Because of the recent advances in embryo modeling techniques, and at the request of the Office of Science Policy in the Office of the Director at the National Institutes of Health, the National Academies of Sciences, Engineering, hosted a 1-day public workshop that would explore the state of the science of mammalian embryo model systems. The workshop, which took place on January 17, 2020, featured a combination of presentations, panels, and general discussions, during which panelists and participants offered a broad range of perspectives. Participants considered whether embryo model systems - especially those that use nonhuman primate cells - can be used to predict the function of systems made with human cells. Presentations provided an overview of the current state of the science of in vitro development of human trophoblast. This publication summarizes the presentation and discussion of the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Mammalian Embryo Research and Pluripotent Stem Cells 3 Examining the Development of Extraembryonic Lineages 4 Stem CellBased Models of Human Embryos 5 Comparative Embryonic Development Across Species 6 Exploring Opportunities and Challenges with Mammalian Embryo Model Systems References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Statement of Task Appendix D: Registered Attendees

Rural America is economically, socially, culturally, geographically, and demographically diverse. This multidimensional diversity presents complex challenges and unique opportunities related to delivering health care and improving health outcomes and health equity in rural communities. To explore issues related to population health in rural America, the Roundtable on Population Health Improvement of the Board on Population Health and Public Health Practice of the National Academies of Sciences, Engineering, and Medicine convened a public virtual workshop, "Population Health in Rural America in 2020" on June 24-25, 2020. The workshop planning committee was composed of rural health experts representing public health, health care, and tribal health. Presentations and discussions focused on rural America in context, rural health vital signs, rural health care in action,assessment and implementation strategies for improving the health and health equity in rural populations, and rural health policy.This Proceedings of a Workshop summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Rural America in Context 3 Rural Health Vital Signs 4 Rural Health Care in Action 5 Assessment and Implementation Strategies for Improving the Health of Rural Populations 6 Rural Health Policy Appendix A: Speaker and Planning Committee Member Biosketches Appendix B: Workshop Agenda Appendix C: References

Immunization against disease is among the most successful global health efforts of the modern era, and substantial gains in vaccination coverage rates have been achieved worldwide. However, that progress has stagnated in recent years, leaving an estimated 20 million children worldwide either undervaccinated or completely unvaccinated. The determinants of vaccination uptake are complex, mutable, and context specific. A primary driver is vaccine hesitancy - defined as a "delay in acceptance or refusal of vaccines despite availability of vaccination services". The majority of vaccine-hesitant people fall somewhere on a spectrum from vaccine acceptance to vaccine denial. Vaccine uptake is also hampered by socioeconomic or structural barriers to access. On August 17-20, 2020, the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a 4-day virtual workshop titled The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy. The workshop focused on two main areas (vaccine access and vaccine confidence) and gave particular consideration to health systems, research opportunities, communication strategies, and policies that could be considered to address access, perception, attitudes, and behaviors toward vaccination. This publication summarizes the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Global Vaccine Uptake During the COVID-19 Pandemic and the State of Vaccine Confidence 3 Improving Access and Closing the Global Immunization Gap 4 Assessing Global and Local Drivers of Vaccine Hesitancy 5 A Systems Approach to Increasing Vaccine Confidence and Uptake: Opportunities in Research, Communication, Legislation, and Technology 6 A Systems Approach to Increasing Vaccine Confidence and Uptake: Opportunities for Community-Based Strategies 7 Reflections and Ways Forward References Appendix A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix C: Speaker and Moderator Biographies

Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Workshop on Resilient and Sustainable Health Systems to Respond to Global Infectious Disease Outbreaks are summarized in this report. Table of Contents Front Matter 1 Introduction 2 Fundamental Principles of Strong Health Systems 3 Health Systems Strengthening: Building Day-to-Day Care and Public Health Capacities 4 Strengthening Information Management Systems 5 Strengthening Outbreak Management and Emergency Response Systems 6 Closing Remarks Appendix A: References Appendix B: Statement of Task Appendix C: Agenda Appendix D: Speaker Biographies

