Improving Biosurveillance Systems to Enable Situational Awareness During Public Health Emergencies

Over the past 10 years, US health security has been threatened by a series of infectious disease events: the 2009 influenza outbreak, the emergence of Middle East respiratory syndrome (MERS), the Ebola outbreak in West Africa, and the rapid spread of Zika virus throughout the Americas. In each of these events, inadequate information has delayed initial detection of the outbreak, and a lack of understanding about the underlying epidemiology of the viruses hindered control efforts. As the ongoing US response to Zika illustrates, delays in detecting and responding to outbreaks can exacerbate their human and economic tolls. While the United States continues to struggle to understand how Zika virus can spread and cause serious disease, more than 37,000 cases have already been identified in the United States and its territories. Each one of these cases must be investigated by health authorities to ensure that they do not spread their infection. In particular, pregnant women must be followed closely, as Zika can cause fetal death or severe birth defects. It is estimated that each baby who is born with Zika-related birth defects will cost families and the US healthcare system up to $10 million. The continued challenge that the United States faces in detecting and knowing how best to respond to acute infectious disease threats like Zika should encourage a closer analysis of our current biosurveillance capabilities and spur action toward much-needed, sustainable improvements. Biosurveillance generally refers to the continued monitoring of information sources for the purposes of detecting and managing an outbreak or other public health event, whether naturally occurring or deliberate. Biosurveillance systems may gather and analyze data from a variety of human, animal, plant, and environmental health sources. The goal of this activity is to provide situational awareness—an understanding of what is going on—with respect to the occurrence of biological threats and to guide efforts to control them. Since 2001, the federal government has made considerable investment in deploying biosurveillance systems across the country with the goal of providing early detection of and situational awareness during public health emergencies. Federal support has vastly improved the state of surveillance in the United States. The nation now benefits from having a network of more than 150 public health laboratories that can detect a biological attack and outbreaks of other diseases of public health significance. Additionally, the majority of health departments in the United States now have a mix of traditional disease-specific and more timely syndromic surveillance systems in place to monitor disease trends and to provide situational awareness during public health emergencies. Despite these important advances, there remain fundamental gaps in the ability of existing biosurveillance systems to support real-time decision making during public health emergencies. In 2012, the White House attempted to address these shortcomings by releasing the National Biosurveillance Strategy. This document established the important expectation that biosurveillance systems will be able to (1) rapidly alert and inform decision makers of potential incidents of national significance; (2) continually provide critical updates as circumstances evolve; and (3) access information that answers decision makers’ questions about probable impacts of an event and the consequences of action/inaction. The National Biosurveillance Strategy did not offer details on how this vision for biosurveillance was to be implemented, but it called for the development within 120 days of an Implementation Plan. To date no such plan has been released. As a matter of priority, the next Administration should work to improve our national biosurveillance capabilities in the following ways.