How a Vulnerability Exploitability eXchange can help healthcare prioritize cybersecurity risk

Diagnosing and treating chronic pain can be complex, difficult, and full of uncertainties for a patient and their treating physician. Depending on the condition of the patient and the knowledge of the physician, making the correct diagnosis takes time, and experimenting with different treatments might be required. 

This trial-and-error process can leave the patient in a world of pain and confusion until the best remedies can be prescribed. It’s a situation similar to the daily struggle that many of today’s security operations teams face. 

Screaming from the mountain tops “just patch it!” isn’t very helpful when security teams aren't sure if applying a patch might create even worse issues like crashes, incompatibility, or downtime. Like a patient with chronic pain, they may not know the source of the pain in their system. Determining which vulnerabilities to prioritize patching, and ensuring those fixes actually leave you with a more secure system, is one of the hardest tasks a security team can face. This is where a Vulnerability Exploitability eXchange (VEX) comes in.

The point of VEX

In previous blogs, we’ve discussed how establishing visibility and awareness into patient safety and technology is vital to creating a resilient healthcare system. We’ve also looked at how combining software bills of materials (SBOM) with Google’s Supply chain Levels for Software Artifacts (SLSA) framework can help build more secure technology that enables resilience. 

The SBOM provides visibility into the software you’re using and where it comes from, while SLSA provides guidelines that help increase the integrity and security of software you then build. Rapid diagnostic assessments can be added to that equation with VEX, which the National Telecommunications and Information Administration describes as a “companion” document that lives side-by-side with SBOM. 

To go back to our medical metaphor, VEX is a mechanism for software providers to tell security teams where to look for the source of the pain. VEX data can help with software audits when inventory and vulnerability data need to be captured at a specific point in time. That data also can be embedded into automated security tools to make it easier to prioritize vulnerability patching.  

You can then think of SBOM as the prescription label on a bottle of medication, SLSA as the child-proof lid and tamper-proof seal guaranteeing the safety of the medication, and VEX as the bottle’s safety warnings. As a diagnostic aide, a VEX can help security teams make accurate diagnoses of “what could hurt” and system weaknesses before the bad guys do. 

Yet making an accurate assessment of that threat model can be challenging, especially when looking at the software we use to run systems. The ability to quickly and accurately evaluate an organizations’ weaknesses and pain points can be vital to hastening response to a vulnerability and stopping cyberattacks before they become destructive. We believe that VEX is an important part of the equation to help secure the software supply chain. 

As an example, look no further than the Apache Log4j vulnerabilities revealed in December 2021. Global industries including healthcare were dealt another blow when Apache’s Log4j 2 logging system was found to be so vulnerable that relatively unsophisticated threat actors could quickly infiltrate and take over systems. Through research conducted by Google and information contributed by CISA, we learned of examples of where vulnerabilities in Log4j 2, a single software component, could potentially impact thousands of companies using software that depend on it because of its near-ubiquitous use. 

While a VEX would not capture zero-day vulnerabilities, it would be able to inform security teams of other known vulnerabilities in Log4j 2. Once vulnerabilities have been published, security teams could use SBOM to find them, and use VEX to understand if remediation is a priority or not.

How does VEX contribute to visibility?

A key reason we focus on visibility mechanisms like SBOM and SLSA is because they give us the ability to understand our risks. Without the ability to see into what we must protect, it can be difficult to determine how to quickly reduce risk.

Visibility is a crucial first step to stopping malicious hackers. Yet without context, visibility leaves security teams overwhelmed with data. Why? Well, where would you start when trying to mitigate the 30,000 known vulnerabilities affecting just open source software, according to the Open Source Vulnerabilities database (OSV)? NIST’s National Vulnerability Database (NVD) is tracking close to 181,000 vulnerabilities. We’ll be patching into the next millennium if we adopt a “patch everything” approach.

It’s impossible to address every vulnerability individually. To make progress, security teams need to be able to prioritize findings and go after the ones that will have the greatest impact first. The goal of a VEX artifact is to make prioritization a little easier.

While SBOMs are created or changed when the material included in a build is updated, VEXs are intended to be changed and distributed when a new vulnerability or threat has changed. This means that VEX and SBOM should be maintained separately. Since security researchers and organizations are constantly discovering new cybersecurity vulnerabilities and threats, a more dynamic mechanism like VEX can help ensure builders and operators have the ability to quickly ascertain the risks of the software they are using.

