Daniel Gastfriend: Manufacturing medical countermeasures against catastrophic biothreats

The United States is un­der­pre­pared for a fu­ture pan­demic. A re­cent simu­la­tion con­ducted by the Johns Hop­kins Cen­ter for Health Se­cu­rity found that an en­g­ineered pathogen could over­whelm U.S. and global re­sponse ca­pac­ity, kil­ling more than 150 mil­lion peo­ple within 20 months. One im­por­tant rea­son: The U.S. lacks the ca­pac­ity to man­u­fac­ture med­i­cal coun­ter­mea­sures (MCMs) fast enough to con­tain a global out­break.

In this aca­demic ses­sion, Daniel Gast­friend, a re­cent vis­it­ing scholar at the Johns Hop­kins Cen­ter for Health Se­cu­rity, dis­cusses three cat­e­gories of emerg­ing tech­nolo­gies that could im­prove our MCM pro­duc­tion ca­pa­bil­ities: flex­ible man­u­fac­tur­ing, plat­form tech­nolo­gies, and lo­cal­ized dis­tributed man­u­fac­tur­ing.

Below is a tran­script of Daniel’s talk, which we’ve lightly ed­ited for clar­ity. You may also watch it on YouTube or read it on effec­tivealtru­ism.org.

The Talk

First, a few quick notes: My back­ground and ex­per­tise are in eco­nomics and busi­ness. I’m not a biol­o­gist or a sci­en­tist, so I’m go­ing to fo­cus on the policy and busi­ness as­pects of prepar­ing for pan­demics rather than the tech­ni­cal as­pects. Also, I’ve con­ducted the re­search I’m pre­sent­ing in part­ner­ship with the Johns Hop­kins Cen­ter for Health Se­cu­rity, but the views I will ex­press are my own.

Let’s be­gin. [Imag­ine] the year is 2025. You wake up at 6:00 AM in the morn­ing to your phone ring­ing. You hear the voice of the chief of staff of the White House. She says, “You’re on the line with the pres­i­dent of the United States of Amer­ica.”

“Good morn­ing,” says the pres­i­dent. “As you know, we are in the midst of a ter­rify­ing pan­demic out­break of the Clade X virus that is threat­en­ing to de­stroy the global sys­tem. We ur­gently need you to re­port to the White House to help co­or­di­nate the U.S. re­sponse.”

You say, “Okay.” You throw on your pants, jump in your car, and drive to the White House, where you’re greeted by the chief of staff.

She says, “Let’s get you up to speed.”

[Daniel plays a fic­tional video with voiceover from ac­tors por­tray­ing a news­caster and gov­ern­ment offi­cials:]

“We are con­tin­u­ing our cov­er­age of a new and deadly in­fec­tious dis­ease, [the Clade X virus, which was in­ten­tion­ally cre­ated and re­leased]. The virus has some ge­netic el­e­ments of the NEPA virus.”

“The care of these pa­tients re­quires ex­traor­di­nary effort.”

“We can­not and will not vol­un­tar­ily take pa­tients from other hos­pi­tals.”

“The im­pact of not do­ing some­thing has lots of con­se­quences.”

“We can’t re­treat from the rest of the world.”

“Con­ti­nu­ity of gov­ern­ment here can­not be over­es­ti­mated.”

“Fed­eral quaran­tine of this scale is un­prece­dented.”


“The ques­tion ev­ery­where: When will there be a vac­cine?”

“We must en­gage the pri­vate sec­tor.”

“[Peo­ple] know that we don’t have a vac­cine yet. They want vac­cines to be pri­ori­tized.”

“I would not want to pull those peo­ple back.”

“With the need on the ground, can we as­sure pro­tec­tion of our first re­spon­ders?”

“This is a non­starter. I’m go­ing to need these peo­ple [first re­spon­ders] — I’ve got this feel­ing — in a whole lot of other places.”

