Abstract: For years, the United States and many other countries have neglected biosecurity because policymakers have underestimated both the potential impact and likelihood of biological threats. COVID-19 has had a devastating effect on the planet and could be followed by outbreaks of even more dangerous viral diseases. Meanwhile, advances in synthetic biology are transforming the potential threat posed by engineered pathogens, creating growing concern over biological attacks and bioterror. Given the scale of the threat, biosecurity needs to be a top priority moving forward. Not only do efforts need to be stepped up to try to prevent the next pandemic (natural or engineered), but resilience needs to be built by developing early warning systems, the capacity to track outbreaks, and medical countermeasures, including “next generation” vaccines. Ideally, efforts need to be globally coordinated, but if this is not possible, a ‘coalition of the willing’ led by the United States needs to step up. Given the current pandemic has resulted in an epidemic of mis- and dis-information and given public behavior is key in controlling the spread of viruses, winning public acceptance for public health measures will be imperative to tackling biological emergencies in the future.
With a quarter of a million dead in the United States and more than a million globally, a massive economic toll,a and a second wave in full swing in the northern hemisphere, the United States and other countries are paying a price for years of neglecting biosecurityb as a top-tier national security priority. For years, biosecurity has been the poor relation of the ‘other’ securities for one simple reason: policymakers and analysts failed to grasp just how devastating a highly transmissible new virus in a highly interconnected world could be, and viewed a devastating global pandemic or catastrophic bioterror attack as very unlikely.
This article first describes how the COVID-19 pandemic has upended such assumptions, requiring policymakers to rethink both the potential impact and likelihood of the most concerning biological threats (bio threats). Based on this author’s decades of experience confronting CBRN threats,c it then makes a series of observations on the approach now needed to counter biological threats.
Some have seen this crisis as a one-in-a-100-year event. But, as this article will outline, this is both naïve and risks creating complacency. Unless countries around the world develop a comprehensive biosecurity strategy and coordinate their efforts, pandemics (either natural or engineered) could devastate the planet every decade.
The New Bio Threat Horizon
The Need to Rethink Potential Impact
Policymakers around the world did not grasp just how large the impact of a bio threat could be. Beyond the enormous human and economic impact, the current pandemic has exposed the weakness, lack of preparedness, and poor responsiveness of healthcare systems of even highly developed countries like the United States and the United Kingdom. And the virus has inflicted carnage, even though SARS-CoV-2 (the virus that causes COVID-19) is not especially virulent. The world may be confronted with other viruses in the future whose combination of virulence (the harm a pathogen does to its host), transmissibility, and other characteristics pose much greater danger.
While overwhelming evidence points to SARS-CoV-2 spontaneously spreading to humans, the advances in synthetic biology and the growth in the number of Level 3 and 4 biocontainment facilities around the world storing deadly viruses1 mean there is also the very real possibility that in the future, bad actors will try to engineer or steal/obtain a highly transmissible and highly virulent virus and unleash it onto the world. Another risk is accidental releases from such biocontainment facilities.
COVID-19, a highly transmissible but not very virulent pathogen, has had a devastating global impact, a fact that will not have gone unnoticed by rogue states and terror organizations. Advances in synthetic biology have created tools that could be put to malevolent use. In the last two decades, scientists synthesized the poliovirus from its genetic sequence,2 recreated the 1918 Spanish flu virus,3 and succeeded in modifying the H5N1 avian flu virus so that it resulted (in a research laboratory) in airborne transmission among mammals.4 In the future, we should think of weaponized biology as no less of an existential threat to the planet than weaponized atomic science. It should also be noted that the fear and panic that even a medium-scale bioterror attack could create could have dangerous implications that may rival or even surpass the immediate loss of life.
The Need to Rethink Likelihood
Given the fact that in late 2019 when, as far as is known, COVID-19 cases first started emerging in China, it had been more than a century since the previous catastrophic outbreak (the 1918-1919 “Spanish flu” pandemic),d it was unsurprising that many thought of such pandemics as a one-in-a-100-year event. Such assumptions should no longer hold. The encroachment of human settlements into areas that had previously been sanctuaries for wildlife5 and the popularity in some parts of the world of markets where people and wild animals are brought into proximity have made it more likely viruses will make the species leap to human beings.e And when they do, as the COVID-19 pandemic illustrated, the interconnectedness of a world in which millions of people fly each day6 means they can spread very rapidly.
