Pandora Report 6.2.2017

Good news – the early registration discount for the Pandemics, Bioterrorism, & Global Health Security Summer Workshop has been extended to July 1st! We’ve got a full Pandora Report for you this week, so buckle up, it’s going to be quite a ride!

Worries, Woes, and Realities of Global Health Security
Novel diseases are a near certainty in life (perhaps the saying should be death, taxes, and disease?). Whether it be a natural event, an accidental lab exposure, or by the hand of a bioterrorist, the threat of a pandemic is real. Five infectious disease experts recently convened to discuss the threat of pandemics and what worries them most about future outbreaks. From this meeting they found five issues that truly worry them. First, the lack of trust in scientists and experts. Second, learning lessons from the past. “Tom Frieden said he’s concerned that people won’t study responses to recent pandemics enough to improve responses to future ones. ‘The world has a unique opportunity following Ebola to close gaps, to address blind spots around the world and to become much safer. If we don’t take action very quickly to close the gaps that are being identified, we will lose that opportunity,’ he said.” Third, antibiotic resistance and the continuous spread of resistant bacteria. Fourth, destruction of species and environments that might hold the key to future medical breakthroughs (we’ll be talking more about this one in a bit…). Lastly, they worry about funding for public health workers and that they have the resources needed when fighting epidemics on the front lines. Sadly, a newly established score card on global health found the U.S. lacking. This new measurement tool uses the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) to establish a healthcare access and quality index. Countries that improved in deaths avoidable due to healthcare at their economic level over the last twenty-five years were China, Ethiopia, the Maldive Islands, Peru, etc. “By that standard, the United States improved slightly over the same period, 1990 to 2015. But the American ranking is still so low that it’s ‘an embarrassment, especially considering the U.S. spends $9,000 per person on health care annually,’ said the report’s chief author, Dr. Christopher J. L. Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, created by the Bill and Melinda Gates Foundation.”

Digital-to-Biological Converter  
Synthetic Genomics Inc. is bringing a bit of excitement to the world of synbio via their announcement within a peer-reviewed Nature article describing this new technology. The development of the digital-to-biological converter (DBC) marks a huge step in synthetic biology. The DBC produces biological compounds on-demand and without any human intervention. The unit is fully automated and allows the “user to create complex synthetic DNA in a single process. To demonstrate feasibility, researchers digitally transmitted a file with DNA sequence information to the DBC. The DBC converted that digital sequence into oligonucleotides, and utilized synthetic biology tools developed by Synthetic Genomics such as gene synthesis, error correction, and Gibson Assembly™ methods to create large and complex DNA constructs with high fidelity. Utilizing this DNA as a template, the DBC further produced a series of biological materials without any human intervention, such as RNA, proteins, and viral particles.Biological products created on the DBC included DNA templates for an influenza vaccine, an RNA-based vaccine, antibody polypeptides, and a bacteriophage.” Co-founder J. Craig Venter noted that the DBC is also the first machine of its kind and can receive digital biology in the form of DNA sequences via the internet or radio wave! “The DBC prototype fully integrates and automates processes from oligonucleotide design and synthesis to the production of biopolymers. Development of a smaller and portable DBC could enable reliable production at the point of demand and potentially reduce costs and increase access to bio-production in research laboratories. Finally, with the incorporation of large-scale synthesis technologies, one can envision the DBC being used in industrial settings to enable high-volume production of biologics such as proteins and RNA vaccines.”

ISIS & CRISPR Article Critique Writing Competition
Calling all GMU biodefense students! A recent article came out in Foreign Affairs that made some rather interesting comments regarding CRISPR, bioterrorism, and the threat of synthetic biology. We’re holding a competition for biodefense students (past and present) to write a critique on the article (700-1,000 words) and the winner (selected by Dr. Koblentz) will be featured in Global Biodefense. Please email me with any further questions and submissions (spopesc2@gmu.edu). The due date for this is June 17th. We look forward to reading your thoughts!

