BIOTERRORISM by Lauren Anderson

BIOTERRORISM By Lauren Anderson

INTRODUCTION

In September 2001, the offices of Senators Patrick Leahy (D-VT) and Tom Daschle (D-SD) received envelopes that contained threatening letters and a dangerous white powder: anthrax. Anthrax, derived from the bacteria Bacillus anthracis, was a key weapon in the 9/11 terrorist attacks. In addition to Senators Leahy and Daschle, various news outlets based in New York received envelopes laced The envelope with the lethal substance. In total, 22 individuals fell ill with anthrax received by Sen. related infections, five of whom died in this 2001 attack (Centers for Leahy’s office, Disease Control). which contained Seven years following the 2001 attack, a suspect within the US anthrax. government emerged. Bruce Edwards Ivins, a senior biodefense Smithsonian Magazine researcher for the United States Army Medical Research Institute of Infectious Diseases, was named as the sole suspect (Landers). His Bioterrorism – a seniority within the United States’ biodefense research teams raised terrorist act involving alarm, prompting investigations by the Federal Bureau of the intentional release Investigation (FBI) and Department of Justice (DOJ). of biological agents The threat of bioterrorism is real. The recent COVID-19 such as viruses, pandemic, though itself not a product of bioterrorism, has re-ignited bacteria, fungi, and debate on the capacity of the federal and state governments to toxins respond to public health and bioterrorism crises. The House of Representatives Committee on Homeland Security is responsible for drafting legislation related to these issues. Additionally, the Committee oversees the Department of Homeland Security (DHS). As representatives, you are tasked with creating legislation that provides the best infrastructure against future acts of bioterrorism, ensuring America has the defenses needed to survive an invisible enemy.

HARVARD MODEL CONGRESS

EXPLANATION OF THE ISSUE

Historical Development The earliest known instance of bioterrorism dates to 600 BCE, when an aqueduct in the ancient Greek city of Krissa was purposely contaminated by a rival city-state. Acts of bioterrorism continued Bubonic Plague– A throughout the Middle Ages. In 1346 rival forces in the Crimean bacterial infection Peninsula used bodies infected with bubonic plague as a tactic transmitted by rats against enemies, while Spanish forces intentionally sold wine laced that forms black with the bodily fluids of leprosy patients to the French in 1495 buboes on an infected (Riedel). Throughout European colonization of the Americas, person’s skin indigenous people were intentionally infected with smallpox as a tool of political conquest. In the twentieth century, biowarfare – a variant of contemporary bioterrorism – was used in both World War I and World War II. Even countries that ratified the 1925 Geneva Protocol that prohibited the use of bacteria in warfare developed biological Smallpox– an weapons. During World War II, prisoners of war were subjected to infectious disease that biological research to test the synthetically modified viruses and has been largely bacteria used for bioweapons (Riedel). eradicated by In 1980, the World Health Organization (WHO) officially vaccination declared the smallpox disease as eradicated. However, the United States and Russia were allowed to keep smallpox samples for future research and the existence of these samples have raised concerns over the possibility of future biowarfare attacks launched by the United States or Russia. Additionally, while over 180 countries are Biowarfare– the use signatory to the Biological Weapons Convention, the threat of of bacteria, fungi, and governments or terrorist cells violating this convention is of viruses with the intent particular concern given bioterrorism’s ability to cause mass to engage in warfare economic and social upheaval. Scope of the Problem Overview of Bioterrorism Bioterrorism is officially defined as “the intentional use of a pathogen or biological product to cause harm to a human, animal, Incubation Period plant, or other living organisms to influence the conduct of – the time between government or to intimidate or coerce a civilian population” (Gostin exposure to a et. al). This type of unconventional terrorism poses a formidable biological pathogen to threat because it can harm a large number of people using relatively the first display of few resources. One estimate posits that bioagents are 600 to 2000 symptoms times cheaper to manufacture, store, and disseminate than conventional weapons of mass destruction (SIU School of Medicine). Additionally, most bacteria and viruses have an incubation period of three to seven days, giving a physical perpetrator the opportunity to escape before any infection is reported. For these reasons,

