Using Risk Analysis to Assess the Value of Improved Biosurveillance

The Department of Homeland Security, Office of Health Affairs (DHS-OHA) manages the National Biosurveillance Integration Center (NBIC) to enable early warning and shared situational awareness of bioterrorism and pandemic disease events.  NBIC’s goal is to improve public response to these incidents by disseminating warning and recommended actions to the appropriate interagency partners in a timely fashion.  Strategic Goal 2 of the NBIC Strategic Plan (DHS 2012) establishes a directive for DHS to:                 

Enhance federal government ability to rapidly identify, characterize, localize, and track a biological event of national concern by integrating and analyzing information relating to human health, animal, plant, food, and environmental monitoring.   Achieving this goal raises fundamental challenges of how to make decisions under dynamic and deeply uncertain conditions.  Biosurveillance and response requires continuous monitoring and updating of decisions based on new information.  Furthermore, the capabilities must be responsive to a wide variety of naturally occurring and terrorism-related disease scenarios.   To achieve this objective, leadership of the NBIC must understand what information and analysis will most improve the nation’s awareness of disease events and make decisions about which biosurveillance activities to support. The primary goal of this study is to develop tools to help NBIC leadership evaluate the benefit of strategies to enhance biosurveillance integration and to improve decisions about whether and how to act after detection of a biosurveillance signal.  The proposed approach applies two standard decision analysis tools to the domain of biosurveillance – decision trees and value-of-information analysis – and will allow the NBIC leadership to decide how to most effectively improve DHS biosurveillance integration capabilities.    Over the course of this study, we achieved the following objectives:

• Identified operational decisions made by the Department of Homeland Security that are informed by NBIC analyses.  One such example is the decisions of whether to distribute prophylactic countermeasures, such as antiviral medication or personal protective equipment (e.g., masks), to DHS personnel in the event of an infectious disease outbreak.
• Developed a decision analysis tools to help NBIC leadership decide how to improve DHS capabilities to inform decisions about both whether to issue warnings and how to respond to incidents.  We developed a tool using the Analytica software package that analyzes the value-of-information from biosurveillance in the context of the decision to distribute antiviral medication to DHS personnel at U.S. land and air point-of-entry.
• Documented tools and analysis to support applications of risk analysis across DHS.  Results of CREATE work are documented in briefings to NBIC and other DHS officials, conference presentations at INFORMS and Society for Risk Analysis, and working papers being submitted to peer reviewed journal articles.
• Worked with OHA to analyze the value-of-information associated with improved biosurveillance. Our on-going work uses this decision analysis tool to further analyze the options DHS has to protect its workers during infectious disease outbreaks, broaden awareness of the decision-analysis approach for public health preparedness decisionmaking across NBIC and its partners at DHS and other agencies, and identify opportunities to extend the approach to other DHS decisions informed by biosurveillance.