RAND-A Brief Overview of Emerging Vaccine Technologies for Pandemic Preparedness-此為英文文檔

ResearchReportTOROBERTHUANGCHRISTOPHERAEUSEBIMELISSASHOSTAKThepasttwodecadesprovidemanyexamplesoftheimportanceofpandemicpreparedness.OutbreaksofSARS,swineflu,MERS,Ebola,andcoronavirusdisease2019(COVID-19)havecausedmajorsocial,political,andeconomicdisruptionsaroundtheworld.Inlightoftheseevents,pandemicpreparednesshasproventobecriticaltohealth,national,andeconomicsecurity.Now,countriesareinvestingbillionsofdollarsinvariouspandemicprepared-nesstools,suchasvaccinesandbroad-spectrummedicalcountermeasures(MCM),toaddressthethreatsarisingfromoutbreaks.Thesetoolsnotonlyofferprotectionagainstnaturallyoccurringandaccidentalbiologicalincidentsbutcanalsohelpprovidesomeprotectionagainstdeliberatebiologicalattacks.Furthermore,pandemicpreparednesshassubstantialeconomicimplicationsforboththepublicandprivatesectorsbecauseofitsconnectionwiththebiotechnologyindustry,animportantcompo-nentoftheworldwideeconomy.Theindustryiscriticalforeconomiccompetition,butitalsopro-videsopportunitiesforrelationship-buildingamongallies,academia,andindustrypartners.Withsomanyaspectsofpandemicpreparednesstiedtopublichealth,nationalsecurity,andeconomiccompetition,understandingthekeytechnologyandpolicytrendsofthemajorcountrystakeholdersinthisspaceprovidesvaluableinsightsintopandemicpreparednessgapsandwaysofaddressingthem.Therefore,inthisreport,wediscussbothtechnicalandpolicyaspectsofvaccineconceptsandtechnologies,broad-spectrumMCM,andimmunizationfacilitation.WeresearchedthesetopicstoprovideinsightsforJapan’sNationalGraduateInstituteforPolicyStudies,focusingspecificallyonthenationalpoliciesoftheUnitedStates,China,andRussia.However,theresultsofthisresearchshouldberelevanttoaudiencesbeyondJapan.WhileJapan’srapidlyagingpopula-tionmakesitparticularlyvulnerabletopandemics,manyothernationsalsohavegrowingnumbersofolderpeople;Japanisaharbingerratherthananoutlier.Moreover,manyofthecapabilitiesandpoliciesthatJapancoulddeveloptocounterpandemicthreatscouldalsobepursuedbyothercoun-tries.Thisresearchisthereforerelevanttobroaderaudiencesaroundtheglobe.2EmergingVaccineConceptsandTechnologiesandBroad-SpectrumMedicalCountermeasuresScopeandStateofEmergingVaccineConceptsandTechnologiesandBroad-SpectrumMedicalCountermeasurestenuatedicableornonisinetechnologies:mRNAvaccines,nanoparticle(NP)vaccines,viral-likeparticle(VLP)vaccines,anduni-versalvaccines.KEYKEYFINDINGS■Vaccineshavemultiuseapplicationsthatnotonlyprotectindividualandpublichealthbutalsohaveeco-nomicandnationalsecurityconsiderations.■TheUnitedStatesinvestsheavilyinvariousemergingvaccinetechnologiesandbroad-spectrummedicalcountermeasures.■Chinahasastrongandstablevaccineindustry,whileRussiafallsbehindtheUnitedStates,Japan,andChina.■Therehavebeenwell-foundedquestionsabouttheefficacyofboththeChineseandRussiancoronavirusdisease2019vaccines.POLICYIMPLICATIONSGovernmentsthatwanttoreducetheirvulnerabilitytopandemicscantakethefollowingapproaches:■Investinemergingvaccinetechnologiesthatcanprotectagainstbothcurrentdiseasesandnovelpathogens.■Investinthedevelopmentofvaccinesthatcanprotectagainstmultiplevariantsofasinglepathogen.■Investinthedevelopmentofvaccinesthatprovidelong-termimmunity.■Investinthedevelopmentoforal,inhalational,orotherlessinvasivemethodsofadministeringvaccines.■Investinresearchonhowtoreducethesideeffectsofvaccines.■Furtherinvestinregulationtoensurethatlaboratorieshandlingpathogensaresafeandsecureandthatnewvaccinescanberapidlyandaccuratelyassessed.