Pandora Report: 6.14.2019

It’s nearly July, have you signed up for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security, to get your early registration discount? Also – as you enjoy the summer weather, practice bat safety, as the CDC has warned that they post the biggest rabies threat in the United States.

How World War II Spurred Vaccine Innovation
Dr. Kendall Hoyt discusses the link between war and disease, and how WWII helped bring forth a renaissance of vaccine development. Did we mention she’ll be speaking at our summer workshop next month? “As the Second World War raged in Europe, the U.S. military recognized that infectious disease was as formidable an enemy as any other they would meet on the battlefield. So they forged a new partnership with industry and academia to develop vaccines for the troops. Vaccines were attractive to the military for the simple reason that they reduced the overall number of sick days for troops more effectively than most therapeutic measures. This partnership generated unprecedented levels of innovation that lasted long after the war was over. As industry and academia began to work with the government in new ways to develop vaccines, they discovered that many of the key barriers to progress were not scientific but organizational.”

Ebola Outbreak – Expanding into Uganda 
By June 12th, the Ugandan Ministry of Health had confirmed three cases of Ebola along the DRC border. In many ways, this was the scenario public health officials had been expecting and fearing. “For 10 months, Uganda has closely monitored its porous border with the DRC for crossover cases, yet, despite numerous alerts, no cases have been detected until now. ‘In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4,700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place,’ the WHO regional office for Africa said in a news release.” Given the growth of the outbreak and now cases in Uganda, many are wondering why the WHO has not declared this outbreak a PHEIC (public health emergency of international concern). This may change though, as the WHO Director-General Dr. Tedros has convened an Emergency Committee under the International Health Regulations for Friday (FYI, this is the third time the Emergency committee has met to discuss the outbreak and classification as a PHEIC). Concerns for the delay in declaring PHEIC have been present for months – “The legal criteria for a PHEIC have been met. The International Health Regulations (2005) (IHR) empower the WHO Director-General to declare a PHEIC. A PHEIC is an extraordinary event with public health risk to other countries that requires a coordinated international response. IHR criteria include public health impact, novelty and scale, and movement of persons. The WHO Director-General must also consider health risks, potential international spread, and EC guidance, among other factors.”

Fighting Global Pandemics By Starting One
In the latest video installment from the Bulletin of the Atomic Scientists’s Say What? series, the hot topic of gain-of-function research is being discussed. “Researchers say making new strains of the H5N1 flu virus in a secure lab can help them see what might happen naturally in the real world. Sounds logical, but many scientists oppose it because the facts show most biosafety labs aren’t really secure at all, and experts say the risks of a mutated virus escaping outweigh whatever public health benefit comes from creating them. But now the US government is funding these same labs again to artificially enhance potentially pandemic pathogens. In this installment of the Bulletin’s video series that provides a sharp view of fuzzy policy, Johns Hopkins University computational biologist Steven Salzberg explains why arguments by researchers in favor of risky viral research aren’t persuasive.”

Burden of Disease Exposures- Reasons to Invest in Hospital Response
GMU biodefense doctoral student and infection preventionist Saskia Popescu discusses the impact that communicable disease exposures have on hospitals. “The time spent responding to an exposure means less time for patient care and infection prevention, but can also result in health care workers having to stay home if they’re exposed and immuno-naïve. A new survey sought to understand the impact for infection preventionist and staff nurses when an exposure to a communicable disease occurs. Investigators wrote in the American Journal of Infection Control (AJIC) regarding this very issue and surveyed staff nurses in a New York hospital network and infection preventionists at the 2018 Association for Professionals in Infection Control and Epidemiology annual conference, as well as members of the Association for Professionals in Infection Control and Epidemiology chapters.  A total of 150 nurses and 228 infection preventionists responded with some insight into just how time-consuming these exposures are. Data regarding workload increase for each exposure was captured in 2 questions asking participants to rank the overall increase in daily workload for each of these exposures (0-3 scale, with 0 meaning not applicable and 3 meaning a dramatic increase in workload of more than 60 minutes), and to explain the 3 most time-consuming activities for outbreak and exposure activities. Infection preventionists reported the most time-consuming outbreaks/exposures resulted from mumps/measles, tuberculosis, gastrointestinal viruses, and multidrug-resistant organisms. For an exposure to Clostridioides difficile, lice or scabies, and influenza, there was a more than 60-minute workload increase for nurses.”

There’s Limited Time To Make America Safer From Epidemics
Dr. Tom Frieden and Margaret Hamburg shine a light on a harsh truth – we’re on tight window if we want to avoid a pandemic. “In one week, the World Bank will decide how to allocate more than $50 billion in development funding to lower income countries. The World Bank should dedicate some of its International Development Association (IDA) funds – say, 5 percent, or about $1 billion per year over three years – to help countries become better prepared for infectious disease outbreaks.” “Disease outbreaks can wipe out years of investments and severely damage development. Economic losses can dwarf the cost of response – the World Bank estimates that SARS cost the global economy $54 billion in little over half a year and that a severe flu pandemic could cost more than $3 trillion, nearly five percent of global GDP. Because of its global reach, the World Bank is in the best position to take the lead on this critical effort, but the United States delegation has one week to make sure it does so at its annual meeting on June 17. The total needed to close preparedness gaps is estimated at about $4.5 billion annually, less than $1 per person per year. An additional $1 billion infusion each year for the next three years will provide a tremendous jump start – and is a bargain the United States cannot afford to miss.”

Russian Biologist Plans for More CRISPR Babies
Just went you thought the CRISPR baby drama was over (or at least being managed)…. “A Russian scientist says he is planning to produce gene-edited babies, an act that would make him only the second person known to have done this. It would also fly in the face of the scientific consensus that such experiments should be banned until an international ethical framework has agreed on the circumstances and safety measures that would justify them. Molecular biologist Denis Rebrikov has told Nature he is considering implanting gene-edited embryos into women, possibly before the end of the year if he can get approval by then. Chinese scientist He Jiankui prompted an international outcry when he announced last Novemberthat he had made the world’s first gene-edited babies — twin girls. The experiment will target the same gene, called CCR5, that He did, but Rebrikov claims his technique will offer greater benefits, pose fewer risks and be more ethically justifiable and acceptable to the public. Rebrikov plans to disable the gene, which encodes a protein that allows HIV to enter cells, in embryos that will be implanted into HIV-positive mothers, reducing the risk of them passing on the virus to the baby in utero. By contrast, He modified the gene in embryos created from fathers with HIV, which many geneticists said provided little clinical benefit because the risk of a father passing on HIV to his children is minimal.”

Stories You May Have Missed:

  • Microbial House Designs– “There’s a little mischievousness about bringing all these things and making them visible,” said Mr. Pallrand’s wife, Rachel Mayeri, who based the tile designs on electron microscopy images. “These things we tend to think of as being kind of ugly and want to hide — mold spores and mildew growing in our bathtub, and bacterial colonies that are on all the surfaces of your house — they’re all noncharismatic animals, but they’re really crucial to our lives.”

 

Pandora Report: 6.6.2019

Happy Thursday! That’s right – you’re getting your weekly dose of biodefense news a tad early, but don’t worry, we’ll be back to our normal schedule next week! Have you registered for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security? From anthrax to Zika, we’ll be covering all the topics, debates, and threats related to health security.

GMU Welcomes New Faculty Member – Dr. Ashley Grant
We’re excited to announce that Dr. Ashley Grant, a lead biotechnologist at the MITRE Corporation, is joining the Biodefense Program as an Adjunct Professor to teach BIOD 620: Global Health Security Policy. Dr. Grant was previously the Senior Biological Scientist at the Government Accountability Office where she led government-wide technical performance audits focused on biosafety and biosecurity issues. Dr. Grant was an American Association for the Advancement of Science (AAAS) Science and Technology Fellow in the Chemical and Biological Defense Program Office in the Department of Defense and also worked at the National Academies of Science on the Committee on International Security and Arms Control. Her work focused on international security, nonproliferation, and medical countermeasures against chemical and biological threats. She completed the Field Epidemiology Course at the Naval Medical Research Center (NMRC) in Lima, Peru and was a Visiting Graduate Researcher at the Instituto Nacional de Enfermedades Virales Humanas J. Maitegui (INEVH) in Pergamino, Argentina. Dr. Grant received her PhD in experimental pathology and a MPH in epidemiology from the University of Texas Medical Branch at Galveston. Her graduate work focused on investigating pathogenesis and potential countermeasures for viral hemorrhagic fevers under biological safety level (BSL)-4 conditions. In addition, she received a MA in National Security Studies from the Naval War College and a BS in Chemistry and a BS in Business Economics and Management from the California Institute of Technology.

Congress Passes the Pandemic and All-Hazards Preparedness and Advancing Innovation Act
On Tuesday, June 4th, the House “passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. The bill reauthorizes existing statute governing public health efforts at the Department of Health and Human Services. Additions made by the bill – some of which were recommended by the Blue Ribbon Study Panel on Biodefense – address biodetection, hospital preparedness, medical countermeasures and response. Many of these programs will enable HHS to better defend the nation against biological threats. Both chambers of Congress have passed the bill, and it will now go to President Trump for signature. ‘Naturally occurring diseases and biological weapons continue to endanger our nation,’ said Governor Tom Ridge, Panel Co-Chair. ‘The Panel is pleased to see that Congress addressed 15 of our recommendations in this legislation, which will help the nation better prepare for, detect, respond to, and recover from large-scale biological events, bioterrorism or other biological events’.”

National Biodefense Science Board Public Meeting
“The June 10-11, 2019 meeting of the National Biodefense Science Board will focus on early results and progress reports from four new programs that were designed to strengthen disaster health preparedness, response and recovery: the Regional Disaster Health Response System; BARDA DRIVe; ASPR’s new Incident Management Team; One Health; and the National Biodefense Strategy. As part of the evolution of the National Disaster Medical System, NBSB will discuss disaster veterinary medicine and National Veterinary Response Teams. The board will also address issues facing the medical community, including disaster medicine training for community physicians and advance practice physicians and learn about ways to develop and operationalize core competencies for disaster medicine.”

 Exploring Lessons Learned from a Century of Outbreaks
Check out the latest from the proceedings of a 2019 NAS workshop on outbreak readiness. “In November 2018, an ad hoc planning committee at the National Academies of Sciences, Engineering, and Medicine planned two sister workshops held in Washington, DC, to examine the lessons from influenza pandemics and other major outbreaks, understand the extent to which the lessons have been learned, and discuss how they could be applied further to ensure that countries are sufficiently ready for future pandemics. This publication summarizes the presentations and discussions from both workshops.” Within this document, you can access sections on global preparedness progress for the next pandemic influenza, building local and national capacities for outbreak preparedness, pandemic vaccine considerations, etc. “The participants in this workshop examined the lessons from major outbreaks and explored the extent to which they have both been learned and applied in different settings. The workshop also focused on key gaps in pandemic preparedness and explored immediate and short-term actions that exhibited potential for the greatest impact on global health security by 2030. Workshop speakers and discussants contributed perspectives from government, academic, private, and nonprofit sectors. This workshop opened with a keynote address and a plenary presentation, followed by three sessions of presentations and discussions. Additionally, panelists, forum members, and attendees were given the opportunity to assemble into small groups and asked to consider potential priority actions and strategies for systematizing and integrating outbreak and pandemic preparedness so that it is a routine activity from the local to global levels.”

Inside Britain’s Top Secret Research Laboratory 
Have you ever wanted to tour Britain’s top secret laboratory? If Porton Down has been on your wish list, here’s your chance to get a virtual tour. “The BBC was given access inside Porton Down to see what the highly secretive facility was like and, for the first time ever, entered a cleansed version of a level four laboratory. This level is where the Defence Science and Technology Laboratory team analyse some of the world’s deadliest viruses – Ebola and Marburg.”

