ing procedures would be. Since 2003, DHS has modified several aspects of the BioWatch system by enhancing the air samplers; deploying additional monitoring devices; relocating devices; and revising protocols for routine operations, analyses, and actions following a positive laboratory result. DHS has also been pursuing alternative approaches to sample collection and analysis to respond to a recognized need to produce results more quickly, more frequently, and from more varied locations than is possible with the current system.

The BioWatch system is a civilian environmental monitoring component of a much broader domestic biodefense effort that encompasses a variety of activities. These include information gathering and analysis to identify potential threats and the risk they pose, various monitoring and detection activities, public health and law enforcement responses, and programs leading to restoration and recovery (The White House, 2004; FEMA, 2008).

Among these activities are efforts being made to strengthen the ability at the local, state, and national levels to detect and respond to infectious disease emergencies of all types.1 The Department of Health and Human Services (HHS) is leading the federal activities with funding and other resources to support the development of a more robust capacity within the public health and the health care sectors to recognize unfamiliar illnesses or unusual clusters of cases, effectively assemble essential information to guide decision making, and speed deployment of an appropriate response.

Despite improvements since 2001 in the nation’s preparedness to detect and respond to bioterrorism or emerging infectious disease threats, some concerns remain. For example, the Government Accountability Office (GAO, 2009) highlighted continuing needs to clarify federal leadership roles and close known gaps in pandemic influenza preparedness plans. Particular concerns about BioWatch include the timeliness, probability, and accuracy of detection using the current system and the maturity of plans for the introduction of a new generation of devices for automated collection, preparation, and analysis of air samples (e.g., O’Toole, 2007a,b; Price, 2008). Another concern is whether the BioWatch system is appropriately integrated with other health-related surveillance and response efforts that must be available to act on a BioWatch alert (e.g., O’Toole, 2007b; Downes, 2008; Price, 2008; Lindley, 2009).

Because of such concerns, Congress, through the Subcommittee on Homeland Security of the House Appropriations Committee, directed the Office of Health Affairs (OHA) in DHS to engage the National Academies to evaluate the effectiveness of BioWatch, to compare the benefits and costs of the current version of BioWatch with a planned modification, and to


Throughout this report, the phrase “federal, state, and local” encompasses territorial and tribal entities.

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