Countering Biological Threats: Challenges for the Department of Defense's Nonproliferation Program Beyond the Former Soviet Union (2009)

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2 Capacities of Developing Countries to Counter Biological Threats The capacities of the more than 130 low- and middle-income countries to counter existing and potential biological threats vary greatly, although most countries have severe weaknesses in this regard. Box 2-1 provides an important overview of systemic weaknesses across the developing countries. This chapter highlights four critical aspects of a country’s capacity to address effectively the proliferation of biological weapons within, into, or out of the country. They should be of special interest to the Biological Threat Reduction Program (BTRP) and are as follows: (1) the availability of trained human resources in many relevant fields; (2) an appropriate policy framework for addressing a variety of cross-cutting biology-related development and secu- rity issues; (3) an adequate physical infrastructure and supporting services for carrying out activities to prevent, detect, characterize, and respond to disease outbreaks; and (4) the government’s commitment, through implementation of appropriate policies, budgetary allocations, or both, to enhancing biosecurity in ways that take advantage of and reinforce global biosecurity efforts. Several BTRP actions are recommended in these areas, taking into account BTRP’s experience in the former Soviet Union (FSU), but recognizing the need to adjust programmatic approaches to the situation in each country of interest. TYPES OF BIOLOGICAL THREATS As discussed in Chapter 1, naturally occurring biological pathogens are of far greater concern to developing countries than seemingly abstract threats of bioterrorism. For decades, common diseases have spread across large portions of the world such as HIV/AIDS, malaria, cholera, hepatitis, and foot-and- mouth disease. Also, disease syndromes such as respiratory illness are com- monplace. Other diseases of concern may be unique to specific regions. 47 

48 COUNTERING BIOLOGICAL THREATS BOX 2-1 Systemic Weaknesses in Addressing the Risk of Disease Threats Most developing countries have limited ability to • monitor disease patterns, • identify new organisms, • investigate outbreaks and routes of transmission, • stockpile and mobilize commodities, • rapidly respond with trained staff, • educate the public on prevention and care seeking, • regulate unsafe animal rearing, transport, and selling, and • coordinate routine and emergency operations among health, animal, and other sectors. SOURCE: U.S. Agency for International Development briefing to the committee, November 3, 2008. Some diseases emerge in one region and are then transported by different mechanisms to other regions hundreds or even thousands of miles away. Avian influenza is an example. At the same time, other disease agents have been con- fined to local areas as the result of national and international disease control efforts. Several infectious diseases that are present in developing countries and are of concern to the U.S. government are set forth in various lists of dangerous pathogens. BTRP in particular has a list of diseases, syndromes, and agents of concern (see Box 2-2). U.S. interagency working groups and other agencies also have their own lists for determining research and surveillance priorities. The focus of this report is on malevolent actions of disenfranchised groups or individuals that deliberately divert dangerous biological substances to destruc- tive causes. The capabilities and approaches of such adversaries vary, depending on their technical skills and on the political, economic, and security environ- ments where they operate. The perpetrators may change their approaches or their target countries over relatively short periods of time, perhaps periods of several years. The threats are usually country-specific and require country-spe- cific responses that should be both flexible and sustainable. Of course, well- developed epidemiological and surveillance programs, together with proven laboratory diagnostic techniques, are broadly applicable in addressing many types of disease burdens and in identifying unusual outbreaks. An important aspect of the capacity of developing countries to address 

