Pandora Report 5.27.2016

Before you start your holiday weekend, what’re your thoughts on Usain Bolt outrunning a mosquito? The Jamaican sprinter jokingly responded to questions regarding athlete concerns over Zika virus, noting that he’s not worried “because I’m fast – they can’t catch me”. (Hint – it looks like he can outrun a mosquito with his 22 mph capabilities versus the 1.12-3.35 mph of an Aedes mosquito). Sticking with the Olympian theme..bacterial teams? Researchers recently found that two strains of E.coli, resistant to different antibiotics, can protect each other in an environment containing both antibiotics. The phenomenon is called mutualism and researchers at MIT are now looking looking into the range of this practice and the potential for population synchronization. At the 69th World Health Assembly this week, the WHO revealed plans to revamp itself however, many point out that for an agency better at giving advice than taking action, it’s too little too late. In the case of the WHO, critics are calling for acta non verba. 

The World Bank Rolls Out the Pandemic Insurance Plan
Following the Ebola outbreak in West Africa, the World Bank has announced a new program that will enable funds to rapidly be mobilized during outbreaks. In hopes of ensuring a more speedy response to infectious disease disasters, World Bank President Jim Yong Kim stated that “pandemics pose a serious threat to global health and economic security.” The new Pandemic Emergency Financing Facility (PEF) is “a combination of catastrophe insurance and bonds, is a direct reaction to the sluggish donor response to the outbreak of Ebola”. Presented at the G7 meeting for finance advisors, Japan has already committed support with a $50 million contribution. The insurance will cover several classes of infectious disease outbreaks most likely to cause epidemics – ranging from new influenza or coronavirus strains, filoviruses like Marburg and Ebola, and other zoonotic diseases. The initial plan is to have a total of $500 million  and hopefully avoid outbreaks, like Ebola, rapidly growing due to poor financial support and response.

Antibiotic Apocalypse
As much as I’d love to say this title is a dramatic take on the issue of antibiotic resistance, the truth is pretty startling. A report done by the Review on Antimicrobial Resistance  (commissioned by the UK government and reviewed by officials including economist Jim O’Neill), estimated that by 2050, 10 million lives per year and $100 trillion are at risk due to drug-resistant infections. That’s quite a stark estimate, but as many have pointed out “the problem of drug-resistant microbes isn’t just about biology and chemistry; it’s an economic problem at heart, a catastrophic and long-bubbling mismatch between supply and demand. It’s the result of the many incentives for misusing our drugs, and the dearth of incentives for developing new ones.” Can we really tackle this issue though? It still amazes me hearing people in an emergency department or urgent care asking for an antibiotic and the physician having to explain that they have a viral infection or that antibiotics simply aren’t warranted. In many ways, when we are sick enough to go to the doctor, we want to walk away with some “cure” and the notion of bedrest and hydration isn’t all that comforting. So what can we do? The report notes some steps to help prevent this impending reality – massive global public awareness campaigns, improve hygiene, improve global surveillance of drug resistance and antimicrobial consumption in humans and animals, promote development and use of vaccines, promote new, rapid diagnostics to cut out the unnecessary use of antibiotics, better incentives to promote investment for new drugs and improve existing ones, improve the numbers, pay, and recognition of people working in infectious diseases (hear, hear!), etc. Other recommendations include improving sanitation and a global innovation fund for early-stage research. Scientists were recently startled to find for the first time in the U.S., a patient with a bacteria that is resistant to antibiotics that are used as a last resort. While the predictions are daunting, the threat of antibiotic resistance is one we can get ahead of if we make the commitment and start immediately.

The Growing Threat of Spillover 
The United Nations Environmental Programme (UNEP) released their 2016 Frontiers Report “Emerging Issues of Environmental Concern”. One of the six major issues was zoonosis. “There is a worldwide increase in disease emergence and epidemics particularly from zoonoses – diseases that can be passed on between animals and humans. The report illustrates how the emergence and re-emergence of zoonotic diseases are closely interlinked with the health of ecosystems. The risk of disease emergence and amplification increases with the intensification of human activities surrounding and encroaching into natural habitats, enabling pathogens in wildlife reservoirs to spill over to livestock and humans.” The report notes that around 60% of all infectious diseases in humans are zoonotic and 75% of emerging infectious diseases are zoonotic. You can also find several great infographics that paint a very surprising picture regarding the emerging zoonotic disease events from 1940-2012 and the top three reported zoonoses for specific continents. The growing Zika epidemic is just another in a long list of spillover cases including those of MERS, SARS, Ebola, and Rift Valley fever.

A Need To Rebalance
GMU Biodefense professor and Program Director, Dr. Gregory Koblentz, is pointing to the need for the U.S. to refocus its nonproliferation efforts on South Asia. Given the region’s high risk for nuclear crisis as a result of territorial disputes, cross-border terrorism, and increasing nuclear arsenals, there is a crucial need to re-allign nonproliferation efforts to include South Asia. “As of 2015, India was estimated to have 120 nuclear warheads while Pakistan was believed to possess 130 weapons. Both countries have also continued to develop, test, and deploy new missiles designed to deliver nuclear warheads. Pakistan has tested seven different types of nuclear-capable ballistic and cruise missiles, including the 2,750-kilometer range Shaheen-3 ballistic missile. Meanwhile, India has tested nine different types of nuclear-capable missiles, including the Agni-V intercontinental ballistic missile with a range of over 5,000 kilometers.” Dr Koblentz points to the impacting introduction of tactical nuclear weapons in South Asia and their ability to be deployed on short-notice – also concerning is India’s planned development of strategic missile submarines, which will likely trigger development from Pakistan. He notes that the international community can help restrain this dangerous competition by encouraging both countries to adopt confidence-building measures (limits on development of tactical nuclear weapons, etc.) and engage in high-level talks with “other nuclear weapon states to discuss measures that could further reduce the risk of nuclear weapons being used deliberately, by accident, or in an unauthorized manner.”

