1

The History of Cooperative Threat Reduction
(1991-2018)

KEY MESSAGES

• International engagement in health-related activities by the Department of Defense (DOD) has historically resulted in direct benefit for the United States by advancing knowledge of infectious disease epidemiology and the development of medical countermeasures as well as fostering good will and trust with international partners.
• With the dissolution of the Soviet Union, both its biological weapons infrastructure and its highly experienced scientists working on offensive programs were vulnerable to exploitation by other malevolent nations or terrorist groups. The Nunn-Lugar Cooperative Threat Reduction (CTR) Program, based on scientist-to-scientist technical engagement, reduced the risk of proliferation when political negotiations and inspections failed.
• The threats and risks of state-sponsored or terrorist misuse of biology have changed over the past 20 years, but the scientist-to-scientist engagement approach to threat reduction, opening channels of communication around common technical interests in relevant health challenges, continues to be effective and has enhanced security for the U.S. military forces, U.S. interests overseas, and the homeland.

STUDY BACKGROUND

The National Academies of Sciences, Engineering, and Medicine (NASEM) Committee on Enhancing Global Health Security through International Biosecurity and Health Engagement Programs was tasked with examining the Biological Threat Reduction Program (BTRP), a

component of the CTR Program within DOD’s Defense Threat Reduction Agency (DTRA), and other domestic and international efforts with similar health security goals. The committee has explored the history of the CTR Program, often called the Nunn-Lugar Program after the two sponsors of the 1991 legislation that established it, and the evolution of the biological threat reduction component and biological threats of concern. The goal of this exploration was the development of a 5-year strategic vision for BTRP’s work within the larger health security space to promote biosafety, biosecurity, disease surveillance, health security, and biorisk management with partner countries, and to make recommendations to ensure this vision can be achieved. (See Box 1-1 for the statement of task guiding the committee’s work and note that although it includes “international health security programs and organizations with missions to enhance health security,” the sole sponsor of this study was BTRP.) When a federal government sponsor requests a study, the National Academies typically provides recommendations to that sponsor and not other parties, but a strategic vision for BTRP must include its partners in the U.S. government and beyond. The committee therefore makes recommendations primarily to BTRP and notes what the program needs from its partners to succeed.

To carry out the study, the committee held a series of information-gathering meetings, requested data and reports from BTRP, conducted an extensive literature review; sent committee members and staff to others’ meetings, including the Fifth Global Health Security Agenda (GHSA) Ministerial Meeting in Bali, Indonesia; and drew on committee members’ experience and expertise. At the information-gathering sessions, the committee heard from relevant U.S. government programs—BTRP, the Office of the Under Secretary of Defense for Policy, the Department of State Biosecurity Engagement Program (BEP), the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS)—contractors and nongovernmental organizations (NGOs) that work on biosafety and biosecurity and global health security more broadly with other countries, other countries’ programs (e.g., the United Kingdom and Finland), international organizations (World Health Organization [WHO], World Organisation for Animal Health [OIE]), and academic experts.

In its discussions, it became clear to the committee that different groups use the same terms differently. Threats and risks, for example, are interchangeable for one group and distinct but related for another. To make our report clearer, we list here several common terms with an explanation of our usage of those terms.

• Bioengagement: the engagement of specialists on issues associated with biology, life sciences, biotechnology, and/or any other related field
• Biothreat: the use of biology, life sciences, biotechnology, and/or any other related field in a way that is highly likely to cause harm or danger

• Biorisk: any aspect of biology, life sciences, biotechnology, and/or any other related field that exposes one to harm or danger
• Deterrence: creating a sense of doubt or fear of consequences as a means of discouraging an action or event
• Dissuasion: efforts made to persuade an individual (or individuals) not to take a particular course of action
• Global determination: the legal provision by Congress to allow BTRP to operate in any country and/or region of the world without additional authorization or approval
• Health security: ensuring the safe and secure provision of healthcare for animals and humans
• Risk: potential for an outcome that exposes one to harm or danger
• Threat: a natural or human-generated occurrence highly likely to cause harm or danger

OVERVIEW OF THE EVOLUTION OF COOPERATIVE THREAT REDUCTION

This chapter provides an overview of the evolution of cooperative threat reduction activities, beginning with programs established to respond to the dissolution of the Soviet Union, continuing to the broader range of today’s U.S. programs and related international activities. This report has adopted the following terms to refer to various programs: The Department of Defense Cooperative Threat Reduction Program is referred to as DOD CTR, and the broader U.S. government CTR programs that span multiple departments and agencies are referred to as U.S. government CTR.

