Pandora Report 4.29.2016

TGIF- We’ve got your weekly dose of biodefense and much more in this edition of the Pandora Report! Kurdish Peshmerga soldiers are saying that recent ISIS attacks have involved chemical weapons. Heads up- you may want to avoid a spiced herbal tea commonly sold at CVS due to a potential contamination with Salmonella. Check out a new study on biodiversity in swine flu and the potential for spillover.  Monday, April 25, 2016 was World Malaria Day! Lastly, here’s a chuckle to help start your weekend.

2016 Survey on U.S. Role in Global Health
A recent survey of Americans performed by the Kaiser Family Foundation addressed the public perception, knowledge, and attitude regarding the role of the U.S. in global health. The survey addressed topics like American awareness of Zika virus and the health issues that are most urgently facing developing countries. The survey found that a “majority of the public wants the U.S. to take either the leading role or a major role in trying to solve international problems generally, as well as in improving health for people in developing countries specifically.” Interestingly, the importance of improving health for developing countries was not ranked as a top priority like protecting human rights, etc. “Seven in ten Americans believe that the current level of U.S. spending on health in developing countries is too little or about right, yet the public is somewhat skeptical about the ability of more spending to lead to progress, with more than half saying that spending more money will not lead to meaningful progress. Republicans and independents are more skeptical than Democrats, and these partisan differences have increased over time. Another notable trend is the decreasing visibility of U.S. efforts to improve health in developing countries; just over a third of the public says they have heard “a lot” or “some” about these efforts in the past 12 months, a decrease of 21 percentage points since 2010.” The survey also found that while Americans believe the U.S. should help women in Zika-affected countries, there was a divide regarding involvement in their family planning and preventative health measures.

GMU Biodefense Alum Awarded Mirzayan Science & Technology Fellowship
Congrats to GMU Biodefense alum, Dr. David Bolduc, on being named a Christine Mirzayan Science and Technology Policy Graduate Fellow! David graduated from GMU with a PhD in Biodefense in 2011 and doctoral work focused on the threats and mechanisms of chemical, biological, radiological and nuclear (CBRN) agents and CBRN proliferation issues such as treaties, histories and the managing of related mass casualty incidences. David is currently a Principal Investigator at the Armed Forces Radiobiology Research Institute. The Mirzayan Fellowship is a very prestigious award – as a program of the National Academies, it is designed to provide mentorship and professional development opportunities to early-career leaders in the field of science and technology policymaking.

Global Health & Military Expenditure 
Last week we discussed the financing of global health versus military.  There was a recent publication by Sipri (Stockholm International Peace Research Institute) that looked at global military expenditure versus health expenditure (in 2015, it was $1676 billion or about 2.3% of the world’s Gross Domestic Product). They utilized the WHO’s recent estimates of government health expenditure as a share of GDP. They reviewed 2013 data and found that “governments worldwide spent just over two and a half times as much on health than on the military in 2013: 5.9% of global GDP went to public health spending, compared with 2.3% for the military.” Here’s the interesting part – it varied regionally. While the U.S. spends a lot on military, healthcare expenditure is still very high. Western and Central Europe spent 7.8% of their GDP on health and 1.5% on military. The Middle East spent 4.6% of their GDP on military versus 3.0% on health expenditures. The study also looks at reallocation of military spending and what that may translate to regarding the UN’s Sustainable Development Goals (SDGs). “Reallocating only around 10% of world military spending would thus be enough to achieve major progress on some key SDGs, supposing that such funds could be effectively channelled towards these goals and that major obstacles, such as corruption and conflict, could be overcome.”