“More than 40 coun­tries are re­port­ing out­breaks and many more are sus­pected of hav­ing cases.”

“Lead­er­ship re­quires do­ing things that are of­ten­times un­pop­u­lar.”

“This is­sue has the amaz­ing ca­pac­ity to be num­ber 11 on any­body’s list of the 10 most im­por­tant items.”

“We have been un­be­liev­ably weak­ened by this crisis.”


“What the world will look like when it’s done is still very un­cer­tain.”

[Video ends.]

This was a table­top ex­er­cise con­ducted by the Johns Hop­kins Cen­ter for Health Se­cu­rity with cur­rent and former se­nior mem­bers of the U.S. gov­ern­ment.


Gastfriend slide 1

They ran epi­demiolog­i­cal mod­el­ing and pre­dicted that within a year or so of the re­lease of this type of virus, there would be 150 mil­lion deaths wor­ld­wide and a 50% drop in global GDP.

If these num­bers ap­pear his­tor­i­cally un­prece­dented, they’re not.

Slide06

We of­ten for­get that the biggest kil­lers in the 20th cen­tury were in­fec­tious dis­ease out­breaks. The 1918 Span­ish flu, in a sin­gle year, kil­led more peo­ple than World War II. Could a pan­demic out­break be even worse than this? Could it per­ma­nently harm and al­ter the tra­jec­tory of hu­man civ­i­liza­tion — or pose a truly ex­is­ten­tial threat to hu­man so­ciety?

There’s le­gi­t­i­mate and on­go­ing de­bate about how se­ri­ously we should take that risk. I will offer two his­tor­i­cal anec­dotes to in­form your think­ing.

In 2012, sci­en­tists were work­ing on the H5N1 avian flu virus. It’s a var­i­ant of the flu with ex­tremely high case-fatal­ity rates, but it’s not trans­mis­si­ble be­tween mam­mals through res­pi­ra­tory path­ways. The sci­en­tists [tweaked the virus such that it be­came] trans­mis­si­ble by air. Sub­se­quent mod­el­ing sug­gests that the ac­ci­den­tal re­lease of this virus from a lab could kill up­wards of one billion peo­ple.

In 1993, the om­ni­ci­dal cult Aum Shin­rikyo, in their efforts to ex­ter­mi­nate hu­man­ity, at­tempted a wide-area an­thrax at­tack in Tokyo.

Slide09

Luck­ily, the group wasn’t ca­pa­ble enough to suc­cess­fully ex­e­cute the at­tack. But the com­bi­na­tion of the in­creas­ing ca­pa­bil­ities of syn­thetic biol­ogy to cre­ate dev­as­tat­ing pathogens and the pres­ence of in­di­vi­d­u­als and groups who would use them against so­ciety is some­thing that should con­cern us all.

Slide10

[Let’s re­turn to the table­top ex­er­cise.] You’re at the White House in your first meet­ing with the pres­i­dent of the United States. The pres­i­dent says, “Tell me, what can we be do­ing to bet­ter pre­pare our­selves? And what should we have been do­ing all along?”

You quickly run through a list. We could:

* In­vest in ba­sic re­search to bet­ter un­der­stand the biolog­i­cal path­ways and mechanisms of dis­ease.
* Build our ar­se­nal of med­i­cal coun­ter­mea­sures against po­ten­tially catas­trophic pathogens.
* Im­prove gov­er­nance, plan­ning and co­or­di­na­tion. There are key gaps within both fed­eral gov­ern­ment and in­ter­na­tional en­tities [that in­hibit our abil­ity] to man­age an effec­tive re­sponse.
* Im­prove our al­lo­ca­tion of re­sources and tar­get them to­ward the most se­vere and sig­nifi­cant threats, es­pe­cially syn­thetic biol­ogy.
* Im­prove our reg­u­la­tion of syn­thetic biol­ogy to pre­vent the wrong tools and pathogens from fal­ling into the wrong hands.
* Strengthen in­ter­na­tional diplo­macy around biolog­i­cal se­cu­rity; [for ex­am­ple, through] the Biolog­i­cal Weapons Con­ven­tion.

