Pandora Report: 12.6.2019

Are We Making Progress on the Antibiotic Resistance Front?
Antibiotic resistance is a problem that crosses sectors, industries, species, and frankly, requires a widespread effort to make a dent in the problem. Whether it be stewardship among medical providers, surveillance and rapid isolation, or use within agriculture, this is a global issue that we’re just not doing that well in. While the latest CDC report shows that annual deaths due to drug-resistant infections is decreasing since their last analysis, the number of infections occurring is still quite high. In 2013 it was reported that 2.6 million infections occur annually and in this latest report, they found that each year there are 2.8 million antibiotic-resistant infections resulting in 35,000 deaths. Moreover, the 2019 report shows 5 new urgent threats and 2 new threats, which emphasizes the role of stewardship initiatives and One Health. “But there is plenty to worry about. Though hospitals are making headway, the agency found some of the greatest increases in infections are acquired outside hospitals. Also, the threat of antibiotic resistance is remarkably fluid; new threats arise even as old ones are mitigated. For example, the CDC has raised the alert level to ‘urgent” for Candida auris, a multi-drug-resistant yeast that can cause invasive infection and death’.” At a global level, the World Health Organization (WHO) has worked to guide national action plans, which countries can employ and modify to their specified needs. Hint: we’ll be doing a spotlight on resistant fungal infections within this newsletter so make sure to keep reading.

The Mystery and the Truth Surrounding the Explosion at Vektor
Since the explosion in September, there’s been  growing conversation around what really happened at Vektor, but also the immediate media coverage that was often over-hyped and opportunistic. Dr. Filippa Lentzos has broken down the facts and ultimately, the implications of those rapid reports. Citing inspections from the WHO-led team, she notes that previously, the site had met international biosecurity and biosafety standards as a smallpox repository. While Vektor’s history includes being an offensive weapons site during the era prior to the Biological Weapons Convention (BCW) and some time after, it has been transformed to a site for research and biodefense. Truly, the biggest issue, Lentzos notes, is the biosafety issues that frequent such research. “Jens Kuhn, a German virologist who was part of a Pentagon-sponsored program that sent young scientists to work in former bioweapons labs, was the first Western scientist through the door at VECTOR in July 2001. Getting in was anything but easy, but once inside he found that contrary to fears he had heard expressed in the West, the high-containment units operated both safely and securely. ‘The Russians don’t want to kill themselves any more than Western scientists,’ Kuhn is quoted as saying in a Nature news story.” While the facility has been upgraded and repaired in recent decades, the Russian government declares biodefense activities and confidence-building measures through the BWC regularly. Sure, they’re doing research with deadly disease like Ebola and Marburg, not to mention storing smallpox, but it’s important to remember that not only is Russia following the International Health Regulations (IHR), which would require them to report risky public health events, but they also did communicate the explosion (although, mostly through the media) and that it happened in the decontamination room – an incident that did not warrant such IHR reporting. As Lentzos underscores, some of the reactions to the event were overblown but this is a prime example of why transparency during such events is critical to avoid misinformation and opportunistic reporting.

Synopsis of the Crimson Contagion 2019 Functional Exercise After-Action Review
This week, the National Biodefense Science Board convened a meeting focusing on the after-action review of the Crimson Contagion 2019 Functional Exercise, a national level exercise series conducted to detect gaps in mechanisms, capabilities, plans, policies, and procedures in the event of a pandemic influenza.  Current strategies include the Biological Incident Annex to the Response and Recovery Federal Interagency Operational Plans (2018), Pandemic Influenza Plan (2017 Update), Pandemic Crisis Action Plan Version 2.0, and CDC’s Pandemic Influenza Appendix to the Biological Incident Annex of the CDC All-Hazard Plan (December 2017). These plans, updated over the last few years, were tested by the functional exercise with emphasis on the examination of strategic priorities set by the NSC. Specifically, examined priorities include operational coordination and communications, stabilization and restoration of critical lifelines, national security emergencies, public health emergencies, and continuity. The Crimson Contagion 2019 Functional Exercise included participation of almost 300 entities – 19 federal departments and agencies, 12 states, 15 tribal nations and pueblos, 74 local health departments and coalition regions, 87 hospitals, 40 private sector organizations, and 35 active operations centers. The scenario was a large-scale outbreak of H7N9 avian influenza, originating in China but swiftly spreading to the contiguous US with the first case detected in Chicago, Illinois. Continuous human-to-human transmission of the H7N9 virus encourages its spread across the country and, unfortunately, the stockpiles of H7N9 vaccines are not a match for the outbreak’s strain; however, those vaccines are serviceable as a priming dose. Also, the strain of virus is susceptible to Relenza and Tamiflu antiviral medications. The exercise was intended to deal with a virus outbreak that starts overseas and migrates to the US with scant allocated resources for outbreak response and management, thereby forcing the Department of Health and Human Services (HHS) to include other agencies in the response. To do so, the exercise began 47 days after the identification of the first US case of H7N9 in Chicago, otherwise known as STARTEX conditions. Then, the HHS declared the outbreak as a Public Health Emergency (PHE), the World Health Organization (WHO) declared a pandemic, and the President of the United States declared a National Emergency under the National Emergencies Act. As was the case in the 1918 Great Influenza, transmissibility is high and cases are severe. At STARTEX, there are 2.1 million illnesses and 100 million forecasted illnesses as well as over half a million forecasted deaths. As the pandemic progresses along the epidemiological curve, the overarching foci of the federal-level response adjusts across four phases:

  1. Operational coordination with public messaging and risk communication
  2. Situational awareness, information sharing, and reporting
  3. Financing
  4. Continuity of operations

The outcome of the Crimson Contagion is that vaccine development is the silver bullet to such an outbreak, but there are complications beyond its formulation. Namely, the minimization of outbreak impact prior to vaccine development and dispersal, strategy for efficient dissemination of the vaccine across the country, allocation of personal protective equipment (PPE), and high expense of vaccine development and PPE acquisitions. The exercise concluded that HHS requires about $10 billion in additional funding immediately following the identification of a novel strain of pandemic influenza. The low inventory levels of PPE and other countermeasures are a result of insufficient domestic manufacturing in the US and a lack of raw materials maintained within US borders.  Additionally, the exercise revealed six key findings:

  1. Existing statutory authorities, policies, and funding of HHS are insufficient for a federal response to an influenza pandemic
  2. Current planning fails to outline the organizational structure of the federal government response when HHS is the designated lead agency; planning also varies across local, state, territorial, tribal, and federal entities
  3. There is a lack of clarity in operational coordination regarding the roles and responsibility of agencies as well as in the coordination of information, guidance, and actions of federal agencies, state agencies, and the health sector
  4. Situation assessment is inefficient and incomplete due to the lack of clear guidance on the information required and confusion in the distribution of recommended protocols and products
  5. The medical countermeasures supply chain and production capacity are currently insufficient to meet the needs of the country in the event of pandemic influenza
  6. There is clear dissemination of public health and responder information from the CDC, but confusion about school closures remains

A final report with greater detail of the after-action review of the Crimson Contagion 2019 Functional Exercise is forthcoming. Stay tuned.

Biosecurity Insight
The latest Biosecurity Insight is out, which is a great source for information from the Centre for Biosecurity and Biopreparedness (CBB) established by the Danish Parliament. In this new volume, you can read about the control of CRISPR, fake news and biological weapons (“Pathogens are impossible to see and their effects difficult to understand. This makes the fear of them a dangerous device to be exploited through fake news. In a world where more than half of the population is online, social media can become a device to spread panic and mistrust, and hamper responses to natural disease outbreaks.”), and how the internet enables bioterrorism. You can read more here.

The Nuclear Balancing Act – Energy and Security
On November 14th, the GMU Schar School of Policy and Government hosted a panel conversation on the intersection of nuclear energy and security. “Students and faculty members from the Schar School of Policy and Government, as well as representatives from government agencies and nongovernmental organizations, joined Brent Park, Deputy Administrator for Defense Nuclear Nonproliferation at the U.S. Department of Energy’s National Nuclear Security Administration, and Mikhail Chudakov, Deputy Director General for Nuclear Energy at the International Atomic Energy Agency (IAEA)” to have frank conversations about the future state of nuclear energy and how to address “energy poverty”. Moderated by GMU biodefense professor and graduate program director Dr. Gregory Koblentz, the group discussed the marriage between these two nuclear components and that we ultimately need to continue having these conversations. As Dr. Koblentz noted, “Given the growing demand for carbon-free energy and the dynamic geopolitical situation, it was very informative to hear about how the IAEA and the United States work together to promote safe and secure nuclear energy.”

Biological Weapons Convention Meeting of States Parties (MSP)
This week the MSP began, bringing together states parties engaged in the prohibition of biological weapons. You can read Richard Guthrie’s daily summaries of the meetings here or even watch the livestream on UN Web TV. Hot topics will likely include funding and the current financial state, national implementation, verification, etc. The United Nations Institute for Disarmament Research (UNIDIR) has provided a 30-page overview of compliance and enforcement in the BWC, which you can access here. Written by Filippa Lentzos “this paper takes stock of the mechanisms that are currently available for attempting to determine and ensure compliance with the Biological Weapons Convention (BWC). It presents three conceptual layers of BWC compliance: one legally binding, one politically binding, and one wholly voluntary. The paper also describes a fourth, elusive layer—the verification layer—which remains one of the fundamental challenges of biological disarmament and non-proliferation.” On day 5 of the MSP, Guthrie noted that during the science and technology meeting of experts  “there was broad agreement of a need for some form of review arrangement, but with very little detail in the discussion. In the past, for example, some delegations have favoured a small committee of experts while others have favoured some form of arrangement that would allow all states parties to contribute to it. The lack of expressions of support for specific models may be a positive sign as many delegates would seem to prefer achieving consensus on some form of review mechanism rather than pressing for their ideal.”

Missing Links – Understanding Sex- and Gender-Related Impacts of Chemical and Biological Weapons
A new report released via UNIDIR is also addressing the interest that “has grown in gender as a useful analytical perspective to examine the impact of particular means and methods of warfare. Multilateral debates on chemical and biological weapons, however, have not systematically considered the relevance of sex- and age-disaggregated data on the effects of these weapons, nor knowledge of gender dynamics, in the implementation of the Biological and Chemical Weapons Conventions (BWC and CWC, respectively).” Written by Renata Hessmann Dalaqua, James Revill, Alastair Hay, and Nancy D. Connell, this is an extremely detailed and thorough look into the sex and gender dynamics that we often fail to address when it comes to CBW. The report is broken down into several sections – like sex and gender specific effects of chemical and biological weapons, which delves into the social roles and exposure as women are often the primary caregivers, as well as the social stigma and discrimination associated with exposure. Perhaps one of the most interesting sections was on health-seeking behaviors, noting that in some areas, the potential for stigma often impacts if medical care is sought. “Evidence from South Asia, Africa, and Vietnam suggests that the potential for stigmatization affects women’s help-seeking more than men”. Overall, this report was extremely informative and helpful in understanding those roadblocks for not only accurate reporting, but also building the most effective response in the event of an attack.

