Rami Puzis

The COVID-19 pandemic highlighted the important role of polymerase chain reaction (PCR) tests in disease diagnosis. These tests are ubiquitous in biology and medicine, facilitating the rapid detection and investigation of new disease agents, their variants and mutations. The development process of PCR tests is long and complex, with multiple critical stages vulnerable to cyber-attacks. One such stage involves obtaining primers, short DNA molecules that match the specific DNA of the targeted disease agents. Primers are obtained through the e-commerce platforms of synthetic DNA providers. In this paper, we investigate the risk of a supply-chain attack in which the integrity of the primers ordered is compromised to potentially increase the false-positive detection rate of PCR tests. Assuming imperfect cyber hygiene of typical e-commerce platforms of synthetic DNA providers, we discuss (1) the order integrity threat due to form-jacking attack, (2) the selection of adversarial primers for different types of positive control, (3) design guidelines of adversary resilient primers, and (4) the benefits of negative control for adversarial resilience of PCR tests.