The global community faces growing risks from emerging infectious diseases and bioterrorism, driven by shifts in national security, globalization, and advances in biotechnology. Biosafety plays a vital role in fostering international collaboration to counter terrorist threats, promote shared benefits, and enhance biosecurity. This study explores global biosecurity challenges and suggests strategies to enhance global biosecurity against bioterrorism.
Methods:
A comprehensive search strategy was designed to identify English-language literature across Scopus, PubMed, and Web of Science. Gray literature was additionally gathered via Google and other relevant websites. The databases were exhaustively searched for articles up to April 20, 2025, irrespective of the publication period. The Preferred Reporting Items for Systematic Review and Meta-Analysis Statement 2020 checklist was applied to screen articles, extract information, and synthesize related findings. This protocol is registered in the PROSPERO database with the number CRD42023445914.
Results:
In total, 25 out of 676 records met the inclusion criteria for the systematic review. The information obtained from the studies was organized and summarized into five sections and 24 subsections. The main categories were biosafety defense, biosafety issues and challenges, health sector challenges, legal frameworks, and solutions to deal with bioterrorism.
Conclusion:
This research systematically reviews biosafety concerns related to bioterrorism, proposing solutions and countermeasures. It offers a roadmap for decision-makers to enhance community preparedness by improving surveillance, strengthening laboratories, enforcing restrictive laws, and promoting international cooperation.
JammiSSS. Biological warfare and bioterrorism–Global perspective and need for reforms in legislation. DME J Law2022;3(01); doi: 10.53361/dmejl.v3i01.01
2.
SubariyahR, MantoroT, RatmonoBM. The role of biosafety and biosecurity in biotechnology to prevent bioterrorism threats. In: 2023 International Conference on Technology, Engineering, and Computing Applications (ICTECA). IEEE; 2023; pp. 1–6.
3.
TinD, SabetiP, CiottoneGR. Bioterrorism: An analysis of biological agents used in terrorist events. Am J Emerg Med2022;54:117–121; doi: 10.1016/j.ajem.2022.01.056
4.
JansenH-J, BreeveldFJ, StijnisC, et al.Biological warfare, bioterrorism, and biocrime. Clin Microbiol Infect2014;20(6):488–496; doi: 10.1111/1469-0691.12699
5.
BroertjesJ, FranzE, FriesemaIH, et al.Epidemiology of pathogens listed as potential bioterrorism agents, the Netherlands, 2009–2019. Emerg Infect Dis2023;29(7):1–9; doi: 10.3201%2Feid2907.221769
6.
SchepLJ, TempleWA, ButtGA, et al.Ricin as a weapon of mass terror—Separating fact from fiction. Environ Int2009;35(8):1267–1271.
7.
TinD, MargusC, CiottoneGR. Half-a-century of terrorist attacks: Weapons selection, casualty outcomes, and implications for counter-terrorism medicine. Prehosp Disaster Med2021;36(5):526–530; doi: 10.1017/S1049023X21000868
8.
TinD, GranholmF, HartA, et al.Terrorism-related chemical, biological, radiation, and nuclear attacks: A historical global comparison influencing the emergence of counter-terrorism medicine. Prehosp Disaster Med2021;36(4):399–402; doi: 10.1017/S1049023X21000625
9.
TinD, FaresS, Al MulhimM, et al.Terrorist attacks in the Middle East: A counter-terrorism medicine analysis. Prehosp Disaster Med2022;37(2):1–5; doi: 10.1017/S1049023X22000358
10.
MirzaMNEE, RanaIA. A systematic review of urban terrorism literature: Root causes, thematic trends, and future directions. J Saf Sci Resil2024;5(3):249–265.
11.
HeidariR, ShawDM, ElgerBS. CRISPR and the rebirth of synthetic biology. Sci Eng Ethics2017;23(2):351–363; doi: 10.1007/s11948-016-9768-z
12.
WuG, LiQ, DaiJ, et al.Design and application of biosafe coronavirus engineering systems without virulence. Viruses2024;16(5):659; doi: 10.3390/v16050659
13.
LiuJ, WongG, LiH, et al.Biosafety and immunology: An interdisciplinary field for health priority. Biosaf Health2024;6(5):310–318; doi: 10.1016/j.bsheal.2024.07.005
14.
