6
Recommendations

This chapter consolidates the recommendations set forth in previous chapters. The recommendations that are of priority importance are so designated below. Determination of whether a recommendation should be classified as a priority recommendation has been based on the committee’s judgment as to (1) the importance and potential impact of the recommendation, (2) the likelihood that the recommendation can be successfully implemented, and (3) other factors particular to the specific recommendation, such as the likelihood of sustainability. Many recommendations call for modification of the approaches of the Biological Threat Reduction Program (BTRP) already under way in the former Soviet Union (FSU) before applying them outside the FSU, recognizing that the operating environments in other countries may be quite different.

SECURITY CONTEXT

Priority–Recommendation 1-1: The Department of Defense (DOD) should, within the U.S. government’s evolving global biological engagement strategy, promptly expand BTRP into selected developing countries beyond the FSU (page 44).

Priority–Recommendation 1-2: BTRP’s initial engagement activities in any developing country outside the FSU should be planned to last for up to 5 years, with consideration then to be given at the end of this period to extending engagement activities up to another 5 years depending on initial successes in reducing biological threats and the future importance of continued engagement (page 45).



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6 Recommendations This chapter consolidates the recommendations set forth in previous chap- ters. The recommendations that are of priority importance are so designated below. Determination of whether a recommendation should be classified as a priority recommendation has been based on the committee’s judgment as to (1) the importance and potential impact of the recommendation, (2) the likeli- hood that the recommendation can be successfully implemented, and (3) other factors particular to the specific recommendation, such as the likelihood of sustainability. Many recommendations call for modification of the approaches of the Biological Threat Reduction Program (BTRP) already under way in the former Soviet Union (FSU) before applying them outside the FSU, recognizing that the operating environments in other countries may be quite different. SECURITY CONTEXT Priority–Recommendation 1-1: The Department of Defense (DOD) should, within the U.S. government’s evolving global biological engagement strategy, promptly expand BTRP into selected developing countries beyond the FSU (page 44). Priority–Recommendation 1-2: BTRP’s initial engagement activities in any developing country outside the FSU should be planned to last for up to 5 years, with consideration then to be given at the end of this period to extending engagement activities up to another 5 years depending on initial successes in reducing biological threats and the future importance of continued engagement (page 45). 

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0 COUNTERING BIOLOGICAL THREATS CAPACITIES OF DEVELOPING COUNTRIES TO COUNTER BIOLOGICAL THREATS Priority–Recommendation 2-1: BTRP should continue to emphasize to partner governments the importance of their strengthening on a broad basis the infrastructures necessary to address human, animal, and plant diseases and the underlying scientific capabilities of the countries as essential foundations for addressing threats of bioterrorism (page 50). Recommendation 2-2: BTRP should give special attention to strengthening the human resource base to address biosecurity challenges (page 53). Recommendation 2-3: From the outset of engagement with a specific country, BTRP should give attention to encouraging the country to improve its policy framework that affects upgrading of biosecurity capabilities and related activities (page 55). Recommendation 2-4: BTRP should draw on its extensive experience in providing and upgrading facilities and equipment in the FSU to improve the functioning of important facilities in developing countries, including both sci- entific and security aspects (page 55). Recommendation 2-5: An early step in BTRP’s engagement efforts with specific countries should be to jointly identify and characterize pathogen col- lections—both collections established under the auspices of the government and informal collections established under the purview of individuals or groups of scientists. The security aspects of these collections, and particularly the capacity of the government to ensure compliance with internationally accept- able biosafety regulations on a long-term basis, should be given high priority (page 56). APPLICABILITY OF BIOLOGICAL THREAT REDUCTION APPROACHES IN THE FSU TO OTHER DEVELOPING COUNTRIES Priority–Recommendation 3-1: As BTRP moves beyond the FSU, the theme of partnerships with counterpart organizations in host countries should be a guiding principle (page 67). Priority–Recommendation 3-2: BTRP should develop in cooperation with each partner government a Strategic Plan that describes the security situation and particularly vulnerabilities relevant to biological assets in the country, dis- ease burdens and trends, local capabilities to detect and respond to outbreaks, and plans for cooperative threat reduction activities within the context of national plans and capabilities of both countries (page 69). Recommendation 3-3: As BTRP considers engagement in developing coun- tries outside the FSU with little or no history of biological warfare or bioterror- ism activities, BTRP should continue to expand its list of pathogens of interest to include pathogens of high-priority local interest (page 72). Recommendation 3-4: Projects requiring renovation or construction activi-

