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Report to Congressional Committees: 

United States Government Accountability Office: 
GAO: 

December 2009: 

Biosurveillance: 

Developing a Collaboration Strategy Is Essential to Fostering 
Interagency Data and Resource Sharing: 

GAO-10-171: 

GAO Highlights: 

Highlights of GAO-10-171, a report to Congressional Committees. 

Why GAO Did This Study: 

Recently, there has been an increased focus on developing the ability 
to provide early detection of and situational awareness during a 
disease outbreak. The Implementing Recommendations of the 9/11 
Commission Act sought to enhance this capability, in part, by creating 
the National Biosurveillance Integration Center (NBIC) within the 
Department of Homeland Security. NBIC is to help provide early 
detection and situational awareness by integrating information and 
supporting an interagency biosurveillance community. The act directed 
GAO to report on the state of biosurveillance and resource use in 
federal, state, local, and tribal governments. This report is one in a 
series responding to that mandate. This report focuses on the actions 
taken by NBIC to (1) acquire resources to accomplish its mission and 
(2) effectively collaborate with its federal partners. To conduct this 
work, GAO reviewed documents, such as NBIC’s Concept of Operations, and 
interviewed officials at NBIC and 11 federal partners. 

What GAO Found: 

To carry out its early detection and situational awareness mission, 
NBIC has made efforts to acquire data from the integration center’s 
community of federal partners, obtain analytical expertise from other 
agencies, establish governance bodies to develop and oversee the 
community of federal partners, and provide information technologies to 
support data collection, analysis, and communication. However, NBIC 
does not receive the kind of data it has identified as most critical 
for supporting its early detection mission—particularly, data generated 
at the earliest stages of an event. In addition, NBIC has faced 
challenges leveraging the expertise of its federal partners. For 
example, NBIC officials have emphasized the importance of agencies 
temporarily assigning personnel to supplement the expertise at NBIC. 
However, only 2 of 11 partner agencies have assigned personnel to 
support the integration center. NBIC has developed governance bodies 
that provide oversight for the integration center and the interagency 
community. Although the integration center has also developed an 
information technology system, it is primarily used to help identify 
and collect publicly available Internet data because NBIC lacks data 
from federal partners that best support the early detection goal of 
biosurveillance. 

NBIC is not fully equipped to carry out its mission because it lacks 
key resources—data and personnel—from its partner agencies, which may 
be at least partially attributed to collaboration challenges it has 
faced. Integrating biosurveillance data is an inherently interagency 
enterprise, as reflected by both law and NBIC’s strategy for meeting 
its mission. NBIC is to help coordinate and support a community of 
federal partners for early detection and enhanced situational 
awareness. Consequently, for NBIC to obtain the resources it needs to 
meet its mission, it must effectively employ collaborative practices. 
However, in interviews with partner agencies, GAO encountered 
widespread confusion, uncertainty, and skepticism around the value of 
participation in the interagency community, as well as the mission and 
purpose of NBIC within that community. Further, interviews with agency 
officials demonstrated a lack of clarity about roles, responsibilities, 
joint strategies, policies, and procedures for operating across agency 
boundaries. We have previously reported on key practices that can help 
enhance and sustain collaboration among federal agencies. For 
collaborating agencies to overcome barriers to working together, they 
need to, among other things, (1) develop a clear and compelling 
rationale for working together by articulating a common federal outcome 
or purpose; (2) establish joint strategies, policies, and procedures to 
help align activities, core processes, and resources; (3) identify 
resources needed to initiate or sustain their collaborative effort; (4) 
work together to define and agree on their respective roles and 
responsibilities; and (5) develop accountability mechanisms to guide 
implementation and monitoring of their efforts to collaborate. 
Development of a strategy for collaboration and the use of these key 
collaboration practices could enhance NBIC’s ability to foster 
interagency data and resource sharing. 

What GAO Recommends: 

To enhance collaboration, GAO recommends that NBIC work with its 
interagency advisory body to develop a strategy for addressing barriers 
to collaboration—such as the lack of clear mission, roles, and 
procedures—and to develop accountability mechanisms to monitor these 
efforts. We provided this draft to DHS and 11 federal partners. DHS 
concurred with our recommendations. 

View [hyperlink, http://www.gao.gov/products/GAO-10-171] or key 
components. For more information, contact William O. Jenkins at (202) 
512-8777or jenkinswo@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

NBIC Has Undertaken Efforts to Coordinate the NBIS and Acquire 
Resources, but Lacks Key Mission-Critical Elements: 

Use of Key Collaboration Practices Could Help NBIC Strengthen 
Collaboration and Promote Fuller Participation: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Comments from the Department of Homeland Security: 

Appendix II: GAO Contact and Staff Acknowledgments: 

Tables: 

Table 1: 9/11 Commission Act Requirements for NBIC and NBIC Member 
Agencies: 

Table 2: Three Data Categories Collected by Federal Agencies: 

Abbreviations: 

BCON: Biosurveillance Common Operating Network: 

BIWAC: Biosurveillance Indications and Warnings Analytic Community: 

DHS: Department of Homeland Security: 

HHS: Department of Health and Human Services: 

HSPD-9: Homeland Presidential Security Directive-9: 

HSPD-10: Homeland Presidential Security Directive-10: 

HSPD-21: Homeland Presidential Security Directive-21: 

IAA: interagency agreements: 

ISA: interagency security agreements: 

IT: information technology: 

MOU: memomorandum of understanding: 

NBIC: National Biosurveillance Integration Center: 

NBIS: National Biosurveillance Integration System: 

NIOC: NBIS Interagency Oversight Council: 

NIWG: NBIS Interagency Working Group: 

NOC: National Operations Center: 

USDA: United States Department of Agriculture: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

December 18, 2009: 

The Honorable Joe Lieberman:
Chairman:
The Honorable Susan M. Collins:
Ranking Member:
Committee on Homeland Security and Governmental Affairs: 
United States Senate: 

The Honorable Bennie Thompson:
Chairman:
The Honorable Peter King:
Ranking Member:
Committee on Homeland Security:
House of Representatives: 

In recent years, there has been an increasing awareness of the 
potential for biological agents to be used as weapons of mass 
destruction and of the threat of catastrophic effects arising from 
emerging strains of infectious disease. For example, the October 2001 
anthrax attacks highlighted longstanding weaknesses in the current 
public health infrastructure and prompted efforts to improve the 
nation's preparedness for and response to public health emergencies, 
including bioterrorism. In addition, the 2001 accidental outbreak of 
foot-and-mouth disease in the United Kingdom caused approximately $5 
billion dollars in losses to the food and agriculture sector, as well 
as comparable losses within the industry.[Footnote 1] These events and 
others like them have underscored the importance of developing and 
maintaining a national biosurveillance capability--that is, the ability 
to detect biological events of national significance with the aim of 
providing earlier warning and better information to guide public health 
or other types of emergency response. 

Effective preparation for, detection of, and response to a major 
biological event requires effective pre-and postdisaster coordination 
and cooperation among different federal agencies, levels of government, 
nongovernmental organizations, and the private sector. In the case of 
biological threats, detection of biological agents is a first step in 
an effective response to a natural, accidental, or intentional outbreak 
of a biological event of national concern. The U.S. government has a 
long history of monitoring human, animal, and plant health--in some 
cases for more than a century--to help limit malady, loss of life, and 
economic impact. Although the United States has numerous surveillance 
programs and systems at various levels of government and in the private 
sector to monitor disease, these programs and systems were developed 
separately for a variety of mission objectives, and as such are 
relatively uncoordinated. 

Since at least the 1990s, there has been an ongoing and evolving effort 
by the federal government to address the need for a strategic approach 
to improving disease surveillance and response. Among numerous federal 
efforts to establish a coordinated national biosurveillance capability, 
a provision in the Implementing Recommendations of the 9/11 Commission 
Act of 2007 (9/11 Commission Act),[Footnote 2] sought to enhance the 
capability of the federal government to rapidly identify, characterize, 
localize, and track biological events of national concern. The 9/11 
Commission Act established, within the Department of Homeland Security 
(DHS), the National Biosurveillance Integration Center (NBIC), which 
was specifically tasked with fulfilling the biosurveillance objectives 
established in the act by integrating and analyzing information from 
surveillance systems across the federal government and disseminating 
alerts, if any biological events are detected. The federal partners 
that maintain these surveillance systems and those that may have 
information helpful for decisionmaking during an event are collectively 
known as the National Biosurveillance Integration System (NBIS). A 
central responsibility for NBIC is to further develop and oversee the 
NBIS with the goal of earlier detection of and enhanced information 
about potentially catastrophic biological events. 

In the same title, the 9/11 Commission Act directed us to examine the 
state of federal, state, local, and tribal government biosurveillance 
efforts and the federal government's use of resources to implement and 
execute biosurveillance systems.[Footnote 3] This report responds in 
part to that mandate by examining actions that NBIC has taken to 
integrate and analyze data for the purposes of early detection and 
warning of biological events of national concern. Specifically, this 
report addresses (1) what actions NBIC has taken to coordinate the NBIS 
and acquire essential resources; and (2) how effectively NBIC has 
employed collaborative practices with NBIS partners to help ensure that 
it acquires and develops essential resources.[Footnote 4] 

In summer 2008, we testified on the status of NBIC's efforts to 
implement its 9/11 Commission Act responsibilities, particularly by 
entering into information-sharing and interagency personnel-assignment 
agreements with NBIS partners.[Footnote 5] At that time, we noted that 
DHS faced difficulties completing some key tasks, such as defining what 
capabilities the center will provide once fully operational, 
formalizing agreements to obtain interagency coordination, and 
completing work related to information technology (IT) systems. In 
addition to this NBIC-specific report, we have ongoing work on 
biosurveillance activities throughout the federal government from which 
we expect to issue a report in early 2010, and a review of state, 
local, and tribal activities, which we expect to report on later in the 
year. 

