RITESH Brazil’s Signing of the Artemis Accords

Brazil’s Signing of the Artemis Accords

Greetings from Washington.

To President Bolsonaro, Minister Pontes, Minister França, and everyone gathered in Brasilia today – congratulations on Brazil signing the Artemis Accords.

Brazil and the United States have a long history of cooperation in scientific discovery – including the exploration of outer space for peaceful uses.

Now we will carry that partnership into a new era of space exploration working together.

Building upon the legacy of the Apollo space program, the Artemis program – named after Apollo’s twin sister in Greek mythology – will land the first woman and the first person of color on the surface of the Moon.

Together with international and commercial partners, it will establish the sustainable human exploration of the solar system.

And it will allow us to develop the technology and experience necessary to mount a historic human mission to Mars.

While the Artemis program will be led by NASA, it will be a truly international effort.

And Brazil will be an important part of it.

The Artemis Accords were written to be inclusive.

It’s our intention to invest in space exploration and development in a manner that promotes our fundamental belief in democracy, the rule of law, science, transparency, human rights, and the economic value of fair trade and private enterprise.

The Artemis program will also include public-private sector partnerships, ranging from delivering cargo to the lunar-orbiting Gateway station to producing the spacecraft that will land on the Moon’s surface.

And while the Accords are a non-binding government-to-government commitment, we hope these principles will create an environment in space that’s conducive to robust commercial investment, development, and operations – to create a vibrant space economy producing the jobs and careers of the future.

So on behalf of the U.S. government, let me say how pleased we are to welcome Brazil to the Artemis Accords.

You join our existing partners from across the globe, as well as new signatories New Zealand and the Republic of Korea – all working to advance international cooperation for peaceful and responsible space exploration and activities.

We hope that other space-faring nations will follow Brazil’s example and consider making their own commitment to the Artemis Accords and its principles.

This is an exciting time – for our countries, for science, and for all of us who ever looked up at the night sky and wondered when the mysteries of space would be unlocked.

Thank you for being on this journey with us, and congratulations.

The United States Establishes Complementary Mechanisms to Bolster Resiliency of the Hemisphere’s Health Economies and Ecosystems

U.S. Department of Commerce, with the support of the U.S. Department of Health & Human Services, announces annual multisectoral forum Americas RISE for Health. U.S. Department of State announces government-only Economy and Health Dialogue of the Americas. Together the two mechanisms will bolster resiliency of the hemisphere’s health economies and ecosystems.

Today on the eve of the Ninth Summit of the Americas in Los Angeles, Deputy Secretary of Commerce Don Graves and Under Secretary of State for Economic Affairs Growth, Energy, and the Environment Jose W. Fernandez announced the United States will establish complementary mechanisms to bolster resiliency of the hemisphere’s health economies and ecosystems. This announcement represents a first of its kind effort that will focus the region’s governments, private sector and civil society on shared challenges and opportunities to build resilient, inclusive, sustainable, equitable health economies and ecosystems.

Americas RISE for Health, convened by the U.S. Department of Commerce, with the support of the U.S. Department of Health & Human Services, will harness the collective strengths of the region’s private sector and civil society and partner with the region’s governments to build the hemisphere’s supply chains back to be more resilient, enable digital health solutions to reach underserved populations, accelerate regulatory improvements, reduce trade and investment barriers to health financing, create ethical environments so health economies can thrive, and address other areas of need.

Economy and Health Dialogue of the Americas (EHA), convened by the U.S. Department of State, will establish a series of official sector-only convenings to increase political will and commitments across health and economy sectors necessary to strengthen public health systems in the Americas by initiating collaboration among countries in the region through ministries of foreign affairs, health, economy, trade and with regional expert organizations. The EHA will support the region’s governments to coordinate on pandemic prevention, preparedness, and response; identify and leverage best practices in the public sector to include health gap assessments, sustainable health budgeting, and effective service delivery to support economic resilience and recovery; promote anti-corruption practices to increase efficiency; and build more resilient health systems. Working in coordination with the Americas Business Dialogue, the EHA provides a government and member state-only platform to enable governments to assess country-specific concrete actions towards policy reform that would enable greater private sector and civil society participation in the region’s health economies, and investment opportunities.

Coordinating these two mechanisms will link governments with civil and private stakeholders to help meet the Biden-Harris Administration’s objectives of building a resilient hemisphere and bolstering economic resilience and opportunity in the Americas.

For more information, please contact: E_Communications@state.gov.

Joint Statement on the COVID-19 Global Action Plan Foreign Ministerial Meeting

The following is the joint statement released by the Secretary of State of the United States and the Foreign Minister of Japan.

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As the world continues to grapple with COVID-19’s far-reaching impacts and new variants, there remains an urgent need to maintain and strengthen political engagement and coordination to end the acute phase of the COVID-19 pandemic. Building on the June 15th COVID-19 Senior Officials Meeting, H.E. Hayashi Yoshimasa, Minister for Foreign Affairs of Japan and the Honorable Antony Blinken, Secretary of State of the United States of America, convened a virtual COVID-19 Global Action Plan (GAP) Foreign Ministerial Meeting on July 19 with over 25 countries, the African Union, World Health Organization (WHO), and World Bank.  Foreign ministers and senior leaders from countries, regions, and international organizations reaffirmed the need for coordinated international leadership and political will to end the acute phase of the COVID-19 pandemic and strengthen readiness for future pandemic threats.

The participants discussed the need for equitable and sustainable access to safe, effective, quality assured and affordable vaccines, diagnostics, and therapeutics as well as the actions countries can take to increase vaccine confidence.  Participants reviewed actions to support the effective production, distribution, and use of diagnostics and therapeutics.  In seeking to close the financing gap for pandemic preparedness and response, participants also discussed how countries can support and fund new endeavors such as the Financial Intermediary Fund (FIF) and paths forward for mechanisms like ACT-A and COVAX.

