A New Era in Health Security

The Issue

The CSIS Bipartisan Alliance for Global Health Security has evaluated the policy changes unfolding in the past several months as a new era in national, economic, and health security begins. This call to action is an appeal to the administration and Congress to protect and strengthen investments in health security programs, which make Americans safer, stronger, and more prosperous. The first order of business is to restore confidence and trust in health security policies and their execution. To that end, the alliance calls on the administration and Congress to (1) stabilize and modernize core health security capabilities; (2) secure and sustain U.S. leadership in science and biomedical research; and (3) accelerate innovations in financing that enable efficient, effective, and accountable health security investments. Together, these actions will ensure Americans remain protected, U.S. innovation remains competitive, and U.S. government programming is more efficient and sustainable going forward, assured of strong support among Americans.

Rebuilding Bipartisan Consensus

The CSIS Bipartisan Alliance for Global Health Security was launched in early 2023 to advance concrete, pragmatic policy to strengthen the health security of the United States and the world.¹ It recognizes that health security is an essential component of national and economic security and builds on a 60-year CSIS legacy of strong bipartisan analysis to inform policymakers in addressing U.S. national interests.

The alliance is committed to advancing approaches that mitigate the risks that biothreats pose to U.S. national security and economic competitiveness.² Its diverse membership includes over 60 seasoned policy experts in the life sciences, public health, security, foreign policy, industry, and philanthropy, many of whom have become signatories to this report.³ It prioritizes preparedness for detecting and responding to emerging outbreaks, analysis of the risks and opportunities of biotechnology innovation, U.S. investments in global immunizations and diseases such as HIV/AIDS, and U.S. diplomacy in the face of geopolitical competition. It has pressed for reforms at the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Department of Defense (DOD), the U.S. Department of State, the U.S. Agency for International Development (USAID), the White House, and in strengthening the U.S. relationship with private, bilateral, and multilateral partners.⁴

A Perilous Moment

Americans face unprecedented, persistent, and expanding health security threats. Infectious diseases that affect humans and agricultural industries continue to emerge and reemerge in a world that has never been more connected through travel, trade, technology, migration, and proximity to animals and other vectors. More than a dozen Ebola and Marburg outbreaks have occurred in the last five years. Tropical diseases such as dengue, leishmaniasis, zika, and chikungunya encroach on U.S. shores. There has been a resurgence of mpox, measles, and H5N1 and other strains of influenza with pandemic potential.⁵ Without warning, new lethal infectious diseases could emerge and spread uncontrollably—either caused by nature, a deliberate action, or large-scale accident—even at pandemic scale. The country is not prepared for these kinds of events.

Advances in artificial intelligence (AI), automation, and biotechnology have lowered the barrier for conducting advanced research.⁶ While these developments promise a new era of improved health, innovation, and economic growth, they also raise the risk of accidents in newly staffed high containment laboratories, and of deliberate misuse and weaponization of biology by bad actors operating through governments or on their own.⁷ There is a dangerous confluence of growing Chinese biomedical investments and collaboration at the same time that the United States is reducing research investments, scientific partnerships, and international commitments. Such an imbalance risks increasing U.S. dependence on China, ceding ground to China to set international norms and standards that may run against U.S. interests, and heightening U.S. vulnerability to future biological threats.

As happened after the 1918 pandemic, many people in the United States and elsewhere grew angry and frustrated during the Covid-19 pandemic that those they trusted were unable to protect them and their loved ones. The Covid-19 pandemic led to at least 1.2 million American deaths spanning two administrations and caused severe economic, social, and educational hardship. It exposed serious weaknesses in U.S. preparedness and deepened popular skepticism about science, the value of international investments, the trustworthiness of public health leaders, and tolerance of scientific dissent. It revealed the influence of misinformation in the digital era as legitimate concerns were spun into falsehoods and conspiracies by actors seeking to confound public confidence.⁸

Underlying this era of profound skepticism is the expansion of populist movements in America, from the left and the right. Rising economic insecurity has led many Americans to prioritize immediate kitchen table financial concerns. 

