Our team was born out of a concern for failure to warn on multiple biological threats that have had historical significance to the United States and its allies:
- the influenza pandemics of 1957, 1968, and 2009
- SARS and MERS
- West Nile virus translocation to the United States
- HIV / AIDS
- biological weapons research, development, and live deployments at multiple points in history
- the war of attrition over antimicrobial resistance
The problem here is a lack of awareness or (for those who know the details) acknowledgement of these examples of failure of Command, Control, Communications, Intelligence, and Reconnaissance (C3IR). While most lay people may be able to intuit the importance of earliest detection and warning of the above bulleted issues, this came very close to home recently with the failed anticipation of the 2009 H1N1 influenza pandemic, which placed our President's life nearly in jeopardy. To this day, we continue to be amazed at the number of public health reporting groups who published peer reviewed manuscripts claiming "first to report" from an automated machine... the outputs of which clearly were not communicated to the White House Medical Unit. And so the key question: how do you define warning failure?
The process of warning relates to the interfacing with a human being with data and analytic tools to distinguish signal from noise. The communication of that information to receivers is dependent on who is issuing the warning message, contents of the warning message, and receiver audience characteristics. For the abovementioned bulleted issues, we note significant problems with having appropriate access to data, understanding signal processing and signature patterns, and understanding which events are of true importance to prioritize for communication. Because the first half of the process, the creation of a warning, is so badly broken, we have not had the luxury of analyzing the second half (communcation of the warning) as the meteorological community has on so many occasions.
We just returned from the recent ISDS conference, which continues to re-emphasize the point that very little operationally relevant progress has been made. Hence the reason for the appearance of history repeating itself over and over again despite millions of dollars in investments. Indeed, the entire field has been politicized, which is unfortunate. Meanwhile, our country (and by proxy, its allies) fail to progress due to lack of aggressive leadership in moving us closer to the real vision that inspired the President's National Strategy for Biosurveillance.
As with Pearl Harbor, and certainly 9/11, we need to reign in the "research" and have an honest review of operations in this space. Questions of "who knew what when" are controversial and politically dangerous, particularly when a President's life is placed at risk. Particularly when an entire nation and international community is put at risk. But this kind of process is long overdue for the public health community. In fact, decades overdue. It is unfortunate the concerns of biological terrorism has placed unbalanced focus on "bad guys doing bad things", when Mother Nature has proven over and over and over again to be a "terrorist" that continues to threaten. While the United States is blatantly reluctant to examine public health failures with the same aggression as intelligence failures, we wonder how many more of these types of warning failures are needed to provoke a Congressional response? The blatant difference between excess mortality during the 2009 H1N1 influenza pandemic and those who died on 9/11 is noted. One event provoked significant national interest in addressing warning shortfalls, the other... was effectively brushed off.
What is warning success? Of course, there is no such thing as a "perfect warning", however we highlight the following features that make for a successful warning. And validity of any claim of being "first to warn" versus "first to [simply] report":
- Adequate data was collected
- Data was appropriately analyzed to facility recognition of a signal of concern; here we emphasize the term "recognize" relates to a human being is in the processing loop of the signal in question
- In comparison to other signals being tracked, the signal in question is prioritized for communication
- That human to human communication has occurred in a manner to reflect the warning prioritization (e.g. posting on a web site versus picking up the phone and having someone paged afterhours)
Of course, what the recipient does with the warning information could be the subject of an entirely different discussion. The total warning sequence may fail if the recipient does not act on a warning that is ultimately indicative of a national security threat. But for the purposes of this discussion, "warning failure" pertains to a human interaction with data where a human has drawn a conclusion that information must be communicated to others. Under this definition, the following we propose "don't count":
- Copy / pasting media articles describing a non-contextualized biological event
- Copy / pasting media articles without indication of prioritization for concern
The above have often been used in online discussions, peer-reviewed journals, and major media outlets as "proof" of warning. We argue, in today's society and in the context of constant information overload, such claims are invalid.