In his remarks, Minister Hayashi reiterated the importance for the whole world to maintain and accelerate countermeasures to overcome the pandemic, and presented Japan’s contributions to ensure equitable access to vaccines through financial contributions to COVAX, dose donations, and its “Last One Mile” support. Minister Hayashi emphasized the importance of the GAP which facilitates information sharing and coordination on the ground to implement assistance to meet the needs of each recipient country. He stated that we have to address the fragility in governance and financing related to global health, and strengthen the foundations for better prevention, preparedness, and response (PPR) to future health crises. He also announced Japan’s decision to contribute seed-funding of 10 million USD to the FIF at the World Bank. Moreover, Minister Hayashi shared his intention to strengthen international partnerships for PPR in Africa at the 8th Tokyo International Conference on African Development on August 27-28 in Tunisia, and to actively contribute to strengthening the global health architecture as the host of the G7 Summit next year, toward the overall goal of achieving universal health coverage (UHC).

Secretary Blinken emphasized that new variants continue to pose a risk to COVID-19 response and that the world’s work to end this acute phase of pandemic is not done, despite other demands and crises straining global attention.  He called on GAP partners to continue advancing GAP lines of effort and to maintain high-level political attention on delivering concrete outcomes in advance of the United Nations General Assembly in September.  Secretary Blinken also called on partners to improve coordination for, and equitable access to, vaccines and treatments, especially with an increased focus on the delivery of doses for boosters and increased demand and uptake for pediatric doses. Secretary Blinken urged participants to focus on the collective commitment to strengthen the global health security architecture to prevent and prepare for future health threats.  He also emphasized the need to simultaneously combat other ongoing health threats, including HIV/AIDS, tuberculosis, and malaria that continue to claim lives and urged countries to contribute toward the Global Fund replenishment.  Lastly, he thanked partners for their support of the new FIF established with the World Bank and World Health Organization and called on other countries to contribute.

WHO Director General Tedros Adhanom Ghebreyesus reiterated alarm for rising global COVID-19 cases, applauded the establishment of a FIF at the World Bank, and the urgency of ending the acute phase of the pandemic.  The Director General emphasized focusing on vaccinating all health workers, all older people, and all at-risk groups, on the way to achieving the WHO’s goal of 70% vaccination coverage in all countries.

Through ministerial remarks and discussions, the participants identified the progress and remaining challenges, and reconfirmed their commitment to strengthen efforts across the GAP’s six lines of effort: to get shots in arms, bolster supply chain resilience, address information gaps, support health care workers, expand access to testing and treatment, and strengthen the global health security architecture in collaboration with multilateral efforts.

Participants joining Japan and the United States in the COVID-19 Global Action Plan Foreign Ministerial Meeting included the Argentine Republic, the Commonwealth of Australia, People’s Republic of Bangladesh, Belize, Canada, the Republic of Colombia, the Republic of Costa Rica, the Federal Republic of Germany, the Republic of India, the Republic of Indonesia, the State of Israel, the Italian Republic, Jamaica, the Republic of Korea, the Republic of Maldives, the Kingdom of Morocco, the Federal Republic of Nigeria, the Kingdom or Norway, New Zealand, the Kingdom of Saudi Arabia, the Republic of Senegal, the Republic of South Africa, the Kingdom of Spain, the Kingdom of Thailand, the United Arab Emirates, the African Union/Africa Centres for Disease Control, Heads of the World Health Organization, and the World Bank.

Joint Statement on the Contribution of Cooperative Threat Reduction Partnerships to Global Health Security

The text of the following statement was released by the Governments of the United States of America, Armenia, Georgia, Iraq, Jordan, Liberia, Philippines, Sierra Leone, Uganda, and Ukraine.

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The COVID-19 pandemic has underscored the importance of strong national capacities for infectious disease surveillance, diagnosis, and response. International cooperation and assistance play a critical role in building these capacities. Our governments have partnered openly and transparently through the Biological Threat Reduction Program, which is a part of the U.S. Department of Defense Cooperative Threat Reduction Program. These partnerships are devoted exclusively to peaceful purposes; they have nothing to do with weapons. These partnerships protect the health of humans and animals in our countries, including in the prevention, detection, and control of infectious disease outbreaks, and in enhancing laboratory biosafety and biosecurity. As partners in this program, we each have firsthand knowledge of its relevance to our shared goal of cooperating to strengthen global health security and reduce the impacts of infectious diseases on our societies. Our governments strongly affirm the common view that such cooperation should not be undermined, but rather promoted and reinforced. Pursuant to Article X, we encourage all Biological Weapons Convention States Parties to work together, including at the forthcoming Review Conference, in support of this goal.

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Deputy Secretary Sherman’s Call with Dutch Ministry of Foreign Affairs Secretary General Huijts

The following is attributable to Spokesperson Ned Price:

Deputy Secretary of State Wendy Sherman spoke with Dutch Ministry of Foreign Affairs Secretary General Paul Huijts today to reaffirm the importance of a successful Seventh Replenishment Conference for the Global Fund to Fight AIDS, Tuberculosis, and Malaria. President Biden will host the Replenishment Conference during the United Nations General Assembly in New York.

The United States is committed to helping the Global Fund reach its goals to help the world end HIV/AIDS, TB, and malaria and to build resilient and sustainable health systems. President Biden has signaled that the United States will make a contribution of $2 billion and an intended pledge of $6 billion for the Seventh Replenishment period, demonstrating the United States’ readiness to match $1 for every $2 contributed by other donors.