Using Genome Sequencing to Combat Healthcare Outbreaks 
GMU Biodefense doctoral alum Saskia Popescu discusses how genome sequencing can change response to outbreaks in healthcare settings. Infection prevention epidemiologists work hard to identify spikes in usual case counts or rapidly respond to single cases of unusual organisms. Unfortunately, identifying a source or transmission mechanism isn’t always that easy and we often don’t find the proverbial “smoking gun”.  However, a study assessed the use of genome sequencing in real-time as a tool to help give hospital epidemiologists and infection control an advantage against microorganisms. Investigators across several universities discussed how they employed the rapid and cost-efficient tool during an outbreak of Acinetobacter baumannii at the Queen Elizabeth Hospital Birmingham in 2011. The source of the outbreak was found to be a military patient from Afghanistan who was being treated for a blast injury. This specific case is unique in that the outbreak lasted an incredibly long time—80 weeks, which is the longest ever studied for Acinetobacter baumannii. 

Antimicrobial Resistant Fungal Infections
Fungi are eukaryotic organisms like molds, yeasts, and mushrooms that can be pathogenic in humans. Antifungal medications treat dangerous fungal infections, but antifungal resistant microbes are on the rise, just like antibiotic resistant bacteria. For example, antifungal resistance is increasingly common in severe Candida (a yeast) infections, which often causes nosocomial bloodstream infections. The Centers for Disease Control and Prevention (CDC) released a report on antibiotic resistance threats in the US, which includes a warning about drug-resistant fungi as a serious public health issue. According to the report, 18 microorganisms cause three million antibiotic resistant infections and 35,000 deaths each year. This is the first CDC report to include antibiotic-resistant fungi to include Candida auris along with other resistant Candida species and azole-resistant Aspergillus fumigatus, a mold. Resistance is inherent to certain fungi but can also develop through the misuse and overuse of antifungal and antibiotic drugs in human medicine and agriculture. As with antimicrobial resistance at large, the ubiquitous use of stronger and stronger antimicrobial medications is contributing to the spread of resistance while struggling to combat ongoing infections. The CDC is taking several steps and actions to prevent and reduce resistance:

  • Tracking trends in antifungal resistance through the Emerging Infections Program (EIP)
  • Supporting a network of regional public health laboratories through the Antibiotic Resistance Laboratory Network (ARLN) to perform antifungal susceptibility testing for Candida
  • Using genetic sequencing and developing new laboratory tests to identify and study specific mutations associated with antifungal resistance in Candida
  • Summarizing antifungal prescribing patterns across different healthcare facilities to promote appropriate use of antifungals

The CDC’s warning also includes suggestions about what can be done to curb the threat of antifungal resistance:

  • Healthcare facility executives and infection control staff can:
    • Assess antifungal use as part of their antibiotic stewardship programs
    • Ensure adherence to guidelines for hand hygiene, prevention of catheter-associated infections, and environmental infection control
  • Doctors and other hospital staff can:
    • Prescribe antifungal medications appropriately
    • Test for antifungal resistance for patients with invasive disease who are not improving with first-line antifungal medications
    • Stay aware of resistance patterns, including antifungal resistance, in your facility and community
    • Document the dose, duration, and indication for every antifungal prescription
    • Participate in and lead efforts within your hospital to improve antifungal prescribing practices
    • Follow hand hygiene and other infection prevention and control guidelines with every patient

Outbreak Dashboard
More attacks have plagued Ebola outbreak response efforts in the DRC, as case counts reach 3,313. Flu activity is also continuing to grow, as B/Victoria viruses are the most common and the CDC reported 8% of respiratory specimens tested by clinical labs were positive for influenza. The CDC is continuing to advise people not to consume romaine lettuce from the Salinas, CA, growing region due to an E. coli O157:H7 outbreak.

News of the Weird
A controversial fence, African swine fever, and Danish critics. In the realm of ASF outbreak response, some are calling the latest efforts in Denmark a waste of money. “On Monday, Denmark completed the fence along the border with Germany to protect its nearly 5,000 pig farms that export 28 million pigs annually, according to the Danish Agriculture and Food Council in a DW.com article. The 1.5-meter tall and half-meter deep fence runs from the Wadden Sea in the west to the Flensburg Fjord in the east. The fence construction cost Denmark around $12 million.” From potentially disrupting migration and an impact on the ecosystem, critics are saying the real threat is the importation of contaminated swine.

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Pandora Report: 11.29.2019

During this holiday time, we’d like to take a moment to thank our readers – we are truly grateful for your support and continued engagement over the years!

USAMRIID Resumes Select Agent Research…Sort Of
In August it was made public that the U.S. Army Research Institute of Infectious Disease (USMARIID) BSL-4 lab had research halted after failing to meet several Federal biosafety requirements. CDC inspectors identified several shortcomings in USAMRIID’s ability to keep safe the BSL-3 and BSL-4 labs it utilizes to study special pathogens. The implications of this were huge, as USAMRIID’s Special Pathogens lab is not only part of the Laboratory Response Network (LRN), but ultimately a huge piece of American biodefense. “Alongside the disruptions to critical medical countermeasure research projects, impaired BSL-3 and BSL-4 laboratory support to national public health emergencies should not be overlooked as USAMRIID works to correct biosafety issues, regain Federal Select Agent Program certification, and answer accountability questions. ‘We have had conversations with the Army’s LRN Liaison at Ft. Sam Houston and the CDC’s Chief, Laboratory Preparedness and Response Branch LRN to let them know what our capabilities and limitations are under the current constraints,’ stated Vander Linden.” Thankfully, USAMRIID has spent the past few months working to correct these failures and restore compliance, leading to a optimistic November site visit from CDC inspectors. Limited research is now allowed to resume and hopefully will be fully restored as CDC inspectors continue their review of personnel, practices, and processes.

CSIS Report: Ending the Cycle of Crisis and Complacency in U.S. Global Health Security
The health security of the United States – frankly, the entire world – is under severe threat as we remain woefully unprepared for outbreaks and other health crises. The recently released Global Health Security Index further confirms the gaps in prevention, preparedness, and response to public health threats. This month, the Center for Strategic and International Studies (CSIS) released its final report of the CSIS Commission on Strengthening America’s Health Security, Ending the Cycle of Crisis and Complacency in U.S. Global Health Security. The Commission advises Congress and the Administration enact the following seven recommendations:

  1. Restore health security leadership at the White House National Security Council.
  2. Commit to full and sustained multi-year funding for the Global Health Security Agenda to build partner capacity.
  3. Establish a Pandemic Preparedness Challenge at the World Bank to incentivize countries to invest in their own preparedness.
  4. Ensure rapid access to resources for health emergencies.
  5. Establish a U.S. Global Health Crises Response Corps.
  6. Strengthen the delivery of critical health services, including immunizations and health services for women and girls, in disordered settings.
  7. Systematically confront two urgent technology challenges: the need for new vaccines and therapeutics and the public health communications crisis.

The full report includes details for each of the recommendations regarding programs and funding needs, with a request for an increase in funding from the current levels to $905 million.  Read the report in its entirety here.

National Biodefense Science Board – Public Meeting
Don’t miss this December 3rd event regarding pandemic influenza preparedness and enhancing medical countermeasures against various biological threats. The public agenda can be found here, which includes emerging topics in biodefense, like Eastern Equine Encephalitis.

Chemical Weapons Convention (CWC) Conference of States Parties (CSP)
This week saw the 24th CSP (Conference of States Parties) of the Chemical Weapons CON Convention – you can watch the live-stream courtesy of the OPCW (Organization for the Prohibition of Chemical Weapons). Richard Guthrie has also provided daily reports of the CSP, which are a highly valuable resource and available here. Since it will run through the rest of this week, make sure to not only check out the daily recaps, but also his summary. Moreover, you can also read last year’s CSP coverage. On the second day of the CSP, one can read the general debate, which revealed the positions different delegates shared – “here were a number overarching themes; some of which will be examined here and some in the next daily report. There were also some notable points from individual statements. The session started with group statements from: the European Union; Azerbaijan on behalf of the CWC states parties that are members of the Non-Aligned Movement (NAM) and China; and Sudan on behalf of the Africa Group.” On Wednesday, it was announced that at the 24th CSP, the CWC adopted two decisions to amend for the first time the Annex on Chemicals to the Convention. “The first decision was jointly proposed by Canada, the Netherlands, and the United States of America while the second decision was proposed by the Russian Federation. Both decisions call for Technical Changes to Schedule 1 of the Annex on Chemicals to the CWC.” Highlighting the adaptability of the CWC, these proposals added families to Schedule 1. This is especially pertinent in the wake of the use of a Novichok agent in Salisbury last year, and the need to revise the the CWC schedules to control for Novichoks. As Stefano Costanzi and Gregory Koblentz noted, “the joint proposal and the portions of the Russian proposal upon which consensus can be reached would significantly strengthen the CWC by considerably expanding the coverage of its Schedule 1 and bringing Novichok agents firmly within the CWC’s verification system. We also argue that, since the OPCW Technical Secretariat did not deem the fifth group of chemicals proposed by Russia to meet the criteria for inclusion in Schedule 1, Russia should withdraw this part of its proposal from consideration. The proposals have also served an important purpose in clarifying the identity of the chemical agent used in the Salisbury incident, squarely placing it within one of the two families of Novichok agents described by the Russian chemical-weapons scientist and whistleblower Vil Mirzayanov.”

Tracking Trends in Toxoplasmosis Transmission 
Too often associated with feline exposures, toxoplasmosis is a neglected parasitic infection that is carried by 40 million people in the U.S. alone. A new study though, broke down decades of outbreaks to better understand the transmission dynamics of toxoplasmosis in humans. The authors note that on a global level, exposure is so high that serologic prevalence varies between 10% and 94% in the adult population. Infection is dependent upon factors like environmental conditions, eating habits, and prevalence of the parasite in the geographical area, among other factors. Transmission mostly occurs through the ingestion of oocyst-contaminated water or vegetables. Reviewing publications on toxoplasmosis outbreaks since 1967, the study team excluded cases in nonhuman species. A total of 573 articles were further analysis was conducted on 33 articles covering 34 reported outbreaks. The highest concentration of outbreaks reported (73.5%) occurred in the Americas, with Brazil having the highest number of published outbreaks. “The authors note, “’the incidence of cyst-related outbreaks from contaminated meat and its derivatives was 47.1% (16/34), and oocysts were implicated in 44.1% (15/34) of the outbreaks. Transmission through the intake of oocysts in water occurred with a frequency of 20.6% (7/34), through contact with sand and soil with a frequency of 17.6% (6/34), and through consumption of vegetables with a frequency of 5.9% (2/34)’.”

Outbreak Dashboard
Influenza activity is picking up as the CDC Flu Tracker noted that 7.3% of respiratory specimens tested by clinical labs were positive for influenza viruses. No new cases of Ebola virus disease were reported in the DRC on Wednesday, but the ongoing conflict has made response in hot spots (Mabalako and Beni) difficult.

Pandora Report: 11.22.2019

Happy Antibiotic Awareness Week! Are you being a good steward of antimicrobials during this respiratory virus season?

When A Lab Explosion Ruins Your Day – Stories of Vector 
A few months back, an explosion at the Russian laboratory complex known as the State Research Centre of Virology and Biotechnology (Vector), raised a red flag regarding the stockpiling of smallpox and realistically, biosafety/biosecurity. Not surprisingly, stories about where the explosion occurred, what was kept in that area, and all manner of horror movie-esque plots began to swirl. Gwyn Winfield though, has broken down the rumors, the realities, and the challenges of understanding what exactly happened when well, there’s not a lot of trust in Russian explanations. Gwyn takes care to highlight how fast speculation occurred though, and that while it may not have been easy to get answers right away, the theatrics of lab-to-bioweapon speculation does little good. Noting that the blast occurred on the 5th floor of building one – “The floor had been under repair since July, and since there was no research in progress there, and the area was not secure, there were no pathogens on that floor to be released.” As Winfield notes, the lack of information makes things challenging and while experts might make guesses, “the individuals that need to take the most lessons from this are exercise planners, globally but especially in Russia”. You can read the full article here.

