Biosurveillance: From Data to Actions and Impact Thursday, May 7th, 2015 Room 105 (overflow room Room 208) National Academy of Sciencess Keck Centerr 5000 5 th Street NW, Washington DC, 20001 Meeting Background Information: For many years, the Department of Defense (DoD) biosurveillance programs have contributed to the development and integration of key capabilities to enhance situational awareness of potential Chemical Biological and Radiological (CBR) threats that could affect thee warfighters and military missions. Over the years, as the whole of government concept has evolved, the enterprise has adapted to national level planning and coordination of federal biosurveillance efforts. First, in 2012, the National Biosurveillance Strategy (hereafter Strategy) broadened the definition of biosurveillance to include all timely decision making at all levels. The Strategy s implementation plan specifies the role and hazards threats or disease activity affecting human, animal, or plant health and focused on improving responsibilities of key federal stakeholders, including DoD. More recently, the Global Health Security Agenda (GHSA) called for the enhancement of national and international biosurveillance networks and other measures to prevent, detect, and respond to infectiouss disease threats. DoD is currently developing an Instruction (DoDI) on BSV to define the roles and responsibilities of different DoD entities, with an overarching aim of coordinating the various BSV elements across the Department. In a cooperative effort to enhance national and global health security toward the Strategy s goals, the Office of the Assistant Secretary of Defense for Nuclear, Chemical, and Biological Health Programs (OASD(NCB)) and the Office of the Assistant Secretary of Defense for Health Affairs (OASD(HA)) developedd a Memorandum of Understanding to prioritize andd facilitate biosurveillancee capacity building and implementation. The DoD conducts comprehensive health surveillance among military members but also supports global disease surveillance by partnering with foreign governments and others to help build biosurveillance capacity and capabilities, particularly through programs such as the Armed Forces Health Surveillance Center (AFHSC)/Global Emerging Infections Surveillance (GEIS) and Defense Threat Reduction Agency (DTRA) Cooperative Biological Engagementt Program (CBEP). DoD does not collect or own other countries surveillance data, but partner governments may share their data with DoD. The intelligence community, through the National Center for Medical Intelligence (NCMI), is also involved in biosurveillance collection and analysis, though typically such analyses remain in classified channels. Also under DTRA, the Biosurveillance Ecosystem (BSVE) program is intended to enable data integration and visualization from a large variety of data sourcess into a Web based from thee BSVE will be further incorporated into cloud network, to enhance the overall DoD biosurveillance capabilities. Information the
Biosurveillance Portal (BSP), currently developed by the Joint Program Executive Office for Chemical and Biological Defense (JPEO CBD), to facilitate unclassified data analysis and information sharing. Basically, the Portal is a controlled access one stop shop for reports that have already been created. Despite these recent advancements toward meeting the global biosurveillance situational awareness needs within the DoD and beyond into the broader whole of government context, challenges remain to the ability to fuse multiple biosurveillance data streams to create information (analysis), derive actionoriented messages (interpretation of analysis) and eventually inform decision making by all relevant users to achieve desired impact. Meeting Purpose: This meeting will provide a forum for decision makers and various contributors and users of Biosurveillance (BSV) information to discuss the potential impacts of biosurveillance activities. The goal of the meeting will be to better understand how DoD can achieve the end states that biosurveillance enables as described in Memorandum of Understanding between the U.S. Department of Defense OASD (NCB) and OASD (HA). The first end state highlighted at the meeting will be the early warning of health threats that focuses on detecting indications of potential CBR events through accurate, near real time, predictive analyses from multi sectoral information, and reporting through integrated DoD, national, and international biosurveillance systems. The second end state is improved situational awareness that covers the analysis of a variety of information streams that depicts the steady state baseline and portrays a dynamic picture of emerging events and circumstances that affect DoD stakeholders. Specifically, the discussion will focus on clarifying the data and information required to make informed decisions. The meeting will not include data tool demonstrations or identification of new data types. Rather, the intent is for interagency contributors from the infectious disease community to discuss ways to make diverse ranges of data streams useful, through accessibility, integration, analysis, interpretation, communication, and coordination in a whole of DoD and whole of government context. Participants will be asked to articulate the specific decisions needed to achieve global impacts and discuss challenges to the access, timeliness and utility of relevant information to enable better and faster decision making. Participants will then discuss current examples of global biosurveillance efforts to provide specificity to the discussion. The discussion between data providers and system developers will explore the current capabilities developed by the DoD and other federal entities to identify, analyze and interpret BSV data to provide outputs that meet users needs, as well as the level of integration and coordination of the different BSV efforts. Finally, participants will discuss shortcomings and issues of data sharing across the federal government and from other governments and how national and international organizations can overcome these challenges.