The Deputy Secretary also extended condolences on behalf of the United States following the shooting of three Royal Netherlands Army soldiers in Indianapolis.

Chairs’ Statement on the COVID-19 Global Action Plan (GAP) Ministerial

The text of the following statement was released by the Governments of the United States of America, Bangladesh, Botswana, and Spain on the occasion of the COVID-19 Group Action Plan (GAP) Ministerial.

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COVID-19 has had a profound impact on all countries, with more than 6.5 million dead worldwide, disrupting the health and well-being of billions, ravaging the global economy and local livelihoods, and threatening peace and stability.  Since the “COVID-19 Prioritized Global Action Plan for Enhanced Engagement (GAP)” was established in early 2022, GAP participants have supported enormous progress combatting the COVID-19 pandemic, globally and locally.  Working with international partners and national governments, they have helped increase vaccination rates in less prosperous countries from low double digits to more than fifty percent, provided last mile support for over 100 countries needing assistance moving safe and effective life-saving vaccines to their most at-risk populations, established regional hubs for mRNA vaccine development and vaccine and medical supply production, and are rolling out pilot treatment programs around the world.

Recognizing that more remains to be done around the world, U.S. Secretary of State Antony Blinken as represented by United States Representative to the United Nations Ambassador Linda Thomas-Greenfield, Bangladesh Minister for Foreign Affairs Dr. A.K. Abdul Momen, MP, Botswana Minister of Foreign Affairs Dr. Lemogang Kwape, and Spain Minister for Foreign Affairs José Manuel Albares Bueno, on September 23, convened a COVID-19 Global Action Plan Ministerial.  Foreign Ministers from Jamaica, Japan, Nigeria, Saudi Arabia, and Thailand participated, as well as the World Health Organization Director General, the acting head of the Africa Centres for Disease Control and Prevention (Africa CDC), and policy leaders from twenty-one other countries and organizations.  Ministers and leaders of the countries and organizations involved in the GAP discussed the state of the global response to COVID-19, and the role of foreign ministries to enhance political will and coordination.  They underscored the importance of enhanced coordination among GAP partners to fill remaining gaps in the pandemic response, and build better health security to prevent, prepare for, and respond to future health threats.  Amb. Thomas-Greenfield on behalf of Secretary Blinken called on GAP partners to maintain our focus to ensure everyone, everywhere is safe, even as other global issues demand our time.  Foreign Minister Momen said that immunization against COVID-19 should be declared a “global public good” and vaccines should be distributed without discrimination.  Foreign Minister Kwape stated that our priority is to preserve lives by investing in effective preparedness and readiness, including access to accelerated COVID-19 vaccination programs and responsive case management to ensure economic and social resilience post pandemic.  Foreign Minister Albares noted that strengthening global health with comprehensive and connected strategies is the best vaccine we can offer as policymakers to our citizens.

Turning Vaccines into Vaccinations

GAP ministers welcomed the progress made in ensuring the global availability of vaccines, but noted the need for continued focus on translating vaccines into vaccinations.  Today, more than 60 percent of the global population on average has been fully vaccinated, saving tens of millions of lives. GAP participants have delivered nearly a billion doses of safe and effective vaccines free of charge to more than 140 countries globally.  In just the last few months, GAP participants have also provided well over US$10 billion in assistance to enhance countries’ capacities to vaccinate and treat.

Ministers expressed concern, however, that the response has not been equitable around the world, and populations in many countries still lack access to safe and effective vaccines.  They reiterated the critical importance of maintaining and increasing political will to efficiently and equitably deliver safe and effective COVID-19 vaccines including boosters where and when they are needed, and reaffirmed a special focus on reaching populations at highest risk of hospitalization and death and health workers.  They applauded the work of the GAP partners and the COVID-19 Vaccine Delivery Partnership (Co-VDP) to coordinate vaccine deployment.  Ministers affirmed the importance of supporting targeted and tailored national campaigns to increase vaccine uptake, and of re-assessing national and local targets based on country contexts, demographics, and other critical health priorities.  They supported programs which seek to accelerate the uptake of COVID-19 vaccine among youths, who constitute for example more than 60 percent of African population.  Ministers called on all countries to facilitate access to vaccinations by vulnerable and marginalized populations including those living in humanitarian contexts and hard-to-reach areas.  Efforts should include mitigating logistical barriers that may disproportionately impact these populations, and facilitating safe, rapid, and unimpeded passage of humanitarian relief for civilians in need.  Ministers noted the potential value in integrating COVID-19 vaccines into national vaccine and immunization programs, to protect high-risk populations while simultaneously promoting routine immunization coverage.

Enabling Medical Supply Chains

Ministers celebrated the success of governments and the private sector in developing and producing vaccines to vaccinate the world’s population.  They noted with concern the inequities between and within countries in timely access to COVID-19 medical and other pandemic response products, notably vaccines, oxygen supplies, personal protective equipment, diagnostics and therapeutics that prevailed during the COVID-19 pandemic.  This also included disruptions to global medical supply chains caused by surges in demand for medical products and related inputs needed for the COVID-19 response, despite the best efforts of international organizations, private companies, and ad hoc groupings.  The Ministers acknowledged the value of regional medical supply platforms to the COVID-19 response.  Participants in this Line of Effort decided to establish an implementation group to determine an appropriate mechanism to facilitate supply chains during pandemics, including establishment of a global clearinghouse for COVID-19 medical and other pandemic response products and services and to coordinate with supply chain mechanisms.

Ministers supported the regional diversification of sustainable manufacturing capacities for vaccines and related products and improved cold chain capacity to enhance standing and surge capabilities.  They discussed considerations including financial sustainability, research and development efforts, regulatory frameworks, voluntary transfer of technology on mutually agreed terms, trade policies, and other critical factors.