There is also growing concern about engineered viruses. Not only have advances in synthetic biology (SynBio) created growing capacity for extremely dangerous viruses to be engineered in a laboratory, but the number of people with access to potentially dangerous ‘dual use’ technology has greatly expanded and continues to expand, making malevolent use of such technology ever more likely.
In the August 2020 issue of this publication, scientists at the U.S. Military Academy at West Point warned that:
The wide availability of the protocols, procedures, and techniques necessary to produce and modify living organisms combined with an exponential increase in the availability of genetic data is leading to a revolution in science affecting the threat landscape that can be rivaled only by the development of the atomic bomb. As the technology improves, the level of education and skills necessary to engineer biological agents decreases. Whereas only state actors historically had the resources to develop and employ biological weapons, SynBio is changing the threat paradigm.
The cost threshold of engineering viruses is also lowering, with the West Point scientists warning that synthetic biology has “placed the ability to recreate some of the deadliest infectious diseases known well within the grasp of the state-sponsored terrorist and the talented non-state actor.”7
As already noted, another source of vulnerability is that deadly viruses could be stolen from or escape from a research laboratory. There are now around 50 Biosafety Level 4f facilities around the world, where the deadliest pathogens are stored and worked on, and this figure is set to increase in the next few years.g This is a large increase over the last 30 years, creating bigger risk of a breach. Of equal, if not greater concern are the thousands of Biosafety Level 3 labs globally,8 which handle deadly pathogens like COVID-19.9
Given what has been outlined above, the risk of a future destructive biological attack or another devastating global pandemic should no longer be seen as low. From this point forward, there should no higher priority for the international community than biosecurity.
The United States and the international community need to prepare for the next pandemic or a potential large-scale bioterror event to ensure physical, psychological, and economic resilience. This will be no easy task. As noted by one writer, “the emerging nature of biosecurity threats means that small-scale risks can blow up rapidly” making it challenging to create effective policies to anticipate them because “there are limitations on time and resources available for analyzing threats, and estimating the likelihood of their occurrence.”10 Another challenge, which has complicated the response to COVID-19, is the likely deluge of mis- and dis-information11 in future biological emergencies, making it more difficult to win public approval for the necessary public health response. The global scale of the threat is another challenge. In an interconnected world where a virus can spread from one side of the planet to the other in less than 24 hours, a coordinated approach is vital.
What follows is a series of observations on what I believe are the precepts that need to guide the United States and other countries’ biosecurity strategies moving forward.
Given how difficult it is to stop the spread of certain infectious diseases, everything needs to be done to prevent future pandemics from occurring and bad actors from weaponizing viruses. The former needs to be the highest global health priority. The latter needs to be the highest national security priority. There needs to be a conversation about whether there should be more control over potentially dangerous biological materials and background checks or stricter vetting for scientists working in research facilities handling dangerous pathogens. As one scholar has noted, “Each person working in an HCBL [high-containment biological laboratory] is an independent variable whose actions cannot be guaranteed by even the most stringent and redundant biosecurity measures. More scientists mean that there is a greater probability that one of them could have malicious intent, or be psychologically unstable. Background checks, psychological tests and certification may reduce these risks.”12
The research community itself will also need to maintain vigilance and maintain channels of communication with authorities.13 But given how many people around the world now have access to the materials, technology, and know-how to potentially make biological weapons, prevention will not be easy. The international community has managed to control and stop the development of chemical weapons through the Chemical Weapons Convention (CWC), policed by the Organisation for the Prohibition of Chemical Weapons (OPCW), and it appears likely that a similar approach is a good starting point for biosecurity and the control of biological weapons.
Although it may be possible for a U.N. body similar to the OPCW to actively police the Biosafety Level 4 laboratories, it is most unlikely it could give equal scrutiny to the Level 3 facilities because of their much larger number.
In preventing natural pandemics, one measure could make a significant impact. “Wet markets,” which sell wild animals and their meat,h need to be either shut down or made subject to strict environmental and health controls.
The difficulty in preventing future pandemics or a future biological attack means that it is essential to create resilience by building capacity to quickly detect and respond to an outbreak.