bioterrorism is likely amongst terrorist cells that lack strong financial or technological resources. Bioterrorist attacks are likely to be covert, rather than overt. As a result of bioagents acting as “invisible enemies,” emergency planning and response poses a challenge to traditional defense policy. Instead, the US has historically taken a position of combining defense and health policy to uniquely respond to the bioterrorism threat (SIU School of Medicine). Upon a bioterrorism attack, healthcare professionals will likely be the first to notice a new trend in hospitalizations and illness. Indications of a likely bioterrorist attack would include outbreak of a new or rare disease, outbreak of a seasonal disease during the off-season, unusual distribution within particular demographics, and genetically identical pathogens Smallpox is one of appearing across disparate geographic areas (Miller). the diseases Threats to Human Populations, Environment, and Agriculture national security experts worry could Bioterrorism presents an enormous threat to human populations be used in an act of and potentiates a large-scale disruption to societies. First, an act of bioterrorism. The bioterrorism would cause visible illness, and possibly death, to the smallpox virus human population. Bioterrorism becomes acutely harmful when causes leisons and health care systems become overwhelmed and all infected people bumps on the skin of cannot be treated. This would result in a large number of people an infected person. being quarantined and economic activity coming to a halt. Because CDC.gov pathogens spread rapidly in confined areas, bioterrorism also threatens transport of passengers and critical resources. Bioterrorism can also be used to harm crops or livestock, posing a threat to American food security. Bioterrorism through agriculture could include the deliberate introduction of insects or viruses known to cause illnesses to plants and animals. While not as direct as causing sickness, bioterrorism can create food insecurity and result in mass hunger or maldistribution of food. Introduction of pathogens that makes soil infertile is an additional form of bioterrorism. Agricultural and environmental bioterrorism may be more The Bubonic challenging to detect and respond to as the outbreak may be initially Plague is estimated undetectable but result in a large outbreak (Johns Hopkins to have killed University). anywhere from Centers for Disease Control Classifications 20% to 60% of The Centers for Disease Control (CDC) is the largest public Europe’s health agency in the United States. Following 9/11, the CDC was population in the tasked with issuing regulations and publicly disseminating Middle Ages. unclassified information about the United States’ bioterrorism preparedness. In line with this mandate, the CDC began categorizing bioagents based on the severity of the national security and health risk they pose. Each tier carries with it a particular set of regulations from the federal government, including restrictions on who can

research bioagents in that category, which labs can store those bioagents, and how those bioagents are to be transported. Category A bioagents are those which pose the highest risk to national security due to easy transmission, high rates of mortality, and need for a specialized public health response. Bioagents in this category include anthrax, smallpox, bubonic plague, rabbit fever, and viral hemorrhagic fevers similar to that caused by the Ebola virus. Category B bioagents have a lower mortality rate than those in Category A, but still have the possibility of causing a public health Federalism–a form crisis. Examples of Category B bioagents include salmonella, a of government that bacterium that makes affected food unsafe to eat, and encephalitis, a combines regional virus which causes brain swelling. authorities and a Category C bioagents are unique in that they are newly emerging unified central viruses that could be synthetically engineered and mass produced for authority bioterrorism. The only two viruses listed in this category are the

Nipah virus and hantavirus. Preparedness at the Federal and State Levels Strategic While the federal government has its own plans for bioterrorism Stockpile– a preparedness and response, states are varied in their degrees of designated location to preparedness for dealing with bioterrorism. It is important to store vaccines, remember is that the US government is structured on the principle antibiotics, masks, of federalism. While there is unified federal policy that can be gowns, gloves, and executed by federal agencies, there are also certain powers relegated other supplies needed to individual states that only state authorities may exercise. The to combat a biological information contained in this briefing focuses on the federal pathogen government’s response, but it will be equally as important to note

Centers for discrepancies in state policies and determine whether or not your Disease Control– representative thinks that states should follow a more unified The United States’ approach. national public health One important discrepancy to note is biological surveillance. agency, funded by Only states, not the federal government, have the authority to the federal conduct biological surveillance. This can result in large disparities in government, focusing testing, tracing, and other epidemiological research between states on the prevention and (Grundmann). While the federal government has a strategic mitigation of stockpile, each state is responsible for maintaining its own strategic infectious disease and stockpile as well. The variety of policy and implementation strategies pathogens between states can create challenges for containing a biological pathogen as an outbreak in one state can likely travel to another. Congressional Action Following the 2001 Anthrax attack, Congress enacted a variety of laws to ensure domestic preparedness against future attacks. HR 3448, the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, established baseline procedures for public health and bioterrorism emergencies. Importantly this bill created the National Disaster Medical System to respond to future health

