Bailar also urged that serious consideration be directed now toward covering the cost of surveillance. He predicted that surveillance would cost somewhere in the range of $3,000-$10,000 per person for lifetime follow-up. Later, Goldman responded that, while surveillance activities and the coordination of those activities will be costly, it is very difficult to project lifetime costs of surveillance. While certain types of surveillance are not very costly, others are. For example, measuring dioxin exposure for just a single individual, as part of Agent Orange exposure surveillance, can cost hundreds to thousands of dollars. Goldman cautioned against making specific cost projections, at least initially.

As so many other panelists had done, Bailar emphasized the urgency of the situation and the immediate need to begin collecting as much data as possible. He stated that it was already (at the time of the workshop) too late to collect some types of information, and he believed that the push for information will intensify over time as more questions arise.

Looking to the future, Bailar remarked that it will be important to allow individuals to join the surveillance group whenever they become aware that joining might benefit them. Bailar also thought that there will be a need for a substantial, dedicated staff to manage the surveillance activities and to learn what can be learned from other long-term followup programs, such as the National Cancer Institute’s Surveillance Epidemiology and End Results Program, the Radiation Effects Research Foundation in Japan, the Framingham Study, the Nurses Health Study, and the World Trade Center follow-up.


What must be done to implement an active surveillance system so that preventive measures can be instituted quickly to protect workers from adverse effects?

Matte replied that, based on what Howard had described earlier during the workshop (see Chapter 4), some of the essential components of an active surveillance system are already in place. These components include (1) a way for injuries and illnesses to be reported such that workers do not feel threatened or inhibited and such that the information can be rapidly collated and disseminated; (2) access to acute illness and injury treatment in places where the examinations are being done; and (3) connections between surveillance managers, incident managers, and oth-

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