CAPACITIES TO COUNTER BIOLOGICAL THREATS 49 BOX 2-2 Diseases, Syndromes, and Agents of Priority Concern to BTRP in the Former Soviet Union • Diseases: high priority for plague, anthrax, brucellosis, tularemia, Crimean- Congo hemorrhagic fever (CCHF), tick-borne encephalitis, foot-and-mouth disease, rinderpest, classical swine fever, African swine fever, Newcastle disease, glanders, poxviruses, avian influenza • Syndromes: high priority for fevers of unknown origin requiring hospitalization, flu-like symptoms requiring hospitalization • Other: entire Select Agent list except plant pathogens SOURCE: BTRP, November 2008. biological threats is the expanding activities of biotechnology firms in some countries. As they increase their activities, local capabilities to understand disease characteristics and countermeasures should also increase. At the same time, however, there may be fears that the dual-use assets of emerging biotech- nology firms, including the expertise of their employees, could be diverted by irresponsible parties for inappropriate purposes. Also of concern is the possi- bility of unintentional incidents. For example, research by local biotechnology firms or governments intended to address chronic food shortages by exploring genetically modified crops could inadvertently damage traditional crops on nearby fields, could create disease viruses with unknown properties, or could break down disease resistance in livestock or humans. As noted in Chapter 1, in Pakistan the government is greatly concerned about this aspect as agricultural research activities intensify. Also as discussed in Chapter 1, reducing and countering the threats of naturally occurring diseases to human health and agriculture have long been an objective of many organizations, including foreign assistance agencies. But the potential problems of bioterrorism are widespread and have not been adequately addressed. Greater efforts by both individual governments and international development organizations are needed to upgrade the capacity of developing countries to counter all types of biological threats. Against this background, this chapter considers common vulnerabilities of developing countries to infectious diseases. These vulnerabilities have been present for decades to some degree within almost all countries. Now, with  Senior Pakistani official, presentation in Washington, D.C., July 2008. 

50 COUNTERING BIOLOGICAL THREATS greater capabilities in the biological sciences of vengeful groups and individuals, actions to reduce vulnerabilities deserve more attention. Biosecurity weaknesses vary in scope and intensity in countries at different stages of development, in different geographical settings, and within different political and economic environments. These countries range from the more advanced middle-income countries such as Malaysia, which has a growing bio- technology sector and is increasing its readiness to counter at least some of the common biological threats, to countries near the bottom of the development scale such as the Democratic Republic of the Congo, where the government has little capability to counter bioterrorism that might take root in the country or to deal with endemic diseases. Tanzania is an example of a developing country with a long history of unre- solved problems that contribute to vulnerabilities to diseases. These problems include the government’s preoccupation with other issues, such as hunger and education, conflicts between the government and international donors over funding priorities and acceptable time lines for discernible impacts of projects on development problems, rudimentary survey and surveillance capabilities, inadequate laboratory equipment, need for trained and motivated personnel, and weak supporting services. At the same time, the government is increasingly aware of steps that should be taken to combat diseases. Countrywide risk assessments or prioritization of vulnerabilities in specific country settings are not presented in this report. Such ambitious efforts, while critically important, were beyond the scope of the study. However, this chapter identifies types of biosecurity weaknesses that should be taken into account in establishing a framework for BTRP’s efforts to carry out risk assessments, to set priorities for countering disease outbreaks, and to determine needed biosecurity upgrades. Recommendation 2-1: BTRP should continue to emphasize to partner gov- ernments the importance of their strengthening on a broad basis the infra- structures necessary to address human, animal, and plant diseases and the underlying scientific capabilities of the countries as essential foundations for addressing threats of bioterrorism. Health and agriculture disease surveillance systems and associated research facilities are obviously important. The security services, facility design and construction entities, and electric and water utilities play significant roles. Well- functioning transportation systems and communication networks are needed. As discussed below, of critical importance are the education, training, and  Yonglolo, M. G. 2008. Sustainable global capacity of surveillance and response to emerging diseases of zoonotic origin. Presentation in Washington, D.C.¸ July. 

