Overdue Outbreak Detection System Leaves Patchwork Defense

The U.S. should have had a nationwide network to monitor for the next viral outbreak or biological threat a decade ago. It still doesn’t.

Instead, public health leaders make do with a patchwork system while waiting for the Department of Health and Human Services races to get its integrated network in service by a new 2023 congressional deadline. Until that nationwide monitoring system is in place, the U.S. runs the risk that a biological threat like a disease outbreak will take hold before it’s noticed.

“The risk is that we don’t have the level of surveillance that we need. The risk is that there are things basically flying under the radar,” said Helen Boucher, an infectious diseases clinician at Tufts Medical Center in Boston and director of the university’s Center for Integrated Management of Antimicrobial Resistance.

The agency responsible for making that system happen, the HHS, is more than a decade overdue to build a comprehensive biological threat awareness network. Although the agency says it’s making taking steps toward meeting that goal, the Government Accountability Office says little progress has been made since Congress first tasked it with the responsibility.

“We’re making incremental progress, but certainly more work needs to be done,” Assistant Secretary for Preparedness and Response Robert Kadlec told Bloomberg Law.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019, which became law in June, gives the HHS until no later than September 2023 to establish networks for public health communications and surveillance and to modernize the public health awareness system. Valerie Melvin, managing director of the information technology and cybersecurity Team at the GAO, who led the last report on the HHS’s progress, said the new law might get the effort moving.

When the GAO checked the progress in March, the HHS said it was waiting for the reauthorization of the law to make plans, Melvin said.

“Now that that’s in place we would expect them to begin taking steps toward implementing the requirements,” she said.

Making Do

In the meantime, public health leaders make do with separate systems already in place, but biodefense clinicians and researchers say that runs the risk of biological threats going undetected.

Those threats could be anything from viral diseases, like Zika and Ebola, to antibiotic-resistant super bugs like methicillin-resistant Staphylococcus aureus, commonly referred to by its acronym MRSA.

“This is a fast moving problem, so anything can do to advance these networks and or ability to have this knowledge would be very, very helpful,” Boucher said.

Congress first identified a need for a comprehensive biothreat detection system in the 2000s when it ordered HHS to establish a “public health situational awareness network.”

The requirement was part of Pandemic and All-Hazards Preparedness Act of 2006, a law to prepare the nation for potential biological threats following the Sept. 11, 2001, terror attacks. It also established national health security plan and created a department housed under the HHS to lead preparedness and response efforts.

But implementation has lagged. Congress has passed laws requiring the HHS create the system at least two other times since 2006, including another reauthorization in June.

Watchdog Report

“What we’re lacking here is a comprehensive almost one-stop-shop-like system where in an emergency you could go and have comprehensive information available,” Nicole Jarvis, an assistant director the Government Accountability Office’s information technology and cybersecurity division in Dallas, said.

Jarvis has been checking on the progress of the HHS’s system following a 2017 GAO report on the lack of progress on the system. It recommended steps the department take to move the project forward.

When she checked in March, the agency had not made progress on those goals.

“They have to start with having people in place that are going to take responsibility for taking the lead,” Jarvis said. “Even though they said they were putting bodies in place, we didn’t see them assigning responsibilities to the folks that needed to have responsibility.”

‘Challenging Problem’

To be sure, creating the network is a tall order. A completed network would require data reporting and integration at federal, state, local, and tribal health levels.

“It is a very challenging problem,” Kadlec said. The HHS must find ways to encourage participation in a system “while protecting what would be personal information, private information, health information, and also proprietary information.”

Kadlec said his office doesn’t have a central role in creating the network, but it would depend on it. The Centers for Disease Control and Prevention, which would help establish the network, didn’t respond to a request for comment.

System Benefits

A public health awareness network would help clinicians like Boucher get ahead of threats to their patients. Systems like this are already publicly available for European countries, she said. “Europe is a different place, it’s smaller, but they’re ahead of us on this.”

If a patient comes to a doctor after having an operation in another state, Boucher said, those new doctors need to know what bugs that patient could be bringing. A system like the one the HHS is working on would help them to do that, by offering up real-time data about potential biological threats in their own area and others.

“If we have a good knowledge of the epidemiology across America, that’s going to help us be more prepared for the patients who arrive at our doorstep,” Boucher said.