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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Edith Amponsah, Gillian Buckley, Julie Pavlin, and Anna Nicholson, Rapporteurs Forum on Microbial Threats Board on Global Health Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation, The California Endowment (#10002009), Health Resources and Services Administration (DHHS-10002817), New York State Health Founda- tion (#10001272), The Rippel Foundation, and Robert Wood Johnson Foundation (#10001270). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25746 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2020 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the frontiers of innovation to tackle microbial threats: Proceed- ings of a workshop. Washington, DC: The National Academies Press. https://doi. org/10.17226/25746. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

PLANNING COMMITTEE ON EXPLORING THE FRONTIERS OF INNOVATION TO TACKLE MICROBIAL THREATS1 KENT E. KESTER (Co-Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur RAFAEL OBREGÓN (Co-Chair), Chief of Communications for Development, United Nations Children’s Fund KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security GREGORY ARMSTRONG, Director, Advanced Molecular Detection, U.S. Centers for Disease Control and Prevention RICK BRIGHT, Director, Biomedical Advanced Research and Development Authority (BARDA), U.S. Department of Health and Human Services JOHN BROWNSTEIN, Chief Innovation Officer and Professor, Harvard Medical School ANDREW CLEMENTS, Deputy Director, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development PETER DASZAK, President, EcoHealth Alliance LORI FOSTER, Professor, Industrial-Organizational Psychology, North Carolina State University EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology, Director, Center for Global Public Health, University of California, Berkeley ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc. JAMES LAWLER, Associate Professor, Department of Internal Medicine; Director, International Programs and Innovation, University of Nebraska Medical Center College of Medicine JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis PAIGE E. WATERMAN, Colonel, U.S. Army, Assistant Director, Biological Threats Office of Science and Technology Policy, Executive Office of the President 1  The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the rapporteurs and the institution. v PREPUBLICATION COPY—Uncorrected Proofs

MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine; Adjunct Professor, Global Health and Population, Harvard T.H. Chan School of Public Health Health and Medicine Division Staff JULIE PAVLIN, Director, Forum on Microbial Threats; Senior Director, Board on Global Health GILLIAN BUCKLEY, Senior Program Officer (from April 2020) EDITH AMPONSAH, Associate Program Officer HANNAH GOODTREE, Senior Program Assistant CECILIA MUNDACA SHAH, Project Director (until December 2019) V. AYANO OGAWA, Senior Program Officer (until December 2019) YAMROT NEGUSSIE, Program Officer (until November 2019) STEPHEN CHUKWURAH, Senior Program Assistant (until December 2019) vi PREPUBLICATION COPY—Uncorrected Proofs

FORUM ON MICROBIAL THREATS1 PETER DASZAK (Chair), President, EcoHealth Alliance KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur MARY E. WILSON (Vice Chair), Clinical Professor of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine; Adjunct Professor, Global Health and Population, Harvard T.H. Chan School of Public Health (until December 2019) KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security RICK BRIGHT, Director, Biomedical Advanced Research and Development Authority (BARDA), U.S. Department of Health and Human Services TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences CRISTINA CASSETTI, Deputy Division Director, Division of Microbial and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health ANDREW CLEMENTS, Deputy Director, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development MARCOS A. ESPINAL, Director, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization KEIJI FUKUDA, School Director and Clinical Professor, The University of Hong Kong School of Public Health (until December 2019) EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology; Director, Center for Global Public Health, University of California, Berkeley ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc. CHANDY C. JOHN, Director, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine RIMA F. KHABBAZ, Director, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention MICHAEL MAIR, Acting Director, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration 1  The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vii PREPUBLICATION COPY—Uncorrected Proofs

JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis SALLY A. MILLER, Professor of Plant Pathology and State Extension Specialist for Vegetable Pathology, Ohio Agricultural Research and Development Center, The Ohio State University SUERIE MOON, Director of Research, Global Health Centre, Graduate Institute of International and Development Studies, Geneva DAVID NABARRO, Advisor, Health and Sustainability, 4SD–Skills, Systems, and Synergies for Sustainable Development RAFAEL OBREGÓN, Chief of Communications for Development, United Nations Children’s Fund KUMANAN RASANATHAN, Board Member, Health Systems Global GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis JAY P. SIEGEL, Retired Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Johnson & Johnson (until January 2020) ALAN TENNENBERG, Chief Medical Officer, Johnson & Johnson Global Public Health MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency National Academies of Sciences, Engineering, and Medicine Staff JULIE PAVLIN, Director, Forum on Microbial Threats; Senior Director, Board on Global Health GILLIAN BUCKLEY, Senior Program Officer (from March 2020) EDITH AMPONSAH, Research Associate HANNAH GOODTREE, Associate Program Officer CECILIA MUNDACA SHAH, Project Director (until December 2019) V. AYANO OGAWA, Senior Program Officer (until December 2019) YAMROT NEGUSSIE, Program Officer (until November 2019) STEPHEN CHUKWURAH, Senior Program Assistant (until December 2019) viii PREPUBLICATION COPY—Uncorrected Proofs

Reviewers T his Proceedings of a Workshop was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engi- neering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review com- ments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: CHANDY C. JOHN, Indiana University School of Medicine RIMA F. KHABBAZ, U.S. Centers for Disease Control and Prevention Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID R. CHALLONER, University of Florida. He was responsible for making certain that an independent ex- amination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rap- porteurs and the National Academies. ix PREPUBLICATION COPY—Uncorrected Proofs

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Acknowledgments T he workshop summarized in this proceedings is the product of many valuable contributions. Special thanks go to the presenters and dis- cussants who gave generously of their time and expertise to make the event possible. A full list of the speakers and moderators and their biographical information may be found in Appendix C. xi PREPUBLICATION COPY—Uncorrected Proofs

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Contents ACRONYMS AND ABBREVIATIONS xix 1 INTRODUCTION 1 Workshop Objectives, 2 Organization of the Proceedings of the Workshop, 3 2 PIVOTAL ROLE OF INNOVATIONS IN TACKLING MICROBIAL THREATS: LESSONS FROM PAST OUTBREAKS 5 Lessons Learned from Innovation in Polio Eradication, 5 Advancing Innovation on the Ground in the Fight Against Ebola, 10 Discussion, 16 3 HARNESSING LESSONS FROM EMERGING SCIENTIFIC, TECHNOLOGICAL, AND SOCIAL INNOVATIONS 19 The Role of Innovation in the Evolution of Global Vector Control Response, 20 Applying Modeling to Inform Infectious Disease Surveillance and Outbreak Response, 23 Unbiased Metagenomics Sequencing to Counter Microbial Threats: Lessons from Bangladesh, 27 Digital Process Innovations for HIV Self-Testing, 30 Discussion, 33 xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv CONTENTS 4 OVERCOMING BARRIERS IN THE FIELD TO BOLSTER ACCESS AND PRACTICAL USE OF INNOVATIONS 37 Digital Innovation to Improve Immunization Service Delivery, 38 Using Data and Modeling to Improve Detection and Response, 40 Outbreak-Related Data Sharing and Collaboration: Challenges and Opportunities, 43 Addressing Health Challenges with Behavioral Insights and Tools, 48 Discussion, 54 5 SYSTEMS APPROACHES TO SPUR INNOVATIONS IN TACKLING ANTIMICROBIAL RESISTANCE 59 Applying Lessons from One Health Surveillance to Tackle Antimicrobial Resistance, 60 Sparking Antibiotic Discovery Through Data Sharing and Scientific Collaboration, 64 Incentivizing Novel Diagnostic Tests to Counter Antibiotic Resistance, 67 Strengthening Systems to Overcome Barriers to Innovation, 70 Discussion, 74 6 BREAKING DOWN BARRIERS AND FOSTERING PARTNERSHIPS TO ENABLE INNOVATION 79 Enabling Biotechnologies Through Partnerships, 80 Fostering New Partnerships to Enable Innovation, 82 Private-Sector Partnerships to Address Global Health Needs, 86 Discussion, 88 7 NURTURING INNOVATIONS THROUGH NOVEL ECOSYSTEMS TO ACCELERATE RESEARCH AND DEVELOPMENT 95 Biomedical Advanced Research and Development Authority, 95 Decoding the Human Immune System to Transform Human Health, 97 Reverse Innovation, 100 Nurturing Innovation to Accelerate Research and Development, 103 Spurring Innovation in Diagnostic Tools, 106 Discussion, 111 PREPUBLICATION COPY—Uncorrected Proofs