Did Newcastle Disease Virus Sneak Out of the Lab?
Newcastle disease virus (NDV) is a highly infectious disease that impacts domestic poultry and other birds. Virulent NDV strains have been endemic in poultry throughout Asia, Africa, and some countries within South America. Current outbreaks continue to cause food safety and agricultural issue. In the 1940s, the first NDV panzootic occurred, specifically genotypes II, III, and IV. Other genotypes have continued to circulate and cause outbreaks. A recent study performed a complete genomic sequence of contemporary isolates from China, Egypt, and India. Researchers performed genetic analysis to distinguish historical isolates (the outbreak from the 1940s) from currently circulating genotypes (V, VI, VII, and XII through XVIII). Through their work, they found that isolates of genotypes II and IX (which are not normally circulating viruses in the environment) were found to be identical to the historical viruses that were isolated in the 1940s. “The low rates of change for these virulent viruses (7.05 × 10⁻⁵ and 2.05 × 10⁻⁵ per year, respectively) and the minimal genetic distances existing between these and historical viruses (0.3 to 1.2%) of the same genotypes indicate an unnatural origin.” The virulent strains isolated during the 1940s have been used in labs and research studies. Researchers noted that it is highly unlikely these viruses remained viable in the environment for over sixty years, which means its very possible (and scary…) that the source of these viral samples, taken from poultry and wild birds, may in fact be from a laboratory. So now we have to wonder…how did these specific virulent viral isolates find their way out of laboratories and into nature?

Is Open Science the Secret Weapon Against Zika and Future Pandemics?
Gene editing tools like CRISPR-Cas9 have the potential to combat diseases like HIV and malaria, but there’s also a potential dual-use for these technologies that is much more sinister. The price of laboratory equipment for some synthetic biology experiments is dwindling and many are becoming concerned about potential for misuse. Should science be left open and researchers ultimately allowed to make the call about potential dual-use or should scientific work/publications be regulated to avoid publications of research that could be used to build a biological weapon? Some are saying that the best way to combat global issues is through global cooperation and communication and thus, open-source information. Should Zika be the first in the test subjects of open science and its application in the global health security toolbox? Many have argued that if a research project is receiving public funding, it should be open sourced (including the data). Would this have helped the Ebola outbreak? “When Ebola was raging through West Africa in the summer of 2014, a group at the Broad Institute in Cambridge, Mass. published open repository sequence data for 99 Ebola genomes taken from patients in Sierra Leone’s Kenema government hospital. This open sourcing of critical scientific data was the second instance in the outbreak. A team of international researchers had initially published three genomes from patients in Guinea in April. For the next three months, no more genomic data was released to the public data repositories that had become the go-to source for scientists studying Ebola. The silence puzzled many prominent scientists. A formidable array of genomic sequencing technology was aimed squarely at the virus. Yet the data was not shared.” Since this outbreak, many have pushed more for open science, especially in the wake of a global outbreak like Zika.

The Other Side of the Spectrum – How Genetic Editing Became a National Security Threat
You may recall in February, Director of National Intelligence, James R. Clapper, stated in his World Wide Threat Assessment testimony that gene editing had become a global danger and should be considered a weapon of mass destruction. The history of genetic research has seen a burst of developments since the discovery of the double helix in 1953. CRISPR-Cas9 is the newest in the genetic engineering arsenal…and at at a fraction of the historical price. If it were only so simple as to do away with malaria by genetically modifying mosquitoes to avoid carrying the parasite. Alas, the realities are a bit darker. The truth is that genome editing of wildlife can alter entire ecosystems, not to mention the risk for accidents and negligence, which is a very real possibility. Those concerns aren’t even touching on the frightening potential for biological weapons. “Gene editing techniques could produce forms of diseases that barely resemble their naturally occurring counterparts. Such engineered pathogens could sicken or even kill hundreds of thousands of people. Armed with the proper genetic sequences, states or bioterrorists could employ genome editing to create highly virulent pathogens for use in such attacks. They could, for example, change a less dangerous, non-pathogenic strain of anthrax into a highly virulent form by altering the genome, or recreate pathogens such as the deadly smallpox virus, which was eradicated in the wild in 1980. Or they could develop specific weapons that target either individuals or even entire races: With the right manipulations, a pathogen could be made to have greater invasiveness or virulence in a target population.” So where do we go from here? With no governance of do-it-yourself facilitates, no training for the at-home gene editing experimenters, and endless debate about the dangers of gain-of-function research, what is being done? Many are saying UN Resolution 1540 should be strengthened to consider this technology and the Dual-Use Research of Concern (DURC) policy shouldn’t just apply to research funded by the government, but also small labs and individuals. With the notion of open science and DURC still up for debate, the stakes will only get higher as global outbreaks, like Zika, continue to burn through countries.

