We can perhaps best summarize this introductory chapter about the biosurveillance process and its role in biodefense with an analogy.
An individual or an organization that is operating a biosurveillance system is like a military commander who cannot see directly every threat he faces. The commander relies on "surveillance systems'' that include reports from frontline units, reconnaissance, and sensing systems located in aircraft or in orbit to make tactical decisions. Both the military commander and a biosurveillance organization are decision makers who make high-stakes decisions under time pressure by using incomplete and uncertain information. Both the military commander and the biosurveillance organization have the ability to increase the information available (by sending out additional reconnaissance or by initiating an outbreak investigation), but that new information comes at a price, which involves both the cost of the investigation as well as the "cost'' of waiting for additional information before acting. This latter cost can be quite high should either disease or a military opponent gain the upper hand during the delay. Interestingly, the technologies that the military and biosurveillance organizations use-signal processing, risk-benefit analyses, methods for decision support—are either already similar or converging.
Like most analogies, this one breaks down the further one goes into detail. The level of training required for the surveillance task in the military is less than that required for the biosurveillance task, and the data required by the commander and the biosurveillance organization are completely different.
Nevertheless, like a military commander, an organization that conducts biosurveillance is primarily action oriented and conducts biosurveillance as a means, not as an end.
Biosurveillance is a means to the end of protecting health. It is an indispensable means to that end, which is absolutely dependent on the quality and timeliness of biosurveillance.
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