Building Resilient Health Systems Intelligence: Adapting Indicators of Compromise for the Cyber-Bionexus.

The health sector is an underutilized source of actionable health intelligence for responding to threats across the "cyber-bionexus," defined as the convergence of threats from the biological and cybersecurity domains to produce harms with widespread societal consequences. The escalation of concerns about such threats-related to misinformation and disinformation; chemical, biological, radiological, and nuclear events; cyberattacks; natural disease outbreaks; and disasters of various kinds-places health system concerns squarely at the forefront of national critical systems and broader security imperatives. Events such as the COVID-19 pandemic have highlighted the dearth of systems available for generating real-time intelligence in relation to critical functions of health sector operations amidst an unfolding crisis. Drawing on principles from the field of cyberthreat intelligence, and building on existing scholarship in health security intelligence, we propose a model for applying health system indicators of compromise for cyberbio events. We further discuss the relevance of this approach within the broader landscape of the cyber-bionexus to signal new pathways for research, practice, and policy engagement.