inspection Stations, which process the pest interceptions made by Customs and  Border Protection officers at ports, and identify pests and diseases on imported goods. This information is also filtered into USDA’s  Plant Protection and Quarantine databases.
FY 2009 Costs (thousands)
The system is planned to be  replaced by a more user-friendly  system in the next five years  Plant resources in the United States, including crops, rangelands, and forests, are vulnerable to endemic, introduced, and emerging  pathogens. More than 50,000 plant diseases occur in the United States, caused by a variety of pathogens. Increasing globalization  and international trade activities create a strong likelihood that many other exotic plant pathogens will arrive in the United States in the  coming years. Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may  affect humans. Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial  strain on response systems, and affect regional and national economies.Outbreaks of foodborne illness can harm human health,  undermine consumer confidence in the safety of the nation’s food supply, and have serious economic consequences. For instance the  2006 outbreak of E. coli O157:H7 linked to bagged spinach, resulted in 205 confirmed illnesses, 3 deaths, and an estimated $100  million loss to industry.
The mission of the Cooperative Agricultural Pest Survey program is to identify exotic plant pests in the United States deemed to be of  regulatory significance to USDA, state departments of agriculture, tribal governments, and cooperators. It facilitates this mission by  working to confirm the presence or absence of environmentally and/or economically harmful plant pests. These pests can impact  agriculture or the environment. The Cooperative Agricultural Pest Survey program also establishes and maintains a comprehensive  network of cooperators and stakeholders to facilitate a plant protection mission.
FY 2009 Costs (thousands)
States provide information on  plant pests and deliver samples  for testing to USDA’s Plant  Protection and Quarantine for  further analysis. Results are  disseminated back to  participating states after testing  has concluded. $9,098 was allocated to support  pest detection activities. Of this,  approximately $8,453.50 was  given to the states via  cooperative agreements to  conduct pest detection  activities.
Plant resources in the United States, including crops, rangelands, and forests, are vulnerable to endemic, introduced, and emerging  pathogens. More than 50,000 plant diseases occur in the United States, caused by a variety of pathogens. Increasing globalization  and international trade activities create a strong likelihood that many other exotic plant pathogens will arrive in the United States in the  coming years.
Exotic Pest Information Collection and Analysis  The purpose of Exotic Pest Information Collection and Analysis is to conduct plant pest biosurveillance for USDA’s Plant Protection  and Quarantine. The program continuously gathers, evaluates, and communicates open-source information on quarantine-significant  plant pests worldwide. The program also produces concise articles about relevant pieces of pest news, placing the news into a  safeguarding context and providing important background information. The articles are distributed weekly in an e-mail notification and  are archived in a Web-accessible, fully-searchable database (known as the Global pest and Disease Database).
FY 2009 Costs (thousands)
The Exotic Pest Information  Collection and Analysis program  team gathers publicly available  information from the World Wide  Web, including scientific  journals, Web sites, listervs, and  blogs  Plant pests such as arthropods, nematodes, pathogens, mollusks, and weeds  Plant resources in the United States, including crops, rangelands, and forests, are threateneded by exotic plant pests. Globalization  and international trade increase the likelihood of exotic pest introduction into the United States. According to USDA, up-to-date pest  information is essential for preparedness and early response.
The Global Pest and Disease Database is an archive of exotic pest information specific to Plant Protection Quarantine needs, for uses  including the prioritization of pest threats to the United States, conducting risk assessments of plant pests, and completing domestic  exotic pest surveys. The Exotic Pest Information Collection and Analysis program contains information on over 600 plant and animal  plant pests not native to the United States. The Exotic Pest Information Collection and Analysis program is primarily intended for use  within USDA but DHS officials, other federal agencies, and state agricultural agencies also have access to the system.
