On October 18th, the White House released an expansive new strategy on Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security.
The strategy sets out a whole-of-government approach to mitigating biological risks. This includes naturally occurring pathogens as well as dangerous new pathogens created in a lab.
In this episode, we speak with Nikki Teran, Director of Biosecurity Policy at Guarding Against Pandemics. We discuss the substance of the new US biodefense strategy — its strengths, weaknesses, and potential barriers to implementation. Nikki Teran also describes as the Bio-risk threat landscape writ large, including the pathogens and broader trends in biosecurity that a strategy like this seeks to mitigate.
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Transcript lightly edited for clarity
What is Zoonotic Spillover?
Nikki Teran [00:00:00] Nikki Teran: [00:00:00] Bio is a national security threat that is capable of producing catastrophic and potentially existential global consequences, which I think i8s somethign that isn’t usually touched upon when talking about biological risks. [00:00:00][0.0]
Mark L. Goldberg [00:03:01] Like Ebola or monkeypox are two recent examples of that.
Nikki Teran [00:03:06] Absolutely. And one that people might not be as familiar with is Nipah, which some bats carry. And when bats drink the palm syrup and then humans drink that same palm syrup, they’re exposed to the bat saliva that can have viruses in it. So especially as animals are changing their migration patterns due to climate change, they’re able to pass pathogens between each other in ways that they didn’t previously, which leads to mutations. And they’re coming in contact with people in a way they didn’t previously, as there’s less wild out there and more human animal interfaces.
Why is zoonotic spillover more prevalent now?
Mark L. Goldberg [00:03:41] And this is partly an example of why we’re seeing increasingly more zoonotic pathogens out there infecting people at a greater clip than we have in past history.
Nikki Teran [00:03:52] Yes, we’re also noticing more, and people are more interconnected than ever. So it could be that Nipah was spilling over in some small village and those people got sick and maybe the village got sick, but it didn’t extend past that village. But now, since people are going into cities and traveling around the world, you’re much more likely to have those pathogens escape that one tiny little corner of the world and become a big problem. And so that’s just the naturally occurring. Biotechnology is advancing rapidly, such that humans are able to almost play God: create and manipulate life in ways that they haven’t been able to before. And it’s becoming cheaper and easier, and there’s more and more information about how to do this. They’re actually like little kits. You can buy a CRISPR kit online, maybe about 50 bucks, maybe it’s 200 bucks, and edit the DNA of bacteria just at home with what comes in the mail. Editing the E coli genome to be resistant to an antibiotic isn’t the biggest pandemic threat, but it is actually gain of function work where you’re adding functionality to a potential pathogen that didn’t happen before.
What are some current biotechnology threats?
Mark L. Goldberg [00:05:08] And it’s work that can happen just in anyone’s garage as opposed to in like a regulated setting.
Nikki Teran [00:05:14] Yes, and that expands the potential for both deliberate uses, where more people are able to create weapons in a way that they weren’t before, and accidental use, because if someone doesn’t know what they’re doing, they might create a problem. Or if they’re trying to deliberately create a problem and are not very effective at doing so and infect themselves, then you have another problem.
What is RSV?
Mark L. Goldberg [00:05:40] And this is just not regulated; this is a corner of the bio-risk world that is like a free for all.
Nikki Teran [00:05:48] Essentially. There are some requirements around reporting if you are funded by the National Institutes of Health, but otherwise, if you’re doing it on your own, there’s basically free rein. Now there is a list of pathogens that you’re not allowed to have unless you have special permission, and those do include smallpox and Ebola, SARS, some stuff like that, but it is a finite list. And so, if you add capabilities to RSV that wouldn’t actually run afoul of any US regulations.
How are non-scientists creating bio-risk with experimenting on pathogens?
Mark L. Goldberg [00:06:20] And RSV, we should note, is just like running like wild through elementary schools right now. So, one can imagine if one wanted to add functionality to RSV to make it more potent or more resistant to treatment, this is something that people could do.
Nikki Teran [00:06:38] Yeah, and not everyone who’s doing work in this vein is doing it maliciously. Actually, for the development of vaccines, people do typically make pathogens more transmissible, but they try to tone down its pathogenicity, its virulence, how sick it actually makes people. So, it’s not like we only need to worry about bad actors, but we also need to make sure that the work we’re doing in the name of defensive measures is both done as productively as possible and as safely as possible.
How frequent are pathogen-experimenting accidents?
Mark L. Goldberg [00:07:09] How frequently do accidents happen that are potentially very catastrophic, that are using some biological agent that is particularly virulent? Is this like a frequent occurrence or are these accidents relatively very rare?
