We reported in September 2009 that as the threats to national security— which include the threat of bioterrorism and pandemic outbreak—have  evolved over the past decades, so have the skills needed to prepare for and  respond to those threats. Although the workforce shortages threaten to diminish capacity to detect  signals of potentially catastrophic biological events as they emerge, some  federal agencies are planning or have taken actions to help mitigate them. In addition,  USDA is using incentives, such as bonuses, to attract and maintain its  veterinarian workforce. Training and accreditation programs are  essential to developing a knowledgeable workforce with the skills needed  to identify potential threats to human, animal, and plant health. For example, in the National  Biosurveillance Strategy for Human Health, CDC has called for the  development of a national training and education framework to articulate  professional roles and competencies necessary for biosurveillance. In this vein, 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. A National Strategy and a Focal Point Could Help Guide Development of a National Biosurveillance Capability

While some high-level biodefense strategies have been developed, there is  no broad, integrated national strategy that encompasses all stakeholders  with biosurveillance responsibilities that can be used to guide the  systematic identification of risk, assessment of resources needed to  address those risks, and the prioritization and allocation of investment  across the entire biosurveillance enterprise. We have reported that developing effective  national strategies and establishing a focal point with sufficient time,  responsibility, authority, and resources can help ensure successful  implementation of complex interagency and intergovernmental  undertakings, such as providing a national biosurveillance capability. Officials from CDC, DOD, DHS, USDA, and HHS stated that having a focal  point would help coordinate federal efforts to develop a national  biosurveillance capability. Because the mission responsibilities and  resources needed to develop a biosurveillance capability are dispersed  across a number of federal agencies, efforts to establish a national  biosurveillance capability could benefit from designated leadership—a  focal point—that provides leadership for the interagency community. Recommendations for Executive Action

In order to help build and maintain a national biosurveillance capability— an inherently interagency enterprise—we recommend the Homeland  Security Council direct the National Security Staff to, in coordination with  relevant federal agencies, take the following two actions:  (1) 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. Appendix I: Objectives, Scope, and Methodology

The Implementing Recommendations of the 9/11 Commission Act of 2007  required GAO to describe the state of federal, state, local, and tribal  government biosurveillance efforts, the duplication of biosurveillance  efforts, the integration of biosurveillance systems, and the effective use of  resources and expertise at these levels of governments. Specifically, this report examines the following: (1) federal agency efforts  to provide resources—personnel, training, equipment, and systems—that  support a national biosurveillance capability; and (2) the extent to which  mechanisms are in place to guide development of a national  biosurveillance capability. We did not review  federal efforts to enhance international disease surveillance. These plans included the National Health  Security Strategy, the National Security Council’s National Strategy for  Countering Biological Threats, and the National Response Framework. In addition, we interviewed  these officials on the degree to which the federal government has built a  national biosurveillance capability, how specific programs could  contribute to a national capability for early detection or situational  awareness of biological events, the degree to which federal programs are  integrated with each other, and the limitations of these programs in  supporting a national biosurveillance capability. The U.S. government has a long history of monitoring human, animal, and  plant health—in some cases for more than a century—to help limit  malady, loss of life, and economic impact. Also posing a challenge to timely detection and situational awareness is  the need for laboratory confirmation. Bioterrorism Information Technology Strategy Could Strengthen Federal  Agencies’ Abilities to Respond to Public Health Emergencies.
Why GAO Did This Study

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.

What GAO Found

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.

What GAO Recommends

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.