The pres­i­dent says, “That’s a great list. But it’s too late for most of this now, so let’s fo­cus on de­vel­op­ing and de­ploy­ing a med­i­cal coun­ter­mea­sure.”

Slide12

[For the pur­poses of this fic­tional ex­er­cise], let’s as­sume that the gov­ern­ment has already de­vel­oped a vac­cine. The ques­tion now is: How quickly can we man­u­fac­ture this vac­cine and de­ploy it globally?

Slide13

The pres­i­dent says, “The in­ter­na­tional econ­omy is col­laps­ing. Millions of peo­ple are dy­ing by the week. I want you to man­u­fac­ture enough vac­cine doses to cover the ma­jor­ity of the global pop­u­la­tion in the next three months. Can you do it?”

You look at the pres­i­dent and say, “You’re not go­ing to like the an­swer to that ques­tion.”

Slide14

[Although I’m fo­cus­ing this talk on] man­u­fac­tur­ing, de­vel­op­ment of coun­ter­mea­sures is also cru­cial be­cause it can take 10 to 15 years to pro­duce a vac­cine. But even un­der the op­ti­mistic sce­nario in which we _have_ a vac­cine, man­u­fac­tur­ing is go­ing to be way too slow to re­spond.

The 2009 flu pan­demic [led to] one of the fastest pro­duc­tion and scale-ups of a vac­cine in his­tory. Yet it still took nine months af­ter the first case to [achieve large-scale vac­cine dis­tri­bu­tion].

Slide15

The blue line rep­re­sents the course of the viral out­break and the red line is a scale-up of vac­cine de­liv­ery. There was a three month de­lay be­tween the peak of the out­break and vac­cine de­liv­ery reach­ing full [ca­pac­ity]. And that was the best that we have ever man­aged.

It turns out that the flu vac­cine is the vac­cine for which there is the most global ca­pac­ity [in place] to re­spond to a global pan­demic. Our ca­pa­bil­ities have im­proved since 2009.

Slide16

This slide sum­ma­rizes the ques­tion of whether we have the ca­pac­ity to cover the global pop­u­la­tion — or at least a ma­jor­ity of the pop­u­la­tion — in 12 months. What’s the cur­rent ex­cess ca­pac­ity to pro­duce the vac­cine, and how quickly can we scale up?

For the flu vac­cine, we can’t quite cover the global pop­u­la­tion in 12 months, but un­der very op­ti­mistic as­sump­tions we can get within strik­ing dis­tance. Un­for­tu­nately, no other vac­cine comes any­where close to hit­ting those num­bers, and it can take three to five years to build a sin­gle new fac­tory for vac­cine pro­duc­tion. Plus, it can take be­tween six to 12 months to re­pur­pose a fac­tory’s ex­ist­ing ca­pac­ity from pro­duc­ing one vac­cine to an­other.

The figures are similar for most other cat­e­gories of coun­ter­mea­sures — the one ex­cep­tion be­ing broad-spec­trum an­tibiotics. If the bac­te­ria hap­pens to be sus­cep­ti­ble to peni­cillin, then we might be in de­cent shape. If not, we’re re­ally screwed.

Let’s rewind five years [from the fic­tional sce­nario] to 2019. You get a very differ­ent call from the pres­i­dent of the United States, who says, “I know that we should be con­cerned about pan­demic out­breaks. I know we should be con­cerned about syn­thetic biol­ogy. What can we do to­day to build out our man­u­fac­tur­ing ca­pa­bil­ities so that if a crisis oc­curs, we’ll be bet­ter pre­pared?”

Slide17

First, it’ll be use­ful to iden­tify the main bar­ri­ers pre­vent­ing us from hav­ing im­proved surge-pro­duc­tion ca­pa­bil­ities.