Agenda 8:30am Welcome and Introductions Donald Burke*, Dean, Graduate School of Public Health, University of Pittsburgh 8:45 Meeting Objectives and Organization a Cycle to Frame Today s Discussions Melinda Moore*, Public Health Physician and Senior Natural Scientist, RAND Corporation Session 1: National and DoD Biosurveillance Policy This session will clarify the desired impacts and processes associated with U.S. and DoD BSV efforts 9:00 National and International Biosurveillance as Seen by the Department of Defense This session will discuss DoD s missions/roles/responsibilities relevant to BSV (internal, interagency, and global) as well as what is intended for the DoD instruction on BSV. CDR Franca Jones, Acting Principal Director, Office of the Assistant Secretary of Defense for Nuclear, Chemical and Biological Defense Programs (via phone) 9:15 National BSV Strategy (2012), Roadmap (2013), Federal BSV Work Group, Global Health Security Agenda This session will discuss the intended impacts, main stakeholders and key pillars of each item listed above; what is needed to achieve the impacts; and the interagency coordination efforts to achieve these impacts. Dylan George, Senior Policy Advisor, Biological Threat Defense, Office of Science and Technology Policy, The White House 9:30 Internal DoD BSV Memorandum of Understanding This session will discuss current efforts to harmonize BSV across two major DoD stakeholders (Office of the Assistant Secretary of Defense for Nuclear, Chemical and Biological Defense Programs and Office of the Assistant Secretary of Defense for Health Affairs) David J. Smith, Deputy Assistant Secretary of Defense for Force Health Protection and Readiness 9:45 Optimizing DoD s Organization for BSV: Status of the Forthcoming DoDI This session will discuss when/how the policy will be finalized and how will it be implemented. Major Kevin Haines, Deputy Director, Division of Integrated Biosurveillance, Armed Forces Health Surveillance Center 10:00 Q&A session with Session 1 speakers 10:25 Break *member of the workshop planning committee
Session 2: Creating Usable Knowledge: Integrating, Analyzing and Interpreting BSV Data This session will explore the roles, responsibilities and mechanisms for different DoD entities as well as other federal, non governmental and international entities to analyze, interpret and share BSV outputs in order to achieve desired impacts. Participants will discuss ongoing government and non government examples of global biosurveillance efforts to provide specificity to the discussion. The discussion with the providers and system developers will cover the current capabilities developed by the DoD and other federal entities to provide outputs that are intended to meet users needs, as well as the level of integration and coordination of BSV efforts. The presentations below will endeavor to answer the following questions, which should also serve to guide the discussion following the sessions: 1. Who are the end users of your products and what will they do with this information? Which other users would you like to reach? 2. How do you determine the needs of end users? What type of end products (e.g., what type of data analyses, raw data) do you provide? Or have plans to provide? 3. What data or information do you have access to? 4. What are the challenges to integrating multiple data streams to create useful information? For example, are there significant interoperability challenges that impact your system performance? 5. What type of synergy exists between your program and other government/non government programs? 6. If you could have access to additional data or information, what additional data would you like and how would this change what you can do? 10:40 Opening Remarks and Panel Discussion Moderator Thomas Slezak*, Program Leader, Lawrence Livermore National Laboratory (all speakers will address some or all of the questions listed above for approximately 10 minutes and then move into panel discussion) Biosurveillance Ecosystem (BSVE) John Hannan, Chief, Threat Surveillance Branch, DOD/DTRA Chris Kiley, BSVE Science & Technology Manager, DOD/DTRA Biosurveillance Portal (BSP) and Ebola Portal Nicole Rosenzweig, Director, Joint Program Executive Office for CBD, DoD. Armed Forces Health Surveillance Center (AFHSC) /Electronic Surveillance System for the Early Notification of Community based Epidemics (ESSENCE) CDR Jean Paul Chretien, Innovation and Evaluation Team Lead, Armed Forces Health Surveillance Center, DoD U.S. Centers for Disease Control and Prevention (CDC) CAPT Michael F. Iademarco, Director, Center for Surveillance, Epidemiology and Laboratory Services (CSELS) at CDC