The modern U.S. concept of CTR originated in November 1991 with the passing of the Nunn-Lugar Act (the Soviet Nuclear Threat Reduction Act of 1991), with an initial focus on securing and dismantling nuclear weapons and missile technology in the former Soviet Union (FSU).¹ The stated purpose of the act at the time was to secure and dismantle weapons of mass destruction and their associated infrastructure in FSU states (Woolf, 2002). Soon after passage of the Nunn-Lugar Act it was recognized that biological weapons and related components and expertise represented serious threats also in great need of threat reduction programs. The senators’ timing was nearly perfect because this new concept and resulting approach to threat reduction, based on building understanding

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¹ Soviet Nuclear Threat Reduction Act of 1991, Pub. L. No. 102-228 (1991).

and ultimately openness and trust, were already accepted when the Trilateral Agreement, which was signed in September 1992 by the United States, the United Kingdom, and the Russian Federation in an attempt to cooperatively halt or demilitarize the massive Soviet biological weapons program, failed for lack of cooperation and trust among parties. The Trilateral Agreement was structured around a security-centric approach to identifying treaty contraventions and negotiating the dismantlement of the Russian bioweapons program. The Nunn-Lugar legislation called for a cooperative science-based approach to disarmament. Early efforts in biological threat reduction under the Nunn-Lugar CTR Program intended to redirect scientists to peaceful activities, and to discourage them from moving to other countries along with their lethal technologies and tacit knowledge.

Pre-History of International Cooperative Threat Reduction Engagement History

DOD engaged in bioweapons research from 1943 until 1969 (Carus, 2017), and formally rescinded the program by signing and ratifying the Biological Weapons Convention in 1972 and 1975, respectively (UN, 2020c). DOD had also sponsored very effective small, bilateral, cooperative initiatives targeting the threats of naturally occurring infectious disease around the globe that could affect U.S. military forces serving in these regions but were surely a concern for the host country population as well. These initiatives include several laboratories focused on locally occurring and emerging infectious diseases in various parts of the world supported by the Naval Medical Research Command, and consisting of Naval Medical Research Units (NAMRUs) (U.S. Navy, 2020a):

• Southeast Asia (NAMRU-2, 1944 to present)
• Egypt (NAMRU-3, 1942 to present)
• Ethiopia (NAMRU-5, 1965 to 1977)
• Peru (NAMRU-6, 1983 to present)

The U.S. Army Medical Research and Materiel Command/Walter Reed Army Institute for Research sponsored U.S. Army Medical Research Units (USAMRUs) in the following countries (U.S. Army, 2008, 2019, 2020):

• Kenya (USAMRU-K, 1969 to present)
• Malaysia (USAMRU-M, 1948 to 1989)

• The Republic of Georgia (USAMRU-G, 2014 to present)
• The Armed Forces Research Institute of Medical Sciences in Thailand (1958 to present)

These units have served as valuable training grounds for military medical research as well as military and civilian scientists from the host country, while fostering strong and lasting personal relationships of trust between local scientists and U.S. military and civilian scientists. The infrastructure and sustained focus on communicable diseases has allowed a large cadre of experts to rapidly address emerging infectious diseases as they have become more common and better recognized as threats to human health.