Early warning is the cornerstone to provide resilience against all biological threats. In the future, we need a global approach to identifying pathogens that have the possibility to turn into pandemics and seal them at source. This will not be easy, especially as those responsible at the origin of the virus may not want to accept responsibility or liability. It is clear that some countries are happier to suppress bad news rather than share it for the common good. Measures need to be developed to enforce global reporting of troubling viral outbreaks. An early warning system should be led by the World Health Organization (on the assumption that the incoming U.S. administration reverses the Trump administration’s withdrawal from the WHO to give it the necessary teeth) and given enough punch to require countries to inform the global health system as soon as a potential pandemic virus is identified. This WHO-run early warning system could be based on a network of bio sensors and all-source intelligence to detect viral outbreaks. This should include monitoring of local medical facilities and social media, which should show an uptick in virus infections or new diseases as they occur. It should also include monitoring around Level 3 and 4 labs, which should highlight leaks, thefts, and accidents. As necessary, this early warning system should quickly trigger lockdowns to contain outbreaks.
Contact Tracing and Data
Rapid contact tracing is key to limiting the spread of a pandemic14 (natural or otherwise), especially to vulnerable groups. Contact tracing apps on smart phones could help contain the spread of viruses by speeding up the process of contact tracing, but are only effective if a significant proportion of the population trusts and uses them. Many in the United States and elsewhere feel uncomfortable about downloading such technologies, and compelling their use may not be feasible in democracies.i Given there are important questions about state surveillance, data privacy, and data security,15 there needs to be a whole-of-society conversation about these technologies and necessary safeguards. Lessons need to be learned from democracies such as Taiwan and South Korea in which digital contact tracing significantly slowed the spread of COVID-19.16 Contact tracing apps could make a big difference but will only be effective if there is widespread opt-in from the public.
Strengthening Medical Capabilities and Countermeasures
All countries need to bolster their biosecurity capabilities, to include medical equipment, the training of personnel, and medical countermeasures (MCMs). In creating resilience, medical countermeasures are as close as it gets to the silver bullet. At the time of publication, 54 vaccines for COVID-19 are undergoing human clinical trials,17 and there is hope several will prove effective, holding out the potential to greatly reduce the danger posed by the virus and even ultimately eradicate COVID-19 as vaccines have done for smallpox and other viruses. There were grounds for optimism when on November 9, 2020, Pfizer announced that according to early data from human trials of an mRNA vaccinej it developed with the German drug maker BioNTech, its vaccine was, so far, over 90 percent effective in preventing COVID-19 among trial volunteers. There was more good news on November 16, 2020, when Moderna announced that, according to early data, its mRNA coronavirus vaccine was almost 95 percent effective. Two days later, Pfizer stated that according to an updated analysis, its vaccine was 95 percent effective.18 Historically, this is about as good as it gets for the efficacy of vaccines, and will likely be seen as a major milestone in the fight against the virus.
MCMs are products such as biologics (including vaccines) and pharmaceutical drugs that can protect against or treat the effects of a pandemic or biological attack.k Countries such as China, which implemented effective lockdowns, social distancing, mask mandates, and contact tracing, have succeeded to some degree in containing the spread of the virus,19 but medical countermeasures are the only way to really subdue the virus. In the future, it is likely to be more cost effective to pay the pharmaceutical industry ahead of time to produce treatments and vaccines, anticipating future biological threats rather than waiting for the pandemic to develop and then throwing huge sums at the problem after the fact. It is highly likely that money spent in advance on stockpiling MCMs, especially vaccines for known and COVID-type viruses will, in the long run, yield huge savings and lead to a more effective biosecurity strategy.
In time, new technologies may also revolutionize our ability to deploy medical countermeasures. As the U.S. National Institute of Allergy and Infectious Diseases (NIAID) has noted, gene-based nucleic acid vaccine platforms, though not approved by U.S. regulators for human use to date, hold great promise because of their “stimulation of broad long-term immune responses, excellent vaccine stability and relative ease of large-scale vaccine manufacture.”20 l These “next-generation”21 vaccines include mRNA vaccines such as the one developed by Pfizer/BioNTech and Moderna, and recombinant vector vaccines such as the one developed by the University of Oxford and AstraZeneca.22 m According to a Johns Hopkins study, “an mRNA-based vaccine platform technique appears particularly promising in terms of ease of manufacture, adaptability to various targets, and biological delivery.”23 Drew Weissman, an mRNA vaccine researcher, has stated that it may eventually be possible to produce a universal mRNA coronavirus vaccine “ready to be shipped out and used very quickly to prevent the pandemic from taking over.”24
Stanford University Associate Chair of Bioengineering Drew Endy recently highlighted that it is conceivable that the medical community will one day be able to create vaccines “on demand” quickly enough to snuff out the danger posed by new viruses before they have a chance to spread.n There needs to be massive funding of research and development for the next generation of vaccine platforms. Paradoxically, when COVID-19 eventually recedes as a public health emergency, securing the level of funding required to build and transform our arsenal of medical countermeasures will likely not be straightforward.