The Microbiome and AMR
Microbiota bear effects on a variety of chronic diseases such as gastrointestinal, autoimmune, respiratory, neurological, and cardiovascular conditions; however, the microbiome also plays a role with infectious diseases. The growing body of research on the importance of the microbiome to human health links natural flora and the immune system, which are in a largely symbiotic relationship. More specifically, a healthy microbiome aids in the induction, training, and function of the immune system and, in return, the immune system maintains a happy balance between natural flora and the host human. Unfortunately, that relationship is under great threat as the persistent overuse of antibiotics destroys not only the invasive bacteria but also the healthy bacteria that help maintain immune function. Antimicrobial resistance (AMR) is ability of microbes – bacteria, viruses, fungi – to circumvent the mediating effects of antibiotic, antiviral, and antifungal therapeutics. The overuse of antibiotics enables strong, resistant bacteria to survive in the host, so your gut ultimately populates with mostly resistant bacteria, even bacteria resistant to multiple drugs. Disruptions to the microbiome by antibiotic use adds to the spread and strength of antimicrobial resistance in harmful microbes. Our overreliance on the prescription of antibiotics to alleviate bacterial infections, even minor ones that the immune system may be able to overcome, and a lack of medication compliance resulting in misuse are chipping away at the clinical efficacy of these drugs. This is of considerable concern as microbes become cleverer and less susceptible to multiple medications, resulting in infections that are less and less treatable. According to the CDC, there are over 2.8 million antibiotic-resistant infections in the US each year and more than 35,000 people die from those infections. The critical task at hand is to develop alternative therapeutics that can treat infections while, at least, not contributing to further microbial resistance. As a mediator for colonization resistance and a symbiote of the immune system, the microbiome possesses potential as a therapeutic gateway to subvert resistance.

Biodosimetry Biomarkers and Serum Proteomic Signatures – GMU Biodefense Alum Tackles It All 
GMU Biodefense doctoral student Mary Sproull is our resident guru on radiation – she’s a biologist in the Radiation Oncology Branch of the National Cancer Institute at NIH. Here are just two more reasons why Sproull is the go-to person for things like biodosimetry: she has two new publications that you’ll want to check out. The first, Comparisons of Proteomic Biodosimetry Biomarkets Across Five Different Murine Strains (try saying that five times fast) “seeks to compare the expression levels of five previously established proteomic biodosimetry biomarkers of radiation exposure, i.e., Flt3 ligand (FL), matrix metalloproteinase 9 (MMP9), serum amyloid A (SAA), pentraxin 3 (PTX3) and fibrinogen (FGB), across multiple murine strains and to test a multivariate dose prediction model based on a single C57BL6 strain against other murine strains.” Make sure to read this study as it discusses why these strain specific differences exist between expression levels. In the second article A Serum Proteomic Signature Predicting Survival in Patients with Glioblastoma, Sproull and the research team discuss this common brain tumor and how developing adequate biomarkers can help drive stronger patient outcomes. “Analysis of potentially relevant gene targets using The Cancer Genome Atlas database was done using the Glioblastoma Bio Discovery Portal (GBM-BioDP). A ten-biomarker subgroup of clinically relevant molecules was selected using a functional grouping analysis of the 40 plex genes with two genes selected from each group on the basis of degree of variance, lack of co-linearity with other biomarkers and clinical interest. A Multivariate Cox proportional hazard approach was used to analyze the relationship between overall survival (OS), gene expression, and resection status as covariates.”

Gene Editing
Advancements in biotechnology pose potentials and perils as such technology becomes easier to access and use by a wide array of bio-users, not just formally trained scientists at professional laboratories. Gene editing, the alteration of an organism’s DNA, is one such biotechnology. A number of research and government entities are working diligently to maximize the potential benefits of gene editing while simultaneously minimizing its perils. Two such entities are the National Academies of Sciences, Engineering, and Medicine and the Defense Advanced Research Projects Agency (DARPA). The former is concerned with perils of synthetic biology while the latter is trying to unlock its potential. The National Academies of Sciences, Engineering, and Medicine just released Strategies for Identifying and Addressing Vulnerabilities Posed by Synthetic Biology: Proceedings of a Workshop in Brief, which summarizes the key discussions in an October 2018 meeting of experts and policymakers following a report for the DOD, Biodefense in the Age of Synthetic Biology. The meeting’s purpose was to assemble federal personnel and the committee for the DOD report to consider the implications for actions DOD might take to quell potential misuse of synthetic biology capabilities. The committee evaluated 12 capabilities associated with (1) the synthesis and modification of pathogens; (2) production of chemicals, biochemicals, and toxins; and (3) modulation of human physiology. Each of the three capability areas were assigned relative levels of concern in terms of the usability of a technology, its usability as a weapon, its requirements of actors, and the potential for its mitigation. Additional workshop discussions included the potential of delivery mechanisms to serve as a barrier to the misuse of synthetic biology to produce weapons, the possibility to use synthetic biology to modify human physiology in new ways, and opportunities in computational biology to alleviate fears about synthetic biology capabilities through the prevention, detection, and attribution of its misuse. DARPA’s latest biotechnology project is the “Detect It with Gene Editing Technologies” program, more lovingly called DIGET. The primary objective of DIGET is “to provide comprehensive, specific, and trusted information about health threats to medical decision-makers within minutes, even in far-flung regions of the globe, to prevent the spread of disease, enable timely deployment of countermeasures, and improve the standard of care after diagnosis.” The DIGET dream deliverables are two devices: (1) a handheld and disposable point-of-need tool that simultaneously screens 10 or more pathogens or host biomarkers and (2) a multiplexed detection platform that simultaneously screens at least 1,000 clinical and environmental samples. DIGET seeks to incorporate gene editors and detectors biosurveillance as well as swift point-of-need diagnostics for endemic, emerging, and engineered pathogens. DARPA is hosting a Proposer’s Day meeting about the DIGET program on 11 December 2019.

Biological Threats to U.S. National Security – Subcommittee on Emerging Threats and Capabilities 
On Wednesday, Dr. Thomas V. Inglesby, Dr. Tara J. O’Toole, and Dr. Julie Gerberding gave testimony to this subcommittee within the U.S. Senate Committee on Armed Services. During the testimony, Dr. Inglesby “noted the growing threat of biological events that can emerge from nature, deliberate attack, or accidental release and reviewed current US government efforts in this arena. He presented recommendations to improve the government’s response to and preparedness for a major biological event.” You can read his full testimony here.

Revisiting the Biological Weapons Convention Protocol
Lynn Klotz recently wrote on the gaps within the BWC in relation to compliance monitoring. Despite efforts to change this in the past, those pushing for a protocol to randomly select site visits as means to do quality checks, have been disappointed over the years as administrations cite that such additions would not truly verify or provide greater security. As Klotz underscores – this sentiment fundamentally misses the goal of the protocol…which is transparency. “But recent events serve to underscore that a protocol to the convention to address the treaty’s shortcomings is an idea that should be revisited. Unfounded Russian allegations about biological weapons development in former Soviet countries are threatening the effectiveness of the convention. This concern along with strong arguments for the high importance of transparency in international treaties calls for revisiting the protocol, which had provisions for both transparency and for dealing with allegations like Russia’s.” Citing the 2019 meeting in which Russia alleged that several former Soviet states had active bioweapons programs, distrust soon grew and disruption rippled throughout the BWC. Klotz emphasizes that this exact situation is a prime reason why a protocol should be revisited – to help build confidence through increasing transparency. Not a free-for-all, but rather through managed-access rules, such as random visits by inspection teams would help verify the absence of bioweapons. Klotz takes care to discuss why protocol efforts were abandoned in 2001 and the role of transparency in multilateral arms control regimes, which you can read more about here.

Health Security Career Panel (Left to Right): Ashley Grant, Stuart Evenhaugen, Syra Madad, Sapana Vora, Halley Smith, Justin Hurt, and Malaya Fletcher.

GMU Hosts Health Security Career Panel 
Last week, adjunct professor Ashley Grant, a lead biotechnologist at the MITRE Corporation, held a career panel at the Schar School of Policy and Government at George Mason University as part of her course on Global Health Security Policy. To highlight the different paths that graduate students in the Biodefense program can take in the health security field, Professor Grant convened a diverse panel of health security practitioners to discuss their jobs and the skills they have needed to succeed. The panel included professionals from a variety of different backgrounds ranging from local health providers to Federal employees. Students in the Schar School’s Biodefense Graduate Program were able to ask the panelists about the challenges of moving from a technical career path into science policy and opportunities for internships. The panel included Stuart Evenhaugen of the Assistant Secretary for Preparedness and Response (ASPR)’s Strategy Division in the Department of Health and Human Services (HHS); Syra Madad, the Senior Director of System-Wide Special Pathogens Program at NYC Health + Hospitals; Halley Smith, a program lead with the U.S. Department of State Cooperative Threat Reduction Program, on detail from Sandia National Laboratories Global Chemical and Biological Security Program; Sapana Vora, the Deputy Team Chief for the U.S. Department of State’s Biosecurity Engagement Program (BEP) and Iraq Program in the Office of Cooperative Threat Reduction (CTR); and Malaya Fletcher, a Lead Scientist at Booz Allen Hamilton in Washington, DC.  The panel also included LTC Justin Hurt a CBRN/WMD Organizational Integration Officer in the Army G-3/5/7 Office who is currently enrolled in the Biodefense PhD program. As biodefense graduate student Michael Krug noted, “The panel was immensely valuable in providing detailed insights and experiences into each of the panelist’s unique career paths. Emphasizing the demand for multi-disciplined approaches, as well as active communication to answer the many health security questions facing the world.”

A Little Bit of Plague and A Whole Lot of Panic  
Plague – a word that still sparks fear after hundreds of years. Two cases were recently reported in China’s Inner Mongolia and of course, it involved a hunter and butchering/eating a wild animal. Diagnosed on November 5th, there were two additional cases reported in Beijing but from the Inner Mongolia area. “In both cases, the two patients from Inner Mongolia were quarantined at a facility in the capital after being diagnosed with pneumonic plague, health authorities said at the time. The Inner Mongolia health commission said it found no evidence so far to link the most recent case to the earlier two cases in Beijing.” As many have pointed out, the fear around this news has been more damaging to response efforts. Pneumonic plague is not as highly contagious as many news outlets have let on – only requiring Droplet + Standard isolation precautions and plague is easily treatable with antibiotics or prophylaxis.

Should We Be Celebrating CRISPR’s Anniversary?
It’s not many times an expert and innovator writes an article entitled “CRISPR’s unwanted anniversary” about a tech they were instrumental in developing. Dr. Jennifer Doudna recently wrote on those moments that can make or break a disruptive technology and in the case of CRISPR, it was last year, when Hong Kong-based scientist He Jiankui started the CRISPR baby drama. This was a pivotal moment in not only biotech, but also genome editing and its future. As Doudna notes, it’s comforting that scientists around the world reacted with conversations about the need for safeguards and transparency as CRISPR technology grows. In the face of this anniversary though, what has been done? Are there consequences for going against widely accepted norms? Doudna leaves us with the notion that “The ‘CRISPR babies’ saga should motivate active discussion and debate about human germline editing. With a new such study under consideration in Russia, appropriate regulation is urgently needed. Consequences for defying established restrictions should include, at a minimum, loss of funding and publication privileges. Ensuring responsible use of genome editing will enable CRISPR technology to improve the well-being of millions of people and fulfill its revolutionary potential.”

