Mounting a Biodefense

Dr. Deon Canyon and Dr. Benjamin Ryan

Daniel K. Inouye Asia-Pacific Center for Security Studies

Emergent infectious diseases are a constant threat to global health security. Southeast Asian countries are particularly vulnerable to infectious diseases due to their location, population density, rapid urbanization, increased development in wildlife areas and overwhelmed resources. In recent years, the Indo-Pacific has experienced outbreaks of COVID-19, severe acute respiratory syndrome (SARS), H1N1 influenza, avian influenza and the Zika virus. These outbreaks have highlighted the need for agile biodefense and biosurveillance systems and strategies in Southeast Asia. Arguably, the region is now the front line for fighting emerging infectious disease outbreaks, and there is an urgent need for countries to strengthen national biodefense strategies. Militaries can play key roles in anticipating and mitigating infectious disease risks. 

Existing Biodefense Strategies 

Several Southeast Asian nations recognize the importance of this issue and invest in the development of biodefense strategies to protect their populations. Singapore, for instance, developed a comprehensive strategy that includes early detection, rapid response and effective management of biological threats. This strategy includes establishing a National Centre for Infectious Diseases in 2019, a high-level biocontainment laboratory and a public health emergency operations center.

Thailand developed a strategic plan for bioterrorism preparedness and response, which includes establishing a bioterrorism surveillance system, capacity-building for laboratory and epidemiological surveillance, and training for medical personnel. 

Malaysia developed a National Disaster Management Framework in 2015. It includes establishing a national bioterrorism response committee and a bioterrorism surveillance system, and developing guidelines for laboratory and medical response to biological threats. 

The Philippines in 1991 was the first Southeast Asian country to adopt national security guidelines for this challenge. It developed a framework for biosecurity and biosafety that includes establishing a training program, developing guidelines for laboratory safety and security, and creating a national oversight committee. 

Indonesia established a national committee for biosecurity and biosafety, which oversees the development and implementation of policies and guidelines for handling and transporting biological agents. In 2020, Indonesia published a five-year National Action Plan for Health Security and announced a whole-of-government biosafety and biosecurity system for human, animal and agriculture facilities. 

In 2009, the 10-member Association of Southeast Asian Nations (ASEAN) ratified an Agreement on Disaster Management and Emergency Response that includes provisions for preventing and controlling infectious diseases. 

While not all Southeast Asian nations have a national biodefense strategy, all have developed policies and guidelines for surveillance, supporting biosafety and responding to biological threats. The platform is now in place to scale biodefense in each country and collectively across the region.

Emerging Pathogens from South Asia

Southeast Asian nations should make plans to counter emerging disease pathogens from South Asia. For example, in Bangladesh and India, infectious diseases can pose a significant threat to public health and regional security. Bangladesh and India are densely populated, which increases risks for the emergence and spread of infectious diseases. Both have experienced outbreaks such as tuberculosis, dengue fever, cholera and COVID-19, which affected not only their own populations, but also those of neighboring countries.

Many Southeast Asian nations have large populations, as well as significant trade and travel links with South Asian countries, which leaves them at risk of infectious diseases and outbreaks. 

The global spread of multidrug-resistant tuberculosis (MDR-TB) also is a significant problem in South Asia and Southeast Asia because of factors including the misuse of antibiotics, poor treatment adherence and inadequate infection control. Also, it is difficult to determine its transmission routes and the extent to which the disease is being transmitted between the regions. It is clear that efforts are needed to improve MDR-TB prevention, detection and treatment. 

To achieve this, Southeast Asian nations can collaborate with South Asian countries and international organizations to strengthen their public health systems, improve disease surveillance and reporting, increase laboratory capacity, enhance research and development, and promote sharing information and resources. These efforts can build resilience against emerging disease pathogens and ensure a coordinated and effective response to outbreaks.