emergencies and regulates the transport of biological agents (HR 3448 2002). This law also created a national register of pre-approved doctors and other first responders who can be called upon in the event of an act of bioterrorism. AAdditionally, the Homeland Security Act of 2002 created DHS, with the House Homeland Security committee as the department’s oversight. From 2003 to 2017, the majority of bioterrorism bills introduced or passed by the House Committee on Homeland Security, but not signed into law, focused on fiscal appropriations needed to execute broad-based homeland security laws introduced in the aftermath of 9/11. These include HR 5430, the Smarter Funding for all of America’s Homeland Security Act of 2004, HR 1187, the Smarter Funding for All of America’s Homeland Security Act of 2009, and HR 4034, the WMD Prevention and Preparedness Act of 2014. Overall, the pattern from these bills shows a historic desire to increase funding spent on preventing bioterrorism. In 2019 the House Committee on Homeland Security introduced and passed through the House of Representatives, HR 269, Pandemic and All-Hazards Preparedness and Advancing Innovation Act. While not solely focused on bioterrorism, this bill contains key policy ideas to prepare the US against biological threats. Key provisions in this bill include a threat-based review of the Strategic National Stockpile, establishment guidelines for regional health emergency preparedness, a review of biological threats to agriculture, and international coordination on vaccine development. While this bill was not addressed by the Senate, it contains provisions

62% of Democrats that may prove popular because of the infrastructural gaps brought support federal funding into focus by the current coronavirus pandemic. for science research, Other Policy Action compared to roughly 40% of Republicans. Since 2001, each president has successively altered the United This gap in public States’ diplomatic and domestic actions on bioterrorism. In addition opinion has grown to signing into law the Homeland Security Act and Public Health significantly since Security and Bioterrorism Preparedness and Response Act, 2001. President George W. Bush also allocated $5.9 billion to bioterrorism Pew Research Center preparedness in fiscal year 2003. The majority of this funding was allocated to the National Institutes of Health (NIH) for research on bioagents. Over the course of 2001 and 2002, President Bush also spent $11 billion in emergency funding for defense against bioterrorism (Miller). President Bush was also an avid supporter of Project BioShield, a law with explicit provisions to improve US defense against chemical, radiological, and nuclear attack. This law allocated over $5 billion to countermeasures against bioagents, including the expansion of anthrax and smallpox vaccines in the Strategic National Stockpile and the acceleration of development of new vaccines and antidotes (Charatan).

Rather than focusing on domestic preparedness, response, and mitigation as President Bush did, the Obama Administration focused its bioterrorism policy on international cooperation as a means to create global system for bioterrorism prevention. Rather than engaging in biodefense, President Obama’s strategy focused on creating biosecurity – a foreign policy approach based on prevention, international cooperation, and mediation between health and security sectors (Koblentz). Biosecurity – In the fiscal year 2017 budget, President Donald Trump moved measures to prevent away from his two predecessors by removing funding from the spread of harmful bioterrorism research and preparedness measures that had been pathogens to prevent built up over the prior two decades. transmission of infectious diseases IDEOLOGICAL VIEWPOINTS Conservative View Conservatives tend to address bioterrorism as an issue of defense and military preparedness. As bioterrorism is viewed as a defense issue, most conservative leaders have not approached this issue through international negotiations or through engaging global institutions such as the United Nations or WHO. This is evidenced by President Bush’s withdrawal from international negotiations to ensure that all nations party to the Biological Weapons Convention were not stockpiling bioagents (Yager 2009). Most conservatives, however, still view biosecurity as an important pillar of American national security. Many conservative Biological senators and representatives disagreed with President Trump’s Weapons funding cuts to programs within the CDC, NIH, and other federal Convention – an agencies responsible for biosecurity, arguing that a natural or man- international treaty made pandemic is inevitable (Baumgaertner). Conservatives support that bans the measures to increase the United States’ preparedness and mitigation production of of bioterrorism, viewing biological warfare as an inevitable threat to biological weapons US defense. Liberal View Liberals similarly believe that biological warfare is a prescient issue that threatens to undermine US national security. However, rather than approaching bioterrorism from a position of militaristic defense, liberals tend to view bioterrorism prevention as part of a comprehensive foreign policy, one that requires international cooperation rather than antagonism. Generally favoring larger government spending, liberals may be more likely to approve of scientific research and public preparedness programs. It is estimated that 62% of Democrats approve of increased federal spending on

science research programs, compared to only 46% of Republicans (Funk).

