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polymerase-chain reaction (PCR) and whole genome sequencing (WGS) of the pathogen, whether the epidemic was caused naturally or deliberately. These kinds of rapid diagnostics have been increasingly used to diagnose respiratory viral infections and so are increasingly familiar tools for diagnosing this class of diseases. WGS could additionally provide indications of whether the pathogen was engineered if it differs significantly from known wild-type forms in existing genetic databases like NBCI BLAST. Countries should also support the adoption of synthesis screening approaches intended to identify research on high-impact respiratory pathogens. Such screening approaches should identify orthopox synthesis efforts, for example, and flag them for national authorities to review. Synthesis of coronavirues and novel influenza strains should also require special review of the proposed work and the proposed buyer before approval. The US government provides guidance on synthesis screening. It is not a perfect approach for preventing the illicit synthesis of high-impact respiratory pathogens, because it focuses on the US select agent list, which does not necessarily include the viral components of greatest concern for this problem. More R&D and informatics will be needed to improve screening strategies for high-impact respiratory pathogens, but the US model provides a good start for now. 75 By building ties between law enforcement and the life sciences community, countries can foster connections between these 2 disparate sectors in anticipation of a deliberate event. Since it takes a significant amount of effort, skill, tacit knowledge, and laboratory equipment to develop a viable bioweapon, reporting by life scientists should be considered one of the first lines of defense against a deliberate event. Life scientists working in high-containment or government laboratories are often required to undergo dual-use research of concern (DURC) training; however, there are very few reporting mechanisms through which a concerned scientist can report the activities of a colleague to a superior without being worried about risking his or her career. There are even fewer clear mechanisms to connect the science and law enforcement communities if a scientist has substantial concerns that someone in her or his community is pursuing bioweapons development. A first step to cultivating this relationship is to create an appropriate and accessible method for life scientists and public health practitioners to report these kinds of concerns. In the United States, special investigators are trained to respond to bioweapons concerns that are reported to them. The framework of this program could be modified to suit different government structures. Finally, a deliberate release event that results in a pandemic spread of a respiratory pathogen would require a high level of sophisticated coordination to bring the outbreak under control. One or 2 governments could not accomplish this effort without working in close concert with other governments and international organizations. REFERENCES 1. Schoch-Spana M. “Hospital’s full-up”: the 1918 influenza pandemic. Public Health Rep. 2001;116(Suppl 2):32-33. 2. Byerly CR. The U.S. military and the influenza pandemic of 1918-1919. Public Health Rep. 2010;125(Suppl 3):82-91. 3. Barry J. The Great Influenza: The Story of the Deadliest Pandemic in History. New York: Penguin Group; 2004. 4. Snyder MR, Ravi SJ. 1818, 1918, 2018: two centuries of pandemics. Health Secur. 2018;16(6):410- 415. 5. World Bank says flu pandemic could cost $3 trillion. CIDRAP. October 17, 2008. http://www. cidrap.umn.edu/news-perspective/2008/10/world-bank-says-flu-pandemic-couldcost-3-trillion. Accessed May 22, 2019. 6. World Bank Group. 2014-2015 West Africa Ebola Crisis: Impact Update. May 10, 2016. http://www. worldbank.org/en/topic/macroeconomics/publication/2014-2015-west-africa-ebola-crisisimpact-update. Accessed June 13, 2019. 7. International Working Group for Financing Preparedness. From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level. Washington, DC: World Bank; 2017. http://pubdocs.worldbank.org/en/890291523304595565/FINAL-IWG-Report-3-5-18.pdf. Accessed May 24, 2019. 8. Mateus AL, Otete HE, Beck CR, Dolan GP, Nguyen-Van-Tam JS. Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review. Bull World Health Organ. 2014;92(12):868-880. https://www.who.int/bulletin/volumes/92/12/14-135590-ab/en/. Accessed June 13, 2019. 9. Madhav N, Oppenheim B, Gallivan M, et al. Pandemics: risks, impacts, and