Emerging Pathogens in the PRC

Southeast Asian nations also should make plans to counter emerging disease pathogens from the People’s Republic of China (PRC). For many reasons, the PRC is the globe’s largest disease incubator and preeminent disease disseminator. For instance, the PRC was ground zero for Asian flu in 1957 and Hong Kong flu in 1968, each causing over 1 million deaths worldwide; H5N1 bird flu in 1996; SARS in 2002, causing more than 750 deaths; A-H7N9 bird flu in 2017; H1N1 influenza; and COVID-19, causing 6.9 million deaths globally. The PRC was not ground zero for African swine fever, which killed nearly half the nation’s pigs, but its management and government policies resulted in the disease spreading to other countries. 

The Chinese Communist Party has been unwilling to collaborate with the global community in a transparent manner. Given Southeast Asia’s proximity to the PRC and its connections via trade and tourism, such poor governance increases the risk of emerging diseases spreading from the PRC. Beijing needs to work with other countries to detect, prevent and respond to epidemics. This cooperative approach is vital to protect public health, maintain global health security, and limit disruption to trade, tourism and investment which, unmitigated, can cause significant economic losses and widespread social turmoil.

Countering New Pathogens 

National biodefense strategies need to focus on key areas to effectively limit the cross-border spread of new pathogens. The backbone of any plan must be early detection and rapid response. Surveillance systems should be in place to detect pathogens at borders or in communities at an early stage. Surveillance should be backed up by adequate laboratory capacity to enable rapid identification and analysis to determine a pathogen’s origin. Rapid response teams with adequate resourcing and supplies should be in place to counter outbreaks, including providing medical care and isolation facilities.

Wastewater monitoring is an inexpensive and effective way to detect and track pathogens, including polio, SARS, HIV and the hepatitis B virus. Poliovirus in one toilet flush can be detected in a sewage treatment plant more than four days later. Use of this method greatly expanded during the COVID-19 pandemic. It allows for predicting localized outbreaks so hospitals can be better prepared and surveillance can be established to monitor virus evolution. 

A national biodefense strategy should prioritize development of laboratory facilities and scientific capacity, including improving equipment and infrastructure, training, and developing diagnostic tests for emerging infectious diseases. This enables early detection and rapid response. While vaccine development is an essential component of any national biodefense strategy for those countries with the capacity to support it, participation in vaccine development and trials is available to every country. Developing vaccines for emerging infectious diseases can take time, but a national biodefense strategy should prioritize this effort to ensure vaccine availability as quickly as possible.

Border control and travel restrictions proved vital in slowing the spread of COVID-19 for many countries. This helped buy time to learn how communities and nations could protect vulnerable populations while allowing society to function. A biodefense strategy should include measures to restrict travel to and from countries harboring infectious cases during outbreaks, including screening travelers for symptoms and quarantining patients. In the case of COVID-19, this strategy was successful for many small island nations. However, as the pandemic persisted, defenses faltered and pathogens entered. 

Fundamental to any crisis response are effective communication and information sharing. A biodefense strategy should establish communication channels with other nations to enable rapid information sharing on the spread of new pathogens and the implementation of appropriate responses. Several such networks exist, including the Pacific Public Health Surveillance Network (PPHSN) created by the World Health Organization and the Pacific Community in 1996. The PPHSN focuses on improving public health surveillance and responding to emergencies caused by dengue, measles, rubella, influenza, leptospirosis, typhoid fever, SARS, and HIV and other sexually transmitted infections. This is achieved through fusing health data, surveillance systems, computer applications, training and promotion of the network. 

Role of the Military

Military assets can support a national center for biodefense and biosurveillance by detecting and responding to biological threats. First, military laboratory facilities can supplement local labs by providing access to newer technology and trained personnel. These facilities can help develop and validate diagnostic tests for emerging infectious diseases, conduct research on pathogen detection and characterization, and support the production of vaccines and therapeutics. Military personnel also can train and support civilian organizations on best practices for handling and storing biological agents, implementing biosafety measures, and preventing accidental release of pathogens.

