According to DHS’s 2014 Quadrennial Homeland Security Review (QHSR), biological threats and hazards—ranging from bioterrorism to naturally occurring pandemics—are a top homeland security risk. The QHSR acknowledges that numerous departments and agencies at the federal, state, local, tribal, and territorial levels, as well as the private sector, contribute to the national effort to address biological threats and hazards. As such, according to the QHSR, DHS aims to focus on those activities and responsibilities assigned to it through statute or presidential directive. Among the identified activities and responsibilities is one that is specific to biosurveillance—biosurveillance integration and detection— and others that can help to support efficient and effective biosurveillance action, such as information sharing and analysis, threat and risk awareness, and technical forensic analysis to support attribution. The Implementing Recommendations of the 9/11 Commission Act of 2007 (9/11 Commission Act) established the National Biosurveillance Integration Center (NBIC) within DHS. NBIC was specifically tasked with integrating and analyzing information from human health, animal, plant, food, and environmental monitoring systems across the federal government and supporting the interagency biosurveillance community. As defined in the July 2012 NBIC Strategic Plan, integration involves combining biosurveillance information from different sources and domains (e.g., human, animal, and plant health; food and environmental safety and security; and homeland security) to provide partners and stakeholders with a synthesized view of the information, and what it could mean. Primary goals of integration include creating a common picture or understanding of potential and ongoing biological events and providing insights that cannot be gleaned in isolation. The 9/11 Commission Act outlines certain requirements for NBIC. Drawing upon these requirements as well as the NBIC Strategic Plan, we identified three main roles that NBIC, as a federal-level biosurveillance integrator, must carry out to achieve the duties and outcomes described by NBIC’s authorizing legislation. Senior NBIC officials agreed that these three roles—analyzer, coordinator, and innovator—are consistent with the center’s responsibilities. These roles are not mutually exclusive and can reinforce one other. For example, NBIC’s efforts as an Innovator might result in the development of data that could enhance its role as an Analyzer by providing the center with another dataset to review. The biosurveillance integrators’ roles we identified: Analyzer: Use technological tools and subject matter expertise to develop shared situational awareness by creating meaningful new insights from disparate datasets and information that could not be gleaned in isolation. Coordinator: Bring together multi-disciplinary partners across interagency organizations to enhance understanding of new or potential biological events, such as through the collaborative development of products and services. Innovator: Facilitate the development of new tools, technology, and approaches to address gaps in biosurveillance integration. According to Homeland Security Presidential Directive 10 (HSPD-10): Biodefense for the 21st Century, a national bioawareness capability providing early warning, detection, or recognition of a biological weapon attack is an essential component of biodefense. To contribute to this national capability, in 2003, DHS created the BioWatch program to provide early warning, detection, or recognition of a biological attack. The BioWatch program uses routine laboratory testing designed to detect an aerosolized biological attack for five specific biological agents considered high risk for use as biological weapons. When DHS was established in 2002, a perceived urgency to deploy useful—even if immature—technologies in the face of potentially catastrophic consequences catalyzed the rapid deployment of many technologies. DHS completed the initial deployment of BioWatch quickly—within 80 days of the President’s announcement of the BioWatch program in his 2003 State of the Union Address. In 2005, DHS expanded BioWatch to an additional 10 jurisdictions, for a total of more than 30. The expanded deployment—referred to as Generation 2 (Gen- 2)—also included the addition of indoor monitoring capabilities in three high-threat jurisdictions and provided additional capacity for events of national significance, such as major sporting events and political conventions. In 2015, we reported that the BioWatch program collaborates with more than 30 BioWatch jurisdictions throughout the nation to operate approximately 600 Gen-2 aerosol collectors. These units rely on a vacuum-based collection system that draws air through a filter. These filters are manually collected and transported to state and local public health laboratories for analysis. Using this manual process, a result can be generated from 12 to 36 hours after an agent is initially captured by the aerosol collection unit. To reduce detection time, DHS began to develop an autonomous detection capability in 2003 for the BioWatch program—known as Generation 3 (Gen-3). Envisioned as a laboratory-in-a-box, the autonomous detection system would automatically collect air samples, conduct analysis to detect