The absence of a comprehensive national playbook for developing and deploying testing has hindered the United States' ability to rapidly suppress recent biological emergencies (for example, the COVID-19 pandemic and outbreaks of mpox). We describe here the Testing Playbook for Biological Emergencies, a national testing playbook we developed. It includes a set of decisions and actions for US officials to take at specific times during infectious disease emergencies to implement testing rapidly and to ensure that available testing meets clinical and public health needs. Although the United States had multiple plans at the federal level for responding to pandemic threats, US leaders were unable to quickly and efficiently operationalize those plans to deploy different types of tests during the COVID-19 pandemic in 2020-21, and again during the US mpox outbreak in 2022. The playbook fills a critical gap by providing the necessary specific and adaptable guidance for decision makers to meet this need.

Health SecurityVol. 18, No. S1 Cynthia H. Cassell and Ronald L. Moolenaar, CDC EditorsOpen AccessThe Road to Achieving Global Health Security: Accelerating Progress and Spurring Urgency to Fill Remaining GapsDiane Meyer, Elizabeth E. Cameron, Jessica Bell, and Jennifer B. NuzzoDiane MeyerAddress correspondence to: Diane Meyer, RN, MPH, Managing Senior Analyst, Johns Hopkins Center for Health Security, 621 East Pratt St., Suite 210, Baltimore, MD 21202 E-mail Address: dmeyer10@jhmi.eduDiane Meyer, RN, MPH, is Managing Senior Analyst and a Research Associate, and Jennifer B. Nuzzo, DrPH, SM, is a Senior Scholar and Associate Professor, both at the Johns Hopkins Center for Health Security and in the Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD. Elizabeth E. Cameron, PhD, is Vice President, and Jessica Bell, MS, is a Senior Program Officer, both in Global Biological Policy and Programs, Nuclear Threat Initiative, Washington, DC.Search for more papers by this author, Elizabeth E. CameronDiane Meyer, RN, MPH, is Managing Senior Analyst and a Research Associate, and Jennifer B. Nuzzo, DrPH, SM, is a Senior Scholar and Associate Professor, both at the Johns Hopkins Center for Health Security and in the Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD. Elizabeth E. Cameron, PhD, is Vice President, and Jessica Bell, MS, is a Senior Program Officer, both in Global Biological Policy and Programs, Nuclear Threat Initiative, Washington, DC.Search for more papers by this author, Jessica BellDiane Meyer, RN, MPH, is Managing Senior Analyst and a Research Associate, and Jennifer B. Nuzzo, DrPH, SM, is a Senior Scholar and Associate Professor, both at the Johns Hopkins Center for Health Security and in the Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD. Elizabeth E. Cameron, PhD, is Vice President, and Jessica Bell, MS, is a Senior Program Officer, both in Global Biological Policy and Programs, Nuclear Threat Initiative, Washington, DC.Search for more papers by this author, and Jennifer B. NuzzoDiane Meyer, RN, MPH, is Managing Senior Analyst and a Research Associate, and Jennifer B. Nuzzo, DrPH, SM, is a Senior Scholar and Associate Professor, both at the Johns Hopkins Center for Health Security and in the Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD. Elizabeth E. Cameron, PhD, is Vice President, and Jessica Bell, MS, is a Senior Program Officer, both in Global Biological Policy and Programs, Nuclear Threat Initiative, Washington, DC.Search for more papers by this authorPublished Online:31 Jan 2020https://doi.org/10.1089/hs.2019.0147AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Five years ago, the world was on a precipice. An outbreak of Ebola that had started in Guinea spilled into neighboring Liberia and Sierra Leone. None of the affected countries had recorded an outbreak of Ebola before, and the response was challenged by lack of public health capacities, community distrust of healthcare workers, poor communication, and difficulties reaching affected populations. International health officials expressed concerns about the potential for further spread of the virus throughout the continent, and, ultimately, more than 11,000 people lost their lives.The United States stepped up as a leader in the global response to the West African Ebola epidemic, which, over a 2-year period, would cost billions of dollars and would lead to the development of a complex web of global partnerships across governments, international organizations, foundations, and private industry. Just before the first Ebola cases in Guinea came to light in 2014, the United States brought together in Washington, DC, partner countries from around the world to launch the Global Health Security Agenda (GHSA). Ironically, the intent of