Human actions continually transform the landscapes in which pathogens can spread within and between vulnerable populations.
For example, rising average household incomes throughout emerging economies have propelled rising consumption of animal proteins. Suppliers respond to this new demand by crowding livestock and poultry into farms and markets mingled with human settlements. At the same time, economic opportunities in the dynamic cities of Asia and Africa are driving urbanization at a pace that often outstrips investments in public health and safety infrastructure. As many as 900 million urban dwellers worldwide live in slum-like conditions marked by crowding and inadequate access to safe water and sanitation, ideal conditions for the rapid spread of communicable diseases. Sprawling suburbs disrupt sylvan or rural ecosystems, creating complex new interfaces for human, domestic animals, wildlife, and insect interactions. The constant churn of highly mobile workforces within and between countries elevates the risk that any emerging infectious disease that does cross into humans will travel between major urban centers in weeks, or even days.
SARS, H5N1 avian influenza, and the 2009 H1N1 influenza pandemic demonstrated that these risks are far from hypothetical. The need to detect emerging infections in real time and develop effective countermeasures creates an obvious conundrum: how to increase laboratory capacity to identify and analyze potentially lethal pathogens while minimizing the risks of exposures – either accidental exposures of workers to pathogens, or exposures of pathogens to actors who would deliberately divert or misuse them. The number of high-level containment laboratories worldwide has climbed steadily in the past decade, meeting public health and research objectives but also creating new vulnerabilities.
Not long ago, the international communities vested in biosecurity and in global health approached these challenges separately, often on a disease-by-disease basis. However, recent processes born of the Biological and Toxin Weapons Convention (BWC) and the revised International Health Regulations [IHR (2005)] regimes have reinforced a systems approach to an objective shared by both communities: comprehensive biological risk management.
Between 2003 and 2010, States Parties to the BWC participated in a series of intersessional meetings aimed at maintaining momentum for BWC implementation between the major review conferences. Despite debate over whether the intersessional program strengthened treaty compliance, the meetings undeniably brought public health and security experts together to examine the practical aspects of biorisk management from a fresh perspective, and to seek new opportunities for cooperation under BWC Article X. Stakeholders forged partnerships and networks aimed at enhancing national capacities to detect and contain – and thus presumably deter – biological attacks.
In 2005, 194 States Parties (including all 193 member states of the World Health Organization) agreed to adopt IHR (2005), a binding agreement that dramatically overhauled the governance of international public health cooperation. Unlike previous agreements, which focused primarily on reporting and responding to specific diseases at ports and borders, the revised regulations call on nations to develop the core capacities required to detect, assess, report, and respond to public health events of any origin, whether naturally, accidentally, or deliberately caused.
This sweeping mandate requires nations to strengthen existing systems to detect and respond to public health events and to close any gaps. The IHR (2005) framework addresses core capacities required to detect emerging health events at the local, intermediate, and national levels – a challenge which relies on establishing appropriate laboratory diagnostic capacities throughout tiered, integrated systems. The IHR indicators include laboratory biosafety and biosecurity measures to ensure that laboratory workers can identify priority diseases in a timely, reliable, and safe manner.
IHR (2005) Article 44 calls upon states to collaborate in building the required capacities by sharing technical, logistical, and financial support. The revised IHR also required states to report to WHO by June 2012 either that they have either achieved the IHR core capacities, or that they require a two-year extension to implement their national action plans. Once the tally of extension requests is released publicly, donor states will have a new opportunity to help partner nations support these ambitious, whole-of-government plans at the operational level.
The objectives of public health and security stakeholders in building national capacities for disease detection and response may not be completely overlapping, but they are certainly mutually reinforcing.
The two communities are beginning to find practical ways to approach their mutual objectives. For example, threat reduction programs in the US, Canada, and other G8 governments have partnered with traditional health and development actors to establish, expand, and connect regional biosafety organizations. Laboratory accreditation programs are another natural area for collaboration, promoting the reliability of reporting and record-keeping. Strengthening these networks and training laboratory and health workers in standard practices from specimen collection through sample storage emphasizes a sustainable “culture of safety” that crosses sectors and incorporates biosecurity as an essential worker and community protection.
These regimes and related agreements have created a new framework for aligning public health and global biosecurity priorities at a systems level. Their success depends very much on maintaining the momentum of the last few years well into the next decade, and on taking the long view. This means continuing the shift from building capacities to detect and protect specific pathogens to enhancing the skills, tools, and knowledge required to manage biological risks across the spectrum – and keeping the health and security dialogue going.