An Utter Lack of Biosurveillance
Let me preface this post by saying that I’m not a big fan of the implication of the commentary that I’m about to describe, but I understand the frustration and ascribe my own frustration to why it was written rightly or wrongly.
James Wilson of VeraTect Corporation posted on April 4 a commentary entitled, “The 2009 H1N1 Experience: Policy Implications for Future Infectious Disease Emergencies.” The title refers to a UPMC Center for Biosecurity invitation-only conference; the post however, focuses solely on what wasn’t discussed at that conference: effective biosurveillance.
Dr. Wilson describes the background and current state of the National Biosurveillance Integration Center (nee System). As someone who has written previously on biosurveillance integration, and feels strongly that it is the backbone of a 21st century public health infrastructure (including preparedness), the following passage (taken from here) is truly upsetting.
The National Biosurveillance Integration System, which is supposed to bring together federal agencies to improve the detection and characterization of biological agents, has been criticized by GAO and the Homeland Security Department’s inspector general as being ineffective and under-resourced.
Tara O’Toole, the department’s new undersecretary for science and technology, told a House panel last week the effort had been suspended. But the department clarified her remarks this week, saying the effort is being reworked under the leadership of Alexander Garza, DHS chief medical officer.
No time line was given for when decisions about the program would be made.
The commentary goes on to give a scathing blow-by-blow of the failure of biosurveillance in the run up to the H1N1 influenza pandemic and failure of integration as the pandemic swept the nation. I have no secondary sources to back up his account, so take it as his word only. Even if it is only partially true, the current state of public health preparedness in the US is such that the future looks bleak. Dr. Wilson talks of decades worth of delay.
He contends that there was extremely little sharing of surveillance data at all levels of government:
Our experience during the pandemic was quite revealing. The timeliness issues with CDC have already been discussed here. The broader public health community generally did not promote informal surveillance processes to share information. With but two notable exceptions, none of the federally-funded public health and healthcare professional organizations we engaged (and we approached all of them) shared situational awareness information during the pandemic. Federal, state, and local authorities pleaded for access to our information but wound up rarely ever sharing information or answering questions about reports in their areas of responsibility. The public would be quite surprised to see the email transcripts during the early days of the crisis of us admonishing public health organizations to share information.
He damns with this sentence:
Indeed, during the emergence of the pandemic, conversation with public health officials became operationally irrelevant.
Our conclusion from these experiences is the bigger and more complex the organization, the less able it is to share critical information in a timely fashion during crises and disasters.
Now, I don’t deign to say that surveillance data should be given freely to the general public (and I have no inside information on how much was shared – I checked the CDCs website every Thursday at 11am last fall, just like the rest of you), and I include Dr. Wilson’s Veratect Corporation in my chiding for engaging in similar practices (though more due to profit motive than any sort of pissing contest), but that this sort of thing continues today baffles me.
We mock the intelligence community in Washington for missing the Christmas Day bomber and for 9/11 – all due to a lack of sharing of critical, operational information. And yet, we in public health response are just as guilty. Moreso even I would argue, because the information hoarding took place as the pandemic was killing people, not prior to the attack when buried in a haystack of potentially actionable intelligence.
The fact of the matter remains that we have no nation-wide surveillance capabilities in this nation. We cannot detect a widespread food-borne outbreak; we cannot coordinate information sharing during an influenza pandemic; we cannot identify novel pathogens before they become widespread in the community. Even putting aside Dr. Wilson’s post, all of this is still true. We have invested BILLIONS of dollars pursuing this goal, admittedly half-heartedly. Then we stopped trying, and we don’t know when we’ll start again.
Don’t get me wrong, I respect Dr. O’Toole. I think she’s one of the smartest cookies in this field (seriously, if you get the chance to hear her speak, do it). I don’t mean to single her out; I will not single out DHS, VA, HHS, CDC, private healthcare providers or other public entities.
No one person is wrong in this. We all are.
In a world where ghastly diseases can circumnavigate the globe in a matter of hours, where two contagious killer diseases have taken root on our continent in the last seven years, where hundreds of people die every year due to the food that they eat, this is unacceptable. The goal of real-time nation-wide biosurveillance can be had. All it needs is a catalyst. We thought it would be SARS, then we thought it would be H1N1 influenza. I can only hope that change comes about because of the bright spotlight of the Oval Office, and not yet another disease that wreaks havoc on Americans.