Nikki Teran [00:07:27] I think it depends on what your definition of relative is. I’ve seen a list of, I think, something like 40 different accidents with high consequence pathogens in the last 50 years. A good example is SARs, where SARs emerged twice from animal reservoirs, but I believe there were six separate incidents where it got out of labs and made people sick. And actually, the last person to die from SARs died as a result of a laboratory outbreak. Actually, it wasn’t even the researcher who died, it was her mother, which is very sad.
What is in the Biden/Harris National Biodefense Strategy and Implementation Plan for Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security?
Mark L. Goldberg [00:08:03] So it’s in this context in which we have an increasing frequency pace of naturally occurring pathogens, the zoonotic pathogens that you were discussing earlier, then you have a whole suite of new technologies that are enabling the deliberate or accidental release of pathogens. And it’s in this context that the Biden administration is releasing its new national strategy for dealing with biological threats. What is in this strategy that is significant and notable to you?
Nikki Teran [00:08:42] One thing that I find particularly notable about the strategy is that it actually refers to catastrophic biological incidents and in the national security memorandum that accompanies it, basically, the strategy is like the game plan and the memorandum is actually telling people they really do have to do it. There is in the memorandum a mention of the fact that bio is a national security threat that is capable of producing catastrophic and potentially existential global consequences, which I think is something that isn’t usually touched upon when talking about biological risks. Often, it’s grouped into a public health issue and not so much a national security or even existential risk issue. So, I don’t think there’s anything particularly revolutionary that’s shown in the National Biodefense Strategy if you’re the kind of person like me who is constantly paying attention to this. But it is like a very solid collection of what needs to be done to prevent and respond to and recover from catastrophic biological incidents.
Mark L. Goldberg [00:09:49] Can you walk those of us who are not so deeply enmeshed in this issue, what are some of those key highlights and key strategy points?
Nikki Teran [00:09:59] So key strategy points here start out with preventing outbreaks from becoming epidemics and preventing incidents before they can happen. So here are the incidents before they can happen revolving around biosafety, trying to make sure that labs have the best resources they can to keep their workers safe and also preventing epidemics or preventing outbreaks from becoming epidemics and pandemics. And here, a big factor is early warning and detection.
How does early warning and detection of outbreaks and pandemics look in practice?
Mark L. Goldberg [00:10:27] What does that mean in practice?
Nikki Teran [00:10:29] Basically, it’s a smoke alarm for pathogens. You don’t want to see the house on fire to know that there’s a problem. So early warning and detection can be pathogen agnostic where you don’t necessarily know what you’re looking for. All living things, most pathogens, most things we’re worried about have DNA or RNA, and you’re able to kind of read those DNA and RNA sequences and see that there’s something there. So that would give you an idea of, say, if there is Ebola in San Francisco or if there is an exponentially growing new pathogen that maybe you’ve never seen before, you can kind of send out that alarm. That’s the smoke, that’s the signal. There are also ones that are more targeted and directed either through wastewater monitoring of known pathogens. This is the thing where we kind of know how much COVID is in a city, by how much COVID RNA you’re able to detect in literally sewer water, like literally from people’s poop. And then there’s also signals in hospital usage. So, if a bunch of people in one city are coming in with pneumonia, especially pneumonia of unknown origin, you can flag that, although I personally think that’s a little bit too late.
How does early pandemic detection work internationally?
Mark L. Goldberg [00:11:42] And to what extent are these early detection systems, the kind of smoke alarm you just describe, also able to be deployed internationally? I mean, one thing that we’ve seen, we discussed Ebola earlier or Nipah, these are diseases mostly of the developing world in countries and places that do not themselves necessarily have such robust health systems, let alone the kind of surveillance that you’re describing. Does this strategy account for that?
Nikki Teran [00:12:14] Absolutely. The strategy does task, not just CDC with trying to implement this kind of surveillance, but also USAID and the State Department. You might be inclined to think that we over here are so civilized, of course, we’d be able to implement these high-tech plans, and what about places where Ebola comes out? But in reality, they actually have better infrastructure than we do in many ways because it is a recognized threat, and there has been investment, especially throughout Africa, in trying to set up some of these surveillance systems. Whereas in the United States there’s actually a big issue of data sharing between states, from states to CDC. So, it’s important to both do that investment on the home front so we can detect things when they’re here, but also around the world. And it’s a large task to do anywhere, but it’s not like we’re totally safe here.
How does the new National Biodefense Strategy tackle the ability to do at-home pathogen experimenting?
