Biosecurity Imperative: An Urgent Case for Extending the Global Health Security Agenda

In 2014, dozens of governments, international organizations and non-governmental groups from around the world came together to accelerate global capacity to prevent, detect, and respond to urgent infectious disease threats and to elevate health security as a global priority. The Global Health Security Agenda (GHSA) was conceived as a five-year initial effort that would run through 2019 – but it’s already clear that this vital partnership with a proven track record must be extended well into the future.

Next week in Seoul, the Republic of Korea will convene the Steering Group of the GHSA to discuss next steps to advance the agenda, including extending the group’s mandate.  Recognizing that the GHSA’s work has never been more vital and would be impossible to replace, more than 100 health and health security organizations and companies operating in over 150 countries, including the Nuclear Threat Initiative (NTI), this week banded together to urge GHSA's extension for at least another five yearsHere’s why we signed on.

As part of our mission to address the threats from weapons of mass destruction and disruption, NTI works to reduce biological risks posed by bioterrorism, pandemics, and advances in technology. Over the last three years, the GHSA has been a major driver to elevate preparedness for biological threats as a top national security priority and health imperative for all countries. For that reason, NTI strongly supports the continuation of the GHSA with a focus on accountability, commitments, financing, and a continued and strengthened inclusion for biosecurity as a core priority for both the health and security communities. 

For the past decade, global biological threats have increased in likelihood and import – magnified by air travel, conflict, urbanization, and terrorist interest in weapons of mass destruction. When the GHSA was launched in 2014, its mission was to address future epidemic threats and, ultimately, to achieve a world safe and secure from biological threats, whether caused by a naturally occurring infectious disease outbreak, a deliberate bioterrorism attack, or an accidental laboratory release. The GHSA has now succeeded in designing the global architecture necessary to assess, measure, and sustain advances in global preparedness for epidemic threats, a global architecture that would be nearly impossible to recreate. Although not all countries choose to participate, the 59-country GHSA serves as an incubator for innovative and new approaches to tough tasks – a way to convene multiple sectors and communities for debate and, most importantly, for action. 

In recent years, Ebola, the SARS, MERS, H1N1 pandemic influenza, and the anthrax attacks have all been major international events, and although these events exercised global response capacity, there’s no question that the world is still not prepared for a pandemic involving a highly lethal biological threat that transmits readily between people. Consider:

·       On prevention, an increasingly vital GHSA element: During the Ebola epidemic, the three affected West African countries banded together, averting country collapse and the potential creation of new safe havens for conflict and terrorism. But, secure and consolidated sample storage and transport during and following the crisis has continued to be a major issue considering terrorist interest in weapons of mass destruction. Furthermore, this area will only continue to grow in need as new advances in technology now portend the possibility of terrorist creation of new and modified pathogens –  underscored by the recent creation of the horsepox virus in Canada.

·       On disease detection, another integral GHSA focus area:The global leaders that launched the GHSA on February 13, 2014 did not yet know that the first cases of Ebola had already surfaced in Guinea. Those initial cases occurred in December 2013 but were not reported until March, 2014 – nearly three months later. National disease detection and reporting systems and a global biosurveillance network remain major gaps in the global architecture for reducing biological threats.

·       Finally, on response: The initial ineffective global response to Ebola in West Africa contributed mightily to the deaths of over 11,000 people and an epidemic that went on to devastate West Africa, cause global fear and panic, wreak havoc on international transportation – subsiding only after multiple deployments of the international public health experts, investments of billions of dollars, and the deployment of the United States military through Operation United Assistance.

It’s clear that although much has been done to improve capability to create global medical countermeasures – and the launch of the Coalition for Epidemic Preparedness Innovations is an important step forward – the world is still many years away from a global “on demand” capacity to produce, test, and distribute vaccines and therapeutics for emerging threats.  Every country must make prevention, detection, and response for biological threats a top-tier priority – and GHSA will continue to be instrumental for keeping leaders sighted.

GHSA: Successes and Areas for Continuing and Future Focus

The GHSA was created to resolve major, longstanding global challenges to save lives, avoid economic loss, and avert political instability as the result of biological threats. Through the GHSA, measurable progress is – for the first time - being made on each of these previously intractable issues. Now is the time to accelerate our efforts, not stop them. 

