Addressing the Threat of Disease Spillover

U.S.-Based Best Practices at the Nexus of Ecological and Biological Security

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Foreword

In recent years, scientists have alerted the world to an alarming trend: infectious diseases are spilling over from animals to humans at an accelerating rate. Some hold the potential for causing serious local or regional outbreaks, and some could risk significant and potentially devastating global consequences.

Understandably, most efforts to address these risks focus on the human side of the equation after diseases have emerged: treating and hopefully stopping outbreaks after pathogens have begun to clearly cause human illness or death. This work is, of course, crucial to addressing major biological risks.

But it’s not the whole picture. Too little attention is paid to prevention – those activities that seek to detect, understand, and stop the transmission of pathogens before they cross into people. Some focus on monitoring and prediction for areas of significant and current human-animal interface; others go further, aiming to find, characterize, and share details about pathogens that may exist in places where human encroachment is not yet happening.

But while all this work is driven by good intentions, there remains an urgent need for an overarching, public policy “stock-taking” regarding the potential effectiveness of different approaches for early warning, as well as the balance of benefits and risks from both biosecurity and ecological security perspectives. Without transparent, risk-reduction strategies, some types of prevention activities could inadvertently increase disease transmission risks and worsen ecological security.

As such, how the United States and other nations address disease spillover remains contentious. To what degree should we seek to catch pathogens before transmission into people? What is the right focus, and what are the most important investments to make? Which activities best balance risk and benefits? How do we ensure safety and security considerations inform these decisions? In terms of U.S. policy, these questions are all far from settled. Indeed, it is an area where the science of what may be possible has advanced more rapidly than broad public debate or policy decisions have.

For this reason, since early 2022 the Council on Strategic Risks (CSR) has conducted an in-depth study of this issue: holding discussions and convenings with a wide variety of experts from different fields and expert communities to better understand their perspectives, ideas, and concerns. CSR has included individuals viewed as key innovators and thought leaders in their respective fields, and experts who play direct or indirect roles in shaping how the world will address spillover risks in the years ahead. Perhaps most importantly, we have deliberately included experts with diverging views on the questions posed above.

The results of these discussions are included in this report. We hope they will serve as an important reference for policymakers and the public by providing a wealth of information about the array of U.S. policies, programs, and activities involved in addressing spillover risks. These include:

• Details regarding who is involved in this work;
• Explanations of the types of activities commonly pursued, and some of their potential benefits and risks;
• A vision of project lifecycles to show the various stages at which expected benefits and risks can be weighed and optimized, including in designing activities and integrating lessons from their conduct; and
• Recommendations for shaping policies and programs.

Beyond the information and lessons found in this report, we’ve come away from the project especially struck by the incredible level of agreement among the diverse experts in different fields of work who shared their time and insights with CSR. Even among experts who disagreed on some core issues, we heard a high degree of alignment—and often shared enthusiasm—regarding the following points:

• There is no lack of concern about the risks regarding spillover prevention research, even if experts differ in how they would seek to reduce risks.
• The expansion of pathogen early warning capabilities must be accelerated.
• Public and private funding for efforts to address spillover risks should include more dedicated resources and consistent guidance regarding safety.
• Enhancing ecological security should be seen as an inseparable part of activities to reduce spillover risks, including tools known to be highly effective such as restoring native habitat and reducing deforestation.
• Technology is quickly expanding the potential toolkit for addressing spillover, including in ways that could make it far faster to identify, test, and replicate effective actions that reduce both biosecurity and ecological security risks.
• Transparency and public communication are crucial.
• Cross-disciplinary collaboration is essential, and should become the status quo as quickly as possible.

In the years ahead, CSR and hopefully others will carry forward concerted dialogues and thoughtful development of policy recommendations to guide how the United States and others seek to prevent and address infectious disease risks. The need is amplified by both the rise of disease threats from natural, accidental, and deliberate sources, and by the destructive forces at play in the information environment that are complicating sound policy making. We hope this report marks a strong step in this direction.

—Hon. Andy Weber & Christine Parthemore
Project Principals

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Definitions & Context

The biological security and ecological security fields are generally siloed from one another, which creates confusion. To minimize this issue, below are some defined terminologies used in the report.

• Biological Security (Biosecurity): plans and activities meant to address biological threats to human health, including from natural, deliberate, and accidental sources.
• Ecological Security: plans and activities meant to address threats to human, national, and global security that arise from ecological destruction and disruption, as well as the collapse of ecosystems.
• One Health: a unified and transdisciplinary approach that considers human, animal, and environmental health as an integrated whole.
• Pandemic: an epidemic occurring across a wide geographical area or region, in which the disease’s growth in affected populations is exponential.
• Spillover: an event where a pathogen is transmitted from a reservoir species to another. Zoonotic spillover refers to the transmission of a zoonotic pathogen from the reservoir animal species into humans (e.g., a Highly Pathogenic Avian Influenza A H5N1 infection occurring in a human due to exposure from livestock).
• Spillback: the transmission of a pathogen from humans into animals, such as SARS-CoV-2 transmission from humans into deer.
• Zoonotic Diseases (also referred to as zoonoses): microbes carried by animals that can spread to humans and have the potential to cause illness. Animals can transmit zoonotic diseases through different routes, including direct contact with blood or body fluid, vectors (such as ticks and mosquitos), and indirect contact with contaminated habitats. Examples include avian influenza (H5N1), Rocky Mountain spotted fever, rabies, and tularemia.
• High-Spillover Sites: regions that have a confluence of risk factors that increase the likelihood that a disease will spread from an animal to a human.
• Rights of Nature: an outlook and approach that extends fundamental legal rights to ecosystems. Just as humans, corporations, and some animals are entitled to certain rights, ecosystems such as rivers and forests are likewise guaranteed certain protections, such as the right to be uncontaminated and biodiverse.

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Executive Summary

Infectious diseases pose a significant threat to human and animal health, and ultimately, to global security: a threat which has been increasing in both frequency and impact over recent decades, as populations grow, the climate changes, and ecological systems are disrupted. The majority of infectious disease threats that we face today are zoonotic; meaning that they originate in animals and can pass to humans when these groups interact.¹ The impacts of zoonotic disease transmission, also known as spillover, can be immense, as seen with recent outbreaks of SARS-CoV-2 (which causes COVID-19), Ebola virus, Zika virus, MERS-CoV,, and other emerging infectious diseases.²

These growing risks demonstrate why pandemic prevention work is so important. This includes efforts to mitigate emerging infectious disease threats from high-risk spillover areas through sampling, analyzing, and mapping what potential pathogens are circulating.³ Such activities catalog what pathogens may be of particular concern to animal and human health, and can facilitate diagnostics and medical countermeasure development in the event said pathogens are involved in a spillover event.⁴

On the other hand, the increased rate and prevalence of infectious diseases are also linked to human activities, such as those that drive climate change, cause ecological disruption through deleterious land-use, and create environments better-primed for spillover (such as certain animal husbandry practices).⁵ Along these lines, some experts have raised concerns that some of the very activities that seek to prevent or mitigate the effects of pandemics may precipitate them.⁶ Further, such activities may also be incredibly disruptive both societally and economically to the associated locales.⁷ Finally, many biological research-based pandemic prevention activities are often done with little-to-no consideration of how to leverage nature-based solutions: a significant gap given the clear connections between the health and balance of ecological systems and the likelihood of disease spillover.⁸

In order to better understand this landscape and deeply explore the policy and practical questions involved, the Council on Strategic Risks (CSR) connected with thought leaders in several fields for more than one year. These experts have strong backgrounds that both directly and indirectly deal with pandemic prevention activities, and span the biological and ecological security communities. Through small-group and one-on-one discussions, CSR engaged experts in data science, life sciences research and regulatory practices, pandemic prevention research and policy analysis, virology, ecology, conservation, and more. Among some of these thought leaders, CSR convened three workshops in 2023 under the Chatham House Rule (two virtual gatherings in March and April of 2023, and one in-person workshop in June 2023). In addition, CSR experts conducted independent research and analysis. This process has culminated in the development of this report.

The report provides a deeper understanding of the current landscape of pandemic prevention activities that focus on high-risk disease spillover sites. It provides examples of the complex web of biological and ecological factors that contribute to spillover risks, and highlights a range of current activities and practices. It also identifies gaps and challenges currently stemming from the existing silos between the biological and ecological security fields—gaps and challenges which result in siloed approaches to the way these activities are conceptualized, considered, executed, and prioritized.

The report is broken into five parts, as follows:

Part 1: Current Approaches to Reducing Spillover Risks: Ecological and Biological Security Aspects. This section describes current approaches to reducing disease spillover risks through biosecurity and ecological security activities. From a biosecurity perspective, activities that scientists carry out to prevent and mitigate spillover include biological sampling, surveillance, and virus discovery. These efforts aim to enhance awareness and foresight into what diseases may emerge, as well as enable a head start in developing diagnostics and medical countermeasures for diseases that may threaten human populations. While these activities seek to avert spillover events, they also potentially pose inadvertent risks, such as those associated with sample collection and transport, and non-standardized lab capabilities and practices.

In addition, the currently insufficient integration of ecologically-focused tools is a huge gap in how the world currently addresses spillover. This must be addressed in order to achieve the One Health vision that the international community has long held for addressing interactions within human, animal, and environmental health. Ecological security activities and tools—which include concepts such as conservation, leveraging defenses against disease risks found in nature, reforestation, addressing illicit wildlife trade, and the legal “rights of nature” approach—should be considered integral to efforts to reduce spillover. Further, those who conduct activities to address spillover need to ensure that sociological issues, such as the compatibility of local customs with potential interventions, are considered.

Part 2: U.S. Work at the Nexus of Ecological and Biological Security. Following from the broad description of spillover-reduction approaches in the first section, Part 2 details domestic and international efforts by the United States to address spillover risks that involve biological and ecological considerations. U.S.-sponsored activities range from tracking and understanding the context of high-spillover sites to addressing invasive species. This requires broad interagency cooperation, with multifaceted projects and initiatives from agencies ranging from the U.S. Department of Defense and the National Institutes of Health to the U.S. Fish and Wildlife Service.

Part 3: Actionable Recommendations and Examples for Projects that Address Spillover. This chapter presents the results of a guided thought exercise with subject matter experts, conducted by CSR. The exercise concludes that it is possible to make progress towards a more holistic approach to pandemic prevention activities at the intersection of biological and ecological security. This involves concrete actions that pandemic prevention activities should incorporate across the lifespan of a spillover prevention project, which include:

• Utilize multidisciplinary teams.
• Generate standardized language, concepts, and methodologies to decrease confusion and ease data sharing.
• Develop communication strategies that effectively target different audiences (from the public to policymakers); and
• Ensure that global collaborative efforts focus on addressing both safety and security concerns in potential high-spillover sites, as well as working with local experts and communities with respect.

Further, through a combination of iterative research cycles and engagement with subject matter experts in diverse fields including biosecurity, biosafety, ecological security, virology, environmental conservation, and others, CSR identified numerous key gaps and challenges in existing activities and policy that are currently inhibiting an integrated approach to spillover prevention involving ecological and biological considerations.

Part 4: Challenges and Solutions at the Ecological and Biological Security Nexus. This chapter presents the results of CSR’s deep research in this space, which also included three workshop engagements with subject matter experts over the course of a 12-month period. These engagements highlighted that there are significant challenges across the entire spectrum of researching, analyzing, and implementing interventions to address potential risks at the nexus of biological and ecological security: risks that include potentially alienating promising partners, miscalculating where disease spillover risks are occurring and to what extent, and on the extreme end, accidentally precipitating the very disease event that stakeholders had sought to prevent. Part 4 distills five categories of challenges and corresponding action items:

• Insufficient integration between biological and ecological security approaches. To maximize the utility of research at this complex intersection, we recommend that policymakers reduce funding silos and foster interdisciplinary opportunities. This must include overdue steps to eliminate legacy policy barriers that separate human and animal health research.
• Initiatives in this space often lack necessary funding and support. Though there are a range of innovative and productive pandemic prevention programs, they need more support. By lengthening project funding and developing more programs focused on ecosystem health, more longitudinal and actionable data can be collected.
• Sociological and historical context is often poorly understood and left unaddressed in research and intervention strategies. For example, asymmetric engagements between Global North and Global South countries continue to create tensions and function as a barrier to collaboration. We recommend ameliorating some of these dynamics by incorporating sociological expertise, integrating community needs and preferences, and employing nuanced approaches.
• There are a variety of structural obstacles that prevent high-quality data collection, sharing, and use—which can create significant challenges in designing and implementing spillover prevention programs. For instance, different groups prioritize and collect data that only directly relate to their interests, thus creating uncontextualized and siloed data. To resolve these issues, we recommend a multidisciplinary approach to enhance data interoperability and incentivize outbreak reporting across stakeholder communities.
• The security implications of ecosystem disruption and loss, and localized disease outbreaks, remain underappreciated, despite recent progress in demonstrating the detrimental effects of ecological destruction. Therefore, we recommend that funders and policymakers increasingly consider the use and viability of conservation as a security measure, focus more attention on combating the illicit wildlife trade, discourage deforestation, address spillover risk in animal husbandry, and prioritize localized outbreaks.

Part 5: Lessons Learned—Utilizing Best Practices in Ecological and Biological Security to Responsibly Prevent and Mitigate the Threat of Zoonotically-Transmitted Diseases. Here the report distills six best practices as a high-level guide on how to actively make improvements in unifying ecological and biological security considerations when it comes to pandemic prevention activities in high-spillover sites:

• Increase collaboration to build tools and dialogues for all the communities that work to address the ecological and biological intersection.
• Build small to build big through the use of pilot projects and other initiatives to establish baselines that help identify which measures are likely to be effective in different cultural, political, and environmental contexts.
• Standardize data-related methods and practices across disciplines, such as study design and data management, to help magnify the impact that data have on everything from basic research to policy recommendations.
• Coordinate efforts through conversations and gatherings to minimize confusion in key areas such as the rules, regulations, and best practices associated with multidisciplinary teams and multi-regional participants.
• Be transparent to better holistically understand the dynamics of spillover, as well as maximize public trust and credibility.
• Gather data in a thoughtful and usable manner since many topics, including microbial spread and vector migration, will require robust, easily understood, and accessible data to ensure accurate baseline measurements and modeling initiatives.

The complexity of these threats poses a challenge to policymakers and those engaged in pandemic-prevention activities, but also an opportunity. In conjunction with ongoing work in preventing pandemics on the life sciences side, ecological solutions such as ecosystem conservation and restoration may also contribute significantly to reducing pathogen emergence and spillover while presenting a host of co-benefits for society.⁹

While much progress has been made in this area, sustained and significant effort is necessary to address the very real rising risks of emerging disease outbreaks in high-risk spillover locations. To this end, bridging biosecurity and ecological security communities and activities will be critical to reaping the full benefits of effectively preventing, identifying, halting, and mitigating spillover events, and hopefully preventing the next pandemic.

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In the wake of the mass devastation of COVID-19, policymakers around the world are facing myriad questions related to how their nations seek to prevent future natural outbreaks from reaching pandemic scale, and address risks from potential outbreaks triggered by accidents or deliberate attacks. After several years of emergency responses to the COVID-19 pandemic, our nations’ leaders are actively deliberating about how these goals should be pursued, what resources will be required, whether significant structural reforms are required, and more.