■Investinstockpilesofdiversemedicalcountermeasures,includingvaccines,drugs,biologics(medica-tionsderivedfromlivingsources),anddevices.■Fosterandincentivizerelationshipsbetweenacademiaandindustrypartners,aswellasbetweenresearchersinotherdemocracies,toaccelerateadvancesinvaccinetechnology.■Facilitateimmunizationbymakingitmoreaccessibleandbyfurtherinvestinginpublichealtheducationtoovercomevaccinehesitancyandvaccinefatigue.■Ensurethatvaccinedistributionchannelsareopentoacceleratevaccinationprocessesinfuturepandemics.3InmRNAvaccines,mRNAisusedinsteadofsubunitsofthepathogen.Incells,mRNAinthenucleusisnecessaryforDNAtoproduceproteins,butthemRNAfrommRNAvaccinesdoesnotenterthenucleusoralterDNA.ThesevaccinesworkbyintroducingapieceofmRNAthatcorrespondstoaviralproteinthattheimmunesystemrecognizesasforeign,soitproducesantibodiestofightagainsttheinfection.1mRNAvaccinetechnologyispavingthewayfornewvaccinesthatarequickerandeasiertomodifyanddevelopagainstemergingviruses.TheCOVID-19pandemicconfirmedhowquicklymRNAvaccinescanbedesignedandproducedagainstanovelpathogen.Notonlyisthistechnologybeingusedforpreventivemeasures,butitisalsobeingusedinthedevelopmentoftreatmentsfornon-infectiousdiseases,suchascancer.2Furthermore,researchersinaModernamRNAskincancervaccinetrialdemon-stratedthatmRNAvaccinescanbepersonalizedforindividualsinaslittleassixweeks.3However,whiletheeffectiveuseofmRNAvaccinesforCOVID-19revealedthatthistechnologyhasgreatpromise,thepotentialandsetbacksofmRNAvaccinetechnologyarenotfullyunderstood.Furtherresearchisneededondifferentwaysthistechnologycanbeusedandhowitcanbeusedmoreefficiently—specifically,howthevaccinescanremainefficaciousevenagainstvirusvariantsormutations.BothNPvaccinesandVLPvaccinesarealterna-tivevaccineapproacheswithincreasedstabilityandimmunogenicitycomparedtovaccinesthatusesub-unitsofapathogen.NPvaccinesworkbyencapsulat-ingantigensneededtoelicitanimmuneresponse.Overall,NPvaccinescanbesimplerindesignthanconventionalvaccines,canbesaferthanlive-attenuatedvaccines,andcanimprovevaccineeffi-cacybyusingtargeteddeliverytoachieveadesiredimmuneresponse.4NPvaccinesmayalsoeliminatetheneedforvaccinestobeinjected,enablingthemtobeadministeredintranasallyorthroughaninhaler.Theirsimplerdesigncandecreaseoverallproductioncostrelativetosubunitvaccines.5VLPvaccines,asubsetofNPvaccines,donothaveanyviralgeneticmaterialbutaremadewithvirus-likemoleculesthatmimicthevirus.Asaresult,theVLPsareunabletoreplicateincellsbutarestillabletotriggeranimmuneresponse.Onekeyadvantageofsuchavac-AbbrAbbreviationsMCMcoronavirusdisease2019medicalcountermeasuresNationalImmunizationProgramnanoparticleviral-likeparticlecineisthatitcanbemoresuitablethanconventionalvaccinesforpeoplewithweakenedimmunesys-tems,whowouldotherwisebeatriskofcontractingthedisease.6Auniversalvaccinecancountermultiplevari-antsofaspecificdisease.Itcantriggeranimmuneresponsebydisplayingaspecificproteinpresentedbymultiplevariantsofthatdisease.Forexample,acoronavirusvaccinecandidatefromtheWalterReedArmyInstituteofResearchusesacoronavirusspikesurfaceproteintoelicitaresponse.7Universalvaccinescanincorporatesomeoftheemergingtech-nologiesmentionedabove.AresearchteamfundedbytheNationalInstitutesofHealthdesignedanmRNAuniversalvaccinethatincludedaviralpro-teinfrom20differentinfluenzatypes.8BeforetheCOVID-19pandemic,afeweffortswereunderwayintheUnitedStatestocreateauniversalinfluenzavaccine;vaccineswereinthepreclinicalstageortheclinicaldevelopmentstage.9Sofar,thetrialsaredemonstratingpromisingresultsof“highlevelsofcross-reactiveandsubtype-specificantibodies.”10Ifsuccessful,thevaccinewillprovidelonger-lastingprotectionagainstawidevarietyofseasonalinflu-enzavirusesandinfluenzaviruseswithpandemicpotential.Althoughtherearecurrentlynouniversalvaccinesapprovedforpublicuse,theycouldbeeffec-tivedespitepathogenmutations,whilerequiringfewornoboostershots.Whilevaccinesarevitalforpandemicprepared-ness,broad-spectrumMCMs—includingantiviraldrugs,biologics(medicinesderivedfromlivingsources),andantibiotics—arealsoneededtocomple-mentthem.Broad-spectrumMCMsalsoincludemedicaldevices,suchaswearabledevices,ventila-tors,andpersonalprotectiveequipment,thatcanbeusedtodiagnose,prevent,ortreatdiseases.Becauseofthepotentialspeedwithwhichoutbreakscan4wnbroadspectrumforpublichealthpreparednessandU.S.andAlliedPolicyTrendsRegardingEmergingVaccineConceptsandBroad-SpectrumMedicalCountermeasuresInOctober2022,theWhiteHousereleaseditsNationalBiodefenseStrategyandImplementationPlanforCounteringBiologicalThreats,EnhancingPandemicPreparedness,andAchievingGlobalHealthSecurity,highlightingtheUnitedStates’emphasisonpandemicpreparedness.Thestrategyoutlinesthenationalvisionforaddressingchallengesarisingfromnaturallyoccurring,accidental,ordeliberatebiologi-calthreats.TheUnitedStatesisfocusingonbuildingitstechnologysector,includingbiotechnologyandbiomanufacturing.Thegoalistoworkwithalliesandpartnerstopioneernewmedicinesandtreat-ments.11Intotal,theUnitedStateswillbeinvestingFIGURE1PatentsGrantedin2022inTwoAreasofVaccineTechnology,byCountryNumberofpatents(thousands)mRNAandvaccineVaccineandmRNAandvaccineVaccineandcancer0UnitedStatesJapanChinaRussiaClaimsIFIClaimsDirectPlatform.$88billioninpandemicpreparednessoverthenextfiveyears.12Inrecentyears,manynewpatentshavebeenfiledforkeyvaccinationtechnologies.Theexponentialincreasesinpatentfilingsindicatewidespreadinter-estinthesetechnologies(althoughthesheernumberofpatentsdoesnotdistinguishthemintermsofqual-ity).Figure1showsthenumberofpatentsin2022,bycountry,intwovaccine-relatedcategories.Thetremendousdisparitiesamongthevariousnationsareapparent.TheUnitedStatesgeneratesanorderofmagnitudemoreofthesepatentsthaneitherJapanorChinadoes,whileeachofthosenationsgeneratesanorderofmagnitudemorethanRussiadoes.Figure2showsthenumbersofpatentsinthoseandtwoadditionalareasofvaccinationresearch,byyear,fortheUnitedStates,Japan,China,andRussia.Notethatweusedadifferentscaleforeachcountry’sgraphsothatthegraphsarelegible;thetopmostnumberoneachverticalscaleisunderlinedtoemphasizethispoint.Asshowninthefigure,acrossallfournations,thenumberofpatentsintheseareashasbeenrisingexponentiallyoverthepastthreedecades.Vaccinedevelopmentrequiresvigilantoversighttopreventsafetylapsesthatcanleadtopeoplebeingexposedtopathogens,aswellastopreventsecuritylapsesthatcanenablevaccineintellectualpropertytobestolenbymalevolentactors.Inanefforttoaddresssuchrisks,theU.S.GovernmentAccountabilityOfficehasdocumentedalackofsufficientoversightofU.S.laboratoriesthathandlepathogensandhasmaderecommendationsonhowtoreducerisks.13TheUnitedStatesisalsofocusedondevelopingbroad-spectrumMCMs.In2023,theU.S.Depart-mentofDefensereleasedareportstatingitsintentiontofocusmoreonbroad-spectrumMCMstoaddressbothnaturaloutbreaksandbioattacks.14ItwillbeinvestinginthedevelopmentofnonspecificMCMsandtestproductsandcapabilitiestorapidlymovefromnonspecifictospecificMCMsandtestproducts.Thisshiftisbeingmadetohelplessensymptomsandreducetransmissionofanydiseaseoutbreak,butespeciallythosefromnovelpathogens.5Numberofpatents(thousands)Numberofpatents(thousands)NumberofNumberofpatents(thousands)Numberofpatents(thousands)Numberofpatents