On June 27 and 28, 2018, the US National Academies of Sciences, Engineering, and Medicine convened an international workshop in Amsterdam, the Netherlands, on developing norms for the provision of laboratories in low-resource contexts. The US Department of State’s Biosecurity Engagement Program provided funding for this workshop to engage an international group of organizations that fund construction, upgrades, and maintenance of biological laboratories in countries without the means to carry out these functions themselves. Twenty-one people from 19 organizations participated. The intent was to advance the conversation about the identification and application of guiding principles and common norms for use by these organizations in making decisions on grants, partnerships, and aid.
Below is a summary of the observations. Inclusion of an observation does not imply a consensus view of the workshop participants or the planning committee.
Funders for biological laboratories in partner countries include development and security agencies of national governments, international organizations, development banks, scientific and clinical health organizations, and foundations. Other stakeholders include the recipient countries, regional health organizations, academic institutions, and private industry. It is very unusual for representatives of these groups to meet together.
Models of assistance and partnership include limited-duration projects aimed at identifying needs, constructing facilities, and training personnel, to open-ended partnerships with recipients that lead to committed collaborations over decades.
Several participants felt there is interest within the funder community to share best practices to improve outcomes for all involved. There are other ongoing efforts to address difficulties associated with providing laboratories in low-resource contexts. For example, the Canadian government, Chatham House, and the World Organization for Animal Health are working together to develop decision tools and “appropriate technology” engineering options.
There is no comprehensive list of existing laboratory resources in low-resource countries, and compiling a list may be impossible or of limited value because of the differing laboratory purposes and local contexts. But this lack of information impedes the funders' ability to allocate resources establishing effective lab networks, to avoid duplication, and to recognize gaps. Some participants indicated that having mechanisms to share plans and coordinate with other funding organizations would be beneficial.
Biological containment laboratories do pose some safety and security risks. When assessing risk, context matters. Participants suggested that the following factors are all of great importance: the lab’s purpose (routine clinical diagnostics, disease surveillance, maintenance of reference samples, research, outbreak response); hazards associated with the pathogens; the adherence of lab staff to safety and security protocols; the regularity and effectiveness of inspections; and the adequacy and reliability of funding, electricity, water, waste treatment, transportation, supply chains, internet, and telecommunications.
A capable workforce and a strong training program are essential to the proper functioning of a biological laboratory. Many participants suggested that funders should address knowledge gaps in regions with inadequate educational systems and arrange for provision of training by local sources when possible, and third parties (professional societies, biosafety organizations, and private companies) or their own personnel (if a technical organization) when local training resources are not available. Funders could also engage with local or foreign universities to provide the needed education and training.
New molecular diagnostic techniques that allow for work with inactivated pathogens are already in use for some purposes in low-resource settings. Many of the new diagnostic methods are not, however, mature, standardized, and inexpensive enough to replace work with live pathogens using classical microbiological approaches for most purposes. For example, polymerase chain reaction–based technology and gene sequencing are well established in clinical laboratory medicine and can be cost-effective, if funders provide support for equipment and reagents.
Some participants noted that repurposing or upgrading existing laboratories is sometimes preferable to building new ones, although it is technically difficult to renovate a lab designed for a lower biosafety level (BSL-1 or BSL-2) into a high-containment (BSL-3) facility.
The principles behind the One Health concept that both human and animal health are important and intertwined are sound; however, several participants noted that with scarce resources, developing countries tend to focus on public health with the agricultural sector receiving much less funding and attention.
Effective implementation of the International Health Regulations (IHR) requires that all 196 World Health Organization (WHO) member countries have adequate legal and regulatory frameworks. Many low-resource countries lack such frameworks and have no formal requirements for the operation and management of biocontainment labs. Potential funders should consider the status of a country’s implementation of the IHR in their funding decisions. Countries that lack the applicable legal and regulatory frameworks to ensure safe and effective lab operation and maintenance can use guidance provided by international organizations (eg, the WHO’s Laboratory Biosafety Manual).
Biosecurity does not receive proper attention in low-resource countries. It is, nevertheless, just as crucial an element in the operation and maintenance of biological labs as is biosafety. Funders should ensure that recipients recognize the importance of biosecurity and biosafety and have plans to adopt and implement all required measures.
The report Developing Norms for the Provision of Biological Laboratories in Low-Resource Contexts: Proceedings of a Workshop is available for free download or hard-copy purchase at https://www.nap.edu/download/25311 on the National Academies Press website, https://www.nap.edu/.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.