the GHSA was to prevent the very type of uncontrolled epidemic that was spreading silently in West Africa by improving countries' capacities to prevent, detect, and rapidly respond to outbreaks occurring within their borders. During the Ebola epidemic, the United States committed $1 billion to advance the goals of the GHSA. This likely represented the world's largest single investment by a country toward improved implementation of the International Health Regulations (IHR, 2005) and helped catalyze additional contributions from other countries.By the time the outbreak was contained, it was clear that it had resulted in considerable loss of life and significant long-term societal impacts. The economic and social burden of the 2014-2016 West Africa Ebola outbreak is now estimated to be around US$53 billion.1 Importantly, the outbreak resulted in significant indirect impacts on the health systems in affected countries, including decreases in the use of maternal health services and disruptions in HIV/AIDS treatment that will have lasting consequences for health outcomes.2The startling tolls of the 2014 Ebola epidemic and the launch of the GHSA helped create political will to externally assess countries' readiness for significant infectious disease events. The GHSA began this effort through the development of pilot assessments of national public health capacities, which were conducted in 6 countries.3* This effort helped to define metrics for assessing whether countries possess the core public health capacities needed to fulfill their obligations under the IHR to prevent, detect, and respond to public health emergencies with the potential for international spread.Eventually, the GHSA assessment process was transitioned to the World Health Organization (WHO), where it became the foundation for WHO's current Joint External Evaluation (JEE) process. Through the JEE, WHO is now taking a proactive role in assessing whether countries can fulfill their obligations under the IHR. For the first time, it is possible to externally assess countries' core public health capacities, identify gaps in countries' readiness, and coordinate with donors to identify and prioritize financing for specific actions to address these gaps.Since 2014, 108 countries have completed a JEE, and additional countries are in the pipeline. Although a high level of participation in the JEE process is a welcome development following nearly a decade of stalled implementation of the IHR, much more work must be done to improve countries' commitment to advancing global health security. By assessing national core public health capacities, the JEEs represent the first step a country must take to improve its readiness for infectious disease emergencies. Political leadership and actionable follow-through are needed to develop, cost, and finance National Action Plans for Health Security to address gaps in capacities that the JEEs have identified. For example, the first 100 JEEs identified more than 7,000 priority tasks necessary to improve health security, but very few of these gaps have been addressed.4 In fact, despite having undergone a JEE, many countries have yet to draft and cost their action plans, and even fewer have mobilized the resources needed to improve preparedness capacities.4These challenges are evident in data from our recently published Global Health Security (GHS) Index.5 This first-ever benchmarking of health security among the 195 IHR states parties† finds that no country is fully prepared for an epidemic or pandemic. In fact, the average overall GHS Index score is 40.2 out of 100, with all countries showing significant gaps. Most states lack essential public health capacities to prevent, detect, and respond to health emergencies, and there is little evidence that most countries can initiate and exercise these capacities in an actual emergency. Many countries face major political and security risks that could undermine national capability to counter biological threats, and most countries have not allocated funding from national budgets to fill identified preparedness gaps. For example, only 5% of the countries assessed score in the top tier‡ for financing health security.In addition, countries are not prepared for a global catastrophic biological risk (GCBR), including those that could be caused by the international spread of a new or emerging pathogen or by the deliberate or accidental release of a dangerous or engineered agent or organism. Alarmingly, 75% of countries received low scores in GCBR-relevant areas, including oversight of dual-use research and medical countermeasure dispensing. As biotechnologies continue to advance for societal benefit, a dedicated international normative body should be established to promote early identification