the presence of biothreat agents every 4 to 6 hours, and communicate the results to public health officials via an electronic network without manual intervention. By automating the analysis, DHS anticipated that detection time could be reduced to 6 hours or less, making the technology more appropriate for monitoring indoor high-occupancy facilities such as transportation nodes and enabling a more rapid response to an attack. DHS also anticipated a reduction in operational costs by eliminating the program’s daily manual sample retrieval and laboratory analysis. However, as we reported in 2015, the Gen-3 acquisition was canceled in April 2014, after testing difficulties and after an analysis of alternatives was interpreted by DHS as showing that any advantages of an autonomous system over the current manual system were insufficient to justify the cost of a full technology switch. In December 2009, we reported that NBIC was not fully equipped to carry out its mission because it lacked key resources—data and personnel— from its partner agencies, which may have been at least partially the result of collaboration challenges it faced. For example, some partners reported that they did not trust NBIC to use their information and resources appropriately, while others were not convinced of the value that working with NBIC provided because NBIC’s mission was not clearly articulated. In order to help NBIC enhance and sustain collaboration, including the provision of data, personnel, and other resources, in 2009, we recommended that NBIC develop a strategy for addressing barriers to collaboration and develop accountability mechanisms to monitor these efforts. In August 2012, NBIC issued the NBIC Strategic Plan, which is intended to provide NBIC’s strategic vision, clarify the center’s mission and purpose, articulate the value that NBIC seeks to provide to its partners, and lay the groundwork for setting interagency roles, responsibilities, and procedures. Further, in November 2014, NBIC completed its first biannual NBIC Federal Stakeholder Survey, which NBIC uses to assess the usefulness of its products and activities and to determine what improvements should be made on the basis of those results. We believe DHS’s actions addressed the recommendations in our December 2009 report. In September 2015, we reported that NBIC had actions and activities underway to fulfill all three of the roles we identified as essential to its ability to carry out its mission—analyzer, coordinator, and integrator. For example, to fulfill its analyzer role NBIC compiled information to create and circulate a variety of products to support disease outbreak monitoring on a daily, weekly, or period basis. Similarly, in its coordinator role, NBIC had put in place a variety of procedures and protocols to convene partners on a routine basis or in response to specific emerging events. Finally, in its innovator role NBIC had efforts to conduct gap analyses, fund pilot projects that aim to develop new biosurveillance tools and technology (such as examining the use of social media data to identify health trends), sought new sources of data and information, and made efforts to enhance its internal IT system. Although NBIC had made efforts to collaborate with interagency partners to create and issue a strategic plan that would clarify its mission and the various efforts to fulfill its three roles, we reported a variety of challenges that remained when we surveyed NBIC’s interagency partners for our 2015 report. Notably, many of these partners continued to express uncertainty about the value NBIC provided. Specifically, 10 of 19 partners stated that NBIC’s products and activities enhance their agencies’ ability to carry out their biosurveillance roles and responsibilities to little or no extent, 4 responded to a moderate extent, and 5 responded that they did not have a basis to judge. Generally, partners that responded to little or no extent noted that NBIC products and activities do not, for example, identify trends and patterns or describe potential impacts of a biological event. For instance, one official stated that NBIC’s products and activities do not “connect the dots” between dissimilar information, provide novel synthesis of information, or recommend possible courses of action. Moreover, most of the federal partners with key roles in biosurveillance (8 of 11) stated that NBIC’s products help their agencies identify biological events to little or no extent, generally because they already obtain such information directly from other federal partners more quickly. We also found in 2015, as in 2009, that a variety of challenges limited the extent to which federal agencies shared data and personnel with NBIC, as envisioned by the 9/11 Commission Act. First, data that NBIC could use to identify and characterize a biological event of national concern using statistical and analytical tools, as called for in the 9/11 Commission Act, are limited. Also, apart from searches of global news reports and other publically available reports generated by National Biosurveillance Integration System (NBIS) partners, NBIC has been unable to secure streams of raw data from multiple domains across the biosurveillance enterprise that would lend themselves to near-time quantitative analysis that could reveal unusual patterns and trends.