A much greater degree of domestic manufacturing and supply of MCMs, including personal protective equipment (PPE), and medical equipment such as ventilators is essential, as are pre-arranged agreements between the United States and its allies to supply each other with such equipment as necessary. Having some allies focus on manufacturing certain products and other allies on other products may be the most efficient and cost-effective way forward. Given growing geopolitical tensions, the United States and other Western democracies should in the future avoid any reliance on China in this regard. For many frontline responders, the abiding memory of COVID-19 will be the lack of PPE. In the future, the United States and other countries need to keep PPE manufacturers on retainers to ensure supply for the next pandemic.
The United States and other countries need to promote and invest in research that could greatly improve the ability of healthcare professionals to inoculate against and treat deadly diseases. The rapid advance of biotechnology is not only a potential threat; it is also a huge public health and counter-bioterror opportunity. Endy noted in the October 2020 issue of this publication that “operational mastery of cells” is for the first time plausible and could eventually help take “infectious diseases off the table.”25
The responsibility for any future biological attacks or accidental releases of pathogens that result in pandemics must be established. Full establishment of responsibility might come later, but investigation must begin immediately. It is likely that many countries do not have the organizations, structures, or expertise in this area at the moment, and they must now address this as a priority. As with chemical attacks, an international body such as the United Nations is best placed to lead this work.
Global Legal Framework
The Biological and Toxin Weapons Convention (BTWC), ratified in 1975, is designed to prevent the development and proliferation of biological weapons. However, it is a poor cousin to the Chemical Weapons Convention (CWC) and does not have a body like the Organisation for the Prohibition of Chemical Weapons (OPCW) to police it. Such a body policing the biological sphere would ideally facilitate multilateral sharing of data and investigate transgressions. But creating such an organization would require complete buy-in from the United Nations Security Council, especially the permanent members. It is likely that China and Russia would block the formation of such an organization as well as veto proposals to broaden the Biological and Toxin Weapons Convention and other controlling protocols. The only way around this may be a ‘coalition of the willing’ to form an effective body, perhaps absent Russia and China. If this is the case, it would have to be strongly led by the United States, European Union, United Kingdom, the additional Five Eyes,o and other leading economies to give it any chance of success.
National Legal Frameworks
Many democratic countries have had to act in haste to implement some very restrictive policies and laws to try to slow down the spread of the virus. With a backlash growing in some countries almost a year into the pandemic,26 governments need to better articulate the need for such measures. They now need to think more carefully about the balance between public health, economic well-being, and civil liberties in developing and reaching a national consensus on a legal and policy framework to respond to the evolving public health emergency and the ones to follow. Without broad-based public support, the risk is that lockdowns and travel restrictions and mask mandates will be ignored, and this has manifested itself in a number of developed countries.
The transmission of information to the public is central to effective outcomes. And winning public trust is key. Authorities can mandate or encourage masks and social distancing, but public buy-in is crucial to these practices being adopted. There is a certain ‘quality in quantity.’ If the quantity of mis- and dis-information being consumed vastly outweighs the real information, it is likely to win out. This is a difficult proposition for politicians to grasp, who seem to agonize over their narrative in the hope of not getting anything wrong whereas others monopolize the ‘airways’ and gain traction, not caring what collateral damage they cause on the way. The growing attachment to conspiracy theories in the United States and other countries means disinformation spread by our adversaries over COVID-19, and other biological threats in the future will be especially challenging to counter.27
For years, the United States and many other countries have neglected biosecurity because policymakers have un-derestimated both the potential impact and likelihood of biological threats. A potentially devastating global pandemic was overdue. During this COVID-19 pandemic, the world has suffered severe impacts from a highly transmissible but not very virulent pathogen. Countries were not prepared to spend money up front to provide resilience. This has been the greatest global shock since World War II, and to avoid this experience being repeated or catastrophic loss of life from an attack with a weaponized virus, the international community must invest in biosecurity and pandemic strategies to try to prevent the next pandemic (natural or engineered) and ensure mitigation for resilience by developing the capacity to track outbreaks, and medical countermeasures including next-generation vaccines. International cooperation is vital. The United States must again be the leading light in the WHO in order to support an early warning system that can ‘throttle’ any new potential pandemic at source.