Outbreak Dashboard
In keeping up with the latest outbreaks, here are some quick updates on a handful of the infectious disease events that are going on  – The outbreak of Ebola virus disease in the DRC may be slowing as there were no new cases reported on November 19th but over 400 suspected cases were still being assessed (total case count is 3,296). With the recent approval of the Ebola vaccine by the European Medicines Agency (EMA), the distribution of the vaccine will increase and could impact the outbreak as well. Nigeria is facing a Yellow Fever outbreak, which it has struggled against since 2017. In the past 4 weeks, 839 new cases have been reported. Flu activity is increasing in the United States and the predominant strains are B/Victoria, A(H3N2) and A(H1N1)pdm09. 2.3% of healthcare provider visits in outpatient settings were for influenza-like illnesses. There is also a new E. coli outbreak linked to pre-packaged chicken Caesar salads impacting 17+ people across 8 states.

Hot Spots and Inadequate Monitoring for Bioterrorism – An American Story
Law professor Ana Santos Rutschman of Saint Louis University recently wrote on the usual and unusual biological suspects and how organisms like Salmonella can easily be overlooked as cases of bioterrorism (case in point the 1984 Oregon attack). Rutschman delves into preparedness efforts, like BioWatch, and how “there is a profound lack of coordination between federal agencies and local communities. When asked about what happens after notifications of a possible bioterrorism attack, Dr. Asha George, executive director of the Bipartisan Commission on Biodefense, answered: “They go off but nobody knows what to do.

Stories You May Have Missed:

  • Ongoing Outbreaks Trigger Laws to Limit Vaccine Exemptions – in the middle of measles outbreaks and pertussis cases occurring frequently, there is a desperate need for reducing vaccine exemptions that protect the anti-vaccine instead of the public’s health. “In 2018, the same research group published a study showing that, despite rising numbers of proposed antivaccine laws, pro-vaccine bills were more likely to become law. For the current study, the team looked at how health data might affect laws. The new findings come following a surge of measles activity in the United States this year, mostly fueled by a few large outbreaks that nearly cost the nation the measles elimination status that it achieved in 2000.”
  • Acinetobacter Baumannii Risk Factors– “After assessing 290 isolates, they found that 169 were endemic (96 of REP-1) and the most common site for isolation was the respiratory tract. In total, 109 patients (37%) had only Acinetobacter baumannii isolated, while some had up to 5 other organisms also identified. In those colonized, 69 were REP-1, and 64 with REP-2-5, the research team found that for those patients with REP-1, there was a 70% increase in carriage per increase in Schmid score (statistically significant), and a 50% increase in REP-2-5. Interestingly, prior colonization, longer lengths of stay, and immunosuppression did now have a statistically significant relationship with Acinetobacter baumannii colonization. “

 

Pandora Report: 11.15.2019

We’re back and we’ve got quite a packed newsletter for you, so grab a beverage and get ready for the warm fuzzies of biodefense news.

Failing to PREDICT the Next Pandemic
A few weeks back, it was announced that funding for the PREDICT program would cease after $207 million was sunk into the initiative. GMU biodefense MS student Michael Krug has provided a deep-dive into what PREDICT worked towards, the debated success, and what its cancellation means. “However, even with the billions of dollars spent on ensuring a robust global biosurveillance network, it remains unknown if this network can predict what the next disease will be or where the next outbreak will occur.” Read more here.

An Antibiotic Eclipse – Scenario or Future?
GMU Biodefense doctoral alum and infection preventionist Saskia Popescu discusses the looming threat of antibiotic resistance and what a future with little to no treatment options would look like. From dwindling options for secondary infections related to influenza to declining surgeries, a future without antibiotics is dim. Popescu highlights what this looks like and how we’re quickly approaching it through both the drying antibiotic pipeline, but also limited surveillance, and challenges in changing both stewardship and infection control measures. The existential threat of antimicrobial resistance is very real and Popescu provides a scenario portraying the economic and human costs that antimicrobial resistance could impose on society 30 years from now, if it is not addressed soon. You can read the full article here. This is an especially relevant topic as the CDC just released new data, finding that annually, 2.8 million resistant infections and 35,000 related deaths occur in the United States. The CDC report notes that “However, deaths decreased by 18 percent since the 2013 report. This suggests that prevention efforts in hospitals are working. Yet the number of people facing antibiotic resistance in the United States is still too high.”

Event Recap – People, Pigs, Plants, and Planetary Pandemic Possibilities 
If you happened to miss this November 5th event, no worries – GMU biodefense doctoral student Stevie Kiesel has provided an in-depth summary of the panel and discussions. Kiesel notes that the panel had insightful discussions on the need to understand local context and empower people and local public health communities. Local context is important for combating misinformation and getting a more accurate understanding of conditions on the ground. For example, the public health community must understand why a country may be disincentivized to report a disease outbreak in its early stages, when it is more easily controlled. Authoritarian governments who maintain tight messaging control may not want to admit to an active outbreak, or the economic drawbacks of announcing an outbreak may be so severe that leaders try to hide what’s going on. You can read more here.

Pandemic Policy: Time To Take A Page Out Of The Arms Control Book
Rebecca Katz is holding back no punches in her latest article on the broken policy approaches we have to international outbreak accountability, and frankly, it’s long overdue. Full disclosure, the first line is one of my favorites – “Last month, the World Health Organization (WHO) was reduced to the equivalent of playground pleading: ‘But you promised!’” Katz highlights that in the face of countries failing to meet their obligations within the International Health Regulations (IHR), the WHO has little recourse to act and frankly, the path to accountability isn’t particularly clear. Ultimately, this problem could be solved though, if instead of rewriting the IHR, we modeled such treaties in the image of the Biological Weapons Convention (BWC) to help convene regular review conferences, discuss developments, and establish a regulatory response that could help drive accountability. “As the former US representative to the BWC, Charles Flowerree, wrote, treaties ‘cannot be left simply to fend for themselves’.”

The 5th Annual Pandemic Policy Summit at Texas A&M University
GMU Biodefense doctoral student Rachel-Paige Casey has provided an in-depth review of this important summit earlier this week. The objective of each Summit is to convene researchers, medical professionals, practitioners, private sector experts, NGO representatives, and political leaders to examine issues in pandemic preparedness and response, health security, and biodefense. The foci of this year’s Summit were the promises and perils of technology; BARDA leadership through its history and today; the effect of the anti-vaccine movement on pandemic preparedness and response; and ongoing outbreaks. Key discussions included the inadequacy of biopreparedness, worries regarding emerging biotechnologies, the modern vaccine hesitancy movement in the US, and the leadership and future of BARDA. You can read more about the summit here.

Catalyst- A Collaborate Biosecurity Summit 
Don’t miss this February 22, 2020 event in San Francisco. “Catalyst will be a day of collaborative problem-solving for a broad range of people invested in the future of biotechnology, including synthetic biologists, policymakers, academics, and biohackers. We aim to catalyze a community of forward-looking individuals who will work together to engineer a future enhanced by biology and not endangered by it.The summit is free to attend for everyone accepted, and the application only takes a few minutes. We expect participants to come from diverse backgrounds, and welcome applicants who do not work professionally in biosecurity or biotechnology, who are early in their careers, and who are skeptical of how biosecurity discussions are typically framed. You can apply to attend here.

Firehosing – the Antivaxxer Strategy for the Transmission of Misinformation
Researchers Christopher Paul and Miriam Matthews of Rand introduced this idea in 2016 and it’s proving to be pretty accurate for how anti-vaccine advocates are pushing out their opinions. Lucky Tran of The Guardian recently made the link between antivaxxers and the strategy of firehosing, which entails a massive flow of disinformation to overwhelm the audience. Just like it sounds, firehosing involves pushing out as many lies as frequently as possible to overwhelm people with information and making it nearly impossible for a logical response to combat that much disinformation. Tran stumbled across this application by seeing it on a television show with anti-vaccine influencers like Jay Gordon and he employed this strategy. “Anti-vax influencers such as Jay Gordon and Andrew Wakefield can keep repeating disproved claims – and in the case of Wakefield, doing so despite having had his medical license revoked – because their lying effectively debases reality and gains them followers and fame in the process.” The Rand study can be found here, which originally discussed firehosing in the context of Russian propaganda – as it has two “distinctive features: high numbers of channels and messages and a shameless willingness to disseminate partial truths or outright fictions. In the words of one observer, ‘[N]ew Russian propaganda entertains, confuses and overwhelms the audience’.” In the face of this relatively new tactic, there is a desperate need to remove false anti-vaccine content from social media and websites, and to put more pressure on media and news platforms to not provide support for such guests/conversations.

Crowd-Control Weapons – Are They Really Non-Lethal?
The term “non-lethal” or “less-than-lethal” gets thrown around a lot when it comes to crowd/riot-control weapons but just how non-lethal are these methods if they’re overused? Physicians for Human Rights (PHR) dug into this very issue because frankly, the use of these weapons is quite common and if they’re not used properly, or with the proper training, they can be devastating. Routine use or misuse of agents like tear gas can be deadly. The PHR conducted several investigations into their use by governments in Bahrain, Georgia, Kashmir, Turkey, and other countries and ultimately, what they found was some pretty startling misuse that can result in long-term health outcomes or even death. They put together a report and factsheets on specific “non-lethals” like acoustic weapons, rubber bullets, stun grenades, tear gas, and even water cannons. Within each factsheet, you can read about the history, how they work, device types, health effects, legality of use, and considerations and policy recommendations. Within the report, they reviewed usage of the weapons including things like people who suffered injuries or even death. As protests occur in China, the use of sonic weapons for crowd control are a very real reminder of the fine line we walk when using “non-lethals”.

Ebola Outbreak Updates and Vaccine Approval 
This week, the European Medicines Agency (EMA) approved the V920 vaccine for Ebola Virus Disease (EVD) and it is already being administered in the Democratic Republic of the Congo. The ongoing EVD outbreak in the Democratic Republic of the Congo (DRC) started in August 2018 and has now exceeded 3,000 cases and 2,000 deaths. Since the 2014-15 outbreak in West Africa, advances in medical research produced new vaccination and therapeutic options. The V920 vaccine, developed and produced by Merck, was tested during the outbreak and showed a 97% efficacy rate and protects against the Zaire species, which is the strain responsible for the current outbreak. Johnson-and-Johnson is also beginning trials for its investigational EVD vaccine. Johnson-and-Johnson’s vaccine requires two doses, a barrier for patient compliance, and does not contain any antigens from the Ebola Bundibugyo species of the virus. Dr. Dan Lucey, professor of medicine at Georgetown University, wrote an editorial in the British Medical Journal about the new treatments for EVD. Dr. Lucey’s article reviews the findings and shortcomings of the four-arm randomized controlled trial (RCT) evaluating the efficacy of four potential EVD treatments: ZMapp, remdesivir, mAb114, and REGN-EB3. The RCT was discontinued when a strict statistical threshold for decreased mortality was reached REGN-EB3, a monoclonal antibody drug. The punchline for the efficacy of REGN-EB3 is that it is efficacious if administered during the early stage of the disease but not as the diseases progresses. Lucey recommends continuing research on EVD treatments that are successful at later stages of the diseases. Last but not least, the article applauds the rigor and difficulty of this randomized-controlled trial given it was conducted during the outbreak, making it a precedent-setting achievement.