In a 2011 assessment of the scientific contributions of these overseas laboratories, Peake and colleagues noted that these laboratories “bring broad global health benefits beyond their immediate mission of force health protection.” Scientists at these labs focus on developing products such as prophylactic and therapeutic drugs, vaccines, diagnostics, and scientific knowledge. Their continued “ability to conduct Phase III clinical trials in indigenous areas result in medical advances that not only save the lives of men and women in uniform, but also have dramatic health benefits for all populations vulnerable to neglected diseases. In many important instances, the DOD laboratories’ findings have helped mitigate or eradicate diseases on a global scale, as well as have identified or diagnosed previously unknown pathogens” (Peake et al., 2011, p. 2).

An example of the effectiveness and trusting relationships built through these laboratories is also found in the history of NAMRU-3 when, in 1967, laboratory staff were allowed to stay through Egypt’s 1967 Arab–Israeli War with Israel and during a 7-year hiatus in diplomatic relations between Egypt and the United States, while all other similar foreign organizations were forced to leave (Hibbs, 1993). These laboratories have helped establish and stabilize infectious disease research capabilities worldwide and have provided the United States with security-related good will around the globe at relatively very little cost and without making security the focus of their efforts. Important scientific discoveries have emerged from these laboratories as a further return on the investment: for example, the early studies on the treatment of scrub typhus with chloramphenicol in Malaysia in 1948 (U.S. Army, 2008), or the treatment of cholera and the development of oral rehydration therapy at NAMRU-2 in Taiwan (Cash, 1987), and NAMRU-3 in the late 1940s and early 1960s, respectively (U.S. Army, 2008, 2019, 2020).

THE ORIGINS OF THE BIOLOGICAL THREAT REDUCTION PROGRAM: CTR 1.0

The dissolution of the Soviet Union raised concerns regarding the potential loss and vulnerability of its tens of thousands of nuclear weapons; tens of thousands of metric tons of stockpiled chemical agents; and a massive biological weapons research, development, and production infrastructure. Hence, the initial focus of CTR was to assist newly independent states of the FSU to safely and securely dismantle weapons systems, particularly at sites where nuclear weapons were located. The Nunn-Lugar Act defined three primary objectives:

1. Assist FSU states to destroy nuclear, chemical, and other weapons;
2. Transport, store, disable, and safeguard weapons in connection with their destruction; and
3. Establish verifiable safeguards against the proliferation of such weapons.²

In 1992, the mission was expanded to include dismantling delivery systems for these weapons, including missiles and missile launchers, destroying destabilizing conventional weapons, preventing the diversion of weapons-related scientific expertise, facilitating demilitarization of defense industries and converting military capabilities and technologies, and expanding military-to-military and defense contacts (Lederberg et al., 1992; NAS, 2009).³ The Trilateral Agreement, signed in the same year by

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² Soviet Nuclear Threat Reduction Act of 1991, Pub. L. No. 102-228 (1991).

³ Coincidentally, also in 1992, the Institute of Medicine published what has proven to be a ground-breaking report, Emerging Infectious Diseases: Microbial Threats to Health in the United States, which documented the increasing frequency of outbreaks due to newly identified pathogens or known pathogens with new properties or outbreak potential (IOM, 1992). A few years later, a Presidential Decision Directive (NSTC-7) was issued and, noting the limited worldwide disease surveillance and preparedness for emerging infectious diseases, called on DOD to improve worldwide emerging infectious disease surveillance and preparedness (NSTC, 1997). The result was the DOD Global Emerging Infections Surveillance and Response System (DOD-GEIS), which expanded the mission of the medical research components of DOD to include global disease surveillance. Over the subsequent two decades, GEIS has coordinated a disease surveillance and response network through collaborations involving the U.S. military overseas laboratories, partners in countries around the world, laboratory capacity-building initiatives, and epidemiologic training endeavors. From the time GEIS was established, it has worked in close coordination with the CTR Program.