To determine the extent of NBIC's efforts to acquire the necessary data 
and resources, we reviewed documents including relevant laws and 
directives, operating documents, program guidance, program evaluation 
reports, and other documentation and interviewed officials at NBIC with 
knowledge of NBIC's management and analytical activities. We visited 
NBIC facilities, specifically NBIC's analysis center at DHS's Nebraska 
Avenue Complex, DHS's National Operations Center, and the 2009 H1N1 
Incident Management Cell at the Office of Health Affairs in Washington, 
D.C., where we observed key meetings, processes, and technologies. To 
identify the elements that are necessary for NBIC to achieve its 
mission, we analyzed the relevant provisions of the 9/11 Commission 
Act, the NBIS Concept of Operations, and interviews with NBIC 
officials.[Footnote 6] Once we identified these elements, we vetted 
them with NBIC officials who agreed they were accurate. To determine 
the extent to which NBIC and NBIS partners have collaborated to help 
ensure that NBIC acquires and develops essential resources, we reviewed 
existing federal interagency agreements and other documentation, such 
as the NBIS Concept of Operations, NBIC's draft strategic plan, and 
post meeting reports from meetings of NBIS governance bodies. We also 
spoke with agency officials from the 11 NBIS partners--agencies NBIC 
has identified as having relevant data or resources to contribute to 
the biosurveillance objectives established in the 9/11 Commission Act. 
[Footnote 7] We conducted semistructured interviews, based on our 
previous work describing practices to enhance and sustain collaboration 
in the federal government.[Footnote 8] We conducted these interviews 
with 14 components of the 11 federal agencies that NBIC identified as 
NBIS partners. We identified the components to interview by contacting 
the 11 partner agencies to determine which had regular interaction with 
NBIC's processes and products. We explored officials' experiences 
working with NBIC and within the NBIS at all of the identified 
components. We asked these officials about their understanding of 
NBIC's mission and purpose; the perceived value to their respective 
agencies of participation in the NBIS; the extent of and reasons for 
their agency's level of participation; and the extent to which joint 
strategies, policies, and procedures have been established and are 
commonly understood and accepted between NBIC and individual agencies, 
as well as across the NBIS. We then analyzed the results of these 
interviews to identify recurrent themes. We provided these officials 
the opportunity to comment on a standard set of collaborative practices 
and provide examples from their experiences, and we analyzed the 
content of their responses to develop our findings. However, due to the 
semistructured nature of our interviews, different groups of officials 
focused on different aspects of their experiences with NBIC; therefore, 
not every theme identified in our analysis was explicitly discussed by 
every group of officials. 

This report is limited to the efforts NBIC has taken or planned to 
carry out related to its 9/11 Commission Act responsibilities. On the 
whole, federal biosurveillance efforts rely on state, local, and tribal 
biosurveillance efforts, and there are many federal efforts designed to 
collect and analyze biosurveillance data. However, this report focuses 
on NBIC's integration efforts and not the effectiveness of the various 
federal systems the data of which NBIC would integrate. 

We conducted this performance audit from February 2008 through November 
2009, in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

Background: 

NBIC Is Responsible for Facilitating Collaboration across Multiple 
Agencies to Enhance Biosurveillance Effectiveness by Integrating Data 
and Expert Analysis: 

Biosurveillance is the process of gathering, analyzing, and 
interpreting data in order to achieve early detection and warning and 
overall situational awareness of biological events with the potential 
to have catastrophic human and economic consequences.[Footnote 9] In 
August 2007, the 9/11 Commission Act established NBIC to contribute to 
the nation's biosurveillance capability by enhancing the ability of the 
federal government to rapidly identify, characterize, localize, and 
track biological events of national concern through integration and 
analysis of data relating to human health, animal, plant, food, and 
environmental monitoring systems (both national and international). 
[Footnote 10] Once a potential event is detected, NBIC is to 
disseminate alerts to enable response to a biological event of national 
concern. To achieve these objectives, NBIC is to coordinate with 
federal and other stakeholders that have information that can be used 
to enhance the safety and security of the United States against 
potential biological events of national significance. This community of 
federal stakeholders is known as the NBIS. 

The NBIS community predated the enactment of the 9/11 Commission Act. 
Beginning in 2004, DHS managed the NBIS and developed an IT system to 
manage other agencies' biosurveillance information, an effort that was 
moved among several DHS Directorates, including DHS's Science and 
Technology Directorate and the Preparedness Directorate. In 2007, DHS 
created the Office of Health Affairs, headed by the DHS Chief Medical 
Officer, to lead DHS's biodefense activities and provide timely 
incident-specific management guidance for the medical consequences of 
disasters. At that time, DHS placed NBIS in the Office of Health 
Affairs.[Footnote 11] Shortly after that, the 9/11 Commission Act 
created NBIC and gave it responsibility for managing the NBIS, which 
has remained in the Office of Health Affairs. Since fiscal year 2008, 
NBIC has operated with an annual budget of $8 million dollars. 
Biosurveillance activities at NBIC are carried out by its Operations 
Division, which is headed by the Deputy Director and Chief Scientist 
and supported by 10 contract employees that serve as the analytic core 
for NBIC's daily operations. These staff members have various 
backgrounds related to biodefense, including public health, veterinary, 
environmental, and intelligence training. 

NBIC Draws Its Early Detection and Situational Awareness Missions from 
Multiple Presidential Directives, in Addition to the 9/11 Commission 
Act: 

As shown in table 1, the 9/11 Commission Act outlines certain 
requirements for NBIC and NBIS member agencies, and most of these 
relate to how NBIC is to coordinate NBIS member agency data and 
information management resources. Generally, there are four elements 
that are critical for NBIC to achieve its early detection and 
situational awareness missions established in the 9/11 Commission Act: 
(1) acquire data from NBIS partners that can be analyzed for 
indications of new or ongoing biological events, (2) leverage 
scientific and event-specific expertise from across the NBIS, (3) 
obtain strategic and operational guidance from NBIS partners, and (4) 
develop and maintain information technologies to support data 
collection, analysis, and communication. 

Table 1: 9/11 Commission Act Requirements for NBIC and NBIC Member 
Agencies: 

Requirements for NBIC: 

* Consolidate data from all relevant surveillance systems maintained by 
member agencies across human, animal, and plant domains; 

* Seek private sources of surveillance when such sources would enhance 
coverage of gaps; 

* Use an IT system with the best available statistical and other 
analytical tools to identify and characterize biological events of 
national concern in as close to real time as practical; 

* Provide the infrastructure for integration including IT systems and 
space, and support for personnel from member agencies with sufficient 
expertise to analyze and interpret data; 

* Work with member agencies to create IT systems that use the minimum 
amount of patient data necessary and consider patient confidentiality 
and privacy in all stages of development; 

* Alert member agencies as well as public health agencies of state, 
local, and tribal governments (in coordination with or through member 
agencies) of incidents that could develop into a biological event of 
national concern. 

Requirements for NBIC member agencies: 

* Use best efforts to integrate biosurveillance information into the 
NBIC, with the goal of promoting information sharing between federal, 
state, local, and tribal governments to detect biological events of 
national concern; 

* Provide timely information to assist the NBIC in maintaining 
biological situational awareness for accurate detection and response 
purposes; 

* Enable the NBIC to receive and use biosurveillance information from 
member agencies to carry out its requirements; 

* Connect the biosurveillance data systems of that member agency to the 
NBIC data system under mutually agreed protocols; 

* Participate in the formation of strategy and policy for the operation 
of the NBIC and its information sharing; 

* Provide personnel to the NBIC under an interagency personnel 
agreement and consider the qualifications of such personnel necessary 
to provide human, animal, and environmental data analysis and 
interpretation support to the NBIC; and retain responsibility for the 
surveillance and intelligence systems of that department or agency, if 
applicable. 

Source: Pub. L. No. 110-53, § 1101, 121 Stat. 266, 375-79 (2007) 
(codified at 6 U.S.C. § 316). 

[End of table] 

Although the act does not specify any member agency that must 
participate in the NBIS, it defines a member agency as any agency that 
signifies agreement to participate by signing a memorandum of 
understanding (MOU) and establishes for them specific requirements-- 
generally related to sharing information and human assets. For example, 
as shown in table 1, the act provides that each member agency shall use 
its best efforts to integrate biosurveillance information into the 
NBIC, with the goal of promoting information sharing between federal, 
state, local, and tribal governments to detect biological events of 
national concern. NBIC has identified 11 NBIS partners at the federal 
level--the Departments of Health and Human Services (HHS), Agriculture 
(USDA), Commerce, Defense, Interior, Justice, State, Transportation, 
and Veterans Affairs, as well as the Environmental Protection Agency 
and the United States Postal Service. In some departments, more than 
one component has been identified for participation. Some of these 
departments, such as HHS and USDA, have major mission responsibilities 
for collecting health data that may indicate an outbreak of a disease 
or other biological event. Other departments may collect data or have 
subject matter expertise that may be used during the course of a 
biological event. For example, the National Oceanic and Atmospheric 
Agency within the Department of Commerce collects meteorological data 
that may be used by NBIC to help inform the progression of an outbreak 
based on weather patterns. 