Emerging zoonotic diseases (or zoonoses)—microbes carried by animals that can spread to humans and have the potential to cause illness—are an increasing threat to human, community, and global security. When they emerge, the results can vary widely. However, recent events such as the 2009 H1N1 influenza and COVID-19 pandemics show the immense mortality, economic damage, and security risks such events can cause. COVID-19 alone has caused roughly 7 million deaths and nearly $13 trillion in global economic damage, and the latest surge in 2023 indicates it is still spreading.¹⁰

Even relatively contained zoonotic events can cause significant harm. For example, the 2014–16 Ebola outbreak in West Africa caused over 11,000 deaths and cost over $2 billion in lost gross domestic product, with estimates of comprehensive economic and social burden costing $53 billion.¹¹ Further, these zoonoses are unevenly distributed in how they affect certain populations: nearly 44% of deaths in low-income countries are attributed to infectious diseases in general, and 2.7 million global deaths annually are attributed to zoonotic diseases. Therefore, even local and regional disease emergencies, particularly in a globalization era, can have significant negative impacts on global health.¹²

Unfortunately, the global threat of zoonoses is rapidly increasing due to anthropogenic and environmental changes. The global community is increasingly connected by trade and transport from local to global scales. Meanwhile, human degradation of ecosystems through land conversion, wildlife exploitation, agriculture, species introductions, pollution, and climate change appears to be driving an increase in zoonotic disease emergence and spillover.¹³ This convergence of drivers across society and nature raises a need for a more holistic approach that combats each stage of the zoonosis transmission chain, from emergence to potential pandemic.¹⁴

The complexity of these threats poses a challenge to policymakers, but also an opportunity. In conjunction with ongoing work in preventing pandemics on the life sciences side, ecological conservation and restoration may also contribute significantly to reducing pathogen emergence and spillover while presenting a host of co-benefits for society.¹⁵ This is consistent with the vision that many governments and international organizations, including the United States and the WHO, use today to address health challenges: the collaborative, multisectoral, and transdisciplinary approach known as One Health.¹⁶ But for that vision to be realized, much more needs to be done to both understand interactions across the biological, ecological, and security fields, and to develop solutions to the spillover risks that emerge from those interactions. Policy-based responses to the threat of spillover-induced outbreaks, especially those of pandemic potential, must also account for the risks of research and interventions that require nuanced efforts in dynamic environments.

In this context, CSR brought together—over the course of three workshops—experts with backgrounds in biosecurity, life sciences research and regulatory practices, pandemic prevention research, conservation, wildlife ecology, data science, and other fields to help understand their respective communities’ perspectives on the integrated nature of ecological and biological risks, and identify gaps and recommendations for preventing and mitigating the threat of zoonotically-transmitted diseases in ways that reflect the inputs of these fields. These experts provided diverse perspectives on key issues they experience, which helped ensure that this report is as expansive as possible.

Further, this marked a first phase in what CSR hopes will be an enduring multidisciplinary community of practice related to spillover mitigation that shows increasing camaraderie in pushing for common goals and respectfully addressing issues when diverging views exist. We hope this network can help policymakers in gaining a holistic view of risks and tradeoffs; while the intersection of biology and ecology is now widely recognized and often embraced, those focused on the security and risk mitigation sides of these issues infrequently collaborate. CSR aims to continue to convene this community in the future for a broader suite of collaborative efforts.

For the purposes of this report, the workshops were convened as a means to understand each community’s viewpoints on the rising ecological and biological nexus and risk concerns, and to distill common themes and key insights on the security dimension of disease spillover risks. Across two virtual meetings and a two-day in-person workshop, and many conversations in between, CSR and subject matter experts were able to identify gaps and security vulnerabilities within existing spillover prevention efforts while developing recommendations to maximize benefits and minimize risks in future activities.

In addition to expert discussions, CSR conducted research and analysis on the nexus of biological security and ecological security risks to identify existing efforts and gaps, further illuminate important nodes of spillover risk, and inform policymakers about important categories of solutions. This report represents the results of our convenings, and research and analysis conducted by CSR staff.

This introduction will proceed with two sections. The first, Biological and Ecological Security: Definitions and Context, lays out the roles of biological and ecological security in addressing disease spillover risks. The second presents a Scene Setter to orient the reader through a concrete and specific example of the ecological and biological security nexus, and how zoonotic disease risk manifests itself in a particular geography—in this case, Indonesia.

Biological and Ecological Security: Definitions and Context

Across different stakeholder communities, common terms can mean different things. Therefore, CSR is providing the following definitions with context to minimize confusion as readers work their way through the report.

Biological Security

Biological Security, or biosecurity, has a range of definitions depending on the individual or community using it. In this report, biosecurity is defined as efforts that seek to address biological threats to human health, including from natural, deliberate, and accidental sources.

A key area of concern in biosecurity is addressing the increasing prevalence and impact of emerging infectious diseases on human and animal populations. This trend is driven by anthropogenic effects such as climate change, land-use change, and the erosion of lines between human- and animal-inhabited spaces. As this erosion occurs, humans, animals, and insects end up interacting more. This intermingling increases the likelihood of disease emergence through what is known as spillover: the transmission of pathogens from animals to humans.¹⁷

Preventing spillover of zoonotic diseases is a core biosecurity goal. While preparedness is also important—developing quarantine protocols, public health guidance, and medical countermeasures—this report focuses on efforts that aim to prevent or limit infectious diseases from entering human populations in the first place.

While spillover prevention activities contribute to biosecurity, these activities are not without risks. In fact, they may inadvertently catalyze the very events they are meant to prevent. Key challenges in this area include ensuring safety and security protocols for collecting and transporting animal samples—samples that may be dangerous based on how they are handled. Samples acquired from known reservoirs of viruses could potentially infect researchers and the ecosystems they interact with in the absence of proper biosafety protocols and equipment, or via accident even if proper protocols are in place.¹⁸ Furthermore, research conducted on these samples may lead to unintentional infections if safety precautions are not strictly followed.¹⁹

Given these risks, it is essential to understand how such events may occur, and take a thoughtful and empirical approach to enhance safety and security throughout the entirety of the pandemic prevention research and activity life cycle. Having an open and agnostic conversation regarding biosafety and biosecurity risks and ways to address them will allow critical pandemic prevention work to be undertaken in the safest way possible.

Ecological Security

In this report, ecological security is defined as resilience to risks to human, national, and global security that arise from ecological destruction and disruption, and the collapse of ecosystems.²⁰ In most cases, ecological security is increased by ecosystems that are healthy (e.g., without heavy fragmentation), intact (e.g., large contiguous blocks), and functional (e.g., containing their native biodiversity, cycling nutrients and water as they would without human disturbance). Currently, many parts of the world are facing ecological strains unprecedented in human history, to the point of rising concerns that some long-held systems that are crucial to societal stability may be reaching tipping points.

Natural ecosystems with intact biodiversity and healthy organisms provide a number of regulating and provisioning services to society. For example, forests provide oxygen, help to regulate global climate by capturing and sequestering carbon, and benefit local communities by limiting floods and stabilizing soils. When managed responsibly, forests can provide a sustainable supply of products such as wood, organisms used in local traditional medicine, and substances that can serve as the basis for new pharmaceuticals.

While anthropogenic ecosystems (e.g., farms) also provide services to people, the more humans alter ecosystems, whether intentionally (e.g., hunting) or unintentionally (e.g., polluting), the more those ecosystems present society with additional costs—just as the diversity of services they provide declines.²¹ Two of these costs are increased parasite and pathogen pressure within the affected ecosystems and a concomitant increase in the risk of zoonotic spillover.²²

Human-induced land use change, particularly deforestation and habitat fragmentation, and climate change are altering the disease landscape and with it the risk of zoonotic spillover. Both land use change and climate change have the potential to alter species assemblages, enabling new contact between hosts, reservoirs, vectors, and humans.²³ Heavily managed landscapes favor generalist species adapted to living near human settlements and there is some indication that these species are more competent hosts of zoonotic viruses than their specialist counterparts.²⁴ Thus, where human alteration of ecosystems has increased spillover risk, ecological security has declined in a way that reduces biological security.

It follows that some steps which would improve ecological security would also improve biological security by decreasing spillover risk as a co-benefit. These ecological interventions might include regulations and programs to halt deforestation, pollution, or species introductions (e.g., Aedes albopictus), alter human-wildlife interactions (e.g., limiting harvest, handling, and sale), restore ecosystems, or combat climate change with nature-based solutions.

An Example of the Ecological and Biological Security Nexus:
The Case of Indonesia

CSR used the following example as a “scene setter” in discussions to display an actual example of the complex interactions that exist at the intersection of ecological and biological security. While the details are unique to Indonesia, the overarching factors (resource extraction, agricultural expansion, infrastructure projects, climate change, and others) and their repercussions are actively shaping other countries and regions as well. The scene setter is intended to give the reader a firm understanding of the issues covered later in the report.

Spillover in Indonesia

Recent infectious disease events such as Ebola, COVID-19, mpox, and Highly Pathogenic Avian Influenza A (HPAI) H5N1 show how zoonoses can potentially reach pandemic scale, with negative impacts to human and animal health, economic damage, and social unrest leading to acts of violence.²⁵ Southeast Asia is considered a hotspot for zoonotic disease risk due to rapid ecological change, an active wildlife trade, and agricultural intensification occurring in-step with rising populations.²⁶

Indonesia has been experiencing significant growth over the past few decades; the population has grown from 98 million in 1964 to over 275 million in 2023.²⁷ Due to factors such as rapid sea level rise, severe land subsidence, pollution, and population growth, the government is planning to move the capital city from Jakarta (located on the island of Java and home to 10 million people), and establish a new capital city in Borneo, a heavily forested island. This $33 billion endeavor has raised concerns, especially regarding the widespread deforestation required for development, the detrimental impact on Indigenous communities, and the extreme threat to biodiversity the move may cause.²⁸

The archipelago is also facing a wide range of extreme climate change impacts, including higher temperatures, extreme weather events, and forest fires. Cycles of aridity and extreme precipitation events, including major cyclones, will lead to increasing instances of drought and severe flooding. At the same time, El Niño/La Niña events will intensify due to climate change, which will exacerbate these patterns and likely erode food production across the region.²⁹ Sea-level rise has and will continue to lead to serious inundations and salt water intrusion (a growing issue that intersects with fresh water stress). Indonesia, like many of its regional neighbors, can expect significant declines in fish stocks, large-scale coral bleaching, and massive marine biodiversity losses. Taken together, a collapse in fisheries and agriculture will undoubtedly erode livelihoods and could potentially manifest into larger-scale socioeconomic and political issues, including instability. At the same time, experts predict climate change will increase infectious and vector-borne disease risks and respiratory illnesses.³⁰

In addition to climate change, other drivers are influencing these types of health risks. Indonesia is a resource-rich country with robust exports of palm oil, coal, gold, crude palm oil, and ferro-nickel. Resource extraction is driving deforestation and associated biodiversity loss, increasing the likelihood of novel intermingling between animals, insects, humans, and the pathogens they carry.³¹

Additionally, as the Indonesian economy has grown, there has been a commensurate increase in the demand for animal protein. This has led to an increase in poultry and pig farming and production. The expansion of these industries has had several important effects. First, different avian species, including chickens and ducks, are being raised and farmed in close proximity to each other and to humans, increasing the likelihood of spillover events.³² Second, pigs, poultry, and humans are living in closer proximity, which is problematic as pigs can serve as intermediaries between avian and human infections of H5N1. Third, Indonesia’s poultry slaughter and processing practices mostly take place in backyard facilities which can lack safer processing mechanisms. In Jakarta alone there are over 2,500 backyard facilities of this kind; this phenomenon increases the likelihood of disease emergence due to unhygienic conditions. Finally, live animal markets (colloquially referred to as wet markets), and traditional markets (pasar) have historical and cultural significance in Indonesia. These are spaces where fresh produce and animals (including bats, poultry, and other wildlife) may be in close proximity to each other, which increases the probability of spillover.³³

The forces above are all interconnected at the local, regional, and global scales. Further, they are the result of similar economic pressures leading to climate change. Degraded ecosystems in anthropogenic landscapes are unable to support the same quantity or quality of functions as intact ecosystems. This decreases their services to people, and increases the stress on the organisms that remain. It is now recognized that their radiating effects undermine security, including through increasing the likelihood of diseases emerging from animals into humans as they interact more, and by introducing novel pathogens into new geographies as animals, insects, and humans migrate to more hospitable climates. Further, disease emergence can exacerbate existing societal and regional tensions due to economic losses, competition over scarce resources, and disinformation and misinformation campaigns that may erode trust in governments and transnational cooperation.

Without further action and interventions, disease spillover is likely to increase. For Indonesia, the issues cited above are recognized and there are efforts underway to address some of them. Fortunately, there are independent biosecurity and ecological security activities that are meant to help address these issues and mitigate disease spillover risks. The next section highlights several biological and ecological security efforts to address spillover and catalyze response in the event that spillover events occur—and discusses some of the benefits and risks involved.

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Preventing zoonotic spillover can take many forms. Within the biological and ecological security spaces, the focus tends to be on four main areas: 1) actively and passively surveilling areas to understand how the local and regional contexts are changing between humans, animals, insects, and nature; 2) understanding the complex dynamics that exist between nature and human populations; 3) preventing ecological changes and damage that are known to increase spillover risks; and 4) acquiring key materials and samples from regions where spillover events are likely to occur in order to accelerate diagnostics and medical countermeasure development for when a disease does emerge. This section discusses the major types of activities that happen within both biological and ecological security work, and concludes with some of the concerns that arise with these types of activities.

Spillover Prevention Research—Biological Sampling and Surveillance

One key way life sciences researchers are working to address spillover risks is to understand what pathogens are circulating in a local environment. The thinking here is that identifying what is circulating in the environment allows advanced warning of possible zoonotic pathogens: this foresight, in turn, empowers stakeholders to develop diagnostics, medical countermeasures, and other mechanisms to monitor, detect, respond to, and recover from spillover events. The following sections show how these activities are conducted and integrated toward the goal of pandemic prevention.

Pathogen Surveillance in Humans

Pathogen surveillance is an essential tool to detect diseases that have emerged or re-emerged in human populations. Approaches include event-based surveillance (incorporating reports, rumors, media, and other unofficial information sources), sentinel surveillance (relying on networks of doctors to report trends they are observing), and syndromic surveillance (incorporating data based on specific symptoms and preliminary diagnosis rather than waiting on laboratory-confirmed diagnoses).³⁴ These tools and information-sharing networks are important components for preliminary detection of disease outbreaks before diagnostic tests or test results are available.

Other forms of pathogen surveillance in humans incorporate the use of diagnostics, clinical testing, and genomic sequencing. Examples like COVID-19 testing at travel hubs and workplaces show how these are common and essential tools in disease management and public health monitoring.

However, surveillance efforts meant to track outbreaks at their inception can be more challenging to implement than ongoing disease outbreaks. This is because testing capacity may be limited when it comes to novel pathogens (no tests may immediately exist) or in resource-stressed areas (where cutting-edge technologies may not be available). As these issues occurred during the COVID-19 pandemic, genomic surveillance—which involves the sequencing of genetic material—has been increasingly used to detect pathogen evolution and rapidly identify novel variants, particularly through targeted efforts in high-risk populations (e.g., immunocompromised patients, congregate living quarters, healthcare providers).

A useful form of pathogen monitoring that emerged during the COVID-19 pandemic is wastewater-based surveillance. Wastewater-based epidemiology is a valuable method of collecting anonymized, representative data from populations through analyzing sewage samples. It does not require any effort from individuals, and people do not have to report to a testing site or interact directly with researchers to trace and track the ebb and flow of a disease outbreak.