Slide18

Some bar­ri­ers are tech­ni­cal. Most pro­cesses to pro­duce med­i­cal coun­ter­mea­sures rely on ex­pen­sive fixed equip­ment, and they are very spe­cial­ized pro­cesses that re­quire spe­cific knowhow. It can take months for a team to get used to the spe­cific man­u­fac­tur­ing pro­cess for any given pro­duc­tion line, such that it’s quite difficult for a fac­tory pro­duc­ing one product to switch to an­other product. It is pos­si­ble, but tends to be challeng­ing.

Slide19

Other bar­ri­ers are eco­nomic. It would be ex­tremely so­cially valuable to in­vest in surge-pro­duc­tion ca­pac­ity to help in­sure against an ex­treme-risk sce­nario. But it’s difficult for pri­vate com­pa­nies to in­ter­nal­ize those benefits as a re­turn on their in­vest­ment. This is be­cause they would need to re­coup quite a sub­stan­tial fi­nan­cial in­vest­ment in a crisis that might only hap­pen once ev­ery 50 years. And the prices that they would have to charge to jus­tify their in­vest­ment, from an eco­nomic per­spec­tive, would likely be viewed poli­ti­cally as ex­or­bitant and un­ac­cept­able. It’s not a play that any pri­vate in­vestor is go­ing to be ex­cited to make.

Slide20

Fi­nally, there are reg­u­la­tory bar­ri­ers. There are ex­tremely stringent reg­u­la­tions of the man­u­fac­tur­ing of med­i­cal coun­ter­mea­sures; these reg­u­la­tions are called “good man­u­fac­tur­ing prac­tices.” They are re­ally im­por­tant for pro­tect­ing users of vac­cines, an­tibiotics, and other health prod­ucts dur­ing peace­time. They’re why vac­cines have such high safety rates. But they can slow down scale-up in an emer­gency, es­pe­cially be­cause there are [reg­u­la­tory] differ­ences in­ter­na­tion­ally.

Slide21

Next, I’m go­ing to pre­sent three po­ten­tial policy strate­gies that we think could help alle­vi­ate these bar­ri­ers. I’ll run through them quickly, and then dive more deeply into the first one.

Slide22

The first strat­egy is to pro­mote plat­form tech­nolo­gies. Th­ese are a cat­e­gory of man­u­fac­tur­ing tech­nolo­gies that could be much more flex­ible and rapidly scal­able than con­ven­tional man­u­fac­tur­ing. They would have trans­for­ma­tive im­pacts on tech­ni­cal and eco­nomic bar­ri­ers, but it would likely take five to 15 years to get these prod­ucts on the mar­ket. It would re­quire an in­vest­ment of at least sev­eral billion dol­lars, if not much more than that.

Se­cond, there’s a slew of ideas that could bolster the ca­pa­bil­ities of the fed­eral gov­ern­ment to re­spond to an emer­gency and in­vest in coun­ter­mea­sures.

The third strat­egy in­volves im­prov­ing plan­ning be­tween the pub­lic and the pri­vate sec­tors to make sure we have strong emer­gency re­sponse plans.

I want to re­turn to plat­form tech­nolo­gies be­cause I think they are our best bet. It’s use­ful to con­trast them to con­ven­tional man­u­fac­tur­ing. In con­ven­tional vac­cine man­u­fac­tur­ing, you typ­i­cally at­ten­u­ate the tar­get pathogen against which you want to stim­u­late im­mu­nity. You’re go­ing to grow that pathogen — for ex­am­ple, a virus — in a large biore­ac­tor or vat of cells. You ex­tract and filter the at­ten­u­ated virus, and ad­minister it to the pa­tient whose im­mune sys­tem then gen­er­ates im­mu­nity against that virus. This turns out to be quite a slow and in­flex­ible man­u­fac­tur­ing pro­cess.

