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Southeast Asia Strategic Multilateral Dialogue on Biosecurity Southeast Asia Strategic Multilateral Dialogue on Biosecurity Anita Cicero,1 Diane Meyer,1 Matthew P. Shearer,1 Sazaly AbuBakar, Ken Bernard,2 W. Seth Carus,2 Chee Kheong Chong, Julie Fischer, Noreen Hynes, Tom Inglesby, Chong Guan Kwa, Irma Makalinao, Tikki Pangestu, Ratna Sitompul, Amin Soebandrio, Pratiwi Sudarmono, Daniel Tjen, Suwit Wibulpolprasert, Zalini Yunus A strategic multilateral dialogue related to biosecurity risks in candid discussions about the priorities, challenges, in Southeast Asia, established in 2014, now includes par- and developments related to biosecurity risks in South- ticipants from Singapore, Malaysia, Indonesia, Thailand, east Asia. the Philippines, and the United States. This dialogue is con- This biosecurity dialogue is conducted at the Track ducted at the nonministerial level, enabling participants to II level, rather than as a formal Track I (i.e., ministerial engage without the constraints of operating in their official level) exchange. Track II diplomacy involves informal capacities. Participants reflect on mechanisms to detect, mitigate, and respond to biosecurity risks and highlight bi- discussions that take place outside official government osecurity issues for national leadership. Participants have channels, enabling a more open and frank exchange of also identified factors to improve regional and global bios- ideas and exploration of possible solutions to problems ecurity, including improved engagement and collaboration (1). These types of dialogues provide a forum for partici- across relevant ministries and agencies, sustainable fund- pants to establish lasting relationships and partnerships ing for biosecurity programs, enhanced information sharing with their counterparts in other countries in advance of for communicable diseases, and increased engagement in a crisis and to discuss common challenges and best prac- international biosecurity forums. tices. Track II formats enable participants to freely share perceptions, vulnerabilities, and new ideas without the Strategic Multilateral Dialogue on Biosecurity was constraints experienced when persons are operating in A established in 2014 that now includes participants their respective official capacities. from Singapore, Malaysia, Indonesia, Thailand, the Phil- Participants in this dialogue (Appendix, https:// ippines, and the United States. This dialogue was initiat- wwwnc.cdc.gov/EID/article/25/5/18-1659-App1.pdf), ed to engage high-level current and former government which includes up to 5 participants from each country, officials and nongovernmental experts and stakeholders reflected collectively about how to effectively detect and mitigate biosecurity risks, especially those faced Author affiliations: Johns Hopkins Center for Health Security, Balti- in Southeast Asia, and they shared information and more, Maryland, USA (A. Cicero, D. Meyer, M.P. Shearer, exchanged ideas on mechanisms to highlight major bi- T. Inglesby); Johns Hopkins Bloomberg School of Public Health, osecurity issues for national leadership. Participants Baltimore (A. Cicero, D. Meyer, M.P. Shearer, T. Inglesby); included current and former senior-level government of- University of Malaya, Kuala Lumpur, Malaysia (S. AbuBakar); ficials and subject matter experts from across relevant US Public Health Service, Washington, DC, USA (K. Bernard); ministries and sectors, including academia, health, de- National Defense University, Washington (W.S. Carus); Ministry fense, and homeland security/home affairs. Persons who of Health, Kuala Lumpur (C.K. Chong); Georgetown University have participated in this dialogue since its inception Medical Center, Washington (J. Fischer); Johns Hopkins are also listed (Appendix). These participants are also University, Baltimore (N. Hynes); S. Rajaratnam School of in positions to transmit key messages to the most se- International Studies, Singapore (C.G. Kwa); University nior levels of government and through major regional of the Philippines Manila College of Medicine, Manila, the forums, such as the Association of Southeast Asian Na- Philippines (I. Makalinao); University of Singapore, Singapore tions (ASEAN). The Johns Hopkins Center for Health (T. Pangestu); University of Indonesia, Jakarta, Indonesia Security convenes the dialogue and has hosted meetings (R. Sitompul, A. Soebandrio, P. Sudarmono); Mayapada thus far in Singapore, Malaysia, Indonesia, and the Unit- Healthcare Group, Jakarta (D. Tjen); Ministry of Public Health, ed States. The purpose of this report is to describe in- Bangkok, Thailand (S. Wibulpolprasert); Ministry of Defence, sights that have emerged from this ongoing dialogue and Kuala Lumpur (Z. Yunus) 1These authors contributed equally to this article. DOI: https://doi.org/10.3201/eid2505.181659 2Retired. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 25, No. 5, May 2019 e5 ONLINE REPORT suggest priority areas for action to strengthen national Ebola, increase operational readiness to isolate and man- and regional biosecurity. age suspected cases, and prepare Ebola-specific risk com- munication (7). Biological Threats that Can Impact Regional Growing threats from sophisticated terrorist groups, and Global Health, Security, and Economies including a number emerging from Southeast Asia, have Numerous risk factors in Southeast Asia increase the vul- raised concerns about the potential for deliberate biologi- nerability of this region to natural, deliberate, and acciden- cal attacks in the region and across the globe. A particu- tal biological threats. Countries in the region have made larly concerning trend is the increasing presence of the major progress in fighting infectious diseases within their so-called Islamic State and affiliated groups, as territo- own borders; however, the widespread geographic popu- rial losses in Iraq and Syria have forced them to shift op- lation distribution—ranging from remote, rural villages erations to other regions (8). In addition, an increasing to densely populated cities—combined with highly mo- number of high-containment laboratories that work with bile populations (e.g., tourists, migrant workers, displaced high-consequence human, animal, or plant pathogens and persons) and areas of porous international borders create emerging biotechnology, including synthetic biology, a dynamic human–animal–plant–environment (i.e., One highlight the need for structured laboratory oversight to Health) interface that enhances the susceptibility of the re- prevent deliberate and accidental releases of dangerous gion to the emergence and spread of infectious diseases. pathogens. Detection and prevention of deliberate misuse Because of increasing ease and speed of travel, infectious will be challenging because of the increase in dual-use disease threats in a country are threats to neighboring and research (i.e., life sciences research with the potential to distant countries alike. In Southeast Asia, intraregional be used both for beneficent and nefarious purposes) 9( ). It airlines have seen explosive growth over the past 10–15 is simply not possible to eliminate the risk of the nefari- years, making regional travel more convenient and afford- ous use of biology because of the ubiquity of raw materi- able (2–4). The susceptibility of this region to the spread als, equipment, basic scientific knowledge, and advanced of infectious diseases was exemplified during the severe technologies. Thus, efforts to engage the scientific com- acute respiratory syndrome (SARS) epidemic during 2003, munity and implement effective organizational oversight which began with the index case in Guangdong Province, and rigorous monitoring and reporting procedures are China, and rapidly spread around the world, including to critical to mitigating the risk. If one considers the poten- Indonesia, Malaysia, the Philippines, and Singapore, ulti- tial consequences to public health, national security, and mately killing >750 persons (5). the economy, dedicated national, regional, and global ef- In addition to the cost of human lives, infectious dis- forts are required to prepare for and respond to a broad ease outbreaks can seriously damage or even devastate range of biological threats, whether they be natural, ac- economies because of impacts on international trade and cidental, or deliberate. local tourism, both of which might slow or grind to a halt. Again, when we used the SARS epidemic during Preparing for and Responding to Biological 2003 as an example, Malaysia lost ≈US $1.7 billion and Threats Requires Coordination across Thailand lost ≈US $33.5 billion in tourism, and Singa- Disciplines and Sectors pore lost ≈US $4.9 billion in gross domestic product dur- The complex nature of biosecurity threats necessitates mul- ing 2003 (5). A dialogue participant also discussed the tisectoral engagement to identify and implement effective tremendous economic impact of the outbreak of Nipah prevention and response mechanisms. These mechanisms virus infection in Malaysia during 1998–1999, which cannot be siloed as the sole responsibility of any ministry resulted in the culling of >1 million pigs, essentially or agency. Although the most likely high-impact biologi- shuttering the pork industry of this nation and exerting a cal threats continue to be emerging or reemerging patho- tremendous economic toll (6). gens, deliberate biological events and high-consequence Even events that do not result in any local cases can accidents are also increasingly possible. Preparedness have high financial impact. For example, during the
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