Pandemics, Bioterrorism, & Global Health Security Workshop Instructor Spotlight 
If you’re hoping to learn from a USAMRIID commander, NSABB member, UN Special Commission chief inspector, and veterinarian for the 10th Special Forces Group (Airborne), look no further than Dr. David R. Franz! He’s our spotlight instructor this week and will be teaching at our summer workshop in July. Dr. Franz has current standing committee appointments including the Department of Health and Human Services National Science Advisory Board for Biosecurity (NSABB), the National Academy of Sciences Committee on International Security and Arms Control, the National Research Council Board on Life Sciences, and the Senior Technical Advisory Committee of the National Biodefense Countermeasures Analysis Center. Dr. Franz was the chief inspector on three United Nations Special Commission biological warfare inspection missions to Iraq and served as technical advisor on long-term monitoring. He also served as a member of the first two US-UK teams that visited Russia in support of the Trilateral Joint Statement on Biological Weapons and as a member of the Trilateral Experts’ Committee for biological weapons negotiations. Dr. Franz was technical editor for the Textbook of Military Medicine on Medical Aspects of Chemical and Biological Warfare released in 1997. He serves as a Senior Mentor to the Program for Emerging Leaders at the National Defense University. He also serves on the Board of Integrated Nano-Technologies, LLC. Dr. Franz holds an adjunct appointment as Professor for the department of Diagnostic Medicine and Pathobiology at the College of Veterinary Medicine, Kansas State University. The current focus of his activities relates to the role of international engagement in the life sciences as a component of national security policy. Dr. Franz holds a DVM from Kansas State University and a PhD in physiology from Baylor College of Medicine. Even better, he’ll be lecturing on dual-use research at the workshop, so make sure to register!

Financial Cuts to Biodefense – Are We Digging Our Own Grave?
Despite a stark outlook painted from the looming threat of pandemics and the realities of American public health inadequacies, things are being further compounded by proposed budgetary hits to biodefense. A 10% increase in military spending means that other government agencies will take a hit, of which many are involved in biosecurity and biodefense. “The Office of Public Health Preparedness and Response, which tracks outbreaks of disease, would be cut by $136 million, or 9.7 percent. The National Center for Emerging and Zoonotic Infectious Diseases — a branch of the Centers for Disease Control and Prevention that fights threats like anthrax and Ebola — would be cut by $65 million, or 11 percent. The CDC’s Center for Global Health would lose $76 million, or 18 percent. Its Emergency Operations Center, which conducts real-time monitoring of outbreak responses, and its Select Agents Program, which sets regulations in lethal toxin labs and helps researchers stay ahead of bioterrorists, face unspecified cuts as well.” Fear is flourishing as there are substantial gaps in the appointment of positions within key federal agencies that are responsible for outbreak response and global health security. The 700 vacancies at the CDC alone is troubling as cases of Ebola continue to bubble up in the DRC and China fights back against a deadly outbreak of avian influenza. Many experts, like J. Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic and International Studies, are horrified and note that these drastic cuts will surely impact health security. A recent op-ed by faculty from the Johns Hopkins Center for Health Security highlights the proposed budget and how it makes the U.S. vulnerable to bioterrorism. In the event of such an attack, there are several links in the response chain that will invariably lose capacity and capability following such budgetary cuts- first responders, hospital staff, public health professionals, MCM research, decontamination efforts, etc.  In fact, the recent announcement of the expected closure of  NBACC, the Fort Detrick research lab only fuels concern. “While the overall spending for the Department of Homeland Security increases in Trump’s budget request, that department also zeroes out funding for the National Biodefense Analysis and Countermeasures Center (NBACC) at Fort Detrick.” NBACC is barely seven years old and is the government’s leading organization for forensic epidemiology in the event of a biocrime or bioterrorism. It is a world class facility for biodefense, collaborates with NIH and the DoD to conduct research gaps, and maintains several partnerships to strengthen U.S. biodefense and global health security. “’President Trump’s budget undermines important work being done in Frederick County to protect our troops and our national security. It guts federal investment in scientific research that saves lives, keeps our nation safe, and supports good-paying jobs in our state. The National Biodefense Analysis and Countermeasures Center at Fort Detrick, which helps protect America from biological threats, is doing critical work and I will fight these cuts and this ill-conceived budget in the U.S. Senate,’ said Sen. Chris Van Hollen (D), who is a member of the Senate’s budget and appropriations committees.” Governor John K. Delaney (MD) recently voiced his concern for the potential closure of NBACC, noting that he is “100% opposed to the closing of the National Biodefense Analysis and Countermeasures Center in Frederick and will fight this deeply misguided move by the Trump Administration. While DHS may be moving forward with plans to close the facility based on the assumption that the President’s request will be enacted, I want to stress that President Trump’s budget proposal is not law yet, that all funding and appropriations matters must go through Congress and that Trump’s budget overall has very little support in the House and Senate.” Unfortunately, as the threat of infectious diseases only grows, these cuts and closures will severely impact global health security. As the faculty from the Johns Hopkins Center for Health Security noted, “We urge Congress to reject the severe cuts proposed by the Trump administration and to support the continuation of these and other critical national biopreparedness and response assets, which protect the health and safety of all Americans.” On top of the budgetary impact to biodefense efforts, Thursday brought forth the troubling news that President Trump will end U.S. involvement in the Paris Climate Agreement . Many experts are highlighting the untold damage that will come from this move by way of climate change and international relations, but also the unintended consequence that is so easily forgotten – the spread of infectious diseases.

