standard diagnosis and case reporting. Another approach to earlier detection of health threats has been the BioWatch program, under which DHS has deployed air samplers, primarily in outdoor locations, in more than 30 major cities with the aim of early detection and characterization of aerosolized biological threats.
BioWatch air samplers were first deployed in 2003. An available technology package—the Biological Aerosol Sentry and Information System (BASIS)—was adapted to allow for rapid implementation of outdoor air monitoring for six major biological threat agents, including the organisms that cause anthrax (CRS, 2003; DHS, 2008). The current version of this technology, referred to as Generation 2.0, requires daily manual collection and testing of air filters from each monitor. Newer technologies being considered by DHS (Generation 2.5 and Generation 3.0) promise to automate the testing process within the monitoring station, which has the potential to produce results more quickly and at lower cost. The Generation 3.0 devices may also eventually have the capability to test for a greater number of threat agents. DHS plans include deploying the next generation of BioWatch monitors in indoor locations.
Questions have been raised about the BioWatch program, including the technological capabilities of BioWatch monitoring devices, operational aspects of the Generation 2.0 deployment, planning for the introduction of Generation 2.5 and Generation 3.0 (e.g., O’Toole, 2007a,b; Downes, 2008; GAO, 2008). Questions have also been raised about the relationship of BioWatch to other surveillance efforts based in the health care and public health sectors, including its contribution to the effectiveness of surveillance and response by the health sectors (e.g., O’Toole, 2007b; Price, 2008), and about the effectiveness of techniques of epidemiologic surveillance such as syndromic surveillance.
Because of such questions, the Congress, through the Subcommittee on Homeland Security of the House Appropriations Committee, directed the Office of Health Affairs (OHA) in DHS to ask the National Academies to evaluate the effectiveness of the BioWatch program, to compare the costs and benefits of the current and planned versions of BioWatch monitoring systems, to examine the costs and benefits of an enhanced national surveillance system that relies on hospitals and the public health system, and to compare the effectiveness of BioWatch to such an enhanced system.1
To carry out this congressionally mandated study, the National Academies has convened the Committee on Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System.
The committee has the following charge:
The Institute of Medicine (IOM) and National Research Council (NRC) will evaluate the effectiveness of BioWatch, including a comparison of benefits and costs for Generations 2 and 3; the costs and benefits of an enhanced national surveillance system that relies on U.S. hospitals and the U.S. public health system will also be assessed, and its effectiveness compared to that of the current BioWatch approach. The evaluation will include examination of the reliability of BioWatch monitoring data and the ability of hospitals and public health officials
Joint Explanatory Statement to Accompany Consolidated Appropriations Amendment (H.R. 2764—State, Foreign Operations, and Related Programs Appropriations Act, 2008) Division E—Department of Homeland Security, Appropriations Act, 2008 [p. 60] http://www.rules.house.gov/110/text/omni/jes/jesdive.pdf.