CAPACITIES TO COUNTER BIOLOGICAL THREATS 51 employment infrastructures that can increase the number and quality of person- nel engaged in biological activities. The following sections address three critical aspects of the necessary infrastructure: 1. Human resources 2. Policy framework 3. Physical infrastructure, including facilities, support services, and data systems HUMAN RESOURCES The deficiencies in the availability of skilled human resources in all devel- oping countries have for many decades been a major international development concern of the United States and other industrialized countries, as well as the developing countries themselves. From research scientists and medical doctors to security guards and maintenance personnel, the types of technical personnel who are needed for an effective biosecurity regime are in short supply. Short- term training programs supported by external parties to enhance specialized skills directly or indirectly related to biosecurity are commonplace in almost every developing country. But they are limited and are seldom adequate in quality of instruction or in the number of graduates to provide a solid basis for reducing pervasive deficiencies in skilled work forces. Many well-educated and adequately trained specialists in biology-related fields have difficulty finding rewarding employment in their home countries. In some developing countries, for example, foreign organizations have donated state-of-the-art laboratory equipment that is idle because of a lack of funds for supplies and maintenance or lack of technical expertise. Frustrated by inadequate salaries, poor working conditions, or both, many specialists simply abandon their scientific careers for positions in banking, commerce, or other more lucrative endeavors. They often turn for employment to foreign entities operating in their countries, which pay higher salaries and provide more com- fortable working conditions than local organizations for specialists, particularly those with international experience. Others leave the country with the intention of returning but find the attractions abroad addictive. In short, at the top of the list of impediments in promoting international development or in enhancing biosecurity are the shortages of adequate human resources with the requisite skills. Examples of the different situations in different countries are Pakistan, Indonesia, and the Philippines. Despite a massive brain drain, Pakistan nev- ertheless has a substantial cadre of well-trained scientists available to work on both biological research challenges and biosafety issues. In Indonesia the situa- tion is bleaker, with only a limited number of specialists, who have been trained 

52 COUNTERING BIOLOGICAL THREATS primarily in Australia. Still of greater concern is the situation in the Philippines, given the inadequacies of the outdated educational system and its failure to keep pace with developments in neighboring countries. The same security personnel frequently assume responsibility for both biosecurity and biosafety. Few formal educational programs exist in these fields, although biosecurity seems to be of growing interest. For example, a leading Moroccan university has established an educational program in the field of biosecurity. Specialized training programs will probably be important in many countries for the foreseeable future. Biosafety associations at the regional and national levels, such as the African Biosafety Association, are increasingly being formed and provide good training venues. Regional organizations have also become interested in sponsoring training workshops and special courses to help upgrade skills in these areas. On a broader but related basis, in the FSU, BTRP has provided training in laboratory management, design of laboratory systems, associated maintenance, and project management. Some level of advanced scientific skill is needed by every country as an underpinning for biosecurity-related programs across a range of development sectors. Designing and managing laboratory systems to detect and respond to outbreaks of diseases, for example, are obviously dependent on scientific capabilities. As countries begin to undertake research efforts that are intended to contribute to improved health, agriculture, or environmental system capa- bilities, a steady influx of well-prepared young specialists is essential for sus- tainability. However, the necessary educational capabilities to prepare such scientific cadres are not well developed in most countries that are likely to be of interest to BTRP. For scientists working in developing countries, continuing communication with an international network of colleagues is important. The network could include U.S. government laboratories and local government facilities. Also, sustained university-to-university relationships can be of special importance. Such contact enables local scientists to use the products of international sci- ence and to have a sense of belonging to the broader international community. Support for attendance at international meetings, encouragement of publica- tions in internationally recognized journals, and development of joint projects are desirable goals. BTRP and its U.S. partner organizations have considerable experience in supporting such activities.  According to the United Nations Educational, Scientific and Cultural Organization (UNESCO) Institute of Statistics, the total number of research and development personnel in these countries was as follows, as of the date in parentheses: Indonesia 52,000 (2001); Pakistan 102,000 (2005); the Philippines 13,500 (2003). These data were taken from the institute’s Web site, stats.uis.unesco.org. Accessed December 31, 2008. For purposes of comparison, such personnel represented approxi- mately 0.02 percent of Indonesia’s population, 0.06 percent of Pakistan’s population, and 0.015 percent of the Philippines’ population, compared with 2007 World Bank population figures.  Information provided by a Moroccan government official, November 2008. 