Addressing Information Gaps

Ministers challenged all actors to address information challenges that preclude the best health outcomes in the COVID-19 pandemic.  Participants noted the critical importance of identifying common topics and sources of mis- and disinformation, coordinating to rapidly address information gaps by promoting credible information, and developing and sharing best practices to prevent the spread of mis- and disinformation, in accordance with national laws and principles.  Ministers welcomed the June 2022 Global Event on Vaccine Demand, hosted by UNICEF, Canada, and Ethiopia, which exchanged best practices on increasing vaccine confidence and uptake, and called on the participants to develop strong action plans for implementation and to build trust.  Participants condemned all efforts to spread disinformation about vaccines.  Participants welcomed the upcoming Disinformation Roundtable, to be hosted by Canada in Fall 2022, to exchange information and ideas on the impact of and effective solutions to disinformation regarding COVID-19 vaccines.

Investing In and Protecting Health and Care Workers

Ministers applauded the actions of health and care workers throughout the pandemic, and called for more support for workers’ overall health and well-being, integrating a gender approach.  All participants noted the importance of safeguarding, equipping, and building capacities health workforce, including the public health, primary care, and emergency workforce.  Participants called for all health and care workers to have priority access to COVID-19 vaccines, tests, and treatments, as well as other locally needed health tools.  They welcomed the WHO’s Roadmap for Public Health and Emergency Workforce, and the opportunity to align activities and investments with the Roadmap to build national capacity for essential public health functions.  Participants confirmed the need to facilitate training and technical assistance to equip health workers in communication, service delivery and surveillance.  Ministers noted reports of increased stress, anxiety, and depression among health and care workers and the need for governments and employers to support health and care workers’ mental health and wellbeing.

Improving Access to Non-Vaccine Interventions

Ministers noted that the pandemic has reached an inflection point, and proper use of medical tools, expertise, and leadership can turn COVID-19 from a global emergency into a manageable illness.  Ministers noted the need to promote and facilitate equitable distribution of safe and effective diagnostics and treatments, including oral antivirals, and medical oxygen, through regulatory efficiencies, market shaping, global access programs, public-private partnerships, sustainable financing, and other interventions. Participants welcomed the report of the ACT-A Facilitation Council Therapeutics and Diagnostics Working Group.  Ministers discussed the need for technological and financial support to some lower income countries.  GAP Ministers will continue sharing experiences and to identifying opportunities to collaborate on effective test-to-treat strategies and its integration into primary health care and public health functions.  Participants also called for continued support for other essential medical interventions, including oxygen.

Building Better Global Health Security Architecture

Ministers acknowledged the urgent need to strengthen the global health security architecture to prevent, detect, prepare for, and respond to COVID-19 and future pandemic threats, including strengthening the WHO, regional health agencies, and national public health institutes, improving finance and health coordination, as well as strengthening health systems towards achieving universal health coverage (UHC).  Leaders affirmed that improvements to strengthen the global health security architecture should be inclusive, equitable, effective, transparent, and efficient.

Participants aimed to identify concrete recommendations and next steps for COVID-19 response and for future pandemic prevention, preparedness and response (PPR).  Participants affirmed that the outcome of the independent evaluation of the Access to COVID Tools Accelerator (ACT-A) should help inform the coordination of the acute phase of COVID-19, and the integration of COVID-19 response into health systems.  They recognized the critical role of nonstate actors in the discussions and design of relevant platforms and approaches, including but not limited to regional institutions, academia, civil society organizations, corporations, and philanthropic foundations.  As part of creating a sustainable investment plan for the future, participants reinforced the need for continuing discussions to gather additional support for the Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness and Response as a complementary mechanism in the global health financing architecture.  In order to strengthen the global health security architecture, including the role of the WHO, participants welcomed the ongoing Member State discussions on the amendments to the International Health Regulations (IHRs) and the intergovernmental negotiating body (INB) to draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response.

Participants underscored that the GAP grouping had provided a valuable forum to coordinate the pandemic response and promote solutions that require political leadership.  Participants supported developing a consensus position on an approach to ensure commitment, action, and accountability at the highest political levels going forward, and identify the appropriate mechanisms to respond more effectively and efficiently to future global health security threats.  Participants will reconvene to evaluate progress and determine the future of the GAP.

Participating Countries and Organizations

Africa Centres for Disease Control and Prevention (Africa CDC), Australia, Bangladesh, Botswana, Canada, Colombia, Costa Rica, European Union, France, Germany, India, Indonesia, Israel, Italy, Jamaica, Japan, Morocco, Namibia, New Zealand, Nigeria, Norway, Oman, Republic of Korea, Saudi Arabia, Senegal, South Africa, Spain, Thailand, United Kingdom, United Arab Emirates, United States of America, World Health Organization (WHO)

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Reducing Biological Threats: Science Diplomacy, Multisectoral and Security Cooperation

As Prepared


Good afternoon, Honorable Andrew Weber, Dr. Lela Bakanidze, Mr. Visser, distinguished guests.  It’s an honor to be here today to provide keynote remarks alongside such esteemed colleagues.

In my capacity as Under Secretary, I oversee three State Department bureaus: the Bureau of Political-Military Affairs; the Bureau of Arms Control, Verification and Compliance; and the Bureau of International Security and Nonproliferation.  A significant part of our mission is to prevent biological threats.