Around the same time as the enactment of the 9/11 Commission Act, the 
President issued Homeland Security Presidential Directive-21 (HSPD- 
21), as a high-level biodefense strategy. HSPD-21 is built on the 
principles of earlier directives--HSPD-9 and HSPD-10--which 
collectively describe the role of the federal government in building a 
national capability to detect a biological event. For example, HSPD-21 
lays out goals for addressing each of four biodefense elements for 
human health,[Footnote 12] one of which is surveillance. In this 
respect, HSPD-21 calls for the United States to develop a nationwide, 
robust, and integrated biosurveillance capability to provide early 
warning and ongoing characterization of disease outbreaks in near real- 
time. Consistent with this goal, HSPD-21 directs the Secretary of 
Health and Human Services to establish a national epidemiologic 
surveillance system for human health, in part, to integrate federal, 
state, and local data into a national biosurveillance common operating 
picture. Although HSPD-21 does not specify a role for DHS in 
biosurveillance, the earlier directives did, and creation and 
maintenance of an electronic biosurveillance common operating picture 
has been an NBIS goal since its inception. 

Biosurveillance Involves Data Gathering and Analysis at Multiple Levels 
of Government for the Purposes of Earlier Warning and Enhanced 
Situational Awareness: 

The data needed to detect an infectious disease outbreak or 
bioterrorism may come from a variety of sources, and aggregating and 
integrating data across multiple sources is intended to help recognize 
the nature of a disease event or understand its scope. Combining and 
comparing data streams from different sectors to detect or interpret 
indications of a potential health emergency is called biosurveillance 
integration. Both HSPD-21 and the 9/11 Commission Act seek enhanced 
integration of disparate systems and programs that collect data with 
the aim of providing early warning and ongoing characterization of 
biological events. HSPD-21 and the 9/11 Commission Act each also seek 
to enhance the situational awareness for the detection of and response 
to biological events. Much of the information gathered for these 
biosurveillance purposes is generated at the state government level. 
For example, state health departments collect and analyze data on 
notifiable diseases submitted by health care providers and 
others.[Footnote 13] In addition, state-run laboratories conduct 
testing of samples for clinical diagnosis and participate in special 
clinical or epidemiologic studies. Finally, state public health 
departments verify cases of notifiable diseases, monitor disease 
incidence, and identify possible outbreaks within their states. At the 
federal level, agencies and departments generally collect and analyze 
surveillance data gathered from the states and from international 
sources, although some federal agencies and departments also support 
their own national surveillance systems and laboratory networks. 

When an issue crosses federal agency lines, as biosurveillance 
integration does, the agencies involved must collaborate to deliver 
results more efficiently and effectively. Due to NBIC's role as an 
integrator of information across the biosurveillance community, it is 
important for NBIC to ensure that it effectively collaborates with the 
NBIS to obtain the cooperation of this interagency community. One 
reason that it is important that NBIC effectively collaborate with 
federal partners is that agencies are not required by law to support 
NBIC or participate in the NBIS community. We have previously reported 
that for collaborating agencies to enhance and sustain collaboration, 
they need to, among other things, (1) have a clear and compelling 
rationale for working together; (2) establish joint strategies, 
policies, and procedures for aligning core processes and resources; (3) 
identify resources needed to initiate or sustain their collaborative 
effort; (4) work together to define and agree on their respective roles 
and responsibilities; and (5) develop accountability mechanisms to help 
implement and monitor their efforts to achieve collaborative results. 
[Footnote 14] 

NBIC Has Undertaken Efforts to Coordinate the NBIS and Acquire 
Resources, but Lacks Key Mission-Critical Elements: 

NBIC has made some efforts to put mission-critical elements in place, 
such as requesting data from other federal partners, initiating 
relationship-building activities among NBIC analysts and subject matter 
experts at other agencies, and establishing governance bodies to 
oversee and guide the NBIS. However, NBIC currently relies on publicly 
available data because it receives limited data from NBIS partners and 
generally lacks assignments of personnel from other agencies to 
leverage analytical expertise from across the NBIS partners. 

NBIC Generally Has Not Acquired Data from Other Agencies to Support the 
Early Detection Mission and Instead Relies on Nonfederal, Open-Source 
Data: 

NBIC's ability to acquire and consolidate data from NBIS partners as 
well as from nonfederal sources is central to achieving its mission. 
Current and initial drafts of the NBIS Concept of Operations reinforce 
this notion,[Footnote 15] noting that the identification of relevant 
and timely data sources, which act in combination to provide actionable 
information for decisionmaking, is essential to accomplishing early 
detection. NBIC has taken some action to acquire these types of data 
from NBIS partners, for instance, by requesting that NBIS partners 
identify the types of data they collect or generate that might aid in 
NBIC's early detection mission. However, as of October 2009, NBIC was 
generally not receiving the types of data best suited to early 
detection of biological events of national concern. NBIC officials 
acknowledge that they lack key data, and NBIC and other NBIS member 
officials described numerous challenges to sharing such information, 
including but not limited to scant availability of such data throughout 
the federal government and concerns about trust and control over 
sensitive information before it is vetted and verified. 

Based on our discussions with NBIS agency officials and review of NBIC 
documents, we have defined and verified with NBIC officials three 
categories of electronic data that are critical for NBIC to achieve its 
mission and might be available from federal agencies or other sources. 
As described in table 2, these data categories are (1) raw structured 
data, (2) raw unstructured data, and (3) final products which are 
typically briefings produced by other agencies in the course of 
monitoring routine and emerging disease. As of October 2009, NBIC was 
receiving some final products from NBIS partners, but was not receiving 
any raw data--particularly data that are generated at the earliest 
stages of a biological event. 

Table 2: Three Data Categories Collected by Federal Agencies: 

Data Category: Raw structured; 
Description: Data that have been collected in an electronic format that 
can be automatically processed by a computer but have not been analyzed 
to reach conclusions about their meaning, such as whether the data are 
signs of a potentially catastrophic infectious disease outbreak. These 
data may frequently be expressed in quantitative terms; 
Example: Codes that represent chief complaints reported by patients and 
entered into a hospital emergency room medical database or test results 
from health laboratories. 

Data Category: Raw unstructured; 
Description: Data that requires manual review or manipulation and are 
not structured for automatic processing by a computer system. Data is 
often qualitative rather than quantitative; 
Example: Media reports of disease outbreaks, gathered from free and 
subscription Internet sites. 

Data Category: Final products; 
Description: A final written product that contains an analysis and 
interpretation of data to provide contextual meaning. Products have 
been reviewed and approved by the leadership of the agency that created 
them before they are shared; 
Example: A written report that is issued after raw or unstructured data 
have been analyzed and interpreted to identify a disease cluster. 

Source: GAO analysis and verification with NBIC officials responsible 
for acquiring and using data. 

[End of table] 

According to officials, receipt of all three types of electronic data 
is important to help NBIC achieve its mission of detecting and warning 
of a biological event because detection of events that are novel, from 
multiple sources, or widespread requires analysis of multiple 
independent data streams. However, the officials told us that they do 
not receive from NBIS partners the raw structured or unstructured data 
that best support the early detection goal of biosurveillance. In 
particular, NBIC identified data that are generated at the earliest 
stages of a biological event--which can include raw data collected by 
federal agencies as part of their biosurveillance responsibilities--as 
being among the highest value for enabling the earlier detection of 
biological events of national concern. For instance, structured data, 
such as medical codes corresponding to diagnoses that are entered into 
databases, as well as some sources of unstructured data, such as 
written observations noted on medical forms, are generated at the 
earliest stages of a biological event and have been identified by NBIC 
as a high priority for early detection. These data can be collected or 
generated by federal agencies with responsibilities for biosurveillance 
and which are participating in NBIS. For example, HHS has developed a 
surveillance system that collects data on symptoms of patients entering 
emergency departments, that when analyzed with statistical tools, may 
be able to indicate the presence of an outbreak in less time than it 
takes to perform diagnostic lab tests. 

NBIC seeks to finalize three types of agreements with NBIS partners to 
articulate and establish protocols and legal authority for resource 
sharing: (1) MOUs, (2) interagency agreements (IAA), and (3) 
interagency security agreements (ISA).[Footnote 16] To date, 7 of the 
11 agencies have signed MOUs,[Footnote 17] but only 1 has a finalized 
ISA in place for data sharing, according to NBIC officials. As of 
October 2009, the federal agency that signed an ISA agreed to provide a 
single data source related to food safety. NBIC officials told us that 
although the agreement and the technology allowing the electronic data 
exchange are in place, the agency has not yet begun transferring the 
data to NBIC, and they did not know when to expect the transfer to 
begin. NBIC's inability to finalize agreements can be attributed in 
part to challenges it faces in ensuring effective collaboration, which 
will be discussed later in this report. 

Five NBIS partners provide NBIC with written final products, such as 
briefings produced on a routine basis that provide information on 
outbreaks of diseases or special alerts of potentially dangerous 
biological events issued as needed. However, NBIC officials noted that 
there are limitations on the value of final reports for supporting 
early detection. These finished products represent the agency's final 
analysis and interpretation of the raw data that it collects and have 
been reviewed and approved by the agency leadership for general 
dissemination to interested parties. According to NBIC officials, these 
products are generally useful for providing context but not for early 
detection of a biological event because they are not generated in a 
timely enough fashion to be valuable for detecting new biological 
events and focus on biological events that have already been detected. 

