The Middle East Respiratory Syndrome (MERS) hit Korea in May 2015 and claimed 38 lives, revealing the problems of the nation’s medical system, including that for the prevention of epidemics.

Now, the government is enhancing the state quarantine system, mainly through biosurveillance.

The United States started to use the term biosurveillance. Biosurveillance refers to “active data gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health to make better decisions at all stages of response and raising awareness of the overall situation,” according to the U.S. National Strategy for Biosurveillance 2013.

The U.S. has operated biosurveillance since 2013, enacting a related law, the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, and operating the National Biosurveillance Integration Center (NBIC).

In Korea, seven government agencies, including the Ministry of Health and Welfare, jointly set up “Government-wide R&D Fund Project for Infectious Disease Research” (GFID) in April 2018. The GFID team paid attention to biosurveillance as an advanced national surveillance system. It commissioned a research project for “building a platform for Korea’s biosurveillance system to jointly respond to infectious disease public health crisis.”

Tak Sang-woo, a principal research fellow at the Institute of Health and Environment of Seoul National University, took up the research project. He had worked for the U.S. Centers for Disease Control and Prevention. He also served as chief epidemiologist at the U.S. Department of Defense.

In an interview with Korea Biomedical Review, Tak said that Korea should establish a system to cope with the public health crisis by integrating fragmented information and that biosurveillance should be the framework. The nation can come up with realistic countermeasures only after it accurately identifies the current state based on data and predicts the future, he added.

Tak Sang-woo, a principal research fellow at the Institute of Health and Environment of Seoul National University, speaks during an interview with Korea Biomedical Review.

Question: The concept of biosurveillance is not known well to the public. Can you explain it?

Answer: The term biosurveillance began to be used in the U.S. After the anthrax terrorism in 2001, the U.S. established a system such as BioWatch and BioShield to detect and respond to bioterrorism threats and created related laws. Later, as the U.S. saw bioterrorism response as an aspect of infectious disease response, it began to use the term biosurveillance, which is based on public health surveillance.

Biosurveillance is not limited to bioterrorism. All hazards that threaten the health of humans, animals, and plants should be monitored. The aim is to detect hazards early and provide situational awareness. The Korean defense system is focused on early detection only, but situational awareness is more important.

Q: What does situational awareness mean?

A: It means recognizing and understanding the current state and predicting the future based on it. Situational awareness allows us to predict the future. If we have situational awareness, we should make policy decisions and responses based on this. After having feedbacks on the result, we should put it together with the current state and get situational awareness again.

If you want to have situational awareness, you should gather information in one place, analyze and interpret it. We need a system to reflux the interpreted content.

Q: Why do we need biosurveillance?

A: I’ll take an example of the U.S., which has built biosurveillance. This was revealed after the Sept. 11, 2001, terrorist attacks. All U.S. intelligence detected signs of the acts of terrorism but did not share them. Critics said if they had shared information and put it together, they could have predicted the future through situational awareness. People paid attention to the importance of information sharing and built a consensus that they should establish a biological surveillance system.

Q: It seems like an ideal system, but is it possible to implement a system that collects and analyzes information from each field into one?

A: In reality, there are many difficulties, but it’s something we must do. In the U.S., the 9/11 attack led to a consensus on establishing a biological surveillance system, but Korea's situation is different. So, our first plan is to integrate the surveillance systems already established by each government agency. We want to show first what different decisions each department can make when looking at public data on the integrated platform.

Q: Each government agency is already sharing information.

A: If we tell them we will integrate information, they understand it as a centralized system used only by decision-makers. However, the “Korean biosurveillance system” that we are building is not a totalitarian information system. Both information providers and recipients can see the information because the information is refluxed in the system. As for the security issue, government agencies can discuss it and determine the level of opening up.

The sharing of information only when necessary makes it challenging to recognize situational awareness. Let me take an example of avian influenza. The Ministry of Environment monitors wild birds. If a dead bird is found among migratory birds, it tests the virus of avian flu, and if it is contagious, it sends it to the Korea Centers for Disease Control and Prevention (KCDC).

Without pathogenicity, information is not shared. At some point, when the carcasses of migratory birds increase, this can help recognize situational awareness of the avian influenza epidemic. At present, however, such information is not shared in real-time, so there is a limit in raising situational awareness.

Q: Do you think government agencies’ fragmented monitoring system and exchange of fragmentary information are the problems?

A: It is a problem to share fragmented information without any direction. The institution that provided information does not know how the information is used. It means a unilateral relationship.

In this study, we regard information sharing important. When departments and agencies actively share information, they feel that they are working together. However, the hardest part is sharing information. Many people think that they can share only the necessary part when they need to.

As the government recently pushed for the “One Health” policy, it emphasized the cooperation among various departments in various fields, including antibiotic-resistant bacteria. However, information sharing is missing here. We should not pick and choose the timing to exchange animal information and human information but monitor them together in real-time.

Q: Even if you could build the platform for the Korean biosurveillance system, it could be useless if it is not used in actual sites.

A: Many observers say we should enact related laws just like in the U.S. That way, each government department will mandatorily provide information. In the long term, after establishing related laws, we should set up an independent, third-party body to look for necessary information actively. It should be able to identify and monitor disease information from around the world.

soo331@docdocdoc.co.kr

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