The necessary measures will take money, political will, time, leadership, and public trust. Ideally, this will be led by the United Nations, but if this is not possible, the United States, the European Union, and the United Kingdom, supported by others, must step up to the plate. COVID-19 has had a devastating effect on the planet and could in the near future be followed by outbreaks of even more dangerous viral diseases. Advances in synthetic biology are transforming the potential threat posed by engineered pathogens, creating growing con-cern over biological attacks and bioterror.
There must be effective oversight and policing of bioterror threats, and it is high time the BTWC gets our full support and the resources necessary to prevent the Armageddon of a highly virulent, highly transmissible pathogen in the hands of bad actors.
Given how poorly many countries have responded to the COVID-19 pandemic, improving biosecurity in the face of what could be significantly worse biological threats in the future is imperative. We cannot afford to get this wrong a second time. CTC
Hamish de Bretton-Gordon (OBE) is a highly operationally experienced CBRN practitioner and a leading expert in chemical and biological counterterrorism and warfare. He was the commanding officer of the U.K. Chemical, Biological, Radiological and Nuclear (CBRN) Regiment between 2003 and 2007 and NATO’s Rapid Reaction CBRN Battalion between 2005 and 2007. A veteran of the First Gulf War and tours in Iraq, Afghanistan, and the Balkans, he retired from the British Army in 2011 but continues to serve in the active Reserve. He has collected evidence of chemical attacks in Syria since 2013 and was one of the peshmerga’s chemical weapons advisors 2015-2017 in northern Iraq. He advises the British Ministry of Defence and the Foreign Office on CBRN and is the Distinguished Visiting Fellow at Magdalene College Cambridge 2020-21. His memoir, Chemical Warrior: Syria, Salisbury and Saving Lives at War, was published in September 2020. Follow @hamishdbg
© 2020 Hamish de Bretton-Gordon
[a] The economic effects have been very serious. For example, the U.K. economy is expected to shrink by 11 percent in 2020, while in the United States, the fallout from COVID-19 is projected by the Congressional Budget Office to reduce the size of the U.S. economy by about $8 trillion over the next decade. The impact in the developing world is likely highly underreported and may end up being greater. Mark Thompson, “The UK economy is heading back into recession,” CNN, November 5, 2020; Jeff Stein, “Coronavirus fallout will haunt U.S. economy for years, costing it $8 trillion through 2030, CBO says,” Washington Post, June 1, 2020; Judy Woodruff, Courtney Vinopal, and Courtney Norris, “Bill Gates on where the COVID-19 pandemic will hurt the most,” PBS News Hour, April 7, 2020.
[b] Biosecurity, as originally conceptualized, was a set of preventive measures designed to reduce the risk of transmission of infectious diseases in crops and livestock, quarantined pests, and living modified organisms. In response to growing concern over the threat of biological terrorism, biosecurity started including the prevention of the theft of biological materials from research laboratories and attempts to stop bad actors from using synthetic biology for nefarious purposes.
[c] Chemical, biological, radiological, and nuclear threats
[d] During the 1918–1919 influenza pandemic, it is estimated that one-third of the world’s population (around 500 million people) were infected and had clinically apparent illnesses. Total deaths were estimated at around 50 million and “were arguably as high as 100 million.” Jeffery K. Taubenberger and David M. Morens, “1918 Influenza: the Mother of All Pandemics,” Emerging Infectious Diseases 12:1 (2006).
[e] In the attempt to pinpoint the origin of the COVID-19 outbreak there has been much focus on the Huanan Seafood Wholesale Market in Wuhan which National Geographic reported contained “a wild animal section where live and slaughtered species were for sale.” The publication noted that “buying, selling, and slaughtering wild animals for food is one way an animal-borne disease may infect people. Viruses can spread more easily if animals in markets are sick or kept in dirty, cramped conditions, such as in stacked cages. When animals are under duress, viral pathogens can intermingle, swap bits of their genetic code, and perhaps mutate in ways that make them more transmissible between species.” A study published in Lancet in January 2020 has challenged the notion that the Huanan market was the source of the outbreak. Dina Fine Maron, “‘Wet markets’ likely launched the coronavirus. Here’s what you need to know,” National Geographic, April 15, 2020; Jon Cohen, “Wuhan seafood market may not be source of novel virus spreading globally,” Science, January 26, 2020.