In the absence of proprietary information from NBIS partners, NBIC 
relies on mostly nonfederal sources of data, such as media reports of 
illness, to attempt to identify biological events. The bulk of data-- 
according to NBIC officials more than 98 percent--NBIC currently uses 
to pursue its mission is unstructured and comes from nonfederal, open 
sources, including an international information gathering service 
called Global Argus, a federally-funded program in partnership with 
Georgetown University. The service searches and filters over 13,000 
overseas media sources, in more than 34 languages. The practice of 
monitoring and translating local news articles has the potential to 
provide information about undiagnosed and other suspicious disease 
activity before it is reported through more official channels. NBIC 
officials stated that continuous monitoring of global news media 
sources and publicly available Web sites would be important to round 
out potential gaps in coverage, even if other data are available from 
federal agencies. 

NBIC Has Had Limited Success Obtaining Expertise from NBIS Partners 
through Interagency Personnel Assignments: 

NBIC officials told us that regardless of the quantity and quality of 
data types shared by collaborating agencies, effective biosurveillance 
depends on human analysts to interpret events and place them in 
context. For example, determining whether an outbreak of a new emerging 
infectious disease has occurred and further assessing whether this 
event is one of national concern are analytic judgments that require 
not only data but also the expertise of an experienced, knowledgeable 
analyst. According to these officials, analyst-to-analyst communication 
in a trusted environment is absolutely essential for rapid vetting, 
verification, and contextualization of events. 

The 9/11 Commission Act calls for member agencies to provide personnel 
to NBIC under an interagency personnel agreement and consider the 
qualifications of such personnel necessary to provide human, animal, 
and environmental data analysis and interpretation support.[Footnote 
18] However, for the most part, NBIC has not consistently received this 
kind of support from NBIS partners. Personnel detailed (that is, 
personnel employed by a federal agency and temporarily assigned to NBIC 
for a specified period of time) from other federal agencies enable 
analysis and interpretation of data by serving as subject matter 
experts for specific issues that are part of their home agencies' 
missions and as conduits of information from their respective home 
agencies. NBIC has signed MOUs with seven agencies, but only two have 
provided a personnel detail to the NBIC headquarters in Washington, 
D.C., and as of October 2009, only one of those personnel details was 
active, because one of those agencies did not replace personnel after 
the initial detail ended. NBIC officials told us that daily interaction 
with officials who had been on detail at NBIC not only enhanced their 
ability to interpret the information immediately on hand but also 
contributed to ongoing contextual learning for NBIC's analytical corps. 

Although most of the NBIS partners have not detailed their subject 
matter experts to NBIC, the integration center officials have used 
other means to obtain expertise and information from other agency 
analysts. NBIC officials told us that they have co-located the NBIC 
analysts at other collaborating agencies where they spend up to 2 weeks 
working with analysts from these other agencies both to learn more 
about their operations and to help forge ongoing relationships. NBIC 
officials stated they have also established a daily process to engage 
the NBIS in sharing information and analytic insights with each other. 
During this process--which NBIC calls the daily production process-- 
NBIC analysts compile information on reports of outbreaks that may be 
of concern, and then this information is disseminated to the NBIS 
community for discussion at a daily teleconference. The participants in 
the teleconference determine whether the events merit further 
monitoring or evaluation and share any relevant information they may 
have about the event. NBIC analysts then use the information gathered, 
as refined by the daily teleconference, to finalize NBIC daily reports 
and update its electronic Biosurveillance Common Operating Picture, 
which is a manually updated electronic picture of current worldwide 
biological events being tracked. 

For example, NBIC analysts might identify local news reports that 
suggest food contamination in a region. During the daily conference 
call, one or more of the agencies with responsibility for monitoring 
food safety or foodborne illness might contribute more information, 
such as a history of similar issues in the same geographical region, 
that gives more context to the reports. Then, collectively, the 
responsible agencies might decide that the event, first uncovered in 
open source media, warrants further investigation and monitoring. NBIC 
analysts would then post all known information to its electronic 
Biosurveillance Common Operating Picture for all interested parties to 
follow. Meanwhile, the agencies with missions of jurisdiction would 
conduct their investigations and report any new findings during the 
following day's teleconference. NBIC officials told us that this 
process requires a wide range of expertise from across the agencies. 
These officials said that they may also communicate directly with an 
agency prior to the daily teleconference if NBIC plans to discuss an 
item relevant to the agency's mission at the meeting. 

Another means NBIC uses to obtain expertise and information from other 
agency analysts is through participation in the Biosurveillance 
Indications and Warnings Analytic Community (BIWAC). The BIWAC is a 
self-governing interagency body composed of federal officials who are 
actively responsible for pursuing a biosurveillance mission. The 
agencies represented include: the Department of Defense, HHS's Centers 
for Disease Control and Prevention, USDA, DHS, and the intelligence 
community. The mission of the BIWAC is to provide a secure, interagency 
forum for the collaborative exchange of critical information regarding 
biological events that may threaten U.S. national interests. On behalf 
of the BIWAC, the Department of Defense's National Center for Medical 
Intelligence hosts an encrypted information sharing portal called 
Wildfire. According to NBIC's Chief Scientist and Deputy Director, in 
addition to engaging in the information exchange through Wildfire, she 
is an active supporter and participant in BIWAC meetings and 
teleconferences. 

According to NBIC officials, although these efforts to obtain the 
analytical insights of subject matter experts from collaborating 
agencies may be valuable, they do not provide a substitute for 
personnel details to the integration center itself. For example, with 
the daily teleconference, NBIC may have limited access to NBIS agency 
subject matter experts because analysts from only a few of the various 
agencies may be available for immediate communication on any given day, 
and not all agencies regularly participate in the daily teleconference. 
In addition, apart from the daily teleconference, NBIC officials said 
that agencies may limit NBIC's ability to communicate with their 
subject matter experts, particularly in the early stages of responding 
to a biological event when the agency is prioritizing its response 
needs. Finally, NBIC analysts may also communicate through federal 
agencies' operations centers during the course of an ongoing biological 
event, but NBIC officials noted that this channel of communication is 
not always an effective means to get meaningful input from agencies' 
subject matter experts. The lack of sustained personnel detailed to 
NBIC from other NBIS partner agencies can be attributed, in part, to 
challenges it faces with ensuring effective interagency collaboration, 
which will be discussed later in this report. 

NBIC Established Governance Structures to Develop and Oversee the NBIS: 

In order to support the ability for NBIS partners to engage in 
overseeing and guiding the NBIS, NBIC has established and administers 
two governance bodies. NBIC sponsors meetings of the two groups on a 
regular basis. The NBIS Interagency Oversight Council (NIOC) is 
composed of representatives at the assistant secretary level from each 
NBIS agency. The NIOC is to act as the senior oversight body to provide 
guidance and direction for the operation, implementation, and 
maintenance of the NBIS, as well as to resolve interagency or 
intradepartmental issues that cannot be resolved at lower levels. The 
NBIS Interagency Working Group (NIWG) is a senior, director-level 
working body created to share information on NBIC activities, such as 
the status of developing draft documents and standard operating 
procedures including procedures undertaken during ongoing biological 
events of national concern. The NIWG can also establish sub-working 
groups to conduct specific work as necessary to provide support to the 
NBIC and the NIOC. For example, NIWG established a sub-working group to 
propose procedures for resolving conflict during the daily production 
cycle. 

NBIC Uses an IT System to Manage Publicly Available Data and to 
Communicate Alerts, but Generally Lacks the Ability to Apply Analytical 
Tools to Data: 

One of the elements that is critical for NBIC to carry out its mission 
is development and maintenance of information technologies to support 
data collection, analysis, and communication of alerts. The 9/11 
Commission Act also specifically mentions the need for statistical 
tools to analyze data to identify and characterize trends of biological 
events of national concern.[Footnote 19] NBIC has taken steps to 
develop an IT system that can manage data from NBIS partners and can 
help identify open source reports of potential biological events, but 
NBIC largely lacks data from federal agencies. Given this condition, 
rather than a system designed to electronically process structured data 
received directly from NBIS partners, NBIC has configured its IT 
system--the Biosurveillance Common Operating Network (BCON)--primarily 
to identify and assemble unstructured data from public sources on the 
Internet that it will later vet with other NBIS analysts in the daily 
production process.[Footnote 20] Therefore, NBIC relies on the NBIS 
community and member agency subject matter experts for analysis and 
interpretation of publicly available data rather than providing the 
NBIS community with an analysis of integrated, raw, structured data 
from the NBIS partners. According to NBIC officials, they anticipate 
using BCON to manage any agency data streams that they may eventually 
acquire. 

BCON is a system of systems that is built on multiple commercial-off- 
the-shelf software packages. Currently, the central feature of BCON is 
its use of a set of keywords within a language algorithm to search the 
Internet for media articles that may contain biosurveillance-relevant 
information and compile them for NBIC analysts to review. As part of 
this function, BCON also flags events for immediate analyst attention. 
Additionally, the information from BCON is the basis for the NBIC 
Biosurveillance Common Operating Picture, which is a manually updated 
Google Maps application of current worldwide biological events being 
tracked. NBIS agency officials can view the Biosurveillance Common 
Operating Picture on the Homeland Security Information Network. 
[Footnote 21] According to NBIC officials, in the future NBIS agency 
officials will also have the ability to create and update event 
information. 