Slide23

By con­trast, plat­form tech­nolo­gies use a spe­cific de­liv­ery mechanism: a plat­form on which you can de­liver many differ­ent types of prod­ucts.

Slide24

I’ll use the ex­am­ple of DNA-based vac­cine man­u­fac­tur­ing. In a DNA-based vac­cine, you iden­tify a spe­cific pro­tein on the tar­get pathogen and anti­gen, which can stim­u­late im­mu­nity. You iden­tify the gene se­quence of this pro­tein and syn­the­size that gene se­quence in DNA. You at­tach it to some de­liv­ery mechanism that can bring it into the cells. You ad­minister it, and the pa­tient’s cells then cre­ate that pro­tein us­ing their own molec­u­lar ma­chin­ery. It’s that pro­tein that then stim­u­lates the im­mune re­sponse.

This is much faster and more flex­ible be­cause it al­lows man­u­fac­tur­ers to type in a new and differ­ent DNA se­quence, and quickly switch from pro­duc­ing one product to an­other us­ing the same de­liv­ery mechanism. You can switch over in weeks or maybe even days.

The prob­lem is that we’re still five to 15 years away from these prod­ucts ma­tur­ing. There are a few bar­ri­ers that pub­lic policy could alle­vi­ate.

Slide25

The first is in­suffi­cient pri­vate-sec­tor in­vest­ment for some of the rea­sons that I men­tioned ear­lier. I think there should be mas­sive pub­lic fi­nanc­ing, on the or­der of sev­eral billion dol­lars over the next decade — if not much more than that — to ac­cel­er­ate re­search into these kinds of vac­cines.

We could also ac­cel­er­ate reg­u­la­tory pro­cesses for these plat­forms by reg­u­lat­ing them based on de­liv­ery mechanism rather than dis­ease type, and by us­ing a va­ri­ety of tools that the FDA has [at its dis­posal] to ac­cel­er­ate product ap­proval.

Fi­nally, I’ll quickly talk through some ideas to strengthen the ca­pa­bil­ities of fed­eral gov­ern­ment to in­vest and re­spond in this space. The fed­eral gov­ern­ment already par­tially in­vests in fa­cil­ities that are de­signed for surge man­u­fac­tur­ing. But it hasn’t yet fully de­liv­ered on its promise.

Slide26

We could help alle­vi­ate that by es­tab­lish­ing multi-year ap­pro­pri­a­tions for the gov­ern­ment to in­vest in med­i­cal coun­ter­mea­sures over the long term.

We could make [it eas­ier for] the Depart­ment of Health and Hu­man Ser­vices to con­tract with pri­vate-sec­tor agen­cies and or­ga­ni­za­tions, and we could al­lo­cate emer­gency-re­sponse fund­ing that the fed­eral gov­ern­ment could draw upon im­me­di­ately [if need be].

Slide27 The fi­nal recom­men­da­tion is to cre­ate gov­ern­ment-in­dus­try plan­ning fo­rums to bet­ter co­or­di­nate emer­gency reg­u­la­tory plan­ning be­tween pri­vate-sec­tor com­pa­nies and the fed­eral gov­ern­ment.

Slide28

This last slide is just a list of ideas for any­one in­ter­ested in get­ting in­volved in biose­cu­rity.

Thank you.

Moder­a­tor: Our dis­cus­sant for this sec­tion will be Greg Lewis. Greg is a scholar at the Fu­ture of Hu­man­ity In­sti­tute where he in­ves­ti­gates long-run im­pacts and po­ten­tial catas­trophic risk from ad­vanc­ing biotech­nol­ogy. He is a doc­torate in philos­o­phy stu­dent in Michael Bon­sell’s math­e­mat­i­cal ecol­ogy group. Pre­vi­ously, he was an aca­demic clini­cal fel­low in pub­lic health medicine, where he won the O’Brien Prize. He holds a mas­ter’s in pub­lic health and a med­i­cal de­gree, both from Cam­bridge Univer­sity. Be­fore study­ing medicine, he rep­re­sented Great Bri­tain in the In­ter­na­tional Biol­ogy Olympiad.