U.S. health security has undergone major changes in the opening months of President Trump’s second term.⁹ The administration has instituted extensive reductions in staff, funding, and programs across the U.S. government, including at the U.S. Department of Health and Human Services (HHS), with the closure of USAID, and through the U.S. withdrawal from the World Health Organization (WHO).¹⁰ Analyses about the potential impact of these changes are accumulating.¹¹ These developments have raised several crucial questions of national policy: (1) the value of U.S. deterrents against emerging biothreats, (2) the appropriate scale and prioritization of biomedical research and development investments, (3) the value of multilateral alliances and foreign assistance, and (4) the size and roles of key government agencies charged with overseeing these activities.

These many challenges notwithstanding, health security programs are essential tools of U.S. domestic and foreign policy that contribute to national security in demonstrable ways, with immense return on investment in terms of both lives and dollars saved. The vast majority of Americans believe that it is important for the United States to invest in health security and the U.S. scientific and medical research and development (R&D) enterprise, both at home and abroad.¹² There is also strong support for new reforms that will improve U.S. performance in the future and better protect Americans.

Recommendations for a Path Forward: The Alliance Call to Action

This is not a moment to look backwards but to build forward from current realities and engineer an orderly redesign that strengthens U.S. national security, informed by four key priorities.

1. Leaders in all sectors including government must work together to re-earn the trust and confidence of Americans and U.S. allies in U.S. health security strategy and its implementation.

Americans deserve a trustworthy, dependable network of public health and biosecurity protection to prevent and deter emerging threats. If the health security community is to effectively reach those Americans and others around the world who remain deeply skeptical about science, public health, and government authorities, Congress should invest in a new nonpartisan and collaborative strategy of engagement—one that is reliant on accessible language, trustworthy communicators, clear and consistent messages, and multichannel outreach that addresses what matters most to the American public. Engaging allies across the political spectrum, community leaders, and a variety of relevant media channels will be imperative to show relevance, demonstrate humility, engage in self-criticism, admit past mistakes, and focus on facts and evidence. Most importantly, Congress should ensure that federal departments and agencies listen carefully to the concerns of the American public. Congress should require that U.S. health security programs have clear timelines and outcomes, and that these programs provide annual reports to Congress that can be accessed by the general public describing how these programs protect Americans from domestic and global health threats.

2. The Trump administration, Congress, and governors should take immediate action to implement reforms that stabilize the core capabilities that protect Americans against biothreats.

Efficient Modernization

The health security reform agenda must be efficient and orderly; deliver concrete, verifiable results; and align with the administration’s stated goals of making America more secure, safe, and prosperous.¹³ The government should prioritize investments in modernized biological detection and response capabilities at home and abroad that take full advantage of emerging technologies and artificial intelligence. Core to this mission are a seamless network of domestic and global disease surveillance, genomic laboratory capabilities, emergency operations coordinating functions, biosafety and biosecurity advances, countermeasure research and development, supply chain stability, and most importantly, the talented staff, partnerships, and alliances that sustain them.

Federal Coordination

President Trump should combine the Global Health Security and Biodefense Directorate in the National Security Council (NSC) and the White House Office of Pandemic Preparedness and Response Policy into a new senior directorate for Biological Preparedness and Response (BPR) and retain the combined team as part of the NSC. Congress should authorize this change and ensure that the BPR senior director has sufficient resources to deliver on this mission, under the guidance of the national security advisor. President Trump and Congress should direct the BPR senior director to work with agency leaders, industry, and other partners to assess U.S. health security capabilities, including R&D, procurement, and manufacturing. This will reduce duplication and improve efficiency and integration as the administration updates the Global Health Security Strategy, and if it chooses to update the National Biodefense Strategy.¹⁴