To explore issues related to community-driven power-building efforts to improve population health, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a virtual public workshop, "Community Power in Population Health Improvement", on January 28 and 29, 2021. Participants discussed the different components and dimensions of community-led action around different population health improvement topics such as education, transportation, environmental health, healthy eating, and active living, among others. This Proceedings of a Workshop summarizes the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Daring to Lead 3 Community Power in the Context of Population Health 4 Community Power: Approaches and Models 5 From Vision to Action: Effective Ways to Support Grassroots Community Power Building 6 Community-Led Transformational Narratives 7 Amplifying the Empirical Base Linking Community Power and Health Equity Appendix A: References Appendix B: Biosketches of Speakers, Moderators, and Planning Committee Members Appendix C: Workshop Agenda Appendix D: Readings and Resources

As of 2017, the emergence and spread of antimicrobial resistance continues unabated around the world, leaving devastating health and economic outcomes in its wake. Those consequences will multiply if collaborative global action is not taken to address the spread of resistance. Major drivers of antimicrobial resistance in humans have been accelerated by inappropriate antimicrobial prescribing in health care practices; the inappropriate use of antimicrobials in livestock; and the promulgation of antibiotic resistance genes in the environment. To explore the issue of antimicrobial resistance, the Forum of Microbial Threats planned a public workshop. Participants explored issues of antimicrobial resistance through the lens of One Health, which is a collaborative approach of multiple disciplines - working locally, nationally, and globally - for strengthening systems to counter infectious diseases and related issues that threaten human, animal, and environmental health, with an end point of improving global health and achieving gains in development. They also discussed immediate and short-term actions and research needs that will have the greatest effect on reducing antimicrobial resistance, while taking into account the complexities of bridging different sectors and disciplines to address this global threat. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 The Global Momentum to Counter Antimicrobial Resistance 3 Microbial and Genetic Movements Across the One Health Domains 4 Applying Social and Behavioral Sciences to Combating Antimicrobial Resistance 5 Research and Development Actions for Reducing the Need for Antimicrobials 6 Strengthening Partnerships and International Cooperation 7 Moving from Knowledge to Action - Participants' Perspectives References Appendix A: Statement of Task Appendix B: Workshop Agenda Appendix C: Biographical Sketches of Workshop Speakers and Moderators

The Forum on Regenerative Medicine of the National Academies of Sciences, Engineering, and Medicine convened a two-day virtual public workshop to address knowledge gaps in the understanding of promising approaches to manipulate the immune system and/or the regenerative medicine product to improve outcomes of tissue repair and regeneration in patients. The workshop, titled "Understanding the Role of the Immune System in Improving Tissue Regeneration," explored the role of the immune system in the success or failure of regenerative medicine therapies. Participants considered potential strategies to effectively "prepare" patients' immune systems to accept regenerative therapies and increase the likelihood of successful clinical outcomes and also discussed risks associated with modulating the immune system. This Proceedings of a Workshop highlights the presentations and discussions that occurred during the workshop.

Despite being preventable and curable since the middle of the twentieth century, tuberculosis (TB) has long persisted as the world's deadliest infectious disease, with the communities most devastated by TB among the poorest and most vulnerable in the world. Only about half of people with TB receive successful treatment each year. As the global threat of antimicrobial resistance continues to escalate, so do cases of drug-resistant TB, or TB that is resistant to various antibiotics that constitute standard treatment regimens. In response, the National Academies of Sciences, Engineering, and Medicine's Forum on Microbial Threats held a two-part virtual workshop on July 22 and September 14-16, 2021 titled Innovations for Tackling Tuberculosis in the Time of COVID-19. The aims of the workshop were to evaluate the current status of TB elimination, assess the effects of the COVID-19 pandemic on the global fight against TB, and examine technical and strategic innovations that could be leveraged to meet the United Nations High-Level Meeting on Tuberculosis targets in 2022 and The World Health Organization's END TB Strategy targets by 2030. This publication summarizes the presentations and discussions of the workshop. Table of Contents Front Matter 1 Introduction 2 Current Tools and Challenges 3 Detection 4 Vaccines and Therapeutics 5 Financing, Ambition, and Preparedness Appendix A: References Appendix B: Workshop Statement of Task Appendix C: Workshop Agenda