Greg Lewis [Dis­cus­sant]: Thank you very much — and sorry for mak­ing you have to quote my own puffery back at me.

Thank you so much, Daniel, for the ex­cel­lent talk. I have two main ques­tions, which might serve as prompts for dis­cus­sion. It seems to me that the tech­nol­ogy is cur­rently not yet there to have suffi­cient ca­pac­ity, no mat­ter what reg­u­la­tory or eco­nomic bar­ri­ers are in place. To re­serve suffi­cient plant ca­pac­ity is go­ing to re­quire sev­eral or­ders of mag­ni­tude more of an ex­ist­ing ag­gre­gate med­i­cal pro­duc­tion in the world, which seems im­pos­si­ble even if you spend a lot of U.S. GDP on it.

So if you were tar­get­ing poli­cy­mak­ers, [the mes­sage would be] to sim­ply in­vest more in plat­form tech­nolo­gies. The other things are nice to have at this stage, but seem to not have as much rele­vance. But maybe I’m over-sim­plify­ing.

Daniel: Yeah, I would broadly agree with that as­sess­ment. But I think the story is a lit­tle more nu­anced than you just pre­sented. I think there is ac­tu­ally an­other set of tech­nolo­gies that can be helpful in the in­terim. I’ll just quickly point them out here.

Slide30

This is quite a com­pli­cated slide, but it sum­ma­rizes differ­ent tech­nol­ogy cat­e­gories based on how flex­ible they are and how effi­cient they can be at scale. [The cat­e­gories at] the top left are effi­cient at scale but ex­tremely in­flex­ible, which is where we are right now.

There’s an­other cat­e­gory of tech­nolo­gies called “flex­ible man­u­fac­tur­ing tech­nolo­gies” that could in­cre­men­tally im­prove flex­i­bil­ity. Th­ese are things like us­ing dis­pos­able bags in your biore­ac­tors, so that if you’re pro­duc­ing one product and want to switch to an­other, you can just throw out that plas­tic bag and use the same biore­ac­tor with­out spend­ing three months ster­il­iz­ing ev­ery sin­gle piece of your equip­ment. I think that for a range of plau­si­bly bad pathogens that we might face, this could im­prove ca­pa­bil­ities, so it is worth [pur­su­ing] some in­terim poli­cies to try to achieve those benefits.

Greg: What sort of surge ca­pac­ity do these things cur­rently have? What or­der-of-mag­ni­tude in­crease might you get from these in­ter­me­di­ate tech­nolo­gies?

Daniel: The in­dus­try is already mov­ing in this di­rec­tion, and im­ple­ment­ing these tech­nolo­gies could re­duce turnover times from a fac­tory when switch­ing from one product to an­other from, say, 12 months to maybe three to six months. I think that’s a mean­ingful im­prove­ment. But if ev­ery­one’s go­ing to die in three months, it’s not go­ing to solve that prob­lem.

Greg: Alas, no. I es­sen­tially agree. But tt seems like re­duc­ing the vuln­er­a­bil­ity sur­face even in­cre­men­tally would be valuable, even if we don’t yet have a sin­gle silver bul­let.

One fur­ther ques­tion: The cost for some of the [strate­gies] you men­tioned would, you said, be on av­er­age from $0.5 to $5 billion, which is on the or­der of the United States’ en­tire spend­ing on biose­cu­rity. So the archety­pal EA ques­tion is: How would you pri­ori­tize this among the en­tire port­fo­lio of biose­cu­rity work?

Daniel: Yeah, it’s a great ques­tion.

Slide36

This slide sum­ma­rizes U.S. in­vest­ment in biose­cu­rity, pan­demic pre­pared­ness, and other types of haz­ards (chem­i­cal, ra­diolog­i­cal, nu­clear, etc.). It’s a few billion for biose­cu­rity each year and maybe $10 billion for multi-haz­ard pre­pared­ness.