(thousands)Numberofpatents0PatentsinKeyAreasofVaccineTechnology,byCountry,overTimeUnitedStates19851995200520155019851995200520155019851995200520151985199520052015mRNAandvaccineVaccineandcancerBCGandvaccineRecombinantvaccineSOURCE:FeaturesglobaldatafromIFIClaims,IFIClaimsDirectPlatform.Thedatapointswerederivedfromsearchingforwordcombinationsorphrasesappearinginpatents.NOTE:BCG=BacillusCalmette-Guérin.Thetopnumberofpatentsontheleft-handscaleofeachofthegraphsisunderlinedasareminderthatthegraphsusedifferentscales.MultiuseApplicationsofEmergingVaccineConceptsandTechnologiesandBroad-SpectrumMedicalCountermeasuresareivevaclerosis,anddiabetes.15Broad-spectrumMCMalsoplaytheeffectsofapandemiceInadditiontoprotectingpublichealthagainstbiologicalattacksorroutineinfections.6Globally,themultibillion-dollarvaccineindustryindustryboostsscientificinnovationandcollabora-ortunitiesforgreaterpartnershipsners,bothinternallyandwithallies.Thisinnovationenefitsinlogytryenablingittosupplyitsownpopulationandexportitsproducts.Manufacturingvaccinescanalsoprovideopportunitiesforvaccinediplomacy:Donat-allydiminishingthefrequencyofnovelmutationsandopportunitiesfortransmission(includingtothenationChineseDevelopmentofEmergingVaccineConceptsandBroad-SpectrumMedicalCountermeasuresneindustrythatenablesgovernment-administeredNationalImmunizationProgram(NIP),butcitizenscanalsovoluntarilychooseandpayforadditionalvaccines(non-NIPvaccines).16China’sNIPvaccinesaremuchlessethanvaccinesincountrieswithamarketUnitedKingdom,allowingagreaternumberofvac-cinationsforagivenbudget.However,China’sNIPizationandfarfewerpeoplehanreceivetheNIPones.17TheChinesegovernment’s“MadeinChina2025”policyaimsforChinatoachievescientificminateinspecifictechnologyfields,includingbiotechnology.ChinahasmanyarchprojectsonvaccinesincludingneseresearchersarecurrentlyconductingclinicaltrialsoftheirownmRNACOVID-19vaccine,whichappearssomeentificpracticesincludingthecollecrsRussianDevelopmentofEmergingVaccineConceptsandBroad-SpectrumMedicalCountermeasuresRussianvaccinedevelopmenthasalonghistory,datingbacktotheSovietUnion.However,likeChina’svaccineindustry,Russia’shasbeenmarredbyalackoftransparency.Furthermore,althoughRussianscientistsarestillpursuingthedevelopmentofnewvaccines,Russianeffortstendtoemphasizetraditionalvaccinetechnologymorethaninnovativeapproaches.TheRusso-UkrainianWaralsoinhibitsvaccineinnovationinRussiabecauseofincreasedsanctionsagainststatevaccinedevelopmentlaborato-ries,decreasedinternationalcollaboration,decreasedfundingforscienceandtechnology,andtheexodusofRussianscientists.Russia’sSputnikVvaccineprovidesagoodcasestudyofthecurrentstateofRussianvaccineinnova-tionandtheproblemsitisfacing.WhileSputnikVwasthefirsteffectiveCOVID-19vaccinetobedevel-oped,RussianscientistsoptedtouseoldervaccinemethodologiestocreateitratherthanpursuemRNAvaccinetechnologytoimprovesafety,efficacy,andeffectiveness.21Inaddition,oneofthemajordevel-opersoftheSputnikVvaccine,the48thCentralResearchInstituteoftheMinistryofDefenseoftheRussianFederation,hasbeensanctionedbytheU.S.governmentoveritsinvolvementinbiologicalweapondevelopmentfortheRussianmilitary.22Asaresult,somecountries,suchasIndia,havepulledoutofagreementsforthepurchase,production,anddistributionofSputnikV.23Domestically,research-ershavereportedhighlevelsofvaccinehesitancyforSputnikV.Forty-threepercentofRussianadultsreportthattheyareresistantto,ordeterminednottobevaccinatedwith,SputnikV,andanother13per-centreportthattheyarehesitant,orunsure,about7tionalscientistshavealsochaltatedefficacyofSputnikVnotingthatotentherelativeopacityoftheconductofthistrialesultssuchasthesearisinginagenuinetrial,itisouropinionthatitisintheresults.”25FacilitatingImmunizationScopeandStateofStrategiesandTechnologiestoFacilitateImmunizationPeopleareoftenreluctantorunwillingtobevacci-natedforavarietyofreasons,includingideologicalbeliefs,concernsaboutthesafetyofvaccines,ques-tionsabouttheirefficacy,dislikeofinjections,fearofsideeffectsorcomplications,theinconvenienceofgettingtoaprovider,andcost.Therearevariouswaystofacilitateimmunizationbyaddressingtheseissues;someoftheseapproachesrequirenoadvancedtechnologyatall.Forexample,providingpublichealthstakeholderswiththeresourcestoaddressquestionsaboutvaccinescanhelpthemreassureindividualswhoareconcernedaboutthevaccines’safetyorefficacy.26Furthermore,easilyaccessiblevaccinesandtestingcenterscanmakeimmunizationanddiagnosismoreconvenientforpatients.27Otherapproachesrequireadegreeoftechnologi-calinnovation.Forexample,enablingvaccinestobedeliveredorallyorviainhalationcanmakepeoplemorereceptivetobeingvaccinated.28Oralandinha-lationalvaccinesoftendonotrequirerefrigeratedstorage,makingthemeasiertotransport,especiallytoremotecommunities,andstore.29Diminishingthesideeffectsofvaccinescouldalsoincreasewillingnesstoreceivethem.However,thereislittlecurrentinvestigationofwaystolessenthesideeffectsofvaccines,althoughtherearesomeeffortstothoroughlydocumentthesideeffects.30U.S.PolicyTrendsRegardingStrategiesandTechnologiestoFacilitateImmunizationIn2021,theU.S.DepartmentofHealthandHumanforoninvaccinedevelopvaccinedistributionanddeliverymechanisms,andheplaneinrecommendedvaccinesFororDiseaseControlandPrevencommunitytrustinvaccinations.32ChineseDevelopmentofStrategiesandTechnologiestoFacilitateImmunizationWhileChinahasawell-developedvaccineindustry,tancyhasbeenrisinginthecountryafteredbytheChangchunChangshengvaccineincident,inwhichChinesevaccinemakerChangshengBio-TechnologyCo.,Ltd.catingproductionandinspectiondataandsellinginferiorchildren’svaccines.33Follow-ChinacreatedtheVaccineAdministrationLawandcompulsoryvaccineliabilitypublictrustinvaccines.34Chinahasalsobeenwork-ingonusingdifferentvaccinedeliverymethods.Inlate2022,ChinarolledoutaninhalableCOVID-19thecountryrelaxeditspandemicrestrictions.35RussianDevelopmentofStrategiesandTechnologiestoFacilitateImmunizationficonRatherRussias8vaccineindustryismarredbydatadiscrepanciesandtrustandimmunizationeffortsinthecountry.OverallImplicationsforPolicymakersInaccordancewiththeaboveinformation,policy-makerscouldconsiderencouragingtheexpansionofacademic,government,andindustryresearchonvaccinedevelopment.Theycouldalsoconsiderfosteringpartnershipsamongresearchersinthoseinstitutionsandtheircounterpartsabroad.Thereareseveralreasonswhypolicymakersmightconsiderthisoverallapproach.Thevulnerabilityofagingpopulationsaroundtheworldmakeseffective,wide-spreadimmunizationparticularlyimportant,whichisanotherreasonwhylong-lastingvaccinesthatcanaddressmultiplediseasesormultiplestrainsofadisease—andthatcanthereforebeadministeredbeforeaspecificoutbreak—areparticularlyvaluable.Suchvaccinescanalsohelpovercomevaccinefatiguebyreducingthenumberoftimesindividualsneedtobevaccinated.Similarly,developingoralorinha-lationalvaccinescanhelpreducevaccinehesitancy.Documentingvaccinesideeffectsandaddressingconcernsthrougheducationcanalsohelpaddressvaccinehesitancy.Vaccinescanalsoserveasmultiusetechnologies.Sometypesofvaccinedevelopmentcanhelpreducetheimpactofnoncommunicablediseases,suchasdiabetesorspecifictypesofcancer.Othersmaypro-tectagainstbiologicalattacksthatcouldbelaunchedagainsteitherthecivilianpopulationorarmedforcespersonnel.Investmentsinvaccinetechnology,andthefos-teringofpartnerships,canalsobenefitacountry’seconomy.Improvedhealthduetoadvancedvaccinescanenablepeopletocontinueworkinglaterintheirlivesandminimizethedayslosttoillness,andahighdegreeofimmunizationcanreducetheextenttowhichnormalactivitiesarecurtailedduringepidem-ics.Moreover,biotechnologyisoneofthe21stcentu-ry’smostimportanteconomicsectors,andbuildingasubstantialbaseintermsofknowledge,equipment,andfacilitiesinthisareacanenablevarioustypesofexports.Ascountriesconsiderwhethertoinvestmoreinemergingvaccinetechnologies,anotherconsider-ationishowtoensuresufficientregulation.Handlingthedangerouspathogensthatvaccinesaredesignedtocounterrequiresstringentsafetyregulationstopreventpeoplefrombeingexposed,aswellassecu-ritymeasurestopreventmalevolentactorsfrombeingabletostealthosepathogens.Italsorequiresensuringthatacountry’sregulatorybodiescanaccu-ratelyassesstheefficacyofvaccinesagainstavarietyofpotentialthreatsratherthansingularones.Policymakersmayalsowanttoconsiderwhethertomakeadditionalinvestmentsinbroad-spectrumMCMtoreducevulnerabilityinpandemics.Forexample,distributedstockpilesofdrugsanddevices(suchasventilators)canimproveresponsesinninthefaceofnewCOVID-19vaccinesthatneedtocouldconsidermakingfurther,sustainedinvest-dingthebenandcommunitiesaroundtheworldbecomescouldalsoconsidercapacityandtoindividualswithlimitedmobility.ClosingThoughtshumanreasingnumbersoflivestockraisedincrowdedconditions,andintensifyinghumanaseportsbriefoverviewadvancesandtheefficacyofpolicytheiroverallsecurity.9Notes1Pardietal.,“mRNAVaccines—ANewErainVaccinology.”2Brisseetal.,“EmergingConceptsandTechnologiesinVaccineDevelopment.”3Park,“Moderna’smRNASkinCancerVaccineShowsEarlyPromiseinaNewStudy.”4Pati,Shevtsov,andSonawane,“NanoparticleVaccinesAgainstInfectiousDiseases.”5Guerrinietal.,“CharacterizationofNanoparticles-BasedVac-cinesforCOVID-19”;Pati,Shevtsov,andSonawane,“Nanopar-ticleVaccinesAgainstInfectiousDiseases.”6Nooraeietal.,“Virus-LikeParticles.”7Thisvaccineisalsoknownasapancoronavirusvaccine;seeCohen,“WhyEffortstoMakeBetter,MoreUniversalCorona-virusVaccinesAreStruggling”;Ramachandran,Satapathy,andDutta,“DeliveryStrategiesformRNAVaccines”;VashishthaandKumar,“LookingtotheFuture.”8NationalInstitutesofHealth,“UsingmRNATechnologyforaUniversalFluVaccine.”Wangetal.,“ProgressTowardstheDevelopmentofaUniversalInfluenzaVaccine.”10Arevaloetal.,“AMultivalentNucleoside-ModifiedmRNAVaccineAgainstAllKnownInfluenzaVirusSubtypes,”p.1.11WhiteHouse,NationalBiodefenseStrategyandImplementa-tionPlanforCounteringBiologicalThreats,EnhancingPandemicPreparedness,andAchievingGlobalHealthSecurity.12WhiteHouse,“Biden-HarrisAdministrationReleasesStrat-egytoStrengthenHealthSecurityandPrepareforBiothreats.”13U.S.GovernmentAccountabilityOffice,High-ContainmentLaboratories.14ChemicalandBiologicalDefenseProgram,ApproachforResearch,Development,andAcquisitionofMedicalCountermea-sureandTestProducts.15Lu,Su,andMeng,“RecentAdvancesintheDevelopmentofVaccinesforDiabetes,Hypertension,andAtherosclerosis.”16Liu,Bai,andZheng,“IntroductionandApplicationRecom-mendationsofNationalImmunizationProgram(NIP)andNon-NIPVaccineinChina.”17Zhengetal.,“TheLandscapeofVaccinesinChina.”18GroverandYu,“China’sCanSinoConfidentItsmRNACOVIDVaccineAsGoodAsModerna,PfizerShots.”19Ben-Achour,“China’sState-SponsoredIndustrialEspionageIsPartofaLargerSystem.”20Needham,“SpecialReport.”21Logunovetal.,“SafetyandImmunogenicityofanrAd26andrAd5Vector-BasedHeterologous