GMU Biodefense Alum Changing the Face of Aerospace Physiology 
We’re excited to share some of the achievements of one of GMU’s biodefense alum – Nereyda Sevilla, a May 2017 doctoral graduate in Biodefense, who is a civilian aerospace physiologist for the Defense Health Agency working as Acting Director of the Military Health System Clinical Investigations Program. She was also recently awarded the Air Force Medical Service Biomedical Specialist Civilian of the Year Award and the Air Force Meritorious Service Medal. If you’d like to see more of Nereyda’s hard work in action, check out the article she and the Spatiotemporal Epidemiologic Modeler (STEM) Team published in the Sept 2019 edition of Health Security,  “STEM: An Open Source Tool for Disease Modeling.” (Volume 17, Number 4, 2019).

Phase 3 Trial of Modified Vaccinia Ankara Against Smallpox
In the last Pandora Report, we discussed the FDA approval of the new smallpox vaccine JYNNEOS, that was tested by USAMRIID. The vaccine, developed by biotechnology company Bavarian Nordic, will enter the market under the name JYNNEOS. You can read about the Phase 3 efficacy trial of JYNNEOS (a modified vaccinia Ankara, MVA) as a possible vaccine against smallpox in the latest New England Journal of Medicine. GMU Biodefense professor and director of the graduate program, Dr. Gregory Koblentz noted that one of the key findings of this Phase 3 efficacy trial is that even though the FDA has approved a two-dose regimen for MVA (since it is a non-replicating vaccine that uses an ), a single dose of MVA provided the same level of protection as a single dose of the replicating vaccinia vaccine ACAM 2000. “At day 14, the geometric mean titer of neutralizing antibodies induced by a single MVA vaccination (16.2) was equal to that induced by ACAM2000 (16.2), and the percentages of participants with seroconversion were similar (90.8% and 91.8%, respectively).” An additional advantage of MVA over ACAM 2000 is that the former can be administered by a subcutaneous injection while the latter requires scarification through the use of a bifurcated needle. The article concludes that “No safety concerns associated with the MVA vaccine were identified. Immune responses and attenuation of the major cutaneous reaction suggest that this MVA vaccine protected against variola infection.”

Key Global Health Positions – A Who’s Who in the U.S. Government
Have you ever wondered who helps support global health within the U.S. government?  The Kaiser Family Foundation (KFF) has created a substantial list on not only the positions, but also who (if anyone) is occupying them. From the Department of Health and Human Services to the Department of the Treasury, you’ll want to utilize this list to not only realize the scope of global health efforts within the USG, but also who you might need to get in touch with.

Stories You May Have Missed:

  • African Swine Fever Continues to Spread in Asia – Unfortunately, this outbreak isn’t showing signs of letting up… “The update shows new outbreaks in Vietnam, Cambodia, Laos, the Philippines, South Korea and on the Russian side of the Chinese border reported during the first week of November. Meanwhile, formal confirmation is awaited of ASF outbreaks in Indonesia. The FAO reports that more than 4,500 pigs are said to have died in 11 regencies/cities in North Sumatra. Dead pigs were also found in a river. FAO is liaising with the Indonesian authorities to ‘confirm the cause and explore needs’.”

Event Summary: People, Pigs, Plants, and Planetary Pandemic Possibilities

By Stevie Kiesel, GMU Biodefense PhD student

November 5 was a great day for doing your civic duty. If you were near Arlington, Virginia, you could stop by your polling place to vote and then head to George Mason University (GMU) for a panel discussion. The discussion, co-sponsored by the GMU Next Gen Global Health Security Network and the GMU Biodefense Discussion Group, centered on the One Health concept, a “collaborative, multisectoral, and transdisciplinary approach” with “the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.” While One Health is not a new concept, humanity’s increasing interconnectedness makes it ever more relevant. For example, as humans expand into new geographic areas, they come into closer contact with animals, increasing the risk of zoonotic disease spread. Additionally, habitat disruptions—whether caused by farming practices, deforestation, or climate change—can provide novel ways for diseases to pass to animals and then on to humans. Successful public health policy thus requires “the cooperation of human, animal, and environmental health communities.”

The panel included Dr. Jarod Hanson and Dr. Taylor Winkleman, who both have military experience as well as veterinary backgrounds, and Dr. Michael E. von Fricken, who specializes in vector-borne diseases around the world. These speakers brought their real-world experience on topics such as disease surveillance, funding for disease prevention, information sharing and collaboration with international partners, and the fight to get good information to all stakeholders during a disease outbreak. Throughout this discussion, three needs emerged: (1) to empower local public health actors and understand local context, (2) to focus more on prevention, and (3) to convert policies and plans into action. Continue reading “Event Summary: People, Pigs, Plants, and Planetary Pandemic Possibilities”

The 5th Annual Pandemic Policy Summit at Texas A&M University

By Rachel-Paige Casey, GMU Biodefense PhD student

Earlier this week, the 5th annual Pandemic Policy Summit was hosted at Texas A&M University by the Scowcroft Institute of International Affairs in the Bush School of Government and Public Service. Most of the Summit’s events were conducted under Chatham House rule, prohibiting attribution of comments and insights to an individual or organization. The objective of each Summit is to convene researchers, medical professionals, practitioners, private sector experts, NGO representatives, and political leaders to examine issues in pandemic preparedness and response, health security, and biodefense. The foci of this year’s Summit were the promises and perils of technology; BARDA leadership through its history and today; the effect of the anti-vaccine movement on pandemic preparedness and response; and ongoing outbreaks. Key discussions included the inadequacy of biopreparedness, worries regarding emerging biotechnologies, the modern vaccine hesitancy movement in the US, and the leadership and future of BARDA.

A commonly recited phrase throughout the panels underscored a concern shared throughout attendees and speakers – “lessons learned to lessons observed.” Over the many health crises, lessons were largely observed and not learned, maintain the distressing paradox of inadequate biopreparedness despite clear evidence of the emerging and re-emerging pathogens threatening human, animal, and environmental health. The 2014-15 West Africa Ebola Virus Disease (EVD) epidemic was a gruesome showcase of failures in imagination, policy, capabilities, and management; however, it was just one among many in recent history. Since the turn of the century, the same failures were apparent in the SARS, H1N1, and Amerithrax events. Four primary causes of the aforementioned failures were proposed: complacency, competing priorities, confusion about risk, and overdependence on government capabilities and capacities. Though not necessarily easy to fix or adjust, the underlying roots of preparedness and response failures can be thwarted. The goal of the Summit is to discern how to address these failures and improve policy, collaboration, and leadership for quicker and more successful prevention, detection, and response to health crises like outbreaks and bioterror attacks. Simply put, how do we learn lessons instead of just observing them? Continue reading “The 5th Annual Pandemic Policy Summit at Texas A&M University”

Pandora Report: 11.1.2019

We hope you had a spooky Halloween – zombie flies, anyone? The Pandora Report will be off next week but rest assured, we’ll be back the week of November 15th!

Haphazard Success Against Ebola and the Future of Predict
More Ebola virus disease cases have been reported in the DRC and despite over 240,000 vaccinations, there have been 3,260 cases and 2,177 deaths. In 2014, the U.S. worked to combat the largest outbreak in history and in the process, learned critical lessons both abroad and at home. Unlike last time, in which the presence of the U.S. military was seen as a hopeful arrival, the existing violence in the DRC and the delicate nature of response means that no US resources will be deployed to assist. “The outbreak today offers a better look at global pandemics to come — ones that begin in regions where international public health workers are unable to move freely to contain the spread of a virus, where the U.S. Army would not be welcomed with open arms.” Moreover, this outbreak has been a particularly painful reminder that despite intentions, trust can not be bought with hundreds of scientists/troops or shiny new equipment – core institutional mistrust can make or break a country’s acceptance of foreign support. Sure, we were able to swoop in during the 2014 outbreak, but that simply isn’t the case in the current one and our preparedness and response efforts must account for this critical aspect of assisting foreign outbreaks. In the midst of this complex situation, a research program that worked to identify zoonotic spillover as a predictive tool, has been defunded. Predict is a program that was launched in the last decade and cost just over $200 million, but worked to learn from the H5N1 scare and the increasing threat of zoonotic diseases and their spillover into humans. By collecting biological samples, it identified over 1,000 news viruses and trained thousands of people across 30 countries to help strengthen medical research at an international level. “Dennis Carroll, the former director of USAID’s emerging threats division who helped design Predict, oversaw it for a decade and retired when it was shut down. The surveillance project is closing because of ‘the ascension of risk-averse bureaucrats,’ he said. Because USAID’s chief mission is economic aid, he added, some federal officials felt uncomfortable funding cutting-edge science like tracking exotic pathogens.” In many ways, this is seen as a devastating blow to global health security, while others have questioned the true utility of the program. There are two things we can take away from the defunding of Predict though – public health and health security efforts do struggle to maintain funding, and perhaps we need to have more conversations regarding the efficacy of predictive approaches. For many, this has been a reminder that investment in critical response efforts are more beneficial, rather than those who seek to predict what the next biothreat will be.

Tracc Event: Sanctions and Illicit Flows
The Terrorism, Transnational Crime and Corruption Center (Tracc) will be hosting an event on November 13th from noon-2pm at GMU’s Van Metre Hall. The event will present “a multi-organizational perspective on sanctions and why they are instituted, and how they are evaded.  The diverse analytical presentations on the Middle East will focus on the networks that are behind this deceptive behavior and the means used to counter this harmful activity. Panelists (including GMU biodefense professor and graduate program director Dr. Gregory Koblentz) will describe how the United States and other countries have used sanctions to prevent the proliferation of chemical weapons to Syria, deter the use of these weapons during that country’s civil war, and hold perpetrators of chemical attacks accountable. Additionally, we will discuss the means by which risk actors evade sanctions and how data can protect government and corporate entities from risk exposure related to sanctions evasions networks.” Lunch will be provided and RSVP is required, so make sure to click here or email traccc@gmu.edu

Upcoming Vaccines and Medications for Infectious Diseases
The US Army Medical Research Institute of Infectious Diseases (USAMRIID) announced that a new smallpox vaccine, which it tested, just received FDA approval. Smallpox is an infectious viral disease in which patients experience flu-like symptoms and a widespread rash; it has no cure. The vaccine, developed by biotechnology company Bavarian Nordic, will enter the market under the name JYNNEOS. BlueWillow Biologics just received FDA clearance for trials on an investigational new drug (IND) that, if approved, will be the company’s upcoming next-generation anthrax vaccine. This vaccine, currently called BW-1010, is administered intranasally. Anthrax is an infectious disease with four types of infection: cutaneous, inhalation, gastrointestinal, and injection. All four types of anthrax can lead to serious illness or death if left untreated. Tuberculosis (TB) is an infectious bacterial disease characterized by lung damage, and it has become resistant to a slew of antibiotics. According to the WHO, there were 10 million cases of tuberculosis and 1.4 million disease-related deaths in 2018. This experimental vaccine has been tested on 3,500 adults in the TB-endemic areas of South Africa, Kenya and Zambia. Also, the vaccine study showed partial efficacy of 50% in preventing a dormant infection from advancing to a disease state. Though 50% efficacy would normally be considered low for a vaccine, this would still be a huge improvement for millions of TB-affected people around the world each year. A phase II trial is underway for a novel antifungal drug called Olorofim, which is showing promise as a treatment against Lomentospora prolificans infections. Lomentospora prolificans is a rare mold that is resistant against current antifungal treatments.  Additionally, a 2018 study showed that Olorofim was also effective against Aspergillus species.