Although NBIC generally lacks direct-feed, raw, structured data from 
NBIS partners to apply statistical and analytical tools, according to 
our observations and review of documents supporting the development of 
the system, BCON is designed to locate and log information associated 
with the events contained in the open source media that it searches. 
This information includes the geographic coordinates and the date and 
time of occurrence for each event. This data is archived and, according 
to NBIC officials, can be used to conduct cross-domain analysis for 
trends, historical context, associated events, anomaly detection, and 
hypothesis generation. Among the applications planned for inclusion in 
BCON is a tool that is designed to perform historical analysis of this 
archived data to help monitor and refine the effectiveness of the 
algorithm. According to NBIC officials, the goal of this analysis is to 
help ensure that NBIC analysts will be able to identify events that 
merit attention by refining the algorithm to limit results that are 
less relevant for monitoring for biological events of national concern. 
However, these officials told us that this aspect of BCON has been put 
on hold due to budget constraints. 

To advance information sharing among federal agencies, NBIC is also 
pursuing $90 million dollars in supplemental funding for a broader 
information sharing initiative. This initiative is intended to enable 
greater information sharing capabilities among federal, state, and 
local agencies and to have the necessary data security to house 
classified data. According to NBIC officials, this initiative is being 
led by the National Security Council. 

To communicate alerts to member agencies and the larger NBIS community 
regarding any incident that could develop into a biological event of 
national concern, NBIC has developed an IT system to provide alerts and 
warnings, based on an existing system that had been developed for 
another DHS component. However, according to NBIC officials, the system 
has not yet been fully implemented because they recently acquired it, 
and NBIC is still testing protocols for using it. According to our 
observations of the system and review of operational protocols, the 
system provides NBIC with the capability to tailor alerts and warnings 
to specific recipients via distribution lists. These officials said 
that in spring 2008 the protocols were approved by the NIWG and briefed 
to the NIOC. NBIC officials said they are currently testing the 
protocols but have not yet needed to employ the system during a 
biological event. 

Use of Key Collaboration Practices Could Help NBIC Strengthen 
Collaboration and Promote Fuller Participation: 

Our analysis and interviews with NBIS partners suggest that NBIC could 
strengthen its use of collaborative practices. Because participation in 
the NBIS is voluntary, effective use of collaborative practices is 
essential to NBIC's ability to successfully develop and oversee the 
NBIS in a way that enhances federal biosurveillance capabilities. 
However, we found (1) widespread uncertainty and skepticism around the 
value of participating in the NBIS and the purpose of NBIC; (2) 
incomplete joint strategies, policies, and procedures for operating 
across agency boundaries; (3) an inability or unwillingness of NBIS 
members to respond to plans for leveraging resources; (4) confusion and 
dissatisfaction around the definitions of mission, roles, and 
responsibilities of NBIC and its NBIS partners; and (5) a lack of 
mechanisms to monitor and account for collaborative results. 

Clearly Defining the Mission and Purpose, the Value of Participation, 
and Joint Strategies and Procedures Could Promote More Effective 
Interagency Cooperation: 

Biosurveillance integration is an inherently interagency enterprise, 
requiring expertise and resources from various federal agencies, such 
as information on human and zoonotic diseases monitored by HHS and 
USDA.[Footnote 22] Indeed, NBIC officials acknowledged that NBIC cannot 
provide national-level capability for cross-domain biosurveillance 
relying solely on DHS resources. As a result, it is crucial for NBIC to 
ensure stakeholder buy-in and participation in clearly defining the 
value of NBIS participation and NBIC's mission or purpose, as well as 
establishing the strategies and procedures for how the partners will 
work together. Our prior work states that effective collaboration 
requires agencies to have a clear and compelling rationale for working 
together, which can be achieved by defining and articulating a common 
federal outcome or purpose.[Footnote 23] The rationale can be imposed 
externally through legislation or other directives or can come from the 
agencies' own perceptions of the value of working together. In either 
case, agency staff can accomplish this by working across agency lines 
to define and articulate the common purpose they are seeking to achieve 
that is consistent with their respective agency goals and mission. 
Because there is no legal requirement for agencies to participate in 
NBIS, agencies must have a clear and compelling rationale to work 
together as a community of federal partners by joining the NBIS and 
providing data and personnel to the integration center. In the case of 
an agency like NBIC, for which collaboration is essential, clearly 
defining and communicating its purpose and mission can help to ensure 
that partners share a vision of the desired outcomes.[Footnote 24] In 
addition, our work has shown that to enhance and sustain collaboration, 
it is important to establish joint strategies, policies, and procedures 
for operating across agency boundaries. Establishing joint strategies 
and compatible policies and procedures helps align collaborating 
agencies' activities, processes, and resources to, among other things, 
bring together diverse organizational cultures to enable a cohesive 
working relationship across agency boundaries and create the mutual 
trust required to sustain the collaborative effort. 

However, we found in interviews with agency officials from 14 
components of the 11 NBIS partners,[Footnote 25] widespread uncertainty 
and skepticism around the value of and rationale for participation in 
the NBIS and incomplete strategies, policies, and procedures for 
operating across agency boundaries that lack key stakeholder buy-in. 
Twelve of the 14 NBIS-partner components expressed uncertainty about 
the value of participating in the NBIS community or confusion about the 
purpose of NBIC. For example, officials from one component stated that 
they were uncertain whether sharing resources with the integration 
center, something that is required of members of the NBIS community, 
would further their agency's missions. Officials from another component 
expressed concerns about the rationale for participating in the NBIS 
and supporting the integration center, stating they were unsure whether 
NBIC contributed anything to the federal biosurveillance community that 
other agencies were not already accomplishing in the course of carrying 
out their biosurveillance-relevant missions. Officials from five of 
these components noted that their uncertainty about the value of 
participation in the NBIS was a factor in not assigning personnel to 
NBIC. Further, officials from 7 of the 14 components we interviewed 
indicated that their experience with a recent tabletop exercise and 
real life events had contributed to their concerns about the value of 
participating in NBIS and the purpose of NBIC. For example, officials 
from one component said that the tabletop exercise showcased agencies' 
reluctance to share information and underscored that there was no role 
for NBIC; while officials from another component said that during 2009 
H1N1 activities, NBIC was not able to demonstrate that it had unique 
value to add. Officials from seven of the components indicated that 
they lacked a concrete understanding of the purpose for which NBIC was 
requesting their agencies' data, which was, in part, the reason they 
had not been able to identify appropriate data sources or to work out 
data sharing agreements with NBIC. 

NBIC officials told us that they regularly reminded NBIS partners of 
NBIC's mission as the coordinator of the NBIS and the value of sharing 
data and personnel to achieve the goal of earlier detection and 
enhanced situational awareness. However, officials from 8 of the 14 
components told us that during negotiations with NBIC, they had raised 
concerns about the purpose of the data or the value of detailing 
personnel to NBIC, and NBIC had not followed up in a timely and 
consistent manner to resolve those concerns. NBIC officials also stated 
that they have taken actions to demonstrate the value of participating 
in NBIS and of sharing resources with the integration center. For 
example, NBIC co-located the integration center's analysts with 
analysts at other agencies, such as the Centers for Disease Control and 
Prevention, for brief periods of time to enhance mutual understanding 
between NBIC and NBIS partner agencies. Further, NBIC officials have 
attempted to demonstrate the value of participating in NBIS and 
supporting the integration center by encouraging agencies to 
participate in NBIC's daily production process. NBIC officials said 
that through daily engagement in the production process and during 
recent real life events like food borne illness outbreaks they have 
been able to demonstrate the value of NBIC. However, agency officials 
told us that their experiences with NBIC during real life events and 
the tabletop exercise created questions about the value of 
participating in the NBIS and NBIC's purpose. 

NBIC officials have drafted but not completed a strategic plan for NBIC 
that includes a mission statement, which could help clarify NBIC's 
purpose. The plan is also to provide strategic and operational guidance 
to NBIC officials for achieving that mission. According to NBIC 
officials, however, they have not shared the draft strategic plan with 
NBIS officials or solicited their input, and it is not currently their 
plan to do so because it is an internal document. Officials have not 
set a deadline for completing the NBIC strategic plan because they are 
still in the process of vetting the initial draft internally. 

In addition to uncertainty about the value of participating in the NBIS 
and the purpose of NBIC, we also found that NBIC has not completed and 
achieved buy-in for joint strategies, policies, and procedures for 
operating across agency boundaries. NBIC has drafted a Concept of 
Operations, which is intended to communicate joint strategies, 
policies, and procedures for operating across the NBIS. According to 
NBIC officials, they have solicited and considered comments from NBIS 
partners as they developed the draft, which is currently on its third 
version. However, NBIC has not yet achieved agreement around 
strategies, policies, and procedures that would support effective 
collaboration across the NBIS. For example, one key partner agency--one 
for which biosurveillance is a mission critical function and is thus 
essential to a strong and effective NBIS--shared with us a memo they 
had written to NBIC expressing their lack of concurrence with the 
current Concept of Operations. The memo cited several concerns that 
related largely to lack of clarity in the document about the desired 
common federal outcome and the role of the different partners in 
achieving it. NBIC officials told us they plan to finalize the Concept 
of Operations by the end of 2009. 

Clearly defining its mission, as well as articulating the value of 
participation in the NBIS, could help NBIC overcome challenges 
convincing agencies to work collectively as part of the NBIS. In 
addition, establishing and clarifying joint strategies, policies, and 
procedures with buy-in across the NBIS, could help address barriers to 
collaboration. 

NBIC Has Not Clearly Identified How to Leverage Resources or 
Effectively Defined Roles and Responsibilities with NBIS Partners: 

Two of the collaborative practices we recommend speak to how agencies 
will share human and other assets to achieve the desired outcomes-- 
identifying and addressing needs by leveraging resources and agreeing 
on roles and responsibilities.[Footnote 26] According to NBIC 
officials, the concept of a national center for integrating 
biosurveillance data from multiple agencies depends on the willingness 
of the collaborating agencies to detail their experts to the center for 
a period of time to interpret the data for signs of an outbreak or 
biological attack; consequently, effectively identifying what resources 
are available and how to leverage them is important. 