The BPR senior director should work with key interagency leaders to craft a unified national strategic plan for health security investments that integrates siloed capabilities and establishes clear timelines and quantifiable impact metrics for each program to prevent, deter, and respond to the biothreats that endanger Americans.¹⁵ The administration should protect and sustain the President’s Emergency Plan for AIDS Relief (PEPFAR); continue U.S. support for the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Pandemic Fund; and restore its partnership with Gavi, the Vaccine Alliance. The BPR senior director should reevaluate and sustain bilateral health security investments around the world, including through the CDC, while effectively integrating them with other global health and global health security assistance.¹⁶ The administration and Congress should build stronger incentives to enhance coordination between departments and agencies working on human and animal health, especially HHS, the U.S. Department of Agriculture (USDA), and the DOD, given the health and economic threats posed by zoonotic diseases.¹⁷

Congress should reauthorize and resource the core capabilities in the Pandemic and All-Hazards Preparedness Act (PAHPA) to ensure that HHS is capable of developing, managing, and deploying flexible, scalable, accessible medical countermeasures on a 100-day timeline.¹⁸ Through authorities at the Administration for Strategic Preparedness and Response (ASPR, which HHS has proposed be split between the CDC and a new Assistant Secretary for a Healthy Future), including the Biomedical Advanced Research and Development Authority (BARDA) and the Strategic National Stockpile, the U.S. government should create a stronger civilian capability to maintain a warm industrial base through BARDA so that it does not fall back on the DOD in each successive emergency.¹⁹

The DOD does not have the mandate to support the civilian mission. However, the administration should strengthen DOD capacities, in close coordination with HHS, to ensure interoperability and minimize redundancies.²⁰ Those assets encompass force health protection through the DOD’s surveillance, preparedness, deterrence, threat reduction, and clinical medicine programs. At the same time, the administration should strengthen complementary capabilities at the U.S. Department of Energy (DOE), USDA, U.S. Department of Homeland Security, and other elements of U.S. biodefense.

Local, Domestic, and Global Capabilities

The most effective way to reach American communities is by protecting the domestic health security capabilities that serve them directly. America is only as strong as its weakest link, and longstanding underinvestment, post-pandemic burnout, and rural health facility closures have left millions of Americans without access to basic health care, public health, and health security protections.

The president should ensure that the fiscal year 2026 HHS budget includes sustainable funding for core preparedness and response capabilities at the local, state, tribal, territorial, and federal level. These capabilities were described in the 2018 National Biodefense Strategy adopted in the first Trump administration and have been outlined—though underfunded—by at least the past five administrations, from both parties.²¹ The administration should work with governors and mayors to identify and prioritize investment in core elements of U.S. health security, such as the National Emerging Special Pathogens Training and Education Center and the Hospital Preparedness Program. Governors, mayors, and tribal and territorial leaders simply cannot amass the data needed from outside their jurisdictions to help inform the investments they make within their respective communities.²² It falls to the federal government to support them by continuing to modernize automated data, wastewater surveillance, and other programs that help senior leaders assess risk and make prudent investments in preparedness. More accessible data dashboards, through modernization and modeling at the CDC in collaboration with state and local health officers and emergency managers, and specific funding for community outreach will help communicate the ongoing value of these capabilities in averting biothreats.

The most efficient and cost-effective way to stop outbreaks, whether domestic or international, is at their source. Congress should reconsider the dissolution of the CDC’s Global Health Center and maintain that capability at the CDC and overseas to assure prompt detection and competent response to emerging threats.²³ The CDC’s global technical and medical staff are a vital national resource with specialized training and experience that cannot be replicated in the State Department. U.S. international engagement—especially through the CDC’s international presence—supports ongoing relationships through which U.S. scientists continue crucial scientific exchange and get the first notification regarding emerging threats. Through those partnerships, the CDC is able to strengthen the ability of countries around the world to quickly detect and contain threats before they pose a risk to Americans. Time after time, the U.S. government has been the first outside state to learn of a dangerous outbreak and intervene early to stop its spread because local personnel trusted their CDC counterparts on the ground. Staff at the State Department Bureau of Global Health Security and Diplomacy will also remain essential for diplomatic engagement and programmatic oversight.