As wastewater-based surveillance has gained in popularity, it has been combined with metagenomic sequencing: a capability that enables the identification of any pathogen or pathogen fragment in a given sample based on its genomic sequence. In the case of wastewater samples, metagenomic sequencing enables researchers to potentially identify any pathogen that is shed in human waste, regardless of whether it is a novel pathogen or not.³⁵

While metagenomic sequencing is a breakthrough technology with many applications, it is still quite cost-prohibitive to use. Therefore, massively multiplexed testing of wastewater or samples in labs (testing for a high but finite number of pathogens) can be a cheaper option than metagenomic sequencing while still providing a great deal of information—some platforms can test for hundreds of pathogens at once.³⁶

Notably, wastewater-based epidemiology only works in communities with access to septic systems and sufficient laboratory capacity. Individuals living on the edge of wild habitats do not always have this access, which may delay this becoming a more viable tool for pathogen surveillance in these communities. Large-scale surveillance approaches, like pooled or batched testing, can be cost-effective methods for screening large or targeted populations, but do not provide individual diagnoses. As such, additional testing of individuals is necessary for further public health interventions, such as isolation and quarantine.

For individuals in low- and middle-income countries (LMICs) who live or work with high-risk animals, point-of-care diagnostics are a feasible and effective surveillance measure. These tests can be done in place and done without transferring samples to laboratories: a process that can take weeks in rural, under-served regions. For instance, in the 2018 Ebola outbreak in the Democratic Republic of the Congo, point-of-care tests enabled health workers to quickly identify Ebola cases and implement quarantine measures—a major improvement over the days-long, high-tech process that was required in the 2014 West African Ebola epidemic.³⁷

Ideally, people working or living with animals could have access to multiplexed point-of-care tests regularly to reduce the time between exposure or symptom onset and diagnosis. As of yet, however, there have been no large scale pilot programs of this sort.

Finally, serological testing—tests that check for the presence of particular antibodies and their levels in the blood—can determine what pathogens individuals have been infected with or exposed to previously. While this data does not provide early warning for an outbreak since differences in antibody levels are typically not detectable until an infection has passed, it can provide insight into what diseases appear to be emerging frequently, as well as demographic indicators for those at higher risk for zoonotic diseases.³⁸

Sampling and Surveillance of Wild and Domestic Animals

In addition to disease surveillance in human populations, collecting wild and domestic animal samples allows researchers to identify potential spillover risks and the overall serological baseline of animal populations. Animal-focused sampling is done for a variety of reasons, such as assessing the impact of human encroachment on animal microbiomes, discovering novel pathogens, responding to outbreaks, and identifying pharmaceutical resistance trends, including those that affect existing vaccines and antimicrobials.

Animal surveillance helps identify where zoonotic emerging and novel pathogens are most likely to originate from, and incorporates serological and behavioral analysis to better understand risk factors and pathways for spillover. Strategic efforts have increasingly been focused on bolstering existing animal surveillance networks, as well as less established networks in high-risk, low-resourced geographic areas. Animal surveillance also integrates community-based risk assessments and considerations for local disease distribution and needs. Targeted efforts to enhance animal disease surveillance and diagnostic capabilities in LMICs have focused on point-of-care tests as those rural and remote communities can be especially impacted by outbreaks.³⁹ As emerging infectious disease outbreaks and spillover events are complex, prevention and research efforts require agile approaches that consider the multitude of contributory factors.

Several initiatives have focused on enhancing disease emergence preparedness through targeted surveillance of animals, humans, and disease vectors. For example, the School of Veterinary Medicine at the University of California, Davis, developed the EpiCenter EID Challenge that works under the Centers for Research in Emerging Infectious Diseases (CREID) Network, funded by National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH).⁴⁰ Their work seeks to understand viral emergence in forests and rapidly expanding urbanized areas, specifically within the Congo Basin forest perimeter in Uganda and the Amazon Basin of Peru. The CREID Network integrates multidisciplinary teams focused on arboviruses, filoviruses, coronaviruses, and novel pathogens.

Animal sampling tends to focus on two components—the pathogen and the animal species that comprise the ecosystem. The first approach focuses on a specific pathogen, which might already have shown a propensity for spillover into humans, or one that could be highly impacting but has limited historical outbreaks. The second method to animal surveillance focuses on the specific animal species that may act as reservoirs or intermediary hosts, such as bats, non-human primates, swine, and birds. Targeted efforts have focused on species with more interactions with humans, also known as the human-animal confluence, which is an indicator for higher spillover risk. For example, the interface surrounding animal husbandry, such as the large-scale production of swine and poultry in cramped quarters, is one important area for sampling since these interfaces facilitate close interactions between human workers and animals. Animals with high contact rates with humans and other animals represent unique health threats, like the spillover of pathogens such as H5N1 and coronaviruses.⁴¹ For example, an outbreak of Shiga toxin-producing E. coli O157:H7 in humans was identified at a farming camp in Tennessee in 2022, prompting animal surveillance testing, which confirmed transmission from animals into human cases.⁴²

In addition, antimicrobial resistance (AMR) is an increasing threat to not only animal and human health, but to environmental health as well. Indiscriminate use of antimicrobials in agriculture has harmful consequences, as it can lead to antimicrobial resistance in the harmful pathogens that infect livestock, and these antimicrobial resistant pathogens can then easily spread to other animals and humans through the food chain and other interactions. Once infected by an antimicrobial resistant pathogen, treatment options are extremely limited, particularly if the pathogen is resistant to multiple antimicrobials. Excessive use of antimicrobials in agriculture can also lead to environmental contamination via runoff, meaning that local ecosystems will also suffer.⁴³ While AMR is a complex public health threat, it is compounded by limited surveillance networks and lackluster regulatory measures globally.

Fundamentally, testing every animal anywhere is not practical or necessary to establish data for early warning and control methods. Instead, selectively sampling high-risk animals in environments most likely to precipitate a spillover event enables an informative and cost-effective approach to animal surveillance. Researchers have used geographic range maps from spatial databases with observed host-zoonoses associations and predictive modeling to identify areas where frequent contact between humans and animals or between animals increases spillover risk.⁴⁴ These analyses allow researchers to better understand the patterns and dynamics of viral diversity in wildlife species, mammalian host-virus relationships, and determinants of spillover events: powerful analyses that facilitate better surveillance networks for certain types of diseases and the geographic regions with the largest risks of emergence.

Bats are frequently identified as the mammalian species with the highest proportion of zoonotic viruses, allowing researchers to target sampling in geographic regions where human encroachment and other spillover risk factors are increasing. Animal surveillance involving bats as a known reservoir has employed several approaches including targeting areas with a known history of spillover events, pathogen-specific efforts, and searching for pathogens that have not been previously identified but may pose a risk to human and animal health—which will be discussed in the following section.

Virus Discovery

Virus discovery activities consist of sampling and surveilling for pathogens with the aim of discovering unknown diseases. Colloquially known as “virus hunting,” these activities focus on mapping what previously unknown viruses are circulating in potentially high-spillover sites, with an emphasis on viruses in animal populations that have the capacity to cause a spillover event into humans. By finding viruses in wildlife prior to spillover, the goal is to proactively develop more rapid response and prevention through early warning systems, vaccine development, diagnostic development, and research to understand transmission risk and dynamics. In addition to the human health implications from novel pathogens, virus discovery can provide critical insight into animal health and improve existing knowledge and strategies around the human-animal confluence.

There are several beneficial aspects of this work, which include shifting the global paradigm of public health response to prevention through proactive knowledge collection. Furthermore, virus discovery draws attention to the key role of the human-animal interface in the growing threat of emerging infectious diseases by identifying the diversity of viruses within species, like bats and rodents, which have higher rates of human interactions and potential for spillover. Virus detection and discovery surveillance can also draw attention to the microbiome changes and host response dynamics of animal species being impacted by ecological degradation and human encroachment. As virus discovery and detection efforts are often focused in areas that are high-risk for spillover, where human encroachment is increasingly problematic, bolstering surveillance can strengthen local public health and lab infrastructure. Establishing partnerships and training to strengthen capacity building within areas at higher risk for spillover is beneficial for local, regional, and international outbreak prevention and response. Virus discovery and detection can provide critical data to inform modeling efforts, of which the end goal is reducing field work.

However, the net gain for such work has been questioned as experts note the limitations of prediction and call for more cost-effective and proactive surveillance efforts within human populations. Holmes et. al noted that “broad genomic surveys of animal viruses will almost certainly advance our understanding of virus diversity and evolution. In our view, they will be of little practical value when it comes to understanding and mitigating the emergence of disease.”⁴⁵ While such research can provide insight on viral diversity and evolution, the dynamics of spillover and sustained human transmission mean that knowledge gained from viral discovery will not alone be sufficient to prevent an outbreak or pandemic. Therefore, it is important to ensure that the risks of such research are carefully considered to ensure that risk-to-reward ratios make sense.

Biological Risk Within Spillover Research

While surveillance of pathogens in animals and humans provides valuable information regarding circulating zoonotic diseases, this work is not without risk. Biosecurity and biosafety risks are present throughout the collection, transport, handling, and processing of samples. Training and close adherence to biosafety protocols and regulations are necessary and in most cases, are required by local and permitting authorities, funders, and academic and health institutes. Surveillance and sampling for known pathogens involves risk, but can utilize pathogen-specific protocols, whereas efforts to identify and isolate novel pathogens carry their own unique challenges. Should any of these samples yield certain high-consequence pathogens such as Ebola virus or Marburg virus, this would require enhanced laboratory biocontainment, Biosafety Level 4 (BSL-4), which may not be available within the region and require specialized protocols, protective equipment, and environmental control mechanisms.

Collection Risks

Field collection and trapping of live animals, sample collection, transportation of biological samples, and biosafety failures within a lab space are all possible during animal surveillance efforts. Risk first starts in the collection phase as working with any live animal can place the team at a higher risk for exposure due to scratches, bites, and fluid splashes: exposures that require specific protocols and protective equipment to safely trap and handle the animals. Exposure during the collection of animal samples (e.g., a bite or scratch) would be considered a spillover event, and represents a very real threat during the research process. In addition, collecting samples should leave the animals and environment as undisturbed as possible, which includes not causing harm to the animal or local environment. Collection of human samples, like blood or other potentially infectious body fluids such as stool, urine, and respiratory fluids like sputum, also carries risk if splash or needle-stick injuries occur. In addition, infectious individuals may also expose others to disease through various pathways (coughing, sneezing, providing contaminated blood, or vomiting) that researchers must be careful of. Ultimately, the collection of human and/or animal samples is a risk that researchers undertake, requiring considerable training, competencies, and resources to ensure safety, which is meant to minimize risk but does not eliminate it.

Transportation Risks

Packing and transporting biological samples represent another important set of risk factors for exposure to infectious diseases. Ensuring that samples are stored at correct temperatures in fully sealed and appropriately labeled containers and transported safely are critical components of biosafety. Furthermore, the biosecurity of these samples during transport and handling requires careful consideration and protocols. If surveillance is performed in remote areas where significant travel and transportation is required, this can pose a biosafety and biosecurity vulnerability. First, transporting samples collected long distances from labs increases the risk of failure for biosafety measures, such as temperature-controlled containers or those prone to breaking. Samples requiring transportation over long distances are also at risk for biosecurity vulnerabilities, such as theft, bribery, or mishandling. For samples requiring more specialized and higher lab containment, such as those that require biosafety and biosecurity measures commensurate with a Biosafety Level-3 (BSL-3) or BSL-4 laboratory, the impact of a biosafety or biosecurity failure is likely to be much more significant than that of a pathogen that can be handled in a BSL-1 or BSL-2 setting. Such specialized labs also introduce a higher risk for critical failure given the limited number that exist and a higher likelihood of large geographical distances between sample collection points and specimen drop-off.

Biosafety/Biosecurity Protocols per Region

Biosafety and biosecurity standards exist to prevent negative unintended consequences of biological agents during research, both as a means to protect the individuals performing the work, and to prevent the pathogens from falling into the wrong hands. Storage of high-consequence pathogens in laboratories with poor security introduces risk, as bad actors may attempt to steal and weaponize these agents.⁴⁶ This may be particularly true if sequences and risk assessments of pathogens are published—potentially publicizing where to find dangerous pathogens. Furthermore, some experts have argued that publishing the sequences of pathogens deemed to pose a high risk to humans (as some programs have proposed) may create an information hazard, enabling rogue actors to construct these pathogens de novo with the intention to cause harm.⁴⁷

Ensuring safe and secure handling of samples requires strict adherence to protocols. While this is the ideal, the protocols can be resource and training intensive. Biosafety protocols protecting against laboratory-acquired infections (LAIs) require training and proficiency in specific skills, as well as knowledge of environmental and engineering controls. This includes waste disposal and cleaning/disinfection/autoclaving capacity, personal protective equipment (PPE) and spaces to safely don and doff such equipment, inventory management, decontamination, and the proper construction of operational workspaces that allow for such work.⁴⁸

However, LAIs can and do occur, and represent a public health threat that needs to be considered. The American Biological Safety Association (ABSA) maintains a LAI database that highlights events such as the 1973 Marburg cluster in laboratory staff as a result of exposure to samples of the then unknown virus, and hantavirus in laboratory animal handlers reported in 1988.⁴⁹ The COVID-19 pandemic has further reinforced the hazards of laboratory work involving novel pathogens and the critical role of biosafety, biosecurity, and laboratory oversight. Biosecurity measures include mechanisms to ensure strict control of lab access, background checks, inventory, physical security, transportation security, incident response plans, cybersecurity, and other protocols to make certain only authorized individuals with a need for access are cleared for this critical work.

The biosafety and biosecurity requirements for this work are based upon several key factors—the impact level of the pathogen and corresponding safety/security requirements, and national/regional protocol requirements. For pathogen surveillance done in rural, remote, and isolated areas, ensuring adherence to biosafety/biosecurity protocols can pose challenges.

Access to high-containment laboratory facilities is required for the safe and secure handling of special pathogens, such as Nipah virus, Lassa fever virus, and suspected hemorrhagic fever viruses like Ebola virus. Sample collection in reservoir animals, such as bats, known to carry special pathogens can pose a risk. Ensuring adequate biosafety and biosecurity may not be simple though, as protocols may have slight variations per region and nation. Moreover, in areas with limited access to high-containment labs, proficient personnel and resources may be a scarce or poorly supported resource.

The 2023 Global BioLabs Report found that despite an expanding number of BSL-3 and BSL-4 labs, there are varied biosafety and biosecurity protocols on a global scale.⁵⁰ For example, if surveillance efforts were focused on filoviruses of high-impact, such as Ebola virus, this would require the highest biosafety level (BSL-4). According to the 2023 Global BioLabs mapping resource, there are less than five such labs within the continent of Africa, which is the natural geographical home for the animal reservoirs of Ebola virus. If field work was being performed around Luebo within the Democratic Republic of the Congo (DRC), where there have been human cases of Ebola due to exposure to fruit bats, the closest BSL-4 lab would be the Emerging Viral Diseases Unit (L’Unité des Maladies Virales Emergentes, or UMVE), located in Franceville, Gabon, which is roughly 1,643km or 29 hours away by car.⁵¹ Given the distance, there is an increased potential for biosafety and biosecurity breakdown to occur. Spillover research and prevention efforts are vulnerable to not only biosecurity/biosafety risks, but also ecological risks, which can further burden the affected communities and ecosystems.