To explore issues related to the effects of disasters on children and youth and lessons learned from experiences during previous disasters, the virtual workshop From Hurricane Katrina to Paradise Wildfires, Exploring Themes in Disaster Human Services was convened on July 22 and 23, 2020, by the National Academies of Sciences, Engineering, and Medicine. The workshop was designed to focus on families engaged with federal, state or local supportive programs prior to disasters. Additional areas of focus were the coordination of disaster response efforts and the transition to reestablishing routine service delivery programs post-disaster by human services, social services, and public health agencies at the state, local, tribal, and territorial levels. The workshop was also intended to provide a platform for highlighting promising practices, ongoing challenges, and potential opportunities for coordinated delivery and restoration of social and human services programs. This publication summarizes the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Exposure Outliers: Children Coming of Age in an Age of Environmental Extremes 3 Effect of Disasters on Critical Child Infrastructure 4 Exploring the Gaps in Evidence 5 Case Studies: Effect of Disasters on Specific Populations 6 Workshop Reflections References Appendix A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix C: Speaker Biographies

Regenerative medicine products, which are intended to repair or replace damaged cells or tissues in the body, include a range of therapeutic approaches such as cell- and gene-based therapies, engineered tissues, and non-biologic constructs. The current approach to characterizing the quality of a regenerative medicine product and the manufacturing process often involves measuring as many endpoints as possible, but this approach has proved to be inadequate and unsustainable. The Forum on Regenerative Medicine of the National Academies of Sciences, Engineering, and Medicine convened experts across disciplines for a 2-day virtual public workshop to explore systems thinking approaches and how they may be applied to support the identification of relevant quality attributes that can help in the optimization of manufacturing and streamline regulatory processes for regenerative medicine. A broad array of stakeholders, including data scientists, physical scientists, industry researchers, regulatory officials, clinicians, and patient representatives, discussed new advances in data acquisition, data analysis and theoretical frameworks, and how systems approaches can be applied to the development of regenerative medicine products that can address the unmet needs of patients. This publication summarizes the presentation and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Introduction to Systems Thinking Concepts 3 Exploring the Challenges of Critical Quality Attributes: The Role of Systems Thinking 4 Challenges Associated with Data Collection, Aggregation, and Sharing 5 Challenges and Opportunities Associated with Systems-Level Analysis and Modeling 6 Addressing Regenerative Medicine Manufacturing and Supply Chain Challenges with Systems-Level Approaches 7 Exploring Issues of Workforce Development Related to Systems Thinking References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Statement of Task

In November 2018, an ad hoc planning committee at the National Academies of Sciences, Engineering, and Medicine planned two sister workshops held in Washington, DC, to examine the lessons from influenza pandemics and other major outbreaks, understand the extent to which the lessons have been learned, and discuss how they could be applied further to ensure that countries are sufficiently ready for future pandemics. This publication summarizes the presentations and discussions from both workshops. Table of Contents Front Matter 1 Introduction 2 Is the World Ready to Respond to the Next Influenza Pandemic? 3 Global Progress to Prepare for the Next Influenza Pandemic 4 Reflections on a Century of Infectious Disease Outbreaks and Pandemics 5 Building Local and National Capacities for Outbreak Preparedness 6 A Spectrum of Considerations for Pandemic Vaccines 7 The Development of the PIP Framework: Global Lessons on Equity and Fairness for Pandemic Preparedness 8 Overcoming Impediments to Achieving Greater Preparedness 9 Visions on Potential Priorities and Actions for Preparedness by 2030 References Appendix A: Commissioned Paper Appendix B: Workshop Statement of Task Appendix C: Pre-Workshop Agenda Appendix D: Workshop Agenda Appendix E: Biographical Sketches of Pre-Workshop and Workshop Speakers and Moderators