U.S. programs to develop and deploy vaccines are a critical national and global resource that must be preserved.²⁴ Bipartisan leaders in Congress should work with the administration as well as community, academic, and industry leaders to restore confidence in and the integrity of the Advisory Committee on Immunization Practices (ACIP), reaffirm decades of sound scientific inquiry, and preserve the broader enterprise of vaccine research, policy, and access for the United States. The CDC Global Immunization program should be preserved as a frontline tool against global outbreaks of preventable diseases.²⁵ The United States should restore its support for Gavi, the Vaccine Alliance, whose work in partnership with governments around the world has saved 18.8 million children’s lives since 2000.²⁶ CSIS will release additional analysis on vaccines and immunization programs in the coming weeks.

3. The Trump administration and Congress should take urgent steps to secure U.S. global leadership and competitiveness in science, biomedical research, and biosecurity innovation.

Bioscience Leadership

The approaching inflection point in the biosciences, aided by AI tools, provides a strategic pathway for continued U.S. leadership in biotechnology and biological discovery. Over the decades, such investments have generated major economic returns and benefited the United States through the development of new methods of tracking and preventing disease, new treatments (from antibiotics to CRISPR-enabled therapies), and better ways of protecting healthcare workers. The creative and safe use of AI and advanced bioengineering hold considerable promise for raising cost-effectiveness and building new alliances.

However, the U.S. competitive edge in spending on R&D, scientific publishing, registering patents, and generating new graduates continues to shrink.²⁷ In a recently completed study, the National Security Commission on Emerging Biotechnology warned that U.S. competitors, especially China, stand to outpace the United States in the next three years and beyond, unless significant investments are made to promote innovation, develop the workforce, and secure the next generation of breakthroughs.²⁸

Advancing Biosecurity Innovation

Congress and the administration should target strategic investments in U.S. biomedicine and biotechnology that match the state of today’s science. Investment in fundamental human research remains foundational to this entire enterprise.

HHS, DOD, and DOE should continue to partner to develop and deliver medical countermeasures on demand for the American people. It is essential to ambitiously fund BARDA and the Food and Drug Administration (FDA) to carry out the mission of developing medicines and vaccines the country needs, while also taking advantage of the DOD’s formidable contracting capacity and industrial base, along with DOE’s high-performance computing and AI-enabled capacity for design and testing. All this work should focus on achieving the goals of the 100 Days Mission, with metrics that are regularly monitored.²⁹ General technologies such as medical countermeasures will protect Americans against biothreats from any source, while targeted investments—in applied biosafety research or gene synthesis screening—will ward against accidents and deter bad actors from weaponizing biology.³⁰

Rebuilding and sustaining the pipeline of talent is essential and will require investments in the recruitment and retention of an adequate technically skilled workforce across the health and defense agencies, including authorities to enable speedier exchange between government and the private sector as well as new forms of technical vocational training. The administration should expedite the resolution of revised overhead guidelines for U.S. universities that define a fair and verifiable reimbursement for indirect costs of research.³¹ These guidelines should acknowledge the economic and health security benefits that rest on the United States’s unique ecosystem of existing and upcoming generations of American scientists, physicians, and innovators. Research grants, especially for young scientists through the National Science Foundation and the National Institutes of Health (NIH), remain essential to U.S. leadership and competitiveness in biomedical research across government, industry, and academic institutions, including academic medical centers. U.S. government investments and incentive programs remain critical to de-risk and unlock private sector capital on the next generation of biomedical innovations from the biotechnology and pharmaceutical sectors. These investments sustain a base of scientific capability, clinical research, and industrial power which cannot be rebuilt overnight.