 DRC Ebola Outbreak Updates 
The outbreak has officially reached 2,000 cases and aid groups in “the region called for pushing the reset button on the response. In its daily update yesterday, the DRC said the outbreak passed the 2,000-case bar on Jun 2. Officials said that, although the landmark is concerning, the health ministry sees some positive signs, including a slight improvement in the security situation, though the situation remains volatile and unpredictable. The ministry added that most incidents related to community resistance have been resolved by community leaders, sensitizers, and psychosocial experts.” For many, the question is still – who is attacking Ebola responders and why? “The first is that local political figures are fomenting and even organizing the attacks as a way of undermining their rivals, presumably officials of the central government or local leaders aligned with them. Many analysts hold that it was actually the national government that set the stage for the use of the Ebola crisis as a political tool, and Gressly largely echoed that account. Last December, he noted, just days before presidential elections, national electoral officials announced that voting would be suspended in the two largest cities in the outbreak zone, Beni and Butembo.” “At least one type of attack appears very much linked: Many of the incidents seem to be outbursts by members of the community who have heard the rumors and believe them. An Ebola team will arrive in a neighborhood to bury a suspected Ebola patient or vaccinate their relatives, and people will throw rocks and chase the team out. Similarly, doctors and nurses at regular health facilities have been threatened by mobs, who are angry that the health workers refer Ebola patients to treatment centers. In one case, a nurse was killed. But there has also been an increase in seemingly well-coordinated assaults by well-armed assailants. More than half-a-dozen times, gunmen have shot up Ebola treatment centers and health facilities where Ebola teams are based, including on April 19, when a group of armed men burst into a hospital where an Ebola team was meeting and killed an epidemiologist with the World Health Organization.”

African Swine Fever and China’s Pork Industry
A highly virulent virus meets a $128 billion dollar industry and we’re not sure which will win. “The virus that causes the hemorrhagic disease is highly virulent and tenacious, and spreads in multiple ways. There’s no safe and effective vaccine to prevent infection, nor anything to treat it. The widespread presence in China means it’s now being amplified across a country with 440 million pigs—half the planet’s total—with vast trading networks, permeable land borders and farms with little or no ability to stop animal diseases.” Despite 50 years of efforts, there has been no vaccine for this devastating disease and “even if China is able to stop the virus transmitting from pig to pig, two other disease vectors may frustrate eradication efforts: wild boars and Ornithodoros ticks. These are the natural hosts of African swine fever virus and are widely distributed in China, though it’s not yet known what role they are playing in spreading the disease there. Zhejiang province, south of Shanghai, has about 150,000 wild boars.”

Stories You May Have Missed:

  • U.S. Measles Cases Top 1,000 – “Federal officials yesterday said US measles cases have reached 1,001, the first time since 1992 that cases have been in quadruple figures, while experts continued to urge vaccination and underscored the safety of the vaccine. Health and Human Services (HHS) Secretary Alex Azar said in an HHS news release, ‘We cannot say this enough: Vaccines are a safe and highly effective public health tool that can prevent this disease and end the current outbreak’.”
  • Nipah Virus in Indian Man – “The Indian government today confirmed that a 23-year-old man from Kerala has a Nipah virus infection, and another 86 case contacts are being monitored for the deadly disease, according to the Deccan Chronicle. Officials said the patient, a college student, is hospitalized and in stable condition. They also said two of the case contacts have fevers, and two nurses who took care of the 23-year-old were also experiencing fevers and sore throats.”
  • GM Fungus Kills 99% of Malaria Mosquitoes – “Trials, which took place in Burkina Faso, showed mosquito populations collapsed by 99% within 45 days. The researchers say their aim is not to make the insects extinct but to help stop the spread of malaria. The disease, which is spread when female mosquitoes drink blood, kills more than 400,000 people per year. Worldwide, there are about 219 million cases of malaria each year. Conducting the study, researchers at the University of Maryland in the US – and the IRSS research institute in Burkina Faso – first identified a fungus called Metarhizium pingshaense, which naturally infects the Anopheles mosquitoes that spread malaria. The next stage was to enhance the fungus. ‘They’re very malleable, you can genetically engineer them very easily,’ Prof Raymond St Leger, from the University of Maryland, told BBC News.”

 

Pandora Report: 5.31.2019

Happy Friday! Before we get started with the biodefense news of this week, you should know that the CDC has reported there have now been 971 cases of measles this year, “topping the 1994 modern-record level, and it warned that if a pair of large outbreaks in and around New York City continue over the summer and fall, the United States could lose its measles elimination status”.

 Extended Workshop Registration Discount 
We’re excited to announce that the early registration discount has been extended to July 1st, which means you have more time to register for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security. This is a great “three and a half-day workshop, non-credit summer workshop designed to introduce participants to the challenges facing the world at the intersection of national security, public health, and the life sciences. The workshop faculty are internationally recognized experts from the government, private sector, and academia who have been extensively involved with research and policy-making on public health, biodefense, and national security issues.” We hope to see you in July and if you’re a returning student, GMU alumni or current student/faculty, or large group, you’re eligible for an additional discount.

Possible European Origin of the Spanish Influenza
What happens when you get a military historian and a virologist together to discuss the 1918 pandemic? A fascinating insight into a possible European origin and all sorts of things we might not have considered. “When we reconsider the virology and history of the Spanish Influenza Pandemic, the science of 2018 provides us with tools which did not exist at the time. Two such tools come to mind. The first lies in the field of ‘gain of function’ experiments. A potential pandemic virus, such as influenza A (H5N1), can be deliberately mutated in the laboratory in order to change its virulence and spreadability. Key mutations can then be identified. A second tool lies in phylogenetics, combined with molecular clock analysis. It shows that the 1918 pandemic virus first emerged in the years 1915–1916. We have revisited the literature published in Europe and the United States, and the notes left by physicians who lived at the time. In this, we have followed the words of the late Alfred Crosby: who wrote that ‘contemporary documentary evidence from qualified physicians’ is the key to understanding where and how the first outbreaks occurred. In our view, the scientists working in Europe fulfill Crosby’s requirement for contemporary evidence of origin. Elsewhere, Crosby also suggested that ‘the physicians of 1918 were participants in the greatest failure of medical science in the twentieth century’. Ours is a different approach. We point to individual pathologists in the United States and in France, who strove to construct the first universal vaccines against influenza. Their efforts were not misdirected, because the ultimate cause of death in nearly all cases flowed from superinfections with respiratory bacteria.”

 Ebola Outbreak Updates and Why The Response Must Be Elevated
Good news – cases have been declining in the past few week…unfortunately the increasingly complex situation has made any progress difficult to measure. “Part of the decline reflects fewer cases in Katwa, which has been the main Ebola epicenter over the past several weeks. At the same time, smaller hot spots such as Mabalako, Kalunguta, and Mandima are experiencing rising cases. For example, the WHO notes that Mabalako has reported 23% of newly confirmed cases over the past 3 weeks. Aside from a drop in cases, the WHO said in its latest situation report that it sees other encouraging signs, including lower proportions of nosocomial (healthcare-related) infections and community deaths. Also, it said outbreak responders are reporting higher proportions of contacts registering when cases are detected. It said, however, that weekly fluctuations in the indicators that health officials track have been reported in the past, and it’s still not clear if the surveillance system has the ability to identify all new cases in areas with ongoing security problems. ‘Operations are still regularly hampered by security issues, and the risk of national and regional spread remains very high,” the WHO said’.” Many charities are now calling for the outbreak to be designated as a crisis and efforts to be enhanced. “Whitney Elmer, country director of DRC for Mercy Corps, said that declaring the equivalent of a level-three emergency would bring ‘manifold benefits’ by clarifying the roles of agencies, allowing greater access to resources and attracting greater global attention. ‘There has never been an epidemic of this complexity or size in the DRC,’ said Elmer, adding that the crisis requires a new structure in line with its scale. The global humanitarian coordination body, Inter-Agency Standing Committee, will consider the call when it meets on Wednesday. Among the factors to be considered are the scale and complexity of an epidemic, and the risk of a failure to respond effectively. A level-three emergency, now known as a system-wide scale up, does not indicate the severity of the crisis, but is activated where there is a mismatch between need and agencies’ ability to respond. On Tuesday, Mike Ryan, assistant director-general of the World Health Organization’s emergency preparedness and response programme, said progress had been made in fighting Ebola, including a drop in transmission of the disease in health facilities.”

Dangerous Levels of Antibiotics Found in World Rivers
“Concentrations of antibiotics found in some of the world’s rivers exceed ‘safe’ levels by up to 300 times, the first ever global study has discovered. Researchers looked for 14 commonly used antibiotics in rivers in 72 countries across six continents and found antibiotics at 65% of the sites monitored. Metronidazole, which is used to treat bacterial infections including skin and mouth infections, exceeded safe levels by the biggest margin, with concentrations at one site in Bangladesh 300 times greater than the ‘safe’ level.”

Stories You May Have Missed:

  • Fertility Clinics Asking for CRISPR Help – “The condemnation of the Chinese scientist who created the world’s first genome-edited babies last year was far from universal: A fertility clinic in Dubai emailed He Jiankui on December 5 — just a week after he announced the births — asking if he could teach its clinicians ‘CRISPR gene editing for Embryology Lab Application.’ Although the English is somewhat tortured, the meaning was clear, Dr. William Hurlbut of Stanford University, who has advised He on the bioethics of his work for several years, told STAT: The fertility center was interested in offering CRISPR embryo editing to its patients. Its opening line is, ‘Congratulations on your recent achievement of the first gene editing baby delivered by your application!’ Hurlbut planned to reveal the email at a panel of the World Science Festival in New York City on Tuesday evening, but shared it with STAT before the event. Hurlbut said He received ‘other inquiries’ making a similar request. When He asked Hurlbut for advice on how to respond, Hurlbut said, ‘I told him not to reply’.”
  • Experimental Ebola Cure Could Protect Against Nipah – “An experimental drug has protected monkeys against infection with Nipah virus, a lethal disease and emerging pandemic threat for which there is no approved vaccine or cure, scientists reported on Wednesday. The antiviral drug, remdesivir, is also being tested against the Ebola virus in the outbreak now underway in the Democratic Republic of Congo. The only current treatment for Nipah virus infection is a monoclonal antibody that is still experimental; it was tested during an outbreak in India last year.”

 

Pandora Report: 5.24.2019

Happy Friday fellow fans of biodefense! We hope you had a lovely week and are ready to get your dose of all things health security…starting with the role of investors in pushing restaurant chains to cut antibiotics in the meat supply.

 Summer Workshop – Get the Early Registration Discount!
Just a couple more weeks to get this early registration discount – are you registered? This 3.5 day workshop will be a great place to hear from experts in the biodefense field, but also network and learn about the current biological threats we face. “The spectrum of biological threats is diverse, including naturally occurring disease outbreaks such as SARS, Zika, and Ebola, lapses in biosafety, dual-use research of concern, and the threat of bioterrorism. A severe disease outbreak, whether natural or man-made, can affect not just public health, but also public safety and national security. Pandemics and bioterrorist attacks will confront government agencies and the private sector with the need to make high-impact decisions with limited information during a rapidly evolving situation. Further complicating this domain is the dual-use nature of biology: the knowledge, skills, and technology developed for legitimate scientific and commercial purposes can be misused by those with hostile intent. Research with dangerous pathogens and the development of advanced biotechnologies such as synthetic biology and genome editing poses a dilemma for policy-makers and researchers who seek to maximize the benefits of such research while minimizing the risks. Thus, public health, law enforcement and national security agencies, the pharmaceutical and biotech industries, and the academic life sciences community need to develop new types of expertise, adopt new types of risk assessment and risk management strategies, and learn to collaborate with each other.” Make sure to register before June 1st for your discount! You can also get an additional discount if you’re a returning participant, part of a large group, or GMU alum/current student or faculty.