FY 2009 Costs (thousands)
Other USDA biosurveillance  systems, such as the Exotic  Pest Information Collection and  Analysis system, the Offshore  Pest Information System, and  the New Pest Advisory Group  Plant pests not known to occur in the United States or in limited distribution in the United States  Plant resources in the United States, including crops, rangelands, and forests, are vulnerable to endemic, introduced, and emerging  pathogens. More than 50,000 plant diseases occur in the United States, caused by a variety of pathogens. Increasing globalization  and international trade activities create a strong likelihood that many other exotic plant pathogens will arrive in the United States in the  coming years.
National Animal Health Surveillance System  Animal and Plant Health Inspection Service  The National Animal Health Surveillance System is a USDA initiative to integrate existing animal health monitoring programs and  surveillance activities into a national, comprehensive, and coordinated system and develop new surveillance systems, methodology,  and approaches. The system is an interdisciplinary network of partners working together to protect animal health and promote free  trade through surveillance, control, and prevention of foreign, emerging, and endemic diseases.
FY 2009 Costs (thousands)
Exotic and endemic infectious diseases affecting animals and public health  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
National Wildlife Health Center Wildlife Mortality Database (EPIZOO)
U.S. Geological Survey National Wildlife Health Center  The USGS National Wildlife Center’s EPIZOO database is a data set that documents information on epidemics in wildlife. EPIZOO  tracks die-offs throughout the United States and territories, primarily in migratory birds and endangered species. Data include  locations, dates, species involved, history, population numbers, total sick and dead, and diagnostic information. The data are collected  from a reporting network developed at the National Wildlife Health Center as well as from collaborators across the North American  continent.
FY 2009 Costs (thousands)
Regular data are available from  1975 to the present; some data  sets are available from earlier  years  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
U.S. Geolgocial Survey National Wildlife Health Center  The Wildlife Health Diagnostic Database is a computerized record of specimens sent to the National Wildlife Health Center for  processing and diagnostic testing. Data include history and recordkeeping information, types of tests run, and some initial diagnostic  and testing results. Data from the system cannot be used as a representative sample of animal health diseases that exist in the wild,  but it may be used to determine if a disease or animal health syndrome has occurred in the wild.
FY 2009 Costs (thousands)
Data have been available since  1975  Animal diseases can affect wildlife as well as livestock, pets, and companion animals. Some of these diseases may affect humans.  Animal disease outbreaks can cause significant and potentially disruptive losses for animal producers, put financial strain on response  systems, and affect regional and national economies.
The U.S. Forest Service Forest Health Protection program is responsible for detection and monitoring of forest health conditions on all  forested lands in the United States. The program annually conducts aerial surveys of nearly 500 million acres of forested lands for  unusual activities of forest insects and pathogens. The Forest Health Protection Program has developed a suite of forest health  indicators that are to monitor forest health and facilitate the detection of the introduction of foreign pests. Pest risk assessments are  used to target detection surveys in areas that are particularly vulnerable to invasion and establishment of invasive pests. Annual  reports at the state, regional, and national levels assess trends in forest condition and highlight new or expanding outbreaks of forest  pests.
FY 2009 Costs (thousands)
System is operational.
Plant resources in the United States, including crops, rangelands, and forests, are vulnerable to endemic, introduced, and emerging  pathogens. More than 50,000 plant diseases occur in the United States, caused by a variety of pathogens. Increasing globalization  and international trade activities create a strong likelihood that many other exotic plant pathogens will arrive in the United States in the  coming years.
The Biohazard Detection System deployed by the USPS is a decentralized locally networked automated collection and identification  system and is used to detect the biological agent causing anthrax that could be present in first-class mail. The system is installed in  mail processing facilities nationwide. The system is integrated with mail processing and letters are automatically fed into the system  where it detects the presence of anthrax. The detecting process runs continuously and alerts system operators if a presumptive  positive case of anthrax is detected.