the United States, the United Kingdom, and the Russian Federation, was an attempt to halt the former Soviet biological weapons program through an effort to negotiate, inspect, and ensure that the former Soviet biological weapons program—consisting of three Russian Ministry of Defense laboratories and some 18 Biopreparat laboratories and factories—had ended. However, when the Trilateral Agreement team arrived in Russia in 1994, the Russian Ministry of Defense funding for the biological warfare laboratories and production facilities had ceased and staff salaries were no longer being paid. As a consequence, employees at the multiple former biological weapon facilities operated by Biopreparat, the non-military part of the program, were increasingly desperate to support themselves and their families (ACDA, 1994; Chevrier and Henry, 1998). To provide support to these individuals, the International Science and Technology Center (ISTC) was established in Moscow in 1994 under an agreement with the Russian Federation. ISTC became the interlocutor for the CTR Program and similar programs of several other countries, and was able to provide money for assistance and collaborative civilian technical research and training to these former biological weapons experts, while avoiding taxation by the Russian or other recipient governments. The United States and other governments insisted on the ISTC arrangement so that the Russian government would not withhold a portion of the funds meant to support struggling scientists and engineers. Thousands of Russian life scientists, if they qualified as former weaponeers, participated in joint projects related to laboratory safety, security, and quality enhancement; basic infectious disease research; development of medical countermeasures and diagnostics for endemic and reemerging diseases. In the first 20 years that ISTC was active, more than 70,000 former weapons scientists in more than 760 research institutes spread across the FSU had been engaged in ISTC projects and activities (ISTC, 2020; Nikitin and Woolf, 2014).

DTRA was established in 1998, incorporating the CTR Program within its organization. Under congressional direction, the Secretaries of Defense, State, and Energy agreed to transfer funding responsibility for certain activities from the DOD budget request into the Departments of State and Energy budgets. By 2000, several government departments supported the CTR activities in the Russian Federation, including the Departments of State and Energy; HHS, including the National Institutes of Health and CDC; the National Science Foundation; the U.S. Agency for

International Development; the Environmental Protection Agency, and the Department of Agriculture. Departments and agencies that had traditionally not been engaged in international security efforts were included in this significant program to support the redirection of the massive Soviet biological weapons enterprise.

In a related policy statement, the Clinton administration’s National Security Strategy of 1999 stated that “diseases and health risks can no longer be viewed solely as a domestic concern. Like the global economy, the health and well-being of all peoples was becoming increasingly interdependent. With the movement of millions of people per day across international borders and the expansion of international trade, health issues as diverse as importation of dangerous infectious diseases and bioterrorism preparedness profoundly affect our national security” (White House, 1999, p. 13).

TAKING STOCK OF THE FIRST 15 YEARS, AND PLANNING AHEAD TO BIOLOGICAL COOPERATIVE THREAT REDUCTION: CTR 2.0

During the 15 years following the passage of the Nunn-Lugar Act, DOD invested nearly $7 billion in CTR activities (Woolf, 2012). As noted above, under the CTR Program, this funding went to safeguard and dismantle vast stockpiles of nuclear and chemical weapons, and a large biological weapons research and manufacturing enterprise in the FSU, as well as to engage scientists in productive peaceful applications of science. Following the terrorist attacks in the United States on September 11, 2001, and the subsequent mailing of anthrax-laced letters to several news organizations and two U.S. senators (FBI), there were renewed concerns that terrorists were interested in acquiring chemical, biological, radiological, and nuclear weapons, related materials, and knowledge from the FSU (Nikitin and Woolf, 2014). In response, the George W. Bush administration released the National Strategy to Combat Weapons of Mass Destruction (WMD) in 2002, expanding the strategic focus of the CTR Program to also address the threat posed by non-state terrorists, particularly those seeking to acquire WMD capabilities (U.S. DOS, 2009). During this period, international cooperation became more formalized to strengthen CTR programs. For example, in 2002 the Group of Eight, or G8, countries announced the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction, committing these countries

to fund a total of $20 billion on nonproliferation projects, with a particular emphasis on the destruction of WMD stockpiles in the FSU, including the destruction of stockpiles of chemical weapons, dismantling decommissioned nuclear submarines, and safeguarding/disposing of fissile material, as well as employing former weapons scientists (NTI, 2018). In the administration’s 2004 National Biodefense Strategy, the importance of preventing and reducing future biological weapons threats was emphasized, while mitigating risks from “advances in biotechnology and life sciences—including the spread of expertise to create modified or novel organisms—[that] present the prospect of new toxins, live agents, and bioregulators that would require new detection methods, preventive measures, and treatments” (White House, 2004a). Congress also authorized the spending of DOD CTR funds outside the FSU under Public Law H.R. 1588,⁴ the first example being CTR’s response to Albania’s request for assistance to destroy its stockpile of chemical weapons. This destruction of a chemical stockpile was subsequently achieved through cooperative efforts between the government of Albania and DTRA (Woolf, 2012).