 Portable Isolation Unit: Coast Guard-Developed System for Evacuating Infectious or Contaminated Patients 
GMU Biodefense alum Dr. Jen Osetek is giving us a special look into how the Coast Guard developed systems for safer transport of highly infectious patients. “The Ebola outbreak of 2014-2015 was notable for a number of important reasons: it was the largest outbreak in history, there were affected Americans (both overseas and domestically), and it was the catalyst for the development of new capabilities that could help transport infected or potentially infected people. One such capability is the Department of Defense’s Transportation Isolation System (TIS) that was featured in the March 15, 2019 issue of Global Biodefense. Another critical solution was the U.S. Coast Guard-developed Portable Isolation Unit (PIU), manufactured by ISOVAC Products and formerly known as the Operational Rescue Containment Apparatus (ORCA®). This was specifically designed to be used in situations involving a rotary-wing maritime evacuation and will allow infected (or potentially infected) patients to be transported without risk of contaminating the aircrew or aircraft.  Due to this mission, it was designed to be used with stokes litter and NATO litter, among others.  he PIU is an FDA-approved positive-pressure device that utilizes a powered air-purifying respirator to supply air to the patient while filtering the exhaust air through a CBRNE cartridge. As a positive pressure apparatus that can filter inlet and exhaust air the PIU can withstand the mechanical force or rotor wash at hover during the hoist phase or rotary wing casevac/medevac evolutions. This is an important aspect of the design that enables its safe use in a variety or challenging operations and environments. The unit is battery operated and capable of running continuously for 4 hours. The PIU is constructed from Gore’s ChemPak® membrane barrier that is utilized in other CBRNE individual protective items. A window is installed for patient visibility and is supported by two flexible rods to prevent contact with the patient’s head and face. Glove ports present on both sides of the PIU are manufactured with Gore’s UltraBarrier® material and allow for limited patient interaction with rescue personnel. As a single-use item, the PIU contains the infectious agent or hazardous chemical contaminant during transport, which after use, is decontaminated for final disposal.”

Blue Ribbon Study Panel – A Manhattan Project for Biodefense: Taking Biological Threats off the Table
The Blue Ribbon Study Panel on Biodefense is hosting this event on July 11th – “Eighty years ago, the United States began leading a research and development effort to produce the world’s first nuclear weapons. Military and federal agencies, academia, industry, government contractors, and predecessors of today’s national laboratories worked together – with a great deal of support from Manhattan, NY and other localities – to establish overwhelming military superiority for the Allies during World War II. Their efforts effectively ended the war. Today, the challenge is defense against the biological threat, for which we are at a decided disadvantage. No matter what the source – intentional, accidental, or natural – the Nation and the world are at catastrophic biological risk. We need to tale this threat off the table for good. Please join the Panel on July 11, 2019, when we hold a meeting to discuss a Manhattan Project for Biodefense – a national, public-private research and development undertaking to defend the Nation against biological threats. Representatives from the same sorts of organizations that contributed to the original Manhattan Project will gather to talk with the Panel about the biological threat, cutting edge biodefense research, needed resources, and business risk. We will also talk about universal flu vaccine as an example of public-private interagency activity.” Make sure to RSVP by July 3rd – the event is available in person and online.

Immune to Drugs: AMR Could Kill 10 Million Per Year and Building New Models to Support the Ailing Antibiotic Market 
Remember that time we kept having increasing antimicrobial resistance but not a lot of people were paying attention? Well, “the United Nations created the Interagency Coordinating Group on Antimicrobial Resistance, and published a report with international agencies and experts noting that without immediate global action, the crisis of drug resistance bacteria and viruses could lead to an economic catastrophe as bad as the 2008-2009 global financial crisis, and by 2030 could force as many as 24 million people into poverty. And it hits home more often than we know. In the U.S., antimicrobial resistance causes more than 2 million infections and 23,000 deaths per year – the equivalent of a Boeing 747 crashing each week.  Financially, it is projected that due to lost wages, hospital stays and premature death, the U.S. lost about $35 billion in 2008 to antibiotic-resistant infections, and this number continues to rise.” Guess what is the root cause of breeding resistance? Hospitals. “Just days ago Senator Chuck Schumer of New York called for the CDC to declare a state of emergency over a fast-spreading outbreak of Candida Auris, a drug-resistant fungus that has infected more than 600 New Yorkers in health centers. But in New York, the state is trying to fight back not with hospital changes or environmental changes, but with technology. ;Given the amount of money it takes to battle these superbugs, and that the states are paying for all the Medicare and Medicaid patients, it makes sense as a money-saving initiative for states to be investing in genomic DNA and informatics,’ says Evan Jones, CEO of OpGen, a genomics and informatics company working with the New York Department of Health.” In the face of the dying antibiotic market, BARDA director Rick Bright recently discussed new approaches to bring some life back into the R&D we desperately need. “Now is the time to build new business models and novel partnerships that foster a robust end-to-end enterprise, making critically needed antimicrobials available to patients. At BARDA, we recognize the complexity of this challenge and are optimistic about what can be achieved. In the near term, these new models must not rely on exits to large pharma, but will benefit from decreases in market fragmentation and leveraging economies of scale. The industry needs to move toward market strengthening by leveraging capital in new ways across a broad portfolio of products with a long-term view and realistic revenue projections. BARDA simply cannot continue to provide non-dilutive investment, only to have companies collapse and their newly minted antibiotics shelved or lost completely. We will focus on bold ideas and new partnerships, utilizing its unique authorities to stimulate innovation, streamline R&D and successfully commercialize critically needed antibiotics. Thereby, ensuring greater health security for our nation. In addition, the biotech and pharmaceutical industry must join in pursuing better, sustainable business models for antimicrobials.”

Biosecurity Workshop – Engaging Young Scientists from the Global South in Biosecurity Diplomacy
Young scientists from the Global South working on topics related to the Biological Weapons Convention are invited to participate in the workshop Engaging Young Scientists from the Global South in Biosecurity Diplomacy. “The workshop will be financed under the auspices of European Union Council Decision 2019/97/CFSP in support of the BWC, managed and implemented by UNODA. The workshop aims to bring together up to 20 young and talented scientists from the Global South working on topics related to the BWC. Participants will be selected on the basis of their professional backgrounds and accomplishments. Young female scientists from the Global South are particularly encouraged to apply. The workshop recognizes that scientific and technological innovation, and youth and women’s empowerment and inclusion in multilateral BWC discussions, are essential to the realization of a world free from biological weapons. The workshop will provide an informal and interactive space for young scientists from the Global South to share their knowledge, insights and concerns, and to provide their vision for the future of responsible bioscience in their own countries. It will also encourage the development of networks of young professionals and provide an opportunity for capacity development in biosafety and biosecurity.”

 Ebola Outbreak Updates and the Role of Nosocomial Transmission
The UN Health Chief recently warned of the very high risk that Ebola will spread – especially in the face of community mistrust for health workers and government officials. “Efforts to combat the epidemic have been hobbled by attacks on treatment centers and health workers; deep suspicion of the national government, which is managing the eradication efforts; and growing mistrust of the international medical experts who have struggled to steer patients into the treatment centers, according to interviews with dozens of family members, politicians, doctors and health workers in recent weeks. When a doctor was killed, and treatment centers attacked by gunmen or set on fire, front-line health workers suspended their work, giving the virus time to spread. Some medical and aid groups have decided to pull some of their personnel from the very areas where Ebola has hit hardest. So far nearly 1,150 people have died in the outbreak, according to the World Health Organization. But that is a significant undercount, aid groups said in interviews. Health workers have been turned away regularly from homes where someone has died, leaving them unable to test for Ebola.” Healthcare workers are increasingly on edge with the attacks and threats, as 19 more cases were reported on May 22nd.  GMU Biodefense doctoral student and infection preventionist Saskia Popescu also discusses the trend of healthcare worker cases in this outbreak. “During the 2013-2016 outbreak, health care workers in West Africa were 32 times more likely to be infected with Ebola. Earlier this week, a nurse was reported as the latest case in this trend, bringing the total of health care worker infections to 99. On Friday, the World Health Organization situation report noted that this number had increased to 101 and now accounted for 6% of the cases. Of these health care worker cases, there have been 34 deaths. The continued need for more health care workers, especially in the wake of frequent threats and violence, makes the possibility of nosocomial transmission that much more real. The enhanced personal protective equipment (PPE) alone is difficult for a novice and can be a considerable source of exposure. Bringing in local health care workers and staff is critical to maintaining local engagement and earning trust in this rapidly evolving environment, however, the tacit knowledge of caring for an Ebola patient is complicated on the best of days.”

ASPR FY2020 Budget-In-Brief 
Check out the latest on the Office of the Assistant Secretary for Preparedness and Response (ASPR) and its FY2020 budget. “ASPR is funded through appropriations to the Public Health and Social Services Emergency Fund. The Fiscal Year (FY) 2020 budget request is $2.6 billion, which is $26 million above the FY 2019 enacted budget. This funding level supports the launch of a new pediatric disaster care initiative to enhance care to infants and children during emergencies; coordination of the National Biodefense Strategy (NBS); support for emergency operations planning and response; and, advanced development of MCMs through procurement, storage, and deployment. These investments ensure that ASPR can fulfill its unique role in protecting Americans from the impact of natural disasters, terrorist threats, and emerging infectious diseases. The request provides: $1.6 billion for the Biomedical Advanced Research and Development Authority (BARDA), including $322 million for Advanced Research and Development (ARD); $180 million for Combating Antibiotic Resistant Bacteria (CARB); $735 million for Project BioShield (PBS); and, $256 million for pandemic influenza (PI). $620 million for the Strategic National Stockpile (SNS) to manage and deliver life-saving MCMs during a public health emergency. $258 million for the Hospital Preparedness Program (HPP) to support cooperative agreements and other programs and initiatives that improve surge capacity and enhance health care readiness. $106 million for Preparedness and Emergency Operations (PEO), the National Disaster Medical System (NDMS), and the Civilian Volunteer Medical Reserve Corps (MRC) to support federal staff and local volunteers in preparing for and responding to public health emergencies and disasters, including training, modernization of equipment, and creation of a pediatric disaster care pilot initiative. $51 million for ASPR’s policy, planning, acquisitions, grants, financial management, business operations, and executive leadership.”

 PHEMCE Multiyear Budget
Have you read the 2017-2021 fiscal budget for the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)? “For the five-year period Fiscal Years (FYs) 2017–2021, this report provides estimates for HHS total spending which would be $24.8 billion, a $4.4 billion, or 22 percent, increase compared with the projection for FYs 2016–2020, which was $20.4 billion. The five-year funding total aggregates MCM-related spending estimates for NIH, BARDA, SNS, and FDA includes estimates of these replenishment costs, would be incurred by the SNS beginning in FY 2020. This change accounts for approximately $900 million of the estimated total $4.4 billion increase described below. This report developed the spending estimates as follows. For FY 2017 and FY 2018 the enacted annual appropriation levels were used and for FY 2019 the President’s Budget was used. The out-year funding levels (FY 2020 and FY 2021) for NIH, BARDA, SNS, and FDA were developed without regard to the competing priorities considered in the budget development process and that must be considered as Congressional budget submissions are developed. These estimates are subject to change in the future.”

Managing an Exposure- Why the EMR is Lacking
Since measles is on the rise, the concern for exposure in an emergency department or healthcare setting is very real. Unfortunately, managing such an event can be problematic with existing electronic medical records systems. “One of the most problematic aspects of an exposure is determining who is involved—both patients and staff alike. If the source case was a patient, the staff involved in their care must be identified, and if the source case is a health care worker, then the exposure list is usually longer as it involves both the individual’s patients and colleagues. For a disease like measles, which is highly contagious and infectious, we must also account for any patients exposed in waiting areas and other public areas where the patient went without the proper isolation (this includes considering patients on the same air-handling unit) Since the incubation period is usually 10-12 days, this often leaves little time for response efforts. One of the tools we often use to identify those involved in an exposure (for both notification and even prophylaxis purposes) is the electronic medical record (EMR) system. The EMR allows us to rapidly pull a list of staff who were involved in the care of a patient (assuming the patient was the index case)…or at least it should. ”

Stories You May Have Missed:

  • CRISPR Used to Tackle Superbugs -“‘We are getting to the point where there are organisms that are resistant to every known antibiotic,’ says Michael Priebe, a doctor who heads the spinal cord injury service at the VA medical center. ‘My fear is that as we are in this arms race, there gets to the point where we are not able to keep up with the enemy — the resistant bacteria. The superbugs take over, and we have nothing to defend against it,’ Priebe says. So Priebe enlisted Evans to help develop a different way to fight superbugs. It’s a new kind of antibiotic made out of viruses that have been genetically modified using the gene-editing tool CRISPR. ‘What CRISPR is able to do is something that we’ve not been able to do before. And that is, very selectively modify genes in the viruses to target the bacteria,’ Priebe says.”
  • Alleged Use of CW By the Assad Regime in Northwestern Syria – “The United States continues to closely watch the military operations by the Assad regime in northwest Syria, including indications of any new use of chemical weapons by the regime. Unfortunately, we continue to see signs that the Assad regime may be renewing its use of chemical weapons, including an alleged chlorine attack in northwest Syria on the morning of May 19, 2019. We are still gathering information on this incident, but we repeat our warning that if the Assad regime uses chemical weapons, the United States and our allies will respond quickly and appropriately. The May 19 alleged attack in northwest Syria is part of a violent campaign by the Assad regime that violates a ceasefire that has protected several million civilians in the greater Idlib area. This renewed Syrian regime offensive has targeted the communities of that area, which include a large number of Syrians who were already displaced from violence in others parts of Syria, and has destroyed known health facilities, schools, residences, and internally displaced person camps. The regime’s attacks against the communities of northwest Syria must end.”