Let’s dig into this VEX example from CycloneDX. You can see the list of vulnerabilities found, third parties who track and report those vulnerabilities, vulnerability ratings per CVSS, and most importantly, a statement from the developer that guides the operator reading the VEX to those vulnerabilities that are exploitable and need to be protected. At the bottom, you’ll see the VEX “affects” an SBOM. 

This information allows the user of the VEX document to refer to its companion SBOM. By necessity, the VEX is intentionally decoupled from the SBOM because they need to be updated at different times. A VEX document will need to be updated when new vulnerabilities emerge. An SBOM will need to be updated when changes to the software are made by a manufacturer. Although they can and need to be updated separately, the contents of each document can stay aligned because they are linked. 

Increasing resilience powered by visibility—SBOM+VEX+SLSA 

VEX could dramatically improve how security vulnerabilities are handled. It’s not uncommon to find operators buried in vulnerabilities, best-guessing the ones that need fixing, and trying to make sense of tens (and sometimes hundreds) of pages of documentation to determine the best, lowest impact fix.

With SBOM+SLSA+VEX, operators are using software-driven mechanisms to conduct analyses and evaluate risk instead of relying on intuition and best guesses. The tripartite SBOM+SLSA+VEX approach provides an up-to-date list of issues and perspective on what needs attention. This is a transformative development in security—enabling teams to get a better handle on doing vulnerability mitigation, starting where it could hurt the most.

Driven by repeated cyberattacks on critical infrastructure such as healthcare, government regulators have taken a more interested stance in software security and supply chains. Strengthening the effectiveness of SBOMs in the United States is a big part of the newly 

proposed Protecting and Transforming Cyber Health Care (PATCH) Act. The law would require medical device manufacturers adhere to minimum cybersecurity standards in their products, including the creation of SBOMs for their devices, and plans to monitor and patch any cybersecurity vulnerabilities that are discovered during the device’s lifetime.

Meanwhile, new draft medical device cybersecurity guidance from the FDA continues that agency’s involvement in aggressively encouraging medical device manufacturers to improve the cybersecurity resilience of their products. The White House spoke for SBOMs, as well. An Executive Order from May 2021 lays out requirements for secure software development, including the production and distribution of SBOM for software used by the federal government.

Regardless of how these initiatives pan out, Google believes controls like those provided by SBOM+SLSA+VEX are critical to protect software and build a resilient healthcare ecosystem. This approach provides detailed, critical risk exposure data to security teams so they can take necessary steps to reduce immediate and long-term risks. 

What do we suggest you do?

At Google, we are working with the Open Source Security Foundation on supporting SBOM development. Our Know, Prevent, Fix report on secure software development creates a broader outline of how Google thinks about securing open source software from preventable vulnerabilities. You can read more about these efforts for securing workloads on Google Cloud from our Cloud Architecture Center. Take a look at Cloud Build, a Google Cloud service that can be used to generate up to SLSA Level 2 build artifacts.

Customers often have difficulty getting full visibility and control over vulnerabilities because of their dependence on open source software (OSS). Assured Open Source Software (Assured OSS) is the Google Cloud service that helps teams both secure the external OSS packages they use and overcome avoidable vulnerabilities by simply eliminating them from the code base. Finally, ask us about Google's Cybersecurity Action Team, the world’s premier security advisory team and its singular mission supporting the security and digital transformation of governments, critical infrastructure, enterprises, and small businesses.

If you’re a software supplier, please consider our suggestions above. Whether you are or not, you should begin:

• Contractually mandating SBOM+VEX+SLSA (or their equivalent) artifacts to be provided for all new software.

• Train procurement teams to ask for and use SBOM+VEX+SLSA to make purchasing decisions. There should be no reason an organization procures software or hardware with known, preventable issues. Even if they do, the information these mechanisms provide should help security teams decide if they can live with the risks before equipment enters their networks.

• Establishing a governance program that ensures those who control procurement decisions are aware of and owning the risks associated with software they are buying.

• Enabling security teams to build pipelines to ingest SBOM+VEX+SLSA artifacts into their security operations and use it to strategically advise and drive mitigation activities.

At Google, we believe the path to resilience begins with building visibility and structural awareness into the software, hardware, and equipment it rides on as a critical first step. Time will tell if VEX becomes widely adopted, but the point behind it won’t change—we can’t know how we are vulnerable without visibility. VEX is an important concept in this regard.

Next month, we’ll be shifting gears slightly to focus on building resilience by establishing a security culture that obsesses over its patients and products.