Following the 2001 end to negotiations on a legally binding protocol, Biological and Toxin Weapons Convention (BWC) states parties (SPs) developed entrenched positions about the necessity of a verification regime, hindering progress on treaty aims. This study aimed to facilitate dialogue on verification-related issues outside the context of those positions, using the term "assurance" to represent the degree of certainty that SPs are meeting their treaty obligations. From August 2020-July 2021, 36 interviews were conducted—16 SPs' delegations and 20 subject matter experts, representing 20 countries—and interview content was analyzed utilizing a mixed methods approach, including quantitative metrics on qualitative interview content. Interviewees' views on verification, compliance, and related concepts varied widely. Efforts by SPs to achieve common understanding on these topics could facilitate concrete progress in these important areas. While no single mechanism is sufficient to achieve verification or assess compliance, packages of mechanisms could increase assurance. There was general support for implementing assurance mechanisms, even in the absence of a comprehensive, legally binding protocol or verification regime, even among SPs for which that is the primary goal. Avenues to increase assurance among BWC stakeholders merit further discussion in the Intersessional Programme following the 9^th BWC Review Conference.

Rapidly providing a definitive diagnostic test that can be used broadly by healthcare providers and members of the public in the setting of a disease emergency is critical to limit pathogen spread, develop and deploy medical countermeasures, and mitigate the social and economic harms of a serious epidemic or pandemic. There is extraordinary expertise within and outside of government working on these issues, and major accomplishments have been made to accelerate test development, expand laboratory testing capacity, and establish widespread point-of-care testing. Still, the United States does not have a plan to rapidly respond, to develop, manufacture, or deploy at national scale diagnostic testing in the earliest days of a new infectious disease crisis. Nor does the nation have a plan to sustain testing capacity at high volume over the course ofan enduring epidemic or pandemic. To address this gap, we are proposing a National Diagnostics Action Plan that describes the steps that are urgently needed to prepare for future infectious disease emergencies, as well as the actions we must take at the first signs of such events. These recommendations require substantial collaboration between the US government (USG) and the private sector to solve a series of challenges now, as well as to prepare for the massive and rapid scale-up of laboratory and point-of-care test development and testing capacity in future emergencies. The recommendations include establishing pre-event contracts; ensuring rapid access to clinical samples; creating a permanent public-private testing coordinating body to allow for rapid information sharing and improved cooperation among the USG, test developers, and clinical laboratories; and accelerating testing rollout at the beginning of an event—andthus, the effective public health management of a disease crisis. These recommendations were informed by extensive discussion with people who managed the COVID-19 and monkeypox responses, review of past reports written on diagnostic challenges, and the experiences of the authors.

In this case study, we describe a well-resourced private school system that implemented COVID-19 mitigation measures based on public health expert guidance as well as the lessons learned from this process. Avenues is a 10-year-old private school with campuses in NYC, São Paulo, Shenzhen, Silicon Valley, as well as online, which offers education at sixteen grades: 2 early learning years, followed by a pre-kindergarten–grade 12 school. We describe the mitigation measures Avenues implemented. We compare COVID-19 case prevalence at the school to the reported case prevalence in New York City, as reported by the New York State Department of Health. We compare the school's indoor air quality (IAQ) to ambient IAQ measures reported in the literature. The school's COVID-19 transmission mitigation measures successfully reduced the prevalence of COVID-19 among its students, staff, and faculty. The school also established a consistent high level of IAQ through various ventilation mechanisms. The school received positive parent and community feedback on the policies and procedures it established, with many parents commenting on the high level of communication and trust established by the school. This successful school reopening provides useful data for school closure and reopening standards to prepare for future pandemic and epidemic events.

In the absence of a treaty protocol or verification regime, the Biological and Toxin Weapons Convention (BWC) instituted Confidence-Building Measures (CBMs) as a mechanism to increase confidence in compliance, by enhancing transparency and mitigating ambiguities regarding states parties’ biological activities. While a promising tool to support treaty compliance, low participation, concerns regarding the completeness and accuracy of CBM submissions, a dearth of analysis, and restricted access to many submissions have limited CBMs’ value. Through interviews with 53 international experts—38 from BWC delegations and 15 independent experts—we identified concrete opportunities to increase CBMs’ value while mitigating the burden on states parties. This study supports states parties’ efforts in the BWC Working Group on the Strengthening of the Convention, as part of a series of research on BWC assurance that aims to characterize challenges around BWC verification and increase certainty in BWC compliance.