FY 2009 Costs (thousands)
Annual Operation and  Maintenance Costs: $73.5M  Anthrax is an acute infectious disease caused by a bacterium commonly found in the soil. Although anthrax can infect humans, it  occurs most commonly in plant-eating animals. Human anthrax infections have usually resulted from occupational exposure to  infected animals or from contaminated animal products. Anthrax infection can take one of three forms: coetaneous, usually through a  cut or abrasion; gastrointestinal, usually by ingesting undercooked contaminated meat; or inhalation, by breathing airborne anthrax  spores into the lungs. The symptoms are different for each form and usually occur within 7 days of exposure. Anthrax can be treated  with antibiotics and a vaccine is available. In 2001, U.S. Postal Service employees and customers contracted anthrax after a domestic  bioterrorism incident that spread anthrax spores through the U.S. mail and resulted in five deaths.
section_title: Appendix VI: GAO Contacts and Staff Acknowledgments
subsections: section_title: Acknowledgments
paragraphs: In addition to the contact named above, Anne Laffoon, Assistant Director;  Michelle Cooper; Kathryn Godfrey; Amanda Krause,;Steven Banovac; and  Susanna Kuebler made significant contributions to the work. Keira  Dembowski, Jessica Gerrard-Gough, and Patrick Peterson also provided  support. Tina Cheng assisted with graphic design. Amanda Miller and Russ  Burnett assisted with design, methodology, and analysis. Tracey King  provided legal support. Linda Miller provided communications expertise.
section_title: Related GAO Products
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Biosurveillance: Developing a Collaboration Strategy Is Essential to  Fostering Interagency Data and Resource Sharing. GAO-10-171.  Washington D.C.: December 18, 2009.
Influenza Pandemic: Monitoring and Assessing the Status of the  National Pandemic Implementation Plan Needs Improvement.  GAO-10-73. Washington D.C.: November 24, 2009.
Interagency Collaboration: Key Issues for Congressional Oversight of  National Security Strategies, Organizations, Workforce, and  Information Sharing. GAO-09-904SP. Washington D.C.: September 25,  2009.
Food Safety: Agencies Need to Address Gaps in Enforcement and  Collaboration to Enhance Safety of Imported Food. GAO-09-873.  Washington D.C.: September 15, 2009.
Influenza Pandemic: Gaps in Pandemic Planning and Preparedness  Need to Be Addressed. GAO-09-909T. Washington D.C.: July 29, 2009.
Veterinarian Workforce: The Federal Government Lacks a  Comprehensive Understanding of Its Capacity to Protect Animal and  Public Health. GAO-09-424T. Washington D.C.: February 26, 2009.
Seafood Fraud: FDA Program Changes and Better Collaboration among  Key Federal Agencies Could Improve Detection and Prevention.  GAO-09-258. Washington, D.C.: February 19, 2009.
Veterinarian Workforce: Actions Are Needed to Ensure Sufficient  Capacity for Protecting Public and Animal Health. GAO-09-178.  Washington D.C.: February 4, 2009.
Health Information Technology: More Detailed Plans Needed For the  Centers for Disease Control and Prevention’s Redesigned BioSense  Program. GAO-09-100. Washington D.C.: November 20, 2008.
Influenza Pandemic: HHS Needs To Continue Its Actions And Finalize  Guidance for Pharmaceutical Interventions. GAO-08-671. Washington  D.C.: September 30, 2008.
Food Safety: Improvements Needed in FDA Oversight of Fresh Produce.  GAO-08-1047. Washington D.C.: September 26, 2008.
United States Postal Service: Information on the Irradiation of Federal  Mail in the Washington D.C., Area. GAO-08-938R. Washington D.C.: July  31, 2008.
Biosurveillance: Preliminary Observations on Department of Homeland  Security’s Biosurveillance Initiatives. GAO-08-960T. Washington D.C.:  July 16, 2008.
Homeland Security: First Responders’ Ability to Detect and Model  Hazardous Releases in Urban Areas Is Significantly Limited.  GAO-08-180. Washington D.C.: June 27, 2008.
Emergency Preparedness: States Are Planning for Medical Surge, but  Could Benefit from Shared Guidance for Allocating Scarce Medical  Resources. GAO-08-668. Washington D.C.: June 13, 2008.