CAPACITIES TO COUNTER BIOLOGICAL THREATS 53 An often neglected aspect of biosecurity is the need for a strong cadre of engineers and technicians who design and maintain equipment, facilities, transportation and communication networks, and electrical and water systems that provide the backbone for many activities. Unfortunately, this physical infra- structure is in fragile condition in almost every developing country. Some of the malfunctioning of existing systems can be attributed to weak engineering skills within the countries. This problem should be recognized in considering future systems that require high-technology skills to maintain and operate. Well-trained specialists usually command substantial salaries in engineer- ing-related fields, resulting in competition for the limited pool of specialists. The number of young specialists trained is woefully inadequate in most coun- tries of interest. Establishment of engineering universities has not been a strong aspect of development assistance activities, although there are exceptions, such as establishment of the Indian Institutes of Technology and the Asian Institute of Technology. BTRP cannot be expected to take on the burden of expand- ing educational opportunities for engineers. But BTRP can provide financial incentives such as fellowships to encourage students who have studied abroad or trained locally to seek engineering careers and then to work to strengthen the physical infrastructures that provide the underpinnings for biosecurity improvements. Recommendation 2-2: BTRP should give special attention to strengthening the human resource base to address biosecurity challenges. Biosafety training may be an appropriate entry point for sustained engage- ment if there is local interest. Training in technical subjects such as epidemiol- ogy, laboratory analytical techniques, use of geographic information systems and global positioning systems, equipment maintenance and repair, and field- sampling methodologies should also be considered. In addition, biological eth- ics and research management are important topics. BTRP has initiated activities in all of these areas in the FSU. But even more fundamentally, BTRP’s contributions to upgrading impor- tant components of the partner nation’s educational system may be necessary to help achieve an acceptable level of biosecurity capabilities. To help ensure sustainability, training of the trainers and education of the educators should be considered from the outset. International and regional initiatives, includ- ing short-term visits to the United States and to regional centers of excellence by developing-country specialists, may offer opportunities for joint external efforts in many aspects of education and training while enhancing the viability of international networks of institutions of specialists. 

54 COUNTERING BIOLOGICAL THREATS POLICY FRAMEWORK Many developing countries have well-developed policy frameworks for programs in the health and agriculture sectors that encompass activities directly related to biosecurity. The international development banks, UN agencies, and U.S. and other bilateral donors have for decades played active roles in the development of such policies. Often a broad policy framework that surrounds and drives a specific program has been a precondition for reaching international agreement on a relevant loan by an external organization (for example, the World Bank) to finance the program. A variety of economic, industrial, environmental, and other policies over- lap with biosecurity concerns. They include, for example, intellectual property rights that may affect support of research activities, export control limitations that relate to international exchanges of pathogen strains, and trade policies that affect the tax aspects of needed equipment for facilities. It is unlikely that biosecurity will command a special policy framework involving a range of legislative actions, national regulations, and ministry direc- tives, as biosecurity cuts across many traditional development fields. Rather, it is more likely that the framework for biosecurity-related activities will have components in a variety of policies established for other purposes (see Box 2-3, for example). Strong policy support for biosecurity programs is important, par- ticularly if funding is to be directed to upgrading facilities and human resources that include substantial investments. Of course, the policy framework must be consistent with the goals of BTRP. A critical issue is the effective implementation of existing policies. Of special concern is sustainable implementation of program commitments if long- term external financing for projects is not available. In any event, a good policy framework is an important starting point for considering major external invest- ments in biosecurity. BOX 2-3 Agriculture Policy as a Component of Biosecurity “Biosecurity is a strategic and integrated approach that encompasses the policy and regulatory frameworks (including instruments and activities) that analyze and manage risks in the sectors of food security, animal life and health, and plant life and health, including associated environmental risk.” SOURCE: Deputy Director General, Department of Agriculture, Malaysia, Asia-Pacific Economic Cooperation workshop, October 13, 2008. 

