Biological Threat Reduction Program (BTRP)
http://cns.miis.edu/cns/dc/cbw_seminars/060328.htm

Purpose
The Biological Threat Reduction Program (BTRP), formerly the Biological Weapons Proliferation Prevention (BWPP) Program, is a DoD surveillance and response program designed to enhance biosecurity and biosafety at research facilities in Kazakhstan, Uzbekistan, Azerbaijan, Georgia, and Ukraine.

History and operational characteristics
The program was established in 2003 by the DoD’s Defense Threat Reduction Agency (DTRA). Using existing research infrastructure and in-country expertise as the backbone of each country’s system, the BTRP is expanding those programs to include disease surveillance and response capabilities. The primary focus is diseases caused by 14 select agents that have a history of being weaponized by a state and diseases that present a pandemic threat (e.g., H5N1 avian influenza).15

Each host country has a network of “sentinel medical ­facilities,” a Central Reference Laboratory, and a national response team(s) that identify, investigate, and respond to deliberate and naturally occurring disease outbreaks.§ Clinicians at sentinel medical facilities report human cases that match the case definitions of interest (e.g., influenzalike illness, acute febrile illness, or acute hemorrhagic fever). Likewise, veterinarians report veterinary diseases of interest to the host country’s Central Reference Laboratory and to the DoD. Each Central Reference Laboratory analyzes environmental and clinical samples using standardized nucleic acid detection methods with quality controlled reagents, protocols, and equipment. Laboratory information and communications with the DoD are managed with an electronic database, Electronic Integrated Disease Surveillance System (EIDSS).

If a disease outbreak caused by one of the 14 pathogens is detected or if a disease outbreak of international public health significance occurs, the closest response team travels to the site to conduct initial epidemiologic investigations and to collect additional samples for laboratory analysis. Response times vary; in smaller countries such as Georgia and Azerbaijan, a team can reach a site in one day. In a larger country like Kazakhstan, it could take longer.** For reports of less serious diseases, more information may be needed before a response team will be mobilized.

All the programs are operational, with the program in Georgia being the most proficient of the BTRP Centers. The surveillance system will be expanded to include drug-resistant tuberculosis, rabies, cholera, malaria, and other diseases of public health importance in the countries; however, these public health efforts will be supported by other sponsors.

Region/countries served
Kazakhstan, Uzbekistan, Azerbaijan, Georgia, and Ukraine

Funding/budget/staff
In FY2006, funding for the Biological Threat Reduction Program was $60 million, and over the next 5 years, the U.S. intends to spend approximately $400 million on the program. The BTRP system is designed to be self-sustaining after an agreed-on start-up period.