Why We Should Be Afraid of Yellow Fever
Angola is getting hit hard by yellow fever and the vaccine shortages only amplified the outbreak. With all eyes on Zika and a century since Rio saw its last case of yellow fever, where’s the link? Global supplies of yellow fever vaccines are pretty much depleted and BioManguinhos/FioCruz in Rio (one of four…yes four… yellow fever vaccine producers in the world) is having production problems. All available vaccines are being rushed to Angola and cases are spilling over into the DRC, Mauritania, and Kenya. Here’s more – “What most people don’t know is that there are a lot of Angolans coming every year to Brazil, and the more who arrive here unvaccinated, but have been exposed to yellow fever in Africa and may be carrying the virus, the greater the risk that they will infect Rio mosquitoes, allowing them to transmit yellow fever to residents and tourists.” Brazil is already waging a massive war against Zika. Add in yellow fever and it’ll be like adding a gallon of gasoline to a house fire. Mosquito control is imperative and now we’re paying the costs of historically lackadaisical efforts.

Zika Updates
The WHO announced that the number of Zika virus cases is dropping in Brazil. A recent study reports that dengue virus antibodies enhance Zika virus infection. Researchers suggest that pre-existing dengue immunity will enhance a Zika infection in vivo and can increase the severity of disease. Many are calling for more research to be done regarding the relationships between Zika and dengue infections. You can also find a timeline of Zika virus here. There are growing concerns regarding blood donations as Zika spreads internationally. The Canadian Blood service noted that new rules to protect against Zika transmission are putting stress on the blood supply. A new study looks at the impact of Zika and the challenges we many face due to the increasing frequency of viral outbreaks. As of April 27, 2016, there were 426 travel-associated cases in the U.S.

Rewiring Outbreak Preparedness and Response
Let’s take more of a deep-dive into why we should apply U.S. biodefense practices to managing and preparing for outbreaks. Hoyt and Hatchett emphasized why we should learn from American biodefense strategies to better fight infectious disease outbreak. “SARS was responsible for 800 deaths but cost $40 billion globally and Ebola has cost West African economies $6 billion plus an additional $4.3 billion in international contributions. Now, consider the cost of developing a vaccine. Hoyt and Hatchett point out that at the most expensive point, it can cost $1.8 billion to develop a vaccine (others argue that is it much closer to $500 million).”

Stories You May Have Missed:

• Neurological Problems in Ebola Survivors – a recent NIH study found that nearly all Liberian Ebola survivors reported neurological symptoms following their recovery. Symptoms were noted to have persisted for over a year, including headaches, difficulty walking, overall muscle weakness, loss of memory, and depression. Hallucinations during treatment in Ebola treatment units was prevalent in 25% of patients, with 4% having persistent hallucinations at follow up.
• Ebola in America: Epidemic of Fear – The Center for Strategic & International Studies has put together a video on the fear and U.S. response to Ebola cases in the U.S. and in West Africa. The video discusses stigma and how Ebola was experienced in the Fall of 2014.
• Biodefense World Summit – The 2016 event will be hosted in Baltimore, MD on June 27-30, 2016. The Knowledge Foundation’s Second Annual Biodefense World Summit brings together leaders from government, academia, and industry for compelling discussions and comprehensive coverage on pathogen detection, sample prep technologies, point-of-care, and biosurveillance. Across the four-track event, attendees can expect exceptional networking opportunities in the exhibit hall, across panel discussions, and shared case studies with members of the biodefense community from technology providers to policy makers