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 RECOMMENDATIONS ties should be an important aspect of BTRP activities in countries outside the FSU (page 74). Priority–Recommendation 3-5: BTRP should support cooperative biologi- cal research in countries where it engages, even if local research capabilities are limited (page 77). Recommendation 3-6: In moving beyond the FSU, BTRP should be flex- ible in the types of formal commitments it requires of partner governments as a basis for cooperation (page 79). Priority–Recommendation 3-7: DOD should streamline its chain of com- mand for implementing BTRP and simplify the operational process within DOD to enhance efficiency, reduce misunderstandings, and increase transpar- ency concerning U.S. intentions toward the host governments (page 81). Recommendation 3-8: BTRP should give priority to adequate advanced planning in order to ease visa problems for travel between the United States and partner countries in both directions (page 81). Priority–Recommendation 3-9: BTRP should continue to develop improved metrics that will help guide evaluations of the impacts of BTRP and provide information for setting priorities for activities designed to reduce proliferation of biological weapons as well as related risks from naturally occurring conta- gious disease agents (page 84). Priority–Recommendation 3-10: BTRP should take into account possible local concerns about a large presence of DOD activities in the countries where it engages. Joint projects with other organizations playing important roles and an emphasis on responding to local initiatives should be helpful in this regard (page 85). Recommendation 3-11: The design and operation of the TADR system should be carefully reviewed by a well-qualified, independent organization that has not been directly involved in the design or establishment of the system before BTRP advocates transportability of the components of the system to other countries beyond the FSU (page 87). Recommendation 3-12: Before BTRP begins planning construction of cen- tral reference laboratories outside the FSU, it should resolve issues concerning the need, location, operations, and international transparency in the long term regarding the facilities to which it has committed in the FSU (page 88). Recommendation 3-13: BTRP should refrain from advocating high-tech- nology approaches that may be inappropriate in low-technology environments (page 88). RELEVANT BIOSECURITY ACTIVITIES OF OTHER ORGANIZATIONS Recommendation 4-1: DOD should continue to be an active participant in the interagency nonproliferation process by responding whenever possible

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 COUNTERING BIOLOGICAL THREATS to requests of the Department of State and the National Security Council to deploy BTRP assets in countries beyond the FSU and by taking the initiative to advocate deployments that can effectively enhance the overall national effort (page 94). Recommendation 4-2: BTRP should work closely with other DOD entities that are involved in activities that support biosecurity in developing countries, drawing on the familiarity of these entities with conditions on the ground and their sensitivity to important issues in dealing with local leaders of government organizations and facilities in the countries of interest (page 98). Recommendation 4-3: BTRP should strengthen its relationships with the U.S. Agency for International Development (USAID) in Washington and in the field. One or more jointly funded projects would be an effective step in this regard (page 100). Recommendation 4-4: BTRP should adopt progress toward the host coun- try’s effective implementation of the International Health Regulations, including actions concerning public health emergencies, as an important measurement of success in countries where it mounts major efforts (page 104). Recommendation 4-5: BTRP should give greater attention to the bios- ecurity roles of the international development banks and of international and regional organizations. In coordination with the Department of State and USAID, BTRP should regularly consult with these organizations concerning the further development of BTRP activities (page 105). Recommendation 4-6: As BTRP carries out activities in developing coun- tries beyond the FSU, it should work with the Department of State and other appropriate government departments to encourage the private sector to become more actively engaged in biosecurity activities in these countries. Joint fund- ing of high-visibility projects would be a good beginning in this regard (page 108). Recommendation 4-7: BTRP should expand its highly successful annual program review conferences, which bring together its specialists with specialists from host-country organizations and specialists of other external organizations involved in biosecurity activities in regions where BTRP has programs or plans to initiate programs (page 109). Priority–Recommendation 4-8: BTRP should station regional or country representatives in areas where new activities are initiated with responsibility for keeping abreast of related activities and for promoting synergies among BTRP activities and related interests of other organizations (page 109). Recommendation 4-9: DTRA should frequently consult with appropriate local officials concerning coordination of activities of both local and external organizations, but such consultations should be designed so as not to create an excessive burden on limited local capabilities to devote personnel to BTRP coordination concerns (page 110).