1. Measurement, Accountability, and Transparency

Before the GHSA was launched in 2014, there was no consensus on metrics for pandemic preparedness, and there were no globally-agreed indicators for such measurement. At least 80% of countries had missed the 2012 deadline for compliance with the International Health Regulations (IHR), which are the pandemic preparedness standards that all 194 World Health Organization (WHO) Member States have signed on to achieve. A major reason for this historic misstep was the lack of agreed metrics for showing improvements.  GHSA was created in large part to create these measurable steps, thereby paving the way for governments, donors, development banks, and the private sector to invest in biological threat reduction with confidence. Within one year of its creation, the GHSA developed 11 targets with indicators. These were then adopted by GHSA participating countries in 2015 and built into the WHO IHR monitoring and evaluation effort the following year.

Furthermore, in 2014, no mechanism existed for independent, external assessment of country capacity to prevent, detect, and respond to public health emergencies of international concern.  Countries were conducting varying self-assessments, which were not published, largely conducted by health ministries, and without the type of multi-sectoral, independent evaluation required to assure a realistic evaluation and a stepwise plan for measurable improvement.  Within one year of its creation, the GHSA and its leadership developed a framework for such evaluations and then pilot tested and published external peer evaluations in six countries and collaborated with the WHO in the development of a voluntary global Joint External Evaluation (JEE) that has now been conducted in more than 40 countries. 

This is a phenomenal track record that most global initiatives could only aspire to attain. And we shouldn’t stop there. All countries should undergo and publish an evaluation, and much work remains to fill identified gaps and establish accountability for commitments and improvements. 

NTI, in partnership with the Economist Intelligence Unit and The Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, is developing a Global Health Security Index to provide a public benchmarking of global health security conditions—building on the JEE, modelling many of the lessons learned from NTI’s successful first-of-its-kind Nuclear Security Index, and informed by an international expert advisory group. The GHSA should continue promote independent monitoring and accountability, public-private partnerships to assist countries, and commitment tracking.

2. Biosecurity as a Public Health Imperative

Before the GHSA was conceived, it was rare for countries to have in place a dedicated coordination mechanism for countering biological threats that includes the health, security, development, defense, and agriculture sectors. Even in these countries that did have such mechanisms, the United States among them, these communities were not using common metrics for measuring programmatic activities with similar goals. Although global health experts in countries within East Africa, the Middle East, and South and Southeast Asia have espoused concerns about bioterrorism, many health experts – often from developed countries – have remained wary about including biosecurity as a core component of public health. The IHR itself didn’t even contain specific metrics related to biosecurity. Shortly after its inception, the GHSA set to work and, in short order, developed initial biosecurity metrics and activities that the health and security communities from participating countries could each agree upon, including metrics urging consolidation of especially dangerous pathogens and maximizing the use of effective modern diagnostic technologies that don’t require culturing and improve disease detection and surveillance. However, in this area of the GHSA, much remains to be done to regularly bring security experts to the GHSA table, to build additional bridges between the GHSA and other initiatives with a core competency in biosecurity, such as the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction, and the United Nations Security Council Resolution 1540 Committee. The GHSA could and should help inform and create consensus on global biosecurity norms that reduce the risk posed by emerging technologies that are increasingly accessible and portend terrorist capability to create and modify dangerous pathogens. As the GHSA extends, this area requires more attention, as do other vital areas like One Health, and the creation of more accessible tools and technologies for real-time biosurveillance. 

Additional work is needed to catalyze more attention to this vital area of the Agenda.  The GHSA should place additional emphasis on inclusion of security experts with an enhanced focus on biosecurity. The GHSA must also consider the urgent need to develop global norms and incentives for reducing risks posed by advances in technology that now enable the creation and modification of pathogens with pandemic potential.

3. Financing and Sustained Attention by Leaders – No More Cycles of “Panic” and “Neglect”

Finally, when GHSA was launched there were not – and still are not – global mechanisms for leveraging financing from host countries, donors, development banks, and private sector companies to fill specific health security gaps. Historically, global leaders pay attention to (and finance) biological threats during an ongoing outbreak. However, attention tends to wane when a major crisis is not at hand. During the 2014-2016 Ebola epidemic, the U.S. Government allocated $1 billion to assist 17 countries to achieve the GHSA targets. The International Working Group (IWG) on Pandemic Preparedness Financing recently called on all countries to be assessed and to develop plans to finance identified gaps. 

The GHSA is a country-driven effort, and the call to action within the IWG report should be heeded. The GHSA should catalyze the development of a mechanism to kick start financing for low-income countries, including sustainable host country financing strategies, plug-ins for private sector support, and synergy with development bank assistance. 

These goals must remain at the forefront of the global agenda, and the GHSA has proven itself as a crucial mechanism for incubating creative approaches to take next steps. Quite simply, the world cannot afford to lose this vital and effective global partnership.

 

July 19, 2017
Authors
Dr. Elizabeth Cameron
Dr. Elizabeth Cameron

Vice President, Global Biological Policy and Programs

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