The U.S. Department of State launched its own global biosecurity engagement program (subsequently designated the Biosecurity Engagement Program or BEP) in 2006. Reflective of CTR’s expanded geographic scope, initial focus was to ensure the physical security of pathogens, upgrade laboratory biosafety procedures, and improve approaches for combating infectious diseases in South Asia, Southeast Asia, and the Middle East (NRC, 2007). It was also during this period that the revised and enhanced International Health Regulations (IHR) (2005) were adopted as an agreement among 196 countries to build their capacities to detect, assess, and report emerging infectious disease outbreaks, and to provide assistance as needed to respond with healthcare and public health control measures (WHO, 2019d). The latest iteration of IHR entered into force in 2007 (WHO, 2016a), and while there have been enduring issues with the implementation of IHR, DOD, and BTRP as a part of DOD, has made large contributions in support of IHR (2005) implementation efforts. These efforts have included participating in reporting activities and establishing disease surveillance in collaboration with host countries, such as building capacities for monitoring of respiratory diseases. During this era, the U.S. government became particularly focused on a natural, but potentially catastrophic threat to

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⁴ National Defense Authorization Act, 108th Congress, § 1301 (2004).

national and global health, stability, and ultimately security: pandemic influenza. The spread of the H5N1 influenza virus in poultry populations in 2005, especially in the East Asia and Pacific regions, generated global fears that the virus could mutate to become a potentially catastrophic influenza pandemic along the lines of the pandemic that killed some 40 million people worldwide in 1918 and 1919. President George W. Bush initiated a whole-of-government response. In November 2015, the U.S. Homeland Security Council issued the National Strategy for Pandemic Influenza to guide preparedness and response. The intention was described as “(1) stopping, slowing or otherwise limiting the spread of a pandemic to the United States; (2) limiting the domestic spread of a pandemic, and mitigating disease, suffering and death; and (3) sustaining infrastructure and mitigating impact to the economy and the functioning of society.” (HSC, 2005, p. 2). The federal government planned to use all instruments of national power and leverage global partnerships to address the pandemic threat.

The May 2006 Implementation Plan for the National Strategy for Pandemic Influenza tasked the Department of State with leading the federal government’s international engagement, bilateral and multilateral, to promote development of global capacity to address an influenza pandemic. The first priority for DOD support in the event of a pandemic was “to provide sufficient personnel, equipment, facilities, materials, and pharmaceuticals to care for DOD forces, civilian personnel, dependents, and beneficiaries to protect and preserve the operational effectiveness of our forces throughout the globe.” DOD, in conjunction with the Departments of State and HHS, would “utilize its existing research centers to strengthen recipient-nation capability for surveillance, early detection, and rapid response to animal and human avian influenza” (HSC, 2006, p. 52).

From 2007 to 2011, negotiations took place at WHO resulting in the Pandemic Influenza Preparedness Framework, approved by the World Health Assembly in May 2011. The objective of the framework is to improve pandemic influenza preparedness and response and to strengthen the protection against pandemic influenza by improving and strengthening the renamed WHO Global Influenza Surveillance and Response System. The objective is to have a “fair, transparent, equitable, efficient, effective system for, on an equal footing: the sharing of H5N1 and other influenza viruses with human pandemic potential; and access to vaccines and sharing of other benefits” (WHO, 2011, p. 6). The global focus on

pandemic influenza preparedness and response was a precursor to the broader effort under the rubric of GHSA.