To address approaches to the respirator approval process in the current landscape for both occupational and non-occupational use of respirators, the National Academies of Sciences, Engineering, and Medicine's Standing Committee on Personal Protective Equipment for Workplace Safety and Health convened a virtual workshop, Current Issues in the Assessment of Respiratory Protective Devices: Nontraditional Workers and Public Use on August 4?5, 2020. Additionally, the workshop considered gaps in respiratory protection for outdoor workers and the general public. This publication summarizes the presentation and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Lessons Learned from 100 Years of Respiratory Protection 3 Respiratory Risks and User Requirements for Nontraditional Workers 4 Respiratory Risks and User Requirements for the Public 5 Assessment Pathways for Respiratory Protective Devices for Occupational Use by Nontraditional Workers 6 Assessment Pathways for Respiratory Protective Devices for the Public 7 Addressing Research and Communication Gaps References Appendix A: Statement of Task Appendix B: Workshop Agenda Appendix C: Biographical Sketches of Workshop Speakers, Moderators, and Staff

On December 4?5, 2019, the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats. The workshop participants examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Pivotal Role of Innovations in Tackling Microbial Threats: Lessons from Past Outbreaks 3 Harnessing Lessons from Emerging Scientific, Technological, and Social Innovations 4 Overcoming Barriers in the Field to Bolster Access and Practical Use of Innovations 5 Systems Approaches to Spur Innovations in Tackling Antimicrobial Resistance 6 Breaking Down Barriers and Fostering Partnerships to Enable Innovation 7 Nurturing Innovations Through Novel Ecosystems to Accelerate Research and Development 8 Visionary Statements on Priorities for Innovation References Appendix A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix C: Speaker Biographies

The urban built environment is a prime setting for microbial transmission, because just as cities serve as hubs for migration and international travel, components of the urban built environment serve as hubs that drive the transmission of infectious disease pathogens. The risk of infectious diseases for many people living in slums is further compounded by their poverty and their surrounding physical and social environment, which is often overcrowded, is prone to physical hazards, and lacks adequate or secure housing and basic infrastructure, including water, sanitation, or hygiene services. To examine the role of the urban built environment in the emergence and reemergence of infectious diseases that affect human health, the National Academies of Sciences, Engineering, and Medicine planned a public workshop. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Perspectives on the Prevention and Control of Infectious Diseases in an Urban and Interconnected World 3 Understanding Infectious Disease Transmission in Urban Built Environments 4 Translating Conceptual Models of Infectious Disease Transmission and Control into Practice 5 Achieving Sustainable and Health-Promoting Urban Built Environments 6 Bridging Drivers and Interventions to Scale Up Successful Practices Appendix A: References Appendix B: Workshop Statement of Task Appendix C: Workshop Agenda Appendix D: Biographical Sketches of Workshop Speakers and Moderators

As the United States continues to adapt to a more digital, mobile, and interconnected world, health care and public health professionals have sought to better prepare for and respond to long-standing and emerging threats to the nation's health security. Health security is the collective effort to prevent, protect against, mitigate, respond to, and recover from the health consequences of natural, man-made, and technological disasters. Although substantial progress has been made in the past 15 years toward improving health care and public health systems and capacities for health security threats, many complex challenges persist, and often the nation's preparedness efforts are not sufficient. On March 8?9, 2017, the National Academies of Sciences, Engineering, and Medicine's Forum on Medical and Public Health Preparedness for Disasters and Emergencies hosted a two-day public workshop to acknowledge these persistent issues; to evaluate past, and perhaps inadequate, approaches to addressing them; and to discuss intentional and innovative new solutions. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 A Brief Overview of Health Security Threats and Programs 3 Proposed Priorities and Persistent Challenges Related to Health Security 4 Underlying Issues in Health Security 5 Potential Strategies for Strengthening the Nation's Health Security 6 Future Opportunities References Appendix A: Workshop Agenda Appendix B: Statement of Task Appendix C: Biographical Sketches of Workshop Speakers and Moderators

