Sep 17, 2018, 9:39 AM ETInterview, Podcast

#27 - Dr Tom Inglesby on careers and policies that reduce global catastrophic biological risks

Natural pandemics currently pose the highest probability risk (e.g., seasonal influenza is unpredictable annually), though human-caused risks (deliberate and accidental) are growing as biotechnology becomes more accessible and "de-skilled."
H7N9 bird flu in China has a case fatality rate of approximately 40%, compared to ~0.01% for seasonal flu, illustrating the potential severity of novel strains.
The field is currently skewed toward natural events, with significantly more funding, institutions, and experts dedicated to natural epidemics than to deliberate misuse or accidental laboratory releases of pathogens.
Global Catastrophic Biological Risks (GCBRs) (events causing billions of deaths) are considered possible but difficult to quantify; Dr. Inglesby argues these should be studied intensively but integrated into the broader health security field rather than treated as a separate, competing sector.
Historical precedents are insufficient for future prediction due to changing demographics (megacities), travel speed (24-36 hours to any location), and agricultural encroachment on wildlife habitats.

Health Security is the broadest term, encompassing prevention and response to all public health emergencies, including epidemics, natural disasters, nuclear events, and chemical spills.
Biosecurity in the US context is inclusive of natural, deliberate, and accidental biological threats; however, definitions vary globally (e.g., sometimes referring only to animal health or pest control).
US Biodefense Strategy is currently in its final stages, marking the first time federal law requires a unified strategy covering international/domestic and human/animal/plant threats, aiming to coordinate disjointed agency efforts.
Center for Health Security (CHS) prioritization relies on qualitative judgment of "scale, neglectedness, and tractability" rather than pure mathematical modeling, due to the lack of sufficient historical data for low-probability, high-impact events.
Zero-sum thinking is discouraged; resources should not be diverted from routine epidemic preparedness to GCBRs, as the underlying systems (medicines, vaccines, hospitals) and personnel overlap significantly.

Open Philanthropy Project provided a $16 million grant to Johns Hopkins' Center for Health Security in the previous year to expand work on global health security and catastrophic risks.
CHS Mission focuses on diminishing epidemic consequences and building community resilience through multidisciplinary teams (clinicians, lawyers, social scientists) operating at the intersection of fields.
Emerging Leaders Fellowship Program (funded by Open Philanthropy) selects 28 fellows annually from a pool of ~110 applicants; it is designed to build a network of early-career professionals from diverse backgrounds (academia, government, biotech).
Fellowship Structure involves three intensive in-person sessions (Washington DC, summer research symposium, and an international location like Oxford or Boston) plus alumni networking.
Job Openings include analyst positions requiring Master's degrees (Public Health, Biotechnology, Clinical, or Foreign Policy) and a willingness to work on multidisciplinary projects like the Global Health Security Index.
AAAS Science and Technology Policy Fellowship is highlighted as a primary pathway for PhD holders to enter US government science policy roles.
CDC's Epidemiological Intelligence Service (EIS) is cited as the world's flagship program for practical outbreak investigation training, highly valued even for those pursuing academic careers.

Global Health Security Agenda (GHSA) launched in 2014 to help countries meet International Health Regulations; while broadly supported, its funding is currently under review in the US budget process.
US Budgetary Concerns: Advocates are calling for a dedicated "public health emergency response fund" (similar to FEMA for disasters) to avoid the 200+ day delay seen during the Zika response, and to protect hospital preparedness and public health system budgets.
Biological Weapons Convention (BWC) is described as under-resourced compared to nuclear or chemical weapons treaties; advocacy for strengthening this convention and supporting national laws (UN Security Council Resolution 1540) is a key entry point for diplomats and lawyers.
Current GCBR Status: The field is largely in the "risk scoping" phase, focusing on raising awareness and integrating GCBR concepts into existing pandemic preparedness frameworks rather than deploying specific "magic bullet" technologies.
Biotechnology Safeguards: The most effective immediate measures are self-governance norms among scientists (e.g., post-Asilomar style guidelines), voluntary screening of gene synthesis orders by companies, and engagement with National Academies of Sciences to set dual-use research norms.

Life Science in Government: A significant gap exists in hiring individuals with life science backgrounds for high-level government policy roles, which have historically favored engineering and physics.
Academic Hubs: Key graduate programs and institutions mentioned include Johns Hopkins, George Mason (biodefense), Georgetown, Harvard, London School of Hygiene, Columbia, RAND Corporation, and US National Academies of Sciences.
Career Advice: Dr. Inglesby recommends acquiring deep expertise in a specific discipline (epidemiology, law, ethics, or basic science) early in one's career, as interdisciplinary collaboration is most effective when team members possess deep domain knowledge.
Future-Proofing: Work should be "shovel-ready" or tied to existing government mandates (e.g., GHSA, Select Agent Rules) to ensure sustainability, as purely theoretical or scenario-based programs often fail to secure long-term funding.