AREAS OF DEBATE

Bioterrorism poses a formidable threat to US national security. As bioterrorism has the potential to affect humans, animals, and the environment, there are few clear-cut solutions. Rather, as you develop solutions, consider how the policies stated below interact with each other. Effective bioterrorism legislation will cross a multitude of themes, political actors, and federal agencies. As you think of your own solutions consider which sectors you think require additional resources and pose the strongest threat to US security, in addition to which federal agencies or local actors will help execute your policies. Surveillance and Bio-surveillance This solution incorporates two congruent policies: surveillance of terrorist cells and bio-surveillance. Surveillance of terrorist groups increased following 9/11 and the 2001 Anthrax attacks. Increasing surveillance on terrorist cells would involve reforms to intelligence and cyber tracking, in addition to tracing the movements of suspected terrorists domestically. This could include increasing the scope of federal agencies to track cell phone and computer data, expanding the “no fly” list for suspected terrorists, and increasing location surveillance. Proponents say that this solution could help prevent suspected terrorists from ever launching an attack, preventing them from entering the US or accessing supplies needed to make dangerous biological pathogens. Opponents argue that, without proper oversight, expanded surveillance could unduly infringe on privacy and basic liberties, and lead to racial profiling. Bio-surveillance is the monitoring of people, plants, and animals for diseases and other pathogens (Wagner). Bio-surveillance entails constant monitoring of public health and environmental data collected by hospitals, agribusinesses, local health departments, and some federal government programs. Reliant on tracking data, bio- surveillance supporters argue that the process can quickly detect an abnormal outbreak before it leads to sickness, death, or disruption of the environment. Some supporters also feel that a federal tracking system and data processing center would facilitate a coordinated national response in the early stages of a bioterrorist attack. Political Perspectives on this Solution As surveillance of terrorist cells would require more use of military and surveillance technologies, some conservatives would likely agree to this solution. Representatives that want to expand

military industries would find this solution to be in the best interest of defending the United States from bioterrorism, while also creating jobs for private companies that manufacture defense and surveillance technologies. However, many libertarians and some liberals may oppose this solution because of the technology’s capacity to infringe on privacy. Bio-surveillance is possible through the 2001 Patriot Act which has previously been criticized for its infringement on personal liberties and privacy. In comparison, bio-surveillance is more likely to be supported by liberals than conservatives. Programs, such as contact tracing, that require large public health expenditures are more likely to be supported by liberals. Additionally, programs that force hospitals and companies to turn over data to a federal watchdog are more likely to have support from Democrats. Strategic Stockpiling The US Strategic National Stockpile is a pillar of domestic preparedness against bioterrorism, holding critical supplies necessary to respond to an attack. This solution is intended to solve Many vaccines, the health and human crisis that could occur after a bioterrorist including the flu attack. The Strategic National Stockpile could be increased to hold vaccine, are made more vaccines and more chicken eggs – a key ingredient in vaccine with chicken eggs. development. The stockpile could also be increased to hold Each egg is able to additional facemasks, protective gowns, and face shields for produce one healthcare workers. Expanding strategic stockpiling can also include an increase to the number of stockpile locations, and ordering states vaccine. to increase their strategic stockpiles. Proponents of this solution argue that an act of bioterrorism is inevitable. US policy against bioterrorism should therefore emphasize the domestic response. Proponents argue that no one cannot predict the true severity of a bioterrorist attack, and the US must be prepared at any cost. Opposition to this solution is varied. Some opponents argue that unnecessary strategic stockpiling of protective equipment and vaccines is akin to hoarding and prevents other countries from accessing equipment to respond to their own domestic public health crises. Other opponents site the costliness of strategic stockpiling, and would prefer to spend these funds on other programs. Political Perspectives on this Solution Liberals are more likely to be in favor of increasing the strategic national stockpile. Viewing strategic stockpiling as a necessary cost, liberals are open to increasing expenditures to enhance the federal reserve of strategic equipment. Conversely, fiscally conservative representatives may not support strategic stockpiling over budget concerns. They may see this strategic stockpiling as an unnecessary burden to taxpayers, and as a responsibility for state governments to

