oneself and one’s organization. As Ackelsberg quipped, a common perception is that “sharing information is for chumps.”

In emergencies, however, these generalizations no longer apply. Sharing information supports common missions, goals, and objectives. Multidirectional information flows are preferred to arrive at a common operating picture.

By examining experiences before and after 9/11 from this perspective, questions that were asked before the terrorist attacks can be reframed in ways that are still relevant today.

Responses to an Event

Public health responses to a covert biological release fall into six categories, Ackelsberg observed:


   Notification of key partners and the public

   Rapid investigation to confirm diagnoses, identify hazards and risk factors, and track impacts

   Risk communication and safety recommendations

   Coordinated interventions, including mass treatments and prophylaxis


Biosurveillance is typically interpreted to include the first three of these items. However, most biosurveillance today, Ackelsberg posits, focuses on detection and notification, but not characterization. These latter two tasks are “complicated and messy,” said Ackelsberg. “It takes people who are experienced to go through information, to share it, to analyze it, to interpret it. It involves instruments, but it goes well beyond gizmos. It’s heavy on people and heavy on the skills that they bring to problem solving.”

Before and After 9/11

The New York City Department of Health and Mental Hygiene was working on biological preparedness even before 9/11. It had instituted an internal incident management structure and had established interagency coordination with the mayor’s Office of Emergency Management, law enforcement, New York City hospitals, and regional public health agen-

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