Military intelligence capabilities can provide early warning of potential biological threats. Intelligence assets such as surveillance systems, reconnaissance platforms and human intelligence networks can identify and track infectious disease outbreaks, providing critical information on the origin and spread of biological agents and the risk to human health.

Military medical response teams could be deployed by a national center for biodefense and biosurveillance to provide care and treatment, isolate and quarantine affected populations, and provide logistical support to distribute supplies and equipment. For instance, the United States Centers for Disease Control and Prevention Global Rapid Response Team (GRRT) has mobilized over 2,400 times since 2015 to support public health within the U.S. and abroad. The GRRT has responded to cholera, COVID-19, dengue, Ebola, hepatitis A, measles, polio, yellow fever, Zika, famine and natural disasters.

Also, the U.S. Defense Department and Navy are well positioned to deliver products and scale services such as vaccines, medical equipment, transportation and logistics chains. U.S. forces also could be the lead provider in logistical support and training, along with local or international nongovernmental organizations and medical staff to conduct clinical work. Such strategies, which are built on shared responsibility and commitment, were effective in tsunami relief efforts in Banda Aceh, Indonesia, via the USNS Mercy hospital ship.

Militaries also have significant logistics and supply chain management capabilities that can be used to rapidly transport personnel, medical supplies and equipment, provide secure storage and transportation of biological agents, and coordinate the distribution of vaccines and therapeutics. The best response combines key capacities from military, private sector and humanitarian logistics systems.

Improving Preparedness

A national biodefense strategy would ensure that Southeast Asian countries are better prepared to detect and respond to emerging and reemerging infectious diseases and to protect against bioterrorism. This should include robust surveillance systems for early detection and comprehensive planning, including risk assessment and medical countermeasures. Laboratory capacity for biosafety and biosecurity requires broad-scale improvements and must support research and development. Finally, communication and information sharing must be facilitated via international cooperation, education and training, and investment.

By leveraging military and private sector capabilities, national centers for biodefense and biosurveillance can enhance governments’ ability to detect and respond to threats, protect public health, and maintain national security.

Through such investment, as well as by enhancing communication and collaboration with South Asian countries, the PRC and partners such as the U.S., the region can mitigate the risk of emerging disease pathogens and protect public health and national security. Finally, national biodefense strategies are essential for protecting global health security and limiting the impact of emerging infectious diseases on human health and economies.  

This article originally was published in the Daniel K. Inouye Asia-Pacific Center for Security Studies’ Security Nexus, Vol. 24, in March 2023. It has been edited to fit FORUM’s format.

Components of a National Biodefense Strategy

Risk assessment: Identify potential biological threats and vulnerabilities.

Early detection and surveillance: Develop and maintain robust surveillance systems to quickly detect infectious disease outbreaks. This includes improving laboratory capacity, establishing a network of surveillance sites and enhancing the response capacity of public health agencies.

Laboratory capacity: Establish and maintain high-quality laboratory systems for identifying and characterizing biological agents. Priority should be given to training, and improving equipment and infrastructure.

Medical countermeasures: Ensure the availability of vaccines, drugs and diagnostics to prevent and treat infections.

Response planning and preparedness: Create a response plan that outlines the roles and responsibilities of relevant agencies, as well as protocols for managing suspected cases, contact tracing and providing medical care.

Public health response: Develop and implement strategies for biological threats, including emergency response plans and coordination of public health response activities.

Biosafety and biosecurity: Ensure the safe and secure handling, transportation and storage of biological agents to prevent accidental release or intentional misuse.

Research and development: Promote activities to advance the understanding of biological agents and the development of medical countermeasures.

Communication and information sharing: Prioritize the establishment of communication networks among countries to ensure timely and efficient information sharing on infectious disease outbreaks and to support
a coordinated response.

International cooperation: Collaborate with countries and international organizations to strengthen global health security and prevent the cross-border spread of biological threats.

Education and training: Enhance awareness of biological threats and build capacity for detection, prevention and response.

Funding and resources: Ensure funding and resources are available to implement and sustain a national
biodefense strategy.