handle. Relevant stakeholders in this solution include pharmaceutical companies and protective equipment manufacturers. Lobbyists for these companies would favor an increase to the national stockpile as it would increase their business. Foreign Policy: Support for International Institutions Strengthening international health groups, such as the World World Health Health Organization, (WHO) is frequently cited as a way to Organization – an provide worldwide public health infrastructure. Biological pathogens agency of the United are likely to spread; even if a bioterrorist attack were targeted in one Nations tasked with state or region, its results can easily spread to other locations. ensuring global public Strengthening WHO could alleviate the threat of bioterrorism for health two primary reasons: deterring terrorist cells from engaging in bioterrorism, and reinforcing domestic response to an act of bioterrorism. Strengthening WHO would include an increase in annual funding. President Trump opposed this stance, announcing that the United States will no longer be a funding contributor or member of WHO. Creating transnational health institutions that reflect US values would involve a recommitment to WHO. This solution can also be executed by encouraging US scientists to work for WHO, incentivizing other countries to follow WHO recommendations, and increasing the capacity of WHO to provide global health programs. Proponents of this solution argue that international cooperation will be necessary to deter and respond to future health crises, Members of the US weather caused by bioterrorism or not. Proponents argue that Marine Corps drill international organizations are the only way to keep terrorist cells clean-up methods from acquiring or manufacturing lethal pathogens. They also argue for a potential that international organization providing supplementary supplies anthrax attack. and medical personnel could allow for the best response to a Politico domestic bioterrorism act. Opponents argue that relying too heavily on international organizations could prevent the US from adequately preparing itself. Opponents also fear that international institutions will become influenced too heavily by a particular country, not providing a truly neutral and global response as promised. Political Perspectives on this Solution US perspectives regarding support for WHO are split along party lines. Liberals overwhelmingly favor reinstating the US’ membership to WHO and increasing US funding to WHO, while conservatives tend not to approve of the WHO’s handling of the COVID-19 pandemic and agree with the withdrawal (Connaughton and Monton). Therefore, Democratic representatives would be more likely to support this solution while Republicans would not.

Foreign Policy: Strategic Partnership with other Nations Another solution to prevent bioterrorism attacks is to establish strategic diplomatic relations with countries or organizations that support terrorist cells. Such a solution would focus on indirect deterrence: limiting financial support and introducing sanctions to state supporters of terrorist organizations (Kosal). On the condition that foreign governments do not support terror cells capacity to commit acts of bioterrorism, the US would provide foreign aid and assistance. This solution would require diplomatic negotiations and approval of foreign assistance. Proposed legislation would most likely call upon the State Department to executive legislation on foreign deterrence. Proponents of this solution cite its ability to create a more secure world, in addition to preventing bioterrorism in the US. Additionally, proponents see deterrence-based foreign policy as a cost worth incurring because of its potential to prevent mass sickness, economic upheaval, and negative social consequences in the US. Opponents of this solution argue that the US should not engage with foreign actors that back terrorist groups. Opponents may be more likely to support unilateral deterrence programs, combined with increasing the US’ response capacity. Political Perspectives on this Solution Perspectives on this solution are not straightforward: as you do your own research, be attentive to your representative’s previous positions on military interventions and foreign relations. Moderate Democrats may be more likely to support this position than progressive Democrats, whereas some Republicans may be hesitant to engage in indirect deterrence as opposed to direct military action. National Strategic Science Research Program Infectious disease research is critical to both bioterrorism preparedness and response. Federally funded research for new vaccines and therapeutics could mitigate illnesses caused by bioterrorism. Increasing federally supported science research may include: providing grants to universities and private research institutes that offer promising biodefense research, expanding the number of federal labs, and subsidizing graduate degrees for scientists who agree to work for the federal government after graduation. An additional component of this solution would involve implementing or increasing security at laboratories and research facilities. Following the 2001 Anthrax attack, the Patriot Act and the Public Health and Bioterrorism Preparedness Act created new guidelines for laboratory security, researcher authorization, and transportation of biohazardous materials. These guidelines include

background checks for researchers who work in federal labs, prohibition of federal researchers from publicly publishing their research, and prohibiting restricted people from transporting some biological agents. One solution could include a review of these guidelines by DHS, and legislation to strengthen guidelines on lab security. Political Perspectives on this Solution Liberals are more likely to approve expanded federal research programs. Conversely, conservatives – while still likely to value such programs as necessary for national security and American innovation – are more likely to encourage research programs funded by state governments or private companies. University lobbies would support expanded federal research programs as it would increase the number of jobs for full time researchers and bring additional money to university science programs.