[f] The four biosafety levels are BSL-1, BSL-2, BSL-3, and BSL-4, with BSL-4 being the highest level of containment. According to the U.S. Department of Health and Human Services, “BSL-3 laboratories are used to study infectious agents or toxins that may be transmitted through the air and cause potentially lethal infection through inhalation exposure,” whereas “BSL-4 laboratories are used to study infectious agents or toxins that pose a high risk of aerosol-transmitted laboratory infections and life-threatening disease for which no vaccine or therapy is available.” “Biosafety Levels,” Science Safety Security, Public Health Emergency, last reviewed November 13, 2015.
[g] A 2018 World Health Organization report noted that “BSL-4 laboratories represent the highest level of biological containment, offering unparalleled protection for the user, sample and environment. At present, more than 50 maximum- and high-containment facilities around the globe handle some of the world’s most hazardous pathogens to human and animal health for research and diagnostic purposes. BSL4 laboratories are located in all WHO regions. While most are in North America or western Europe, a number have been built in Asia, and construction projects are underway in China, Japan and sub-Saharan Africa.” Report of the WHO Consultative Meeting on High/Maximum Containment (Biosafety Level 4) Laboratories Networking, Lyon, France, 13–15 December 2017 (Geneva: World Health Organization, 2018).
[h] The term “wet market” and “wildlife market” is often conflated. As one publication noted, “wet markets are typically large collections of open-air stalls selling fresh seafood, meat, fruits, and vegetables. Some wet markets sell and slaughter live animals on site, including chickens, fish, and shellfish. In China, they’re a staple of daily life for many. More rarely, wet markets also sell wild animals and their meat.” Maron.
[i] It was suggested in one survey that a majority of Americans would not download a contact-tracing app because of privacy concerns. Chandra Steele, “Most Americans Reject COVID-19 Contact-Tracing Apps,” PC Mag, June 17, 2020.
[j] The PHG Foundation of the University of Cambridge provides this useful explainer on RNA vaccines: “Conventional vaccines usually contain inactivated disease-causing organisms or proteins made by the pathogen (antigens), which work by mimicking the infectious agent. They stimulate the body’s immune response, so it is primed to respond more rapidly and effectively if exposed to the infectious agent in the future. RNA vaccines use a different approach that takes advantage of the process that cells use to make proteins: cells use DNA as the template to make messenger RNA (mRNA) molecules, which are then translated to build proteins. An RNA vaccine consists of an mRNA strand that codes for a disease-specific antigen. Once the mRNA strand in the vaccine is inside the body’s cells, the cells use the genetic information to produce the antigen. This antigen is then displayed on the cell surface, where it is recognised by the immune system.” See “RNA vaccines: an introduction,” University of Cambridge, PHG Foundation.
[k] According to the FDA, “MCMs can include: Biologic products, such as vaccines, blood products and antibodies[;] Drugs, such as antimicrobial or antiviral drugs[;] Devices, including diagnostic tests to identify threat agents, and personal protective equipment (PPE), such as gloves, respirators (face masks), and ventilators.” For more on MCMs, see “What are Medical Countermeasures?” fda.gov, accessed November 11, 2020.
[l] As explained in one medical journal, “Current antiviral vaccine designs can be described as falling into 2 camps: protein based or gene based. Protein-based vaccines deliver the immune system–stimulating antigen to the body. This category includes whole-inactivated (killed) vaccines, as in the polio and flu shots, and subunit vaccines and virus-like particles, like in the hepatitis B and human papillomavirus vaccines. Gene-based vaccines take a different tack. They carry the genetic instructions for the host’s cells to make the antigen, which more closely mimics a natural infection. In the case of coronaviruses, the antigen of interest is the surface spike protein the virus uses to bind and fuse with human cells.” Jennifer Abbasi, “COVID-19 and mRNA Vaccines—First Large Test for a New Approach,” JAMA 324:12 (2020).