Mark L. Goldberg [00:13:07] On bio safety, what specific either regulations or directives does this strategy suggest be used to improve biosafety concerning some of the risks that you were discussing before, both in terms of gain of function research, the idea that you could manipulate pathogens ostensibly to study them, but bad things might come from having manipulated them, and also that kind of off the shelf CRISPR by mail you discussed earlier.
Nikki Teran [00:13:41] The National Biodefense Strategy doesn’t have very clear guidelines as to exactly how these things should be implemented, but it does stress that safe and secure bio laboratory practices should be a priority and should be promoted. So, it’s not saying like you need to wear this kind of gloves, but it is saying that there needs to be an interagency review of what the current recommendations and standards are, and best practices should be propagated from that. Similarly, that it should be a priority of the United States to make sure that these best practices are shared internationally as well, so that we’re not the only ones sitting on good information as to how to keep people safe. And here in that prevention bucket is not just biosafety, there’s also deterrence of biological weapons. So, this is making it really obvious that you don’t want to use biological weapons. Having everyone affirm that this is a norm that we’re not going to break. And also coming up with the tools to decide very quickly who released a biological weapon so that there can be appropriate responses to that.
What is the Congressional Republican stance on the National Biodefense Strategy?
Mark L. Goldberg [00:14:45] That leads me to a set of questions around implementation. You know, this is a strategy, accompanying the strategy is an implementation plan, part of that includes $88 billions of funding. Where does Congress stand on these issues? I mean, we’ve seen in recent months partisan squabbling over covid funding with republicans balking at additional funding requests from the administration on COVID related issues, both domestically and internationally. Does Republican reluctance to want to continue to fund COVID issues at the level the White House is requesting shadow or carry over into other issues around biosafety and biosecurity?
Nikki Teran [00:15:42] I don’t think that there’s so much a large pushback against investing in the future through pandemic prevention, so much as there’s some apathy towards it and it’s no one’s greatest priority.
Mark L. Goldberg [00:15:53] Do you fear that funding for the implementation of this plan might go the way of COVID and become partisan?
Nikki Teran [00:16:02] I absolutely do worry about it becoming a partisan issue. There are people that are interested on both sides of the aisle in making sure this doesn’t happen again. People can agree on a solution to a problem without necessarily agreeing what the key components of those problems are. So here, Democrats might be really concerned about the equity issues surrounding pandemic prevention and response, where the people on the front lines are not the most privileged. The people that need to keep food on the table are not necessarily the same ones that are making the decisions here. Whereas for Republicans, there’s also the issue that this is a national security threat, that this could destabilize the country and put our freedoms in danger. We saw a lot of loss of freedoms during the COVID response, especially early on, and you want to prevent that from happening again. And so, the solution here is funding. The White House has requested that $88 billion in mandatory spending. So that’s kind of a promise, for the next five years, we’re going to give this money, which is not the way that Congress typically operates on these things. They like being able to have the oversight of the agencies and making sure that the funding that you give them every year is well allocated year to year. You can tell it was well spent. You’re not just promising things in the future. In this plan, it is not just the request for that 88 billion, but I believe it’s in the national security memorandum, there’s a requirement for the agencies to make pandemic preparedness and prevention funding part of their yearly budget. So that’s incorporating this priority into their normal form of action.
Why is government coordination important for the National Biodefense Strategy?
Mark L. Goldberg [00:17:47] And this is the meat on the bones of a whole of government approach. When we say whole of government, we mean that agencies themselves adopt this as a strategy, sort of intrinsic to how they operate. Part of what they do from now on needs to incorporate pandemic preparedness and bio threat mitigation.
Nikki Teran [00:18:11] Exactly. It’s not just that it needs to be part of how they operate day to day as a priority but also a whole of government response requires a lot of coordination between different parts of the government. And here there are leads presented and support for every goal and strategy in the subtheme. But that still doesn’t necessarily guarantee that everyone’s going to play together nicely and you’re going to get a coordinated whole of government response, because that coordination part really matters for efficiency and cost effectiveness.
How robust is the Biden/Harris National Biodefense Strategy?
Mark L. Goldberg [00:18:46] I’m curious what grade would you give this Biden administration biodefense strategy plan? This is what you study, what you do for a living, how would you assess it as it has been released thus far?
Nikki Teran [00:19:03] I think it’s a great comprehensive game plan. I think I would probably give it — well, I don’t know, it depends on what kind of curve we’re grading on — A minus. I think it’s very well done, very well put together, thinks through all the different components that might be necessary for preventing outbreaks, responding to outbreaks, recovering from outbreaks. But I guess it depends on what the assignment is. I’m worried that there isn’t enough in the actual implementation. Like when you get down to the nitty gritty of some of these things, they’re really complicated and this is a very high-level plan, as it should be from the NSC. So, I think it’s got a lot of good information all in one place. It’s got a comprehensive idea of where you need to start, how you need to get things going, how you need to respond. But the devil’s in the details, and no single document that any one person can read can really encompass all of those details, so maybe I’m just grading too harshly. I’m expecting too much from anything like this.