In our work on practices to enhance and sustain collaboration, we call 
for agencies to assess relative strengths and weaknesses to identify 
opportunities to leverage each other's resources, thus obtaining 
additional benefits that would not be available were the agencies 
working separately. However, agency officials we met with stated that 
NBIC did not recognize the different levels of resources and capacities 
that each agency brought to this effort. Seven of the 14 groups of 
agency officials we interviewed noted that the NBIC made personnel 
requests that were not compatible with the resources agencies had 
available. For example, one of the comments officials made to us 
regarding NBIC's request for personnel details was that they did not 
have available or could not spare personnel that matched NBIC's request 
for senior-level officials with sufficient analytical knowledge and 
authority to make immediate decisions about sharing information across 
the NBIS. Officials from one of the components without a direct 
biosurveillance mission told us that they only have one such person on 
staff and needed to keep that person in house to be able to carry out 
their mission-critical activities. Officials at two agencies described 
methods they had devised for human-resource sharing arrangements that 
did not involve locating senior staff at NBIC for several months. 
However, NBIC officials told us that this is no substitute for the 
value of a member agency personnel detail that is physically located at 
NBIC. NBIC officials noted that the Secretary of Homeland Security had 
sent a memo to other NBIS agency leadership requesting help in securing 
personnel details on May 23, 2008. In addition, they stated that the 
issue is regularly addressed in NIWG and NIOC meetings. The officials 
also provided several examples of outreach to NBIS officials at all 11 
agencies, such as through discussions with NBIS partner agency 
representatives at NIWG meetings. 

Similarly, 5 of 14 groups of officials we interviewed reported that 
they had experienced confusion about how NBIC planned to use personnel 
details if they were provided. For example, one such agency expressing 
this confusion said that NBIC's guidance on what it is looking for in a 
personnel detail had changed frequently. NBIC officials told us that 
initially they requested individuals with strong scientific backgrounds 
to assist with data analysis and interpretation (analyst model). 
However, they later determined that they could use senior-level agency 
officials who were knowledgeable about their home organization to act 
as liaisons by identifying specific subject matter experts to consult 
with NBIC, as needed (liaison model). According to these NBIC 
officials, they have communicated to the NBIS partners that if they 
detail personnel to NBIC, they can follow either the analyst model or 
the liaison model. Nevertheless, during our interviews a lack of 
clarity about personnel detail roles and responsibilities was among the 
reasons cited for not finalizing MOUs or interagency agreements for 
personnel details. 

Of the two NBIS partners that placed personnel at NBIC, officials from 
one agency told us that although they still were not entirely clear on 
NBIC's needs, they were committed to the NBIS concept. Therefore, they 
committed to send two half-time detailees each fitting one of the two 
types of detailees NBIC had alternately requested. These personnel 
details were ongoing as of October 2009. According to agency officials, 
they committed to a shorter detail than NBIC requested because they 
intend to use the current detail placement to help clarify for 
themselves what NBIC's needs are and the extent to which the detail 
arrangement might be valuable to their agency. However, officials at 
the only other agency that had detailed personnel to NBIC told us that 
they had not renewed the detail agreement when it ended, in part 
because of budgetary challenges, but also because of a general 
perception at their agency that the detail had not been particularly 
valuable for the individual or for their agency. According to NBIC 
officials, the personnel details from this agency assisted NBIC 
immeasurably in both the analysis work and in thinking through how to 
grow and shape the personnel detail program. 

We also discuss in our work on practices for enhancing and sustaining 
collaboration the importance of defining and agreeing on roles and 
responsibilities, to allow each agency to clarify who will do what, 
organize their joint and individual efforts, and facilitate decision 
making.[Footnote 27] Our analysis of NIOC and NIWG post meeting 
reports, NBIS tabletop exercise results, and interviews with NBIS 
agency officials reveals some ambiguity about NBIC's mission, roles, 
and responsibilities, particularly during a crisis. Officials from 8 of 
14 components we interviewed expressed uncertainty about NBIC's role 
during a response relative to the biosurveillance capability provided 
by other agencies in the course of their routine, mission-critical 
duties. In large part, these officials said that if they had 
information to share that might involve a biological emergency, they 
would be more likely to interact with DHS's National Operations Center 
(NOC), at which NBIC has representation, than directly with NBIC. 
[Footnote 28] The after action report, as well as comments from these 
officials, show that such questions about NBIC's response role 
manifested during a recent tabletop exercise. In our interviews, 
officials from seven components expressed concerns about NBIC's role in 
the exercise or real life events, ranging from lack of clarity about 
what role NBIC played or should play to statements that the exercise 
showed clearly that NBIC has no proper role in event response. 
According to the memo that the moderator prepared after the tabletop 
exercise, although the NOC did not participate, some participants 
thought NBIC would have been bypassed in favor of the NOC. They said 
the NOC would perform the essential biosurveillance integration roles 
of coordinating and disseminating information across agencies, states, 
and the private sector. In addition, the memo notes that exercise 
participants were not in agreement about the proper role for NBIC in 
ongoing collection and dissemination of data specific to an identified 
event. Among the recommendations in the after-action memo was for NBIC 
to work internally with the appropriate DHS parties, including the NOC, 
to write protocols defining the NBIC role inside DHS. According to NBIC 
officials, they have followed up on this recommendation, by among other 
things, exploring it through the NIWG. Additionally, NBIC, the NOC, and 
other stakeholders have initiated discussions about how to develop 
appropriate protocols. 

A related issue that came to light during the tabletop exercise and was 
a theme in interviews with NBIS officials is the extent to which NBIS 
partners trust NBIC to use their information and resources 
appropriately. According to the exercise after-action memo, 
participants repeatedly raised concerns about trusting NBIC with data, 
and participants also expressed concern that NBIC would reach the wrong 
conclusions or disseminate erroneous data or reports. Similarly, in our 
semistructured interviews, officials from 5 of 14 components said they 
were cautious about sharing data or information with NBIC because they 
lack confidence that NBIC will either interpret it in the appropriate 
context or reach back to the agency to clarify before sharing the data 
across the whole interagency community. These comments generally noted 
concerns that NBIC's lack of contextual sophistication could lead to 
confusion, a greater volume of unnecessary communication in the 
biosurveillance environment, or even panic. NBIC officials acknowledged 
that subject matter expertise from the agencies with frontline 
responsibility for disease surveillance is essential for drawing 
appropriate conclusions about emerging situations. However, they also 
noted that analysts at NBIC have experience with public health and have 
been building their expertise as the program matures. Clearly 
identifying how NBIS resources, including personnel details, will be 
leveraged and establishing institutional roles and responsibilities, 
could strengthen NBIC's efforts to obtain buy-in for agencies to fully 
participate in the NBIS, including by committing to personnel detail 
arrangements. 

Creating a Mechanism to Monitor Performance and Accountability Could 
Help NBIC Enhance and Sustain Collaboration: 

We have previously reported that federal agencies can use their 
strategic and annual performance plans as tools to drive collaboration 
with other agencies and partners.[Footnote 29] Such plans can also 
reinforce accountability for collaboration by establishing performance 
measures and aligning agency goals and strategies with those of the 
collaborative efforts. Using established performance measures to 
evaluate and report on the effectiveness of collaboration could 
identify ways to improve it. NBIC's draft strategic plan outlines 
milestones, goals, objectives, and key tasks needed for NBIC to meet 
its mission. These tasks include, among other things, defining an 
information-sharing strategy among its stakeholders, deploying IT to 
support its mission, and establishing standard operating procedures. 
However, despite acknowledging that interagency cooperation and 
collaboration remain a concern to resolve, the strategic plan does not 
address how NBIC will improve collaboration among current and potential 
NBIS member agencies or how it will measure collaborative results. 
NBIC's draft strategic plan includes one proposed performance metric 
related to collaboration with NBIS partners--to assess current 
collaboration activities for relevance and contribution to NBIS mission 
requirements. However, the plan lacks a discussion of strategic 
objectives to achieve collaboration and, correspondingly, lacks 
associated measures and targets to monitor efforts to achieve 
collaborative results. Strategic objectives for collaboration and 
associated targets and measures could provide NBIC with a critical tool 
to help ensure that it appropriately focuses its efforts on enhancing 
collaboration with NBIS members and that the desired results are 
achieved. 

Leveraging NBIS Governing Bodies to Develop a Strategy for 
Collaboration Could Help NBIC More Effectively Meet Its Mission: 

NBIC has the means to engage NBIS partners through the organizations 
that help organize and manage the NBIS community--the NIOC and the 
NIWG--but our analysis shows the integration center has not yet fully 
leveraged these groups to develop effective collaboration strategies. 
The purpose of the NIOC and NIWG governance bodies is to provide 
strategy and policy advice on the operation of the NBIS. Information on 
the status of NBIC's efforts to achieve its mission has been provided 
to the NIOC, an oversight council serving the NBIS community, but 
substantive discussion of strategies for overcoming barriers to 
collaboration that impact NBIC's execution of its mission did not occur 
during meetings with the NIOC. For example, post meeting reports from 
the NIOC--the higher level strategic governance body for the community 
of NBIS partners--show that the NBIC director routinely gave a status 
update of the MOUs and interagency agreements for each agency, during 
which agencies report the status from their perspective. However, in 
these segments of the NIOC meetings, the post meeting reports reflect 
little, if any, discussion of the reasons NBIS agency officials cited 
in our interviews for not finalizing the agreements. Neither do the 
reports show any focused effort to discuss barriers to participation or 
solutions to working across agency boundaries. 