Pandora Report: 5.17.2019

GMU Biodefense Spring Graduates 
It’s that time of year and we’re so excited to celebrate the graduation of several  students from the Schar Biodefense graduate program. Congrats to Carlos Alvarado, Nicolas Bertini, Anna Cannone, Anthony Falzarano, Kelsey Gloss, Megan Hudson, Kate Kerr, Mimish Kothari, Christopher Lien, Jessica Lovett, Janet Marroquin-Pineda, Annette Prieto, Jessica Smrekar, and Stephen Taylor, for their hard work in earning a MS in biodefense! (Hint – check out those white NextGen Health Security sashes). We can’t wait to see what amazing things you’ll accomplish and the impact you’ll have in the world of biodefense.

Biodefense Graduate Student Awards
We’d also like to show off two new graduates who were just awarded for their dedication to the field of biodefense during their studies and as role models for others within the program. Jennifer Osetek was awarded the Outstanding Doctoral Student in Biodefense award and Stephen Taylor was the recipient of the Outstanding Biodefense Student Award. “Stephen’s passion for biodefense and global health security was shaped by his experience as a Peace Corps volunteer in Mozambique. He not only observed first-hand the impact of infectious diseases on the local community, he even suffered a bout of malaria himself. Thankfully he made a full recovery and went on to enroll in our program.” Jen’s dissertation, “The Last Mile: Removing Non-Medical Obstacles in the Pursuit of Global Health Security asks the question, “Does the current approach to public health response planning and execution adequately incorporate all known obstacles to delivery of care and resources?” Drawing on evidence from multiple disease outbreaks over the last thirty years, her answer is an emphatic no. To fill this important void in the literature on global health security, Jen introduced the concept of non-medical obstacles, which are material and intangible factors that slow or prevent the timely delivery of available critical healthcare resources to populations in need during a public health emergency. ”

Outbreak Updates – Ebola in the DRC  and Measles in the U.S.
The onslaught of Ebola cases hasn’t let up in the DRC as 15 more cases were reported this week and the incidents of vandal and violence have continued. The outbreak is now at 1,720 cases, with 1,136 deaths. The attacks have been increasingly making response efforts strained and pose a challenge for maintaining community trust. “’Identifying specific groups responsible for specific attacks is difficult. Many of these groups resist control by the central government and they see this public health response as a threat posed by the government,’ explained Gregory D. Koblentz, Director of the Biodefense Graduate Program at George Mason University.’  Others have a more general suspicion of outsiders. Finally, health centers and health care workers may be caught in the cross-fire of competition between different groups. The conflict between so many armed groups is a toxic stew that makes public health campaigns exceedingly difficult.” South Korea is stepping in to assist by providing “$500,000 in cash assistance will help fund the response plan developed by the DRC’s health ministry along with 15 international organizations, including the World Health Organization (WHO). It added that with DRC’s outbreak pushing into its 10th month, the international community’s engagement and support is all the more needed. The donation isn’t South Korea’s first for Ebola. In 2014 the country sent a disaster relief team to help with West Africa’s Ebola outbreak and in 2018 it provided $1.5 million to the WHO’s emergency fund to help address Ebola in the DRC.” For the United States, measles is still on the rise as the case counts have passed 800. “The new cases boost the current US total to 839 from 23 states, with many of the cases linked to 10 outbreaks in seven different states: New York, Michigan, New Jersey, California, Georgia, Maryland, and Pennsylvania. The modern record of 963 cases occurred in 1994, the year the federally funded Vaccines for Children program began, an event that stabilized the number people vaccinated against the disease and set the stage for measles elimination in 2000. Added to the outbreak list this week is Maryland. The Maryland Department of Health (MDH) said five cases have been confirmed this year as of May 9. It said cases have been localized to a small geographic area involving three zip codes. Two are centered in Baltimore and one is in Pikesville, a suburb just northwest of the city Of the 75 new cases, more than half appear to be linked to large outbreaks in New York City and New York’s Rockland County, both centered in Orthodox Jewish communities.”

U.S. Government Global Health Security Strategy
The White House recently released their strategy for combating global health security threats. The approach includes three goals – strengthening partner country global health security capacities, increasing national support for global health security, and a homeland prepared for and resilient against global health security threats. “Promoting global health security to detect and mitigate outbreaks early remains a core tenet of our National Security Strategy. United States Government investments in global health security can help prevent the spread of human and animal infectious diseases and protect populations at home and abroad, including those serving in our Armed Forces. Furthermore, investments that focus on prevention and preparedness are far more cost-effective than responding to infectious disease epidemics. To maximize global health security and preparedness for infectious disease threats, all countries must address global health security challenges.” The strategy also addresses the technical and geographic priorities for the CDC and USAID including the monitoring, evaluation, sustainability, and transition to country ownership. You can also read about the US government’s health security activities.

Summer Workshop – Are you Registered?
If you’re looking to strengthen the preparedness within your workplace or simply hoping to understand the complex biological threats that stress global health security, check out our workshop this July. “Threats to global health security continue to evolve due to the changing nature of conflict, advances in science and technology, globalization, and the growing threat posed by emerging infectious diseases and pandemics. Pandemics, Bioterrorism and Global Health Security: From Anthrax to Zika is a three and a half-day workshop, non-credit summer workshop designed to introduce participants to the challenges facing the world at the intersection of national security, public health, and the life sciences. The workshop faculty are internationally recognized experts from the government, private sector, and academia who have been extensively involved with research and policy-making on public health, biodefense, and national security issues.” Signing up before June 1st will get the early registration discount and large groups/returning attendees/GMU faculty or students are also eligible for an additional discount.

Senate HELP Committee Leaders Applaud Passage of Legislation to Combat Bioterrorism and Pandemics
The senate has passed the Pandemics and All-Hazards Preparedness and Advancing Innovation Act. The act “supports and strengthens America’s ability to prepare for and respond to the full range of public health threats we face, both naturally occurring or as a result of a deliberate attack on our country. ‘When it comes to combatting pandemics or biological attacks, being prepared is everything,’ said Senator Burr. ‘Today, our nation has an incredible response framework that brings the private and public sectors together to address a range of public health threats, both natural and man-made. As these threats grow increasingly complex, however, it is critical that our capability to respond keeps pace. I am pleased my Senate colleagues joined me in supporting this legislation that ensures America’s biodefenses are ready for the public health challenges of the 21st century’.”

 Germ Warfare and Why Max Brooks is Worried
The author of World War Z is worried about bioterrorism, and here’s why… “The first is that my paranoid notions of corpse diggers and lab smugglers are pathetically outdated compared with what’s coming at us now. The age of the homegrown bioterrorist is right around the corner, a time where anyone with a little cash and access to the internet will be able to cook up designer plagues. Lab equipment that used to cost millions of dollars can now be purchased on the cheap from eBay. Knowledge that used to require a Ph.D. and top-security clearance is available on the dark web or, in many cases, in open-source publications for the whole world to view. Even worse, breakthroughs in genetic manipulation will allow tomorrow’s lone wolf to harvest a seemingly harmless bug anywhere in nature and tweak it just enough to wipe us out. If that first fact wasn’t bad enough, the second is even worse. We, the public, you and I, are the ones letting it happen. Because we’ve conquered so many diseases, and therefore don’t have to worry about the specters that killed and crippled our grandparents, we’re starting to question the science that saved us. Thanks to the anti-vaxxer movement, I’m writing this piece from a city (Los Angeles) that in late April quarantined hundreds of people exposed to a disease that was officially eliminated in the United States. And that’s just measles. Just wait till polio makes a comeback! And what if that polio, or an entirely new disease, doesn’t come from nature? In February, a Coast Guard lieutenant named Christopher Paul Hasson was arrested with a cache of firearms and ammo. In an email, he had allegedly sought to ‘acquire the needed/ Spanish flu, botulism, anthrax.’ Pulling that off right now might have been difficult, to say the least. But if he had, in an age of anti-vaxxers and alternative facts, he might have killed more people than all our past enemies put together.”

Soviet Efforts to Eliminate Plague
Tying into our discussions last week on the Soviet Union’s efforts to eliminate plague,  more attention has been placed on the significant work they employed towards this monumental goal. While some progress was made, there was a divergence between the promotion of success and what scientists were actually able to achieve. In fact, Soviet scientists stated in the 1960s that there hadn’t been a human case of plague since 1928. “Local authorities would say, ‘It’s eradicated’ or ‘We don’t have an outbreak.’ Because they ignored the outbreak, it would spread to other republics of the Soviet Union,” says Sonia Ben Ouagrham-Gormley, a biodefense researcher now at George Mason University who also coauthored the CNS reports on the Soviet anti-plague system. When the plague broke out on the border of Kazakhstan and Uzbekistan, for example, Kazakh scientists would try to contact their colleagues across the border, who were kept from telling the truth. But, says Ben Ouagrham-Gormley, “if they were told the colleague was on vacation, most of the time that meant he was out in the field responding to the outbreak.” Sadly, the shear size of the country proved challenging to truly complete the task and “Beginning in the 1960s, as reality intruded, the Soviet anti-plague system shifted from total eradication to control. The scientists knew that plague outbreaks among humans tended to follow rodent outbreaks in any local area. So they would conduct plague surveillance by systematically testing animals.”

New Maps Reveal First Global Estimate of Anthrax Risk
Check out this new resource for understanding the risks of anthrax at a global level. “Newly published maps reveal, for the first time, where anthrax poses global risks to people, livestock and wildlife. Popularly viewed as a frightening airborne agent of bioterrorism, the bacteria that causes anthrax infections naturally occurs in the soil on every continent and some islands. The maps, published today in Nature Microbiology, are the result of 15 years of data collection covering 70 countries compiled by Emerging Pathogens Institute associate research professor Jason Blackburn and his colleagues. Until now, the geographic distribution of anthrax has not been mapped globally. ‘Our main purpose was to describe where anthrax occurs, or is likely to occur, across the globe, and to illustrate sub-national areas where surveillance is necessary,’ Blackburn says. ‘Anthrax is a disease that affects both animals and humans, and it is most commonly associated with rural and agricultural communities which contend with it nearly worldwide. Our maps will help countries and health authorities focus on specific anthrax-prone areas to target control and surveillance’.”

Is Antibiotic Development Now the Road Less Traveled?
“Although attention has been focused on the use of genetically modified bacteriophages to fight a highly resistant infection in a young girl, the antibiotic pipeline is not just drying up…but dying. This isn’t news though; in fact, we’ve known about it for a while. It’s been decades since a novel antibiotic hit the market and, as antimicrobial resistance surges, the treatment options are becoming increasingly scarce.  Recent attention has been focused on the bankruptcy of the biotech company Achaogen. It’s likely you haven’t even heard of them, let alone know that they filed for bankruptcy a few weeks ago. The reason this bankruptcy is worrisome is that Achaogen’s antibiotic, plazomicin, was actually approved by the US Food and Drug Administration in June 2018 and, despite its efficacy against multidrug-resistant Enterobacteriaceae, it failed to keep the company afloat. The cost-prohibitive nature of antimicrobial research and development is all but ensuring that the pipeline for development is drying up. Not only does the Achaogen bankruptcy highlight the costly nature of antimicrobial development, but it’s even more worrisome that a company that was solely focused on such efforts couldn’t stay in business even with the financial push and support from the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X).”