What are some of the most important implementations from the National Biodefense Strategy?
Mark L. Goldberg [00:20:04] Well, what would be a detail in this plan that you could foresee either being resolved in a way that’s really effective and impactful or, on the other hand, be resolved in a way that does not live up to the purported purpose of this document. Like, what are some of those nuances and details in implementation that you’ll be looking towards in the coming months, years as this rolls out?
Nikki Teran [00:20:31] One of the things that is mentioned but not spelled out super consistently is protecting infrastructure, and that can mean a lot of different things. In context, it might seem to mean like medical countermeasure infrastructure, things that you would need to make masks or vaccines. But it can also mean like literally keeping the lights on, keeping food going into stores or into people’s homes, keeping water systems running. And I don’t think that this document spells that out as clearly as might be desired. And then when you get there, there’s a bunch of issues where a lot of these things are run at the state and local level, and so how do you coordinate with who exactly needs to do the coordination? Some things are listed as HHS as the lead for this, but HHS is giant. There are subagencies within them and then subcomponents within those and then different people within there. Yeah, I think that there’s no one playbook for everything. This can’t be the single playbook but there are plans to have representatives from agencies meet every 90 days. And my hope would be that the kind of detail that I’m really seeking would get hashed out in those or even at a more micro level. I just have to trust that things will get done.
Mark L. Goldberg [00:21:50] To what extent do you consider this strategy to be a response to COVID, like the last pandemic obviously still ongoing, as opposed to predicting how a future pandemic might unfold?
Nikki Teran [00:22:09] I do think that there’s a basis for this strategy that’s independent of COVID. This is basically updating a 2018 version of the strategy, which obviously happened before this pandemic. I don’t think it’s super targeted. I think that a lot of these components are necessary almost regardless of what the outbreak is. And I don’t think it’s playing too much of favorites. It does mention, again, catastrophic risks, but I’m not sure that when you get into the actual details, it encompasses what a catastrophe could actually really be like. So, it maybe is hanging too much on how COVID ended up being in that respect, even though it seems that they are conscious of and want to work on potentially larger issues.
What is not included in the National Biodefense Strategy?
Mark L. Goldberg [00:22:59] So what was left out of this strategy that if you were designing it, you would be sure to include?
Nikki Teran [00:23:07] Yeah. One part that I didn’t find in the biodefense strategy was around information and potential problems of biological information and how do you deal with that? There is the biosafety component where you want to make sure that pathogens don’t get out of labs and there is the biosecurity component of deterring development of biological weapons. But I don’t think that there’s enough of, or really any, mention of the kinds of information that can be generated that could be easily misused. And that is to say, like, is not sufficient to prevent bugs from getting out of labs. You need to prevent the information on how to create those bugs from getting out as well. And it was just kind of glossed over here or omitted.
Mark L. Goldberg [00:23:59] The idea is that you have scientists who could be doing legitimate scientific research. They might want to publish their findings, but their findings might be really problematic for humanity.
Nikki Teran [00:24:10] Absolutely. And I think that’s a problem that we’ve seen during COVID, where in order to do good research on COVID, there have been scientific developments that have made it so that people can essentially manufacture COVID-like pathogens quite easily. And I think that that’s a threat that isn’t touched on here and I would like to see focused on more in the future.
Mark L. Goldberg [00:24:33] Are there any key inflection points that you’ll be looking towards that will suggest to you whether or not this strategy and this this plan is actually being implemented in impactful ways?
Nikki Teran [00:24:45] Yes. I would hope that there’d be some readout of that NSC mediated interagency gathering to see that everyone is on the same page. But I think one of the biggest readouts will probably be the budget requests next year, whether these agencies are actually thinking about how they would need to implement this plan and what funding they would need for it and in what specific accounts. So, I think it’ll really be pushed on to the agencies to figure out those details or the readout we’ll get about whether they’re actually going through that, will be those budget requests.
Mark L. Goldberg [00:25:18] Well, Nikki, thank you so much for your time and for putting this new strategy in context. I really appreciate it.
Nikki Teran [00:25:27] Thank you for having me.
Mark L. Goldberg [00:25:35] Thank you for listening to Global Dispatches. Our show is produced by me, Mark Leon Goldberg, and edited and mixed by Levi Sharp.