if a large-scale aerosol attack occurs where BioWatch is deployed, if an air sampler lies in the path of the release, and if the pathogen used is one of those included in the BioWatch laboratory assays. To date, the BioWatch system has generated dozens of BioWatch Actionable Results, none of which has been associated with bioterrorism or human illness. The annualized direct cost of continuing the current program (Generation 2) over the next 10 years is estimated to be $80 million; if the planned transition to the timelier and more widely deployed Generation 3 is successful, the estimated annualized direct cost for acquisition and operation over 10 years is $200 million.

Given the BioWatch system’s serious technical and operational challenges and its costs, DHS should assess its effectiveness and frame program goals from a risk-management perspective; conduct systematic operational testing of current and proposed BioWatch technologies; establish an external advisory panel with technical and operational expertise; and strengthen collaboration and coordination with public health officials in BioWatch jurisdictions.

Infectious disease surveillance through the public health and health care systems is broader and more flexible than BioWatch, having the potential to detect infectious diseases resulting from various exposures. Surveillance is an essential activity for health departments at local, state, and federal levels and relies on information from health care providers and laboratories in the public and private sectors. But insufficient data are available to measure the overall costs and effectiveness of infectious disease surveillance.

To enhance disease surveillance capabilities, the Department of Health and Human Services (HHS) should lead efforts to develop, test, and evaluate new disease surveillance methods and technologies to improve clinical recognition and reporting of infectious diseases of concern. DHS and HHS should aim to integrate BioWatch’s health protection role more effectively into a stronger, nationally coordinated public health surveillance system and should further the development of mechanisms for improving situational awareness of biological threats, including secure sharing of relevant intelligence information with state and local health officials. DHS and HHS should also collaborate to build and sustain essential state and local workforce and operational capacities for detecting and responding to disease outbreaks and biological attacks.

Concern about the possibility of bioterrorism and epidemics of emerging infectious diseases has spurred interest among the national security, public health, and health care communities in developing new and better ways to detect biological threats as quickly as possible so that preventive measures or treatment can be started in time to reduce illnesses and deaths.