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nucleic acid synthesis, increase the possibility that pathogens could be engineered to meet specific objectives of a sophisticated attacker. Advances in synthetic biology capabilities have driven innovation in the life sciences and created novel capabilities and novel risks. One such capability is nucleic acid synthesis, which has enabled the creation of new therapeutics. However, one research team demonstrated the possibility of utilizing this technology to create the horsepox virus (closely related to smallpox) from scratch.135 Although these were leading researchers with good 61 intentions, their published results demonstrated the mechanism for creating orthopox virus without accessing the 2 known highly restrictive smallpox reserves in Russia and the United States. To prevent the misuse of synthesis technologies, an industry organization called the International Gene Synthesis Consortium (IGSC) has developed shared practices for the screening of sequences and of customers, and IGSC companies comprise 80% of the total gene synthesis market. However, to date, only the United States has guidance for screening of gene synthesis products, and no country actively encourages their research institutions and researchers to preferentially use the services of IGSC companies or other companies that perform screening. The BWC is the oldest international treaty that bans an entire class of weapons. Of importance in this regard, the United Nations Secretary-General’s Mechanism (UNSGM) provides an international body of evidence to determine whether a deliberate event has occurred. The UNSGM is convened at the Secretary-General’s discretion. While this capability exists on the international level, and its effectiveness is often called into question, there are few similar mechanisms for reporting at lower levels of government or private industry.136,137 It is often unclear how suspicions of a crime can be reported by a life sciences practitioner. In many cases, law enforcement would not have the biological research knowledge to appropriately evaluate concerns, which would discourage reporting. To counteract that, law enforcement agents and life scientists need to cultivate stronger relationships with each other so that suspicious activity may be reported and potential crimes prevented. Intelligence officials also need a better understanding of biological risks to enhance prevention. Communication, data sharing, outreach, and coordination are key capabilities for a country to be able to manage an effective response to any fast-moving epidemic. This is even more important in the case of a directed release scenario in which one can presume that the attacker will be deliberately eroding such capabilities as part of a broader objective. It may be possible to provide partial deterrence of deliberate events by establishing attribution tools and methods that would support the potential identification of the responsible actor. Even if such capability is underdeveloped, the potential for attribution may change the perceived risk of developing and deploying such a weapon for some actors. Not all deliberate use cases are equally subject to deterrence, because some motivations may outweigh concerns of being identified. Effective deterrence would require that a potential actor is aware of attribution capabilities and persuaded that governments or the international community would respond to the attack. 62 In recent times there has been growing attention to deliberate use scenarios, including tabletop and simulation exercises, to provide lessons and recommendations for responding to a deliberate biological event. While many exercises call for the strengthening of the UNSGM and the identification of the organizations that would be involved in any aspect of a response, including the public health response and investigation and attribution, there is still a leadership deficit. Of particular note, a tabletop exercise hosted by the Nuclear Threat Initiative, Georgetown University, and the Center for Global Development at the 2019 Munich Security Conference called for the establishment of a “permanent facilitator and/or unit [within the UN] devoted to coordinating the response to deliberate, high-impact, or unusual biological events.”37 While the increasing interest in preparing for a deliberate event is positive, these exercises highlight the lack of current preparedness for such an event. CONCLUSIONS: STRENGTHENING PREPAREDNESS FOR A HIGHIMPACT RESPIRATORY PATHOGEN PANDEMIC 1. Countries should build up their national core public health capacities. Countries should continue to build and improve core public health capacities across the globe. While these capacities cannot fully prepare countries or the international community for high-impact respiratory pandemic events, they provide fundamental structure, planning, and workforce for outbreak detection and response and are critical underpinnings for additional capacities that are needed. Member States should continue to endorse JEE assessments and to ensure that WHO has the resources it needs to continue to play a coordinating role. Those countries that have not yet agreed to take part in JEEs should be encouraged by WHO and pressured by allies to do so. But the JEEs should be viewed as only the start of a process that is ultimately meant to result in improvements being made. Once countries identify gaps in their core capacities, it is essential that they commit to addressing them. Countries should then develop, cost, and finance national action plans to improve their core capacities and conduct exercises to test the extent to which capacities will function as planned during emergencies. Special attention should be paid to ensuring action plans are sustainable and the national and regional financial mechanisms used are maintainable over a number of years. This will ultimately require national resources, in addition to donor funding that may be available. As countries work to develop core public health capacities in fulfillment of their domestic and IHR obligations, it is important that they evaluate the functionality of these capacities. Risk-specific exercises (eg, pandemic influenza, Ebola) and after-action reports following actual events are important for examining how capacities worked or