Countering violent extremism consists of various prevention and intervention approaches to increase the resilience of communities and individuals to radicalization toward violent extremism, to provide nonviolent avenues for expressing grievances, and to educate communities about the threat of recruitment and radicalization to violence. To explore the application of health approaches in community-level strategies to countering violent extremism and radicalization, the National Academies of Sciences, Engineering, and Medicine held a public workshop in September 2016. Participants explored the evolving threat of violent extremism and radicalization within communities across America, traditional versus health-centered approaches to countering violent extremism and radicalization, and opportunities for cross-sector and interdisciplinary collaboration and learning among domestic and international stakeholders and organizations. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Understanding Violent Extremism 3 Contemporary Approaches to Countering Violent Extremism 4 The Challenges and Opportunities of Countering Violent Extremism 5 Applying Public Health Models and Approaches to Countering Violent Extremism 6 Ways Forward in Countering Violent Extremism References Appendix A: Workshop Agenda Appendix B: Workshop Statement of Task Appendix C: Biographical Sketches of Workshop Speakers and Moderators

Large catastrophic events, or rare acute events, may cause situations in which a local jurisdiction's medicines and medical supplies are not sufficient to provide care to the population it serves. In these cases of natural or engineered disasters, such as a terrorist attack, influenza pandemic, or earthquake, state or local authorities can request that the federal government provide assets from the Strategic National Stockpile to augment the state and local jurisdictions' resources. The Centers for Disease Control and Prevention's (CDC's) Strategic National Stockpile (SNS) is the nation's repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other medical materiel designed to supplement and resupply state and local public health agencies in the event of an emergency. The materiel is intended to support national health security and is managed by the Office of Public Health Preparedness and Response's (OPHPR's) Division of Strategic National Stockpile (DSNS). The stated mission of the SNS is to prepare and support partners and provide the right resources at the right time to secure the nation's health. The National Academies of Sciences, Engineering, and Medicine organized a two-day public workshop to explore opportunities to improve the efficiency, effectiveness, and sustainable methods used by the CDC's SNS to distribute medical countermeasures and other supplies during disasters and other public health emergencies, especially those which result in disruption of physical infrastructure such as the electrical grid, central roadways, bridges, and tunnels within the impacted community. Participants explored relevant distribution lessons learned from other federal agency stockpiles and the private sector as well as opportunities to develop public-private collaborations in the purchase, warehousing, management, and distribution of medical countermeasures. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction, Background, and Context 2 The Strategic National Stockpile: Origin, Policy Foundations, and Federal Context 3 Studies and Reports Related to the Strategic National Stockpile 4 Potential Opportunities for Restructuring Strategic National Stockpile Scope, Governance, and Decision Making 5 Reaching the Last Mile: Potential Opportunities to Improve Coordination and Communication Among Local, State, and Federal Agencies 6 Potential Supply-Chain Opportunities and Lessons from the Commercial Sector and Government Partners 7 Wrap-Up References Appendix A: Workshop Agenda Appendix B: Workshop Speaker Biographies

Brain health affects Americans across all ages, genders, races, and ethnicities. Enriching the body of scientific knowledge around brain health and cognitive ability has the potential to improve quality of life and longevity for many millions of Americans and their families. The Centers for Disease Control and Prevention estimate that as many as 5 million Americans were living with Alzheimer's disease in 2014. That same year, more than 800,000 children were treated for concussion or traumatic brain injuries in U.S. emergency departments. Each year, more than 795,000 people in the United States have a stroke. Developing more effective treatment strategies for brain injuries and illnesses is essential, but brain health is not focused exclusively on disease, disorders, and vulnerability. It is equally important to better understand the ways our brains grow, learn, adapt, and heal. Addressing all of these domains to optimize brain health will require consideration about how to define brain health and resilience and about how to identify key elements to measure those concepts. Understanding the interactions between the brain, the body, and socioenvironmental forces is also fundamental to improving brain health. To explore issues related to brain health throughout the life span, from birth through old age, a public workshop titled Brain Health Across the Life Span was convened on September 24 and 25, 2019, by the Board on Population Health and Public Health Practice in the Health and Medicine Division of the National Academies. This publication summarizes the presentation and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Fundamentals of Brain Health and Resilience 3 BrainBody Interactions 4 Behavioral and Biological Convergence 5 Measuring Brain Health 6 Brain Health in the Social Context 7 Brain Health Across the Life Span Appendix A: Speaker Biographical Sketches Appendix B: Workshop Agenda Appendix C: References