The Ecological Dimension of Life Sciences Pandemic Prevention Activities

Many of the ecological security risks associated with sampling and surveillance are closely related to the biological security risks explored above. Sampling of wildlife that are vectors or reservoirs of zoonotic disease—whether this sampling is a component of surveillance, or other research—poses risks to wildlife and ecosystems linked to exposure, transport risk, and containment within labs. Biosafety or biosecurity failures during such activities may result in direct transmission of a pathogen to a new species, the same species in a new location, or may lead indirectly to a phenomenon known as disease spillback: when diseases are transmitted from human populations into animal populations. This creates potential new reservoirs for disease and increased possibilities of mutations that may then spillover again into human populations. We are already seeing examples of spillback with cases like COVID-19, where humans have transmitted SARS-CoV-2 to local and regional deer and mink populations. Linking specific research activities to outbreaks in wild populations is difficult, but there is ample evidence of diseases spilling back or over into wildlife from people.⁵²

Research and surveillance work that involves people from one region traveling to another risks introducing novel pathogens or species (other than those under study) into sensitive ecosystems. Some introductions will be inconsequential because the species in question does not establish, thrive, and spread. However, there are many examples of people introducing pathogens that threaten local populations of wildlife and non-native species of plants or animals that become destructively invasive.⁵³ Incidental spread of diseases by researchers is particularly concerning in the case of primates—where there is substantial evidence of spillover or spillback from humans.⁵⁴ Institutional, federal, and local guidelines, requirements, and laws should all help to prevent these accidents, but they cannot eliminate risk.

Two notable examples of diseases that could theoretically be spread by researchers, and are very likely spread in part by people in general, are Chytridiomycosis (often referred to as “chytrid”) and white-nose syndrome. Chytridiomycosis is an infectious disease caused by a fungus (Batrachonchytrium dendrobatidis) that can be fatal to amphibians, and may be responsible for the major declines and extinctions of 200 species world-wide.⁵⁵ It has spread to every continent other than Antarctica and is capable of spreading further within each continent.⁵⁶ Chytrid is likely spread in part by people’s muddy boots, though also through the pet trade.⁵⁷

White-nose syndrome is a fungal disease that affects bats. In the United States, what started as a few cases in New York in 2006 spread to bat populations across half the United States and five Canadian provinces by 2016.⁵⁸ The rapid spread of this disease and the high mortality rate it causes have been responsible for the dramatic declines of several species in North America.⁵⁹ This is a critical ecological problem as bats play numerous important roles in the ecosystems they inhabit: as pest control agents, as pollinators, and as seed dispersers.⁶⁰ Given the spread of white-nose syndrome and its impact on the critical services bats offer, it is key to address issues such as the ability of humans to transmit the disease’s fungal spores via exposed clothing and equipment.⁶¹

There may also be physical risks from research activity in isolated areas. For example, researchers might trample sensitive plant species, disturb reproductive cycles in animals such as birds, or cause more extensive damage by accidentally starting a wildfire. However, researchers are trained and regulated (e.g., Institutional Care and Animal Use Committees) under sets of rules and ethical codes that are meant to limit negative, and promote positive, impacts on the ecosystems and communities in which they work.⁶² Further, researchers should apply for permits when working on government or private lands. Well-designed permitting systems will evaluate the potential harm that could be done by research activities and constrain them accordingly.⁶³

With the risks noted above, researchers, permitting authorities, policymakers, funders, and institutional committees need to weigh the potential costs and benefits of the research activity when considering whether to support or modify it, such as by requiring certain precautions or eliminating specific activities due to the risks. Impact assessments and monitoring aimed at understanding the implications of research activities where they are taking place will help to inform policymakers about the efficacy of current rules, regulations, and precautions.

Ecological Considerations in Spillover Prevention Activities

While there is considerable attention paid to the role of biological sampling and surveillance in pandemic prevention activities, ecological considerations also play a key, if understated, role in preventing pandemics.⁶⁴ After all, climate change, habitat fragmentation, and biodiversity loss all increase the likelihood of zoonotic spillover.⁶⁵ Therefore, this interdependence also implies that finding ways to mitigate these factors could decrease the likelihood of zoonotic spillover.

Elevating the “rights of nature” could do much to halt the many sources of ecological disruption which, as a side effect, increase spillover risk. In broad terms, the rights of nature concept extends the fundamental legal rights that humans benefit from to non-human entities. As animals and corporations have received legal rights, so too have ecosystems such as forests and rivers. A river might be judged to have the right to be clean, biodiverse, subject to its natural seasonal cycles, and natural physical evolution. In 2008, Ecuador became the first country to grant nature rights in its constitution and it has successfully applied the law in several circumstances. A recent example, in 2021, centered on a state-owned mining company’s attempt to develop a reserve rich in biodiversity and critical to the regulation of ecosystem services. Enami EP was granted concessions to a significant area of Los Cedros, which included exploratory mining as well as access to the biological reserve’s freshwater resources. This decision was contested and during appeal, the Ecuadorian constitutional court ruled that the project would ultimately violate the rights of nature.⁶⁶ Domestically, the New York Assembly Bill A3604B, known as the “Great Lakes’ bill of rights,” “declares the right of the Great Lakes to exist, flourish and naturally evolve.”⁶⁷ While the bill is currently in assembly committee, if passed it would grant rights to the Great Lakes ecosystem.

Rights often entail the assignment of legal guardians who can represent the ecosystem. While implementation of the rights of nature has met with mixed success in the so-far relatively early years of this work, its application in concert with efforts to elevate the legal rights of Indigenous communities and the fundamental human right to healthy ecosystems may help to level the playing field against actions likely to have negative ecological consequences.⁶⁸ Since the rights of nature can rely on moral and legal justifications, it may also complement conservation strategies based on economic or utilitarian valuation of ecosystems.⁶⁹

Improving health security through ecological security approaches is also encapsulated in the One Health approach: a collaborative, multisectoral, and transdisciplinary approach which seeks to create the best health outcomes by recognizing the interconnected nature of animals, plants, people, and their shared environment.⁷⁰ While the vision for this approach is laudable, there is significant work that experts and stakeholders must do to expand One Health activities from predominantly human-centric models (focusing mostly or exclusively on human health) to holistic activities that address the health of people, animals, and the environment.⁷¹ Therefore, it is important to not only acknowledge the ecological component of zoonotic disease, but also for stakeholders to conduct activities that address the ecological component of zoonotic diseases.

This shift from a human-centric approach to a holistic approach that properly integrates ecological security has significant benefits. First, studying conservation and ecosystem restoration as tools for pandemic prevention can help provide a deeper understanding of how pandemics both emerge and may be stemmed. In the event that a disease does emerge, incorporating these tools with existing life sciences interventions may significantly reduce the impact of such events through a layered approach.

Tropical Deforestation

Tropical forests, such as rainforests, contain high levels of biodiversity. Rainforests house half of all the living animal and plant species on the planet, and contain a wide variety of insects and tree species, and over two-thirds of all flowering plants.⁷² Therefore, disrupting and degrading tropical forests is one of the greatest contributors to the risk of spillover of zoonotic pathogens to humans.⁷³ Currently, the world’s rainforests are disappearing at a rate of 6,000 acres per hour.⁷⁴

Fragmenting forests through a variety of activities causes significant effects that increase spillover risks. First, such activities destroy native plant populations and force animals and insects to find new areas to inhabit, which erodes existing barriers that limit interactions among wildlife, humans, and domesticated animals. Second, it reduces ecosystem functionality and biodiversity, which simultaneously alters disease host behavior and pathogenicity. Combined, converting such habitats for greater human use increases the chance of spillover events.⁷⁵ Therefore, minimizing tropical deforestation and further habitat degradation is a key risk reduction measure to prevent spillover events.

In addition, deforestation and other forms of ecosystem degradation have species-specific effects. This includes which pathogens a host may carry and how the host’s behavior changes in relation to their environment and human encroachment.⁷⁶ For example, bats shifted their habitat and foraging behaviors closer to human settlements as human development changed the landscape in northern Laos. This led to increased direct contact between bats, humans, and livestock, particularly in barns and around houses.⁷⁷ Such scenarios underscore the ways land-use changes can alter the way species assemble, leading to “artificially high wildlife densities” in disturbed habitats, and ultimately creating more risky contact between humans, livestock, and wildlife.⁷⁸

Fortunately, promoting healthy ecosystems reduces the contact rate among humans, animals, and wildlife. Spillover of Hendra virus from flying foxes (Pteropus rodricensis, also known as fruit bats) in Australia is correlated to land-use change and food stress, which has led to bats’ persistent residence in agricultural areas; however, large winter flowerings in nearby remnant forests appear to mitigate the risk of spillover.⁷⁹ Intact ecosystems are also able to maintain functionality and biodiversity, which are key elements that act as significant buffers to zoonotic pathogens and reduce the likelihood of spillover events. Therefore, minimizing tropical deforestation rates provides a favorable return on investment for pandemic prevention when compared to the expenditures associated with preparedness and response.⁸⁰ Further, restoring natural habitats that reduce forest fragmentation can lead to a reduction in host abundance and risk of acquiring hantavirus from rodents and lyme disease from ticks.⁸¹

Illicit Wildlife Trade

Illicit wildlife trade can cause long term ecological damage when keystone species—species that play a critical and disproportionately large role in shaping and maintaining habitats—are affected. Elephants represent a prime example as they are critical elements of particular ecosystems where they function as seed dispersers and use their tusks to dig and create waterholes in the dry season that other animals rely upon.⁸² The loss of elephants due to illicit wildlife trade, unsurprisingly, has disproportionately large impacts on the ecosystems they inhabit. One United Nations (UN) study noted that the loss of particular species of African forest elephants would end up decreasing the “aboveground biomass in Central African rainforests by 7%.”⁸³ This loss would affect areas such as the Congo Basin and contribute to a significant increase in carbon dioxide in the atmosphere, which would supercharge climate change effects by causing global temperatures to rise even more quickly.

Illicit wildlife trade also brings humans into direct contact with wildlife in an unprotected manner, creating an interface for zoonotic spillover. Hunting, trapping, and butchering of wildlife pose significant direct and indirect risks of zoonotic spillover as individuals engaged in these activities risk injury and direct exposure to bodily fluids. In addition, transport and trade of both live and dead wildlife presents its own risks by increasing exposures between humans and animals across increasing geographic locations. Such exposures are particularly concerning since researchers have found pathogens of zoonotic concern in illegally imported wildlife in the United States.⁸⁴ Trading in live animal markets can also create novel assemblages of stressed—potentially immunocompromised—species, allowing pathogens to interact with multiple species, infect new hosts, and evolve.⁸⁵ Finally, even trading in dead wildlife poses risks: hosts may carry the causative agents of anthrax and African swine fever, which are resistant to environmental degradation and decontamination. Without proper preparation, this can result in disease outbreaks such as dermal exposure or foodborne illnesses through raw or undercooked meat.⁸⁶

Animal Husbandry

The livestock sector is a key pillar of global development that contributes to a wide-ranging set of areas, including food security, poverty reduction, and agricultural development. However, the fast-growing sector also corresponds to environmental and public health impacts such as the endangerment of species and human disease outbreaks.⁸⁷ This agricultural expansion has often come at the expense of natural ecosystems, with feed crops—particularly soybeans—linked to deforestation. In fact, agriculture accounts for almost 90% of global deforestation, of which 40% is driven directly by livestock grazing.⁸⁸ The livestock revolution also catalyzes fragmented forests which, in turn, decreases the distance and increases the rate of contact among domesticated animals, humans, and wildlife. Beyond deforestation increasing contact rates with wild animals, current animal husbandry practices, such as keeping animals in close proximity to each other, exacerbate ecological and biological security risks such that international supply chains could act as conduits for spreading infection.⁸⁹

Further, domesticated animals often function as transmission intermediaries between humans and wildlife, incubating and amplifying zoonotic pathogens.⁹⁰ In addition, intensive animal husbandry practices (e.g., high density industrial livestock production) exacerbate the risks and impact of zoonoses compared to small-scale or extensive management practices (e.g., free range grazing).⁹¹ This includes creating waste lagoons, wastewater sources with excess nutrients that cause algal blooms, and other major environmental concerns from industrialized livestock-rearing which can all negatively impact human health.⁹² In addition, existing animal husbandry practices deal with a high density of potentially immunocompromised animals with low genetic diversity: the perfect breeding ground for pathogens to circulate and mutate.⁹³

To combat health risks and their associated economic fallout, it is estimated that livestock use accounts for 70% of global antibiotic use, though this can exacerbate animal and human health risks, as noted previously.⁹⁴ Moreover, industrial animal production—at least in higher-income countries—has turned to non-therapeutic doses of antimicrobials for animal growth promotion. However, this also catalyzes ecological and biological security concerns by creating a “constant pressure on bacterial pathogens to select for resistance,” which is the perfect environment for pathogens to develop antimicrobial resistance.⁹⁵

Industrialization has also led to the geographic concentration of production and subsidiary production stages both on a regional and global scale in a quest for competitive advantage.⁹⁶ This concentration has led to higher regional and global trade throughout the supply chain, including of live animals.⁹⁷ As mentioned previously, the transportation of live animals presents various risks as stressed animals have lower immunity and higher levels of viral shedding.⁹⁸

Although there are strict biosecurity measures in place in high-income countries, relying solely on biosecurity regulations has limitations. Despite the use of antibiotics, diseases such as foot-and-mouth disease in cows and avian influenza in commercial poultry flocks continue to emerge.⁹⁹ In addition, while there are numerous ecological and biological concerns associated with intensive industrialized animal husbandry, small-scale and extensive agriculture production systems are not without their own hazards and risks.¹⁰⁰ For example, small backyard poultry flocks present challenges for biosecurity in both low and high resource settings—13% of households in the United States reported owning chickens in 2020.¹⁰¹

Unfortunately, governments often lack data on extensive producers which could undermine zoonotic contingency plans.¹⁰² Low- and middle-income countries (LMICs) face different biosecurity challenges than those of high-income countries; however, as exemplified by the Global Action Plan on Antimicrobial Resistance 2015 guidance on reducing antibiotic use, the contexts of LMICs are not always considered or addressed by the international community.¹⁰³

Zoonotic pathogens can also spillback from humans to domestic animals to wildlife. Spillback heightens biosecurity risks by providing pathogens, which have undergone some evolution in humans, with the chance to evolve outside the pressure of human immune systems. In such cases, pathogens can accumulate mutations that increase their transmissibility or virulence when they spill over into humans again.¹⁰⁴ For example, during the COVID-19 pandemic, SARS-CoV-2 appeared to spill in and out of mink farms in the Netherlands, accumulating mutations that some believe increased transmissibility in humans.¹⁰⁵ This is problematic as minks are often successful at escaping from captivity, creating opportunities for spillback (transmission of a pathogen from humans into animals) to spread beyond these domestic populations and into wild populations and other species. Aside from the biosecurity risks posed by these dynamics, spillback into wild animals may undermine their populations and the ecosystems of which they are a part.¹⁰⁶ Spillback dynamics in farmed mink are additionally concerning because mink are susceptible to—and may transmit—human and avian influenza strains.¹⁰⁷

Sociological Considerations for Ecological and Biological Security Interventions

Ecological and biological interventions offer an important suite of tools that can reduce the likelihood of spillover events. These include conventional strategies such as fences and culling herds that have disease outbreaks, and using personal protective equipment and antibiotics to mitigate disease spread in close-quarter situations such as farms. Ecological interventions include habitat modification and introducing natural enemies into an ecosystem.¹⁰⁸

While these interventions may reduce the probability of spillover, they must also balance the costs or tradeoffs for the communities in which they are implemented. These tradeoffs must be balanced by aid agencies, philanthropies, non-governmental organizations (NGOs), and regional or national governments in order to prevent the following:¹⁰⁹

• Misalignment of intervention scale and scope with local capacities
• Incompatibility with local customs and traditions
• Impact on local food and economic security
• Perpetuation or creation of colonialist relationships
• Enabling of oppression of minorities, women, or Indigenous groups

Ecological interventions supported by groups external to the location of the work should be designed with these issues in mind. The above pitfalls might be avoided by engaging with and empowering local communities rather than attempting to dictate interventions.¹¹⁰ Engagement might include meetings with community leaders, studies of public opinion, or participatory workshops exploring the relationship between people and their environment and the interventions they might embrace.¹¹¹ Empowerment might include providing educational materials, training opportunities, and funding to support a set of locally compatible interventions.¹¹² It might also include investments in the sustainable development of the community’s food security and economy.

