Pandora Report 5.5.2017

Welcome to your weekly dose of all things biodefense. We hope you’ll celebrate World Hand Hygiene Day today by practicing awesome hand hygiene to help stop the spread of germs! Will Bill Gates save us from the next Ebola?

Summer Workshop Discount Extended
We’re excited to announce that the early registration deadline has been extended to June 1st for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security! This is a great opportunity to experience a 3-day workshop led by some of the top biodefense people in the field, not to mention networking opportunities with fellow global health security gurus. Don’t miss out on this July 17-19th workshop in which you’ll learn about bioterrorism, synthetic biology, dual-use research of concern, and how experts are working to stop the next pandemic.

Three Insights from the World Bank’s Tim Evans on Global Health
“While in the previous year the U.S. was the biggest single source of development aid finance for health at $12.8 billion — 34 percent of the global total — its future position is less clear. Specifics on U.S. commitments to global health were lacking in U.S. President Donald Trump’s ‘skinny budget‘ released in March. The latest budget document released this week, meanwhile, shows proposed cuts to USAID’s global health funds.” At a recent event hosted by the Kaiser Family Foundation and the Center for Strategic and International Studies, Tim Evans, senior director of health, nutrition, and population at the World Bank Group, pointed to three important lessons. Firstly, we must catalyze domestic resource mobilization. Domestic spending impacts a country’s capacities and universal healthcare development. “Evans said the global health community needs to rethink the way it views and packages development assistance, from largely being linked to service provision to one that can strengthen countries’ domestic resource mobilization.” Second, he notes that it is crucial to build a demand for health. Policy shifts and economic strain increasingly threaten global health security efforts. He notes that there is a “very strong need to think about building demand and not to pretend that because you’re doing health and saving lives that everybody thinks that’s a great idea,”. “Actively cultivate that community, because you know if you don’t, then it doesn’t take much of a counter force — and we’ve seen this in the areas of vaccines and immunizations — to erode that base of support.” Lastly, the growing threat of disease requires that we expand beyond the “public sector-only mindset”. It’s critical to consider and utilize the private sector for public health efforts. He mentioned that “the public sector has massively important functions. But we have to look in a granular way, various ways, in which the private sector is active, will be active, and work with that in ways that are going to address burden of disease in cost effective manners,”.

Has The Deep State Hoodwinked Trump?
GMU Professor Charles P. Blair and biodefense MS student Rebecca Earnhardt are pointing to Trump’s recent military action in Syria and what really happened behind closed doors. “Though many of the administration’s more centrist supporters cheered the US missile strike on the Syrian air base, characterizing it as a bold move necessitated by the weakness of Barack Obama, other Trump supporters argued that the president had been tricked into a grand mistake. Was Trump the victim of a ruse by the ‘deep state’—a monolithic alignment of federal power centers so intent on maintaining command that it was willing to derail the new administration by encouraging it to pursue unwise military action? Or was the president misled by an even more ominous version of the deep state: one that subverts legitimate civilian leadership in a bid to recouple the United States to ‘regime change’ and similar globalist policies of militant ‘humanitarian’ interventionism?” Blair and Earnhardt look at this history of “deep state”, the rise of the “new world order”, and the growth of fringe beliefs in conspiracy and the notion of a hidden organization (think The X-Files, Men in Black, and the Matrix). “This elevated circulation of cross-pollinated conspiratorialism, now manifest in the increasingly normalized views of the fringe far right, has been facilitated not just by television and movies, as discussed above, but also by Internet platforms.” While not all associate the deep state with some totalitarian global group (which reminds me of James Bond‘s Spectre and Mission Impossible‘s Syndicate), the increasing belief in “sanitized conspiracies” has highlighted some changes how we form beliefs and what that translates to. Earnhardt and Blair also note that that while such beliefs have increased while faith in government, science, and the press have declined.