The NIWG--operational level working group--post meeting reports between 
March 2008 and May 2009 reflect only one discussion during which the 
need to finalize agreements was addressed. Although the NIWG has formed 
a sub-working group specifically to address collaboration, our review 
of the post meeting reports shows that neither the full NIWG nor the 
sub-working group has been effectively engaged in a focused effort to 
identify, discuss, and address challenges to working across agency 
boundaries. According to NBIC officials, they place contentious issues 
before the NBIS governance structure in a way that may not be clearly 
captured in post meeting reports. NBIC officials noted that the post 
meeting reports do not clearly reflect the numerous times they have 
made proposals for solutions to problems and have been met with silence 
from the attendees. However, they acknowledge that they have approached 
the NBIS governance bodies seeking buy-in for their proposals for 
tactical and operational approaches rather than an open-ended 
discussion seeking strategic solutions to the broader barriers to 
information and resource sharing. Leveraging these bodies to get 
meaningful input from NBIS-partner leadership could help NBIC ensure 
that it is able to identify commonly accepted solutions to working 
across agency boundaries. 

Conclusions: 

Enhancing the federal government's ability to detect and warn of 
biological events of national concern and to provide better situational 
awareness for response to those events depends on multiple actors 
inside and outside the federal government to work together effectively. 
The 9/11 Commission Act charged NBIC with early detection and 
situational awareness, but both the act and the operational guidance 
NBIC has developed acknowledges that this is to be done, in large part, 
through the NBIS--a multi-agency collaborative community. Despite the 
critical role of this collaborative community in achieving the act's 
charge, the act does not require any specific agency to participate in 
the NBIS or to support the integration center. Therefore, it is 
imperative that NBIC employ collaborative practices to enhance and 
sustain collaboration across the NBIS so that this community of federal 
partners are fully and effectively engaged in pursuit of the 
overarching missions of early detection and enhanced situational 
awareness. 

Although NBIC has made some efforts to strengthen relationships with 
and solicit participation from NBIS partners, working with the NBIS to 
develop a strategy for collaboration that includes key collaboration 
practices identified in our previous work could help the integration 
center promote more effective collaboration. During the course of our 
review, officials from the NBIS community recounted a number of 
constraints on their participation, including concerns about the 
clarity of NBIC's mission and the ends to which shared information and 
resources would be used. We have previously reported that having a 
mission statement helps to clarify an agency's focus and purpose. 
Moreover, our prior work on enhancing and sustaining collaboration in 
the federal government advises that practices such as articulating 
common outcomes, identifying appropriate resources to be shared, 
clarifying roles and responsibilities, and developing mechanisms to 
monitor performance and accountability could help NBIC address barriers 
to collaboration. However, NBIC has not formulated goals and objectives 
for overcoming barriers to collaboration and has no supporting 
performance and accountability mechanisms--such as performance 
measures--to help ensure that they are pursuing those goals 
effectively. In addition, although NBIC has created the NIOC and NIWG 
to provide strategic and operational advice on how the NBIS should 
function, NBIC had not effectively engaged them in a focused effort to 
identify shared solutions for overcoming barriers to collaboration and 
creating buy-in for joint strategies, policies, procedures, roles, and 
responsibilities. A strategy for helping ensure that NBIC applies key 
collaborative practices effectively and consistently, that draws on the 
existing intellectual resources of its strategic partners in the NIOC, 
and that includes mechanisms to monitor performance and accountability 
for collaborative results, may help NBIC and NBIS partners to identify 
and overcome challenges to sharing data and personnel for the purposes 
of earlier detection and enhanced situational awareness of potentially 
catastrophic biological events. 

Recommendations for Executive Action: 

In order to help NBIC ensure that it effectively applies practices to 
enhance and sustain collaboration, including the provision of data, 
personnel, and other resources, we are making the following two 
recommendations to the Director of NBIC: 

* In conjunction with the NIOC, finalize a strategy for more 
effectively collaborating with current and potential NBIS members, by 
(1) clearly defining NBIC's mission and purpose, along with the value 
of NBIS membership for each agency; (2) addressing challenges to 
sharing data and personnel, including clearly and properly defining 
roles and responsibilities in accordance with the unique skills and 
assets of each agency; (3) developing and achieving buy-in for joint 
strategies, procedures, and policies for working across agency 
boundaries. 

* Establish and use performance measures to monitor and evaluate the 
effectiveness of collaboration with current and potential NBIS 
partners. 

Agency Comments and Our Evaluation: 

We provided a draft of this report for review and comment to the 
following agencies: DHS, HHS, USDA, and the Departments of Commerce, 
Defense, Interior, Justice, State, Transportation, and Veterans 
Affairs, as well as the Environmental Protection Agency and the United 
States Postal Service. DHS provided written comments on December 10, 
2009, which are summarized below and presented in their entirety in 
appendix I of this report. HHS, USDA, and the Departments of Commerce, 
Defense, Interior, Justice, Transportation, and Veterans Affairs, as 
well as the Environmental Protection Agency and the United States 
Postal Service did not provide written comments. We incorporated 
technical comments from DHS, USDA, and the United States Postal Service 
where appropriate. 

DHS generally concurred with our findings and recommendations and 
stated that NBIC will work with the NIOC and all NBIS partners to 
develop a collaboration strategy to clarify both the mission space and 
roles and responsibilities of all NBIS partners. DHS has taken initial 
steps to implement our recommendations. For example, DHS noted that at 
the December 9, 2009, quarterly NIOC meeting, the Assistant Secretary 
of Health Affairs and Chief Medical Officer for DHS, Dr. Alex Garza, 
referenced this report's findings and challenged NIOC members to work 
to resolve and address confusion regarding NBIS and NBIC. We are 
encouraged by DHS's efforts to engage the NIOC to identify and overcome 
barriers to collaboration; continuing to work with the NIOC to develop 
and finalize a strategy for collaboration could help NBIC overcome 
challenges to sharing data and personnel. In addition, monitoring the 
effectiveness of collaboration through the use of performance metrics 
could help NBIC ensure they are progressing towards their goal of 
obtaining the resources necessary to accomplish its mission of early 
detection and situational awareness of biological events of national 
concern. 

While DHS stated that we clearly identify the challenges faced by NBIC 
in carrying out its mission, the department also commented that the 
lack of a legal requirement for other federal agencies to participate 
in the NBIS prevents DHS from compelling the cooperation that is needed 
to ensure success of the NBIC mission. As we noted in our report, the 
lack of a legal requirement is what makes the effective use of 
collaboration best practices crucial for NBIC to be successful. 

We are sending copies of this report to the Secretary of Homeland 
Security, Secretary of Health Human and Services, Secretary of 
Agriculture, Secretary of Commerce, Secretary of Defense, Secretary of 
Interior, Attorney General, Secretary of State, Secretary of 
Transportation, and the Secretary of Veterans Affairs, as well as the 
Administrator of the Environmental Protection Agency, the Postmaster 
General, the Director of NBIC, and interested congressional committees. 
The report is also available at no charge on GAO's Web site at 
[hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report please 
contact me at (202) 512-8777 or JenkinsWO@gao.gov. Contact points for 
our Offices of Congressional Relations and Public Affairs may be found 
on the last page of this report. GAO staff who made major contributions 
to this report are listed in appendix II. 

Signed by: 

William O. Jenkins, Jr. 
Director, Homeland Security and Justice Issues: 

[End of section] 

Appendix I: Comments from the Department of Homeland Security: 

US. Department of Homeland Security: 
Washington, DC 20528: 

December 10, 2009: 

Mr. William 0. Jenkins: 
Director, Homeland Security and Justice Issues: 
U.S. Government Accountability Office: 
441 G St., N.W. 
Washington, D.C. 20548: 

Dear Mr. Jenkins: 

Thank you for the opportunity to review and provide comments on the 
Government Accountability Office's (GAO) draft report titled, 
Biosurveillance: Developing a Collaboration Strategy Is Essential to 
Fostering Interagency Data and Resource Sharing (GAO-10-171).
The Department of Homeland Security (DHS) has reviewed the referenced 
draft GAO report and generally concurs with its findings regarding the 
National Biosurveillance Integration System (NBIS) and the National 
Biosurveillance Integration Center (NBIC). DHS would, however, like to 
offer two additional comments to more properly place the 
recommendations in context. 

First, the GAO report clearly identifies the challenges faced by NBIC 
in carrying out its mission — challenges exacerbated by the lack of 
data and personnel resources from federal partner agencies. DHS 
respectfully points out that there is no legal requirement for other 
federal agencies to cooperate with NBIC, and therefore, DHS cannot 
compel the cooperation that is needed to ensure success of the NBIC 
mission. Nonetheless, DHS has and will continue to make every effort to 
engage appropriate interagency members and bolster confidence in the 
NBIC mission, which is to provide homeland security-relevant 
biosurveillance information to senior leaders and partner agencies 
regarding natural disease outbreaks, accidental or intentional uses of 
biological agents, and emergent biohazards through the acquisition, 
integration, analysis and dissemination of information from existing 
human disease, food, agriculture, water, meteorological, and 
environmental surveillance systems and relevant threat and intelligence 
information. 