and reduction of associated risks.Perhaps one of the most concerning thematic findings of the GHS Index is how poorly countries score in the category that measures whether they have a "sufficient and robust health system to treat the sick and protect healthcare workers." This category specifically looks at whether countries have the foundational healthcare system capacities necessary to support mobilization of the public health capacities measured elsewhere. The average country score in this category was 26.4 out of 100. This finding suggests a strong need to integrate efforts aimed at strengthening national health systems and promoting adoption of universal health coverage with efforts to boost countries' core public health capacities to tackle infectious disease outbreaks. An important first step will be to reinforce that, as countries are assessing the availability of core public health capacities via the JEE, they are also assessing and improving the strength of their broader health system.These findings highlight an urgent need to increase the financial, technical, and human capacity available to strengthen global health security. Though difficult, it is possible to make progress. The World Bank has determined that "investing in health security through financing preparedness is a highly cost-effective way to protect lives and safeguard livelihoods and communities."6 It estimates that in low-income countries, needed investments in preparedness may cost around US$1 per person per year—a reasonable sum compared to the cost of the outbreaks described above.6More leaders are prioritizing the creation of urgent health security financing mechanisms, including expanding the use of World Bank International Development Association allocations for epidemic preparedness. The potential for a global health security matching fund, which we have recommended, is also within reach, but making that fund a reality will require urgent and coordinated leadership from decision makers to leverage investments from national country budgets, international organizations, philanthropists, and donors against specific action plans and measurable targets. This work should start now and could be one focus area for a heads-of-state summit convened by the UN Secretary-General, another key recommendation from our GHS Index report.In our view, long-term global health security cannot be achieved without increased and sustained investments. The GHSA has set an ambitious target of more than 100 countries achieving, by 2024, completion of health security evaluations, resource mobilization, and implementation to fill gaps. To meet this goal, it is essential that the United States play a major leadership role in improving health security capacities across the globe. Continued technical and financial support by the United States for global health security efforts is central to making measurable progress. US support of the GHSA and country-level global health security activities has been a major contributor to the success of health security programs to date, providing both financing and technical experts from the US Centers for Disease Control and Prevention (CDC), the US Agency for International Development, and the US Departments of Health and Human Services, Defense, and State. The United States is also working behind the scenes to support the JEE process, which has helped more than 100 countries assess their public health capacities and begin addressing any shortfalls. Although these efforts are clearly multilateral, US leadership has been instrumental in setting up and enabling their success.This CDC supplement provides compelling evidence of the impact of US leadership and investment toward achieving global health security and highlights the important ongoing international work to prepare for biological threats. The challenges faced and lessons learned by the authors are integral to building and sustaining national health security capacities, particularly at the subnational level. We all know that preparedness begins in the very communities affected by outbreaks, and a country's collective health security is only as strong as its weakest link. Thus, each effort to identify and implement novel, integrative solutions is one small step toward making the world safer and more secure from outbreaks.References1. Huber C, Finelli L, Stevens W. The economic and social burden of the 2014 Ebola outbreak in West Africa. J Infect Dis 2018;218(Suppl 5):S698-S704. Crossref, Medline, Google Scholar2. Brolin Ribacke KJ, Saulnier DD, Eriksson A, von Schreeb J. Effects of the West Africa Ebola virus disease on health-care utilization—a systematic review. Front Public Health 2016;4:222. Crossref, Medline, Google Scholar3. Bell E, Tappero JW, Ijaz K, et