In some contexts, education can be a powerful tool for reducing human-wildlife interactions. Sometimes, a traditional activity regularly results in spillover potential without being overtly risky. For example, communities in Bangladesh have suffered Nipah virus spillover through a traditional practice of harvesting date palm sap, rather than the well-known pathway of bats infecting pigs and pigs infecting people. In these communities, infection with this virus—which can have a mortality rate of up to 70%—occurred when people consumed sap from trees that were also a food source for bats.¹¹³ When people wounded the tree to harvest the sap, bats also fed on these flows and urinated on them: a condition ripe for people to get infected by the contaminated sap.¹¹⁴ This route of exposure was unknown until researchers conducted a surveillance study and identified the connection. Part of this work was led by anthropologists from an international health research group known as the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). They interviewed locals individually and conducted case mapping exercises with larger groups, finally confirming the hypothesized mechanism of transmission by capturing videos of bats contaminating sap as it was collected.¹¹⁵

After identifying this connection, the next step in prevention might be to share this information on spillover risk widely with the public. Such knowledge might alter consumer preferences and thus, exposure.¹¹⁶ In the case of Nipah in Bangladesh, the solution was to stop drinking raw sap. Unfortunately, education campaigns by the Bangladeshi government were unable to convince enough people to cease this traditional practice.¹¹⁷

An alternative to completely abandoning risky activities may be the introduction of practices or equipment that limit exposure to zoonotic disease.¹¹⁸ Here, a combination of education and funding or provisioning of materials like PPE might help reduce risk. In Bangladesh, after public campaigns failed to stop raw sap drinking, similar campaigns promoted the use of protective skirts to exclude bats from sap flows.¹¹⁹ While this strategy did not translate to complete public acceptance, the combination of campaigns likely reduced spillover risk where their recommendations were implemented.¹²⁰

As this example shows, raising public awareness of the spillover risk associated with a particular activity will not always be dissuasive. Where livelihoods and nourishment rely on these risky practices, the risk alone may not outweigh the food and economic security that results. For example, some research suggests that ceasing bushmeat harvest could meaningfully undermine food security in some countries while leading to further loss of natural ecosystems and biodiversity to expanded agriculture.¹²¹ In this context, interventions would need to supplement the losses that would be incurred from a change in behavior by supporting alternative food systems, income sources, or other strategies to improve food and economic security.¹²² While many such interventions have been attempted, few have collected sufficient data to demonstrate that they achieved their intended goals (e.g., reduced wildlife harvest, deforestation, or spillover).¹²³

Another approach is to target the international demand that drives many of these activities. Demand for rare and desirable animals or products that contribute to deforestation might be diminished through campaigns aimed at shifting consumer preferences. Regulation and enforcement could target the flow of these goods. Further, investors can sometimes be convinced to divest from companies that contribute to deforestation.¹²⁴

Changing practices in communities where local consumption and livelihoods are tied to wildlife harvest and deforestation is probably best achieved through a bottom-up, participatory approach. This would hinge on community engagement and might help to design the intervention based on their knowledge, needs, and preferences. There are also many approaches available for executing community-based conservation.¹²⁵ Where such approaches fail to change patterns of exploitation and habitat loss, higher-level regulation and enforcement, or monetary incentive schemes like payments for ecosystem services, might be implemented.¹²⁶ Better data collection and sharing will help in understanding when and where each approach is most likely to succeed.

Addressing spillover risks – either in prevention or reduction of impact – requires a myriad of efforts. As this section noted, current prevention research and strategies aimed at combating ecological disruption are exceedingly complex and require considerable resources and partnerships. In response to these challenges and to address the ecological and biological dynamics of spillover prevention, the United States has focused attention through various agencies, initiatives, and programs.

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Before the COVID-19 pandemic, U.S. pandemic preparedness efforts varied in emphasis and resourcing over time. These activities are now being elevated through more ambitious national policies such as the 2022 National Biodefense Strategy and the creation of an Office of Pandemic Preparedness and Response Policy (OPPR) in the Executive Office of the President. U.S. leaders are now clear that pandemic prevention work is critical to U.S. and global security.¹²⁷

There is a wide array of U.S. programs aimed at addressing infectious disease threats, ranging from tracking and understanding the context of high-spillover sites to addressing invasive species. This section will provide an overview of several key initiatives that specifically take ecological concerns into account alongside biosecurity. The COVID-19 pandemic has spotlighted the need to more directly integrate environmental and ecological concerns into pandemic prevention work, which includes giving more consideration to agencies that typically are not considered central to human health. The following discussion is not comprehensive, but rather meant to show how relevant U.S. agencies are increasingly taking a One Health approach to spillover prevention. This section will primarily focus on U.S. efforts due to a) the significant influence that U.S. funding, leadership, and policy have in the domestic and international spheres, and b) the constrained scope of this report. This U.S. focus is not meant to diminish the importance of essential spillover prevention work occurring around the world without U.S. involvement.

U.S. Fish and Wildlife Service

The roles of the U.S. Fish and Wildlife Service (FWS) in combating biological threats through ecological interventions and research received more recognition as a result of the COVID-19 pandemic, as is evidenced by a few new funding streams provided by the 2021 American Rescue Plan Act (Rescue Plan).

For instance, the Rescue Plan provided $45 million to FWS to strengthen early detection, management, and response to contain disease outbreaks in wildlife populations.¹²⁸ Among other things, this funding has been used to establish the Zoonotic Disease Initiative, which funds projects run by states, territories, and tribes to improve detection and early warning for zoonotic pathogens with spillover potential. Many of the projects funded so far take an explicitly One Health approach.¹²⁹

The Rescue Plan also provided $20 million to improve wildlife inspections at ports. While there is little information publicly available at this stage, enhancing inspections is essential to ensuring that animals carrying pathogens do not enter the United States. Additionally, the legislation provided $10 million to support implementation of a provision of the Lacey Act (18 U.S.C. 42) that regulates which species are allowed to be imported into the United States.¹³⁰ As a part of this effort, FWS is working in partnership with the Smithsonian Institution to create a list of species deemed to be potentially injurious to human health due to the pathogens they may carry.¹³¹ To inform this work, the Smithsonian team is using data from the Law Enforcement Management Information System, which is a FWS-run database containing basic information on wildlife imports and exports.¹³² This resource provides important information and awareness on what species are entering the United States through the wildlife trade.

U.S. Geological Survey

The U.S. Geological Survey (USGS) conducts mapping of wildlife populations and animal disease surveillance that provides useful early warning and situational awareness for spillover risks. The agency received some new funding streams through the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act to enhance its ability to fulfill this mission.

USGS research on COVID-19 pathways and wildlife dynamics received $5.2 million in CARES Act funding.¹³³ Some of this funding has supported the establishment of the Disease Decision Analysis and Research team at the Eastern Ecological Science Center, which seeks to integrate disease ecology and decision analysis to provide support to federal, tribal, and state management agencies on zoonotic disease issues and outbreaks.¹³⁴ The CARES Act also provided several million in funding to enhance surveillance capabilities, much of which is being spent on better understanding bat populations, roosting behavior, and interactions with humans, as well as sampling bats to characterize their viromes, with a particular focus on coronaviruses.¹³⁵ For instance, this funding is supporting the North American Bat Program, which consists of a network of public and private partnering organizations collecting data on bat occurrence and behavior across the United States. NABat Monitoring Hubs help coordinate regional data collection efforts, which inform wildlife management. Work at USGS’s Western Ecological Research Center is investigating the utility of using environmental guano sampling as a safer and easier method of understanding bat viromes than live animal sampling. Furthermore, the National Wildlife Health Center, which investigates wildlife mortality events, is working to create a standardized next-generation sequencing protocol to sequence unknown pathogens in animal deaths without a clear cause.

The USGS also administers several important data and mapping resources. The American Rescue Plan provided some funding to support improvements to USGS’s Wildlife Health and Information Sharing Partnership-event reporting system (WHISPERs), which is a reporting system for wildlife health and mortality events and is mainly used by natural resource managers.¹³⁶ Goals include increasing the amount of data that is reported and increasing the utility of the system for understanding trends. USGS is also piloting the U.S. Node of the Global Biodiversity Information Facility (GBIF-US).¹³⁷ This database will provide important information on biodiversity, species occurrence, and drivers of change in biodiversity, which can be useful in understanding ecological systems in the United States and potential pathways of disease spread, as well as a warning system for sharp changes in populations that may indicate a disease event. This aims to replace the Biodiversity Serving Our Nation database, which was retired in 2021.¹³⁸

U.S. Department of Agriculture

The U.S. Department of Agriculture (USDA) plays an important role in livestock health and spillover prevention. The Animal and Plant Health Inspection Service (APHIS) conducts surveillance on wild birds and swine, and monitors agricultural imports for pathogens. In 2022, APHIS laid out a strategic framework to develop an early warning system for novel SARS-CoV-2 variants and other emerging biological threats in animals, making use of some of the $300 million in Rescue Plan funding that USDA received for animal health surveillance.¹³⁹ The USDA Agricultural Research Service also provides important contributions through its work on crop and livestock protection research and in co-leading the National Bio and Agro Defense Facility, which is being built in Kansas to replace the existing Plum Island Animal Disease Center.¹⁴⁰ This state-of-the-art BSL-4 facility will be used to study high-risk animal diseases that could have severe economic impacts or potential to spillover into humans.¹⁴¹

U.S. Agency for International Development

The U.S. Agency for International Development (USAID) Global Health Bureau provides support for international partners in preventing and addressing emerging and endemic diseases. This includes Strategies to Prevent (STOP) Spillover, a five-year, $100 million project that was launched in late 2020, and is led by Tufts University.¹⁴² STOP Spillover takes a One Health approach to monitoring priority pathogens and implementing risk reduction measures in select Asian and African countries. Its work so far has included risk assessments and preliminary interventions led by technical working groups to limit risks to communities in spillover hotspots. Some of these interventions include protecting drinking water from bat excrement, improving biosafety on farms, and characterizing bat populations and bat-human interactions.¹⁴³

USAID also hosts a Conserving Biodiversity program which conducts important work at the ecological and biological security nexus.¹⁴⁴ One particularly relevant project under this program is the Wildlife Trafficking, Response, Assessment and Priority Setting Project (TRAPS). This program has worked to combat wildlife trafficking since 2013, but in 2020 its focus shifted more specifically toward understanding and reducing the risk of zoonotic disease in wildlife trade.¹⁴⁵ This shift is indicative of an increased understanding of the disease risks posed by human-wildlife interactions that are common along trade chains.

A recently canceled USAID program worth noting is DEEP VZN (Discovery & Exploration of Emerging Pathogens—Viral Zoonoses), which was announced in 2021 with an estimated budget of $125 million. The project planned to focus on understanding and addressing the risks posed by zoonotic pathogens, with an emphasis on unknown threats. Its initial aims included collecting about 800,000 samples from wildlife, with an anticipated yield of 8,000 to 12,000 novel viruses.¹⁴⁶ These viruses would then be screened and sequenced to determine which pose the most risk to human and animal health. However, work on DEEP VZN never began, as personnel in the Executive Branch and Congress expressed concerns regarding a potential lack of safety and security practices, inherent potential for accidents in sample handling, and the associated information hazards that may arise from publishing pathogen sequences.¹⁴⁷ In September 2023, USAID confirmed it had decided to close down DEEP VZN, citing that “focus on the search for and characterization of unknown viruses prior to spillover into humans are not…[a] global health security priority at this time.”¹⁴⁸

U.S. Department of State

The U.S. Department of State’s (State) Biosecurity Engagement Program works with international partners to strengthen animal and human disease detection systems and to support safety and security in high-containment labs.¹⁴⁹ Through this program, State provides equipment and training to build capacity for disease surveillance of a number of pathogens, including emerging zoonotic diseases. Additionally, it supports laboratories that handle dangerous pathogens (including animal pathogens) to ensure that they have sufficient precautions, infrastructure, and training to conduct safe research and storage. However, State does not encourage or provide funding for the construction of new high-containment laboratories.

State is also the largest funder of Wildlife Enforcement Networks (WENs), and is the sole funder of the Central American and Dominican Republic Wildlife Enforcement Network.¹⁵⁰ WENs are a critical tool in wildlife trade law enforcement, and as such a crucial preventative tool in limiting dangerous, unregulated contact between high-risk wildlife and humans. In 2022, a representative from State provided opening remarks at the Fourth Global Meeting of Wildlife Enforcement Networks, and her remarks specifically mentioned disease as a key reason to focus on reducing wildlife trafficking.¹⁵¹

U.S. Environmental Protection Agency

While the Environmental Protection Agency (EPA) does not conduct much work with the explicit or primary goal of preventing spillover, it plays a crucial role in protecting fragile environments, which has important One Health implications.¹⁵² Additionally, the EPA’s role in reviewing other agencies’ environmental impact statements under the National Environmental Policy Act may be a tool to ensure that pandemic prevention programs that involve sampling or intrusion into sensitive environments do not create undue risk to ecosystems.¹⁵³

The EPA and the WHO signed a memorandum of understanding in 2022 that commits to the continuation of previous interactions between the two entities, with a few updates. The memorandum cites climate change as a major risk factor to human health and an important area for collaboration, though it does not explicitly mention zoonotic spillover.¹⁵⁴

National Institutes of Health

The National Institutes of Health (NIH)—and more specifically, the National Institute of Allergy and Infectious Diseases (NIAID)—performs a variety of research relevant to protecting humans from infectious disease threats. NIAID’s Centers for Research in Emerging Infectious Diseases (CREID) conduct research relevant to disease spillover in regions with high potential for infectious disease emergence or reemergence.¹⁵⁵ The CREID network of laboratories work to better understand the full process of zoonotic diseases turning into epidemics, including focusing on wildlife-human dynamics that enable the spillover of diseases, particularly at the borders of wild and populated areas. They are designed to be flexible and able to quickly adapt to focus on newly-emerged diseases.¹⁵⁶

National Science Foundation

The National Science Foundation (NSF) primarily conducts research that is not explicitly connected to human health. However, its Division of Environmental Biology funds important research on the human impact on ecosystem dynamics and the socio-ecological interface at which humans interact with and influence their environments.¹⁵⁷ Particularly important is NSF’s Ecology and Evolution of Infectious Diseases (EEID) program, which it jointly runs with NIH.¹⁵⁸ This program focuses on using quantitative methods to understand the ecological and environmental drivers of disease emergence and re-emergence and pathogen transmission dynamics. The call for applications notes that broad, highly interdisciplinary projects are encouraged, as are projects on disease systems of public health concern to low and middle income countries. This collaboration is an important case study in cross-agency work integrating human and environmental health concerns.

U.S. Department of Defense

The Department of Defense (DoD) operates the Biological Threat Reduction Program (BTRP), which partners with international labs and researchers to support work related to lab biosafety, zoonotic disease surveillance, consolidation of pathogens, as well as a range of other areas.¹⁵⁹ For example, BTRP has programs to surveil and assess the risk of emerging pathogens in migratory birds in partner countries.¹⁶⁰ DoD’s international network of labs also conduct disease surveillance work. Particularly notable are the Naval Medical Research Units, which support regional efforts in monitoring emerging infectious diseases.¹⁶¹ Lastly, DoD has several commitments to conservation and biodiversity on DoD-managed lands in the continental states and abroad. For instance, the Legacy Resource Management Program provides guidance to coordinate the conservation of biological (among other) resources on DoD land and property.¹⁶²

U.S. Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) One Health Office coordinates CDC’s interdisciplinary work focused on protecting humans from disease threats posed by animals.¹⁶³

For instance, it implements One Health Zoonotic Disease Prioritization (OHZDP) workshops, which bring together representatives from human, animal, and environmental health sectors to prioritize zoonotic diseases for One Health collaboration in a country, region, or other area of interest. The One Health Office also coordinates important educational work to ensure that people interact with wildlife, livestock, and pets safely.