On June 11 and June 12, 2019, the National Academies convened a workshop to explore the growing understanding of how the interplay between humans and microbes affects host physiology and causes noncommunicable diseases. Discussions included an overview of colliding epidemics, emerging research on associations between infectious and noncommunicable diseases, risks posed by chronic diseases to the development and severity of infectious diseases, and the influence of the microbiome. Workshop participants also examined the challenges and opportunities of convergence, the integration of health care delivery models and interventions, potential approaches for research, policy, and practice in the immediate-term, and potential directions for the long-term. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 An Overview of Colliding Epidemics and Syndemics 3 Emerging Research on Associations Between Infectious and Noncommunicable Diseases 4 Risks Posed by Chronic Diseases to the Development and Severity of Infectious Diseases 5 Microbial Dimension to Human Development and Well-Being 6 Confronting "The Blind People and the Elephant" Metaphor to Bridge the Silos 7 Integrating Health Care Delivery Models and Interventions 8 Potential Approaches for Research, Policy, and Practice in the Immediate Term 9 Visionary Statements on Potential Priorities to Address the Convergence References Appendix A: Statement of Task Appendix B: Workshop Agenda Appendix C: Speaker Biographies

To effectively treat patients diagnosed with drug-resistant (DR) tuberculosis (TB) and protect the population from further transmission of this infectious disease, an uninterrupted supply of quality-assured (QA), second-line anti-TB drugs (SLDs) is necessary. Patients diagnosed with multidrug-resistant tuberculosis (MDR TB)-a disease caused by strains of Mycobacterium tuberculosis (M.tb.) resistant to two primary TB drugs (isoniazid and rifampicin)-face lengthy treatment regimens of 2 years or more with daily, directly observed treatment (DOT) with SLDs that are less potent, more toxic, and more expensive than those used to treat drug-susceptible TB. From 2000 to 2009, only 0.2-0.5 percent of the estimated 5 million MDR TB cases globally were treated with drugs of known quality and in programs capable of delivering appropriate care (Keshavjee, 2012). The vast majority of MDR TB patients either died from lack of treatment or contributed to the spread of MDR TB in their communities. A strengthened global supply chain for SLDs could save lives by consistently delivering high quality medicines to more of the people who need them. This public workshop explored innovative solutions to the problem of how to get the right SLDs for MDR TB to people who critically need them. More specifically, the workshop examined current problems and potential opportunities for coordinated international efforts to ensure that a reliable and affordable supply of high-quality SLDs is available. Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis: Workshop Summary covers the objectives of the workshop, which were to review: -To what extent and in what ways current mechanisms are or are not effectively accomplishing what is needed, including consideration of bottlenecks. -The advantages and disadvantages of centralization in the management of the global drug supply chain, and potential decentralized approaches to improve operations of the supply chain. -What can be learned from case studies and examples from other diseases (e.g., the Affordable Medicines Facility-malaria (AMFm) and the U.S. President's Emergency Plan for AIDS Relief [PEPFAR]) - The current allocation of responsibilities and roles of the private (including industry and nonprofit public health organizations) and public sectors, and examination of opportunities for enhancing and optimizing collaboration -Identification of potential innovative solutions to the problem Table of Contents Front Matter 1 Introduction 2 Logistics, Supply, and Demand 3 Financing of MDR TB SLDs 4 Innovative Suggestions and Potential Solutions References Appendix A: Workshop Agenda Appendix B: Participant Biographies Appendix C: Registered Workshop Attendees