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own citizens for attempting to stop the outbreak, but historical evidence and modeling and public health experts would argue such measures would be unlikely to substantially add to disease control efforts. Prenegotiated bilateral material transfer agreements could help to ensure data and specimen sharing across borders. Currently, there are few viable avenues for attribution of a deliberate event to a specific actor. Few countries have any existing framework to begin pursuing attribution, and the language of the Biological Weapons Convention leaves much open to interpretation. Continued research into the science of attribution, as well as the strengthening of surveillance systems, international collaboration, and treaty agreements, are all needed for an effective response to the deliberate use of a biological weapon with a high-impact respiratory pathogen. WHAT PREVIOUS REVIEWS TELL US ABOUT PREPAREDNESS FOR HIGH-IMPACT RESPIRATORY PATHOGENS Numerous high-level reviews have been commissioned in recent years to take stock of global preparedness. These reviews—whether comprising a panel of subject matter experts, a written report, or both—have sought to assess current preparedness structures and capabilities, identify existing gaps, and propose recommendations for strengthening outbreak prevention, detection, and response. Assessments from the United Nations, the World Health Organization, the World Bank, the World Economic Forum, the US National Academies of Science and Medicine, nonprofit organizations, and academic institutions have all contributed valuable analyses and recommendations on this topic. Many of these initiatives* were commissioned following the 2014-2016 Ebola outbreak in West Africa and reflect on the challenges associated with that response.42-45 While some recommendations from these Ebola-action reviews are generalizable to other epidemic and pandemic events (eg, strengthening IHR implementation), others focus on identifying and recommending improvements needed to prepare for an outbreak of Ebola virus disease or other hemorrhagic fever, and, as such, their findings are not necessarily applicable to high-impact respiratory pathogens.7,46-51 Some reviews provide recommendations that are intended to be generalizable for any disease outbreak, with the goal of improving overall international and national preparedness capabilities. For example, the National Academy of Medicine report provided recommendations to the World Health Organization, the World Bank, the International Monetary Fund, and national governments to strengthen public health preparedness, improve existing global systems for outbreak response, and increase research and development efforts.46 A review by the National Academy of Science calls for initiatives such as national governments building information-sharing mechanisms into their institutions, growing the role of nontraditional response actors such as philanthropists, and increasing research and development efforts, particularly with at-home diagnostics.52 However, while there is overlap between the systems and capabilities required to respond to any disease outbreak, a high-impact respiratory pathogen poses additional challenges *Among the reports we considered, those specific to the West Africa Ebola outbreak include the Harvard-LSJTM Independent Panel on the Global Response to Ebola, the European Parliament Report on the Ebola Crisis, the 2015 Ebola Interim Assessment Panel, and the IHR Review Committee on Ebola. Other reports that were commissioned in light of the Ebola crisis and focus on recommendations to improve general preparedness systems include the UN Panel on Protecting Humanity of Future Health Crises; the Global Health Crisis Task Force; the World Economic Forum report, Managing the Risk and Impact of Future Epidemics: Options for Public-Private Cooperation; the International Vaccines Task Force report, Money & Microbes: Strengthening Clinical Research Capacity to Prevent Epidemics; the National Academy of Medicine Report, The Neglected Dimension of Global Security; the International Working Group on Financing Preparedness report, From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level; and the reports of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme. 24 that deserve special consideration. A small number of high-level reviews do specifically examine global preparedness for a major outbreak of pandemic influenza, such as the report of the Committee on the Functioning of the International Health Regulations in relation to the 2009 H1N1 pandemic, known as the Fineberg Report. Convened following the global transmission in 2009 of the H1N1 virus, the Fineberg Report made several high-level recommendations for improving the IHR and public health emergency response in the context of pandemic influenza. The chief recommendations included: faster implementation of IHR core capacity requirements, the creation of a global public health workforce, building the evidence base for decisions on international trade and travel restrictions, making the IHR Emergency Committee declaration process more transparent, developing uniform and agreed-upon measures to assess the severity of pandemic and seasonal influenza strains, and establishing advance agreements with manufacturers for vaccine distribution.19 Of note, several of these recommendations were later adopted, including the committee’s calls for agreements on influenza virus sample sharing and access to benefits, which culminated in the Pandemic Influenza Preparedness (PIP) Framework.53 Another framework, the WHO Global Influenza Strategy for 2019-2030, also followed reports recommending the establishment of robust international and national preparedness capacities for seasonal and pandemic influenza; development of vaccines, antivirals, and treatments; and implementation of measures to increase country prevention, preparedness, and response capacities.54 Other high-level reviews with a specific focus on preparedness for