ZhouD, SongH, WangJ, et al.Biosafety and biosecurity. J Biosaf Biosecur2019;1(1):15–18; doi: 10.1016/j.jobb.2019.01.001
15.
GuptaJN, SharmaS. Handbook of research on information security and assurance. IGI Global; 2008.
16.
Cena-NavarroR, RondinaMMR, BibayJIA. Biosafety and biosecurity in laboratory animal facilities. In: Biosafety and Biosecurity. CRC Press; 2025; pp. 183–205.
17.
Milián‐GarcíaY, YoungR, MaddenM, et al.Optimization and validation of a cost‐effective protocol for biosurveillance of invasive alien species. Ecol Evol2021;11(5):1999–2014; doi: 10.1002/ece3.7139
18.
DevittSK, BaxterP, HamiltonG. The ethics of biosurveillance. J Agric Environ Ethics2019;32(5–6):709–740; doi: 10.1007/s10806-019-09775-2
19.
UlandayGEL, Lamata-PorrasTR. Hazards to harmony: Biosafety and biosecurity practice in healthcare settings. In: Biosafety and Biosecurity. CRC Press: 2025; pp. 138–153.
20.
O’BrienC, VartyK, IgnaszakA. The electrochemical detection of bioterrorism agents: A review of the detection, diagnostics, and implementation of sensors in biosafety programs for class A bioweapons. Microsyst Nanoeng2021;7(1):16; doi: 10.1038/s41378-021-00242-5
21.
GillumDR, SchwartzA, AlbrechtRA, et al.Seven opportunities for effective biosafety and biosecurity governance. Health Secur2024;22(4):324–329; doi: 10.1089/hs.2023.0189
22.
KharaishviliN, BlakeJW, GorslineDH, et al.Global health security capacity and capability measurement framework within the biological threat reduction program. Health Secur2021;19(2):163–172; doi: 10.1089/hs.2020.0023
La TorreG, BackhausI, MannocciA. Rating for narrative reviews: Concept and development of the international narrative systematic assessment tool. Senses Sciences2015;2(2):31–35; doi: 10.14616/sands-2015-2-3135
25.
VillanuevaJ, SchweitzerB, OdleM, et al.Detecting emerging infectious diseases: An overview of the laboratory response network for biological threats. Public Health Rep2019;134(2_suppl):16S–21S; doi: 10.1177/0033354919874354
26.
YaoL, ZhangY, ZhaoC, et al.The PRISMA 2020 statement: A system review of hospital preparedness for bioterrorism events. Int J Environ Res Public Health2022;19(23):16257; doi: 10.3390/ijerph192316257
27.
BurnettJC, HenchalEA, SchmaljohnAL, et al.The evolving field of biodefence: Therapeutic developments and diagnostics. Nat Rev Drug Discov2005;4(4):281–297; doi: 10.1038/nrd1694
28.
BravataDM, McDonaldKM, SmithWM, et al.Systematic review: Surveillance systems for early detection of bioterrorism-related diseases. Ann Intern Med2004;140(11):910–922; doi: 10.7326/0003-4819-140-11-200406010-00013
RudrikJT, SoehnlenMK, PerryMJ, et al.Safety and accuracy of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of highly pathogenic organisms. J Clin Microbiol2017;55(12):3513–3529; doi: 10.1128/jcm.01023-17
31.
SnyderJW. Role of the hospital-based microbiology laboratory in preparation for and response to a bioterrorism event. J Clin Microbiol2003;41(1):1–4; doi: 10.1128/jcm.41.1.1-4.2003
32.
LeissnerKB, HolzmanRS, McCannME. Bioterrorism and children: Unique concerns with infection control and vaccination. Anesthesiol Clin North Am2004;22(3):563–577, viii; doi: 10.1016/S0889-8537(04)00029-X
33.
NieJB. In the shadow of biological warfare: Conspiracy theories on the origins of COVID-19 and enhancing global governance of biosafety as a matter of urgency. J Bioeth Inq2020;17(4):567–574; doi: 10.1007/s11673-020-10025-8
34.