Stories You May Have Missed:

  • Creating Bacteria With a Synthetic Genome – “Scientists have created a living organism whose DNA is entirely human-made — perhaps a new form of life, experts said, and a milestone in the field of synthetic biology. Researchers at the University of Cambridge on Wednesday reported that they had rewritten the DNA of the bacteria Escherichia coli, fashioning a synthetic genome four times larger and far more complex than any previously created. The bacteria are alive, though unusually shaped and reproducing slowly. But their cells operate according to a new set of biological rules, producing familiar proteins with a reconstructed genetic code.”
  • Army Planning to Begin User Acceptance Testing of Malaria Drug Tafenoquine – “The U.S. Army Medical Research Acquisition Activity (USAMRAA) located at FT. Detrick, MD, has issued a solicitation outlining plans to conduct User Acceptance Testing for the malaria prophylactic drug (Tafenoquine) brand name Arakoda. The announcement (W81XWH-19-R-0052) supports sourcing of one commercial lot of ~120,000 tablets (7,500 packages) of Tafenoquine brand name Arakoda immediately, with options to procure up to 3 orders of 3,750 packages each.”

 

 

 

 

 

GMU Biodefense Graduate Student Awards – 2019

We’re so proud to announce two recipients of awards within the biodefense program this year. Below, you can read more about Stephen Taylor (recipient of the Outstanding Biodefense Student Award) and Jennifer Osetek (recipient of the Outstanding Doctoral Student in Biodefense award).

This year’s outstanding biodefense student aware goes to Stephen Taylor – Stephen’s passion for biodefense and global health security was shaped by his experience as a Peace Corps volunteer in Mozambique. He not only observed first-hand the impact of infectious diseases on the local community, he even suffered a bout of malaria himself. Thankfully he made a full recovery and went on to enroll in our program. Stephen has been an outstanding student both inside and outside the classroom. He achieved an impressive 3.97 GPA while working full time for the animal parasitic diseases laboratory at the USDA. Outside the classroom, Stephen took advantage of opportunities offered by the Schar School to pursue his passion for global health security. He was a regular contribute to the Biodefense program’s blog and weekly newsletter, The Pandora Report, where he wrote about range of health security issues. In 2017, he was selected to be a Mason Global Health Security Student Ambassador, to attend the 4th Global Health Security Agenda Ministerial Summit in Kampala, Uganda, which was attended by heads of state and senior health officials from 50 countries. Following the conference, Stephen led an effort to establish a chapter of the Next Generation Global Health Security Network at Mason, to engage more students and young professionals in this important field. Stephen’s commitment to global health security and his leadership abilities make him well-deserving of this award.

This year’s outstanding doctoral student in biodefense goes to Jennifer Osetek – Jen’s dissertation, The Last Mile: Removing Non-Medical Obstacles in the Pursuit of Global Health Security asks the question, “Does the current approach to public health response planning and execution adequately incorporate all known obstacles to delivery of care and resources?” Drawing on evidence from multiple disease outbreaks over the last thirty years, her answer is an emphatic no. To fill this important void in the literature on global health security, Jen introduced the concept of non-medical obstacles, which are material and intangible factors that slow or prevent the timely delivery of available critical healthcare resources to populations in need during a public health emergency. She then applied this framework to the eradication of smallpox in West Africa and India, and modern Ebola outbreaks in Africa, in order to derive valuable lessons for how to reduce the impact of these non-medical obstacles on current outbreak responses. For her persistence in completing the last mile of her dissertation, and providing a new conceptual approach to strengthening global health security, the faculty recognize her achievement.

Pandora Report: 5.10.2019

Welcome to your weekly source for all things biodefense- Have you registered for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security? The early registration discount has been extended to June 1st, so make sure you reserve your spot! The theme of this week’s biodefense news follows one of the most ancient diseases – plague.

Living with Plague- Lessons from the Soviet Union’s Antiplague System
Plague is one of those zoonotic diseases that has done some damage over the millennia and the Soviet Union is one that has worked to eradicate the disease. “During the 20th century, one of the most extensive plague-eradication efforts in recorded history was undertaken to enable large-scale changes in land use in the former Soviet Union (including vast areas of central Asia). Despite expending tremendous resources in its attempt to eradicate plague, the Soviet antiplague response gradually abandoned the goal of eradication in favor of plague control linked with developing basic knowledge of plague ecology. Drawing from this experience, we combine new gray-literature sources, historical and recent research, and fieldwork to outline best practices for the control of spillover from zoonoses while minimally disrupting wildlife ecosystems, and we briefly compare the Soviet case with that of endemic plague in the western United States.” The authors note that “living with emergent and reemergent zoonotic diseases—switching to control—opens wider possibilities for interrupting spillover while preserving natural ecosystems, encouraging adaptation to local conditions, and using technological tools judiciously and in a cost-effective way.” Looking for more information on the anti-plague system of the Soviet Union? Check out GMU biodefense professor and antiplague system guru Sonia Benouagrham-Gormley.

Schar School Security Studies Program Ranked No. 2 in Nation
What can we say, the Schar School is the place to be for security studies like biodefense! “The Schar School of Policy and Government’s “security studies” program is ranked No. 2 in the country according to the March 12, 2019 survey in U.S. News and World Report. While the ranking is for ‘security studies’ programs, that term encompasses three of the Schar School’s strengths:”

“We continue to do what we do well, which is deliver a classroom experience grounded in both theory and practice in the field,” Schar School dean Mark J. Rozell said. “Our program is made up of full-time faculty who are both scholars and practitioners. Students see that investment by the school in their success.”

Review of Books on the Anti-Vaccination Movement
Trying to make sense of the anti-vaccine movement? Check out this review on three books that address vaccines, the anxieties that follow them, and distrust in the whole process. These reviews provide detailed insight into the books and what they mean in the context of the challenges surrounding the anti-vaccination movement. “Several recent books by doctors, scientists, and journalists have delved further into the history and science of vaccines and immunity, and the anxieties that accompany them. In Calling the Shots: Why Parents Reject Vaccines, Jennifer Reich, a sociologist who has also written about child protective services, brings meticulousness and sensitivity to this emotional issue. One parent tells Reich that she lies about having vaccinated her children to avoid disapproval from pro-vaccine neighbors: ‘I think it’s to the point where we need to keep quiet about our health choices if we are not within a like-minded community’.”

Biocrimes and Misdemeanors – This Week in Virology Podcast
Check out the latest podcast from ASM on biocrimes with guest Dr. Jens Kuhn (who just so happens to be a lecturer at our summer workshop!). “Jens Kuhn returns to TWiV to explain Select Agents, Priority Pathogens, Australia List Pathogens, Risk Group Agents, biosafety, biosecurity, and biosurety.”

First Utilization of Genetically Modified Bacteriophage Used to Treat Resistant Infection
In a pretty astounding first, a British teenager has recovered from a considerable drug-resistant infection following treatment with a genetically modified virus. Patients with cystic fibrosis, like the young British girl, frequently battle resistant infections that often lead to death. Following a severe post-lung transplant infection, doctors tried a new treatment involving engineered bacteriophages to treat her drug-resistant Mycobacterium abscessus. “Spencer and her colleagues contacted Graham Hatfull, a professor of biological sciences at the University of Pittsburgh who specializes in phage research. Hatfull searched a collection of 15,000 phages he has assembled with his students. He identified one that appeared to be good at killing the bacterium, Mycobacterium abscessus, which was causing the girl’s infection. (As it turns out, the phage he identified, known as ‘Muddy,’ was discovered in a rotting eggplant.) Hatfull’s team also identified two other phages that could be useful, which they then genetically modified in a way they hoped would boost their ability to zero in on and kill the bacterium attacking the teen. ‘Using genetic approaches with genome engineering, we were able to assemble this collection of three phages that we could then combine in a cocktail to use for treatment. They not only infect, but kill efficiently,’ Hatfull says.”

Urgent Steps Are Needed Against Ebola
Things are only getting worse in the DRC as cases have surged past 1,500 and 100 new cases were reported in 5 days. While this isn’t the first time the DRC has faced Ebola, this is one that is proving a formidable force against international efforts. Dr. Tom Inglesby and Dr. Jennifer Nuzzo discuss the urgent actions needed to help prevent this outbreak from spreading out of control. “First, countries and international donors must provide the finances the DRC, WHO, and their partners need to contain this outbreak. WHO depends on countries and donors to respond to emergencies. On April 30, WHO Director Tedros Ghebreyesus said in a statement that ‘WHO and its partners cannot tackle these challenges without the international community stepping in to fill the sizeable funding gap.’ In the same statement, the WHO said that only half of the currently requested funds have been received, ‘which could lead to WHO and partners rolling back some activities precisely when they are most needed’.” Expansion of the vaccine supply is also critical, they note, as well as a large-scale vaccination campaign. “Second, new security strategies are needed to allow public health workers to contain the virus. Violence in the region is a central reason the epidemic continues to worsen despite broad containment efforts. The DRC and the UN peacekeeping force, known as MONUSCO, have not been able to control the violence enough to allow public health response activities to proceed without interruptions. Failing to develop a security strategy risks the possibility that Ebola could spread to neighboring countries, a situation that would greatly exacerbate Ebola’s human and economic costs and further erode security in the region.” The WHO has just released their plans to adapt a specific Ebola vaccine strategy to the DRC to account for insecurity and community feedback – you can read the release here.

GMU Biodefense Student Awarded ASIS National Capital Chapter Security Education Foundation Scholarship
Congrats to GMU Biodefense MS student Jessica Smrekar for securing the prestigious scholarship! Jessica notes that “This scholarship is awarded to those with academic excellence within the field of security. My work in biosecurity, both in academic and career, represents an underserved area of security that the Chapter recognizes as a vital part of the field. I will be graduating in May 2019 with my Master’s in Biodefense from George Mason University and I have used my academic opportunities to begin a career in biosecurity. Through my work, I have had the pleasure of working an internship within the Department of Health and Human Services Office of the Assistant Secretary of Preparedness and Response. My position was in the Office of Strategy, Policy, Planning and Requirements working on biosecurity policy development and implementation of National Biodefense Strategy goals. During the ceremony, I was delighted to hear that this was the first time the Chapter broke the rules and awarded not one, but two George Mason students with a scholarship. The President stated the board was extremely impressed with our submissions and academic work and it was a quick decision to make this novel decision. Impressed enough that after the ceremony, I was offered the chance to educate other chapter members on biosecurity and conduct a presentation of biosecurity at a future Chapter meeting. I am honored to say I will be presenting an introduction of biosecurity to the National Chapter of ASIS this coming fall and look forward to continue working within this organization.”

Stopping the Gaps in Epidemic Preparedness
“A more productive, integrated approach to research would encompass disciplines such as context-specific social science, clinical and data sciences, and genomics and involve pursuit of innovative study designs and improved regulatory pathways. If trials of diagnostics, drugs, and vaccines became routine parts of responses to epidemics, with open multiyear and multicountry protocols prepared in advance, we could prevent potential lifesaving tools from being left to gather dust on shelves. Effective prevention and response require strong public health systems that provide equitable, universal access to high-quality health care. Effective health care cannot be available if health care workers are not protected. In every outbreak, health care workers have died. Here, infection control and vaccines can make all the difference, allowing people to be treated without putting caregivers, nurses, doctors, and support staff at unacceptable risk.”

The Case of the Raw Marmot and Plague
A couple in Mongolia recently died of bubonic plague following consumption of a raw marmot in the pursuit of health benefits. “The ethnic Kazakh couple died in Bayan-Ulgii, Mongolia’s westernmost province bordering Russia and China. It is not clear what treatment they received, if any. The incident prompted local panic. The government ordered a quarantine for six days for the region, preventing scores of tourists from leaving the area. At least one aircraft was examined by health officials in contamination suits. After no new cases appeared by Monday, the quarantine was lifted.”

 8 Zoonotic Diseases Of Most Concern in the U.S. 
Speaking of zoonotic diseases… the CDC just released information on the eight zoonotic diseases shared between animals and people of most concern int he U.S. “‘Every year, tens of thousands of Americans get sick from diseases spread between animals and people. CDC’s One Health Office is collaborating with DOI, USDA, and other partners across the government to bring together disease detectives, laboratorians, physicians, and veterinarians to prevent those illnesses and protect the health of people, animals, and our environment,’ said Casey Barton Behravesh, M.S., D.V.M., Dr.P.H., director, One Health Office, CDC.” These diseases include zoonotic influenza, salmonellosis, West Nile virus, plague, emerging coronaviruses, rabies, brucellosis, and Lyme disease.

