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1 U.S.-Russian Working Group on Bioterrorism Claire Cornelius (Rapporteur) Experts from several U.S. and Russian organizations convened March 19-20, 2007, at the Russian Academy of Sciences (RAS) in Moscow to discuss terror- ism threats and responses involving biological pathogens and to further define the role that the scientific, medical, and agricultural communities should play in preventing and containing bioterrorist occurrences in the United States, Russia, and worldwide. Informal presentations were made by specialists in the areas of biomedical research, epidemiology, public health, and scientific instrumentation technology as indicated in Appendix A. The American specialists also had the opportunity to visit several Russian health-oriented organizations in Moscow and St. Petersburg as discussed below. SITE VISITS Members of the working group met with representatives from the Federal Medical–Biological Agency (FMBA) and the Center for Hygiene and Epidemiol- ogy (Rospotrebnadzor) in Moscow. In 2004, under a new administrative reform, several research institutions were transferred from the Ministry of Health to FMBA, including the important Research Institute of Highly Pure Biopreparations in St. Petersburg. Four major 

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 COUNTERING TERRORISM functions of FMBA are (1) organization and implementation of state sanitary and epidemiological services for industries and territories with known dangerous working conditions; (2) detection and containment of hazardous agents (nuclear, biological, and chemical); (3) development of policy and regulations governing the safety and well-being of the population, with emphasis on those employed in industries and institutions with dangerous working conditions; and (4) pro- vision of direct medical care for researchers and industry workers working in dangerous fields, including those who previously were affiliated with activities of Biopreparat. Various programs and technological capabilities were discussed, particularly in the areas of chemical research, which is a major concern of FMBA. Russian specialists at FMBA emphasized the need for more formalized biological and chemical safety programs for workers and appropriate medical services and financial compensation when appropriate for researchers and laboratory workers, while others emphasized the need for general nonproliferation strategies for ad- dressing weapons of mass destruction. The discussion with the specialists of the Center for Hygiene and Epide- miology focused on (1) methods of surveillance and control of communicable disease, (2) areas of public health and medical research of special interest, and (3) model development for predictions of morbidity and mortality. In response to a bioterrorist incident or significant infectious disease outbreak, the center plays a key role in cooperation with other public health organizations in Moscow. The visitors were able to observe the operation of the computer-based epidemiologi- cal program, which is connected to hospitals and other public health facilities throughout the city as well as to the federal ministries and agencies responsible for public health. At present, this center is not a partner in an international epi- demiological network for megacities, but it could make significant contributions to such a network. In St. Petersburg, the Research Institute of Highly Pure Biopreparations has achieved Good Laboratory Practices (GLP) and Good Manufacturing Practices (GMP) status with the assistance of American collaborators with research and production experience who served as consultants funded by the U.S. Depart- ment of State. At present, only a very small percentage of the institute’s income comes from international contracts and grants (less than 2 percent, in contrast to much higher levels in years past). Sales from the production of several locally developed drugs for consumption in Russia complement the core budget and the income from local contracts and grants. At the same time, the institute is highly motivated to retain contacts with American colleagues in order to stay abreast of worldwide developments in research and related activities. Also in St. Petersburg, a visit to the Institute of Influenza focused on the response of Russia to the outbreak of avian influenza, particularly in the Siberian region of the country. The institute serves as the hub for the national effort to respond to the outbreak. The response was complicated by the large number of small poultry operations scattered over large geographical areas, which required

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U.S.-RUSSIAN WORKING GROUP ON BIOTERRORISM  the killing of tens of thousands of birds—both domestic and wild. Institute representatives emphasized the value of international collaboration, through the World Health Organization and other bilateral and international mechanisms, as essential in efforts to control this outbreak as well as other types of influenza that often cross international borders. (See Chapter 10 for more details on recent avian influenza outbreaks and control strategies in Russia.) A brief meeting with public health authorities of the city of St. Petersburg provided opportunities to consider the relationships between preparations for responding to a bioterrorism incident and ongoing activities directed to control of public health problems. The leadership for such response is vested within the Office of the Mayor, which can mobilize support from a wide variety of research and other scientific facilities throughout the city. The Security Committee of the city, which had just moved into very modern new premises with excellent com- munication facilities, has overall responsibility for overseeing all such incidents. Public health and scientific institutes are represented on the committee. To date, the only threat apparently has been a continuing influx of hoax letters—more than 1,000 in 2006—containing harmless white powder that have been received by various government organizations. AREAS OF COMMON INTEREST The roundtable discussions in Moscow reviewed key issues surrounding bioterrorism, and particularly developments in countermeasures in both coun- tries, that have arisen since the previous workshop in 2005. At the onset of the workshop, several participants urged the scientific and medical communities not to lose sight of the fact that nature has a prodigious arsenal of bioagents (some known, some not, most zoonotic) that are deleterious in their own right to hu- mankind. Of special concern are multidrug-resistant pathogens and pathogens for which there are no vaccines or therapeutic remedies, as well as nosocomial infections. Working group members pointed out that the challenge for the scientific community worldwide is multifaceted. Some focused on the need for the scien- tific community to make every effort to discover causative agents of disease with alacrity and great precision. To this end, highly sensitive detection and sample collection tools and devices should be available and a solid global team approach should be instituted. Within the context of international teamwork, the working group examined the strengths and weaknesses of previous collaboration strategies (the Cooperative Threat Reduction Program of the U.S. Department of Defense, the International Science and Technology Center, the U.S. Civilian Research and Development Foundation, the BioIndustry Initiative of the U.S. Department of State, the Nuclear Threat Initiative, and so forth). Several discussants stated that the focus of research and development on technical applications, preventive measures, and therapeutics must be comprehensive and take into consideration

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 COUNTERING TERRORISM all of the intricacies and niches of the biological agents of disease, as emerging biothreats are often species neutral. Additionally, an efficient and secure epide- miological data collection system should be developed to facilitate information reporting and exchange. Finally and most importantly, they felt that scientists and medical professionals must continue to draw on their skills and expertise to posi- tively influence the way governments shape biodefense and biodisaster policies. Although commonality in data collection and management is desired, it is not an easy feat to accomplish. In fact, some working group participants identified an even larger concern—that is, the extent to which scientists can safely acquire and disseminate the data. Joint projects and a certain degree of transparency benefit many researchers and communities; however, this same approach poses the potential threat of negative utilization and exploitation. These individuals emphasized the need for standard operating procedures worldwide for the han- dling of pathogens, along with criteria for the sharing of sensitive (and potentially deadly) scientific discoveries. Additionally, a global consensus is needed on a code of conduct of scientists engaged in biological research, particularly those handling “select agents.” The importance of education and specialized training for biomedical researchers and their professional development and recruitment and retention was highlighted by some working group members: We should not forget the value of increasing the scientific literacy of the general populace, which in turn can assist in efforts to recognize and respond appropriately to a biological catastrophe as well as ensure sustained scientific scholarship through public support. Working group members reaffirmed the value of international collabora- tion in assisting in the retention of biological scientists in Russia essential to strengthening the scientific workforce, strengthening the biological nonprolifera- tion regime by promoting transparency and fostering trust among scientists, and generating joint awareness and reporting of infectious diseases. Several members also suggested potential future joint initiatives in expanded biosafety and bios- ecurity activities, development of response technologies, development of medical countermeasures; and joint studies of emerging infections. Throughout the discussions, the members of the working group noted the im- portance of linking national activities with broader global programs. In particular, the roles of the World Health Organization, the Food and Agriculture Organiza- tion of the United Nations, and the World Organization for Animal Health were acknowledged.