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Over the past 50 years, attention has intensified on Biological and Toxin Weapons Convention (BWC) Article X, which obligates states parties to provide international cooperation and assistance (ICA) and ensure the broadest accessibility of biology for peaceful purposes. In the absence of a treaty protocol and institutional support, Article X’s scope of activities and standard for compliance remain up to the interpretation of each state party. The Ninth BWC Review Conference established the Working Group on the Strengthening of the Convention (Working Group) and mandated it to address ICA, including establishing a mechanism to facilitate Article X implementation. Utilizing a mixed-methods methodology, this study characterizes the landscape of Article X and ICA perspectives among BWC delegations and other stakeholders. It identifies concrete opportunities to strengthen Article X implementation, in support of the Working Group’s efforts, including a pillar framework to illustrate alignment across an ICA mechanism’s roles, activities, and resources.
In the absence of a treaty protocol or verification regime, the Biological and Toxin Weapons Convention (BWC) instituted confidence-building measures (CBMs) as a mechanism to increase confidence in compliance by enhancing transparency and mitigating ambiguities regarding states parties’ biological activities. While a promising tool to support treaty compliance, low participation, concerns regarding the completeness and accuracy of CBM submissions, a dearth of analysis, and restricted access to many submissions have limited CBMs’ value. Through interviews with 53 international experts—38 from BWC delegations and 15 independent experts—we identified concrete opportunities to increase CBMs’ value while mitigating the burden on states parties. This study supports states parties’ efforts in the BWC Working Group on the Strengthening of the Convention, as part of a series of research on BWC assurance that aims to characterize challenges around BWC verification and increase certainty in BWC compliance.
To assess experience, physical infrastructure, and capabilities of high-level isolation units (HLIUs) planning to participate in a 2018 global HLIU workshop hosted by the US National Emerging Special Pathogens Training and Education Center (NETEC).
Design:
An electronic survey elicited information on general HLIU organization, operating costs, staffing models, and infection control protocols of select global units.
Setting and participants:
The survey was distributed to site representatives of 22 HLIUs located in the United States, Europe, and Asia; 19 (86%) responded.
Methods:
Data were coded and analyzed using descriptive statistics.
Results:
The mean annual reported budget for the 19 responding units was US$484,615. Most (89%) had treated a suspected or confirmed case of a high-consequence infectious disease. Reported composition of trained teams included a broad range of clinical and nonclinical roles. The mean number of HLIU beds was 6.37 (median, 4; range, 2–20) for adults and 4.23 (median, 2; range, 1–10) for children; however, capacity was dependent on pathogen.
Conclusions:
Responding HLIUs represent some of the most experienced HLIUs in the world. Variation in reported unit infrastructure, capabilities, and procedures demonstrate the variety of HLIU approaches. A number of technical questions unique to HLIUs remain unanswered related to physical design, infection prevention and control procedures, and staffing and training. These key areas represent potential focal points for future evidence and practice guidelines. These data are important considerations for hospitals considering the design and development of HLIUs, and there is a need for continued global HLIU collaboration to define best practices.
This article describes implementation considerations for Ebola-related monitoring and movement restriction policies in the United States during the 2013–2016 West Africa Ebola epidemic.
Methods:
Semi-structured interviews were conducted between January and May 2017 with 30 individuals with direct knowledge of state-level Ebola policy development and implementation processes. Individuals represented 17 jurisdictions with variation in adherence to US Centers for Disease Control and Prevention (CDC) guidelines, census region, predominant state political affiliation, and public health governance structures, as well as the CDC.
Results:
Interviewees reported substantial resource commitments required to implement Ebola monitoring and movement restriction policies. Movement restriction policies, including for quarantine, varied from voluntary to mandatory programs, and, occasionally, quarantine enforcement procedures lacked clarity.
Conclusions:
Efforts to improve future monitoring and movement restriction policies may include addressing surge capacity to implement these programs, protocols for providing support to affected individuals, coordination with law enforcement, and guidance on varying approaches to movement restrictions.
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