KharaishviliN, HudsonTML, KannanJK, et al.Global health security risk assessment in the biological threat reduction program. Health Secur2020;18(3):177–185; doi: 10.1089/hs.2019.0132
35.
IppolitoG, PuroV, HeptonstallJ. Biological weapons: Hospital preparedness to bioterrorism and other infectious disease emergencies. Cell Mol Life Sci2006;63(19–20):2213–2222; doi: 10.1007/s00018-006-6309-y
36.
NolteKB, FischerM, ReaganS, Members of the National Association of Medical Examiners (NAME) Ad Hoc Committee for Bioterrorism and Infectious Diseases. et al.; Guidelines to implement medical examiner/coroner-based surveillance for fatal infectious diseases and bioterrorism (“Med-X’’). Am J Forensic Med Pathol2010;31(4):308–312; doi: 10.1097/PAF.0b013e3181c187b5
37.
GaoGF. For a better world: Biosafety strategies to protect global health. Biosaf Health2019;1(1):1–3; doi: 10.1016/j.bsheal.2019.03.001
MillerSE. Bioterrorism and electron microscopic differentiation of poxviruses from herpesviruses: Dos and don’ts. Ultrastruct Pathol2003;27(3):133–140; doi: 10.1080/01913120309932
40.
DasS, KatariaVK. Bioterrorism: A public health perspective. Med J Armed Forces India2010;66(3):255–260; doi: 10.1016%2FS0377-1237(10)80051-6
41.
YuY, DingJ, ZhouY, et al.Biosafety chemistry and biosafety materials: A new perspective to solve biosafety problems. Biosaf Health2022;4(1):15–22; doi: 10.1016%2Fj.bsheal.2022.01.001
42.
Al-EitanL, AlnemriM. Biosafety and biosecurity in the era of biotechnology: The Middle East region. J Biosaf Biosecur2022;4(2):130–145; doi: 10.1016/j.jobb.2022.11.002
43.
SuZH, McDonnellD, BentleyBL, et al.Addressing biodisaster X threats with artificial intelligence and 6G technologies: Literature review and critical insights. J Med Internet Res2021;23(5):e26109; doi: 10.2196/26109
44.
PejcicB, MarcoRD, ParkinsonG. The role of biosensors in the detection of emerging infectious diseases. Analyst2006;131(10):1079–1090; doi: 10.1039/B603402K
45.
PrestinaciF, PezzottiP, PantostiA. Antimicrobial resistance: A global multifaceted phenomenon. Pathog Glob Health2015;109(7):309–318; doi: 10.1179/2047773215Y.0000000030
46.
RoopeLS, SmithRD, PouwelsKB, et al.The challenge of antimicrobial resistance: What economics can contribute. Science2019;364(6435):eaau4679; doi: 10.1126/science.aau4679
47.
EdwardsB, NovossiolovaT, CrowleyM, et al.Meeting the challenges of chemical and biological weapons: Strengthening the chemical and biological disarmament and non-proliferation regimes. Front Polit Sci2022;4:805426; doi: 10.3389/fpos.2022.805426
48.
MackbyJ, KatakamS. A cliffhanger conference seeks to strengthen biological weapons convention. Arms Control Today2023;53(1):34–36.
49.
MinshullJ, WagnerR. Preventing the misuse of gene synthesis. Nat Biotechnol2009;27(9):800–801; author reply 801; doi: 10.1038/nbt0909-800
50.
DehshiriMM. Invasive alien species of Iran. Invasive alien species: observations and issues from around the world, Vol. 2. Wiley; 2021; pp. 103–125, doi:10.1002/9781119607045.ch17
51.
NolteKB, MullerTB, DenmarkAM, et al.Design and construction of a biosafety level 3 autopsy laboratory. Arch Pathol Lab Med2021;145(4):407–414; doi: 10.5858/arpa.2020-0644-SA
52.
KmanNE, BachmannDJ. Biosurveillance: A review and update. Adv Prev Med2012;2012(1):301408; doi: 10.1155/2012/301408
NovossiolovaT. Role of the life science community in strengthening the web of prevention for biosafety and biosecurity. Essentials of Biological Security: A Global Perspective2024;107–120, doi:10.1002/9781394189045.ch9
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