Stories You May Have Missed:

  • UV Light Disinfection: A New Infection Prevention Tool – “In the battle against health care-associated infections and emerging infections, hospitals and infection prevention programs are constantly looking for new ways to prevent the transmission of organisms. From alcohol-based hand sanitizers to the advent of electronic surveillance systems, technology has helped infection preventionists (IPs) compete with increasing biotechnology in medicine. One of these new technologies tackles a particularly hard area for infection control—the environment. Cleaning and disinfecting these environments, especially patient rooms, is an imperfect process prone to human error. Although we seek to do our best, the rapid pace of health care and patient care means turning over a room after discharge is often a matter of life and death. Unfortunately, along with the fast pace often comes mistakes and, ultimately, it’s exceedingly hard to clean and disinfect every possible item and surface within a patient’s room. A new technology, though, is harnessing UV light to clean those hard-to-reach areas and even ceilings.”
  • Support the JASON Science-Advisory Group“For nearly 60 years, the scientists on the panel — the Jasons — have provided the US government with unvarnished, independent advice on matters ranging from classified military developments and nuclear weapons to artificial intelligence and global warming. Its members are a roll call of elite and illustrious scientists. The Pentagon said its decision was economic: it was cancelling all but one study, on electronic warfare, and it made no financial sense to renew the full contract. This decision would have effectively ended the group’s work — but then, on 25 April, it received a last-minute reprieve. The National Nuclear Security Administration (NNSA) — a branch of the energy department that maintains the country’s nuclear-weapons arsenal — offered new funding for the Jasons. This summer, the group will now be able to hammer out around a dozen studies for federal agencies, including the NNSA. But the new contract runs only until 31 January 2020; previous DOD contracts lasted for five years.”

 

Pandora Report: 5.3.2019

Happy Friday and welcome to May! To start the month off right, here’s the download of the Max Brooks graphic novel, Germ Warfare: A Very Graphic History. 

Summer Workshop – Discount Extended!
We’re excited to announce that the early registration discount for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security has been extended to June 1st. In this 3.5 day workshop, you’ll hear from experts in the field on virology, public health response, biosecurity, vaccine development, synthetic biology, and so much more. Make sure to register prior to June 1st for an early discount and if you’re registering as a returning student, GMU alum/student/faculty, or part of a large group, you’re eligible for an additional discount. Join us in July for this exciting biodefense event!

U.N. Issues Warning on Growing Antimicrobial Resistance
In a new report from the United Nations, the threat of antimicrobial resistance is front and center. Citing a World Bank simulation that notes deaths due to AMR could rise to 10 million by 2050 if no action is taken, the U.N. highlighted a desperate need to innovate, invest, and accelerate progress in countries. “This is a silent tsunami,” said Dr. Haileyesus Getahun, director of the U.N. Interagency Coordination Group on Antimicrobial Resistance, which spent two years working on the report. ‘We are not seeing the political momentum we’ve seen in other public health emergencies, but if we don’t act now, antimicrobial resistance will have a disastrous impact within a generation’.” “Health officials are struggling to understand the scope of the problem because many countries are ill-equipped to monitor drug-resistant infections. In a survey the United Nations conducted for the report, 39 of 146 nations were unable to provide data on the use of antimicrobials in animals, which experts say is a major driver of resistance in humans as resistant bacteria get transferred to people through contaminated food and water. ‘We are flying pretty blind and working hard to get some clear vision,’ said Sally Davies, the chief medical officer of England and a leader of the United Nations panel. As a first step, the report calls on member states of the United Nations to create national stewardship plans to reduce the unnecessary use of antimicrobials.”

Measles Updates and Why Anti-vaxxers Should Face Isolation and Fines
The U.S. topped 700 measles cases this week as 78 cases were reported in the last week. “Thirteen outbreaks—defined as three more related cases—have now been reported in 2019 so far, and account for 94% of all cases. Nine outbreaks are currently active, up from six reported the previous week. The CDC today spelled out all the details and implications of this year’s surge in cases in an early report in Morbidity and Mortality Weekly Report (MMWR) and in its weekly case update.” Juliette Kayyem is taking a stand on anti-vaxxers, noting that they are dangerous and should face isolation, fines, and arrests. “It is time we stop viewing the anti-vax movement and its adherents’ responsibility for the measles outbreak as a public health problem. With more than 700 reported cases confirmed in 22 states, it is now a public safety crisis, and the tools of public safety — arrests, fines, isolation — are absolutely necessary. The initial steps we have taken are essential: prohibit non-vaccinated children from public spaces, including schools; promote educational efforts; and, in extreme cases, force isolation on pockets of populations that might have been exposed to the outbreak, as is happening now in the University of California system. But these efforts impact the children who might have been put at risk by the decision of individuals not to vaccinate. Viewed through the lens of public safety, it is the parents who should be punished. Why not make them pay for the harms they are causing?Fines for the increased public safety burdens put on these communities by a few ought not to be the responsibility of all. In many states, when hikers ignore warnings that certain trails are too dangerous and then have to be rescued, the fees for the rescue must be paid by the hikers. It’s a fine for making a self-centered decision that placed an unreasonable burden on a larger community. Measles should be no different.”

Are Frontline Hospitals Ready for a Patient With Ebola?
GMU biodefense doctoral student and infection preventionist Saskia Popescu, discusses the gaps in frontline healthcare facilities and what this means for bioprpearedness efforts. “Now fast forward to 2019…how prepared are these frontline facilities today? Unlike the treatment centers, they do not receive funding or undergo assessments of their biopreparedness and frankly, there are a lot of competing interests for hospital administrators to invest in the costly PPE for Ebola. Although some hospital systems have run drills on their preparedness for high-consequence pathogens, they are also typically the systems that maintain a heightened level of readiness, and for most of the other facilities it is less likely Ebola or other special pathogens are getting much attention. Investigators sampled 5 major frontline hospitals in Maricopa County, Arizona, to perform a gap analysis in how their response would be for a patient with Ebola or another high-consequence pathogen. From entering the hospital through the emergency department to cleansing and disinfecting protocols, the investigators evaluated whether health care workers could still answer the questions that were heavily drilled into these hospitals in 2014.”

Trends in Foodborne Pathogen Transmission in the U.S.
Just how much foodborne illness are we seeing in the United States? The CDC just released a new study in their MMWR regarding surveillance from 10 sites across the U.S. from 2015-2018. “During 2018, FoodNet identified 25,606 cases of infection, 5,893 hospitalizations, and 120 deaths. The incidence of infection (per 100,000 population) was highest for Campylobacter (19.5) and Salmonella (18.3), followed by STEC (5.9), Shigella (4.9), Vibrio (1.1), Yersinia (0.9), Cyclospora (0.7), and Listeria (0.3). Compared with 2015–2017, the incidence significantly increased for Cyclospora (399%), Vibrio (109%), Yersinia (58%), STEC (26%), Campylobacter(12%), and Salmonella (9%). The number of bacterial infections diagnosed by CIDT (with or without reflex culture§) increased 65% in 2018 compared with the average annual number diagnosed during 2015–2017; the increase ranged from 29% for STEC to 311% for Vibrio. In 2018, the percentage of infections diagnosed by DNA-based syndrome panels was highest for Yersinia (68%) and Cyclospora (67%), followed by STEC (55%), Vibrio (53%), Shigella(48%), Campylobacter (43%), Salmonella (33%), and was lowest for Listeria (2%).”

The Future of the SNS
While most of us know of the Strategic National Stockpile (SNS), for much of the population, this critical aspect of preparedness and biodefense is likely an unknown. A new article addresses what the SNS is and its future in biodefense. “Consequently, one of the most surprising features about the stockpile is that in all likelihood, it is probably incomplete. The reason for this is that although the stockpile includes what are presumed to be the best medical countermeasures for a broad range of potential biothreats—we don’t know the exact inventory because the identity of the contents are closely held —there is an even broader range of potential biothreat agents that an adversary could use in an attack. And stockpiling countermeasures for every conceivable individual agent is currently not feasible because countermeasures for some biothreat agents do not even exist yet—and even if they did, the continuous maintenance of copious countermeasures may not be logistically or financially feasible. There is also the possibility that an adversary could select or engineer an agent that is simply resistant to all-known medications.”

Ebola in the DRC- What’s the Latest News?
Officials from the WHO recently visited the frontlines of the Ebola outbreak in the DRC. Both WHO Director-General Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa Matshidiso Moeti visited Butembo, following deadly attacks and 14 new cases. “In a statement, the two said they were profoundly worried about the situation and acknowledged that recent surges in infections are the result of setbacks each time the response sustains violent attacks. Most of the response activities—such as community engagement, vaccination, and case investigation—have restarted following a slowdown after the attacks that killed Mouzoko and injured two others, the WHO said. It notes, however, that the torrent of cases in recent weeks is further straining resources.” As the situation worsens in the DRC, financial concerns are growing as only half of the response budget is funded. “In a statement issued 30 April 2019, WHO Director-General Dr. Tedros Adhanom Ghebreyesus expressed his worries about handling increasing cases counts in a volatile ground situation while under-funded. ‘We are entering a phase where we will need major shifts in the response,” said Dr. Tedros. WHO and partners cannot tackle these challenges without the international community stepping in to fill the sizeable funding gap.’ Dr. Tedros made these remarks during a WHO delegation visit to Butembo, the site of the 19 April killing of WHO epidemiologist Dr. Richard Mouzoko by armed men while he and colleagues were working on the Ebola response.”

Rapid Response Teams- 10 Years of Collaborating on Public Health Emergencies
“In 2008, to enable faster, more efficient responses to emergencies, the FDA launched a network of state-based Rapid Response Teams (RRT), comprised of multi-agency, multi-disciplinary teams that operate by the principles of the Incident Command System/National Incident Management System to respond to human and animal food emergencies. In an emergency, the Rapid Response Teams coordinate efforts to align the response activities of agencies that may have overlapping jurisdiction to prevent harm to consumers as quickly as possible. These teams have become valued partners in responding to outbreaks from contaminated human and animal foods, conducting large-scale recalls, and ensuring availability of safe foods during a natural disaster. The FDA can respond more rapidly during an emergency by leveraging the relationships and resources with local, state, and federal partners for the common public health goals we share.”

Meet the Virus Hunters
In the face of this mounting Ebola outbreak in the DRC, Bill Gates has written about the “real-life Sherlock Holmes who helped discover Ebola” and the response team (RST) that helped control the outbreak. “But identifying a virus on a microscope is only the first of many steps to stopping an outbreak. So, with no real idea of what he was up against, Peter headed to Zaire to hunt for patient zero. He and his colleagues drove from village to village in a Land Rover, collecting information about who was sick and where they had been before symptoms appeared. Peter’s experience with Ebola was just the beginning of a long career fighting infectious disease. He was one of the first microbiologists to study AIDS, and in 1995, he became the founding executive director of UNAIDS. During his 13-year tenure, he coordinated the global response to HIV/AIDS through the discovery of the first treatments for the disease and the peak of the pandemic. After a brief stint at the Imperial College London and as a fellow with our foundation, he became the director of the London School of Hygiene and Tropical Medicine where he still teaches today.” “In just a little more than two years since it was created, the RST has already assisted in controlling 11 outbreaks in seven countries. The team has deployed to scenarios ranging from a diphtheria outbreak at a Rohingya refugee camp in Bangladesh to a plague flareup (yes, that plague) in Madagascar. Here’s how the RST works: as soon it becomes clear that an outbreak is underway, the local government (or, in rare cases, the WHO) requests their help. Not every team member is needed for every outbreak—sometimes you need an epidemiologist and a data scientist but not a microbiologist—so the first step is to identify who needs to go. The chosen team then has 48 hours to get their visas squared away, pack up any special equipment, and get to the airport for their flight to the outbreak zone.”

Beyond the Biocontainment Unit: Improving Pathogen Preparedness for Health Workers
“These specialized designations within hospitals have allowed for 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs) that not only work to enhance preparedness for high-consequence diseases, but have also taught us some critical lessons and provided novel insight into what this level of preparedness means for hospitals.  A recent article published in Health Security focused on the impact that the creation of the BioContainment Unit (BCU) at Johns Hopkins Medical Center brought to infection prevention, preparedness, and evening nursing. The investigators found that beyond ensuring they could care for multiple patients with high-consequence pathogens, the BCU supported institutional efforts including research, educational training, and strengthening infection prevention practices. The BCU also facilitated preparedness networks and collaborative efforts. Within their article, the investigators pointed to several specific examples of how the hospital’s investment in the BCU impacted other facets of health care efforts.”