The COVID-19 pandemic highlighted just how devastating an infectious disease can be, and how it can have such a profound effect on our daily lives, especially the loss of life of those closest to us.  On a global scale, we collectively realized the need for all countries to come together and prioritize efforts to prevent, prepare for, detect, and respond to pandemics and other health security threats.  We must work together to swiftly share and integrate experiences from around the world to improve these capabilities, including better coordination across various sectors.  We also need to be able to take rapid, transparent, and accountable actions and apply the critical lessons learned from this pandemic and past health emergencies.  Now is the time to deliberately integrate these lessons into regional, national, and global efforts to improve capacities and strengthen the global health security architecture.  We must prevent, detect, and respond to biological threats and infectious disease outbreaks, regardless of whether they are naturally occurring, or accidentally or deliberately spread.

T Family Efforts on COVID-19 Responses

On the global scale, the United States is committed to the Intergovernmental Negotiating Body (INB) process at the World Health Organization, and to developing an international instrument that effectively addresses the gaps and weaknesses in the global health architecture exposed by the COVID-19 pandemic and past health emergencies, and enables meaningful action, transparency, and accountability for pandemic prevention, preparedness, and response in the future.  Since the pandemic, the offices I oversee worked quickly and diligently with broader State Department and interagency stakeholders to enhance bio surveillance capabilities, promote multisectoral coordination, and strengthen biosafety and biosecurity practices with partner countries.  We also worked to build and strengthen multilateral nonproliferation regimes such as the Biological Weapons Convention, the Australia Group, and the UN Security Council Resolution 1540.

Lessons Learned

The COVID-19 pandemic has made clear that we, as a global community, have more work to do in this space.  We need to strengthen biosecurity and biosafety around the world.  The pandemic response created new challenges in these areas.  It forced our health care and public health systems to do more – stretching the capacity of the workforce and systems for disease surveillance, performing laboratory diagnostics, and coordinating emergency responses.  In many places, adequate training and administrative controls for biosafety and biosecurity risks are still needed.

The pandemic has also catalyzed the development of new tools and technologies, and pushed them to become better integrated within laboratories.  However, these advancements have given rise to new challenges, such as cybersecurity issues related to laboratory biosecurity and biosafety.  We need to learn from these lessons, and this requires that we facilitate sharing of strong laboratory biosecurity, biosafety, and cybersecurity practices within the international bioscience community.  But more than just share, we must integrate these best practices into the routines and operations of our critical research institutes and laboratories.

At the Department of State, we are taking steps to integrate these security measures by partnering with the International Federation of Biosafety Associations to develop a new certification to increase cyber risk awareness and encourage adoption of cybersecurity best practices in biological laboratories.  This will help protect sensitive research, data, databases, and facilities, and addresses another important lesson many government officials and policy makers realized early in the pandemic:  that national legislation pertaining to public health emergencies, biosafety, and biosecurity was often inadequate or too antiquated to face modern threats.

Developing a national biosafety and biosecurity strategy and regulatory framework while responding to a pandemic is not ideal, leaving the implementing government bodies, such as the Ministry of Health or Emergency Response Agency, to grapple with how to quickly respond to biological crises without the necessary tools or guidelines.  By coming together, as we have here today, we will be better prepared to face the next pandemic.

We must use the time between emergencies [outbreaks] to strengthen international and national regulatory capacities, as well as national laws and other measures that we need to prevent, prepare for, detect, and respond to public health emergencies, and to improve biosecurity and biosafety.  We should also use this time to build awareness, trust, transparency, and cooperation among the appropriate stakeholders, including the bioscience community.

For example, I am pleased to have the opportunity at this conference to meet with distinguished colleagues from Georgia’s Richard G. Lugar Center for Public Health Research, a public biomedical research laboratory owned and operated by Georgia that was established through a U.S. partnership in 2011.  This national capacity did not develop overnight, and required years of Georgian investment, commitment, and step by step improvement in their systems to detect, report, diagnose, and respond to the presence of animal and human disease outbreaks.  The Lugar Center has been a trailblazer in developing these capacities and was instrumental in Georgia’s fight against the COVID-19 pandemic.  The U.S. is proud of our peaceful partnership with the Lugar Center, the pre-eminent public health institution in Georgia, which maintains strong and longstanding partnership with the United States.

I applaud the professionalism and openness of the Lugar Center staff who opened their doors to the media earlier this year in a show of transparency.  For example, Georgia has become a world leader in reducing the health burden of Hepatitis C.  To do that, labs are needed to diagnose people appropriately and provide the molecular fingerprinting of the Hepatitis C virus to see if the virus is changing.  The Lugar Center provides this diagnostic testing capacity.  With its program expansion, the Center was able to provide quality control on testing done at other labs.  When the COVID-19 pandemic emerged, these capabilities, both the equipment and especially the very capable people, proved crucial.

Georgia was able to start diagnosing quickly to exponentially expand testing with good quality control, and to track COVID variants with molecular fingerprinting.  Georgia is a regional leader in testing and variant tracking because of the Lugar Center.  COVID-19 showcases this progress.  Unknown threats in the future will continue to test us.  It is critical that we continue to work together transparently, learn from both our successes and failures, and share our experiences with colleagues.

Impact and Role of Georgian Women

We also recognize the role that Georgia’s women, throughout all sectors of healthcare, have played in preventing, treating, and educating society on COVID-19 and other health security threats.  We have seen data on how the pandemic and its responses disproportionately impacted women, girls, and those historically marginalized.  Women comprise over 70 percent of the global health and social care workforce, and were required, either by the nature of their jobs or the need for financial stability, to put themselves at risk every day.  For them and others such as those living in rural areas, of a lower socio-economic status, ethnic minorities, and other intersecting factors, access to PPE, treatments, and public education were noticeable sparser; it is a matter of national security to ensure that people in these communities not only have a seat at the table, but a voice in the decisions.

