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 confined 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 destructive causes. The capabilities and approaches of such adversaries vary, depending on their technical skills and on the political, economic, and security environments 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-specific 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

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