Enhancing Nationwide Biosurveillance for Human Health

1. Enhancing Nationwide Biosurveillance for Human Health Biosurveillance Coordination Unit Dan Sosin, M.D., M.P.H, F.A.C.P.(CDC/COTPER)

2. Urgent Threats: Infectious Diseases SARS West Nile Virus Pandemic Influenza Foodborne Disease

3. Urgent Threats: Terrorism Anthrax 9/11

4. Urgent Threats: Chemical Releases Chlorine Spill Ammonia Leak Hazardous Materials

5. Urgent Threats: Natural Disasters Wildfires Hurricanes Floods

6. Public Health Protection in a Small World Requires: • Fast and accurate detection • Fast and credible science • Fast and effective communication • Fast and effective coordination • Fast and effective action

7. National Biosurveillance Priority • Homeland Security Presidential Directives 9 and 10 • Create new biological threat awareness capacity; • Establish an integrated warning system • Pandemic and All-Hazards Preparedness Act of 2006 • Homeland Security Presidential Directive-21 mandates the need to, “establish an operational national…[bio]surveillance system for human health” and a “Federal Advisory Committee … to ensure that the Federal Government is meeting the goal of enabling State and local government public health surveillance capabilities” • Biosurveillance Coordination Unit (BCU) formed to lead interagency efforts

8. Scope of Biosurveillance “active data-gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health --whether infectious, toxic, metabolic, or otherwise, and regardless or intentional or natural origin--in order to achieve early warning of health threats, early detection of health events, and overall situational awareness of disease activity” (HSPD-21, paragraph 2 a) The science and practice of managing health-related data and information so that effective action can be taken to mitigate adverse health effects from urgent threats

9. Biosurveillance Inputs Biosurveillance

10. Enhanced Biosurveillance: A Different Look • Situation awareness “The perception of elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future” -- Endsley • Critical information requirements -- Weaver • How I see the enemy (threats) • How I see my myself (response assets) • How I prevent the enemy from seeing me (what makes me vulnerable)

11. Enhanced Biosurveillance: What The Future Looks Like • All-source, relevant, accurate, timely, and actionable information for government, healthcare, business, and personal decision-making around health emergencies • Improved horizontal and vertical information sharing • Enhanced capability through shared responsibility • Related initiatives integrated and priorities set collaboratively for limited resources

12. Enhanced Biosurveillance: What It Will Take • Workforce • New skills • Greater capacity • New Science • Bridging of information and analytic fields • Data and information safeguards • Responsible application of new methods • Modified Workflows and Business Processes

13. Enhanced Biosurveillance: Challenges • Workforce Limitations • Capacity reductions at the most skilled end of the workforce • Lack of competencies, curriculum, and mechanisms to develop with biosurveillance workforce of the future • Duplication of Efforts • Constrained data sharing • Limited interagency collaboration and visibility of relevant work • Unstable Funding • Impedes research and development • Impedes recruitment, retention, and collaboration

14. Enhanced Biosurveillance: The Way Forward • The National Biosurveillance Strategy for Human Health (NBSHH) • Builds on the current capabilities and relationships • Respects multiorganizational and multidisciplinary perspectives • Ensures protection of rights and authorities • Serves as a reference point for the next generation biosurveillance capability • Version 1.0 was distributed on December 15, 2008 • The National Biosurveillance Advisory Subcommittee

15. The Strategy: Collaborations • The Strategy is a product of the collaborations of several multi-disciplinary working groups and engagements of additional biosurveillance stakeholders. • The network of stakeholders includes: • Federal Agencies and State, Local, Territorial and Tribal Governments • The Healthcare Industry and International Partners • Private Sector, Academia, and Community-based Organizations • While having broader missions, the professional communities protecting Animal, Plant and Environmental Health have direct impact on human health security and are stakeholders as well.

16. The Strategy: Vision • An approach that addresses all-hazards and all-populations to mitigate the full spectrum of public health emergencies; • A vertically- and horizontally-networked enterprise of complementary systems which provides biosurveillance capability and multi-directional information exchanges between and among domestic and international stakeholders; • A dynamic situation awareness capability that meets the health-related needs appropriate for the roles, responsibilities, and assets of the stakeholders.

17. The Strategy: Vision • An environment that enables both ongoing and ad hoc data collection, real-time analyses, and feedback processes to facilitate continuous evaluation and adaptation; • Enhanced case detection and disease reporting through electronic health and laboratory information; • Evaluation and judicious integration of newer sources of biosurveillance data; • Biosurveillance technology to support professional judgment; and • A strengthened and competent biosurveillance workforce.