Why Are We More at Risk Than Ever for a Global Pandemic? 
GMU Biodefense PhD student, Saskia Popescu, looks at the seven reasons we’re more at risk than ever for a global pandemic. While concurring with a recent list following CNN’s pandemic documentary, she highlights two gaps within it – attitude towards infectious diseases and the role of healthcare infrastructure. “The current attitude towards infectious diseases puts us more at risk. Ebola brought the realities of borderless outbreaks to the forefront, especially with availability of faster information. Industrialized countries view diseases—emerging infectious diseases, in particular—differently than developing countries. In the United States, we relish our vaccine availability enough that we refuse it and often see emerging diseases as third world problems. Ebola showed us two things; the unfounded and irrational fear that occurred in the United States, and the lack of preparedness or acknowledgement that a disease in West Africa could venture across the pond.” She highlights the damaging implications of viewing emerging infectious diseases as “third world country problems” and what cultural shift is needed for this to change. The second missing component to the list is healthcare infrastructure and infection control efforts. “Physicians and nurses alike are desperately needed in developing countries; however, it is important to include another role that is often forgotten: infection control and prevention. Although there are fewer doctors and nurses in outbreak regions, there is also something to be said about the grossly underfunded and underutilized role of infection control as a preparedness and response tool. Whether it is in the United States or in a developing country, infection prevention and control programs are vital for both patient and employee safety, frequently understaffed, and economically strained.” Highlighting the nosocomial cases in Dallas, TX, she notes that infection control is bigger than just hospital-acquired infections and trickles down to antimicrobial resistance, communicable disease reporting, and patient isolation. “Overall, the way we look at emerging infectious diseases, our role in preventing and responding to them, and how we utilize (or fail to utilize) healthcare have created a substantial vulnerability for future public health threats. We have more than enough proof to show how vulnerable we all are to infectious diseases and how vital hospital infection control is to not only internal infections, but also preventing the spread from the community. Now is the time to truly utilize a holistic approach—including infection control programs, public education and cultural awareness, and more—to prevent the next pandemic.”

U.S. Biodefense Failures
Despite the bipartisan nature of biothreat preparedness, the U.S. struggles to to support such efforts. A recent Blue Ribbon Study Panel on Biodefense meeting highlighted yet again, the lack of leadership for U.S. biodefense efforts -whether that be an agency or person. “For at least two decades, infectious disease experts have been urging the U.S. government to do more to keep the country prepared for outbreaks of diseases such as a new strain of flu, Ebola and severe acute respiratory syndrome, or SARS. They’ve also noted that other countries have prepared biological weapons such as smallpox and anthrax and have used chemical weapons — such as Syria’s use of sarin gas against its own citizens.” Despite the constant supply of warnings from experts regarding the eventuality of a new flu pandemic, the 2014 Ebola outbreak, and concerns over dual-use research and gene editing, we just can’t seem to get it together. We know what the threat of infectious diseases, whether it be natural, intentional, or accidental, is real and will only increase as populations grow and globalizations strengthens. “The United States needs to be ready ahead of time, with stockpiles of drugs, vaccines and equipment, plans for deploying them and someone with the authority to make fast decisions, Cole and other experts said. The 2017 budget agreement worked out early Monday by Congress would provide just $57 million specifically to prepare for a new pandemic of influenza.” The truth is that U.S. response tends to be more reactive than proactive. We’ve gotten lucky so far in that the diseases weren’t highly transmissible with high fatality rates, but the truth is that our luck won’t hold forever.

Contaminated CRISPR Kits
This is quite an interesting twist in the concerns over DIY-gene editing…. While many worry about the outcomes of biohackers and garage genome editors, a recent finding of contaminated CRISPR kits sold by the company, The Odin, has added a new worrisome layer. The kits are normally sold online for $150 for those interested in doing gene engineering at home however, this recent finding by the European Centre for Disease Prevention and Control (ECDC) has resulted in a halting of all CRISPR kits imported into Germany. The kits were meant to contain harmless laboratory strains of E. coli HME63, however multiple kits were found to be contamined with several pathogens, including some that are antibiotic resistant. Klebsiella pneumoniae, Enterobacter, and Enterococcus faecalis were the microbial culprits found in the contaminated kits. The ECDC has stated that there is a low risk for users “because the manipulation of the kit does not involve percutaneous injury-prone manipulations. However, infection resulting from the contamination of broken skin or mucous membranes may occur, even though the kit recommends and provides disposable gloves. Furthermore, the kit includes lyophilised materials that need to be reconstituted, which may lead to contamination of the mucosae of the eyes, mouth and nose. Finally, the risk of infection may be increased for immunocompromised or immunosuppressed persons.” You can find the ECDC statement here, which notes that LGL, the Bavarian Health and Food Safety Authority, issued the press release in late March. There is also concern related to the potential release of drug-resistant organisms into the environment, of which the ECDC noted, “the potential contribution of the contaminated kit to the increasing burden of antimicrobial resistance in the EU/EEA is marginal, and the associated public health risk is considered very low”. They also encouraged users of the kits to appropriately dispose of their used materials to avoid releasing any drug-resistant bacteria into the environment.