Strategic Scientific Engagement

The administration should encourage a strategic degree of global engagement among U.S. experts at the NIH, the FDA, and the CDC, and international scientists, regulators, clinical trial specialists, and transnational private sector partners, to ensure continued progress on developing new generations of safe, effective, and protective countermeasures, treatments, and diagnostics for Americans. The administration should sustain U.S. leadership and membership in the Pan American Health Organization (PAHO) and work to reengage with the WHO to ensure early warning of new disease events, preserve U.S. influence on health issues internationally, keep U.S. companies from being cut out of the global marketplace, and to ensure that the United States is not flying blind in the face of emerging global biothreats.

Assuring U.S. primacy in the biosciences will be a fundamental part of U.S. diplomatic efforts in the coming decades as bilateral partnerships change. This includes industrial capacity to produce critical medicines, as more than 72 percent of facilities supplying active pharmaceutical ingredients (APIs) and the majority of finished product manufacturing are based outside of U.S. borders.³² The United States can work with allies and partners to generate unified industrial strategies to friend-shore capabilities and collectively reduce supply chain vulnerabilities, while incentivizing investment by generating greater collective market demand. This will help ensure Americans can get the medicines they need even in times of crisis.

The United States also has a responsibility to continue to refine regulations and routinize investment in biosafety and biosecurity protections for U.S. and partner scientists—as well as finding narrow pathways for dialogue with China and other strategic competitors—to ensure that innovation in the bioeconomy proceeds as safely as possible.³³ Support for biosafety and biosecurity measures should be integrated into U.S. grants and contracts for infectious disease research at home and abroad, through domestic and multilateral programs. The United States should consider creating a new federal biosecurity entity, such as the one recently recommended by the National Security Commission on Emerging Biotechnology.³⁴

4. The administration and Congress should accelerate the development of new financing instruments for health security, while revisiting existing approaches.

Rising concerns over unaddressed U.S. domestic challenges have prompted broad austerity measures, but health security programs continue to deliver outsized returns on investment and can become even more efficient. New, more cost-effective and economically sustainable ways of working will be essential if the United States is to maintain its role as a global leader. In particular, new forms of funding for health security hold considerable promise through the U.S. International Development Finance Corporation (DFC) and the Millennium Challenge Corporation (MCC), which has been under threat but should continue in some capacity. These U.S. institutions should work in partnership with the World Bank, regional financial institutions, and multilateral partners, and leverage U.S. contributions to these organizations to compel them to step up their global health security work.

The first Trump administration made an important contribution in creating the DFC to promote investment in partner countries in a more nimble, private sector–like approach. The president’s budget request for FY 2026 indicates that the DFC will be a lead element of U.S. foreign investment.³⁵ It will use tools that differ significantly from traditional global health implementers—including loans, guarantees, blended finance, private sector partnerships, development bonds, and insurance—that could be targeted instruments of sustaining health security capabilities. The DFC and the MCC should leverage investments for domestic resource mobilization and set clearer expectations for country ownership and financial pathways to build partners’ self-reliance.

In this new era, health security commitments should be focused on economic returns and clear pathways to hold partner governments accountable for taking over programmatic and financial ownership on a reasonable timeline. Under the MCC’s compacts, foreign and finance ministries were involved from the beginning to measure progress and ensure high-level buy-in. Such compacts should be one of the preferred vehicles through which the U.S. government makes future investments in global health security, to ensure that national resources cover foundational workforce and procurement needs while donor funding provides complementary support. Flagship U.S. programs such as PEPFAR should be reauthorized, sustained, and modernized through a five-year transition that concludes new compacts to align with these goals.³⁶

As the reauthorization of the DFC unfolds in the fall of 2025, special effort should be taken to map out how an enhanced DFC can advance evolving health security priorities with the private sector. Regional organizations including the Africa CDC and PAHO have already signaled a willingness to pursue new approaches to leverage public and private resources and should be approached as new potential partners to develop concrete incentives for domestic resource mobilization.³⁷