Since 2017, Georgia’s status has steadily increased in terms of initiatives towards women’s inclusion, justice, and security, and ranks in the top 25 percent of countries doing so as measured by the global Women Peace and Security Index.  This has been even more important since 2020, as these aspects, as cross-analyzed with the INFORM Epidemic Risk Index, reveal a strong correlation between the status of a country’s inclusion, and its ability to respond to a widespread pandemic.

We should not need this type of research – it should be common sense that including all of society will warrant more sustainable and long-lasting solutions.  Research and development of new tools and technologies must consider all people within a society and assess potential impacts, both positive and negative.  Risk management and early action requires collaboration and communication between health sectors, emergency responders, private sector, and grassroots organizations to adequately address a biosecurity threat.

Strengthening International Obligations

Strengthening national laws and other measures for public health emergencies, biosecurity, and biosafety also supports nations’ commitments to international obligations and norms.  For example, national implementation of the Biological Weapons Convention requires countries to prevent the development of biological weapons.  Countries are also encouraged to regularly coordinate and interact with the bioscience community to ensure that work is carried out in a safe, secure, and responsible manner.  As you well know, biosafety officers are often responsible for managing both the safety and security risks of programs.  These are mutually reinforcing goals and it is important that your combined expertise drives your work.  Let us take the opportunity during this two-day conference to introduce ourselves to each other, share our experiences, and learn from each other.

Multisectoral Coordination

Coordination among government public health sectors, law enforcement and other first responders, the private sector, civil society, bioscience researchers, and international communities is vitally important if we are to strengthen global health security and effectively respond to future outbreaks and biological threats.

In any large-scale biological incident, the medical community is often not the first to respond to an outbreak – it is normally the emergency responders including law enforcement.  And most often, the emergency response sectors do not routinely handle high consequence pathogens and do not have the training or experience to operate under the unique conditions of a biological incident.  So, we must ensure that multiple sectors within societies are trained to engage in outbreak detection and response for effective mitigation.  I recall the scenes from the early days of the pandemic.  First responders were on the frontlines of the outbreak response, and they were being called upon to transport sick patients, enforce social distancing, and other measures to help contain the pandemic.  Not only did those first responders play a critical role in the pandemic response, but they put their own health at risk. Remember that in the early days of the outbreaks, we were without vaccines, without testing, and often without personal protective equipment.  

For events that are potentially deliberate or accidental, law enforcement teams depend on training and equipment to:  1) Detect a biological incident; 2) Safely and securely handle and transport pathogen samples, including using personal protective equipment; 3) Decontaminate and implement other measures to prevent further spread of the infectious disease; 4) Disseminate information regarding the incident to the public; 5) And coordinate with the public and animal health sectors.

In addition, the pandemic showed us that multisectoral coordination between the public and private sectors can enable a faster response in several ways.  Governments and the private sector working together were able to quickly develop, manufacture, and distribute safe and effective vaccines, diagnostics, and therapeutics.  In the area of health security information sharing, close coordination among the government, public health, and the bioscience research communities was vital to detect and assess emerging threats and to counter misinformation.  Ensuring timely, accurate, and reliable information is available to the public was, and continues to be, critical to response efforts in order to reduce confusion around the nature of biological risks and biological response best practices.  The pandemic also taught us of the very real challenges with mis- and disinformation, and how that can adversely affect public health responses, and affect international cooperation to tackle these enormous challenges together as a global community.

The Way Forward

The COVID-19 pandemic has driven home the point that we must learn the lessons from past health emergencies and finally break the cycle of pandemic panic and neglect.  This includes working to address new biosafety and biosecurity challenges.  The rapid expansion of new vaccines, diagnostic tools, therapeutics, and other medical countermeasure capacities helped meet the demands of this pandemic.  Work is ongoing to consider how best to build on these capacities and create sustainable, adaptable, rapidly scalable, and geographically distributed capabilities to better address future threats.

Most countries now recognize the importance of investing in national and regional approaches to build health security and resiliency to prepare for future pandemics and other unknown health threats.  This includes the need to enhance bio surveillance, laboratory capacity, workforce development, and emergency response.  It also includes mitigating the risks associated with biological facilities and professionals handling and storing infectious pathogens around the world.  Ensuring that facilities and individuals handling pathogens are equipped to do so safely, securely, and responsibly is critical.  Therefore, building biosafety and biosecurity capacity remains a top priority for my team.

Now more than ever before, we must strive for enhanced security at laboratories, and workforce training in biosafety and biosecurity best practices to ensure safe pathogen handling, secure storage, and waste management.  We need to strengthen our national capacities and other measures for public health emergencies and biosafety and biosecurity, as these are critical tools to prevent accidental or deliberate biological incidents, and enable a more rapid response should prevention prove inadequate.

As President Biden and Secretary Blinken have said, an effective approach to strengthening global health security requires an all-of-government and all-of-society approach in an inclusive and equitable manner.  Our health sectors, security forces, and first responder communities will be stronger if they work together; if we cross-train these sectors now on biological incident detection and response, we will have a more coordinated response and save more lives in the future.  


As biological threats continue to be a significant international security concern, I urge us all to continue scrutinizing the areas of our pandemic response that were insufficient and take action at all levels and within all sectors to ensure rapid, effective, and coordinated biological incident prevention, preparedness, detection, and responses in the future.  Thank you.

Under Secretary Jenkins’ Statement to Media in Tbilisi, Georgia

I am pleased to be here—not only at this conference—but in Georgia, where the United States enjoys such productive collaboration across a wide range of areas, including continued democratic development and needed reforms, economic growth and diversification, and defense and security cooperation.  I would like to thank our partners in the Georgian government, the Biosafety Association for Central Asia and the Caucasus, and, above all, the citizens of Georgia, who, for since regaining independence for more than 30 years, have chosen a Euro-Atlantic path.  We are honored to work with you.

