Biosurveillance: Efforts to Develop a National Biosurveillance Capability Need a National Strategy and a Designated Leader

GAO-10-645 Published: Jun 30, 2010. Publicly Released: Jun 30, 2010.
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The U.S. government has a history of employing health surveillance to help limit malady, loss of life, and economic impact of diseases. Recent legislation and presidential directives have called for a robust and integrated biosurveillance capability; that is, the ability to provide early detection and situational awareness of potentially catastrophic biological events. The Implementing Recommendations of the 9/11 Commission Act directed GAO to report on the state of biosurveillance and resource use in federal, state, local, and tribal governments. This report is one in a series responding to that mandate. This report addresses (1) federal efforts that support a national biosurveillance capability and (2) the extent to which mechanisms are in place to guide the development of a national biosurveillance capability. To conduct this work, GAO reviewed federal biosurveillance programs, plans, and strategies and interviewed agency officials from components of 12 federal departments with biosurveillance responsibilities.

Federal agencies with biosurveillance responsibilities--including the Departments of Health and Human Services, Homeland Security, and Agriculture--have taken or plan to take actions to develop the skilled personnel, training, equipment, and systems that could support a national biosurveillance capability. GAO previously reported that as the threats to national security have evolved over the past decades, so have the skills needed to prepare for and respond to those threats. Centers for Disease Control and Prevention (CDC) officials stated that skilled personnel shortages threaten the capacity to detect potentially catastrophic biological events as they emerge in humans, animals, or plants. To address this issue, some federal agencies are planning or have taken actions to attract and maintain expertise using fellowships, incentives, and cooperative agreements. Moreover, CDC has called for the development of a national training and education framework to articulate professional roles and competencies necessary for biosurveillance. The Department of Agriculture has also developed training programs to help ensure that diseases and pests that could harm plants or animals can be identified. In addition, federal agencies have taken various actions designed to promote timely detection and situational awareness by developing (1) information sharing and analysis mechanisms, (2) laboratory networks to enhance diagnostic capacity, and (3) equipment and technologies to enhance early detection and situational awareness. While national biodefense strategies have been developed to address biological threats such as pandemic influenza, there is neither a comprehensive national strategy nor a focal point with the authority and resources to guide the effort to develop a national biosurveillance capability. For example, the National Security Council issued the National Strategy for Countering Biological Threats in November 2009. While this strategy calls for the development of a national strategy for situational awareness, it does not meet the need for a biosurveillance strategy. In addition, this strategy includes objectives that would be supported by a robust and integrated biosurveillance capability, such as obtaining timely and accurate insight on current and emerging risks, but it does not provide a framework to help identify and prioritize investments in a national biosurveillance capability. GAO previously reported that complex interagency efforts, such as developing a robust, integrated, national biosurveillance capability, could benefit from an effective national strategy and a focal point with sufficient time, responsibility, authority, and resources to lead the effort. Efforts to develop a national biosurveillance capability could benefit from a national biosurveillance strategy that guides federal agencies and other stakeholders to systematically identify risks, resources needed to address those risks, and investment priorities. Further, because the mission responsibilities and resources needed to develop a biosurveillance capability are dispersed across a number of federal agencies, efforts to develop a biosurveillance system could benefit from a focal point that provides leadership for the interagency community. GAO recommends that the Homeland Security Council direct the National Security Staff to identify, in consultation with relevant federal agencies, a focal point to lead the development of a national biosurveillance strategy to guide the capability's development. GAO provided a copy of this draft to the 12 federal departments and the National Security Staff.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Homeland Security Council In order to help build and maintain a national biosurveillance capability--an inherently interagency enterprise--the Homeland Security Council should direct the National Security Staff to, in coordination with relevant federal agencies, establish the appropriate leadership mechanism--such as an interagency council or national biosurveillance director--to provide a focal point with authority and accountability for developing a national biosurveillance capability.
Closed – Implemented
According to a spokesperson for the National Security Staff, which supports the Homeland Security Staff, it has convened an Interagency Policy Group, which is responsible for leading the development and oversight of a National Biosurveillance Strategy. This group did complete a National Biosurveillance Strategy in 2012--demonstrating that, at the time, the leadership mechanism established by the Homeland Security Council was able to provide guidance for the biosurveillance enterprise. Therefore, this recommendation should be closed as implemented.
Homeland Security Council In order to help build and maintain a national biosurveillance capability---an inherently interagency enterprise---the Homeland Security Council should direct the National Security Staff to, in coordination with relevant federal agencies, charge this focal point with the responsibility for developing, in conjunction with relevant federal agencies, a national biosurveillance strategy that: 1) defines the scope and purpose of a national capability; 2) provides goals, objectives and activities, priorities, milestones, and performance measures; 3) assesses the costs and benefits associated with supporting and building the capability and identifies the resource and investment needs, including investment priorities; 4) clarifies roles and responsibilities of leading, partnering, and supporting a national capability; and 5) articulates how the strategy is integrated with and supports other related strategies' goals, objectives, and activities.
Closed – Not Implemented
In July 2012, the White House released the National Strategy for Biosurveillance to describe the U.S. government's approach to strengthening biosurveillance. A strategic implementation plan was to be completed within 120 days of the strategy issuance. As we testified in September 2012, the strategy did not fully meet the intent of our recommendation; however, when the implementation plan is complete, it may meet our recommendation. Specifically, the strategy did not provide the mechanism GAO recommended to identify resource and investment needs, including investment priorities. As of August 2018 , there was no evidence that this implementation plan had ever been finalized or considered operational by the White House and the key interagency partners. This recommendation is closed as not implemented.

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