The BioWatch program has been under scrutiny for its high costs and effectiveness as an early warning detection system to biological warfare agents. Although the program is expensive and there have been issues that question its effectiveness, the impact of not having an early warning detection system and the costs associated with the recovery of an attack if no system was in place are far greater. This post will discuss these issues by providing a brief history, identify the stakeholders, and discuss the issues of the cost and effectiveness of the program. In closing, it will provide a recommendation as to why BioWatch should continue to be funded and remain part of the biosurveillance strategy if additional analysis and improvements are made prior to securing new technology.

The BioWatch program was created in 2003 by the Department of Homeland Security (DHS) in response to the post 9/11 anthrax attacks in the United States. The purpose of BioWatch program was to create an early warning detection system that recognizes specific biological warfare agents that have been intentionally aerosolized into the atmosphere. The BioWatch system is currently deployed in more than 30 major cities within the United States with approximately 500 sensors deployed in theses areas. Prior to the development of BioWatch, primary health-care providers needed to be vigilant because they would most likely be the first to observe and report unusual illnesses or injuries.

The BioWatch program falls under the auspice of DHS, but due to its overlay with public health and national security there are several other stakeholders that need to be included in addressing the issues of the program. Those agencies are the Department of Health and Human Services, the Center for Disease Control, the Department of Defense, the Environmental Protection Agency, and the National Science Foundation. State and local public health officials within BioWatch jurisdictions should also be included as key stakeholders.

Early detection and control of biological or chemical attacks depends on a strong and flexible public health system at the local, state, and federal levels. The National Strategy for Biosurveillance states, early detection is one of our first lines of defense against these threats. The early detection of biological warfare agents may save lives and potentially limit the number of individuals within the population who become infected. The main purpose of the BioWatch program is to alert authorities prior to victims showing symptoms and providing the opportunity to deliver prophylaxis earlier, decreasing illness and death.

If the BioWatch program were not utilized there would be no early detection of a potential biological warfare attack until symptoms were being reported to public health officials. This may greatly increase the cost of responding and recovering to a bioterrorism incident. In their article, Kman and Bachmann state “the costs are high, because many agents go undetected until the onset of symptoms when treatment is less effective and more expensive.” Therefore, using this framework for detection may delay a positive alert to a biological warfare agent for days or weeks after an attack, which would have adverse affects on the overall response and cost of the incident. According to Kaufmann, Meltzer, and Schnid, the minimum cost of a biological attack would range from 478 million per 100,000 persons exposed (brucellosis scenario) to 26.2 billion per 100,000 persons exposed (anthrax scenario). This cost does not consider the public panic caused by such an incident and its potential impact on the economy.

The sensors that have been used in the BioWatch program are the primary area of concern. The current sensor, Generation 2, takes 12-36 hours to obtain results from the samples taken in the field. In his article, BioWatch: Enhancing Biological Threat Detection, Bucci advises the cost of the current program has been approximately 1 billion dollars, but the cost of the newest version, Generation 3, will be 3.8 billion dollars over the next five years. However, the Generation 3 technology would reduce the amount of time to obtain results to approximately 4-6 hours. The concern with the new technology is how effective will these sensors be compared to the last generation of sensors. The costs for the initial purchase of the new detection equipment is higher, however, the manpower needed to collect and process samples is greatly decreased due to the automated system.

Opponents to the BioWatch program believe the false positives created by the Generation 2 sensors indicate the system is ineffective and further funding should not be spent to enhance the program with Generation 3 sensors. The Committee on Effectiveness of National Biosurveillance Systems states, there have been dozens of BioWatch Actionable Results (BARs) but none have been directly linked to bioterrorism or human illness. However, once a BAR is received there is a protocol that must be followed to safeguard the population. The Government Accountability Office states there have been more than 100 BARs since 2003, but none were considered health risks to the public.

The large number of erroneous alerts by the current BioWatch detection equipment has created a gap with those decision makers needing to assess the information being received and their confidence in the BioWatch program. Lister and Shea question the value of the program stating, if public officials lack confidence in the functioning of the monitor, consequence management may be delayed, leading to increased casualties. This distrust creates a delay by those decision makers who need to enact protocols and procedures in response to BARs, which negates the effectiveness of an early warning detection system.

The Committee on Effectiveness of National Biosurveillance Systems suggests officials do not want to risk the trust of the population by initiating potentially high-regret actions for a potential bioterrorist attack when a full-scale response is not warranted. To become more effective in the decision making process it is essential that federal, state, and local health officials work closely to ensure the most timely and appropriate decision is made in response to a BAR. The Committee on Effectiveness of National Biosurveillance Systems further states, “the procedures for interpreting and responding to positive test results have improved; there remain serious gaps in effective communication and trust between the BioWatch program and public health personnel in BioWatch jurisdictions.”

Although the BioWatch program is costly and is not a flawless system it does provide early detection capabilities that are necessary to protect the population. Dr. Steven Bucci said, “the availability of biological weapons and the educational material for use of these resources is increasing exponentially—and our adversaries are very eager to try their hand at using them.” Therefore, it is recommended BioWatch continue to be funded as part of the overall biosurveillance strategy of the United States, but only after an analysis of the current system and continued testing of the Generation 3 monitoring equipment is completed. The costs of a bioterrorist incident and the potential casualties greatly outweigh the funding necessary to continue the BioWatch program. To increase effectiveness there must also be improved collaboration among all levels of government to enhance the decision making process to ensure there is a timely and accurate response to BARs. By moving forward with the testing of new technology and improving the coordination of the stakeholders the system may produce better results and increase its effectiveness against a bioterrorism attack.