Priority was placed on developing a biosurveillance strategy following the September 11, 2001, terrorist attacks on the United States and the 2001 anthrax attacks. Several activities resulted, some of which were parallel but independent of each other at different agencies, in recognition of this priority. The following describes some of these activities, many of which overlap but do not necessarily align.

In 2004, HSPD-9 (Defense of United States Agriculture and Food) and HSPD-10 (Biodefense for the 21st Century) charged the Secretary of Homeland Security to “integrate all federal agency efforts” and to “create a new biological threat awareness capacity” that would detect biological attacks early. In 2004, the Department of Homeland Security (DHS) created the National Biosurveillance Integration System (NBIS), which was intended to be the nation’s “first system capable of providing comprehensive and integrated biosurveillance and situational awareness” (OIG, 2007), and designed to include a role for the pertinent federal agencies in building this integrated system.

In 2007 the Implementing Recommendations of the 9/11 Commission Act created the National Biosurveillance Integration Center (NBIC) within DHS to identify, integrate, and analyze data to detect biothreats and disseminate alerts. NBIC is charged with working with partner agencies to (1) acquire data that can be analyzed, (2) leverage expertise, (3) obtain strategic and operational guidance, and (4) maintain innovative information technologies. NBIC was established to realize the goals of NBIS and to serve as the center for information and personnel contributed by NBIS partners.

HSPD-21, which was released a few months after passage of the act that created NBIC, charged the U.S. Department of Health and Human Services (HHS) with establishing “an operational national epidemiologic surveillance system for human health, with international connectivity where appropriate, that is predicated on state, regional, and community-level capabilities and creates a networked system to allow for two-way information flow between and among Federal, State, and local government public health authorities and clinical health care providers.” In response to this directive, the Centers for Disease Control and Prevention (CDC) established the Biosurveillance Coordination Unit (BCU) in 2008. BCU supports the National Biosurveillance Advisory Subcommittee (NBAS), established in 2008 by CDC per a mandate in HSPD-21 to create an advisory body to HHS on biosurveillance matters. In 2008, BCU released the National Biosurveillance Strategy for Human Health, and it subsequently revised the strategy and released an expanded version

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