Schar School Biodefense Open Houses
From anthrax to Zika, Schar School is the place to be for all things biodefense. Next week you can attend the last PhD Open House of the year – on Thursday, November 7th at 7pm at our Fairfax campus. This is a great opportunity to meet current students, chat with faculty, and find out more about our biodefense doctoral program. If you’re looking to do a MS in biodefense (online or in person), the Master’s Open House is November 13th at 6:30pm at the Arlington campus.

The Gut Microbiome and Pathogens
If you peruse through your local grocery market, you will likely find fermented drinks like kombucha and kefir, which are just a couple of the popular items praised for providing probiotics for microbiome health. The human microbiome is the collection of genetic material of all the microbes (bacteria, fungi, protozoa, and viruses) living on and in the body and it aids in efficient digestion as well as protection against disease-causing invaders, like bacterial pathogens. According to Baumler and Sperandio, “pathogenic bacteria exploit microbiota-derived sources of carbon and nitrogen as nutrients and regulatory signals to promote their own growth and virulence.” Additionally, microbiota can operate as either fighters or promoters of viral infections. Research discovered and continues to explore connections between the health of the gut microbiome and a range of conditions and ailments such neurodegenerative and systemic autoimmune diseases, cancer, and depression. Ongoing research at universities, laboratories, and institutes will surely reveal more insights into the relationships and interactions between the body’s flora and pathogenic activity. As further breakthroughs regarding the nexus of the microbiome and pathogens occur, the Pandora Report will feature those discoveries and findings.

Bringing On the Big Guns Against African Swine Fever
In what sounds like a video game, South Korea is employing drones and snipers along the demilitarized zone to prevent wild boars from spreading African swine fever (ASF) throughout the country. Cases have sprung up in South Korea near the North Korean border only last month, resulting in the culling of over 150,000 pigs. Snipers, civilian hunter teams, and drones with thermal vision are now being utilized to track the boars that might be carrying the devastating disease. South Korea isn’t the only country on the offense to avoid an outbreak – the United States has been working to avoid cases that could devastate the porcine industry. Unfortunately, many researchers have noted that we could have worked towards a vaccine that would’ve avoided so much of this situation. Despite 15 years of research on a vaccine at the U.S. Agriculture Department, the program and team was disbanded due to budgetary moves and limited resources in 2004 and it wasn’t until 2010 that efforts resumed. ASF is a prime example of not only One Health, but how we often prove to be our own worst enemy when it comes to disease prevention.

People, Pigs, Plants, and Planetary Pandemic Possibilities Event
Don’t miss out on next week’s GMU One Health Day Panel Discussion hosted by GMU Next Gen Global Health Security Network and the GMU Biodefense Discussion Group. From 4:30-6:30pm in Van Metre Hall at the Arlington campus, you can grab a slice of pizza and engage in discussions with panel members from health security, emerging infectious diseases, and more. This panel will discuss the One Health approach through the various lens of their real world experiences. Discussions and interactions with the audience will address insightful views of innovation and emerging technology developments for biosafety and biosecurity. So, come join the Next Gen Network as we investigate what it means to utilize the One Health approach in the biodefense realm! Space is limited, so make sure to RSVP to reserve your spot.

News of the Weird
Is your stomach a brewery? Well you’re not alone. A North Carolina man was experiencing a bizarre occurrence – he kept getting drunk without a drop of alcohol. Seven years after a DWI and years of arguing that he truly hadn’t consumed any alcohol, he was diagnosed with a rare disorder – “auto-brewery syndrome”. That’s right, his body was creating a plethora of alcohol-fermenting yeasts and would go into overdrive whenever he had a heavy carbohydrate meal. In this case, he was treated with antifungals but relapsed when he snuck some of the forbidden foods – pizza and soda.

Stories You May Have Missed

  • How is the EU Battling Drug-Resistant Gonorrhea? In the United States, there is a national surveillance program, which was established in 1986, and tracks antimicrobial susceptibility of Neisseria gonorrhoeae strains throughout STD clinics. A new report in 2017 found considerable trends in gonorrhea incidence, noting that it is the second most reported STD with roughly 820,000 cases each year. Abroad, multi- and extensively drug-resistant gonorrhea (MDR and XDR NG) poses a considerable problem. The European Centre for Disease Control (ECDC) has recently created a 2019 response plan to control and manage these varying levels of resistant gonorrhea throughout Europe.
  • TED Talk – Vaccinating Vampire Bats and Pandemic Lessons – Could we anticipate the next big disease outbreak, stopping a virus like Ebola before it ever strikes? In this talk about frontline scientific research, ecologist Daniel Streicker takes us to the Amazon rainforest in Peru where he tracks the movement of vampire bats in order to forecast and prevent rabies outbreaks. By studying these disease patterns, Streicker shows how we could learn to cut off the next pandemic at its source.

Pandora Report: 10.25.2019

Happy Friday! We’re excited to provide you with the latest in biodefense news. We’ve even added a new section (News of the Weird) for those health security stories that make you chuckle/shake your head in disbelief.

GMU Biodefense Open Houses
You’ve got two more chances to attend the Schar School Open Houses to learn about our PhD and Master’s programs – don’t miss out! The PhD Open House will be on Thursday, November 7th at 7pm at our Fairfax campus, and the Master’s Open House will be held on Wednesday, November 13th, at 6:30pm at the Arlington campus. This is a great opportunity to learn about our biodefense programs, the coursework, application process, and chat with faculty. You can find more information and RSVP here.

Global Health Security Index is Released 
On Thursday, a joint project and report was released by the Nuclear Threat Initiative (NTI), the Johns Hopkins Center for Health Security, and the Economist Intelligent Unit (EIU). Several recent biological events – the ongoing Ebola outbreak, the 2014 Ebola outbreak in West Africa, the Zika outbreak, and so on – made clear that there was a terrible lack of preparedness to infectious disease outbreaks. The Index confirms and expands upon this worrisome realization. The Global Health Security Index assessed 195 countries across six categories with 34 indicators, and through 140 questions via public information. The short story? No one is prepared to handle a pandemic or global catastrophic biological event. 92% of the studied nation lack security checks for people accessing dangerous biological materials. From infection prevention efforts to capacity to acquire medical countermeasures, this index is immensely detailed and helpful in understanding the scope of global health security and what it truly means. Some of their findings also include – fewer than 5% of countries show a requirement to test their emergency operations annually, 77% do not demonstrate a capability to collect ongoing to real-time lab data, most countries lack foundational health systems capabilities for epidemics or pandemic response. Out of 100, the average GHS Index sore was 40.2, while high-income countries had an average score of 51.9. Key recommendations derived from the GHS Index include:

  • Governments should pledge to address their respective health security risks
  • Every country should maintain transparency and regular measurement of its health security capabilities and capacities
  • New or updated financing mechanisms should be established to fill the gaps highlighted by the Index

The Index was created to highlight gaps in the prevention, detection, and rapid response capabilities and capacities of nations against major biological events. Further, the Index aims to catalyze action and accountability in governments, public and private sector entities, and civil society toward improved biosecurity and biosafety. The full 2019 report containing the background, methodology, findings, recommendations, and country profiles is available here.

Nuclear Aspirations of Turkey
Recent and alarming statements made by Turkish President Recep Tayyip Erdogan insinuate that Turkey may exit the Nuclear Non-Proliferation Treaty (NPT) and procure its own nuclear weapons as it seeks supremacy in the Middle East. His first suggestion of nuclearizing was during an AKP party rally in September 2019, at which he bemoaned the restriction on Turkey acquiring nuclear weapons. At the recent UN Assembly, Erdogan purported that either no countries should be allowed to possess nuclear weapons or all countries should be allowed, another not-so-subtle hint at Turkey’s nuclear intent. This prospect is especially daunting not only because the world may see the creation of a new nuclear state but also because the United States maintains an arsenal of nuclear weapons within Turkish borders. There is current deliberation within the Pentagon about removing 50 B-61 nuclear bombs from the Incirlik Air Base in southern Turkey, weapons housed there since the Cold War to discourage Soviet ground forces. Such an evacuation comes with both physical and political risks. Of course, relocating nuclear material is no simple feat, an activity requiring substantial security, but the potential political repercussions are of greater concern. Withdrawal could instigate a stronger relationship between Turkey and Russia, because the removal could be interpreted by Turkey as a pivot away from NATO. Additionally, withdrawal of weapons from Turkey may catalyze withdrawal requests from other NATO members like Belgium or Germany. Though it would take years for Turkey to develop a nuclear program and there is expert speculation that his recent insinuations are intended to highlight the asymmetry of the treaties like the NPT, his true intent is unclear. The Pandora Report will continue to follow the statements and actions from Turkeys for future updates.

Save the Date – People, Pigs, Plants, and Planetary Pandemic Possibilities- One Health Day Panel Event
On Tuesday, November 5th, the GMU Next Gen Global Health Security Network and the GMU Biodefense Discussion Group are sponsoring a GMU One Health Day Panel Discussion! Pizza will be served before the panel starts, so join us at 4:30PM to grab a slice and discuss biodefense with the panelists.  The event will take place from 4:30pm to 6:30pm in Van Metre Hall at the GMU Arlington Campus. This panel will discuss the One Health approach through the various lens of their real world experiences. Discussions and interactions with the audience will address insightful views of innovation and emerging technology developments for biosafety and biosecurity. So, come join the Next Gen Network as we investigate what it means to utilize the One Health approach in the biodefense realm. You can register for the event here.

Drug Resistant E coli – An Unlikely Source
Combating antimicrobial resistance is one of those tasks that often seems so complex and challenging, we may never truly recover. From poor antibiotic stewardship to usage in agriculture and even a drying pipeline in drug development, this problem is particularly resistant (pun intended) to resolution. Pulling from Dr. Koblentz’s term for biosecurity, it might be that antimicrobial resistance (AMR) is a wicked problem. When we start to look at the origin of resistant microbes and how they’re being shared between people, animals, and the environment, there is a considerable concern for the role of animals farmed for human consumption. Maryn McKenna has long highlighted the considerable role of antibiotic usage in chickens and has recently written on the role of antibiotic resistance in animals, but a new study is shedding light on how food might not be a source for some infections. Recently published in The Lancet Infectious Diseases, a team of researchers performed epidemiological surveillance on extended-spectrum β-lactamase-producing Escherichia coli isolates (ESBL-E coli). The goal was to understand this organism as a source for bacteremia (blood infection) and the role of the food chain in supporting such resistant infections. What they found was startling – while ESBL-E coli was found frequently in sewage and retail chicken, it was rare in other meats and plant-based foods. Moreover, most human bacteremia ESBL E coli in their study actually involved human-associated sequence types, meaning that the non-human reservoirs were not as much the culprit. Ultimately, this means that as we work to combat drug resistance through targeted efforts, we should give more credence to the role of human transmission.