International Agreements, Conventions, and Treaties

There are a vast number of international treaties, agreements, and conventions that the United States supports in this space. Particularly notable is the One Health Quadripartite, which is made up of the World Health Organization, the United Nations Environmental Programme, the World Organisation for Animal Health, and the Food and Agriculture Organisation of the United Nations.¹⁶⁴ In late 2022 the One Health Quadripartite released a One Health Joint Plan of Action, which integrates systems and capacity to collectively better prevent, predict, detect, and respond to health threats.¹⁶⁵

The United States is the only country in the world (other than the Vatican) that is not party to the UN Convention on Biological Diversity.¹⁶⁶ Representatives from the United States attend meetings of the Convention, but without having ratified the agreement, the United States is relegated to “observer” status. While the United States is working to support Convention goals—such as protecting 30% of land and oceans by 2030 through the America the Beautiful Initiative—conservation experts say that formally joining the Convention would be an important step in making the United States a trusted leader in this space.¹⁶⁷

An Example of a European Spillover Prevention Program: PREZODE

Launched in 2021, PREZODE (Preventing Zoonotic Disease Emergence) is a global One Health initiative led by the French government and supported by the One Health Quadripartite. Valued at over €100 million, the program includes around 20 government and 180 non-government partners worldwide.¹⁶⁸ It seeks to transform pathogen emergence and spillover research and prevention. Some of its defining features include a focus on understanding how environmental degradation contributes to disease emergence and spillover, and identifying and supporting interventions that will often focus on ecosystem conservation and restoration. The program seeks to avoid many of the pitfalls of international spillover work by making bottom-up participatory involvement of local communities a core component of the research and interventions it supports. The hope is that such interventions will be more effective and less disruptive to local communities’ food security and development. At a high level, PREZODE will also seek to create sustained dialogue among policymakers, scientists, and practitioners across all levels of political organization—globally—recognizing that information sharing will enable effective measures to be implemented quickly to reduce global spillover risk. Finally, it aims to help build a global spillover and pandemic early warning system.¹⁶⁹

The PREZODE initiative is young and has been largely preoccupied with working across a global stakeholder community to develop its strategic plan. It has however taken action by putting out a call for proposals and supporting a field research and intervention project. The call for proposals, PEPR PREZODE, is a €9 million effort focused on early detection and risk reduction, and understanding the links between human activities, global environmental change, and the mechanisms of pathogen emergence.¹⁷⁰ The program will support activities that identify and analyze the interactions of hosts, reservoirs, and vectors that lead to emergence of zoonotic pathogens.¹⁷¹

The field program, AfriCam, receives €10 million from AFD (French Development Agency) to fund research and interventions coordinated by two French institutions (CIRAD–French Agricultural Research Centre for International Development and IRD–Research Institute for Development) and includes 34 local implementing partners. AfriCam aims to strengthen surveillance and early detection systems in Cameroon, Guinea, Madagascar, Senegal, and Cambodia. The project will work with local communities to assess the risks inherent in their wildlife interactions and animal husbandry and then work with them to develop tailored prevention strategies and surveillance. Research will include pathogen and environmental sampling in the field, case investigations in hospitals, socio-ecological study of the community, and modeling how local manifestations of global environmental change impact emergence and spillover risk. Prevention and surveillance interventions are meant to be sustainable and match the community’s capacity.¹⁷²

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Part 1 of this report provided examples of the range of biosecurity and ecological security issues the global community must navigate. Part 2 spotlighted U.S. government programs and activities that aim to understand and prevent disease spillover.

Given this landscape, the CSR team conducted a guided thought exercise with subject matter experts on specific practices that policymakers should consider for better integrating biological and ecological security practices to mitigate spillover events in the future. Such insights would allow the field to make critical gains in this space, including by realizing the true potential of the One Health vision by shifting from a human-centric to a truly holistic model; creating a diverse, inclusive community of practice consisting of experts across ecological, biological, social science, epidemiological, and security perspectives; building a common frame of understanding across the historically disparate communities on key concepts and terms such as risk, biosecurity, and One Health; and properly prioritizing and providing consistent funds to current and future activities in this space.

The experts we convened provided extremely thoughtful input based on their deep, diverse experiences. With their input, the CSR team highlighted actionable recommendations to integrate when designing research and/or intervention initiatives throughout the seven key activities that occur across the lifecycle of spillover prevention activities, as well as examples to highlight how these recommendations may be applied in this context. This lifecycle can be described as follows:

• Conceptualization: Project leads convene and generate an initial plan.
• Review: Institutional bodies review proposed activities to ensure they balance innovation, safety, and security.
• Planning and Execution: In the event of a successful review by an institutional body, project leads refine approaches, address challenges, and ultimately conduct the activity with frequent reviews to best balance innovation, safety, and security concerns.
• After-Action Assessment: Project leads and participants conduct an after-action assessment that can both highlight areas in which the activity went well, and discuss challenges that emerged and should be considered in future activities.
• Communication: Project leads, participants, and other relevant experts develop a strategy to effectively communicate key elements of an executed activity to key stakeholders, including policymakers and the general public.
• Implementation of Future Activities Based on Outcomes: Using the body of knowledge generated from both the activities as well as their after-action assessments, practitioners work to generate a more flexible, iterative approach to balancing the opportunities and challenges of research and activities at high-spillover sites.
• Evaluation of Priorities: Spillover prevention work and understanding the dynamics that contribute to disease spillover from animals to humans are some of the many priorities that countries address in the 21st century. Evaluating where such critical work should be conducted, as well as where interventions would be most effective, are some of the considerations that policymakers and other stakeholders should take when evaluating how to prioritize these types of activities.

This part of the report discusses concrete recommendations that workshop subject matter experts proposed. It then includes examples to show how these activities might be implemented in various hypothetical situations (provided as textbox examples in each section).

Conceptualization

The subject matter experts convened by CSR for this report made three main recommendations during the workshops on best practices for the conceptualization phase of a potential spillover prevention activity.

First, activities intended to mitigate and prevent spillover risks are multidisciplinary in nature; therefore, conceptualizing and reviewing these activities needs to be multidisciplinary from the beginning. This means diverse experts across multiple fields (including biologists, ecologists, social scientists, data scientists, interpreters and cultural interlocutors) must be consulted and engaged from the start, rather than involved after the project is already underway.

Second, within interdisciplinary projects, terminologies such as “surveillance,” “biosecurity,” and “countermeasure” should be defined from the onset to minimize confusion and enhance cohesion. Subject matter experts noted that these and other terms have different meanings across communities, so it is important to make sure everyone is on the same page.

Third, it is important to consider activities that enhance understanding of the drivers and potential intervention points of disease spillover, and then follow these efforts with pilot projects focused on gathering data for cost-benefit analyses. Many take an all-or-nothing approach when it comes to funding activities and projects: the project must create observable, impactful change, or it should not be funded at all. This is a perennial problem that has plagued pandemic prevention research in high-spillover sites: technical interventions are favored over foundational work to create a deeper environmental and sociological understanding of why spillovers happen.¹⁷³

Vignette 1.

In response to a large outbreak of tick-borne Rocky Mountain Spotted Fever within Tribal lands in northern Arizona, public health and local environmental services requested plans to identify key climate, ecosystem, biological, and human drivers that led to spillover impacting the community. In conceptualizing the project, a diverse team of experts was brought together to establish a prevention plan and identify factors resulting in spillover.

This collaborative approach included experts from disciplines including epidemiology, entomology, ecology, sociology, as well as veterinarians, interpreters, Indian Health Services, Indigenous community members and healers, and medical experts. As part of the conceptualization, project leaders conducted community engagement to identify attitudes, beliefs, and stressors that might guide future efforts to intervene in the transmission chain. During this design phase of activities, funding opportunities were recommended to serve a holistic approach through efforts across ecological and biological initiatives such as epidemiological modeling, field collection of ticks and animal testing, and ecological assessment of the impacted area.

Review

Workshop experts noted two key ways reviews can be implemented to better and more effectively balance data acquisition and innovation with safety and security considerations during the review phase of a potential spillover prevention activity.

First, review panels need to be composed of cross-over communities of practice. This helps ensure that the full range of benefits and risks are considered when evaluating an activity, as well as ensuring that all potential tools are being considered if a study is meant to focus on an intervention to mitigate spillover risks. There are many tools and frameworks that ecologists use but biologists may not be aware of, including ecological restoration, harnessing ecosystem services, and appealing to the rights of nature as a legal tool. Likewise, ecologists are unlikely to be aware of the full suite of tools and approaches that biologists employ. Diverse review boards will help ensure that all angles are being considered, and that proposed projects are as impactful and comprehensive as possible.

Second, bodies that review activities and research should be well-staffed with experts that have the right expertise, and are not overloaded. A major challenge in activity review processes is that review boards tend to be understaffed and overworked. This creates critical challenges to activity leads that may be under a variety of time pressures to complete an activity or project in a given time frame. This has also led to a dynamic whereby individuals submitting projects to an institutional review board (IRB) may just tick the boxes to get their activity approved, rather than taking a thoughtful and thorough approach.¹⁷⁴

Vignette 2.

Leadership at E University noticed that more multidisciplinary teams are being formed to research the complex intersection of activities that contribute to increased spillover risks in certain geographic areas. These multidisciplinary teams do not fall squarely into singular committees at this point: rather, the research topics span multiple committees, including those that focus on biomedical, sociobehavioral, and ecological hurdles. To increase its capability and address the transdisciplinary nature and activities of these new research projects, E University instituted several changes.

First, it introduced policies to consider the time IRB reviewers spend evaluating projects as part of their workload.

Second, E University expanded its pool of committee members to incorporate expertise that corresponds to the multidisciplinary research teams that are being formed, including experts with backgrounds in ecology, data science, and the social sciences.

Finally, it developed both physical and virtual processes to allow the greatest flexibility to the research teams being reviewed, as well as flexibility to the reviewers, including accommodations for external members (such as members of the community) that participate in such proceedings. While the initial lift and working out the fine details of scaling activities was difficult, E University now finds that its IRB processes are faster, more efficient, and more capable of handling complex topics like research in high-spillover sites than it has ever been before.

Planning and Execution

Depending on the type of project, workshop experts shared four primary recommendations on how to more effectively plan for complex activities such as research and interventions at high-risk sites during a potential spillover prevention activity.

First, understanding the full extent of the data that is available can be immensely helpful. Several experts noted that many relevant data sources are disparate: for example, public health experts have a bevy of data to draw from, but often do not consider or access data related to land use change and human activities in high-spillover sites. This is in part due to the limited accessibility and availability of environmental, behavioral, and related data types, but also reflects a lack of awareness of existing data sources. Conversations among experts in different disciplines can help elucidate the available data sources that may be relevant to project goals. That said, projects dedicated to collecting, streamlining, integrating, and managing data will also be essential to fill this gap.

Second, engaging with local communities where activities and studies are being conducted is critical to bolster the success of a project and ensure that it is not creating harm. Experts noted that local community members have a depth of knowledge of current events and changes in the environment that would prove invaluable for everything from research to pilot testing interventions.

Third, doing a full assessment of the safety, security, and training needs and requirements for an activity or project is key. While this work is necessary to better understand the issues and risks we face in the future, researchers and practitioners must also do their due diligence to minimize negative outcomes and security risks—many of which are discussed in this report.

Finally, projects and activities should consider how data can best be used, stored, distributed, and aggregated to increase research and review efficacy in this area. As this report will highlight in Part 4, gaining data and insights is only one of many challenges that stakeholders must overcome to make progress in this area. Therefore, carefully considering the type of data that will be gathered, as well as how that data is structured, distributed, and communicated, is an important best practice during the project planning phase.

Vignette 3.

A nongovernmental organization focused on ecological interventions to address pandemic prevention wished to do so from the angle of preserving native habitats to the greatest extent possible. To do this, its team conducted due diligence through robust research and analysis to uncover key pieces of data, including tapping into the broader community to find experts that may supplement the data that is more readily accessible to them.

This broader community was also helpful in gaining subject matter expertise and perspective on the different biological, sociological, and environmental factors that contribute to the unique challenges of a geographic site they are interested in—this includes recommendations and assessments on what type of geopolitical factors to take into account, as well as safety and security guidance in the event that field work and direct engagement with local communities is necessary. As plans finalized for executing this activity, the project team took one last look through their protocols to ensure they had covered all angles: everything from the way they would engage with the local community, to how they planned on acquiring, structuring, presenting, and sharing their data to support future research and activities in this critical space.

After-Action Assessment

CSR’s workshops pointed to three, easy to implement recommendations on improving the process and outcomes of after-action assessments for a pandemic prevention activity. After-action assessments are essential for evaluating strengths and weaknesses of a completed project, but must be carried out strategically to ensure no important details are missed.

First, incorporating input and feedback from as wide a pool as possible (those directly involved and even just tangentially affected by the activities) is crucial.

Second, after-action assessments need to be treated as vital and fundamental evaluations to ensure concrete progress is being made. Therefore, in a similar vein to how preparing for institutional reviews should not just be about checking off boxes, projects should also be evaluated rigorously and thoughtfully to ensure that lessons learned can be applied to future work. Project developers should consistently integrate previous after-action assessments into the conceptualization phase of new projects, and this should be a standardized process.

Third, experts highlighted the need to address challenges that arise in multi-geographical efforts. Efforts to study disease spillover risks often involve multinational teams with participants from at least two or three geographic locations. Experts noted that serious consideration needs to be given to what rules and regulations apply based on the primary institution(s) that are responsible for leading or funding a project, as well as the laws and regulations that apply in the locality where field work or lab work is being physically conducted.

Vignette 4.

A nongovernmental organization has just completed its work on better understanding the linkages between environmental and human health, as well as understanding what types of ecological measures may mitigate spillover in high-risk locations. As part of their after-action assessment, members of the research team convened with key community members with whom they had previously engaged during their field work. The team and the community members noted that, for the most part, the engagement was successful. However, the team also observed that there were several altercations that happened during their engagement that could have been avoided with a greater understanding of the society and culture they entered while they were conducting their work. To this end, the team decided to increase the number of community guides and ensure that team members always have at least one guide present with them. The team also committed to spend more time and effort learning the history, social values, and culture of communities they would be working alongside prior to entering the field in the future.

Communication

Expert input pointed to two critical recommendations on how to ensure that project findings are communicated effectively to the right audiences.

First, special considerations must be made to keep up with today’s complex and ever-changing information environment. The porous and ubiquitous nature of information, particularly as transmitted through social media platforms, has contributed to an environment where scientific facts contend with misinformation and disinformation campaigns from near and peer competitors. Experts noted that this dynamic makes science-based and science-related activities potentially more controversial than they have been in the past, so stakeholders engaged in this space must carefully plan and prepare communications with this in mind.

Second, those advising policymakers and lay audiences on these issues need to communicate key points with minimal jargon, and pinpoint actionable steps. Experts noted that there is a classic challenge in the way evidence-based policies are considered and executed: making said evidence broadly understandable. This is especially challenging in spillover-related work, as information from a variety of technical and sociological disciplines must be conveyed clearly and take into consideration varying levels of science literacy.

Vignette 5.