18. The Strategy: Priorities • Electronic Health Information Exchange • Create nationwide capability for health information exchange • Strengthen surveillance processes and notifiable disease reporting mechanisms, including electronic laboratory reporting • Electronic Laboratory Information Exchange • Create a governance structure for electronic laboratory information exchange • Ensure interoperability and collaboration across human health-relevant laboratory domains • Unstructured Data • Identify options for the use and management of unstructured data • Develop the capacity to collect and utilize unstructured data for biosurveillance for human health purposes

19. The Strategy: Priorities • Integrated Biosurveillance Information • Establish a nationwide capability for integrated biosurveillance information management and exchange • Create a collaborative environment for sharing of situation awareness information and health intelligence • Global Disease Detection and Collaboration • Strengthen Partnerships and leverage resources of U.S. Government (USG) and Non-USG partners • Support efforts to connect the worldwide “network of networks” to foster more rapid information sharing and earlier detection • Biosurveillance Workforce of the Future • Assess current biosurveillance workforce capability – Identify numbers, composition and gaps • Ensure a competent biosurveillance workforce through a continuous learning system

20. The Strategy: Phase II Interagency Concept Plan (CONPLAN) • Concept Plan encourages interagency collaboration and more effective data sharing • Cataloging Biosurveillance Activities • Internal CDC registry • Intergovernmental registry • Governance Component • Draft version of the CONPLAN is due no later than June 30, 2009

21. National Biosurveillance Advisory Subcommittee (NBAS) • “To ensure that the Federal Government is meeting the goal of enabling state and local government public health surveillance capabilities” (HSPD-21) • To review, research, guide, and endorse the National Biosurveillance Strategy for Human Health on an annual basis • To serve as an innovative engine for advancing nationwide biosurveillance capability

22. NBAS Facts • Created by the Advisory Committee to the CDC Director on May 1, 2008 • Comprised of 33 prominent public and private biosurveillance stakeholders and contributors • Independent advisors for the development of the next generation biosurveillance capability • Chaired by Dr. Larry Brilliant, Exec. Dir. Google.org • Supported by Federal agencies : HHS– ASPR,CDC, FDA, ONC; DHS; DoD; VA; USDA; FBI; and EPA

23. NBAS Task Force Composition Cross-Sector Collaborations for Biosurveillance Strategies Tara O’Toole (Champion)Greg PolandPaul JarrisConsultants: Eric Rasmussen, Jeff Levi

24. NBAS Task Force Composition

25. Animal Foods and Vectors Arthur Reingold Integrating Clinical and Public Health Reporting Farzad Mostashari Genomic Epidemiology and Digital Technologies W. Ian Lipkin Biosurveillance Workforce of the Future James Hadler NBAS Steering Committee Dr. Larry Brilliant, Chair • Cross Sector Collaborations • Tara O'Toole • Environmental Monitoring • Linda McCauley • Global Disease Detection and Collaboration • Peggy Hamburg and David Heymann • Diagnostics and Laboratory Information Exchange • Steven Hinrichs

26. NBAS Time Line • Aug 08 – Full Subcommittee convened • Sept 08 – Task Forces convened • Dec 08 – Task Force recommendations received • Jan 09 - NBAS Steering Committee Meeting • Set 5 priority themes and writing process • Secretary’s Interim Letter Report • Stimulus/recovery package-ready recommendations • Mar 09 – NBAS Report and 2009 workplans

27. Enhanced Biosurveillance:What You Can Do • Learn more about BCU activities • http://intra-apps.cdc.gov/od/otper/bcu/default.asp • Contribute to current activities • Open dialogue forums: BAT, SLTT • Concept Plan Team • Improve the National Biosurveillance Strategy for Human Health, V1.0 - Comments Blog • http://nbshh10.blogspot.com/

28. Current BCU Detailees • Pam Diaz (NCPDCID)- Director • Curtis Weaver (DSNS)– Deputy Director • Cathy Chow (COTPER) NBAS Scientist • Helen Schurz Rogers (NCEH)NBAS Scientist • Laura Conn (NCPHI)NBAS Scientist • Yoon Miller (DSAT)NBAS Scientist • Christine Bradshaw (DSLR)Medical Officer • Jennifer McGehee (NCPHI)Public Health Informatician • Gail Williams (NCHM)Communications Lead

29. Current BCU Openings • BCU Director • Policy/Communications Lead • Epidemiology Lead • Informatics Health Scientist • Sr. Public Health Advisor • Apply and find job descriptions at: http://www.usajobs.gov • For additional questions contact:Curtis Weaver (BCU) – atr8@cdc.gov

30. Biosurveillance Coordination Unit For more information contact: Biosurveillance Coordination Unit Centers for Disease Control and Prevention 1600 Clifton Rd., NE, MS:K-72 Atlanta, GA 30333 Phone: 770-488-8806 bcucomments@cdc.gov http://intra-apps.cdc.gov/od/otper/bcu/default.asp Thank you!