CAPACITIES TO COUNTER BIOLOGICAL THREATS 55 Recommendation 2-3: From the outset of engagement with a specific coun- try, BTRP should give attention to encouraging the country to improve its policy framework that affects upgrading of biosecurity capabilities and related activities. PHYSICAL INFRASTRUCTURE: FACILITIES, SUPPORT SERVICES, AND DATA SYSTEMS In most developing countries, some or all facilities that handle pathogens should be upgraded, and in some cases, new facilities should be constructed, in order to address both biosafety and broader biosecurity concerns. In some countries, such as Pakistan, there are dozens of significant facilities. In other countries, such as Bolivia, there is only a handful. Often several facilities are well secured but others are not (for example, in Colombia). In addition to the security aspects of facilities, there are issues regarding the capabilities of these facilities to contribute effectively to the national effort in controlling diseases and in conducting research. The laboratories may be searching for new tools for use in the agricultural, health, and environmental sectors. They may be laboratories for training university students. They may be diagnostic or health service centers. Whatever their functions, it is important for BTRP to work with counterpart ministries to ascertain whether they should be upgraded, reconfigured, or even closed because of the risks associated with security inadequacies. In the FSU, BTRP correctly focused on establishing near-term security of pathogen collections. This concern is equally important in many developing countries. These collections may be distributed throughout the country for use in veterinary laboratories and health clinics. They may be housed in universi- ties that have relevant courses and research. Professors concerned about theft of their research materials may even keep them in private basements or other places that they consider to be safe from theft. As underscored in the preceding section, supporting services are often unreliable. Electricity failures can affect both scientific endeavors and secu- rity procedures. Water and sewage problems can disrupt work. Communica- tion failures may prevent reporting of outbreak data and receiving of relevant information to investigate outbreaks. Heating and cooling problems can ren- der facilities inoperable, and scientific equipment breakdowns are rampant in developing countries. The foregoing concerns lead to two recommendations. Recommendation 2-4: BTRP should draw on its extensive experience in pro- viding and upgrading facilities and equipment in the FSU to improve the functioning of important facilities in the developing countries, including both scientific and security aspects. 

56 COUNTERING BIOLOGICAL THREATS Recommendation 2-5: An early step in BTRP engagement efforts with specific countries should be to jointly identify and characterize pathogen collections— both collections established under the auspices of the government and infor- mal collections under the purview of individuals or groups of scientists. The security aspects of these collections, and particularly the capacity of the gov- ernment to ensure compliance with internationally acceptable biosafety regula- tions on a long-term basis, should be given high priority. Effective data systems are an essential component of the infrastructure required to control the spread of diseases. Unfortunately, in most developing countries, these systems are very rudimentary in design and operation. Com- mon problems include the following: • Some diseases are not reported, and the data that are available on reported diseases are incomplete. • Available data are unverifiable, and the data may be politically biased. • Detection, diagnosis, and confirmation of suspected outbreaks are impossible to carry out. • Sources of diseases (tourists, business travelers, migrant laborers, neigh- boring countries, indigenous reservoirs) are unknown. The objective of BTRP’s Threat Agent Detection and Response (TADR) Program is to address precisely these questions. It is still in the early stages of development, but some aspects may be helpful in the developing countries, as discussed in Chapter 3. Additional systems that deserve mention are the systems to protect water and food supplies from bioterrorist attacks. While this has not been an area of responsibility for BTRP in the past, the unprotected character as well as the generally poor sanitation aspects of these systems should be taken into account. Also, deliberately infecting the components of the systems with biological agents may not be difficult. It is unlikely that in the near future developing countries will take aggressive measures to replace water and food delivery sys- tems that have been in place for many decades. However, a few precautionary upgrade steps (for example, licensing of operators of facilities and surveillance of critical points in the distribution systems) should be easy to implement. Simply raising awareness about these steps to counter the threat of bioterrorism is important. COMMITMENT TO BIOSECURITY BY DEVELOPING COUNTRIES The commitment of a developing-country government to adopting and maintaining biosecurity standards is reflected in actions or lack of actions in all of the above areas: the involvement of skilled personnel in disease-related 

CAPACITIES TO COUNTER BIOLOGICAL THREATS 57 programs, the policy framework within which these personnel work, and the infrastructure and support systems that are available to enable the specialists to address important problems. Frequently, external parties play important roles in supporting this commitment. However, too often the government does not recognize the importance of controlling diseases beyond limiting the immediate adverse impacts of diseases on the population and on agricultural resources. Of course, addressing these impacts is essential and is an important aspect of a long-term biosecurity program. Raising awareness of local government officials, specialists, and the public regarding the seriousness of biological threats in the future is important if cooperative threat reduction programs are to succeed. An effective mechanism for raising awareness is the launching without delay of cooperative projects that highlight existing vulnerabilities and demonstrate by example practical approaches to correcting deficiencies both in security and in productivity of facilities. The communities of specialists in biosecurity, systems management, and scientific research are small in most developing countries. Thus, word about cooperative projects will spread quickly. Promptly launched cooperative projects that team national and international partners rather than vague prom- ises and discussions will help win support of other governments for achieving a variety of U.S. objectives in the economic and political spheres, including economic development and counterterrorism objectives.