I would put in­vest­ment in plat­form tech­nolo­gies near the top. There may be even more cru­cial in­vest­ments we could be mak­ing in ac­cel­er­at­ing de­vel­op­ment timelines for new coun­ter­mea­sures — things like broad-spec­trum an­tivirals might be even more im­por­tant. But I do think in­vest­ment in plat­form tech­nolo­gies would be bet­ter than some of the in­vest­ments the gov­ern­ment is cur­rently mak­ing, and it’s cer­tainly worth in­creas­ing this bud­get by $1 billion a year. A 10% in­crease each year would be very worth­while.

Greg: In terms of pri­ori­tiz­ing be­tween the op­tions you your­self have se­lected, I think you men­tioned that maybe the fed­eral gov­ern­ment could fund some­thing like the [Pro­ject BioShield Act] to stock­pile vac­cines. That feels to me to be of very limited value, be­cause you can only stock­pile a set num­ber of vac­cines, and it might cost $4 billion. I’d rather spend $4 billion on [the other ideas you men­tioned]. I’m won­der­ing how you look at it.

Daniel: Yeah. So, so my un­der­stand­ing of [Pro­ject BioShield] is it funds stock­piles, but it also funds the de­vel­op­ment of coun­ter­mea­sures and man­u­fac­tur­ing ca­pa­bil­ities. I could be wrong about that.

I think stock­piles are a “nice to have” but not as cru­cial as de­vel­op­ing new coun­ter­mea­sures.

Greg: I guess we’re in fu­ri­ous agree­ment. Let’s hand this over to au­di­ence ques­tions.

Moder­a­tor: One au­di­ence mem­ber asks: Is there any pos­si­bil­ity that some of these plat­form tech­nolo­gies that you de­scribed could also pose a dual-use con­cern [i.e., be mis­ap­plied and in­ad­ver­tently cre­ate a threat in an­other area]?

Daniel: That’s a re­ally good ques­tion. Yeah, I think that ad­vance­ments in de­liv­er­ing DNA and RNA to cells and get­ting that pro­tein ex­pressed by the cells prob­a­bly could have some dual-use con­cerns. Based on what I’ve heard from sci­en­tists, I think it would be worth the risk be­cause there are many other ways you could de­velop com­pletely catas­trophic pan­demics. But [per­haps Greg could weigh in, since he is a sci­en­tist].

Greg: Yeah. To a first ap­prox­i­ma­tion, all of biotech­nol­ogy is dual-use. I agree there’s a risk of mi­suse. That be­ing said, you want to differ­en­ti­ate be­tween [mi­suses]. I’m keen to [risk what Daniel has dis­cussed] over peo­ple syn­the­siz­ing pathogens from scratch as they’ve done in the past.

Moder­a­tor: One au­di­ence mem­ber asks: How do the re­search and de­vel­op­ment ca­pa­bil­ities of other coun­tries, such as China, com­pare to those of the United States? Could we po­ten­tially team up with other coun­tries to ac­cel­er­ate the de­vel­op­ment of plat­form tech­nolo­gies or flex­ible man­u­fac­tur­ing meth­ods?

Daniel: It’s a great ques­tion. I definitely think there should be in­ter­na­tional co­op­er­a­tion. My un­der­stand­ing is that the U.S. and Europe are much more ad­vanced in terms of biophar­ma­ceu­ti­cal man­u­fac­tur­ing, and China has more ca­pac­ity in terms of the syn­thetic man­u­fac­tur­ing of small molecules. So my sus­pi­cion is that a lot of this re­search would be done in the U.S. and Europe. But I’m not an ex­pert in that area, so I could be wrong about that.

Moder­a­tor: That’s all the time we have for ques­tions. Let’s thank Daniel and Greg.

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