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be multipurpose, serving everyday health priorities, but then tapped, and modified or expanded, if necessary, during emergencies.56 Arguably, the IHR’s greatest value lies in early efforts of detection and control, before a respiratory pathogen becomes widespread. The IHR requires countries to develop the capacities to detect and report potential PHEICs, with the goal of providing early warning of events that could spread beyond borders and threaten other countries.63 Past detection of significant zoonotic events, such as Middle East Respiratory Syndrome (MERS) and H7N9, have occurred in a manner that was generally in accordance with IHR protocols, and many countries have adhered to the IHR through transparency in their reporting to WHO. If surveillance and reporting systems can quickly detect and notify WHO of a novel respiratory pathogen that has acquired human-to-human transmissibility, global decision makers may be able to act to limit the spread of the disease by adopting evidencebased nonpharmaceutical interventions. This could, in turn, buy time to mobilize a research agenda to better understand the nature of the threat, collect and share samples, and develop medical countermeasures. However, the IHR faces challenges in its implementation and content. There is a large disparity in countries’ efforts to strengthen their core capacities to prepare for, detect, and respond to potential pandemics. There is a lack of legal provisions to penalize countries for not conforming to WHO recommended measures during emergencies on travel and trade restrictions, and there are concerns related to the criteria for PHEIC declarations.56,64 The influence of IHR provisions on travel and trade and on a PHEIC declaration 30 during a high-impact respiratory pathogen event would be more limited than in a geographically circumscribed event such as Ebola, since disease would spread quickly across the world. Joint External Evaluation The IHR requires signatories to develop core public health capacities to prevent, detect, and respond to any disease outbreaks. The Joint External Evaluation (JEE) process was developed as a voluntary, multisectoral program to assess national-level IHR implementation and identify critical gaps and challenges in national preparedness mechanisms.65 To date, more than 85 countries have voluntarily undergone a JEE and have published the results, as determined by the number of available JEE mission reports.66 While the number of countries that have completed JEEs is encouraging, the small number of these that have followed through to address gaps in their JEEs is concerning and suggests that new strategies are needed to keep countries motivated to complete the intended full JEE process that would result in improved core capacities. Data will be essential to motivating political leaders and to measuring progress. Efforts should be made to ensure assessments of core capacity developments are conducted regularly. Currently, it is planned that the JEEs will be repeated every 5 years. However, given the pace with which JEEs are being conducted and the current level of resources allocated to the JEE process, it is unlikely that this timetable will be met. The JEE is broadly capacity-focused so that it can address a range of threats. Because of this focus, it does not encourage or call on countries to develop plans specific to the unique needs of high-impact respiratory pathogens.65 There are additional capacities that would likely be needed during a potential high-impact respiratory pandemic that are currently not captured in the JEE. These include the healthcare system’s capability to cope with serious respiratory disease, the capacity to manage continuity of critical government functions despite widespread illness and absenteeism, and the capacity to rapidly acquire medical countermeasures and other equipment when other countries are concurrently seeking the same countermeasures and materials (eg, masks). Deliberate Release Scenarios It is often said that responding to a deliberate biological event would be just like responding to a natural pandemic. While there are a number of similarities related to medical and public health response, there are also critical distinctions that need to be understood and prepared for. The deliberate release of a high-impact respiratory pathogen would complicate application of international frameworks and global decision-making and response models. The activation of national and international security and intelligence apparatuses, which would be called on to identify the source of a deliberate event 31 and attribute blame or responsibility, could interact with the public health response in unforeseen ways. Central involvement of the security sector, the possibility that countries may be less likely to share information during a deliberate event, and the potential for major societal fissures are just some of the elements that would complicate or interfere with current international response frameworks in ways that would make them less effective in addressing the response to a major deliberate event.67 The Biological and Toxin Weapons Convention (BWC) prohibits the development, production, stockpiling, and acquisition of biological weapons. This prohibition serves a crucial normative global role. In addition to explicitly committing countries to preventing the development and proliferation of biological weapons for both state and non-state actors, the BWC also includes provisions that promote international collaboration to support capacity building and the prevention of disease. States Parties to the BWC are obligated to provide response assistance in the event of a deliberate biological event, including for respiratory diseases with pandemic potential, but the scope of this assistance is not clarified. Beyond these goals, the BWC also serves as a forum in which countries, international organizations (eg, WHO), and civil society can engage on a range of topics relevant to the prevention, detection, and response to a range of biological threats, deliberate or otherwise. Unfortunately, the BWC remains under-resourced, particularly as it relates to coordinating response assistance in the aftermath of a deliberate event. In addition, the BWC was given neither an