The Past Decade of Biological Threat Reduction: CTR 2.0

The National Defense Authorization Act for Fiscal Year 2008⁵ authorized the DOD CTR Program activities to expand partnerships and cooperation agreements to countries beyond the FSU and Europe, namely in the Middle East and Asia, as well as to pursue denuclearization activities in the Democratic People’s Republic of Korea. The same law authorized the National Academy of Sciences (NAS) to undertake a review of the DOD CTR Program and recommend ways to strengthen and expand it. The report, Global Security Engagement: A New Model for Cooperative Threat Reduction, was released in 2009, and the programmatic modifications described in the report necessary to address the changing international security environment in the future were described as “CTR 2.0.” Box 1-2 summarizes the key recommendations of the report.

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⁵ National Defense Authorization Act, 110th Congress, § 1301 (2008).

Further geographical expansion of engagements occurred under the Obama administration, largely through BTRP, and programmatic expansion occurred through a shift in emphasis from destroying and securing weapons facilities and diverting activities of former weaponeers to increasing security by strengthening detection/diagnostic and disease surveillance capabilities. The second Presidential Policy Directive and the National Strategy for Countering Biological Threats in late 2009, was very much in agreement with recommendations of the 2009 NAS report, and outlined three important themes relevant to CTR: (1) the inclusion and combination of intentional and natural biological threats; (2) an increased focus on international engagements; and (3) increased efforts to prevent adverse events. DTRA, working primarily in Africa, the Middle East, and Southeast Asia, placed a new emphasis on university-to-university collaborations by soliciting collaborative research proposals from U.S. and partner-country academic institutions. Program leadership added influenza to the list of threat agents authorized for collaboration, because of the security consequences of a major pandemic and the global concern about the potential consequences of such an event, and greatly increased its efforts in global disease surveillance. The National Security Strategy of 2010 also emphasized the need to continue working with international and domestic partners on ways to reduce the risks associated with unintentional as well as deliberate outbreaks of infectious disease and to strengthen resilience across the spectrum of high-consequence biological threats (White House, 2010). From a functional perspective, Congress provided DOD with co-mingling authority, requested in the 2009 NAS report, which allowed the CTR Program to accept funding contributions from appropriate outside organizations and foreign governments.⁶ In addition, as requested in the 2009 NAS report, the DOD CTR Program

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⁶ Authority to carry out Department of Defense Cooperative Threat Reduction Program, U.S. Congress, Pub. L. No. 113-291 § Chapter 48, 50 Stat. (2014).

was given limited notwithstanding authority by allowing the National Defense Fund the use of funds regardless of the restraints of any other law.⁷

It had become clear that the metrics for success of CTR activities (the so-called “Nunn-Lugar Scorecard”) could not accurately illustrate the impact and effectiveness of CTR 2.0 programs for biological engagement. While the scorecards could be used to count numbers of nuclear warheads deactivated, submarines decommissioned, ballistic missiles eliminated, and nuclear test tunnels sealed, they did not reflect important activities such as long-term working relationships between scientists and clinicians, crisis prevention, and improvements in biological security and biosafety capabilities.

In 2013, the memorandum of understanding known as the umbrella agreement that established the legal framework for U.S.–Russian collaboration under the CTR Program expired. Russian leadership chose to terminate its support for ISTC in Moscow, originally established to administer grants and manage the transfer of funds from the United States, the European Union, Japan, Norway, and South Korea to support threat reduction projects and facility renovation efforts aimed at redirecting scientists to peaceful activities.

Beginning in early 2014, three important events occurred. First, ISTC moved from Moscow to Nur-Sultan, Republic of Kazakhstan, where it continues to operate under the same name. A similar body, the Science and Technology Center in Ukraine (STCU) was established in 1993 and still exists today. STCU and ISTC provide support for CTR-type activities, indicating that different geographical offices provide the necessary flexibility to serve different needs. Second, GHSA was launched to pursue a multilateral and multisectoral approach to “strengthen both the global capacity and nations’ capacity to prevent, detect, and respond to human and animal infectious diseases threats,” whether natural, accidental, or intentional (GHSA, 2019). At present 67 countries have signed GHSA membership agreements; this has created new opportunities for global engagement. GHSA has taken on the essential need to advance IHR (2005) capacity by an invigorated effort to assess the state of readiness of countries for disease surveillance, reporting, and response to emerging infectious disease outbreaks through its process of voluntary Joint External Evaluations. Third, in 2014, the U.S. government, including DOD, responded to the West Africa Ebola epidemic at the direction of President Obama, coordinated by the Assistant Secretary of Defense for

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⁷ Ibid. § 3713.

