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HSPD 21: Biosurveillance

November 4, 2007

Surveillance Sign This post is one in a series examining the recently-released Homeland Security Presidential Directive 21: Public Health and Medical Preparedness. Previous posts can be found here: Initial Reactions.

Today we’re going to talk about the first in a list of four “critical components” of public health and medical preparedness – biosurveillance. I, for one, agree that this is of primary importance to public health preparedness. Properly surveilling the health of the people is key to not only responding to unusual outbreaks and events, but also to preserving our way of normal life.

The goals of the biosurveillance section are impressive and worthy. The Directive hopes to:

…develop a nationwide, robust, and integrated biosurveillance capacity, with connections to international disease surveillance systems, in order to provide early warning and ongoing characterization of disease outbreaks in near real-time.

Given that there are some places with no biosurveillance going on, a national system that ignores political boundaries – as diseases are wont to do – is a potential boon to small communities across the country. In a big city, like where I am, health departments are increasing seen as a burden and have to contend with bloated local budgets with no room to buy an up-t0-date biosurveillance package. The first section touts the idea of a system with multiple modalities (ie. using different means for locating unusual symptoms, e.g. ER diagnoses, commercial pharmacy purchases, primary care reporting, zoonotic diagnoses, environmental events, etc.). The true goal is, and I really like this, is the idea of developing a “common operating picture.” I think this has the potential to be a radical new way of doing business. If you know what’s normal everywhere in the country, you can easily pick out what’s ab-normal and begin working to identify, mitigate and fix what’s wrong. There are the usual calls to include state and local governments, public and private health care providers and practicing clinicians – we’ll see how well that works.

The Directive calls on the Secretary of HHS to build “an operational national epidemiologic surveillance system.” As we all know, this effort is already underway, or, should I say, currently burning money with no end in sight. New readers are directed to check my previous post on the NBIS.

The Directive also directs that the surveillance system create “a networked system to allow for two-way information flow between and among Federal, State, and local government[.]” Much like Epi-X, you might say? Your guess is as good as mine in this case. There’s also talk of using currently non-existent electronic health records as the basis for this system, as feasible.

And finally, the deadline. This is an easy one, but seemingly kind of pointless. The Secretary of HHS is directed, within 180 days, to establish yet another advisory committee. This one should be called the Epidemiologic Surveillance Federal Advisory Committee, and shall wear funny robes (not really). The goal of this advisory committee?

[t]o ensure that the Federal Government is meeting the goal of enabling State and local government public health surveillance capabilities.

Not a very rousing goal, especially after all of that talk of multiple modalities, and a “common operating procedure.” Nope, just make sure that the checks keep on flowing.

Overall, great rhetoric, and yet another mention of the aforementioned NBIS, but it falls short due to lack of deliverables. Later sections are better in this regard, so stay tuned.

Photo credit: Irene Kaoru


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