o secure early warning of a bioterror attack, the government is building a computerized network that will collect and analyze health data of people in eight major cities, administration officials say.
The Centers for Disease Control and Prevention is to lead the multimillion-dollar surveillance effort, which officials expect to become the cornerstone of a national network to spot disease outbreaks by tracking data like doctor reports, emergency room visits and sales of flu medicine. "Our goal is to have a model that any city could pick up and apply," a senior administration official said of the plan.
Officials would not disclose the program's cost or which cities will be involved. But experts say Washington is likely to be one of the eight.
Such surveillance is now possible because of an explosion in commercial medical databases that health authorities, with permission and under strict legal agreements, are starting to mine. In ambition and potential usefulness, the health network goes far beyond an environmental surveillance system, disclosed by the administration last week, that will sniff the air for dangerous germs.
The emerging health monitoring network, officials and experts say, will provide information that could save lives if terrorists strike with deadly germs like smallpox or anthrax. In detecting attacks, a head start of even a day or two can greatly lower death rates by letting doctors treat rapidly and prevent an isolated outbreak from becoming an epidemic. A senior official said President Bush was expected to refer to these new bioterrorism defenses in his State of the Union address.
The disease centers' initiative represents a sharp swing to civilian leadership in a field the military pioneered and once dominated. But even in civilian hands, the emerging network has raised concerns that such surveillance may violate individual medical privacy rights.
Officials said concerns were initially heightened because of the Pentagon's central role in the genesis of many systems, and especially because Vice Adm. John M. Poindexter, architect of the much-criticized Pentagon computer surveillance effort known as Total Information Awareness, is in charge of the Defense Department agency that finances some of the government's disease monitoring research.
In November, as the Bush administration came under fire for Admiral Poindexter's project, White House officials ordered the military to drop plans to link four cities into a $420 million health monitoring network and shifted responsibility for such work to the new domestic security agency. The transfer was not motivated by privacy concerns, administration officials say, but by a judgment that the military was ill suited to exploit monitoring for public health.
"We all agreed that doing this surveillance in the civilian sector was not the military's job," Dr. Anna Johnson-Winegar, a Pentagon biodefense official, said in an interview.
Experts say the prospect of war with Iraq, and the chance that Baghdad might retaliate with germ weapons, are accelerating the effort to expand and integrate scores of rudimentary disease surveillance systems being developed by cities, states and the federal government. But public health experts argue that even if the United States never suffers another bioterror attack like the anthrax strikes of late 2001, the emerging network can still help doctors better track, treat and prevent natural disease outbreaks.
"We want as much protection as we can afford," said Dr. Daniel M. Sosin, director of public health surveillance at the Centers for Disease Control and Prevention in Atlanta. Dr. Sosin is helping to expand the nation's health surveillance to incorporate the new systems.
Supporters of the emerging surveillance network insist it raises few privacy issues, saying that the data are laundered of names and identifiers. People are not tracked as individuals, they say, but their symptoms are, and often their age, sex and ZIP code as well. But computer surveillance itself has drawn criticism from the American Civil Liberties Union, members of Congress and others.
The system is needed, proponents say, because few cheap, reliable sensors exist for detecting deadly germs in such likely target areas as subways and shopping malls. Sensors are also prone to false positives, or incorrect germ identifications.