Some bilateral grant financing will still be needed as a bridge in the near term, especially in countries that are highly indebted with limited fiscal space. As bilateral U.S. missions and aid budgets shrink, the administration should seek efficient and sustainable uses of U.S. global health security dollars to preserve and sustain ongoing U.S. investments. International and regional financial institutions, including the World Bank, the Pandemic Fund, and the Global Financing Facility can help mobilize concessional financing and catalyze domestic resource mobilization while the United States shifts its grant funding to high-need areas. The State Department should consider creative new ways to work with and through the Global Fund, Gavi, the Pandemic Fund, and CEPI, which have transnational R&D, procurement, and delivery mechanisms that are force multipliers for U.S. taxpayer dollars.³⁸ These organizations have built-in cofinancing principles that hold governments accountable for investing their own funds to build country capacity and enable transition away from external support.

No Time to Lose

Although the Trump administration has ushered in a new era of health security, both globally and domestically, and the changes are painful and confusing to many, the imperative now is to begin building a vision of what comes next. The United States must rapidly implement reforms while stabilizing core capabilities and embracing new technologies. This is a critical national priority to secure the health of Americans for the coming decades.

In this next phase, the CSIS Bipartisan Alliance pledges to build on its long history of bipartisan engagement to help this and future administrations and Congress to develop and implement a smart reform strategy. Ultimately, success will rest on finding common ground despite the current polarization in U.S. society, restoring trust and confidence, and building a renewed, durable bipartisan consensus. The alliance can help bridge across experts, policymakers, and diverse U.S. communities to articulate the relevance of health security programs and the benefits they accrue for the economic stability and national security of the United States.

Above all, the new strategy needs to be grounded in faith in the United States, enduring American values, and the strategic importance of U.S. global leadership. Americans remain committed to U.S. health security leadership in the world. It is now the responsibility of the administration and Congress to chart and invest in what new forms that lifesaving work will take.

This report is produced under the auspices of the CSIS Bipartisan Alliance for Global Health Security, generously supported by a grant from the Gates Foundation.

Signatories

This paper conveys a majority consensus of the signatories, who are participating in their individual capacity, not as representatives of their respective organizations. No expert is expected to endorse every point contained in the paper. In becoming a signatory to the paper, experts affirm their broad agreement with its findings and recommendations. Language included in this report does not imply institutional endorsement by the organizations the experts represent.

Richard Burr, Former U.S. Senator (NC); Principal Policy Advisor and Chair, Health Policy Strategic Consulting Practice, DLA Piper; and Co-Chair, CSIS Bipartisan Alliance for Global Health Security

Julie Gerberding, Chief Executive Officer, Foundation for the National Institutes of Health; and Co-Chair, CSIS Bipartisan Alliance for Global Health Security

J. Stephen Morrison, Senior Vice President and Director, Global Health Policy Center, CSIS

Jerome Adams, Presidential Fellow, Executive Director of the Center for Community Health Enhancement and Learning; and Distinguished Professor of Practice, Purdue University

Jennifer Alton, President, Pathway Policy Group

Phyllis Arthur, Executive Vice President and Head of Healthcare Policy & Programs, Biotechnology Innovation Organization (BIO)

Asaf Bitton, Executive Director, Ariadne Labs

Katherine E. Bliss, Senior Fellow and Director, Immunizations and Health Systems Resilience, Global Health Policy Center, CSIS

Susan Brooks, Former U.S. Representative (IN)

Elizabeth (Beth) Cameron, Senior Adviser, Global Health Policy Center, CSIS; Senior Advisor, Brown Pandemic Center; and Professor of the Practice of Health Services, Policy and Practice, Brown University School of Public Health

Rocco Casagrande, Former Managing Director, Gryphon Scientific

Chris Collins, President and Chief Executive Officer, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria

Rear Admiral Thomas R. Cullison (Ret.), U.S. Navy; Senior Associate, Global Health Policy Center, CSIS

