December 2022

By Rhys Dubin, Rassin Lababidi, John Moulton, Harshini Mukundan, Lillian Parr, Christine Parthemore, Saskia Popescu, and Daniel P. Regan | Edited by Francesco Femia

Executive Summary

When COVID-19 struck in late 2019 and early 2020, governments worldwide were caught off guard. Despite decades spent improving global capacity to detect, track, and analyze disease threats, the virus still managed to rapidly spread around the globe within weeks. The systems that countries and international institutions established, particularly those designed to spot novel threats before they metastasized into something more dangerous, ultimately proved insufficient to halt COVID-19’s spread. 

In response to this fundamental challenge, the Council on Strategic Risks (CSR) published an assessment of the state of the global infrastructure designed to alert decision-makers to hazardous pathogens before they touch off significant outbreaks—henceforth referred to as pathogen early warning systems in this report. In July 2021, CSR released the results of this work in our report, Toward a Global Pathogen Early Warning System: Building on the Landscape of Biosurveillance Today.

Since then, the importance of effective early warning systems has only increased. COVID-19 has killed more than one million people in the United States alone, and the International Monetary Fund estimates that the global response will cost more than $12 trillion. Scientists are still working to understand SARS-CoV-2’s lasting health impacts—ranging from antibiotic-resistant coinfections to a host of other lasting symptoms. Other diseases are also spreading in new and dangerous ways, including monkeypox (now referred to as mpox), a virus once limited to West and Central Africa that has traveled to 110 countries in less than one year. Ebola has resurfaced in Uganda, spreading to seven districts with infection control measures resulting in school closures. Russia’s invasion of Ukraine, moreover, has sparked fears that Moscow might use biological weapons during the conflict. 

In light of these developments, this new report aims to update public understanding of contemporary biosurveillance and pathogen early warning capabilities across three dimensions: the United States government, select regions worldwide, and ongoing efforts toward global pathogen early warning integration. This report also seeks to provide an overview of the structural and technical tools required to create effective early warning systems. In doing so, CSR’s objective is to provide context for understanding the current state of biosurveillance, while also highlighting notable shifts since 2021. This includes:

• Major U.S. policy rollouts, including the updated National Biodefense Strategy & Implementation Guide, National Security Memorandum 15, the first annual review of the American Pandemic Prevention Plan, and the Department of Defense’s (DoD) highly-anticipated inaugural Biodefense Posture Review expected in early 2023.
• The launch of the U.S. Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics. The center is actively building its team and capacity as it defines its role in the U.S. pathogen early warning landscape.
• Growing international efforts to bolster effective biosurveillance and early warning capacity throughout Central Asia, Africa, Latin America, East Asia, and the Middle East.
• Increased dialogue by international organizations such as the WHO and the G7 Global Partnership on the future of biological threats and the need for robust global early warning systems.

Despite these examples of progress, however, early warning systems in the United States and around the world remain far from comprehensive. Major structural, technical, and political gaps remain. Namely:

• Biosurveillance capabilities remain largely tied to specific pre-identified threats. Governments and international institutions need to develop a wider set of pathogen-agnostic tools designed to detect any potential novel or deliberate threat.
• Many biosurveillance and early warning efforts lack the resources necessary to be sustainable over the long term. Indeed, some existing capacities may see reduced or halted operations if new funding streams do not arise soon. 
• The absence of a standardized approach to assessing the quality of early-warning systems and biosurveillance coverage.
• Within the United States in particular, data sharing and transparency are still insufficient, both across different federal agencies and from state and local public health systems to federal counterparts. 
• Although major stakeholders around the world have highlighted the need for comprehensive global early warning systems, no state or international institution has advanced a concrete plan designed to take this challenge on. 

Although these gaps are significant, genuine pathogen early warning systems are not out of reach, and many of the necessary digital and technical tools are already available. CSR has therefore laid out a series of recommendations for immediate and near-term action across the U.S. interagency, the global community, and key U.S. partners. These include:

• The U.S. government must establish a clear strategy for the CDC’s Center for Forecasting and Outbreak Analytics, including guidance for how the new center will engage with other agencies across the U.S. government.
• The Department of Defense (DoD) should ensure that its biosurveillance activities and agencies are optimally organized, integrated, and attached to its technology development planning to ensure it provides leaders with timely threat assessments from a variety of sources and evolves ahead of threats.
• DoD should plan and pilot a pathogen-agnostic early-warning system at several strategic military bases and facilities. This could act as a trial-run for a larger national or international system. 
• The U.S. government must increase its engagement with the private sector. Companies, including biotech firms, can provide unique data and advanced capabilities that are vital for effective biosurveillance and early warning. 
• Governments around the world should prioritize developing interoperable biosurveillance systems. This should lay the groundwork for new cross-border and regional early-warning systems.
• Affluent states should extend existing partnerships and develop new programs designed to bolster biosurveillance efforts in resource-limited and remote settings across the globe.
• Governments and international organizations worldwide should actively pursue a global early-warning framework. 

CSR is releasing this report at a critical juncture for national and international biosecurity efforts. Fatigue from COVID-19 and decreasing interest in biological threat reduction pose a real threat to global efforts to address the outbreaks of today and the dangers of tomorrow. Returning to the status quo will not suffice, and experts agree that the drivers and incidence of biological threats will only increase over time. 

As an independent nonprofit, CSR will continue its work to support and encourage stakeholders as they consider the guidance offered throughout this report, and help fill the gaps in efforts to chart actionable steps forward. Given how high the stakes are for all actors working to address biological threats, we must continue to push for urgent advancement toward effective pathogen early warning systems.  

Direct inquiries to: Andrew Facini, afacini [at] csrisks.org

Cover image: Scanning electron micrograph of Crimean-Congo hemorrhagic fever (CCHF) viral particles (yellow) budding from the surface of cultured epithelial cells from a patient. Courtesy NIAID.