Department of BUDGETARY CONSIDERATIONS Homeland Security agents prepeare for As you draft your solutions, keep in mind that they will be a bioterrorism executed by DHS. Funding for your proposed solutions will therefore attack in a practice need to be within the constraints of the DHS budget. The DHS 2020 drill. Fiscal Year budget included $51.7 billion for discretionary funding Department of and $19.4 billion for disaster relief. DHS’ Science and Technology Honeland Security Directorate oversees bioterrorism operations, and has an annual budget of $582 million. DHS’ office on Countering Weapons of Mass Destruction has an annual budget of $423 million, part of which is used for bio-surveillance and detection of biothreats. As you prepare budgets for your own solutions, keep these figures in mind but with the caution that they are overarching figures spent between multiple, individualized programs.

CONCLUSION

Bioterrorism poses an existential threat to national security. While the chances of bioterrorism are minimal, the societal ramifications of only one attack would be long-lasting and severely affect the wellbeing of Americans. When drafting legislation, Congress must be sure to address both our preparedness and response. Representatives will need to consider the cost-benefit ratio of increased preparedness programs. Representatives should consider the strategic value of their preparedness including what to put in the national stockpile, how much additional funding federal science research programs should receive, and if US foreign policy should change to incorporate bioterrorism deterrence. When

weighing response measures representatives should consider how effective bio-surveillance programs will be at responding to a biological pathogen, and how adequately state public health programs can respond. Solutions to bioterrorism may be influenced by partisan beliefs, but ultimately bioterrorism is an issue of national security. Representatives will be tasked with ensuring national security, despite dilemmas that may arise out of concerns for individual liberties, overuse of federal authority, and cost. While this briefing has provided suggested solutions, representatives are asked to be innovative in their approach to defending national security.

GUIDE TO FURTHER RESEARCH

As you start your own research, look for background information published by the CDC, WHO, and National Institutes of Health. These three public health organizations summarize the past actions on bioterrorism, the threat it presents, and scientific information about individual pathogens. Look to news sources such as The New York Times to find information about how federal and state governments have prepared for public health crises over the past 10 to 15 years. Additionally, to find information about your representative’s position, websites such as Ballotpedia and www.govtrack.us provide summaries of your representative’s voting record, as well as detailed records of individual votes. As an exercise, you can look to your representative’s response to COVID-19 to assess how they would vote on a bioterrorism or public health bill. Ask yourself: how did my representative react to the US’ withdrawal from WHO? Did they support increasing production of personal protective equipment? Did they provide support for contact tracing programs? How did my representative talk about China’s response to the pandemic? Although COVID-19 is a natural occurrence and not an act of bioterrorism, you can use your representative’s response to gain a general assessment of their views on public health preparedness and response.

GLOSSARY

Bioterrorism – a terrorist act involving the international release of biological agents such as viruses. Bacteria, fungi, and toxins.

Biological Warfare Conventions – an international treaty that bans the production of biological weapons

Biosecurity – measures to prevent the spread of harmful pathogens to prevent transmission of infectious diseases

Biowarfare – the use of bacteria, fungi, and viruses with the intent to engage in warfare

Bubonic Plague – A bacterial infection transmitted by rats that forms black buboes on an infected person’s skin.

Centers for Disease Control - The United States’ national public health agency, funded by the federal government, focusing on the prevention and mitigation of infectious disease and pathogens.

Federalism – A form of government that combines regional authorities and a unified central authority

Incubation Period – the time between exposure to a biological pathogen to the first display of symptoms

Smallpox – An infectious disease that has been largely eradicated by vaccination

Strategic Stockpile – a designated location to store vaccines, antibiotics, masks, gowns, gloves, and other supplies needed to combat a biological pathogen.

World Health Organization – An agency of the United Nations tasked with ensuring global public health.

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