Rebuilding Trust in Biology 
Between the gain-of-function talks and biosecurity failures at major U.S. labs, there’s been a subtle shifting in the trust and support for biological sciences. New regulations could change oversight for sciences within the U.S. and many are wondering how we can restore trust back into this field. While we can all agree that forgotten smallpox vials and an accidental bird flu release translates to a need to revamp practices and facilitate more effective and efficient oversight, there’s been little mention of how we can combat the trust issues. This week the National Science Advisory Board for Biosecurity (NSABB) met to conclude their 18-month deliberation on select pathogen research practices and regulations. Let’s hope that with more effective and efficient practice recommendations, they are also looking into repairing the reputation of science and biology. Dr. Filippa Lentzos and Dr. Nicholas Evans recommend four ways to rebuilt this trust- transparency in process and outcome of experiments and review, life scientists need to play their part in monitoring and preventing deliberate misuse of biology, accountability needs to be built into scientific norms, and decisions on pursuing dangerous experiments need more transparency in regards to their process. “There should also be clear, internationally-recognized red lines about the sorts of experiments—such as attempting to make Ebola virus transmit like the flu, or modifying an extinct virus like smallpox—that simply should not be done.”

Energy & Commerce Subcommittee Looks at U.S. Biological Threat Preparedness
The Energy and Commerce Subcommittee on Health held a hearing regarding H.R. 3299, Strengthening Public Health Response Act, last week to discuss and review legislation that would enable the U.S. to prepare and defend against biological attacks. The act was presented in response to the October 2015 Blue Ribbon Study on Biodefense that highlighted the general lack of preparedness against emerging biological threats. “Thirty-three recommendations to improve the U.S. response to biological threats were made by the Blue Ribbon Study on Biodefense, which was led by former U.S. Sen. Joe Lieberman (I-CT) and former Pennsylvania Gov. Tom Ridge, the first Secretary of Homeland Security. The panel’s report was based on meetings, interviews and research.” Acting Biomedical Advanced Research and Development Authority (BARDA) Director Dr. Richard Hackett noted that “the array of threats for which we must be prepared is vast. Such threats include bioterrorist agents such as anthrax, smallpox and botulism; evolving and emerging threats causing substantial regional disruption such as Ebola and Zika; and highly communicable diseases with pandemic potential such as influenza.” This act would also expand the Priority Review Voucher program within DHS and work to facilitate BARDA’s partnership with the private sector.

Weekly Zika Updates
On Monday, WHO Director-General Dr. Margaret Chan pointed to the failure to maintain mosquito-control efforts and the spread of Zika. “Let me give you a stern warning. What we are seeing now looks more and more like a dramatic resurgence of the threat from emerging and re-emerging infectious diseases. The world is not prepared to cope. Above all, the spread of Zika, the resurgence of dengue, and the emerging threat from chikungunya are the price being paid for a massive policy failure that dropped the ball on mosquito control in the 1970s,”. The European Centre for Disease Control and Prevention (ECDC) released a risk assessment for European travelers to the Olympic Games, finding that they’re most at risk for gastrointestinal illness and vector-borne diseases. Researchers are also considering the association between Zika virus and eye problems in babies that have microcephaly. During your holiday weekend, take a minute to learn about the Scottish professor who discovered Zika virus. Experts are also pointing to the role of misinformation (via social media conspiracy theories) in prevention efforts.  “The researchers behind the study—from Johns Hopkins University, George Washington University, and the University of Georgia—say the misinformation they detected by analyzing thousands of Twitter posts could cause many vulnerable people to refuse future Zika vaccinations.” The CDC has estimated that a fetus infected with Zika virus during the first trimester has a 1-13% risk of developing microcephaly. As of May 25th, the CDC has reported 591 travel-associated and 11 sexually transmitted cases in the U.S.

Stories You May Have Missed:

• Why Victorian Diseases Are Making a Comeback – Scarlet fever and TB have been on the rise in the UK and many are pointing to the growing threat of antibiotic resistance and poor vaccination compliance. Many of these diseases have been under control for centuries so any uptake can cause a sensational public response, however it’s important to remember the recent plethora of measles outbreaks and just how vital vaccination is. Antibiotic resistance alone could bring back these diseases and take us back to a time where infectious diseases were the major cause of death.
• The Threat of Agroterrorism and Zoonotic Disease in the U.S. –  Gary Flory, Agricultural Program Manager of the Virginia Department of Environmental Quality, discusses the threat of these diseases for the Non Conventional Threat CBRNe Meeting. “The threat of agroterrorism and naturally occurring disease outbreaks in the United States continues to expand as new diseases emerge and existing diseases become endemic in many parts of the world. The food and agricultural sector is one of the easiest sectors of any nation’s economy to disrupt and its disruption could have catastrophic consequences both nationally and regionally. Both developing and developed countries will be impacted by a disease outbreak or agroterrorism attack.”
• The Awful Diseases on the Way– check out this overview of Sonia Shah’s book, Pandemic: Tracking Contagions from Cholera to Ebola and Beyond, that also discusses the impact of infectious disease outbreaks from smallpox to Ebola. The review is done by a pediatric physician who has worked with UNICEF and the Global Fund to Fight AIDS across three continents. Aside from the wonderful points on infectious disease outbreaks and the importance of public health, Annie Sparrow gives a delightful segment on the corrupt schemes of outbreak coverups.