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 RECOMMENDATIONS POLICY AND PROGRAM COORDINATION AND INTEGRATION Recommendation 5-1: DOD should ensure that the interests of BTRP, as well as other DOD entities, are adequately represented at an appropriate level in a variety of biology-relevant interagency coordination mechanisms that are led by the National Security Council, the Office of Science and Technology Policy, the Office of Management and Budget, other White House offices, and the Department of State (page 115). Recommendation 5-2: As BTRP expands the geographic coverage of its activities, DOD should ensure more systematic interactions among the many DOD units with biology-related programs in developing countries (page 115). Priority–Recommendation 5-3: The authors of the National Defense Authorization Act should include in the act a provision calling upon DOD to utilize as appropriate the capabilities of other U.S. government departments and agencies, and particularly the Department of Health and Human Services and the Department of Agriculture, to assist in the development and implemen- tation of BTRP activities. To this end, the act should recognize the importance of transfers of BTRP’s resources to these organizations as necessary and should call for BTRP to provide Congress within its annual reports information on the extent and effectiveness of such transfers (page 116). Recommendation 5-4: BTRP should ensure that its activities are an integral component of the coordination portfolios of U.S. ambassadors in countries where BTRP has activities (page 117). Recommendation 5-5: BTRP should adopt and adapt successful approaches that have been pioneered by other organizations while developing its own niche among the many programs of other external organizations devoted to reducing biological threats in the low- and middle-income countries (page 118). THE WAY AHEAD The risk of bioterrorism is too great for BTRP not to be among the leading organizations internationally in addressing the threat outside the FSU. BTRP, in continuing consultation with host-country governments, should emphasize a systems approach to address a range of pathogens—particularly those of day- to-day concern—that strengthens health and agricultural surveillance capabili- ties, pathogen security, and research activities on a broad basis. BTRP needs to expand cooperation with U.S. and foreign government and nongovernment organizations with overlapping interests. DOD’s planning and operational pro- cedures should be streamlined. Sustainability must be at the top of BTRP’s priority concerns. Strategic plans and more meaningful metrics developed with host-country governments that respond to the overall interests of the govern- ments need to guide the effort. DOD should consider this report as more than a series of disconnected recommendations from which it can simply choose. Each recommendation

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 COUNTERING BIOLOGICAL THREATS addresses an important issue that needs to be addressed if BTRP is to find success in its effort to reduce the risks associated with the threat of bioterror- ism. This report provides a framework and a starting point to finding the best approaches within the overall framework. As the first step in developing an action plan, DOD should promptly identify initial target countries outside the FSU. The selection criteria for target countries are numerous but should include (1) the likelihood of significant risk reduction and (2) the near-term likelihood that successes can be sustained over the long term. In some cases, BTRP may be the appropriate lead organizations for the U.S. effort, while in other cases, BTRP may play a supporting role in the national effort. Of course, BTRP must be welcomed in the countries of interest. Whether reconstructing facilities, upgrading surveillance or research capabilities, or providing training and related services, BTRP’s activities should be based on a clear vision of how they will improve biosecurity in the next 5 years. In some cases, a broad countrywide approach may be necessary to reduce vulnerabilities significantly. In other cases, a relatively minor contribution by BTRP may make a substantial difference in the biosecurity landscape of the country. In conclusion, BTRP can make a significant contribution to raising aware- ness of the governments, specialists, and public in developing countries of the importance of a range of policies and programs for addressing biologi- cal threats. An effective mechanism for raising awareness is the launching of cooperative projects that demonstrate the impacts of practical approaches to addressing vulnerabilities while also enhancing economic development and public health. The global community of specialists in the field of biosecurity is small, and information about BTRP cooperative projects will spread quickly. Action-oriented projects rather than vague promises and general discussions should continue to characterize BTRP’s approaches. In time, BTRP activities, as part of an integrated U.S. government approach, should increase respect for U.S. humanitarian-oriented objectives while help- ing to contain biological assets that could be misused. Achieving these parallel objectives will help reduce the dangers highlighted by the biodefense strategy of the White House that is summarized in Box 6-1. In summary, BTRP should play an important role in the U.S. government’s global response to the growing biological threat, with special attention to potential bioterrorism activities with roots in the developing countries outside the FSU.

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 RECOMMENDATIONS BOX 6-1 Threat Posed by Biological Weapons “Biological weapons in the possession of hostile states or terrorists pose unique and grave threats to the safety and security of the United States and our allies. Biological weapons attacks could cause catastrophic harm. They could inflict widespread injury and result in massive casualties and economic disruption. Bioterror attacks could mimic naturally occurring diseases, potentially delaying recognition of an attack and creating uncertainty about whether one has even occurred. An attacker may thus believe that he could escape identification and capture or retaliation.” SOURCE: Biodefense for the 21st Century. 2004. Available online at www.whitehouse.gov/home- land/20040430.html. Accessed November 27, 2008.

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