al. Joint external evaluation—development and scale-up of global multisectoral health capacity evaluation process. Emerg Infect Dis 2017;23(Suppl). Google Scholar4. Shahpar C, Lee CT, Wilkason C, Buissonnière M, McClelland A, Frieden TR. Protecting the world from infectious disease threats: now or never. BMJ Glob Health 2019;4(4):e001885. Crossref, Medline, Google Scholar5. Global Health Security Index. https://www.ghsindex.org/. Accessed December 10, 2019. Google Scholar6. International Working Group on Financing Preparedness. From Panic and Neglect to Investing in Health Security. Financing Pandemic Preparedness at a National Level. Washington, DC: World Bank; 2017. Google Scholar* Pilot countries were the Republic of Georgia, Peru, Portugal, Uganda, United Kingdom, and Ukraine.† As of April 16, 2013, there are 196 states parties to the World Health Organization (WHO) 2005 International Health Regulations (IHR), including the Holy See. The Holy See is a sovereign juridical entity under international law, but it was not included in the country-specific research for the GHS Index in light of the Holy See's lack of an independent health system.‡ The GHS Index scoring system is on a 100-point scale and includes 3 tiers. Countries that score between 0 and 33.3 are in the bottom tier, countries that score between 33.4 and 66.6 are in the middle tier, and countries that score between 66.7 and 100 are in the upper or "top" tier.FiguresReferencesRelatedDetailsCited byValidation analysis of Global Health Security Index (GHSI) scores 201926 October 2020 | BMJ Global Health, Vol. 5, No. 10A Scientometric Analysis of Global Health Research24 April 2020 | International Journal of Environmental Research and Public Health, Vol. 17, No. 8 Volume 18Issue S1Jan 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Diane Meyer, Elizabeth E. Cameron, Jessica Bell, and Jennifer B. Nuzzo.The Road to Achieving Global Health Security: Accelerating Progress and Spurring Urgency to Fill Remaining Gaps.Health Security.Jan 2020.S-1-S-3.http://doi.org/10.1089/hs.2019.0147creative commons licensePublished in Volume: 18 Issue S1: January 31, 2020PDF download

Infectious disease outbreaks pose major threats to human health and security. Countries with robust capacities for preventing, detecting and responding to outbreaks can avert many of the social, political, economic and health system costs of such crises. The Global Health Security Index (GHS Index)-the first comprehensive assessment and benchmarking of health security and related capabilities across 195 countries-recently found that no country is sufficiently prepared for epidemics or pandemics. The GHS Index can help health security stakeholders identify areas of weakness, as well as opportunities to collaborate across sectors, collectively strengthen health systems and achieve shared public health goals. Some scholars have recently offered constructive critiques of the GHS Index's approach to scoring and ranking countries; its weighting of select indicators; its emphasis on transparency; its focus on biosecurity and biosafety capacities; and divergence between select country scores and corresponding COVID-19-associated caseloads, morbidity, and mortality. Here, we (1) describe the practical value of the GHS Index; (2) present potential use cases to help policymakers and practitioners maximise the utility of the tool; (3) discuss the importance of scoring and ranking; (4) describe the robust methodology underpinning country scores and ranks; (5) highlight the GHS Index's emphasis on transparency and (6) articulate caveats for users wishing to use GHS Index data in health security research, policymaking and practice.

This Viewpoint attempts to reconcile the US's high 2019 preparedness ranking on the Global Health Security Index, an international framework for benchmarking health security, and its faltering coronavirus disease 2019 (COVID-19) pandemic response, and explores lessons learned from other countries whose higher rankings and efficient responses were more closely aligned.

Biology can be misused, and the risk of this causing widespread harm increases in step with the rapid march of technological progress. A key security challenge involves attribution: determining, in the wake of a human-caused biological event, who was responsible. Recent scientific developments have demonstrated a capability for detecting whether an organism involved in such an event has been genetically modified and, if modified, to infer from its genetic sequence its likely lab of origin. We believe this technique could be developed into powerful forensic tools to aid the attribution of outbreaks caused by genetically engineered pathogens, and thus protect against the potential misuse of synthetic biology.