Stories You May Have Missed:

  • Dr. Frances Kelsey vs. Chemie Grünenthal – “In 1960, Frances Kelsey was a recently appointed medical reviewer at the U.S. Food and Drug Administration. The new drug application (NDA) for Kevadon, or thalidomide as it is better known, was her second file. ‘They gave it to me because they thought it would be an easy one to start on,’ she said. ‘As it turned out, it wasn’t all that easy.’ The applicant was William S. Merrell Inc. of Cincinnati, an American pharmaceutical company with plans to manufacture thalidomide under license from Chemie Grünenthal, a family-owned West German company. As it turned out, Grünenthal had a record of rushing bad and inadequately tested drugs to market.”

Pandora Report: 4.26.2019

Summer Biodefense Workshop – From Anthrax to Zika
The May 1st early registration discount is nearly here – have you registered for the summer workshop on pandemics, bioterrorism, and health security? Our 3.5 day workshop will be discussing everything from biosecurity as a wicked problem to synthetic biology and the challenges of responding to Ebola. If you’re part of a large group, GMU faculty, or current/past GMU student, you also qualify for an additional discount, so reserve your spot ASAP.

The Impact of Synthetic Biology and Genome Editing on Biosecurity 
If you’ve ever wanted to learn more about the biosecurity implications of synbio and genome editing, check out a lecture by GMU Biodefense Associate Professor and Graduate Program Director Dr. Gregory Koblentz, who recently spoke at the James Martin Center for Nonproliferation Studies in Middlebury Institute of International Studies at Monterey. You can watch the video here, which also includes the powerpoint.

 Max Brooks Introduces His New Graphic Novel on the History of Germ Warfare at Awesome Con
“Max Brooks, the best-selling author of “World War Z” and non-resident fellow at the Modern War Institute at West Point, has partnered with the Blue Ribbon Study Panel on Biodefense on GERM WARFARE: A Very Graphic History. This highly stylized and engaging graphic novel, set for release beginning this Saturday, reminds us never to take public health for granted. It’s all part of an effort by the bipartisan Study Panel to not only work with the federal government to strengthen our national biodefense, but also to educate Americans about the risks, and why a strong biodefense is critical to our individual health and safety. Germ Warfare will officially be released this weekend (4.27.2019) at Awesome Con, Washington DC’s Comic Con event, at the Walter E. Washington Convention Center. Brooks, along with Study Panel member Ken Wainstein and Panel Executive Director Asha George, will host a panel discussion and hand out free copies of the graphic novel at 12pm this Saturday in Panel Room 146.”

Ebola Outbreak Update 
This past weekend saw 23 new cases reported in the DRC and two deadly hospital attacks. “The Katwa attack came 1 day after a hospital attack in Butembo took the life of a World Health Organization (WHO) epidemiologist deployed to the outbreak region. Both Katwa and Butembo have been hot spots of virus activity in the last several months—more than half of all cases reported in recent weeks originated in Katwa.According to officials, the attack in Katwa took place around 3 a.m. local time on Apr 20 at the sub-coordination office located at the Katwa Reference General Hospital. Police controlled the attack, and three assailants were wounded in addition to the assailant that the police killed. The attacks are another challenge to response efforts in the region, which have been hindered by community resistance and earlier violent attacks.” The violence against healthcare workers has gotten so bad that they are threatening to strike. “The doctors and nurses who work in the heart of the Ebola outbreak zone in Democratic Republic of the Congo say they’ve had enough. For weeks they’ve been subjected to threats of violence and even actual assaults. On Wednesday they gave the government an ultimatum: Improve security within one week or we’ll go on strike. The workers making these demands include the Congolese staff of two government-run treatment centers for patients with Ebola, but the demand mostly comes from about 200 doctors and more than 1,000 nurses who work at hospitals and health centers across Butembo, a city that’s the current hot spot of the outbreak.”

GMU Biodefense Students in Health Security Journal
We’re proud to share that two doctoral students from the GMU Biodefense program were published in the latest Health Security issue. Alum Christopher Brown discusses respiratory protection in his article “Respiratory Protection Against Emerging Infectious Diseases: Face Masks, Respirators, and Tools for Choosing Between Them“. Brown writes that “Previous reviews have called for more information, chiefly in the form of clinical trials, to better inform decision making about RPDs. However, alternative approaches to respirator selection, including control banding tools that match groups of similar hazards to appropriate control measures, may be useful in choosing RPDs for workers with potential bioaerosol exposures on the job. These tools, while offering more streamlined approaches to RPD selection, come with challenges of their own, including questions about how to allocate different RPDs to different workers. This article reviews arguments on both sides of the face mask–respirator divide and considers the use of control banding tools in the context of preparedness for serious emerging infectious disease outbreaks.” Doctoral student Saskia Popescu discussed frontline healthcare biopreparedness in “Identifying Gaps in Frontline Healthcare Facility High-Consequence Infectious Disease Preparedness” – “While certain hospitals were designated as EVD treatment facilities, the readiness of most American hospitals remains unknown. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the existing US healthcare system. Hospital infection disease preparedness gaps were revealed during the 2013-2016 Ebola virus disease outbreak. The ability of US hospitals to rapidly identify, isolate, and manage patients with potentially high-consequence pathogens is a critical component to health security. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the US healthcare system.”

Are Philanthropy Funds Shifting the Focus in Biosecurity?
Filippa Lentzos is drawing attention to a possible shift in the biosecurity field and if splashy philanthropy funding is driving the focus towards the wrong risks. “While biosecurity experts critically examine the funding sources of cutting-edge biological research like the Insect Allies program, they rarely turn their gaze inward on their own community of biosecurity experts. This should change. A new actor with deep pockets and a cause has entered the scene. Established in 2017, Open Philanthropy Project (Open Phil) is a limited liability company operating on the basis of donations from Cari Tuna and Dustin Moskovitz, an internet entrepreneur and co-founder of Facebook. Moskovitz is reportedly the youngest self-made billionaire in history. He and Tuna are also the youngest couple to sign Bill Gates and Warren Buffett’s Giving Pledge, which commits billionaires to giving way most of their wealth in the form of philanthropy. Open Phil largely operates as a non-profit, despite not legally being one. Unlike a charity, the company also carries out so-called “impact investments,” and these may extend to political contributions in some cases. The main focus of the company, however, is eye-popping grant-giving. It aims to give an average of more than $100 million a year to “accomplish as much good as possible” by giving effectively and openly to important and neglected causes. One of those is global catastrophic risks. The two risks Open Phil considers most likely to permanently worsen humanity’s long-term future or lead to human extinction are pandemics and advanced AI. Open Phil has gifted over $100 million to work on managing potential risks from advanced AI since 2017, and nearly $40 million in biosecurity and pandemic preparedness grants in the same time frame. While the company is enabling a great deal of good work in the biosecurity field, it should not be beyond critical scrutiny. It matters where research funding comes from.”

The Impact of Chronic Underfunding of America’s Public Health System: Trends, Risks, and Recommendations
Trust for America’s Health has just released their 2019 report on public health funding trends and recommendations. “A rapid rise in deaths from drugs, alcohol, and suicide represent an urgent crisis. Weather-related emergencies are becoming more frequent and intense, as the world begins to feel the effects of climate change. And across most health outcomes, socioeconomic, racial, and ethnic disparities persist. Tackling these issues requires a strong, well-resourced public health system focused on prevention, preparedness, wellness, and community recovery for all Americans. But chronic underfunding has presented a consistent obstacle. In 2017, public health represented just 2.5 percent — $274 per person — of all health spending in the country. Such underfunding flouts overwhelming evidence of the life-saving cost-effectiveness of programs that prevent diseases and injuries and prepare for disasters and health emergencies. Public health interventions, such as childhood vaccinations, school-based violence prevention programs, and indoor smoking bans, improve health outcomes and prevent illness and death. Moreover, many such interventions save money; a 2017 systematic review of the return on investment of public health interventions in high-income countries found a median return of 14 to 1.”

We Ignore the Disaster in the Antibiotics Market at Our Peril and Why The Antibiotic Business is Broken 
In a perfect world, the pursuit of novel antimicrobials would be a top priority. Of course, in a perfect world, we also wouldn’t need them as antimicrobial stewardship would be in full force. The recent announcement of Achaogen’s bankruptcy is alarming for a company few have heard of, let alone used a product. “The few who have (used a product) probably don’t know the company either, even if its product saved their life. And yet its recently announced bankruptcy is one of the most significant — and worrying — corporate failures of this decade. In the global struggle against superbugs, Achaogen is a biotech at the front line. Its failure is the latest symptom of an ailing antibiotics market. Decades of disinvestment have left perilously few companies active in antibiotic development. Those remaining are often dependent on support from philanthropic or public funders — such as the Wellcome Trust, the medical research charity, or the US government. Without external investment, small biotechs cannot carry prospective drugs through the complex and expensive later-stage trials they must pass. Against the odds, Achaogen appeared to have succeeded. Its antibiotic, plazomicin, was approved by the US Food and Drug Administration in 2018 for treating complex urinary tract infections caused by drug-resistant bacteria. It is a vitally needed drug and just one of the many new antibiotics we need to replace drugs that are rapidly losing their effectiveness against superbugs. Achaogen was a leading example of what could be achieved by a smart start-up working in partnership with government and philanthropic funders.” Beyond investors losing money, the hard truth of this bankruptcy is that there are fewer and fewer routes for new drug development in the field of antimicrobials. Now we must consider if in the face of antibiotic resistance, we really are ok with with killing innovation while not being able to kill superbugs. Maryn McKenna also addresses the broken business of antibiotics – “Last year, a European coalition known as DriveAB that has been examining antibiotic production and distribution drew up a menu of possible pull incentives and evaluated how powerful each might be. They too concluded that market entry rewards hold the most promise, though they recommended spacing payments out over the life of the drug, to ensure that companies keep manufacturing them. A raft of studies written over the past few years have recommended other possibilities, such as transferrable exclusivity vouchers, essentially allowing companies that develop a successful antibiotic to keep another drug under patent for extra years, or purchase commitments between governments and companies in which a certain amount of drugs is bought and shelved until needed. Some thinkers have recommended changes in reimbursement, in which Medicare would pay more for an antibiotic deployed after a diagnostic test has been performed—a maneuver that makes the drug intrinsically more valuable, slowing its use and keeping resistance at bay.”

Telemedicine and Antimicrobial Stewardship
Speaking of antimicrobial stewardship…how common is it in the world of telemedicine? “One of the more impressive medical advances in recent years has been the development of telemedicine, which allows a medical provider to interact remotely with patients. Using video equipment to allow providers and patients to maintain face-to-face consultations, telemedicine allows people to get a medical consultation if they don’t have immediate access to a health care facility or provider or just need a quick consult. Imagine you’ve got a fever and cold but are traveling and may not be able to go to a doctor. Skyping your primary care physician who could evaluate your symptoms, and provide a face-to-face consult would be helpful, right? Even in medical facilities, telemedicine has allowed specialty practitioners to consult on cases and provide an extra layer of care if a specialized provider isn’t available. While there are inherent limitations in what can be done via telemedicine, especially if the patient is not in a medical facility, a new article in Pediatrics is calling to light some worrying antimicrobial prescribing practices.”

Next Steps for Access to Safe, Secure DNA Synthesis
How can we incorporate biosecurity/biosafety into DNA synthesis without stifling innovation? “Informed by guidance from the U.S. government, several of these companies have collaborated over the last decade to produce a set of best practices for customer and sequence screening prior to manufacture. Taken together, these practices ensure that synthetic DNA is used to advance research that is designed and intended for public benefit. With increasing scale in the industry and expanding capability in the synthetic biology toolset, it is worth revisiting current practices to evaluate additional measures to ensure the continued safety and wide availability of DNA synthesis. Here we encourage specific steps, in part derived from successes in the cybersecurity community, that can ensure synthesis screening systems stay well ahead of emerging challenges, to continue to enable responsible research advances. Gene synthesis companies, science and technology funders, policymakers, and the scientific community as a whole have a shared duty to continue to minimize risk and maximize the safety and security of DNA synthesis to further power world-changing developments in advanced biological manufacturing, agriculture, drug development, healthcare, and energy.”