Oseltamivir vs. Influenza
If you’ve read Stefan Elbe’s book Pandemic, Pills, and Politics, you’ll appreciate this recent study even more when it comes to the hot topic of Tamiflu (oseltamivir). The wonder drug oseltamivir was touted as a medical countermeasure and response to influenza and potential pandemics. While Elbe heavily discusses the creation, questionable efficacy, and politics surrounding Tamiflu in his book, a new study has shed some light on its efficacy against the H1N1 subtype responsible for the 1918/1919 pandemic. While oseltamivir phosphate is effective against this particular reconstructed strain of influenza, they also found it was vulnerable to escape through resistant mutations. As the authors note, “Nevertheless, we conclude that oseltamivir would be highly beneficial to reduce the morbidity and mortality rates caused by a highly pathogenic influenza virus although it would be predicted that resistance would likely emerge with sustained use of the drug.” We’ll have to put this “double-edged sword” category of medical countermeasures against pan-flu…

Too Great A Thing to Leave Undone: Defense of Agriculture
This event hosted by the Bipartisan Commission on Biodefense is only weeks away – are you registered? Even if you’re not able to attend in person in Colorado, you can live-stream the November 5th event to ensure you don’t miss any of the critical conversations on defending US agriculture.

Novichoks To Be 86’d
Since the 2018 use of Novichok poison against a former Russian spy in the UK, there has been increased scrutiny regarding the control and proliferation of such chemicals. Richard Stone recently wrote on the ominous future of Novichoks after the October 9th meeting of the Executive Council of the Organization for the Prohibition of Chemical Weapons (OPCW), which would bring them under the treaty’s regime. “This is a historic milestone for the treaty,” says Gregory Koblentz, a chemical and biological weapons expert at George Mason University in Fairfax, Virginia. This is not the first time Novichoks have been discussed in relation to bans and their use as tools for assassination, but adding them to the CWC’s list has been long fought by treaty nations worried that their ingredients would also be regulated. You can read a review of what happened here, but the truth is that there has been a long need to control this class of nerve agents. Developed by the Soviet Union during the Cold War, their use in 2018 was a turning point for not only their control, but also their place within the Chemical Weapons Convention. Next month, the Schedule 1 listing (i.e. amending the CWC and putting Novichoks on their list of chemical weapons in which signatories are required to declare and destroy) will be discussed and voted upon. “It’s not like Novichoks are relics of the past,” Koblentz says. “These are weapons that are still killing people.”

News of the Weird
No, it’s not Groundhog Day and you’re not stuck in a time loop – there is yet another measles exposure at Disneyland. Sure, it’s the happiest place on earth – if you’re vaccinated. A friendly reminder to all our readers, if you’re looking to indulge in some Disney Dole Whip or visit the new Star Wars park, make sure your MMR is up to date.

China Drafts Biosecurity Laws
Between the outbreak of African Swine Fever (ASF) that’s threatening global heparin supply and the continued fallout of He Jiankui’s CRISPR baby drama, conversations revolving around China and biosecurity have been pretty consistent. This week though, China’s draft biosecurity law was submitted to the National People’s Congress Standing Committee for discussion and deliberation. Focused on protecting the country’s biological resources and biotech industry, it also points to the importance of prohibiting the misuse of biological agents or biotech. Not only do the laws include provisions on preventing bioterrorism and managing antimicrobial resistance, they also emphasize an early warning system and emergency response efforts in addition to risk assessments. “The draft also reiterated China’s commitment to the building of a community with a shared future for humanity through efforts in achieving biosecurity.”

Stories You May Have Missed:

  • PTSD and a Link Within Infections – When assessing risk for infections, we need to start considering mental health issues, like PTSD. A new study actually sought to evaluate the relationship between PTSD and prevalence of infections. “The investigators found that not only were the majority of PTSD cohort members younger than 60 years and female, but they also had a higher proportion of diagnosis of anxiety disorders and depression. Ultimately, they found that those with PTSD diagnosis were at an increased risk for infections than those without a diagnosis. There were more diagnoses of urinary tract infections in those women with PTSD than those without, while skin infections were more prevalent in men with PTSD diagnoses than women with PTSD diagnosis. The findings related to urinary tract infections was the strongest evidence of a relationship between PTSD diagnosis and risk of infection.”

Pandora Report: 10.18.2019

Happy Friday to our fellow biodefense gurus! We hope you had a lovely week and are ready to enjoy a healthy dose of health security news. To start things off with a bang… it was recently reported that the terror group JAD has been working to make bombs fused with poisonous ingredients.

Rejected! 
Science and Global Security, the peer-reviewed nonproliferation journal based at Princeton University, has rejected Ted Postol’s article that called into question the findings of the Organization for the Prohibition of Chemical Weapons (OPCW) and the UN Joint Investigative Mechanism (JIM) that the Syrian government attacked the town of Khan Sheikhoun with the nerve agent sarin on April 4, 2017. This rejection follows a scathing critique of the article by Bellingcat as well as public criticism of the journal by Biodefense Program director, Gregory Koblentz. In response to his rejection, Postol has resigned from his position on the editorial board of Science and Global Security. Science has a great write-up of the latest developments in this controversy. According to Koblentz, “Postol has abused his affiliation with MIT and his reputation as a whistleblowing missile defense expert to promote a series of conspiracy theories over the last six years whose only common theme is to exonerate the Assad regime for gassing its own people. A clear indication of Postol’s motivation is that he still publicly embraces a long-discredited theory that there was no sarin attack at Khan Sheikhoun and that the incident was staged as a “false-flag operation” by the Syrian opposition. Given this record of disinformation on the use of chemical weapons in Syria, allowing Postol to publish in a peer-reviewed nonproliferation journal would be akin to letting Andrew Wakefield publish an article about vaccines and autism in JAMA or Alex Jones to opine in the Columbia Journalism Review about media coverage of the mass shooting at Sandy Hook. This episode is an important reminder that in an age of disinformation, scientific journals have a special responsibility to ensure that their peer review processes are designed to ensure the integrity of the research they are publishing.

People, Pigs, Plants, and Planetary Pandemic Possibilities
Here’s your chance to register for this November 5th event at GMU to celebrate One Health Day. This panel will discuss the One Health approach through the various lens of their real world experiences. Discussions and interactions with the audience will address insightful views of innovation and emerging technology developments for biosafety and biosecurity. So, please come and join in the discussion as we collectively investigate what it means to operationalize the One Health concept for the biodefense realm and global health security challenges! Space is extremely LIMITED and will be capped at 35 participants, so register as soon as possible to ensure your spot in the audience. The final day to register for the event is November 1st – you can reserve your spot here.

House Homeland Security Subcommittee to Evaluate Bioterrorism Preparedness
Yesterday, Rep. Donald Payne, the Chairman of the Subcommittee on Emergency Preparedness, Response, and Recovery, held a hearing entitled Defending the Homeland From Bioterrorism: Are We Prepared?. In her testimony to the Subcommittee yesterday, Dr. Asha M. George (Executive Director of the Bipartisan Commission on Biodefense), spoke as an expert witness, urging the Subcommittee to utilize the findings of the 2015 Bipartisan Commission report to help remedy the lack of preparedness against biological terrorism. “Dr. George noted that the federal government has spent millions to develop, improve, and deploy technology in hopes of rapidly detecting biological attacks. Effective environmental surveillance should assist with pathogen identification and provide early warning. ‘Unfortunately, as this Committee is well aware, the equipment designed to detect airborne biological contaminants do not perform well and have not progressed significantly since their initial deployments’.”

Putting the Cart Before the Horsepox
The Alliance for Biosecurity, a consortium of companies that develop medical countermeasures against biological threats, has a new member: Tonix Pharmaceuticals. Tonix burst onto the biodefense scene in 2017 when it was revealed that the company funded the synthesis of horsepox virus, an extinct orthopoxvirus closely related to variola, the virus that causes smallpox. Tonix is promoting its TNX-801 smallpox vaccine candidate which is based on the horsepox virus. As Gregory Koblentz, Biodefense Program director, has previously written “the claimed benefits of using horsepox virus as a smallpox vaccine rest on a weak scientific foundation and an even weaker business case that this project will lead to a licensed medical countermeasure.” The business case for Tonix’s new vaccine took a major hit last month when the Food and Drug Administration (FDA) approved Bavarian Nordic’s Jynneos vaccine (formerly known as Imvamune) to prevent smallpox and monkeypox. Jynneos provides a safer alternative to the ACAM 2000 smallpox vaccine and can be given to a wider population. With two licensed smallpox vaccines now in the Strategic National Stockpile, it is less likely that the Biomedical Advanced Research and Development Authority (BARDA) would be willing to invest in a third vaccine based on an unproven platform.

Predicting Man-Made Pandemic Risks
Lynn Klotz, a member of the Scientists Working Group on Biological and Chemical Security at the Center for Arms Control and Non-Proliferation, has published a new analysis of the risks posed by research with lab-created avian-influenza viruses that have been modified to be transmissible in mammals through the air. According to Klotz, there are at least fourteen labs worldwide working on such viruses. Based on newly available data, Klotz calculates that over the course of five years, there is about a 16% probability of an accidental release into the community. Given the estimated 5% to 40% probability that such a virus could seed a pandemic, these calculations should be ringing alarm bells in the global health community.

Ebola Outbreak Updates 
International and DRC public health responders are cautiously optimistic as another week of low case numbers was reported. With three new cases, the total is up to 3,227, however there is increasing concern with those hot spots being in areas of limited security, there will be a resulting increase in transmission. Thankfully, the patient under investigation for Ebola in Sweden has been ruled out following negative lab findings, but there are lessons we can take away from this experience. “While this was a fortunate situation, it should be seen as a reminder to those of us in health care, especially infection prevention, to conduct an internal audit to see how well the training and process mapping has persevered since 2014. Despite the efforts that were put in place nationally, like the tiered health care approach to special pathogens, many in frontline facilities struggle to maintain readiness.” A new article on influencing factors in the development of state-level movement restrictions in response to Ebola during the 2014/2015 outbreak was just published – noting some important findings from interviews with 30 people who had knowledge of the state-level Ebola policy development. Representing 18 diverse jurisdictions, findings from these interviews yield critical components that we’ll need to consider in the future, like science and evidence versus public fears and that “According to interviewees, politics played a limited role in the formation of Ebola policies in most cases. The midterm elections, gubernatorial elections, and prospective 2016 presidential campaigns were mentioned as important influencers of monitoring and movement restriction policies in several states, but the policy development process largely reflected collegial relationships between elected officials and public health professionals.”

Mapping the Synthetic Biology Industry and Biosecurity Implications 
Sarah Carter and Diane DiEuliis recently wrote on this growing industry and biotech platform, noting that there are inherent risks for biosecurity as many of the practitioners come from a variety of backgrounds and may not realize the implications. In their analysis, they interviewed dozens of people in the industry and U.S. government. Ultimately, they focused on the areas for best practice, further discussion, and mapped the landscape of industrial tools and their capabilities.”We found that the landscape of the synthetic biology industry features an emerging and diverse set of horizontal tools being applied across many vertical sectors in a complex and interconnected ecosystem of companies. The availability of these tools and how the industry will develop into the future has significant implications for policymakers and others concerned about the potential for misuse and the vulnerabilities of these capabilities.”

Cutting Edge Chemical and Biological Defense Science: Topics at CBD S&T 2019
If you’re planning to attend this November event (or need a reason to), here are some hot topics that will be presented at the 2019 Chemical and Biological Defense Science & Technology Conference hosted by DTRA.