BACKGROUND:Since the 2014-2016 West Africa Ebola epidemic, the concept of measuring health security capacity has become increasingly important within the broader context of health systems-strengthening, enhancing responses to public health emergencies, and reducing global catastrophic biological risks. Efforts to regularly and sustainably track the evolution of health security capabilities and capacities over time - while also accounting for political, social, and environmental risks - could help countries progress toward eliminating sources of health insecurity. We sought to aggregate evidence-based principles that capture a country's baseline public health and healthcare capabilities, its health security system performance before and during infectious disease crises, and its broader social, political, security, and ecological risk environments. METHODS:We conducted a scoping review of English-language scholarly and gray literature to identify evidence- and practice-based indicators and proxies for measuring health security at the country level over time. We then used a qualitative coding framework to identify recurrent themes in the literature and synthesize foundational principles for measuring global health security. Documents reviewed included English-language literature published after 2001 until the end of the research period-September 2017-to ensure relevance to the current global health security landscape; literature examining acute infectious disease threats with potential for transnational spread; and literature addressing global health security efforts at the country level. RESULTS:We synthesized four foundational principles for measuring global health security: measurement requires assessment of existing capacities, as well as efforts to build core public health, healthcare, and biosecurity capabilities; assessments of national programs and efforts to mitigate a critical subset of priority threats could inform efforts to generate useful metrics for global health security; there are measurable enabling factors facilitating health security-strengthening efforts; and finally, measurement requires consideration of social, political, and ecological risk environments. CONCLUSION:The themes identified in this review could inform efforts to systematically assess the impacts and effectiveness of activities undertaken to strengthen global health security.

Biosecurity and biosafety measures are designed to mitigate intentional and accidental biological risks that pose potentially catastrophic consequences to a country's health system, security, and political and economic stability. Unfortunately, biosecurity and biosafety are often under-prioritized nationally, regionally, and globally. Security leaders often deemphasize accidental and deliberate biological threats relative to other challenges to peace and security. Given emerging biological risks, including those associated with rapid technological advances and terrorist and state interest in weapons of mass destruction, biosecurity deserves stronger emphasis in health and security fora. The Global Biosecurity Dialogue (GBD) was initiated to align national and regional donor initiatives toward a common set of measurable targets. The GBD was launched by the Nuclear Threat Initiative (NTI), with support from Global Affairs Canada's Weapons Threat Reduction Program and the Open Philanthropy Project, and in coordination with the government of The Netherlands as the 2018-19 Chair of the Global Health Security Agenda (GHSA) Action Package Prevent-3 (APP3) on Biosafety and Biosecurity. The GBD provides a multisectoral forum for sharing models, enabling new actions to achieve biosecurity-related targets, and promoting biosecurity as an integral component of health security. The GBD has contributed to new national and continent-wide actions, including the African Union and Africa Centres for Disease Control and Prevention's new regional Initiative to Strengthen Biosafety and Biosecurity in Africa. Here we present the GBD as a model for catalyzing action within APP3. We describe how the benefits of this approach could expand to other GHSA Action Packages and international health security initiatives.

The Ebola epidemic in the Democratic Republic of Congo (DRC) is exceptionally dangerous, occurring within active armed conflict and geopolitical volatility, including a million displaced persons. With 421 cases, 240 deaths, and the numbers increasing, this Ebola outbreak is the second deadliest in history. Recent spread to Butembo, home to 1.2 million people, raised concerns. The DRC, World Health Organization (WHO), and partners are leading a vigorous international response, yet despite deploying an experimental vaccine, cases doubled in October 2018 and many cases had unknown origin. Uncontrolled Ebola outbreaks can expand quickly, as occurred in West Africa in 2014. Averting that outcome in the DRC requires rapid action including a strengthened public health response, security, and community outreach. If violence escalates, it could compromise a fragile response. Yet resources are insufficient. The United States and other countries are not permitting personnel deployment to the epicenter, including from the Centers for Disease Control and Prevention (CDC) and US Agency for International Development (USAID). In this Viewpoint, we review recommendations of experts convened by Georgetown University and listed at the end of this article. The United States and international community should launch high-level political mobilization, with diplomatic, human, and economic resources. It is critical to recognize that future health crises will occur in fragile, insecure settings. To prepare, the international community needs long-term planning and enhanced capacities to improve the safety and effectiveness of epidemic response operations.

In this Viewpoint, Gostin and colleagues review recommendations developed by experts convened by Georgetown University on how the international community can respond to the 2018 Ebola outbreak in the Democratic Republic of Congo (DRC) in the midst of active conflict and insecurity from armed rebels.