National Biosafety and Biocontainment Training Program (NBBTP)
Don’t miss the July 5th deadline for this amazing opportunity! “The NBBTP was conceived as a partnership between the National Institute of Allergy and Infectious Diseases (NIAID) and the Division of Occupational Health and Safety (DOHS) at the National Institutes of Health in Bethesda, Maryland. The program is administered by CDIC, Inc. The NBBTP Fellowship is a two-year program designed to train Fellows specifically to support high containment research environments by acquiring knowledge and skills necessary to meet the scientific, regulatory, biocontainment, biosafety, engineering, communications, management, and public relations challenges associated with the conduct of research in these facilities. NBBTP Fellows do not engage in any primary patient care activities. The mission of the NBBTP is to prepare biosafety and biocontainment professionals of the highest caliber to meet the needs of the biomedical emerging disease and civilian biodefense research communities through the 21st century.”

Outbreak Insurance
Instead of a tiny gecko or duck, perhaps the mascot would be a friendly looking microbe? Metabiota has a new CEO and a plan for outbreak response that involves insurance. Bill Rossi thinks that this could be the key to stopping outbreaks and Metabiota plans to help by providing the monitoring tools that would facilitate its success. “The company’s chief executive said that the new policies will provide financing in the wake of deadly pandemics and encourage multi-national corporations and nation-states to invest in preventing the spread of disease. Metabiota launched its insurance product last month and has been pitching its services to insurers, nations, and companies ever since. Indeed, Metabiota is partnering with the African Risk Capacity (ARC) agency, an agency of the  African Union (AU) to help nations respond to threats.” Rossi points to the growing interest in pandemic insurance since the 2014 Ebola outbreak and acknowledges that there will have to be work to avoid potential abuse of such policies that would result in perverse incentives (i.e. profitable insurance payouts should a country be afflicted by an epidemic). Regardless of insurance, early detection systems are a necessary investment and that’s where Rossi and his Metabiota team come in. Metabiota is working with “sovereign nations and also the insurers who have the financial wherewithal to ensure that policies are put in place to prevent the spread of disease.” Epidemic insurance is looking better every day, especially after the World Bank revealed that most nations aren’t ready for a pandemic. Recently, a working group was tasked with evaluating the world’s pandemic readiness and sadly, they found that most countries simple aren’t prepared. “Recent economic estimates suggest the global total for a moderately severe to severe pandemic could be $570 billion, or 0.7% of the world’s income. The 131-page report said many countries chronically underinvest in critical public health tasks that help with early identification and containment of infectious diseases: surveillance, diagnostic labs, and emergency operations centers. It also spells out 12 recommendations to ensure adequate financial support and infrastructure”. The recommendations include preparing a detailed financial proposal to support implementation of the plan to improve preparedness, developing partners and building on existing collective and bilateral commitments to help finance preparedness in countries needing support, etc.

