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Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
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6

Reflections on the Workshop

The final session of the workshop was devoted to identifying ideas and challenges for the Department of Homeland Security (DHS) Office of Health Affairs (OHA) to consider with regard to the future development of the BioWatch program. Stephen Morse began this conversation by noting the important contribution BioWatch makes to public health laboratories in terms of paying for trained laboratory personnel that can be cross-trained to carry out other tasks. He noted, too, how BioWatch’s public health focus served as a catalyst for bringing together a broad coalition of stakeholders to create what appears to be well-functioning emergency response networks where none existed before. Along those lines, one positive and unanticipated outcome of the BioWatch program has been the personal relationships, both within and across jurisdictions, that have developed in forming those response networks. BioWatch, he said, also provides opportunities for those stakeholders to determine ahead of time what roles they should each play in the event of a bioterrorism incident and to practice those roles using the BioWatch Actionable Result (BAR) as the trigger.

However, said Morse, clearly more can be done to compile best practices and share them across the localities in the BioWatch program and to develop a quality assurance program for the entire system. He added that a systems-based perspective is also needed that examines the entire preparedness cycle that Emily Gabriel discussed to ensure that all components of that cycle are integrated. He singled out communications—internally, among partners, and with the public—as an important component that he believes is still a work in progress. With regard to BioWatch technology, Morse said there are “new technological horizons and new threats that

Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
×

have developed since the days of the original system, which is essentially what we are living with now, and new capabilities that can be leveraged.”

Gerald Parker seconded Morse’s comment about BioWatch’s unintended positive consequences with regard to collaboration and relationship building. He also pointed out that any response to a biological event, whether it is an attack, a natural outbreak, or an accidental release, will deal initially with low-confidence information, but BioWatch has been able to get federal, state, and local jurisdictions to put processes and protocols in place that can deal effectively with low-confidence information and take actions to increase the veracity of the information as quickly as possible. “That is a tremendous achievement of the program,” said Parker.

He then noted that the threat of a biological event is real, and even if it is not a biological attack, the “increasing drumbeat of emerging infectious diseases is no doubt real, and many of the systems we put in place as part of a broader biosurveillance system are definitely needed,” said Parker. He encouraged OHA and DHS to make sure that positive message is heard by the transition team for whomever wins the 2016 presidential election, and he suggested that OHA could be a champion for an overall biosurveillance effort that encompasses the human–animal–environmental nexus, including disease vectors. He also recommended that OHA push and work with the science and technology directorate at DHS to introduce quick, incremental improvements to the BioWatch technology, probably in collaboration with the Department of Defense, and to look at what technologies might be able to contribute to the system over the next decade. He also thought it would be interesting to have more data sharing and networking with the epidemiology community given that the first warning of a biological event may not come from BioWatch, but from other surveillance sources.

John Vitko, Jr., said he was tremendously impressed by the feedback from the local officials who participated in the two-panel session. “There is no question in my mind that we are much better prepared [for a biological event] than we were a decade ago, and I was impressed both by the expertise we have here at the local laboratory level and at the decision-making level,” said Vitko. In his opinion, an important message from the local officials was that they have confidence in the technical pieces of BioWatch as a tool and in the decision-making process and relationships that have developed as part of the BioWatch planning process. As someone who is concerned about biodefense and considers it an important problem, he said the national BioWatch network makes him feel better as a citizen.

One topic he did not hear enough about was how BioWatch fits into an overall system to protect the U.S. population. “We heard about BioWatch being one of several tools, but we’ve not seen how those tools are meant to play together and how their response time lines work,” said Vitko. He said he appreciated the Government Accountability Office (GAO) study, and

Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
×

though he has questions about some of the recommendations, he believes more dialogue is needed between DHS and GAO to make sure that the solutions DHS proposes answer the questions GAO raised in the report.

Vitko also commented on the multiple requests he heard to deploy more collectors and to move the system indoors, but he said it is not clear to him that these requests have all been fully analyzed with regard to understanding how those additional collectors would be used. He recommended that before rolling out more collectors in new environments, the local jurisdictions and the BioWatch national program office should work together on a serious systems-level analysis and ask the difficult questions about which venues need protecting and how thorny issues, such as when to evacuate a facility after getting a preliminary positive result, would be handled. “When I get an indication that is not confirmed, do I have to evacuate a population at that point? What are my moral responsibilities, what are my legal responsibilities, how do I decide, how do I clear the facility, and how do I resume operations? I think it makes sense to do indoor monitoring, but I think these are the issues that have to be looked at in advance,” said Vitko. He also noted that after talking with Julia Gunn, the answers to those questions might differ depending on the facilities in which BioWatch would be deployed. He concluded his comments by crediting everyone at this workshop and at DHS who worked together over the past decade to put the pieces of the BioWatch program together and, as a result, make the country safer than it was a decade ago.

