Toward Integrated DoD Biosurveillance: Assessment and Opportunities.

In the context of the 2012 National Strategy for Biosurveillance, the Office of Management and Budget (OMB) asked the Department of Defense (DoD) to review its biosurveillance programs, prioritize missions and desired outcomes, evaluate how DoD programs contribute to these, and assess the appropriateness and stability of the department's funding system for biosurveillance. DoD sought external analytic support through the RAND Arroyo Center. In response to the questions posed by OMB request, this study finds the following: (1) Current DoD biosurveillance supports three strategic missions. Based mostly on existing statute, the highest-priority mission is force health protection, followed by biological weapons defense and global health security. (2) Guidance issued by the White House on June 27, 2013, specified priorities for planning fiscal year 2015 budgets; it includes an explicit global health security priority, which strengthens the case for this as a key DoD biosurveillance strategic mission. (3) DoD biosurveillance also supports four desired outcomes: early warning and early detection, situational awareness, better decision making at all levels, and forecast of impacts. (4) Programs and measures that address priority missions-force health protection in particular-and desired outcomes should be prioritized over those that do not do so. (5) More near-real-time analysis and better internal and external integration could enhance the performance and value of the biosurveillance enterprise. (6) Improvements are needed in key enablers, including explicit doctrine/policy, efficient organization and governance, and increased staffing and improved facilities for the Armed Forces Health Surveillance Center (AFHSC). (7) AFHSC has requested additional funding to fully implement its current responsibilities under the 2012 Memorandum of Understanding between the Assistant Secretaries of Defense for Health Affairs and for Nuclear, Chemical, and Biological Defense Programs. Additional responsibilities for coordinating the entire DoD biosurveillance enterprise would need concomitant resourcing. (8) There is not a single, unified funding system for the DoD biosurveillance enterprise; the multiple current funding systems would likely benefit from an organizing mechanism with the authority to manage and control funds to meet enterprise goals. Interim guidance issued by the Deputy Secretary of Defense on June 13, 2013, is significant because it is the first policy to explicitly address biosurveillance; it adopts the definition from the National Strategy for Biosurveillance, calls for development of a DoD Directive for biosurveillance, and specifies tasks for DoD's implementation of the Strategy.