Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System

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Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System Interim Report Committee on Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System Board on Health Sciences Policy Board on Chemical Sciences and Technology Board on Life Sciences

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• 500 Fifth Street, N.W. • THE NATIONAL ACADEMIES PRESS Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. HSHQDC-08-C-00043 between the National Academy of Sciences and the Department of Homeland Security. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2009. Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System: Interim Report. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON EFFECTIVENESS OF NATIONAL BIOSURVEILLANCE SYSTEMS: BIOWATCH AND THE PUBLIC HEALTH SYSTEM BERNARD D. GOLDSTEIN (Chair), Professor, Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health JOSEPH M. DeSIMONE (Vice-Chair), Chancellor’s Eminent Professor of Chemistry, University of North Carolina at Chapel Hill, and William R. Kenan, Jr. Distinguished Professor of Chemical Engineering, North Carolina State University MICHAEL S. ASCHER, Senior Medical Advisor, California Emergency Management Agency, and Visiting Researcher, Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis JAMES W. BUEHLER, Research Professor, Department of Epidemiology, Center for Public Health Preparedness and Research, Rollins School of Public Health, Emory University KAREN S. COOK, Ray Lyman Wilbur Professor of Sociology, Department of Sociology, Stanford University NORMAN A. CROUCH, Assistant Commissioner of Health, Minnesota Department of Health FRANCIS J. DOYLE III, Professor, Duncan and Suzanne Mellichamp Endowed Chair in Process Control, Department of Chemical Engineering, University of California, Santa Barbara SETH FOLDY, State Health Officer and Administrator, Division of Public Health, State of Wisconsin ELIN A. GURSKY, Principal Deputy for Biodefense, ANSER/Analytic Services, Inc., Arlington, Virginia SANDRA HOFFMANN, Fellow, Resources for the Future, Washington, DC CALVIN B. JOHNSON, Vice President and Chief Medical Officer, Temple University Health System, Philadelphia PAUL KEIM, Regents Professor and Cowden Endowed Chair in Microbiology, Northern Arizona University, and Director of Pathogen Genomics, The Translational Genomics Research Institute ARTHUR L. KELLERMANN, Professor and Associate Dean for Health Policy, Emory University School of Medicine KENNETH P. KLEINMAN, Associate Professor, Department of Ambulatory Care and Prevention, Harvard Medical School MARCELLE LAYTON, Assistant Commissioner, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene EVA K. LEE, Associate Professor and Director, Center for Operations Research in Medicine and Health Care, School of Industrial and Systems Engineering, Georgia Institute of Technology SHANE D. MAYOR, Research Professor, Department of Geological and Environmental Sciences California State University, Chico TIMOTHY F. MOSHIER, Senior Principal Scientist, Environmental Science Center, Syracuse Research Corporation FREDERICK A. MURPHY, Department of Pathology, The University of Texas Medical Branch at Galveston ROYCE W. MURRAY, Kenan Professor, Department of Chemistry, University of North Carolina, Chapel Hill DOUGLAS K. OWENS, Senior Investigator, VA Palo Alto Healthcare System, and Professor of Medicine and of Health Research and Policy, Center for Primary Care and Outcomes Research and Center for Health Policy, Stanford University STEPHEN M. POLLOCK, Herrick Professor Emeritus of Manufacturing, Professor Emeritus of Industrial and Operations Engineering, University of Michigan I. GARY RESNICK, Bioscience Division Leader, Los Alamos National Laboratory R. PAUL SCHAUDIES, Chief Executive Officer, GenArraytion, Inc., Rockville, MD JEROME S. SCHULTZ, Distinguished Professor and Chair, Department of Bioengineering, University of California, Riverside v

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Study Staff LOIS JOELLENBECK, Study Director, Board on Health Sciences Policy JANE S. DURCH, Senior Program Officer, Board on Health Sciences Policy MICHAEL McGEARY, Senior Program Officer, Board on Health Sciences Policy KATHRYN HUGHES, Program Officer, Board on Chemical Sciences and Technology ERICKA McGOWAN, Associate Program Officer, Board on Chemical Sciences and Technology SUSAN McCUTCHEN, Senior Program Associate, Board on Health Sciences Policy JON Q. SANDERS, Program Associate, Board on Health Sciences Policy JESSICA PULLEN, Administrative Assistant, Board on Chemical Sciences and Technology DONNA RANDALL, Financial Associate, Board on Health Sciences Policy ANDREW POPE, Director, Board on Health Sciences Policy FRANCES SHARPLES, Director, Board on Life Sciences DOROTHY ZOLANDZ, Director, Board on Chemical Sciences and Technology Consultants JENNIFER BAXTER, Industrial Economics, Incorporated, Cambridge, MA HENRY ROMAN, Industrial Economics, Incorporated, Cambridge, MA vi

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Edward H. Kaplan, Yale School of Management Frances S. Ligler, Center for Bio/Molecular Science and Engineering, U.S. Naval Research Laboratory Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Georges C. Benjamin, American Public Health Association. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. vii

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Contents Introduction 1 Study Committee and Study Charge 2 Study Process 4 Status of the Committee’s Investigations 4 References 5 Appendix A: Agendas for Data-Gathering Sessions Open to the Public 7 Appendix B: Biographical Sketches of Committee Members 11 ix

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