Bios surveillan nce: From m Data to Actions a and - nas

 Biossurveillan
nce: From
m Data to Actions aand Impaact Thursdayy, May 7th
h, 2015 Ro
oom 105 (ove
erflow room –– Room 208)
Nattional Academ
my of Sciencess Keck Centerr th
500
0 5 Street NW
W, Washingtoon DC, 200011 Meeting B
Background Information: For many years, the De
epartment off Defense (DoD) biosurveil lance program
ms have conttributed to the ment and integgration of keyy capabilities to enhance ssituational aw
wareness of potential Chem
mical developm
Biological and Radiologgical (CBR) threats that could affect thee warfighters and military missions. Oveer the years,, as the whole
e‐of‐governm
ment concept has evolved, the enterprisse has adapteed to national level planning and coordination of ffederal biosurveillance effforts. First, in 2012, the Naational Biosurveilllance Strateggy (hereafter Strategy) bro
oadened the ddefinition of b
biosurveillancce to include all‐
hazards th
hreats or dise
ease activity aaffecting hum
man, animal, oor plant health and focused on improving timely deccision makingg at all levels. The Strategyy’s implementtation plan sp
pecifies the ro
ole and responsib
bilities of key ffederal stakeholders, inclu
uding DoD. M
More recentlyy, the Global H
Health Security Agenda (G
GHSA) called for the enhan
ncement of national and innternational b
biosurveillancce networks aand other meaasures to prevent, detect, and respond to infectiouss disease threeats. DoD is currently developin
ng an Instruction (DoDI) on
n BSV to defin
ne the roles a nd responsib
bilities of diffeerent DoD enttities, with an ovverarching aim of coordinaating the variious BSV elem
ments across the Department. In a coope
erative effortt to enhance n
national and gglobal health security tow
ward the Strattegy’s goals, tthe Office of tthe Assistant Secretary of Defense for N
Nuclear, Chem
mical, and Bio
ological Healtth Programs (OASD(NC
CB)) and the O
Office of the A
Assistant Secrretary of Defeense for Heallth Affairs (OA
ASD(HA)) developed
d a Memoran
ndum of Unde
erstanding to prioritize andd facilitate biosurveillancee capacity buiilding and imple
ementation. TThe DoD cond
ducts comprehensive healtth surveillancce among military members but also supports global disease surrveillance by partnering w ith foreign go
overnments aand others to help he Armed Forces build biossurveillance capacity and ccapabilities, particularly th rough prograams such as th
Health Surveillance Center (AFHSC)/Global Emerrging Infectio ns Surveillancce (GEIS) and
d Defense Thrreat Reduction
n Agency (DTR
RA) Cooperattive Biological Engagementt Program (CB
BEP). DoD do
oes not collecct or own other countries’ ssurveillance data, but partn
ner governmeents may shaare their data with DoD. Th
he he National Ce
enter for Meddical Intelligence (NCMI), iis also involveed in intelligencce community, through th
biosurveilllance collection and analyysis, though tyypically such analyses rem
main in classifiied channels. Also under DTR
RA, the Biosu
urveillance Eco
osystem (BSV
VE) program i s intended to
o enable data integration aand visualizatiion from a larrge variety off data sourcess into a Web‐ based cloud n
network, to eenhance the overall Do
oD biosurveilllance capabilities. Informaation from thee BSVE will bee further inco
orporated into
o 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 action‐
oriented 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 10:25 Q&A session with Session 1 speakers 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 2:55 3:05 Barriers to Data Sharing in Public Health Donald Burke, University of Pittsburgh 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. 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. 3:15 3:25 Rebecca Katz, Associate Professor of Health Policy and Emergency Medicine, George Washington University 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 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 Biossurveillan
nce: From
m Data to Actions aand Impaact Friday, May 8th, 2015 Room 206 Nattional Academ
my of Sciencess Keck Centerr th
500
0 5 Street NW
W, Washingtoon DC, 200011 CLOSED SESSSION: CO
OMMITTEEE AND STAFFF ONLY 8::30am Discusssion of Dayy 1 Meeting and Next M
Meeting Topiics O
OPEN SESSIION 9::30am Meetiing Discussio
on between
n Committeee and Sponsor  Sponsor Thoughts  Meeting In
nsights from
m Committeee Members
 Summary of Meeting Insights 10
0:30 Impaccts of Previo
ous Meetinggs CDR FFranca Jones,
s, Acting Prin
ncipal Directoor, Office of f the Assistan
nt Secretary of Defense for Nu
uclear, Chem
mical and Bio
ological Defeense Program
ms 10
0:45 Breakk 11
1:00 Platfo
orms Meetin
ng – July 201
15 12
2:15 Lunch
h CLOSED SESSSION: CO
OMMITTEEE AND STAFFF ONLY 1::00 1::15 2::00 Updattes Platfo
orms Meetin
ng Discussion Adjou
urn