Health SecurityVol. 15, No. 4 Special Feature: Global Catastrophic Biological RisksOpen AccessEmerging and Converging Global Catastrophic Biological RisksElizabeth E. CameronElizabeth E. CameronPublished Online:1 Aug 2017https://doi.org/10.1089/hs.2017.0043AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Biology holds enormous promise for enhancing human welfare in the 21st century, including the potential to engineer and fabricate new life-extending treatments, vaccines, and therapeutics to combat disease; technologies to advance food security; and new sources of energy and materials. But the converse of this tremendous promise is the risk that an emerging or manufactured agent could spread quickly and kill millions, or hundreds of millions, before a countermeasure could be developed and dispensed. Equally important, such an event could rapidly shift global security dynamics by destabilizing economies, changing political landscapes, and disproportionately affecting specific populations. While the world continues to receive wake-up calls—including recent outbreaks of pandemic influenza, MERS, Ebola, and Zika—2 things are increasingly apparent. First, society is changing in ways that are likely to make a rapidly spreading biological agent even more deadly and destabilizing. Second, the world is largely unprepared for a fast-spreading, highly lethal, politically destabilizing biological event.In starting a global dialogue about the definition and nature of global catastrophic biological risk (GCBR), the Center for Health Security provides a major service to the field. Within the proposed definition of GCBRs, the Center proposes to include "… events with world-reaching impacts on humanity, marked by profound and lasting social, economic, and political consequences, even if those events don't necessarily carry the potential to cause millions of fatalities [emphasis added]." The Center wisely avoids a narrow focus on the number of fatalities when it comes to GCBRs. The proposed definition appropriately recognizes the often unpredictable and far-reaching nature of GCBRs while affirming the potential interconnectivity of GCBRs with other types of global catastrophic risks (GCRs), such as climate change and nuclear war. For example, climate change can drive an increase in GCBRs and their global impact. And a GCBR—particularly an event with unclear origin, originating in an unstable region, or destabilizing a state possessing nuclear weapons—could exacerbate nuclear tension. In each case, the extent of global consequences, including the number of fatalities, will depend greatly on where a GCBR originates, how it spreads, and the ability of the international community to mount an effective, rapid response. The bottom line is that we need systems that prepare and practice for the worst potential outcomes, so that we can prevent them from occurring.The RiskGCBRs will continue to be magnified by global travel and trade, migration, terrorist interest in weapons of mass destruction, and rapid advances in technology that can create and manipulate pathogens with pandemic potential. Although progress has been made, the 2014-2016 Ebola epidemic highlighted the global risk to political and financial stability posed by weak health systems anywhere in the world.In addition, while rapidly accelerating peaceful applications of biotechnology hold great promise for addressing emerging threats and must be pursued, these same technologies could also advance terrorist and state capability for developing and deploying biological weapons. Finally, escalating tension in unstable regions can further enhance the likelihood that a cross-border biological event could result in a catastrophic outcome. Senior officials must sustain a focus on GCBRs to thwart future world- and humanity-changing events.Today's EnvironmentThe global context is changing in ways that could increase the likelihood for epidemics to become GCBRs. Conflict is driving migration while also creating potential for new diseases to emerge and spread silently in regions of instability or ungoverned territories. Unchecked climate change will continue to exacerbate movements and will create new patterns of disease. And compounding all of these risks is the potential for terrorists to create, customize, and deploy biological agents—including within conflict-laden environments in which humanitarian assistance is challenging or impossible.We Are Not PreparedGCBRs quickly become local in an increasingly globalized world. Yet, the world is still unprepared—particularly if faced with an airborne pandemic with a high rate of spread and mortality. Despite intermittent focus and funding during periods of crisis, world leaders and