Strategies for Effective Improvements to the BioWatch System Proceedings of a Workshop (2018) / Chapter Skim
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1 Introduction and Overview
1 Introduction and Overview
Pages 1-17
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. As noted by BioWatch program officials, to date all BARs were triggered by the detection of DNA from organisms that are naturally present in the local environment.
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Overview of the BioWatch Program In his introductory remarks to the workshop, Michael Walter, BioWatch program manager at DHS, noted that the presentations and discussions at a 2011 Institute of Medicine and National Research Council workshop (IOM and NRC, 2011) led to the conclusion that issues around cost, sensitivity, and available technologies meant it would be many years before the program would be deploying a completely autonomous detection system.
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In addition to the detection piece, the BioWatch program serves as a forum for networking among local, state, and federal public health officials and that should continue, said Walter, because no technology, automated or not, is going to replace the people who are going to make the decisions on the actions to take upon declaration of a BAR. Walter suggested that any new technology should also fit into the program's extensive quality assurance program and address sensitivity issues (i.e., remain as sensitive to detection of specific pathogens)
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As far as what the optimal future BioWatch system would provide, Walter said that it would be good if the system would identify not only the specific biological threat, but whether it was susceptible to treatment with specific antibiotics or if it was an endemic organism that represented a public health threat but not a nefarious act. In the indoor environment, speed is the current limitation, so any new system needs to be able to operate rapidly and in such a way that it supports real-time environmental dispersion modeling and response time.
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Budowle noted that there is a tremendous amount of data available in existing databases that can be used to interpret background signals. John Clements, professor and chair of microbiology and immunology at the Tulane University School of Medicine, said the panel discussion he would be moderating would address the current quality assurance program and discuss the use of dispersion modeling to understand the probabilities of a potential threat.
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This panel was also going to talk about how the public health community might act upon information from indoor surveillance and about information that might be useful to those responsible for operating and maintaining the local BioWatch infrastructure. Grace Kubin, director of the laboratory services section at the Texas Department of State Health Services, said the panel she would be moderating would examine the various operational considerations that go along with the introduction of a new technology.
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In that case, said Kahn, the CIA would want a definitive identification of the biological agent, down to strain characterization. He noted that the current BioWatch system looks at a limited number of biological organisms, and that the intelligence community, if it had its wish, would like to see that list expanded greatly.
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sponsored a study in 2017 that focused on remediation in a subway system following a release using DNATrax, a PCR-detectable, DNA-based sugar designed by investigators at LLNL to serve as a bioweapon simulant. BioWatch filters collected that material over the course of a week and the results have informed modeling efforts and provided a better understanding of how airflow affects the potential spread of an agent.
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Before ending the discussion, session moderator Mahmoud asked the planning committee members to reflect on which technologies could be implemented over the next 10 years. Budowle thought that multiplexing technologies and data mining will make an impact, and that there will be more work on defining false positives and false negatives.
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THE BIOWATCH PROGRAM Overview: A Local Public Health Perspective of the BioWatch Program Paul Biedrzycki, retired director of disease control and environmental health at the Milwaukee City Health Department, presented the first of five papers that the planning committee commissioned for this workshop (see Appendix E)
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Local public health, he explained, often serves as the broker in terms of messaging between government, the public, the media, and policy makers. With regard to public health emergency preparedness, the core competencies are modeling leadership, communicating and managing information, planning for and improving practice, and protecting worker health and safety.
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The system, as others have noted, was designed to identify select aerosolized biological agents of public health importance in the outdoor environment, though it has since moved indoors. The system has been deployed in coordination and consideration primarily around environmental field operations and laboratory analytical metrics, and its primary focus is to reduce or limit widespread and severe morbidity and mortality associated with an outdoor aerosolized bioagent release through rapid identification, deployment of the Strategic National Stockpile, and timely treatment of the affected population.
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Given that technological improvements have to be cost effective and value added, it will be important to leverage a wide range of partners over a much broader region than has been typical in preparedness activities. The basics of the BioWatch program, some of which Walter discussed earlier, include Portable sampling units with high-volume air-monitoring units dispersed in networks in various jurisdictions that are operated continuously; State and local environmental field staff that collect and transport sam ples from the collectors to the laboratory; Dedicated laboratory capability, typically in the form of CDC Labora tory Response Network facilities and including extensive quality assur ance and quality control components to minimize ambiguity in test re sults; Local BioWatch Advisory Committees (BACs)
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14 FIGURE 1-3 The BioWatch local operating space. SOURCE: Biedrzycki slide 8.
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Today, a BAR is a confirmed laboratory finding of select biological agent genetic markers on a previously collected portable sampling unit filter. What a BAR does not provide is information on viability, susceptibility of the agent to available medical countermeasures, or any genetic modifications relevant to human health.
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The limitations he identified in his review paper included A limited array of pathogen and other threat analytical capabilities and rapid pathogen detection to enhance early warning and detection and subsequent public health protective actions; A limited and nonuniform distribution of air-monitoring technology within indoor and outdoor environments near or within critical infra structure or high-risk target locations; Limitations in population coverage that fails to reflect changes in popu lation demographics and where people live in cities and suburban areas; A lack of near-real-time event reconstruction capabilities for more pre cise environmental exposure analysis, efficient deployment of public health countermeasures, and better decision making in concert with pol icy makers; A lack of standards of practice for next-generation BioWatch technology and field deployment metrics that incorporate public health input; and A lack of adequate funding mechanisms to local public health jurisdic tions and partners for sustaining BioWatch preparedness and response capabilities into the future. Biedrzycki noted that public health departments are losing personnel while becoming increasingly dependent on grant funding.
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In addition, he would like to see faster and more accurate reporting to state and local public health officials to produce more meaningful situational awareness. On a final note, Biedrzycki offered that BioWatch technology should inform, support, assist, and advance public health emergency preparedness goals and objectives on the ground floor, and public health collaboration should be a key evaluation metric for any new technology.
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