Terry Mullins also noted the high regard that the local officials voiced for the BioWatch program, and he credited the hard, diligent work put in by the national program office for that achievement. He did have one suggestion for the program that could help protect the BioWatch brand that everyone has worked so hard to create: Conduct a random sampling of negative results from BioWatch collectors to confirm they are true negatives, and publish that information in the program’s regular reports.

Daren Brabham agreed with Parker that BioWatch needs to do a better job telling its story, to engage in some public relations and not just public information activities to counter the negative stories that lead to Congress questioning the value of the system. He said he did not think it was GAO’s responsibility to look at the response networks and other positive components that BioWatch has developed, but it is Congress’s responsibility to know that this system works.

James Lambert noted the importance of the program’s science base, the need to build on that base, and the need to educate decision makers about the science behind the BioWatch system. One challenge he raised was the need to account for all of the different timescales at play and the roles that different stakeholders play with respect to those timescales. Another challenge, which Parker touched on, is to take ambiguous inputs and take

Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
×

unambiguous actions. He mentioned the need to prepare the public and stakeholders for the potential surprise of threats and emergencies.

Maxie Bishop, Jr., emergency medical services (EMS) coordinator, Division of Emergency Management, Texas Department of Public Safety, stressed that BioWatch is a surveillance tool that local jurisdictions find useful for preparing for an emergency based on uncertain information. In the same respect, the National Weather Service provides the same type of tools, and the nation would never think of eliminating it. Given how strongly local jurisdictions appear to feel about the positive value of BioWatch, Bishop thought they need to also engage in efforts to sell the program and get the word out about all of the good results that have come from participating in the BioWatch program. He also said he was impressed by how BioWatch gets people to the table and motivates them to practice responses before an event occurs rather than trying to do it on the fly.

Dave Fluty said that DHS understands that emergency response is local, and it wants to understand what it can do at the federal level as a partner to help build the bridges and communication channels to support local efforts. He noted that based on his experience working previously in the radiation/nuclear response area, a communication strategy is important for building confidence among policy makers, and to ensure that professionals in the field know what they are doing and have the ability to run these programs effectively and efficiently. In that vein, he seconded Brabham’s comment that the program at all levels needs to do a better job telling the program’s story, because BioWatch is not a secret program. “We need to be able to advertise the great story that we have,” said Fluty.

On the science side, he said that determining the threat basis—where a release is mostly likely to occur—is important for determining the best places to deploy BioWatch sensors. For the radiation/nuclear threat detection system, such an analysis helped site the radiation monitors that have been deployed at entry points and ports in the United States. “We have not done that in the bio world, and that is why we get nitpicking questions from the science types on what we are doing and what we are trying to detect,” said Fluty. He noted that it is impossible to get 100 percent assurance that a system can detect all threats, but 80 to 90 percent assurance should be a goal as information on the threat basis improves.

Lisa Gordon-Hagerty provided the closing comments, first thanking all of the participants; the workshop planning committee; National Academies of Sciences, Engineering, and Medicine staff; the BioWatch national program office staff; and the OHA staff that has supported BioWatch. She concluded by saying she feels safer as a citizen knowing that the BioWatch program exists, and commented, “I want to echo everyone else’s position that I feel more confident as a private citizen that my taxpayer dollars are being well spent.” She then adjourned the workshop.

Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
×
Page 71
Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
×
Page 72
Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
×
Page 73
Suggested Citation:"6 Reflections on the Workshop." National Academies of Sciences, Engineering, and Medicine. 2017. Enhancing BioWatch Capabilities Through Technology and Collaboration: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23687.
×
Page 74
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The Department of Homeland Security’s (DHS’s) BioWatch program aims to provide an early indication of an aerosolized biological weapon attack. The first generation of BioWatch air samplers were deployed in 2003. The current version of this technology, referred to as Generation 2 (Gen-2), uses daily manual collection and testing of air filters from each monitor, a process that can take 12 to 36 hours to detect the presence of biological pathogens. Until April 2014, DHS pursued a next-generation autonomous detection technology that aimed to shorten the time from sample collection to detection to less than 6 hours, reduce the cost of analysis, and increase the number of detectable biological pathogens. Because of concerns about the cost and effectiveness of the proposed Generation 3 system (Gen-3), DHS cancelled its acquisition plans for the next-generation surveillance system.

In response to the cancellation announcement, Congress asked the Government Accountability Office (GAO) to conduct a review of the program and the proposed system enhancements that would have been incorporated in BioWatch Gen-3. However, Mike Walter, BioWatch Program manager, Office of Health Affairs, DHS, said that DHS did not agree with all of GAO’s characterizations of the BioWatch program efforts described in this review. In response to this, DHS requested that the National Academies of Sciences, Engineering, and Medicine conduct a workshop to further explore the findings of the 2015 GAO report and discuss the impact these findings may have with regard to the future development of the technical capabilities of the BioWatch program. Workshop participants also discussed existing and possible collaborations between BioWatch, public health laboratories, and other stakeholders that could contribute to the enhancement of biosurveillance capabilities at the federal, state, and local levels. This publication summarizes the presentations and discussions from the workshop.

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