Eastern Europe Antibiotic Usage Report
A new WHO report is providing information regarding antibiotic consumption and usage in 11 non-EU countries and Kosovo from 2011-2014. “The most commonly used class of antimicrobials was beta-lactams, whose share of the total ranged from 35.4% in Belarus to 65.6% in Azerbaijan, the report says. Cephalosporins accounted for between 6.1% (Azerbaijan) and 30.3% (Turkey) of total consumption, while the share for quinolones ranged from less than 0.1% in Uzbekistan to 17% in the Republic of Moldova. The report notes that cephalosporins and quinolones are broad-spectrum antibiotics and are considered second-line drugs in many prescribing guidelines. The two groups combined accounted for 10% (Azerbaijan) to 38% (Moldova) of total consumption.”

Workshop on Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology
Don’t miss this May 25th event at the National Academy of Sciences Building! This meeting will be open to the public, and will run from 8:30am until 4:30pm. The committee will hear from speakers who will discuss the current state of the science in DNA synthesis, assembly, and engineering; pathogen engineering and zoonosis; and ease of use as it relates to synthetic biology. There will be question and answer periods following each panel discussion, and members of the public will be invited to ask questions of the panelists, so we invite you to attend in person, if you are able. You can also check out the draft agenda here. It will be interesting to see if the workshop will discuss CRISPR kits and the potential for contamination.

Stories You May have Missed:

  • NIH Sets Research Cap on Funding for Scientists–  On Tuesday it was announced that for the first time, the NIH will restrict the amount of funding any individual scientists can hold at a given time via a point system. It is “part of an ongoing effort to make obtaining grants easier for early- and mid-career scientists, who face much tougher odds than their more-experienced colleagues. According to the agency, just 10% of grant recipients win 40% of the agency’s research money. Advocacy organizations and groups that advise the NIH director have been urging the agency to address this inequality for more than a decade. They are also concerned that increasing competition for grant money drives researchers to spend more time on paperwork and personnel issues associated with grants, and less time in the lab.”
  • Yellow Fever Vaccine Levels Are Dangerously Low – The CDC recently announced that the supply of yellow fever vaccine will be depleted by this summer. France is said to be able to cover the U.S. populations in need of the vaccine by the time the U.S. supply runs out, however the ongoing manufacturing problems continue to strain response efforts. “A number of vaccine doses were lost while Sanofi was transitioning vaccine production from an old site to new construction, slated to open in 2018.The United States uses 500,000 doses of yellow fever vaccine each year, distributed to travelers and military personnel who will be visiting yellow fever–endemic regions. Just 1 dose of the vaccine confers lifelong immunity, with recipients showing 80% immunity to yellow fever virus 10 days after inoculation and 99% immunity within 30 days. According to unpublished data from Sanofi, approximately 60% of these doses are distributed among about 4,000 civilian clinical sites.”
  • Attacking Antibiotic Resistance With Behavioral Approaches
    A recent Dutch study looked at antimicrobial stewardship strategies and found that by letting providers determine the root-cause of inappropriate antibiotic prescribing, they were more effective in responding to the problem. “The aim of the study was to test the effectiveness of a stewardship approach in which prescribers were asked to determine the root causes of inappropriate antimicrobial prescribing in their department, then develop one or more interventions to improve prescribing based on those root causes. The theory behind this strategy is that if you respect prescriber autonomy and allow prescribers to create their own program to improve prescribing, they will value this approach more and show more commitment to it.  Overall, there were 21,306 clinical admissions during the baseline period and 15,394 clinical admissions during the intervention period, with the appropriateness surveys including 1,121 patients and 882 patients, respectively. In the baseline period, 64.1% of antimicrobial prescriptions were considered appropriate, compared with 77.4% in the intervention period, an increase of 20.7% that equaled 4,927 improved days of therapy.”

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