A recent study conducted by an academic consortium confirmed existing findings that climate change is contributing to species displacement including microbes, large animals, and humans: a displacement that is causing greater interactions among species and thus is increasing disease spillover risks. Through their social media engagement, they manage to also catch the attention of a member of Congress, who would like a briefing on the very topic they published on. The team decides to accept the briefing opportunity, and plan accordingly by conducting background research on what the congressperson is interested in (particularly in the ecological security space) and finding ways to tailor their communications with the esteemed member by simplifying concepts, pulling together key points, and communicating information in a way that would appeal specifically to that member.

Implementation of Future Activities Based on Outcomes

This project exposed two important lessons for the field of reducing spillover risks moving forward.

First, these communities should continue to collaborate with each other to ensure that future activities to address the complex risks that arise from pandemic prevention research at high-spillover sites are aligned. Experts suggested finding ways to build infrastructures that allow for easier communication across these disparate communities, including online text-based platforms and cloud storage capabilities to help share and discuss past, present, and future activities in this area.

Second, fluctuations in funding for research and activities in this area must be addressed. This area, like many spaces in biodefense, biosecurity, and public health, suffers from feast and famine cycles: cycles where reactions to an event open the funding floodgates, then are shut abruptly as other priorities take precedence.¹⁷⁵ Therefore, experts emphasized that stable funding mechanisms for this space will be critical to success in mitigating disease spillover events.

Vignette 6.

At a recent workshop, an individual from an academic background shared some field work they had been conducting on the socio-economic dimension of land-use change happening in certain parts of Vietnam. Another workshop participant, who had been predominantly interested in the life sciences side of disease spillover as a government employee, decided to engage the academic. The two hit it off and began to introduce each other to their networks, ultimately resulting in a collaboration across multiple individual experts who now use online communication and cloud storage resources to produce papers and find other opportunities to collaborate.

This network collaboration happened just as an outbreak of Nipah in Vietnam had occurred, and resources were being poured into understanding the potential causes of spillover. Over the course of three years, this network of collaborators ultimately determined that bat and animal migration, combined with land-use change, forest fragmentation, and animal and plant farming practices were most likely to have contributed to the spillover event. While historically the funding window would close at this time since the immediate clause was three years, recent changes in the political landscape prioritized a sustained level of funding for spillover prevention work into the foreseeable future. This allowed the networked team to find more funding and conduct another similar study investigating disease outbreaks in the Golden Triangle in southeast Asia.

Evaluation of Priorities

Based on our discussions among experts, the most important, overarching recommendation in terms of prioritization is that the nexus of ecological security and biological security issues must be taken into account as a consistent standard. As the experts that CSR consulted came from various backgrounds in academia, industry, and government, they were knowledgeable and sensitive to how priorities can shift over time across these different spaces. However, they noted that consistency is key to making progress in complex areas such as mitigating risks from high-spillover sites. Therefore, citing the accelerated rate of emerging and re-emerging infectious diseases as the human-animal interface increases, they noted that this area of activity and research should consistently be labeled as a high priority. These risks do appear to increasingly be reflected in key U.S. policy documents, such as the National Biodefense Strategy, yet work to address them in tandem must be expanded upon and persistently pursued.¹⁷⁶

Vignette 7.

While the funding level for spillover prevention work has been stabilized, the types of work that get funded have varied wildly based on the grant evaluators and recent events that touch on the topic. As the unique combination of disease spillover risks are better understood around the world, there has been a push to conduct more pilot projects: to see if different combinations of biological and ecological interventions can mitigate the rising risks of disease spillover. To this end, the government set up a series of engagements with top scientists and community leaders from potentially affected regions to discuss what the next best steps may be in prioritizing activities for understanding versus intervening on disease spillover risks. In the end, it was ultimately decided that the best-characterized regions with the highest confidence in their assessments would be prioritized for pilot projects, while researchers still have access to resources to continue characterizing local and regional sites that are projected to be high-risk for spillover.

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Thus far, this report has provided overviews on the activities, opportunities, and challenges that exist at the nexus of ecological and biological security in pandemic prevention activities. Through the process of analyzing these dynamics, the CSR team has identified key gaps and challenges in existing activities and policies that can and should be addressed to create a more integrated approach to spillover prevention: an approach that aligns with the vision and ideals of the One Health approach. These issues can be categorized into five main issue areas or “challenges,” all of which should drive effectiveness in preventing widespread outbreaks if addressed. The recommendations we offer in each section below are meant to help balance safety, security, and innovation.

Challenge #1: Biological Security and Ecological Security Approaches for Pandemic Prevention Are Insufficiently Integrated.

There is considerable work being done to address ecological degradation and increasing biological threats from spillover. Yet, currently, there is no unified approach in the way ecological and biological studies are conducted in potential high-spillover sites. Despite this, there are considerable opportunities to improve collaborative efforts and unification.

Current approaches create gaps in three ways. First, the lack of integration ignores how life sciences and ecological activities are interrelated. Second, limiting this integration potentially creates silos of information, which might negatively impact both disciplines. Third, narrowly focusing on one discipline places artificial limitations on the spectrum of tools that may be considered to address or mitigate spillover risks. Pathogens are often not recognized as an intrinsic part of healthy ecosystems. Understanding these dynamics may allow for more effective pathogen management techniques, such as by applying lessons from integrated pest management methods.

U.S. policies that create formal and informal silos between human and non-human health research programs continue to linger. This can constrain efforts and limit cross-disciplinary—and likely more effective—collaborations. For example, NIH is tasked with conducting research related to human health, and NSF is tasked with all other scientific research. Projects that could overlap have trouble finding funding from either institution, landing in an interdisciplinary doldrums. NSF and NIH have some joint funding calls, but these are small in scope and financial scale. Within these initiatives and research efforts, there is often inertia that may prevent new collaborations. Researchers tend to collaborate with the same people repeatedly—often with people in their networks who may work in closely related fields. This makes awareness of research outside of one’s field difficult, preventing innovative collaborations among those focused on human health, biosecurity, or sociology, and those focused on ecosystems, or environmental and animal health.

Additionally, integrating biological and ecological security considerations into pandemic research, especially spillover prevention, requires consideration for how interventions are designed and implemented. There is often resistance to ecological and environmental interventions, which should be consistently considered in program designs. There is a common misconception that ecological interventions undermine people’s livelihoods and culture in favor of protecting the environment. This perspective neglects the reliance humans have on the environment and the vast amount of services that ecosystems provide humans: services that are eroded as ecological and environmental disruption occurs.

Given both the progress that is occurring and the need to overcome these challenges, the following recommendations are meant to help advance efforts that better integrate biosecurity and ecological security considerations.

• Recommendation 1: Consistently Integrate Ecological Considerations into Biological Activities and Vice Versa. Given the complex and dynamic relationship that exists among humans, animals, insects, and microbes, future work must integrate ecological and/or biological considerations into pandemic prevention work at high-risk spillover sites. Funders should consider having grant applicants include explanations of how their work might impact spillover potential. Funders should also incentivize projects that integrate ecological considerations and toolkits into their proposals. These measures will help reduce the blind spots in many studies, as well as open opportunities to use the full suite of tools that an integrated One Health approach offers for addressing and mitigating costly spillover events.
• Recommendation 2: Reduce, and Ultimately Eliminate, Formal Silos Between Human and Non-Human Research Programs. Research that integrates human, animal, and ecosystem health should be encouraged by institutions and funding agencies. The joint NIH-NSF Ecology and Evolution of Infectious Diseases (EEID) program is a useful model. NIH and NSF should expand upon this program to allow for more holistic work. Within agencies, mandates should be given more flexibility—NIH may be tasked with research on human health, but understanding interactions between humans, animals, and ecological systems is extremely relevant to human health and should not be excluded from NIH requests for proposals (RFP) or funding.
• Recommendation 3: Support Responsible Ecological and Environmental Interventions. Research and interventions aimed at reducing spillover should include programs to identify and communicate benefits to the community (e.g., intact forests reduce flood risk) or include explicit benefits (e.g., clinical services are paired with disease early warning activities). Benefits will be easier to communicate where the community has helped to design the intervention and contributed relevant local knowledge—an often underutilized resource in this type of work.
• Recommendation 4: Create and Foster Interdisciplinary Opportunities to Create New Collaborations. Valuing diversity and novel ideologies is necessary to address the evolving nature of spillover risks and vulnerabilities. While tenured field leaders are an important aspect of understanding historical context of efforts, ensuring infusions of transdisciplinary experts catalyzes continued progress within the field. Future research and interventions should integrate requirements for new and diverse collaborations in both design and implementation stages. Efforts to promote early-career researchers, new working groups and organizations, and multi-disciplinary collaborators can only serve to strengthen approaches to spillover prevention. This recommendation applies to government funding, but should be embraced by philanthropic funders, academic leaders, and private companies as well.
• Recommendation 5: Shift Perspectives to Incorporate Pathogens as Part of, Not Separated from, Ecosystems. Integrating awareness for pathogens as an intrinsic part of ecosystems rather than a separate component can reduce siloing. Infectious diseases play a role in ecosystems and should be considered an integral aspect of their health, rather than an adverse event requiring only reactive measures. Incorporating consideration of pathogens as a functional aspect in ecosystems can strengthen responses across stakeholders and ensure a more holistic approach to spillover prevention. Indeed, this perspective is increasingly embraced by many scientists and community leaders, and reflected in reporting by many leading journalists; federal policies and programs need to catch up.

Challenge #2: Spillover Prevention Programs Lack Necessary Funding and Support.

While there are some promising programs working to prevent and address disease spillovers, these programs need to be expanded in a few key ways. First, programs taking a One Health and ecological approach to addressing biological threats receive a fraction of the funding compared to efforts focused solely on human health. While it is understandable that funders focus on disease threats that have clear and direct impacts on human health, this approach unfortunately prevents recognition of the benefits of protecting animal and environmental health, and often ignores the root causes of infectious disease outbreaks.¹⁷⁷

A second issue is that funders generally do not support long-term monitoring or interventions. However, projects that implement measures to reduce spillover in a community or ecosystem need sufficient funding to conduct impact assessments and support the longevity of the intervention. For example, a project that funds tree planting, but not maintenance over the long term, will likely fail to reach its ultimate goal of reforestation.

Third, research projects often are not optimally designed to inform policy decisions, and are poorly understood by policymakers. For instance, it is difficult to measure the success of “pandemic prevention programs,” as it is impossible to directly attribute the lack of a pandemic to one specific approach. Furthermore, implementing practices to reduce the likelihood of a zoonotic spillover does not eliminate the risk of spillover, yet policymakers and the public may consider any spillover event as proof of failure. Relatedly, policymakers lack estimates of the economic tradeoff (in terms of spillover reduction or prevention) between allowing ecological disruption or supporting conservation and restoration. For example, there are few estimates of the economic cost of spillover cases that follow specifically from deforestation, despite the known connections to costly disease risks. Valuing ecosystems in terms of their services to people has a long history, but few of these valuations consider that intact or restored ecosystems may reduce spillover.

To maximize the efficacy of programs that address spillover risks, this report offers the following recommendations:

• Recommendation 1: Develop More Programs that Focus on Animal and Environmental Health. Upstream strategies for reducing spillover risk should begin with improving our understanding of spillover-relevant animal health and environmental stressors. A primary prevention strategy would focus on increased and sustained funding to reduce disease burden within targeted animal populations, while also minimizing or reversing environmental pressures that lead to human-animal interactions.
• Recommendation 2: Lengthen Funding Duration of Projects. For example, to understand if reforestation reduces spillover risk, such an effort should be paired with some kind of pathogen monitoring and this data must be collected longitudinally. Grants supporting this kind of work should include a schedule of tranches for long-term upkeep and monitoring.
• Recommendation 3: Bolster Cost-Benefit Analyses and Valuations. Though imperfect, additional cost-benefit analyses should be conducted to assess the value of intact or restored ecosystems and other activities specifically aimed at reducing spillover. By comparing the costs of potential spillover with those of conservation or restoration, policymakers will be better able to make informed decisions about which interventions to pursue. These comparisons should be conducted at global, regional, and even local scales given the diversity of context-specific factors that influence the costs and benefits of conservation and spillover. These analyses will benefit from long-term data collection and monitoring efforts at a diversity of sites.
• Recommendation 4: Develop Models, Metrics, and Other Methods for Counterfactuals that Allow Transparency. Prevention strategies are often measured by the events that did not occur, which can present outbreaks or a pandemic as indicators of total failure, and cause the public and policymakers to overlook successes. Moving forward, efforts should be made to collect, analyze, and communicate data regarding the efficacy of interventions across various metrics for success, such as lives saved, hospital beds kept open, flocks or herds spared from culling, etc.
• Recommendation 5: Develop Clear Pathways from High-Level Recommendations to Implementation Guidance Documents. Future efforts and initiatives must include operational plans to ensure recommendations are pragmatic, actionable at the grass-roots level, and can be translated to actual change rather than presenting broad concepts.

Challenge #3: Sociological and Historical Context Is Often Poorly Understood.

Many successful intervention strategies have underscored the importance of integrating cultural, anthropological, and sociological considerations into design and implementation efforts. However, social science expertise is still lacking in many research projects—subject matter experts who informed this project noted that more attention needs to be directed toward understanding the sociological and historical context of communities involved in research or conservation efforts. On funding-constrained projects, sociologists and behavioral scientists are often the first to be cut. This lack of expertise can cause serious issues in work that necessitates engagement with local communities with different traditions, backgrounds, cultures, and conceptualizations of humans and their relationship with nature. Furthermore, the legacies and realities of colonialism undermine the ability of scientists from wealthy countries to engage with many communities in LMICs.¹⁷⁸ This dynamic may lead individuals in these regions to feel uncomfortable with outsiders attempting to impose new practices and systems.

Given the complexities of hindering spillover, intervention strategies increasingly call for nuance and consideration of the interrelated factors that can impact risks. Many voices in spillover prevention advocate for the complete banning of risky practices (such as wildlife markets), without considering whether such interventions are socio-economically or politically feasible or the impact such steps would have on communities. A formal ban will not eliminate wet markets, but rather cause them to go underground, where they will be subject to even less regulation. Further, such blanket bans would disrupt the culture of communities, as well as their economic and food security. Unfortunately, decisions are sometimes made without taking these issues into account. We offer the following recommendations to better leverage insights from the social sciences and to enhance community buy-in:

• Recommendation 1: Incorporate Sociological Expertise and Local Knowledge To Increase Buy-In and Efficacy. Ecological interventions and surveillance programs aimed at decreasing spillover rates will be most effective where sociological considerations and local cultural, political, and economic contexts are integrated into intervention planning. Without accounting for this context, programs may, for example, outstrip local capacity, conflict with local traditions, or miss unique spillover pathways. Furthermore, involving local communities in bottom-up participatory evaluation of spillover pathways and planning of interventions will increase community buy-in, ability to execute, and the program’s longevity.
• Recommendation 2: Consider the Historical Context of Colonialism and Exploitation in Communities Impacted by Research/Conservation Efforts. Prior to entering communities, research teams should learn the history, cultural practices, and values of the people they will be working alongside. Research and intervention priorities should be established in partnership with these communities—it is essential to include sociological experts in this phase and throughout the research process. If communities are asked to change practices that could affect their food or income security, they must be presented with viable alternatives and resources.
• Recommendation 3: Employ Nuanced Approaches. Rather than banning wildlife markets outright, for example, public health experts, zoologists, and sociologists should work with communities to develop risk reduction measures that are feasible and minimally disruptive. This same collaborative approach can also be employed when working with communities to reduce illicit hunting, deforestation, and other behaviors that increase the likelihood of a spillover event. In short, the most effective interventions and regulations are those that have community buy-in.

Challenge #4: Structural Obstacles Prevent High-Quality Data Collection, Sharing, and Use.