[m] According to the U.S. National Institute of Allergy and Infectious Diseases (NIAID), “rather than delivering DNA or mRNA directly to cells, some vaccines use a harmless virus or bacterium as a vector, or carrier, to introduce genetic material into cells. Several such recombinant vector vaccines are approved to protect animals from infectious diseases, including rabies and distemper … Today, NIAID-supported scientists are developing and evaluating recombinant vectored vaccines to protect humans from viruses such as HIV, Zika virus and Ebola virus.” “Vaccine Types,” National Institutes of Health, NIAID. For more, see Susanne Rauch, Edith Jasny, Kim E. Schmidt, and Benjamin Petsch, “New Vaccine Technologies to Combat Outbreak Situations,” Frontiers in Immunology 9:1,963 (2018).
[n] In the October 2020 issue of CTC Sentinel, Drew Endy stated: “I thought Craig Venter did a nice job in giving people the vision of a technology-enabled public health system in response to a pandemic, be it natural or intentional, which would detect where things were happening at the time they were happening, upload that information on the web, transmit that information at the speed of light, and people could be compiling prophylactics and vaccine candidates faster than the planes were landing with infected people. So you can have a speed of light public health bio defense system; it would require the equivalent of a hurricane satellite warning system. Imagine a bio weather map. This century we’ll have enough sequencing capacity to sequence the DNA of every organism on the planet. Like literally every base on earth, we’ll sequence. So now let’s just imagine a bio surveillance system. We have a bio weather map. We can see when things are happening. We can transmit that information over the network. We can instantly develop, using computer algorithms, attenuated vaccine candidates. We have enough experience with trialing against scaffolds for vaccine vectors that we just integrate the new sequence specific to the novel pathogen such that we have a vaccine on demand.” Stephen Hummel, Paul Cruickshank, and Don Rassler, “A View from the CT Foxhole: Drew Endy, Associate Chair, Bioengineering, Stanford University,” CTC Sentinel 13:10 (2020).
[o] The Five Eyes is an intelligence alliance of Australia, Canada, New Zealand, the United Kingdom, and the United States.
 Donald G. McNeil Jr., “Bird Flu Paper Is Published After Debate,” New York Times, June 21, 2012; Denise Grady and Donald G. McNeil Jr., “Debate Persists on Deadly Flu Made Airborne,” New York Times, December 26, 2011; Eryn Brown, “Scientists create bird flu that spreads easily among mammals,” Los Angeles Times, June 21, 2012.
 John Vidal, “Destroyed Habitat Creates the Perfect Conditions for Coronavirus to Emerge,” Scientific American, March 18, 2020; Dina Fine Maron, “‘Wet markets’ likely launched the coronavirus. Here’s what you need to know,” National Geographic, April 15, 2020.
 J. Kenneth Wickiser, Kevin J. O’Donovan, Michael Washington, Stephen Hummel, and F. John Burpo, “Engineered Pathogens and Unnatural Biological Weapons: The Future Threat of Synthetic Biology,” CTC Sentinel 13:8 (2020).
 “Biosafety for Specimen Handling,” Coronavirus Disease 2019 (COVID-19), Centers for Disease Control and Prevention, updated September 19, 2020.
 Fazlul Haque, “Bio-security and its importance,” Daily Observer, June 24, 2018.
 Amir Bagherpour and Ali Nouri, “COVID Misinformation Is Killing People,” Scientific American, October 11, 2020; Mark Dubowitz and Saeed Ghasseminejad, “Iran’s COVID-19 Disinformation Campaign,” CTC Sentinel 13:6 (2020).
 For more on the debate over contact tracing apps, see Yann Sweeney, “Tracking the debate on COVID-19 surveillance tools,” National Machine Intelligence 2 (2020).
 Jonathan Corum, Sul-Lee Wee, and Carl Zimmer, “Coronavirus Vaccine Tracker,” New York Times, updated November 16, 2020.
 Katie Thomas, David Gelles, and Carl Zimmer, “Pfizer’s Early Data Shows Vaccine Is More Than 90% Effective,” New York Times, November 9, 2020; Denise Grady, “Early Data Show Moderna’s Coronavirus Vaccine Is 94.5% Effective,” New York Times, November 16, 2020; Katie Thomas, “New Pfizer Results: Coronavirus Vaccine Is Safe and 95% Effective,” New York Times, November 18, 2020.
 “AstraZeneca and Oxford University announce landmark agreement for COVID-19 vaccine,” AstraZeneca, April 30, 2020; Umair Irfan, “These Covid-19 vaccine candidates could change the way we make vaccines—if they work,” Vox, August 13, 2020.