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

Career & Field Overview

• There is a recognized need for greater cross-fertilization between public health professionals and those with national security training, though both groups currently remain in the minority within their respective fields.
• Dr. Inglesby advocates for interdisciplinary work, noting that the most effective solutions to biosecurity problems often exist at the "seams" between disciplines (e.g., clinical care, policy, law, and social science).
• The Center for Health Security (CHS) at Johns Hopkins is actively hiring analysts (typically requiring a Master's degree) and runs an annual Emerging Leaders Fellowship in Biosecurity, which selects 28 fellows from a pool of roughly 100-110 applicants.
• The Emerging Leaders Fellowship is a part-time program involving three in-person sessions (in Washington D.C., a university hub like Oxford or Boston, and a research symposium) designed to build a network of 130+ professionals across government, academia, and industry.

Risk Assessment & Priorities

• Natural vs. Human-Caused Risks: Natural pandemics currently represent the highest probability of occurrence, but the probability and feasibility of deliberate or accidental biotech misuse are increasing as biotechnology becomes more accessible and "de-skilled."
• Influenza Uncertainty: Annual influenza remains a top concern due to unpredictability in timing, severity, and vaccine effectiveness, with case fatality rates in the wild-type virus being negligible compared to potential pandemic strains like H7N9 (approx. 40% CFR) or H5N1.
• Global Catastrophic Biological Risks (GCBRs): Dr. Inglesby supports prioritizing research into worst-case scenarios (potential extinction-level events) but argues against creating a separate, zero-sum field; instead, he believes these risks should be addressed by expanding the existing public health and biosecurity communities to include GCBR considerations.
• Neglected Areas: Deliberate misuse of biotechnology receives comparatively less funding and attention than natural epidemic response, while dedicated efforts specifically focused on high-consequence laboratory accidents are even more limited.

Strategic Approach & Definitions

• Terminology: "Health security" is the broadest term, encompassing responses to epidemics, natural disasters, and chemical/nuclear events. "Biosecurity" in the US context includes natural, deliberate, and accidental biological threats.
• US Biodefense Strategy: A new US Biodefense Strategy is in its final stages, mandated by law to integrate natural, deliberate, and accidental threats (human, animal, plant; domestic and international) into a single government-wide framework, moving away from siloed agency approaches.
• Sustainability of Focus: Dr. Inglesby warns that creating parallel systems for catastrophic risks without connection to day-to-day public health operations is unsustainable; such systems fail without exercise, broader constituent support, and integration with existing scientific communities.
• Avoiding Conflict: Advocating exclusively for catastrophic risks can alienate the scientific community whose innovations are necessary for solutions; a collaborative approach that integrates high-end risk prevention with routine epidemic response is preferred to avoid political backlash.

Policy & Government Performance

• Global Health Security Agenda (GHSA): Launched in 2014 with a US commitment of $1 billion over five years to help 39 countries improve epidemic prevention and response; while politically supported, its future funding depends on US congressional appropriations.
• Legislative Recommendations: Key areas for US government funding to protect are: (1) GHSA, (2) the creation of a dedicated public health emergency response fund (distinct from FEMA's disaster fund to avoid legislative delays during crises), and (3) sustained hospital preparedness funding for mass casualty events.
• Agency Gaps: No single US government agency currently holds a specific mandate or dedicated budget for planning "low probability, high magnitude" catastrophic events; responsibilities are fragmented across the CDC, HHS, and ASPR, which prioritize immediate crises.
• International Governance: The Biological Weapons Convention (BWC) is underfunded compared to nuclear or chemical treaties; strengthening it requires advocacy for the State Department's portfolio and supporting UN Security Council Resolution 1540 regarding national laws against non-state biological weapon development.

Technology & Safeguards

• Biotech Trends: Technologies like CRISPR-Cas9 are advancing rapidly, driven by market forces, making them impossible to "turn off" or fully control; they are inherently international and difficult to classify.
• Safeguard Levers: Primary interventions include: (1) scientific norms and self-governance by the research community, (2) industry-led screening systems (e.g., gene synthesis companies screening orders), (3) National Academies of Sciences setting policy norms, and (4) regulatory programs like the US Select Agent rule.
• Limitations of Tech Fixes: No single technological solution can prevent deliberate misuse by hostile actors; a "mix of safeguards" including raised scientific consciousness and international norms is required.
• Future Priorities: Long-term goals include dramatically accelerating vaccine/medicine development timelines, enabling distributed global manufacturing capabilities, and building robust national clinical response teams for international deployment.

Career Pathways & Education

• Recommended Training: Deep expertise in a specific realm (epidemiology, basic science, clinical medicine, economics, law, or ethics) is highly valuable; clinical or scientific training provides a competitive advantage for rising to senior leadership roles.
• Graduate Programs: Top institutions include Johns Hopkins (MPH/PhD), George Mason (Biodefense), Georgetown (Global Health Security), Harvard School of Public Health (Governance/Modeling), and the London School of Hygiene & Tropical Medicine.
• Government Entry: The AAAS Science & Technology Fellowship Program is a primary pathway for scientists to enter government policy roles (Congress, State Department); the CDC's Epidemiological Intelligence Service (EIS) is the premier program for practical outbreak investigation training.
• Key Contacts & Supervisors: Specific experts recommended include Greg Koblenz (George Mason), Julie Fisher and Rebecca Katz (Georgetown), Mark Lipsitch (Harvard), Megan Palmer and David Relman (Stanford), and Ian Lipkin and Steve Morse (Columbia).

Forward-Looking Statements

• Feasibility of Prevention: Dr. Inglesby notes that while the likelihood of an extinction-level event is difficult to quantify, the changing global landscape (urbanization, increased travel, encroachment on wildlife) has increased the risk of extraordinarily substantial epidemics compared to historical norms.
• Political Evolution: He expects that just as the "Biodefense" concept evolved from ridicule to consensus following the anthrax attacks and 9/11, the integration of GCBR planning into standard government policy will eventually occur, though it requires time and coalition-building.
• Research Needs: There is a significant need for more quantitative risk assessment and "risk scoping" to understand emerging threats, as well as more people working in science policy and international diplomacy to translate scientific risks into actionable governance.
• Systemic Resilience: Success in health security depends on shifting from a cycle of "neglect followed by emergency" to sustained investment in global public health infrastructure and medical systems that can operate continuously regardless of immediate threat levels.