Second, DHS acknowledges the shared responsibility among NBIC and the 
NBIS partners related to GAO's findings that there is "widespread 
confusion, uncertainty, and skepticism around the value of 
participation in the interagency community, as well as the mission and 
purpose of NBIC." NBIC established the NBIS Interagency Oversight 
Council (NIOC) as an Assistant-Secretary-level governance function to 
provide guidance and assist in the resolution of interagency issues 
that are not resolved at the staff level. All NBIS partners are 
represented at the NIOC and other working groups. Since the signing of 
the NIOC charter in August 2008, the NIOC has met quarterly to review 
NBIC actions, progress, and future plans. In August 2009, Dr. Alex 
Garza was appointed as the Assistant Secretary of Health Affairs and 
Chief Medical Officer for DHS. At the December 9, 2009, NIOC meeting, 
Dr. Garza referenced GAO's findings and challenged NIOC principals to 
work to resolve and address confusion regarding NBIS and NBIC. The NBIC 
will work with the NIOC and all NBIS partners to develop a strategy to 
eliminate the impediments to collaboration to clarify both the mission 
space and roles and responsibilities of all NBIS participants. Through 
the focused, joint efforts of the NIOC principals, NBIS partners and 
the NBIC staff, we will improve our Nation's biosurveillance 
capabilities to better secure and protect the homeland from intentional 
and naturally occurring biological threats and events. 

DHS is dedicated to ensuring the Nation is prepared against all threats 
and will ensure NBIC is best able to accomplish its important mission. 
Thank you for the opportunity to review and provide comments to the 
draft report and we look forward to working with you on future homeland 
security issues. 

Sincerely, 

Signed by: 

Jerald E. Levine: 
Director: 
Departmental DHS GAO/OIG Liaison: 

[End of section] 

Appendix II: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

William O. Jenkins, Jr., (202) 512-8777 or jenkinswo@gao.gov: 

Acknowledgments: 

In addition to the contact named above, Anne Laffoon, Assistant 
Director; Michelle Cooper; Clare Dowdle; Kathryn Godfrey; and Andrea 
Yohe made significant contributions to the work. Keira Dembowski, 
Susanna Kuebler, Alberto Leff, and Juan Tapiavidela also provided 
support. Amanda Miller assisted with design, methodology, and analysis. 
Tracey King provided legal support. Linda Miller provided 
communications expertise. 

[End of section] 

Footnotes: 

[1] GAO, Homeland Security: Much Is Being Done to Protect Agriculture 
from a Terrorist Attack, but Important Challenges Remain, [hyperlink, 
http://www.gao.gov/products/GAO-05-214] (Washington, D.C.: Mar. 8, 
2005). 

[2] Pub. L. No. 110-53 § 1101, 121 Stat. 266, 375-79 (2007) (codified 
at 6 U.S.C. § 316). 

[3] § 1102, 121 Stat. at 379. 

[4] The 9/11 Commission Act defines an NBIS "Member Agency" as a 
federal department or agency that has signified its willingness to 
participate in the NBIS by signing a memorandum of understanding with 
NBIC. 6 U.S.C. § 316(j)(4). We use the term "NBIS partner" throughout 
this report to describe those federal departments and agencies and 
their related components that NBIC has identified as having potential 
to share relevant information and data with the NBIS community 
irrespective of whether the agency in question has entered into any 
interagency agreement. At least one such federal department, for 
example, told us that it does not plan to sign a memorandum of 
understanding to become a "Member Agency," but participates with the 
NBIS community to some degree. 

[5] GAO, Biosurveillance: Preliminary Observations on Department of 
Homeland Security's Biosurveillance Initiatives, [hyperlink, 
http://www.gao.gov/products/GAO-08-960T] (Washington, D.C.: July 16, 
2008). 

[6] NBIC issued the first version of the Concept of Operations in 
December 2007. Subsequently, NBIC created version 2.0 of the Concept of 
Operations, which has not yet been finalized. We reviewed both of these 
documents in the course of our work. 

[7] NBIC has identified the following NBIS partners at the federal 
level--The Departments of Health and Human Services (HHS), Agriculture 
(USDA), Commerce, Defense, Interior, Justice, State, Transportation, 
and Veterans Affairs, as well as the Environmental Protection Agency 
and the United States Postal Service. 

[8] GAO, Results-Oriented Government: Practices That Can Help Enhance 
and Sustain Collaboration among Federal Agencies, [hyperlink, 
http://www.gao.gov/products/GAO-06-15] (Washington, D.C.: Oct. 21, 
2005). 

[9] Situational awareness, in the biosurveillance context, includes 
cognizance of the existence and meaning of a biological threat, as well 
as the ability to make projections regarding its probable status in the 
near future--for example, the likelihood of an emerging infectious 
disease becoming an epidemic. 

[10] 6 U.S.C. § 316. 

[11] In July 2007 the DHS Office of Inspector General reported that the 
program lacked sustained program leadership and was not a priority, 
because ownership of the program shifted among department organizations 
numerous times, with corresponding fluctuations in the program 
approach, priority, and accomplishments. According to the DHS Inspector 
General, despite the changes in program focus, the program benefited 
from increased senior-level support and priority under the Office of 
the Chief Medical Officer. DHS OIG Report, Better Management Needed for 
the National Bio-Surveillance Integration System Program, OIG-07-61 
(July 26, 2007). 

[12] HSPD-10, also called Biodefense for the 21st Century, describes 
four "pillars" of biodefense: (1) threat awareness, (2) prevention and 
protection, (3) surveillance and detection, and (4) response and 
recovery. 

[13] Most states use a national list of notifiable diseases maintained 
and revised by the Council of State and Territorial Epidemiologists in 
collaboration with HHS's Centers for Disease Control and Prevention. 
This national list is reviewed annually and revised periodically. 
However, each state adapts this list such that the diseases considered 
notifiable and the requirements for reporting them vary by state. 

[14] [hyperlink, http://www.gao.gov/products/GAO-06-15]. 

[15] NBIC issued the first version of the NBIS Concept of Operations-- 
version 1.0--in December 2007. Subsequently, NBIC issued version 1.1 of 
the Concept of Operations in October 2008 and created version 2.0 of 
the Concept of Operations to incorporate NBIS member comments regarding 
the earlier versions. NBIC shared the latest version with NBIS member 
agencies for review in August 2009 and it is currently undergoing 
interagency review. 

[16] The MOU is a general agreement to participate in NBIC. The IAA is 
a more specific agreement that outlines how personnel will be shared. 
The ISA, which ultimately must be finalized for data to be shared, 
addresses security and privacy issues related to the handling of the 
data. 

[17] The number of MOUs signed does not directly reflect the level of 
agency participation in the NBIS. In the absence of an MOU outlining 
agencies' agreement to participate in the NBIS, NBIC and other NBIS 
officials told us that federal agencies may still take part in NBIS 
activities. For example, three of the federal agencies that have not 
signed an MOU participate in key NBIS processes and meetings while some 
agencies have not provided data or personnel to NBIC even though they 
have signed an MOU. 

[18] 6 U.S.C. § 316(e)(1)(F). 

[19] 6 U.S.C. § 316(c)(3). 

[20] The early version of the information management system was called 
NBIS 2.0, but it is currently known as the Biosurveillance Common 
Operating Network. For the purposes of this report, we use the current 
NBIC nomenclature, where NBIS refers to a community of stakeholders and 
the Biosurveillance Common Operating Network is the technology 
management system. 

[21] The Homeland Security Information Network is a comprehensive, 
nationally secure and trusted Web-based platform able to facilitate 
Sensitive but Unclassified information sharing and collaboration among 
federal, state, local, tribal, private sector, and international 
partners. 

[22] Zoonotic diseases are those that can be transmitted from animals 
to humans. 

[23] [hyperlink, http://www.gao.gov/products/GAO-06-15]. 

[24] In addition to our call for agencies to clearly define common 
outcomes to support collaborative efforts, we have also recommended 
clearly defined mission statements to keep agency objectives in focus. 
In prior work on strategic planning and management, we have reported 
that statements that clearly define the mission of an organization are 
important because they bring the agency into focus, explain why the 
agency exists, and tells what it does. GAO, Agencies' Strategic Plans 
under GPRA: Key Questions to Facilitate Congressional Review, GAO/GGD-
10.1.16 (Washington, D.C.: May 1997). 

[25] At HHS, we interviewed a group of officials from the Office of the 
Assistant Secretary for Preparedness and Response, groups of officials 
at the Centers for Disease Control and Prevention, and a group of 
officials from the Food and Drug Administration. At USDA, we 
interviewed officials from the Animal and Plant Health Inspection 
Service and the Food Safety Inspection Service. At the Department of 
Defense, we interviewed a group of officials responsible for medical 
force readiness and a group of officials at the National Medical 
Intelligence Center. Although DHS is a member of the NBIS, we excluded 
DHS from our analysis of these 14 components from 11 federal agencies 
because it houses the program. 

[26] [hyperlink, http://www.gao.gov/products/GAO-06-15]. 

[27] [hyperlink, http://www.gao.gov/products/GAO-06-15]. 

[28] DHS's NOC is to provide real-time situational awareness and 
monitoring, coordinate incidents and response activities, and, in 
conjunction with the Office of Intelligence and Analysis, issue 
advisories and bulletins concerning threats to homeland security, as 
well as specific protective measures. The NOC operates 24 hours a day, 
7 days a week, 365 days a year. Information on domestic incident 
management is shared with Emergency Operations Centers at all levels 
through the Homeland Security Information Network. 

[29] [hyperlink, http://www.gao.gov/products/GAO-06-15]. 

[End of section] 

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