While there have been extensive efforts to strengthen spillover prevention with data collection, how such information is collected and then harnessed must continue to improve. There are several obstacles that prevent effective data collection, management, and translation. First, stakeholders often collect data for purposes outside of scientific research without meeting design and data management best practices. Collected data often lacks contextual information about the environment surrounding the pathogen, such as information about the biodiversity of the ecosystem, sources of environmental stress that may influence viral shedding, and the behaviors of people living in the focus region.

Second, researchers sometimes needlessly repeat studies that have already been conducted due to the lack of accessibility of no-effect results. Negative or no-effect results are just as important for spillover surveillance and prevention research as studies that report significant effects. However, perverse incentives in academia mean these results are rarely included in papers submitted to, or accepted by, peer-reviewed journals. If researchers are not aware that someone else has already asked a question and found no effect, they may waste efforts on the same or similar projects.

A third issue lies in data reporting. Farmers (especially those on small farms in LMICs) may be reluctant to report livestock illnesses and deaths to local authorities for fear of having their entire flock or herd culled. Furthermore, countries fear the economic repercussions of large-scale livestock culling events. Unfortunately, these concerns prevent scientists from gaining necessary data and ultimately may fuel disease spread.

To help resolve these challenges in data collection and management, we recommend the following:

• Recommendation 1: Strengthen Basic Data Considerations and Requirements, Including Contextual Information and Ease of Data Interoperability. Better contextualized data can guide more accurate risk assessments and inform modeling efforts to predict where spillover is most likely to occur. Making data interoperable across information systems will help ensure it can be used by a wide range of researchers, policymakers, and other stakeholders.
• Recommendation 2: Encourage Academic Journals to Publish Negative or No-Effect Results for Academic and Public Consumption. Expert communities, government agencies, philanthropies, and others should incentivize journals to expand in this critical way—and possibly launch an academic journal that solely publishes negative or no-effect results in a range of fields or in specific subfields such as zoonotic spillover or ecological interventions.
• Recommendation 3: Incentivize Reporting of Livestock Illnesses and Deaths. Reporting animal health events should be incentivized by guarantees of economic security, particularly in LMICs. This will encourage farmers to report animal deaths and illnesses without fear of losing their livelihood. Funding to support economic security for farmers could be provided by international organizations such as the World Organisation for Animal Health and the Food and Agriculture Organisation of the United Nations. At the international level, restrictions on imports and exports should be region-based rather than excluding entire nations—this way a culling in one part of a country will not prevent the entire country from exporting livestock or crops. This is the approach advocated for by the U.S. Animal and Plant Health Inspection Agency and practiced by the World Organisation for Animal Health.¹⁷⁹

Challenge #5: The Security Implications of Ecosystem Disruption and Loss, and Localized Outbreaks Are Underappreciated.

There are widespread efforts to conserve nature and prevent spillover at scales ranging from local to global, just as there are increasing efforts to combat climate change. Yet, while climate change is widely recognized to have significant national security implications (e.g., acting as a “threat multiplier”), the ways in which ecological degradation shapes stability and security dynamics are not yet well understood.¹⁸⁰ As such, conservation, preservation, and restoration are not considered security imperatives. However, ecological disruption has a variety of security implications, including increasing the risk and range of disease spillover. Evidence from continued outbreaks, a global pandemic, and rapid loss of global ecosystem services all demonstrate that policymakers and funders are struggling to curb these potentially game-changing risks.

While the recent pandemic has galvanized efforts to prevent such catastrophes in the future, the emphasis around spillover research is largely limited to pandemic prevention. This neglects infectious disease threats that may still have high consequences for communities, countries, and regions, but are less likely to reach global pandemic scale (e.g., Ebola). Limiting resources to spillover events that have pandemic potential, or framing research metrics only within the context of preventing the next pandemic, diminishes incremental efforts, overlooks events that were prevented, and translates to failure if a pandemic occurs. Spillover events leading to outbreaks that are limited in geographical range but not considered a Public Health Emergency of International Concern (PHEIC) or of pandemic potential should also be recognized for their potential to drive instability, dislocation, disruption, and other security effects. The interactions among conflict, disease risk, and ecological and climatic changes can also readily be seen in past and contemporary cases including in the Congo Basin, Yemen, the Horn of Africa, and beyond.

We offer the following recommendations to focus policymakers and funders on the strategic risks of ecosystem loss and localized outbreaks:

• Recommendation 1: Spread Awareness that Conservation is a Security Issue. The security threats posed by ecological disruption should motivate the United States and other nations to invest in ecological conservation and restoration to bolster national, regional, and global security.
• Recommendation 2: Ensure that Biological Threats, Even Those without Pandemic Potential, are Not Neglected. Biological threat prioritization should be broadened to account for the implications of those previously considered low-impact or not of pandemic potential. Most spillover events do not lead to larger outbreaks, but still represent a potential risk to surrounding communities and ecosystems. Investing in prevention and response measures that acknowledge the impact of outbreaks on communities, economies, and global partnerships would signal that regardless of the pandemic potential, local health is intrinsically linked to global outcomes.
• Recommendation 3: Develop and/or Strengthen Policies to Discourage or Reverse Deforestation. Developing policies to address deforestation includes integrating enforcement mechanisms, spotlighting incentives for maintaining forest cover, and removing enticement towards deforestation and forest degradation. The largest-scale example of targeted deforestation reduction occurred in Brazil between 2005-2012. During this time, deforestation in the Amazon decreased by 70% while agricultural output was maintained or even increased.¹⁸¹ This was achieved through a mixture of land-use zoning, market and credit restrictions, and enhanced enforcement through satellite monitoring.¹⁸² Economic incentives may take a number of forms, such as direct cash payments for forest protection or performance-based mechanisms such as carbon storage. Payments for ecosystem services incentivize landowners to maintain or increase forest cover on their lands. They are part of a broader acknowledgment that people receive various benefits from nature that are not fully accounted for by current economic systems. This lack of inclusion leads to a market distortion that at a minimum does not include, and at its worst encourages, poor ecological/resource management.¹⁸³
• At the same time, a significant proportion of deforestation and degradation occurs legally—estimates posit that of an average USD $540 billion provided yearly in incentives and fiscal subsidies to agricultural producers world wide, “87% is considered harmful to the environment and human health”.¹⁸⁴ There is a need to address commodity value chains and the international drivers of deforestation. Regulatory market-based approaches can be implemented to affect the demand side of products linked to deforestation, such as the risk-based controls adopted by the European Union.¹⁸⁵ A recent law adopted by the European Union regulates products linked not only to deforestation but to degradation, acknowledging that seriously altered ecosystems lack functionality and undermine planetary, human, and economic health.
• Recommendation 4: Implement Strategic Approaches that use Systems Thinking and Consider the Nexus Between Economic, Demographic, and Cultural Factors to Address the Illicit Wildlife Trade and its Health Risks.¹⁸⁶ The human dimensions of conservation interventions are what determine their success; therefore, interventions should be context specific and participatory in order to understand and address motivations driving illicit wildlife activities.¹⁸⁷ Limiting only supply or demand will likely not yield sufficient or sustainable independent results. Diversified income sources and other economic resilience interventions are essential components of altering incentives in the wildlife trade supply chain.¹⁸⁸ When community needs and traditions are not considered, such as with the ban on bushmeat consumption during the 2014 West Africa Ebola outbreak, supply-side interventions can engender distrust and exacerbate tensions between communities and authorities.¹⁸⁹ Although socioeconomic inequalities are known to drive poaching behavior, the systematic evaluation of livelihood outcomes alongside conservation outcomes is not routinely considered, ignoring a major enabling factor impacting sustained conservation outcomes.¹⁹⁰
• The long-term effectiveness of outright bans on wildlife consumption such as China’s history of banning, and then reversing, the trade and consumption of palm civets after the 2003 SARS-CoV-1 outbreak, and the recent expansion of the country’s Wildlife Protection Law in response to COVID-19, remains weak at best.¹⁹¹ Demand-driven interventions work to reduce the economic incentives for engaging in illicit wildlife trade. Trade follows global consumer demand for things like luxury status items, pets, or for medicinal or cultural reasons.¹⁹² The nuances of what drives consumer demand have not been fully parsed in the literature, and present an opportunity to engage in targeted and more successful policy design.¹⁹³ Demand management interventions should be based on a clear “understanding of the social, economic and cultural aspects” of individuals along the entire value chain”.¹⁹⁴ This means policies and interventions are not solely directed at producer countries or communities, but also at consumers in urban and international markets who are willing to pay high prices, thereby encouraging illicit activity.
• Recommendation 5: Explore Structural Changes to the Livestock Sector and Animal Protein Market to Reduce Zoonotic Risk.¹⁹⁵ Structural change would mean adjusting the direct and indirect economic incentives received by the livestock industry. Currently, zoonotic risk is an externality—as many aspects of environmental disruption are—whereby the true cost is not reflected in the price of animal protein products.¹⁹⁶ The lion’s share of veterinary costs around the world are borne by the public sector while taxpayers also pay the cost to compensate producers in the event of culling, though compensation schemes do not differentiate based on the timeliness of reported outbreaks.¹⁹⁷ Additional subsidies received by producers include vaccines and vaccine research, wildlife population control around facilities, and assistance for biosecurity modernization.¹⁹⁸ Other options include choice architecture and nudging to affect the demand side of the livestock market.
• Direct conservation and restoration approaches offer risk mitigation potential for this intersection. Decades of natural wetland and habitat loss in the United States—partly driven by agriculture expansion—has led to wild birds turning to artificial habitats, particularly those in conjunction with livestock production facilities.¹⁹⁹ Proximity to highly protected habitats has been found to reduce avian influenza outbreak risk, whereas proximity to unprotected habitat and artificial wetlands increased risk.²⁰⁰ Restoration and conservation of wetlands, whereby ecosystem functions are restored or improved, could reduce the risk of transmission between wild waterfowl and domestic livestock.²⁰¹

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The nexus of ecological and biological security within spillover prevention is complex and still insufficiently understood. Further, as this report highlights, communities of practice engaged in spillover prevention activities have been historically siloed, which has complicated the efforts to aggregate information, coordinate activities, and build a more comprehensive understanding of the relationships among humans, insects, animals, the environment, and disease spillover.

Therefore, this report concludes with a series of sections to empower policymakers and stakeholders in this area to take concrete next steps to increase integration of both biological and ecological security in pandemic prevention activities at high-spillover sites. First, it identifies six common themes, which we refer to as best practices, to guide future efforts in this space. In addition, this report recommends areas of policy focus for addressing spillover at the ecological and biological security nexus.

Best Practices for Addressing Spillover at the Nexus of Ecological and Biological Security

Six key best practices emerged through CSR’s research and analysis, and the authors’ significant engagement with subject matter experts. These six best practices are:

Increase Collaboration. Build tools and dialogues that bridge gaps between the communities that operate at this intersection. CSR’s year-long effort to build a more holistic community of practice on spillover mitigation highlights how siloed certain communities have been in this space. These divides were evident in the way concepts were approached by experts in each discipline, and the diversity of tools that each community would employ to address the same issue. Creating a common frame of reference and vocabulary across these communities will help align goals and efforts, and ensure that ecological and biological security considerations are better integrated into pandemic prevention activities at high-risk spillover sites.

Build Small to Build Big. Support pilot projects, long term monitoring, and impact assessments to test and compare potential interventions across ecosystems and communities. One of the challenges to establishing prevention and surveillance programs and interventions is the lack of data to inform best practices across a diversity of societal and ecological contexts. Participants in CSR’s expert workshops noted that an intervention that is successful in one potentially high-risk spillover site may not work in another. This is due to differences in the local social, health, and ecological context, including climate, ecosystem-type, economy, culture, and institutional capacity. Conducting pilot projects that test interventions will help identify which measures are likely to be effective in different contexts. Long term monitoring and impact assessments can help determine the effect of ecosystem conservation, restoration, public health strengthening, and other systemic interventions. Moreover, sharing no-effect and negative outcomes will be crucial to smaller-scale and pilot projects successfully informing larger-scale efforts.

Standardize Data-Related Methods and Practices. Establish standards for study design and data collection, analysis, archiving, and sharing to enable use across projects and in larger meta analyses. A challenge to leveraging the current data collected across pandemic prevention, surveillance, and disease ecology initiatives at high-risk spillover sites is knowing what to do with all this data after it is acquired and analyzed. A more intentional, standardized, and accessible approach will magnify the impact of these data by enabling a wide range of researchers to apply them across basic science and policy analyses. Standardization of methods and practices enhances the capacity to identify trends and compare intervention strategies. As mentioned previously, the current infrastructure is scattered across numerous other databases and success requires finding ways to integrate, streamline, and federate such data.

Coordinate Efforts. Streamline and deconflict multi-partner transnational spillover surveillance and prevention programs at high-risk spillover sites. As this report highlights, there are many confusing challenges that arise due to inconsistent rules, regulations, and best practices: challenges that can stem from the location of a lead institution or differences in guidance and requirements in different countries. Policymakers and subject matter experts should convene together in the coming years to hold conversations and coordinate.

Be Transparent. Make preparations for engaging a broad community of stakeholders to ensure concrete progress can continue in this critical area. Addressing biological risks, including the emergence and re-emergence of infectious diseases from spillover sites, will likely experience increased scrutiny given recent events such as the COVID-19 pandemic. Therefore, the communities involved in doing the crucial work necessary to understand the dynamics of spillover and what may emerge in the future will need to ensure transparency in order to maximize credibility and public trust.

Gather Data in a Thoughtful and Usable Manner. Conduct further landscape and topic assessments of pandemic prevention activities. This first foray for CSR looked primarily at the opportunities and risks that arise specifically from pandemic prevention research and interventions in high-risk spillover sites. However, there are many other topics that came up through CSR’s research and expert consultations. Some of these include areas such as animal husbandry practices and their impacts on spillover; species migration and its impact on host, vector, and microbial spread; and vector migration and viral shedding patterns driven by anthropogenic activities such as land-use change, climate change, pollution, and wildlife trade. Further investigations will help raise awareness of the complexities of this issue, and hopefully drive action to address spillover risks in different contexts: actions that countries, philanthropies, and others can target with specialized investments.

The aforementioned six best practices provide the foundation necessary to make progress at this complex nexus in pandemic prevention work. They also highlight how stakeholders across multiple communities need to engage and work together to ensure that the community is using the full suite of tools it has available to mitigate pandemic emergence risks.

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Conclusion

This report is the culmination of a year-long effort in which CSR convened interdisciplinary experts and practitioners bridging epidemiology, ecology, biosecurity, sociology, policy, and conservation to address the rising risks of disease spillover. This multidisciplinary community will hopefully continue to uncover the drivers of zoonotic emergence and spillover, identifying the interventions to arrest these trends, and the surveillance strategies that will enable global early warning systems.

Through in-depth research and multiple expert convenings, CSR identified actionable recommendations and examples for projects that address spillover risks, five categories of challenges and solutions to move past the status quo, and best practices to address spillover risks and ripe areas of policy focus at the ecological and biological security nexus.

With these results, CSR aims to help empower stakeholders to develop an understanding of the complex opportunities and challenges that arise at the intersection of ecological and biological security to effectively prevent and mitigate spillovers in high-risk regions. This type of work will be more critical than ever to mitigate zoonotic spillover as humans and animals interact more due to issues such as land-use change, climate change, habitat fragmentation, and animal and human migrations. At the same time, prevention and biosurveillance work is not without risks.

Business as usual in this field is likely to fail at preventing an acceleration of spillover events that will increasingly disrupt security from the local to global scale. While the work ahead will not be simple, the international community must act now to address the urgent challenges and opportunities highlighted in this report.

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Notes