#12 - Dr Cameron works to stop you dying in a pandemic. Here’s what keeps her up at night.

Organizational Context

• The Nuclear Threat Initiative (NTI) was founded in 2001 by Senator Sam Nunn and Ted Turner to reduce risks from weapons of mass destruction (nuclear, biological, chemical, radiological, and cyber).
• NTI operates as a "think tank" that catalyzes activities by convening governments, NGOs, and civil society to develop creative solutions to CBRN threats.
• Secretary Ernest Moniz (former US Energy Secretary) serves as NTI CEO as of early 2017.
• NTI has a history of impacting global security, including co-sponsoring the first WHO emergency outbreak response fund and facilitating the Global Dialogue at the Nuclear Security Summit.
• NTI is launching a competition for the "Next Generation Global Health Security Network" ahead of the Kampala Ministerial in October to engage emerging leaders across different sectors and countries.

Current Projects and Strategic Focus

• NTI is leading a pilot project to develop a Global Health Security Index in partnership with the Johns Hopkins Center for Health Security and the Economist Intelligence Unit, supported by the Open Philanthropy Project and the Robertson Foundation.
• The Index aims to create common metrics for countries to assess national capacity for health security, incorporating broader indicators like political security, economic security, and global norms.
• NTI is focusing on the intersection of technological innovation and security, seeking to align the innovation community with the security community to develop international standards and norms for dual-use biological technologies.
• NTI is working to convene diverse government ministries (health, foreign affairs, defense) to improve biosecurity commitments, noting a historical lack of engagement from non-health sectors in multilateral forums.

Risk Landscape and Threat Assessment

• Biological risk is increasing in both likelihood and importance due to air travel, conflict, migration, urbanization, and growing terrorist interest in WMDs.
• Dr. Cameron argues that pandemic preparedness requires a dual approach integrating public health and national security, as these threats are no longer siloed.
• The "cycle of panic and neglect" describes the tendency of governments to fund and oversee biosecurity only during crises, leaving preparedness low during calm periods despite being the optimal time for investment.
• There is currently no adequate pandemic emergency response fund in the US, and many nations prioritize infrastructure (roads) over health systems during budget decisions.
• The risk of dual-use technology is elevated, particularly the increasing ability to create pathogens (e.g., the recreation of horsepox portending smallpox synthesis) for which countermeasures may not exist.
• Dr. Cameron does not advocate for stopping dual-use technology, noting that these same technologies (e.g., DNA synthesis) are essential for creating countermeasures, vaccines, and drugs.
• The primary concern is the separation of technology developers from risk assessors; the solution is integrating risk assessment into the technology development phase rather than a moratorium.

Policy and Governance Challenges

• The US Congress mandated four departments (Defense, HHS, Agriculture, DHS) to develop a new biodefense strategy in 2017, which is expected to garner bipartisan attention.
• The US implemented a moratorium on funding for specific gain-of-function research (SARS, MERS, flu) following biosafety incidents in 2014-2015, later lifting it with a new oversight policy in early 2017.
• There is no global mechanism to coordinate international moratoriums or risk assessments; if one country stops funding, research often shifts to other nations with weaker safety protocols.
• Current governance focuses on specific pathogen lists, making it difficult to assess risks associated with novel or modified agents.
• The Global Health Security Agenda (GHSA) has established metrics and an external evaluation mechanism (Joint External Evaluations) where experts assess countries against 19 target areas; over 50 countries have completed this, including the US.
• The US government has historically under-prioritized biosecurity, often placing it below issues like nuclear security and climate change unless a specific crisis is active.

Ebola Response Analysis

• The 2014-2015 Ebola outbreak exposed critical failures in biosurveillance, data analysis, and global coordination, with the WHO initially failing to raise the alarm effectively.
• A significant factor in containing the outbreak was the shift in burial practices in West Africa, replacing traditional contact-based rites with safe burial protocols supported by USAID.
• The response highlighted the need for a high-level, singular point of accountability for biological crises within the US government (e.g., the Ebola Response Coordinator role).
• The "PHEMA" (Public Health Emergency Management Agency) concept was proposed to mirror FEMA's role for disasters but specifically for public health emergencies.
• Personal tragedies included high mortality among health workers and severe stigma faced by survivors, which continues to impede community engagement and research.
• The crisis underscored the necessity of "exercise" (simulations) to test response systems, as real-world coordination during the Ebola crisis was often hampered by lack of preparedness.

Future Needs and Recommendations

• NTI recommends establishing a global fund to leverage domestic government funding for pandemic preparedness, helping countries fill gaps identified in external evaluations.
• The Coalition for Epidemic Preparedness Innovations (CEPI) is a promising public-private partnership for rapidly developing and distributing vaccines, but more investment is required globally.
• Specific technological needs include pandemic prediction capabilities (treating disease emergence like weather forecasting) and security-focused innovations (e.g., DNA synthesizers that cannot create smallpox).
• There is a significant talent gap; the field requires interdisciplinary experts who combine science, policy, and security, as biosecurity is often viewed as a niche lacking funding and trained personnel.
• Advocacy is identified as a missing component; grassroots campaigns are needed to shift public and political perception from "response" to "prevention."
• For early-career professionals, recommended entry points include the Emerging Leaders in Biosecurity (ELB) program, the NextGen GHS Network, and conferences like the ASM Biodefense Conference.
• Dr. Cameron encourages diverse educational backgrounds (biology, political science, anthropology) and suggests that no single pipeline exists, advocating for building networks across disciplines.
• Recommended government employers for global health security include the CDC Center for Global Health, USAID's Bureau for Global Health, the State Department (for health diplomacy), and the Department of Defense (for surveillance and lab networks).