Involve An Infectious Disease Physician – Improve Patient Outcomes
Infection preventionist and GMU Biodefense alum Saskia Popescu discusses a new study that sheds light on just how much of a difference involving an infectious disease physician can make. “For hospitalized patients, the concern for infections related to invasive medical devices (central lines, Foley catheters, etc.) is very real. Bloodstream infections are a serious concern for patients and infection preventionists alike. Unfortunately, Candida fungal infections are all too common in the bloodstream. It is estimated that there are 25,000 bloodstream infections related to Candida annually in the United States and that roughly 40% of those patients ultimately die from the infection. For health care-associated infections, candidemia is the 4th most common. New research from the Washington University School of Medicine in St. Louis, published in The Lancet Infectious Diseases, actually found that when an infectious disease physician oversaw care of a patient with candidemia, the mortality rate declined by 20% .”

Building Biosafety Capacity in Our Nation’s Laboratories
An analysis by Chung, Bellis, Pullman, O’Connor, and Shultz in the latest issue of Health Security evaluated the biosafety practices of public health laboratories (PHLs) and clinical laboratories in the United States since the 2014 Ebola Virus Disease epidemic exposed several vulnerabilities. After the outbreak revealed gaps in biosafety practice, the Enhanced Laboratory Biosafety Capacity Project was born to support the enhancement of biosafety practices over a 3-year period. Over $24 million was provided by the CDC’s Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases to 63 health departments for the Project. The research team constructed nine performance indicators for public health and clinical laboratories to assess the efficacy of the Project’s primary objective to improve biosafety practices in the 63 awarded laboratories. The assessment concluded that although not all Project targets were reached, there were overall improvements in biosafety practices and heightened emphasis on the importance of biosafety. The article is available to read for free through October.

Stories You May Have Missed:

  • Europe Has Drop in Veterinary Antibiotic Sales – In a small win for combatting antibiotic resistance, “Data from the EMA’s latest European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) report show a 32.5% decline in sales of antibiotics for food-producing animals from 2011 through 2017, with sales of two antibiotic classes considered critical for human medicine—polymyxins and third- and fourth-generation cephalosporins—falling significantly.”

 

Pandora Report: 10.11.2019

 

GMU Biodefense Graduate Program Open House
Have you considered expanding your education and experiences through a graduate degree in biodefense? Learn more about our MS (online and in-person) and PhD programs in our upcoming Open Houses! The Master’s Open House will be held on Thursday, October 17th at 6:30pm at our Arlington campus, and the PhD Open House will be on Thursday, November 7th, at 7pm at the Fairfax campus. We invite you to learn more about our programs by attending an open house. You will have the opportunity to discuss our graduate programs with program directors, faculty, admissions staff, current students, and alumni. The current schedule is reflected below, but be sure to sign up for emails from the Schar School’s Graduate Admissions Office to be notified of future admissions events!

What Can We Glean from a Bean: Ricin’s Appeal to Domestic Terrorists
GMU biodefense doctoral student Stevie Kiesel breaks down the use of ricin and its application as an agent of domestic terror. “Just as policymakers have been slow to acknowledge and act upon the threat of domestic CBRN terrorism, timely extant research on the issue is scarce as well. In this article, I focus on ricin as an agent of domestic terror. As government agencies acknowledge the threat domestic terrorism poses, policymakers and law enforcement should take ricin seriously as a potential weapon. To understand the plausibility of ricin’s use as a weapon, I reviewed a number of journal articles, news articles, and court records from 1978 through 2019 and compiled data on 46 incidents of ricin acquisition and/or use. Of these 46 incidents, 19 could be credibly tied to terrorism, 19 were not related to terrorism, and 8 were unclear. The most common motivation after terrorism was murder (10 instances). Of the 19 terrorist incidents, 58% were committed by extreme right-wing terrorists, a term that here encompasses the following ideologies: neo-Nazi/neo-fascist, white nationalist/supremacist/separatist, religious nationalist, anti-abortion, anti-taxation, anti-government, and sovereign citizen.”

GMU One Health Day Panel Discussion                                          Save the date for this November 5th event sponsored by the GMU Next Gen Global Health Security Network and the GMU Biodefense Discussion Group. “One Health Day is November 3 – Connecting Human, Animal, and Environmental Health. One Health is the idea that the health of people is connected to the health of animals and our shared environment. Learn why One Health is important and how, by working together, we can achieve the best health for everyone. [CDC} Did you know that animals and humans often can be affected by many of the same diseases and environmental issues? Some diseases, called zoonotic diseases, can be spread between animals and people. More than half of all infections people can get can be spread by animals – a few examples include rabies, Salmonella, and West Nile virus.” On November 5th, you can listen to the panel from 5-7:10pm in Van Metre Hall at the GMU Arlington Campus. Panel members include Michael E. von Fricken,  PhD, MPH   GMU Global Health and Community Health Security, Dr Jason Hanson,   DVM, PhD, DACVPM,  Associate Editor at Program for Monitoring Emerging Diseases, Willy A. Valdivia-Granda, CEO, ORION INTEGRATED BIOSCIENCES, INC., and Dr Taylor Winkleman,  DVM, CEO, Winkleman Consulting, LLC. “This panel will discuss emerging ONE HEALTH approaches through the various lens of their real world experiences in the world of Global and Community Health, national security arenas, and the international biodefense security domain. Discussions and interactions with the audience will address insightful views of innovation and emerging technology developments for biodefense leveraging data mining, genomics of infectious diseases, implementation of algorithms for the development of medical countermeasures against known and unknown biothreats, one health biosurveillance challenges in detecting infectious diseases, and strategies for integrating the efforts of health security professionals and biotech experts working together to improve the health of people, animals — including pets, livestock, and wildlife —as well as the environment. Common types of professionals involved in One Health work include disease detectives, human healthcare providers, veterinarians, physicians, nurses, scientists, ecologists, as well as policy makers.”

Ebola Outbreak Updates
After two weeks of halted response efforts due to security concerns, things are resuming in the DRC. “The WHO said though the decline in cases is encouraging and gains have been made in the response, several challenges remain and that the current trends should be interpreted with caution.” On Wednesday, case counts reached 3,207 with 2,144 deaths and 441 suspected cases being investigated. There was concern over a Swedish patient admitted for Ebola testing, but results have come back negative.

Biosafety Levels in Laboratories – Whats the Difference?
We throw around the term “BSL-4” around a lot, but how well do you actually know the different biosafety levels? “The United States is home to several types of laboratories that conduct medical research on a variety of infectious biological agents to promote the development of new diagnostic tests, medical countermeasures, and treatments. To promote safe medical research practices in laboratories studying infectious agents, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health have established four BSLs. The levels consist of requirements that have identified as protective measures needed in the laboratory setting to ensure the proper management of infectious agents to avoid accidental exposure or release into the environment. The BSL designations, ranked from lowest to the highest level of containment, are BSL-1, BSL-2, BSL-3, and BSL-4. The BSL designations outline specific safety and facility requirements to achieve the appropriate biosafety and biocontainment. The BSL is assigned based on the type of infectious agent on which the research is being conducted. The CDC has designed an infographicto help visualize the differences between each level. Each level builds on the previous level, adding additional requirements.”

African Swine Fever: An Unexpected Threat to Global Supply of Heparin
In a conversation I never thought I’d have in healthcare…the outbreak of African swine fever (ASF) is hitting heparin supplies at a global level – what a prime example of One Health! “Since August 2018, China has culled more than one million pigs in efforts to contain the spread of ASF within the country. Widespread culling of pigs consequently affects the supply of raw materials needed to produce heparin, which is derived from mucosal tissues in pig intestines. Heparin is a critical anticoagulant drug used to treat and prevent the formation of blood clots in blood vessels in healthcare. As pig herds continue to become infected and culled, should the United States form contingency plans in the event of a heparin shortage?”

Getting Ahead of Candida auris 
“As IDWeek 2019 continued into the weekend, there was no shortage of information for those seeking to prevent and control infectious diseases. For many of us, the threat of antimicrobial resistance has been a major challenge and one for which guidance is desperately needed. Challenging organisms, like Candida auris, make infection prevention efforts in health care that much more difficult and patient care intrinsically more dangerous. In a presentation at the meeting, the presenting author and medical epidemiologist, Snigdha Vallabhaneni, represented the US Centers for Disease Control and Prevention (CDC), while co-authors included experts from health care and public health from California, Connecticut, and CDC.  Researchers emphasized that over 1600 patients have been identified in the United States to have C auris infections or colonization. Of those confirmed cases, risk factors were identified, which include high-acuity post-acute care admissions – like long-term acute care hospitalizations, colonization with carbapenemase-producing organisms (CPOs), or hospitalization abroad.”
 
2019 White House Summit on America’s Bioeconomy
“On October 7, 2019, The White House hosted the Summit on America’s Bioeconomy. The Summit marked the first gathering at The White House of our Nation’s foremost bioeconomy experts, Federal officials, and industry leaders to discuss U.S. bioeconomy leadership, challenges, and opportunities. The bioeconomy represents the infrastructure, innovation, products, technology, and data derived from biologically-related processes and science that drive economic growth, improve public health, agricultural, and security benefits. Bioeconomy outputs are incredibly diverse, and future applications limitless in terms of both application and value, including new ways to treat cancer; enable novel manufacturing methodologies for medicines, plastics, materials, and consumer products; create pest and disease resistant crops; and support DNA-based information systems that can store exponentially more data than ever before. Advances realized over the past two decades have resulted from the unique U.S. innovation ecosystem and the convergence between biology and other disciplines and sectors, such as nanotechnology and computer science. The U.S. bioeconomy – spanning health care, information systems, agriculture, manufacturing, national defense, and beyond – is growing rapidly with increasing impact on our Nation’s vitality and our citizens’ lives. Biotechnology represents 2% of the U.S. GDP, or $388 billion. To remain a world leader in the bioeconomy, the U.S. must foster an ecosystem that puts innovative research first in addition to promoting a strong infrastructure, workforce, and data access framework.”

Social Media and Vaccine Hesitancy                                                    As of this year, vaccine hesitancy is listed one of the WHO’s 10 big threats to global health. Vaccine hesitancy is the foot-dragging or refusal to vaccinate yourself or your children, when vaccines are available. Social media are platforms for the dissemination of both accurate and inaccurate information regarding vaccine safety and benefits. Unfortunately, vaccine content shared on social media is overwhelmingly anti-vaccine material and often lacking scientific or medical evidence. According to Ana Santos Rutschman at Saint Louis University, malicious bots are being used to more efficiently disseminate vaccine misinformation on these platforms. Fortunately, major platforms are instituting policies to curb the spread of vaccine misinformation and support the spread of accurate information from credible sources. Though misinformation remains abundant online, these new policies are promising steps toward eliminating erroneous data. Santos Rutschman “believe[s] social media can and should be redesigned to facilitate the promotion of accurate vaccine information.”

Stories You Might Have Missed:

  • UK Report Cites Lack of AMR Progress-“A paper issued yesterday by policy institute Chatham House concludes that not enough progress has been made on recommendations from a series of reports that alerted the world to the rising threat of antimicrobial resistance (AMR). The AMR Review, commissioned in 2014 by former UK Prime Minister David Cameron and chaired by British economist Lord Jim O’Neill, outlined the threat of AMR to global public health and highlighted the potential costs of inaction in eight separate reports issued over 2 years. Among the highlights from the first AMR Review paper were two startling figures—that drug-resistant infections could cause the deaths of 10 million people by 2050 and could cost the global economy up to $100 trillion if the problem was not addressed in the coming years.”