United States Agency for International Development (USAID) Andrew Clements, Executive Deputy Director, Emerging Pandemic Threats (EPT) Program, USAID National Security Council Lawrence Kerr, Director for Medical Preparedness Policy, National Security Staff, The White House National Center for Medical Intelligence (NCMI) Lisa Pearse, Clinical Consultant, National Center for Medical Intelligence Panel Discussion with Session 2 speakers 1. What type of data and analyses will generate usable, actionable information? 2. How can the different developers improve the flexibility and efficiency of the systems? 3. Are there opportunities for additional synergies among biosurveillance programs? 12:30 Lunch (will not be provided. There is a cafeteria located on the third floor of the Keck Center.) Session 3: Uses of Biosurveillance Data and Information for Decision Making This session brings anticipated users of biosurveillance together to discuss outputs they need to make decisions. Participants will articulate the specific decisions (e.g., from early detection and alert to forecasting emerging and future threats) where biosurveillance information can be impactful and discuss challenges in accessing and interpreting relevant information to enable timely decision making. The presentations below will endeavor to answer the following questions during opening remarks: 1. What types of decisions can or should be informed by BSV, and what type of BSV information (outputs) do decision makers need for to make such decisions? 2. What information do decision makers have access to, and how do they and other end users access this information? 3. What is the minimal level of data needed for different types of decisions (for example, are aggregated case count data sufficient or are individual level data needed?) 4. Which format is most useful to end users for the actionable information they need? (e.g., purely data analyses or also interpretation in the context of potential courses of action; push pull or both)? 1:30 Opening Remarks and Panel Discussion Moderator Stephen Morse*, Professor, Columbia University (all speakers will address some or all of the questions listed above for 5 7 minutes and then move into panel discussion) Michael Butel, Chief Epidemiology Session, Public Health Command Pacific (via WebEx) LTC Sueann Ramsey and MAJ Antonio Leonardi, Force Health Protection Branch, Command Surgeon's Office, HQ, U.S. Africa Command (via WebEx) James E. Cook, Preventive Medicine, Pacific Regional Medical Command (via WebEx) Richard Danila, Deputy State Epidemiologist, State of Minnesota Larry Madoff, Director, Division of Epidemiology and Immunization, State of Massachusetts
Panel Discussion with Session 3 speakers 1. What additional types of decisions could/should be informed by BSV? 2. What are the end products needed for such decisions? 3. Are there insights about possible improvements for dissemination? 2:30 Break Session 4: Communicating and Sharing BSV Data and Information Moderator: C. Rick Lyons*, Director, Infectious Disease Research Center, Colorado State University 2:45 Barriers to Data Sharing in Public Health Donald Burke, University of Pittsburgh 2:55 Data Sharing Across Federal Stakeholders: Experiences and Lessons from the National Biosurveillance Integration Center (NBIC) Teresa Quitugua, Chief Scientist and Associate Director of Operations and Outreach, Department of Homeland Security. 3:05 U.S. Government Engagement in Support of Global Disease Surveillance This talk will address IHR reporting and regulation, WHO biosurveillance efforts, the concerns of sovereign nations regarding sharing information, and implications of this for non WHO groups who would like access to this type of international data. Rebecca Katz, Associate Professor of Health Policy and Emergency Medicine, George Washington University 3:15 Experiences and Lessons Learned from Assisting Partner Countries to Improve Biosurveillance Capabilities Lance Brooks, Division Chief, J3CTB, Cooperative Biological Engagement Program, Cooperative Threat Reduction, Defense Threat Reduction Agency 3:25 Panel Discussion with Session 4 Speakers Moderator: Donald Burke, University of Pittsburgh 1. What can be done to overcome data sharing challenges? 2. Assuming there are improvements in capacity building that lead to greater collection of data that will be useful for biosurveillance, what should be expected in terms of access to that data? 3. What challenges should be addressed to enhance access to BSV data? 4. Do the new forms of data collection have a different set of barriers than the traditional sharing of public health data?
Session 5: Structured Discussion Moderator: Melinda Moore, RAND Corporation 4:10 Discussion What new opportunities might there be to better integrate BSV data/information? What new opportunities might there be to better share/disseminate BSV data/information? What new opportunities might there be to better use BSV data/information? How might the forthcoming DoDI help facilitate such opportunities and improvements? 5:00 Adjourn
Biosurveillance: From Data to Actions and Impact Friday, May 8th, 2015 Room 206 National Academy of Sciencess Keck Centerr 5000 5 th Street NW, Washington DC, 20001 CLOSED SESSION: COMMITTEEE AND STAFF ONLY 8: :30am Discussion of Day 1 Meeting and Next Meeting Topics OPEN SESSION 9: :30am 10:30 10:45 11:00 12:15 Meeting Discussion between Committeee and Sponsor Sponsor Thoughts Meeting Insights from Committeee Members Summary of Meeting Insights Impacts of Previous Meetings CDR Franca Jones, Acting Principal Director, Office of the Assistant Secretary of Defense for Nuclear, Chemical and Biological Defense Programs Break Platforms Meeting July 2015 Lunch CLOSED SESSION: COMMITTEEE AND STAFF ONLY 1: :00 1: :15 2: :00 Updates Platforms Meeting Discussion Adjourn