Stories You May Have Missed:

  • E coli Ground Beef Outbreak and Recall – “In an outbreak update, the Centers for Disease Control and Prevention (CDC) said the 47 new cases boosts the outbreak total to 156 cases, with 4 more states reporting cases, expanding the outbreak to 10 states. The newly added states include Florida, Illinois, Minnesota, and Mississippi. The already-affected states are Indiana, Georgia, Kentucky, Ohio, Tennessee, and Virginia. The latest illness onset is Apr 7, and patients range in age from less than 1 year to 83. Fifty percent of them are female. Of 127 people with available information, 20 (16%) were hospitalized. No deaths or cases of hemolytic uremic syndrome (HUS)—a potentially fatal kidney complication—have been reported.”
  • First Malaria Vaccine Launches– “Developed by GlaxoSmithKline, the RTS,S vaccine has been in the making for 30 years and has shown partial protection against Plasmodium falciparum in young children. Clinical trials found that the vaccine prevent 4 of 10 malaria cases, as well as 3 in 10 cases of severe malaria. The vaccine also cut the level of severe anemia—the most common reason kids die from the disease—by 60%. In a World Health Organization (WHO) statement today on  the launch of the pilot program, designed to assess its role as a control tool alongside other interventions, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said tremendous gains against malaria have been made over the past 15 years with the use of bed nets and other measures, but progress has stalled or even reversed in some areas.”

 

Pandora Report: 4.19.2019

Happy Friday all! We hope this morning finds you well and ready for your weekly dose of all things biodefense. As we’re getting closer to the May 1st discount deadline, have you registered for the Summer Workshop on Pandemics, Bioterrorism, and Health Security?

 Measles Cases Continue to Grow and the Implications for Biodefense
90 new cases have been identified in the last week, bringing the 2019 cases to 555 which means we’re on track to see more cases in 2019 than any years since the disease was eradicated in the U.S. in 2000. “So far this year 20 states have confirmed measles, including Maryland, which recorded its first case of the year. Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington, have all recorded cases. The number of affected states is likely to increase to 21, as Iowa today reported that a person from the northeastern part of the state was diagnosed as having measles, and likely contracting the disease on a recent trip to Israel. The Iowa Department of Public Health (IDPH) said the case-patient has been complying with health officials.” Even worse, the WHO has reported that globally, measles cases have risen 300%. The U.S. measles outbreak also has implications for biodefense though, as response efforts are draining resources we depend upon for future outbreaks and even bioterrorism attacks. “This reemergence of measles teaches us two things. First, our public health system needs additional resources if it is to control the occurrence and spread of disease throughout the nation.Second, since local governments — including New York City — are having to spend their limited public health resources to contain diseases like measles, they will not be sufficiently prepared for large-scale biological events such as a bioterrorist attack or an infectious disease pandemic. If measles draws down New York’s resources now, the city will be less able to withstand the next major biological event. Devastation could be vast and swift, followed quickly by an impact on the national economy that we cannot afford.” While many might see vulnerabilities and weaknesses, the measles outbreaks have also shown that these surveillance systems do work and that vaccination programs can be rapidly initiated…so sure, we have work to do, but in many ways we have shown the progress that’s been made.

 Book Review – The Alphabet Bomber: A Lone Wolf Ahead of His Time
Looking for a new book? GMU Biodefense doctoral alum Dr. Keith Ludwick has provided us with a great review of Jeffrey D. Simon’s latest book on the Alphabet Bomber. “While not necessarily a textbook, A Lone Wolf Terrorist Ahead of His Time offers insight of use to a wide variety of individuals including scholars, practitioners, and students. By presenting detailed information about the history of Kurbegovic, his terrorist attacks and plots, and arrest, Simon provides a resource for future investigators and practitioners from which to draw information and details pertinent to their work. Of note, investigators who seek information about the ‘early’ use of chemical weapons by lone wolf terrorists, Kurbegovic’s case, as presented by Simon, would be particularly interested in Simon’s discussion. Kurbegovic’s represents a lone wolf who assimilated one of the largest caches of chemical weapon precursors to date (Simon, 2019, p. 115). While he did not realize his goal of fully developing or deploying a chemical weapon, it is apparent that his terrorist attacks were escalating, he had the necessary material, the motivation, and the knowledge to develop and deploy such a weapon.”

Altering an appreciative system: Lessons from incorporating dual-use concerns into the responsible science education of biotechnologists
“An important instance of this problem is the relationship between the potential of scientific advances which can greatly enhance human well-being but also find application in new or enhanced weapons of mass destruction. Clearly, preventing such weapons from becoming a normal part of conflict during a period of rapid scientific and technological change in the sciences will require an integrated system of laws and regulations implementing the international agreements. Yet it will also require that the scientific community, through their daily practice and norms of professional conduct, support the efforts to maintain and further develop relevant international treaties that seek to limit the spread of and outlaw such weapons. The purpose of this paper therefore is to examine the utility of Vickers’ concept of an Appreciative System for developing a systematic theoretical framework for understanding what change mechanism is efficacious in the education of scientists regarding the extent to which new ideas about ethics and professional responsibility can be grasped, acknowledged and applied.”

First U.S. Patients Treated With CRISPR – Gene-Editing Trials Begin
A new CRISPR study has been approved in the U.S. to help fight cancer at the University of Pennsylvania. “One patient had multiple myeloma, and one had sarcoma. Both had relapsed after undergoing standard treatment. The revelation comes as several other human trials of CRISPR are starting or are set to start in the U.S., Canada and Europe to test CRISPR’s efficacy in treating various diseases.”

 Your Cell Phone is Helping Spread Ebola
I’d be lying if I didn’t consider wiping down my phone with a disinfecting wipe when I first read that headline, but the truth is much more painful and harder to change…which is why Laurie Garrett is pulling back the curtain on the impact valuable minerals have in global health security. “One set of actions, however, can and should be taken immediately by the Trump administration, the U.N. Security Council, the G-20, and international trade offices in countries with significant mobile phone and laptop production and manufacturing facilities. It concerns the vast mineral riches in the soils of North Kivu, sales of which finance weapons purchases for all of the rival forces in the region and constitute a key incentive behind the ongoing violence. Conflict seems to have deepened in North Kivu alongside the spectacular global growth in the mobile phones market, which has made the locally plentiful black stones of columbite-tantalite, or coltan, potentially more valuable than Congo’s gold, diamonds, uranium, and other minerals and gems. (The mineral trade brings as much as $1.4 billion per year.) Coltan is a heat-resistant mix of compounds that conduct high-energy signals inside laptops, electric cars, and cell phones, allowing compressed signals to display videos and games without exploding and batteries to safely store energy. Médecins Sans Frontières and other NGOs doing humanitarian work in the region noted a clear increase in regional violence in 2018, and rape, possibly linked to higher coltan demand. Coltan is labeled a ‘conflict mineral’, which, like ‘blood diamonds,’ is meant to be shunned. Nine years ago, the U.N. Security Council passed Resolution 1952, calling for an end to the trade in conflict minerals and stipulating that ‘all States, particularly those in the region, regularly publish full import and export statistics for natural resources including gold, cassiterite, coltan, wolframite, timber, and charcoal and enhance information sharing and joint action at the regional level to investigate and combat regional criminal networks and armed groups involved in the illegal exploitation of natural resources’.” Of note – the outbreak has now topped 1,290 cases and last week, the WHO decided not to declare it a PHEIC. This outbreak is also increasingly difficult to control, as it was reported that a physician had fallen ill with the disease and had 534 contacts now requiring epidemiological efforts.

The Infectious Disease Physician Well is Running Dry
GMU biodefense doctoral student and infection preventionist Saskia Popescu discusses what the shortage of infectious disease physicians truly means for biodefense efforts. “Right now, there is an Ebola outbreak raging in the Democratic Republic of the Congo (DRC), measles spreading throughout many states due to increased rates of vaccine exemptions, and resistant microorganisms continuing to spread globally. These are just a few of the infectious disease concerns we face, but that doesn’t paint a full picture of the nuanced care these physicians provide—from complex secondary infections to health care-associated infections, there is a desperate need to fix this problem. We rely on infectious disease physicians for managing complex antibiotic regimens with comorbidities. Moreover, they are often the only providers with experience in identifying these vaccine-preventable diseases. In terms of future needs, consider the threats we know vs the ones we haven’t really experienced. Pandemics, novel diseases, newly resistant organisms, nefarious uses of synthetic biology, and even bioterrorism—these are all events or scenarios that we worry about in biodefense, and infectious disease physicians play an absolutely critical role.”

Scientists: We kept pig brains alive 10 hours after death. Bioethicists: “Holy shit”
And the award for best headline this week goes to Vox‘s Brian Resnick regarding this new finding that researchers were able to revive 23 dead pig brains after slaughter. “In a paper that reads a bit like an adaptation of Mary Shelley, researchers at Yale University describe how they were able to partially revive disembodied pigs’ brains several hours after the pigs’ death. First, the researchers took 32 brains from pigs slaughtered for food and waited four hours. Then they hooked them up for six hours to a system called BrainEx, which pumped those brains full of oxygen, nutrients, and protective chemicals. At the end of the 10 hours, the scientists found that the tissue of the pig brains was largely intact, compared to controls. Individual brain cells were up and running, performing their basic duties of taking up oxygen and producing carbon dioxide. To be clear: The neurons in these brains were not communicating, so there was no consciousness. But the cells were alive — and that alone is a very big discovery.” Following this announcement, there was likely an audible sigh from every bioethicist in the world. “’My first reaction was holy shit,’ says Hank Greely, a Stanford law and ethics professor who reviewed the findings and co-authored a commentary on the paper in Nature. ‘The conventional wisdom is brain cells die, irretrievably, after about 10 to 12 minutes without oxygen — and that’s part of the scientific underpinning for the definition of brain death, the definition of death in humans. The idea [that] after four hours with no oxygen, or glucose, or anything else, most of the cells in the pig’s brain would start functioning again? That’s astounding.’ It’s so astounding, he says, that perhaps we should reconsider the definition of death. And we should definitely consider the unexplored ethical implications of partially reviving a dead animal. Because, what if, even for a moment, that pig brain felt something?”

Base Editor Tool Accidentally Mutates RNA While Editing Targeted DNA
Whoops? “When researchers first reported 3 years ago that they had created base editors, a version of the powerful genome-editing tool CRISPR, excitement swirled around their distinct powers to more subtly alter DNA compared with CRISPR itself. But the weaknesses of base editors have become increasingly apparent, and a new study shows they can also accidentally mutate the strands of RNA that help build proteins or perform other key cellular tasks. Researchers say this could complicate developing safe therapies with the technology and hamper other research applications. Human diseases from sickle cell to Tay-Sachs are caused by a single mutation to one of the four DNA bases—adenine, guanine, cytosine, and thymine—and CRISPR has often had difficulty swapping out the bad actors. That’s in part because CRISPR cuts double-stranded DNA at targeted places and then relies on finicky cell repair mechanisms to do the heavy lifting of inserting a corrected DNA sequence for a mutation. Base editors, in contrast, chemically change one DNA base into another with enzymes called deaminases, which doesn’t require a cut or help from the cell.”

Stories You May Have Missed:

  • Family Duo Sold Body Parts Infected With HIV, Hepatitis – “A father and son have been federally charged for allegedly selling body parts on the black market they knew were contaminated with infectious diseases. Donald Greene Sr. was charged with wire fraud in relation to a years-long operation that involved selling diseased cadavers to unwitting researchers, the Associated Press reports. His son, Donald Greene II, was charged with intentionally concealing a crime. The family duo was associated with the Biological Resource Center of Rosemont, Ill., which provided human remains donated to science to medical professionals for a fee.”
  • Salmonella and the Case of the Tainted Tuna– “Late yesterday the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) announced that a line of frozen tuna tainted with Salmonella Newport is associated with illnesses in 13 people in seven states, resulting in two hospitalizations. Jensen Tuna of Houma, Louisiana, voluntarily recalled the frozen ground tuna product associated with the outbreak yesterday. The frozen tuna is individually packaged in clear, 1-pound bags and only sold wholesale in 20-pound boxes.”