Unexpected Mutations Following CRISPR           
I guess what happens in CRISPR doesn’t stay in CRISPR, eh? A recent letter published in Nature notes that despite the hopes many had for the gene editing technology as a means of solving disease-causing mutations, a new study found that there were some unintended changes to other genes. “When correcting blindness in mice, researchers at Columbia University found that though CRISPR did manage to successfully edit the particular gene responsible for blindness, it also caused mutations to more than a thousand other unintended genes. The off-target effects of CRISPR have long been known, but this new research highlights just how extensive they can be, and highlights the importance of research to understand them.” Shortly after the letter was published in Nature, investments in genome-editing companies took a hit and stock prices dropped.

Ebola in the DRC
This week the DRC approved the use of the experimental Ebola vaccine rVSV-ZEBOV. The WHO plans to use a ring vaccination method to roll out the new vaccine. “The situation report also said that several cases of suspected Ebola have now been ruled out, meaning the outbreak appears to be not as extensive as once feared. As of Sunday, there were 2 confirmed, 3 probable, and 14 suspected cases. No new possible cases have been identified since May 11.” You can read the latest WHO situation reports here for updated case counts and geographic distribution.

Virus Hunters
Researchers are currently hunting for the next lethal virus in the Democratic Republic of the Congo (DRC). The team is in the DRC with the PREDICT project, which is part of USAID’s Emerging Pandemics Threat program to create a database of zoonotic pathogens that are the most likely emerging pandemic threats. “If scientists can detail the places where lethal viruses simmer in wait, the thinking goes, they can head off a swelling pandemic and better manage outbreaks while they are still small and local. Researchers and other outbreak responders could consult this database to begin mapping the source of an emerging disease, for example, and quickly get to work on minimizing transmission and developing potential new vaccines that could save countless lives. ‘We have a job to do,’ Dr. Prime Mulembakani explains. ‘We also have the opportunity to be in contact, in close contact, with people who are on the front line—the communities who are really at risk for a virus spillover from animals into people.’ The irony of potentially disease-carrying bats hanging from the rafters of the local health center is not lost on Mulembakani, an epidemiologist by training, and he pauses for emphasis: ‘We need to stop these events from getting out of control’.”

Stories You May Have Missed:

• Pale Rider – The Spanish Flu of 1918 and How It Changed the World – Laura Spinney’s new book, Pale Rider, is coming out this fall, which details the history of the 1918 pandemic. Spinney takes the reader through a journey of the influenza virus history and how the pandemic was quickly forgotten after it took as many as 100 million lives. “By early 1920, nearly two years after the end of the first world war and the first outbreak of Spanish flu, the disease had killed as many as 100m people— more than both world wars combined. Yet few would name it as the biggest disaster of the 20th century. Some call it the ‘forgotten flu’. Almost a century on, Pale Rider, a scientific and historic account of Spanish flu, addresses this collective amnesia”.
• Salmonella Outbreak in 47 States – Nearly 400 have been sickened following a salmonella outbreak tied to live poultry. “Since early January and through May 13 the outbreaks have sickened 372 people in 47 states. So far, 71 people have been hospitalized but no deaths have been reported. Just over a third (36%) of the sick patients are children. During the investigations, interviews revealed that 83% (190) of 228 sick people had contact with live poultry the week before they got sick. People bought live baby poultry from a variety of sources, including feed supply stores, Web sites, hatcheries, and relatives.”