The federal BioWatch program faces the challenge of supporting both a national security mission and the health care and public health systems, at state and local levels, in monitoring threats to human health. The BioWatch system has the potential to contribute to its health protection goal by providing early warning of a biological attack, but only if the attack uses certain aerosolized pathogens and if BioWatch air samplers lie in the path of the release.

BioWatch’s potential contribution to minimizing illness and death relies upon an awkward and organizationally challenging arrangement for responding to BARs and depends heavily on the ability of health departments and the health care system to analyze the nature of a detected threat and to take quick and decisive action. It is therefore essential that the operation and management of the BioWatch system be well integrated with the jurisdictions where it operates. State and local authorities, whose legal responsibilities as well as knowledge of endemic health risks and available resources cannot be replicated at the federal level, must be recognized as essential and valuable partners not only in the BioWatch program but also in broader national biosurveillance and emergency preparedness efforts.

It is essential that policy makers recognize that the benefits of any form of infectious disease surveillance will not be realized if states and communities do not also have the capability to respond effectively to a public health emergency. Despite the substantial progress that many localities have made in advancing mass dispensing capacity, having the ability to administer antibiotic prophylaxis to hundreds of thousands, if not several million, urban area residents within a few days following detection of a bioterrorist attack remains challenging.