Federal Oversight of Food Safety: FDA Has Provided Few Details on the  Resources and Strategies Needed to Implement its Food Protection Plan.  GAO-08-909T. Washington D.C.: June 12, 2008.
Food Safety: Selected Countries’ Systems Can Offer Insights into  Ensuring Import Safety and Responding to Foodborne Illness.  GAO-08-794. Washington D.C.: June 10, 2008.
Federal Oversight of Food Safety: FDA’s Protection Plan Proposes  Positive First Steps, but Capacity to Carry Them Out is Critical.  GAO-08-435T. Washington D.C.: January 29, 2008.
Project Bioshield: Actions Needed to Avoid Repeating Past Problems with  Procuring New Anthrax Vaccine and Managing the Stockpile of Licensed  Vaccine. GAO-08-88. Washington D.C.: October 23, 2007.
Global Health: U.S. Agencies Support Programs to Build Overseas  Capacity for Infectious Disease Surveillance. GAO-08-138T. Washington  D.C.: October 4, 2007.
Global Health: U.S. Agencies Support Programs to Build Overseas  Capacity Overseas Capacity for Infectious Disease Surveillance.  GAO-07-1186. Washington D.C.: September 28, 2007.
Anthrax: Federal Agencies Have Taken Some Steps to Validate Sampling  Methods and to Develop a Next-Generation Anthrax Vaccine.  GAO-06-756T. Washington D.C.: May 9, 2006.
Agriculture Production: USDA Needs to Build on 2005 Experience to  Minimize the Effects of Asian Soybean Rust in the Future. GAO-06-337.  Washington D.C.: February 24, 2006.
USPS: Guidance on Suspicious Mail Needs Further Refinement.  GAO-05-716. Washington D.C.: July 19, 2005.
Information Technology: Federal Agencies Face Challenges in  Implementing Initiatives to Improve Public Health Infrastructure.  GAO-05-308. Washington D.C.: June 10, 2005.
Homeland Security: Much Is Being Done to Protect Agriculture from a  Terrorist Attack, but Important Challenges Remain. GAO-05-214.  Washington D.C.: March 8, 2005.
Drinking Water: Experts’ Views on How Federal Funding Can Best Be  Spent To Improve Security. GAO-04-1098T. Washington D.C.: September  30, 2004.
Emerging Infectious Diseases: Review of State and Federal Disease  Surveillance Efforts. GAO-04-877. Washington D.C.: September 30, 2004  Federal Food Safety and Security: Fundamental Restructuring is Needed  to Address Fragmentation and Overlap. GAO-04-588T. Washington D.C.:  March 30, 2004.
Combating Terrorism: Evaluation of Selected Characteristics in  National Strategies Related to Terrorism.GAO-04-408T. Washington D.C.:  February 3, 2004.
Drinking Water: Experts Views on How Future Funding Can Be Best  Spent To Improve Security. GAO-04-29. Washington D.C.: October 31,  2003.
Infectious Diseases: Gaps Remain in Surveillance Capabilities of State  and Local Agencies. GAO-03-1176T. Washington D.C.: September 24, 2003.
Bioterrorism Information Technology Strategy Could Strengthen Federal  Agencies’ Abilities to Respond to Public Health Emergencies.  GAO-03-139. Washington D.C.: May 30, 2003.
Combating Terrorisms Selected Challenges and Recommendations.  GAO-01-822. Washington D.C.: September 20, 2001.
Food Safety: CDC Is Working to Address Limitations in Several of Its  Foodborne Disease Surveillance Systems. GAO-01-973. Washington D.C.:  September 7, 2001.
Global Health: Challenges in Improving Infectious Disease Surveillance  Systems. GAO-01-722. Washington D.C.: August 31, 2001.
West Nile Virus Outbreak: Lessons for Public Health  Preparedness.GAO/HEHS-00-180. Washington D.C.: September 11, 2000.
Global Health: Framework for Infectious Disease Surveillance. NSIAD-00- 205R. Washington D.C.: July 20, 2000.