CONTENTS xv 8 VISIONARY STATEMENTS ON PRIORITIES FOR INNOVATION 117 Innovations Against Vector-Borne Diseases in Brazil, 117 Innovations to Address Antimicrobial Resistance in Canada, 118 Innovations to Maximize Impact in AIDS, Tuberculosis, and Malaria, 120 Final Synthesis and Discussion, 122 REFERENCES 125 APPENDIXES A WORKSHOP STATEMENT OF TASK  135 B WORKSHOP AGENDA  137 C SPEAKER BIOGRAPHIES  143 PREPUBLICATION COPY—Uncorrected Proofs

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Boxes and Figures BOXES 3-1 Case Example of Innovation in Vector Control: New Nets Project, 22 5-1 Shared Platform for Antibiotic Research and Knowledge (SPARK), 66 6-1 Examples of the U.S. Agency for International Development’s (USAID’s) Successful Private-Sector Partnerships, 83 FIGURES 2-1 Global cases of wild poliovirus type 1 and circulating vaccine- derived poliovirus (November 27, 2018–November 26, 2019), 7 2-2 Epidemic curve of Ebola virus disease in the West Africa outbreak (2014–2016) and Democratic Republic of the Congo (2018–present), 12 3-1 WHO’s global vector control response framework, 21 3-2 Optimal use of new approaches depends on epidemiological context, 26 4-1 Behavioral insights from Nudge Lebanon randomized controlled trials, 50 xvii PREPUBLICATION COPY—Uncorrected Proofs

xviii BOXES AND FIGURES 4-2 Behavioral insight tools, 51 5-1 Zoonotic disease in the community—an epidemiological unit, 61 5-2 Antimicrobial resistance gene co-occurrence among humans, animals, and environment in a community context in Kathmandu, Nepal, 62 PREPUBLICATION COPY—Uncorrected Proofs

Acronyms and Abbreviations AFP acute flaccid paralysis AI artificial intelligence AMP Health Aspen Management Partnership for Health AMR antimicrobial resistance BARDA Biomedical Advanced Research and Development Authority CDC U.S. Centers for Disease Control and Prevention CDDEP Center for Disease Dynamics, Economics & Policy CEPI Coalition for Epidemic Preparedness Innovations CHRF Child Health Research Foundation cVDPV circulating vaccine-derived polio virus DARPA Defense Advanced Research Projects Agency DoD U.S. Department of Defense DRC Democratic Republic of the Congo EHP Ebola Host Project ESKAPE pathogen Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species pathogens ETU Ebola treatment unit xix PREPUBLICATION COPY—Uncorrected Proofs

xx ACRONYMS AND ABBREVIATIONS FDA U.S. Food and Drug Administration FIND Foundation for Innovative New Diagnostics IPV inactivated polio vaccine JJDC Johnson & Johnson Development Corporation JPEO-CBRND Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense LMIC low- and middle-income country MERS Middle East respiratory syndrome NAP-AMR national action plan for antimicrobial resistance NGO nongovernmental organization NGS next-generation sequencing OPV oral polio vaccine PCR polymerase chain reaction PHEIC public health emergency of international concern qPCR quantitative polymerase chain reaction SPARK Shared Platform for Antibiotic Research and Knowledge UN United Nations USAID U.S. Agency for International Development VAPP vaccine-associated paralytic polio VDPV vaccine-derived polio virus WHO World Health Organization PREPUBLICATION COPY—Uncorrected Proofs

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On December 4–5, 2019, the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats. The workshop participants examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. This publication summarizes the presentations and discussions from the workshop.

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