At this conference, I emphasized that we must take the lessons we have learned from the pandemic and apply them to our future global health security and pandemic preparedness and response efforts.  This is a vital area of cooperation between the United States and Georgia, one driven by the excellent leadership at Georgia’s National Center for Disease Control, a ready and willing partner who has become a regional leader in the field of public health.  From Hepatitis C elimination to COVID-19 monitoring and treatment, their work is truly valuable.  I am here to stress that this cooperation will continue far into the future.

One of my priorities as the United States Under Secretary of State for Arms Control and International Security is to enhance biosafety and biosecurity norms, practices, tools, and resources to bolster cooperation in forums such as the Biological Weapons Convention, the Global Partnership, and the Global Health Security Agenda.  My team will work to ensure the tools needed to address these challenges get the attention and resources required.

I am also here to meet with Georgian leaders to discuss several other areas of strategic interest to both our countries:  border security, customs, and defense.  In all these engagements, I look forward to delivering a message of strong support from Washington for the tremendous work Ambassador Degnan and her Embassy team have done to help advance Georgia’s Euro-Atlantic aspirations, and to the Georgian Government for their collaboration and partnership in working with us in addressing these concerns.

These efforts have not come easily, especially of late, where we’ve been dismayed to see personal attacks on Ambassador Degnan and the Embassy.  Let us be clear – this is part of a bigger pattern of disinformation aimed at obscuring the truth and the realities of the current crises in Europe that one man has started.  The United States will always honor Ukraine’s internationally recognized borders, just as we will always recognize Georgia’s sovereignty and territorial integrity within its internationally recognized borders.  Together, we should all be standing by and supporting the people of Ukraine as they fight for their freedom and sovereignty.

Thank you.

Virtual Welcome Remarks at the “One Arctic, One Health” Workshop

Thank you to our Norwegian colleagues for hosting this workshop, and thank you for your leadership on One Health in the Arctic. I’m pleased to see such a diverse group of participants engaging on One Arctic, One Health.

I have placed a heavy emphasis on taking a One Health approach in my bureau.  We recognize the linkages between the health of people and the health of the planet. We also recognize that climate change has profound impacts on health – human health as well as the flora and fauna we interact with. And when I think about the Arctic region, one issue comes to mind before almost any other:  climate change.

Tackling the health effects of climate change – in a region warming at four times the global average rate – requires a One Health approach and urgency. So your work is at the front lines.  It’s essential that we use tabletop exercises like this one to simulate and better understand the complex dynamics between climate, humans, and animal communities.

At the same time, I recognize that there’s more to One Health than climate change.  I am pleased to see zoonotic avian influenza is also part of this week’s simulation. We are all too aware of the pandemic threat here, and the need to address this issue with a robust human-animal-environmental approach.

I’d also like us to recognize the importance of indigenous communities as vital sources of wisdom and as the primary responders to Arctic emergencies. We should celebrate and applaud the strong participation and commitment from indigenous communities on these vital issues.  This is a hallmark of the Arctic Council, and it’s a tradition of doing diplomacy in the Arctic that we must continue to build upon.

Addressing One Health, climate resiliency, and Arctic sustainable development demands integrated action and leadership.  That’s what the Arctic Council is designed to deliver, and that’s why your leadership is so important.

The United States recently released its National Strategy for the Arctic Region.  Of the four pillars that make up the strategy, I’m going to touch on two:  1) Climate Change and Environmental Protection, and 2) International Cooperation and Governance. On climate change and environmental protection, the U.S. government is committed to building resilience to the impacts of climate change and conserving Arctic ecosystems. On international cooperation, despite the challenges to Arctic cooperation caused by Russia’s war in Ukraine, the United States will continue to sustain institutions for Arctic cooperation and position these institutions to manage the impacts of increasing activity in the region. A great example of the nexus of these two pillars is found in the work of the Arctic Council.  The Arctic Council is the foremost intergovernmental forum that encompasses both environmental protection and international cooperation in the Arctic.

We’re proud to have been deeply involved in its work for more than 26 years since the signing of the Ottawa Declaration, and we continue to support the Council as we conduct its critical work going forward, including here, in Norway, through the work you’re doing today via the Sustainable Development Working Group’s One Arctic, One Health Project. This activity represents a key example of how Arctic Council stakeholders can continue to advance regional health security and climate resilience, even amid these challenging times.

As part of this National Strategy, the U.S. government reiterates its commitment to coordinating, and co-managing with U.S. Indigenous Arctic inhabitants, their communities, and organizations. We recognize that Indigenous communities are at the heart of everything we do in the Arctic, from addressing health, water, and energy security in a changing climate, to monitoring and protecting the health of Arctic ecosystems.

Thank you for your time.  I wish you all a very successful workshop.

Transgender people in rural America struggle to find doctors willing or able to provide care

For Tammy Rainey, finding a health care provider who knows about gender-affirming care has been a challenge in the rural northern Mississippi town where she lives.

As a transgender woman, Rainey needs the hormone estrogen, which allows her to physically transition by developing more feminine features. But when she asked her doctor for an estrogen prescription, he said he couldn’t provide that type of care.

“He’s generally a good guy and doesn’t act prejudiced. He gets my name and pronouns right,” said Rainey. “But when I asked him about hormones, he said, ‘I just don’t feel like I know enough about that. I don’t want to get involved in that.'”

So Rainey drives around 170 miles round trip every six months to get a supply of estrogen from a clinic in Memphis, Tennessee, to take home with her.

The obstacles Rainey overcomes to access care illustrate a type of medical inequity that transgender people who live in the rural U.S. often face: a general lack of education about trans-related care among small-town health professionals who might also be reluctant to learn.