Enoh T. Ebong, President, Global Development Department, CSIS

Gary Edson, former Deputy National Security Advisor

Tom Frieden, President and Chief Executive Officer, Resolve to Save Lives

Maj. Gen. Paul Friedrichs (Ret.), U.S. Air Force; Senior Adviser, Global Health Policy Center, CSIS; and Adjunct Professor of Surgery, Uniformed Services University

Bruce Gellin, Senior Advisor, Georgetown University Global Health Institute; and Professor of Medicine (Adjunct), Georgetown University School of Medicine

Asha M. George, Executive Director, Bipartisan Commission on Biodefense

Nikolaj Gilbert, President and Chief Executive Officer, PATH

Jeffrey Gold, President, University of Nebraska System

Margaret “Peggy” Hamburg, Co-President, InterAcademy Partnership for Science, Health, and Policy (IAP)

Ambassador Karl Hofmann, CEO, HealthX Partners

Yanzhong Huang, Senior Fellow, Global Health, Council on Foreign Relations

Tom Inglesby, Director, Center for Health Security, Johns Hopkins Bloomberg School of Public Health

Seth G. Jones, President, Defense and Security Department; Harold Brown Chair, CSIS

Rebecca Katz, Professor and Director, Center for Global Health Science and Security, Georgetown University

Janeen Madan Keller, Deputy Director of Global Health Policy Program and Policy Fellow, Center for Global Development

Fred Khosravi, Chairman and Chief Executive Officer, Imperative Care

Heidi Larson, Senior Associate, Global Health Policy Center, CSIS; and Director, Vaccine Confidence Project™, London School of Hygiene & Tropical Medicine

Rebecca Martin, Vice President for Global Health and Director, Emory Global Health Institute, Emory University

Raj Panjabi, Senior Associate, Global Health Policy Center, CSIS

Stephanie Psaki, Senior Adviser, Global Health Policy Center, CSIS; and Distinguished Senior Fellow, Brown University School of Public Health

David A. Relman, Thomas C. and Joan M. Merigan Professor, Departments of Medicine and of Microbiology & Immunology, and Senior Fellow at the Freeman Spogli Institute for International Studies, Stanford University

Carolyn Reynolds, Senior Associate, Global Health Policy Center, CSIS; and Co-Founder, Pandemic Action Network

Deborah G. Rosenblum, Former Assistant Secretary of Defense for Nuclear, Chemical and Biological Defense Programs

Leonard Rubenstein, Senior Associate, Global Health Policy Center, CSIS; and Distinguished Professor of the Practice, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health

Stephanie Segal, Former Senior Fellow, Economics Program, CSIS

Michaela Simoneau, Associate Fellow, Global Health Policy Center, CSIS

Stewart Simonson, Senior Adviser, Global Health Policy Center, CSIS

Jeffrey L. Sturchio, Senior Associate, Global Health Policy Center, CSIS; and Chairman of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria

Krishna Udayakumar, Founding Director, Duke Global Health Innovation Center; and Associate Professor of Global Health and Medicine, Duke University

Jaime Yassif, Vice President, Global Biological Policy and Programs, Nuclear Threat Initiative

Acknowledgements

Special thanks to Alliance members, many of whom are listed above as signatories, for their many contributions to the group’s deliberations and for their essential guidance throughout the drafting of this report. Luciana Borio, Janet Fleischman, Jennifer Kates, Jimmy Kolker, Jeremy Konyndyk, Mitchell Wolfe, and several other members also shared critical expertise with the group, though they bear no responsibility for the Alliance’s final analysis and recommendations. Special thanks to CSIS staff Sophia Hirshfield, Maclane Speer, Caitlin Noe, Priya Chainani, Hana Fentahun, and Hannah Lee for their support of Alliance meetings in advance of this report, and to the CSIS Dracopoulos iDeas Lab and External Relations staff for their efforts in producing and promoting this report.