policymakers have not established adequate capacity and financing mechanisms to prevent, detect, and rapidly respond to GCBRs. Ongoing challenges include: minimal global funding aimed at intentional or accidental GCBRs; no consensus among innovators or governments on norms and incentives for reducing biological risks associated with advancing technology; absence of adequate pandemic emergency funds; lack of threat awareness; dearth of creative financing mechanisms to spur sustained host country investment; and weak global biosurveillance, coupled with no global capability for pandemic prediction.Promising Signs, but Persistent GapsNew global initiatives are emerging, including the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Health Security Agenda (GHSA), and the Joint External Evaluations (JEE). Taken together, these efforts focus on global capability to create and deliver new vaccines safely, affordably, and quickly (CEPI) and national preparedness and financing for countering biological threats (GHSA and JEE). However, additional creative mechanisms will be necessary to achieve the vision of a world safe and secure from GCBRs and to attain a global capability to prevent and counter disease threats that can keep pace with their emergence and the technology that can advance their creation.VisionIt is in our collective interest for all countries to place GCBRs among their top national security priorities. Intense prevention efforts should be implemented so that emerging outbreaks don't become GCBRs in the first place. These activities must also minimize the potential for intentional misuse and accidental release so that the biological revolution, which is needed to save lives in the long run, does not itself cause a catastrophic outcome. Investments in global pandemic preparedness and the platforms necessary to manufacture, distribute, and dispense drugs and vaccines for any emerging threat will require a much greater degree of organization and synergistic financing among finance ministries, private sector actors, and donors. Governments, civil society, and the private sector should rightly view these investments as necessary down-payments—both to ensure that global efforts to address other transnational challenges are not thwarted by the impact of future GCBRs and to ensure that humanity is ready and able to reap the future rewards that modern biology promises.FiguresReferencesRelatedDetailsCited bySurveillance policies, levels, patterns, and techniquesThe concept of humanome and the microbiomic dimensionPublic health microbiomicsGlobal catastrophic biological risks: Nature and responsePoint-of-need molecular processing of biosamples using portable instrumentation to reduce turnaround timeBiosafety and Health, Vol. 2, No. 3Microbial Genomics in Public Health: A Translational Risk-Response AspectMicrobiomics: A Focal Point in GCBR and BiosecurityEpilogueWarning! Increases in interest without enjoyment may not be trend predictive of genuine interest in learning scienceInternational Journal of Educational Development, Vol. 62Humanome Versus Microbiome: Games of Dominance and Pan-Biosurveillance in the Omics Universe Manousos E. Kambouris, Georgios Gaitanis, Yiannis Manoussopoulos, Michael Arabatzis, Maria Kantzanou, George D. Kostis, Aristea Velegraki, and George P. Patrinos1 August 2018 | OMICS: A Journal of Integrative Biology, Vol. 22, No. 8Rebooting Bioresilience: A Multi-OMICS Approach to Tackle Global Catastrophic Biological Risks and Next-Generation Biothreats Manousos E. Kambouris, Yiannis Manoussopoulos, Maria Kantzanou, Aristea Velegraki, Georgios Gaitanis, Michalis Arabatzis, and George P. Patrinos1 January 2018 | OMICS: A Journal of Integrative Biology, Vol. 22, No. 1 Volume 15Issue 4Aug 2017 InformationCopyright 2017, Mary Ann Liebert, Inc.To cite this article:Elizabeth E. Cameron.Emerging and Converging Global Catastrophic Biological Risks.Health Security.Aug 2017.337-338.http://doi.org/10.1089/hs.2017.0043creative commons licensePublished in Volume: 15 Issue 4: August 1, 2017Online Ahead of Print:July 25, 2017PDF download

Since the end of the 1918 pandemic the world has faced three more influenza pandemics, the most recent being the 2009 H1N1 pandemic which infected 2 billion people in 6 months. Additionally, we face an ever increasing frequency of emerging infectious diseases with pandemic potential. These diseases could kill millions, cost billions, and have other significant economic, social, national security, and political consequences. If the United States and international system do not make progress towards closing the gaps addressed in this and previous Scowcroft white papers, countries will remain vulnerable to a devastating outbreak.