Special Operations/Low-Intensity Conflict. BTRP was able to provide critical assistance early in the response through its ongoing laboratory engagement program at the Lassa fever study ward at Kenema Hospital in Sierra Leone. BTRP was in place well before the declaration by WHO of a Public Health Emergency of International Concern and a vigorous international response could be organized. Major contributions of BTRP were to convert its established Lassa fever diagnostic platform in Kenema to Ebola diagnostics and to transfer the technology to Liberia as well.

Finally, in September 2017, NASEM held a symposium titled Cooperative Threat Reduction Programs for the Next Ten Years and Beyond (NASEM, 2018). The symposium focused not just on biological threat reduction, but also included nuclear and chemical threat reduction as well. Bringing together many current and former government officials and representatives of NGOs who had developed policy for and managed or observed the impacts of CTR programs over the years, the symposium opened with a brief review of history, evolution, and contributions. Speakers then discussed technological, geopolitical, and fiscal realities in 2017, and the way ahead. At the end of the symposium, the co-chairs summarized the meeting with a series of observations taken from the plenary and breakout sessions:

• Cooperation between and among government agencies, NGOs, and the private sector are critical to reducing threats to the United States. The “cooperative” part of CTR makes the concept unique and especially valuable in an increasingly interconnected world.
• It is important for CTR programs to communicate how engagement improves the security of the United States, demonstrating explicitly, through detailed examples, how their work is done and what threats are being reduced. CTR programs can better articulate their value to policy makers by designing and using simple (outcome) metrics, but only where appropriate.
• The United States and the Russian Federation have years of experience working together on arms control and CTR programs, and these efforts have created longstanding positive relationships that could be used to renew technical cooperation and improve transparency and trust between the United States and the Russian Federation. Although expert views differ on the current state of Russia’s plans and programs, the relationships established through this engagement can help address concerns that may arise and establish a path forward to reengagement in the future.

• CTR programs will continue to focus on reducing threats and risks but can also support efforts that build relationships and scientific partnerships, which are the foundation of sustainable CTR. Scientific partnerships often lay the foundation for larger cooperative efforts and can eventually lead to more transparency between governments, creating sustainable long-term security.
• Labels are important. Sometimes cooperative efforts stall because the CTR partner country thinks that the United States has deemed the partner a threat. “Global security engagement” or “cooperative risk management” as opposed to “cooperative threat reduction” might be better ways to describe some programs with certain countries.
• The United States can enhance the impact of CTR by creating government–industry collaborations, including flexible arrangements to more easily partner with industry and create incentives for companies to support national and international security goals.
• The United States can do better at engaging and partnering with multilateral organizations like the United Nations (UN), Security Council Committee established pursuant to resolution 1540 (2004), UN Office for Disarmament Affairs, UN Office for Counter-Terrorism, WHO, Food and Agriculture Organization of the UN, International Plant Protection Convention, and OIE to strengthen global and international norms against the acquisition and use of WMD.
• It is important for the United States to maintain robust capabilities to undertake classical CTR-like WMD elimination, as U.S. CTR programs and expertise could be the basis for eliminating WMD abroad if the opportunity arises. In the future, CTR capabilities can also be used to address threats and risks from dual-use technologies like additive manufacturing, process-intensive chemical production, genome editing and synthetic biology, drones, and cyber systems.

THE CURRENT REALITY: BTRP POISED FOR CTR 3.0

It was with that backdrop that the Committee on Enhancing Global Health Security through International Biosecurity and Health Engagement Programs undertook the deliberations associated with this study, and developed the findings and recommendations described in the following chapters. The committee began its work with a review of the current state of BTRP and CTR (See Box 1-3).