“Medical communities across the country are seeing clearly that there is a knowledge gap in the provision of gender-affirming care,” said Dr. Morissa Ladinsky, a pediatrician who co-leads the Youth Multidisciplinary Gender Team at the University of Alabama-Birmingham.

Accurately counting the number of transgender people in rural America is hindered by a lack of U.S. census data and uniform state data. However, the Movement Advancement Project, a nonprofit organization that advocates for LGBTQ+ issues, used 2014-17 Centers for Disease Control and Prevention data from selected ZIP codes in 35 states to estimate that roughly 1 in 6 transgender adults in the U.S. live in a rural area. When that report was released in 2019, there were an estimated 1.4 million transgender people 13 and older nationwide. That number is now at least 1.6 million, according to the Williams Institute, a nonprofit think tank at the UCLA School of Law.

One in 3 trans people in rural areas experienced discrimination by a health care provider in the year leading up to the 2015 U.S. Transgender Survey Report, according to an analysis by MAP. Additionally, a third of all trans individuals report having to teach their doctor about their health care needs to receive appropriate care, and 62% worry about being negatively judged by a health care provider because of their sexual orientation or gender identity, according to data collected by the Williams Institute and other organizations.

A lack of local rural providers knowledgeable in trans care can mean long drives to gender-affirming clinics in metropolitan areas. Rural trans people are three times as likely as all transgender adults to travel 25 to 49 miles for routine care.

In Colorado, for example, many trans people outside Denver struggle to find proper care. Those who do have a trans-inclusive provider are more likely to receive wellness exams, less likely to delay care due to discrimination, and less likely to attempt suicide, according to results from the Colorado Transgender Health Survey published in 2018.

Much of the lack of care experienced by trans people is linked to insufficient education on LGBTQ+ health in medical schools across the country. In 2014, the Association of American Medical Colleges, which represents 170 accredited medical schools in the United States and Canada, released its first curriculum guidelines on caring for LGBTQ+ patients. As of 2018, 76% of medical schools included LGBTQ health themes in their curriculum, with half providing three or fewer classes on this topic.

Perhaps because of this, almost 77% of students from 10 medical schools in New England felt “not competent” or “somewhat not competent” in treating gender minority patients, according to a 2018 pilot study. Another paper, published last year, found that even clinicians who work in trans-friendly clinics lack knowledge about hormones, gender-affirming surgical options, and how to use appropriate pronouns and trans-inclusive language.

Throughout medical school, trans care was only briefly mentioned in endocrinology class, said Dr. Justin Bailey, who received his medical degree from UAB in 2021 and is now a resident there. “I don’t want to say the wrong thing or use the wrong pronouns, so I was hesitant and a little bit tepid in my approach to interviewing and treating this population of patients,” he said.

On top of insufficient medical school education, some practicing doctors don’t take the time to teach themselves about trans people, said Kathie Moehlig, founder of TransFamily Support Services, a nonprofit organization that offers a range of services to transgender people and their families. They are very well intentioned yet uneducated when it comes to transgender care, she said.

Some medical schools, like the one at UAB, have pushed for change. Since 2017, Ladinsky and her colleagues have worked to include trans people in their standardized patient program, which gives medical students hands-on experience and feedback by interacting with “patients” in simulated clinical environments.

For example, a trans individual acting as a patient will simulate acid reflux by pretending to have pain in their stomach and chest. Then, over the course of the examination, they will reveal that they are transgender.

In the early years of this program, some students’ bedside manner would change once the patient’s gender identity was revealed, said Elaine Stephens, a trans woman who participates in UAB’s standardized patient program. “Sometimes they would immediately start asking about sexual activity,” Stephens said.

Since UAB launched its program, students’ reactions have improved significantly, she said.

Elaine Stephens gets exam from a medical student
Elaine Stephens is examined by a medical student in University of Alabama-Birmingham’s standardized patient program. In the early years of this program, Stephens says, some students’ bedside manner would change once she revealed she was transgender. 

UAB Office of Standardized Patient Education

This progress is being replicated by other medical schools, said Moehlig. “But it’s a slow start, and these are large institutions that take a long time to move forward.”

Advocates also are working outside medical schools to improve care in rural areas. In Colorado, the nonprofit Extension for Community Health Outcomes, or ECHO Colorado, has been offering monthly virtual classes on gender-affirming care to rural providers since 2020. The classes became so popular that the organization created a four-week boot camp in 2021 for providers to learn about hormone therapy management, proper terminologies, surgical options, and supporting patients’ mental health.

For many years, doctors failed to recognize the need to learn about gender-affirming care, said Dr. Caroline Kirsch, director of osteopathic education at the University of Wyoming Family Medicine Residency Program-Casper. In Casper, this led to “a number of patients traveling to Colorado to access care, which is a large burden for them financially,” said Kirsch, who has participated in the ECHO Colorado program.

“Things that haven’t been as well taught historically in medical school are things that I think many physicians feel anxious about initially,” she said. “The earlier you learn about this type of care in your career, the more likely you are to see its potential and be less anxious about it.”

Educating more providers about trans-related care has become increasingly vital in recent years as gender-affirming clinics nationwide experience a rise in harassment and threats. For instance, Vanderbilt University Medical Center’s Clinic for Transgender Health became the target of far-right hate on social media last year. After growing pressure from Tennessee’s Republican lawmakers, the clinic paused gender-affirmation surgeries on patients younger than 18, potentially leaving many trans kids without necessary care.

Stephens hopes to see more medical schools include coursework on trans health care. She also wishes for doctors to treat trans people as they would any other patient.

“Just provide quality health care,” she tells the medical students at UAB. “We need health care like everyone else does.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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