Table 2. Key CDC-supported accomplishments toward achieving GHSA targets related to national laboratory systems in 17 Phase I countries, 2015–2017*.

GHSA target and CDC-supported accomplishments	Related JEE indicators (12)	No. countries
Real-time biosurveillance with a national laboratory system
Strategic planning and assessment
Identified national policies, legal authorities, and gaps for the conduct of a national public health laboratory system	P.1.1, P.1.2, D.1.2, D.1.3, D.1.4	17
Operationalized national plan of action with internationally accepted best practices for priority diseases	D.1.1, D.1.2, D.1.3, D.1.4	11
Developed tier-specific testing strategies for priority diseases at designated laboratories	D.1.3	10
Specimen referral system
Established functional system for specimen transport to reference laboratories within the appropriate timeframe of collection	D.1.2	9
Conducted investigations or training exercises to confirm functionality of specimen referral systems	D.1.2	8
Training
Trained laboratory technicians	D.1.1, D.1.3	17
Effective modern point-of-care and laboratory-based diagnostics
Strategic planning and assessment
Assessed diagnostics, data quality, and staff performance	D.1.1, D.1.3, D.1.4	9
Assessed antimicrobial resistance and drug-resistant tuberculosis laboratory capacity	P.3.1	10
Diagnostics
Acquired new diagnostic equipment and capabilities (e.g., specimen test kits) to detect priority pathogens (e.g., influenza virus, poliovirus, HIV, Mycobacterium tuberculosis, Salmonella enterica serovar Typhi, Plasmodium sp., Vibrio cholerae)	D.1.1, D.1.3	16
Whole-of-government national biosafety and biosecurity system is in place, ensuring that especially dangerous pathogens are identified, held, secured, and monitored in a minimal number of facilities according to best practices; biologic risk management training and educational outreach are conducted to promote a shared culture of responsibility, reduce dual-use risks, mitigate biologic proliferation and deliberate use threats, and ensure safe transfer of biologic agents; and country-specific biosafety and biosecurity legislation, laboratory licensing, and pathogen control measures are in place as appropriate
Biosafety and biosecurity
Trained staff on biosafety and biosecurity	P.6.2	15
Identified staff in ministries of health, agriculture, and defense responsible for inspection or certification of laboratories for compliance with biosafety and biosecurity requirements	P.6.1	8
Inventoried dangerous pathogens and developed a plan to manage them	P.6.1	6

*Countries: Bangladesh, Burkina Faso, Cameroon, Côte d’Ivoire, Ethiopia, Guinea, India, Indonesia, Kenya, Liberia, Mali, Pakistan, Senegal, Sierra Leone, Tanzania, Uganda, and Vietnam. CDC, US Centers for Disease Control and Prevention; GHSA, Global Health Security Agenda; JEE, Joint External Evaluation tool.