Pandora Report 4.27.2018

Happy Friday! To start the weekend right, let’s take a walk down memory lane with this list of deadly epidemics throughout history. In fact, March 25th, was World Malaria Day!

 Inside the Strategic National Stockpile
Warehouses filled with millions of doses of medical countermeasures to protect Americans against infectious disease outbreaks or bioterrorism – that’s what makes up the SNS. The national stockpile is not new, but ownership will soon change as the Trump administration moves oversight from the CDC to a separate department within HHS. ASPR (Office of the Assistant Secretary for Preparedness and Response) is set to take charge of choosing and purchasing what products go into the SNS, come October. “But some public health officials and members of Congress in both parties worry the move will disrupt a complex process that relies on long-standing relationships between the federal program and the state and local agencies responsible for distributing the medicine. During a congressional hearing last week, lawmakers expressed concern that a change could risk the government’s ability to deliver lifesaving medical supplies to what public health officials call ‘the last mile’ — to people in need during a disaster.” While some are opposed to the shift in oversight, others say it will streamline processes. Unfortunately, there is also increasing concern that this move will encourage biotech companies to lobby for specialized, more expensive drugs.

Elevating CRISPR-Cas9
GMU Biodefense graduate student Janet Marroquin is delving into a world of CRISPR and artificial intelligence. “The contentious debate regarding the precision of the commercially available gene-editing tool, CRISPR-Cas9, continues as Nature recently retracted a study published last year on the unintended effects of off-target mutagenesis. The 2017 study used CRISPR-Cas9 to edit a genetic mutation causing blindness in mice but the researchers observed CRISPR-induced mutations in other genes due to off-target editing at higher rates than previously documented.” Marroquin asks – what does this mean for evaluating off-target effects on gene editing? “Joining independent research teams in the application of data analytics and machine learning to gene-editing is Microsoft’s artificial intelligence tool, Elevation, designed specifically for the prediction and reduction of off-target effects by CRISPR.”

Facing the Myths Surrounding Proliferation Financing
A recent report from the Financial Action Task Force (FATF) was released regarding the financing of WMD proliferation however, an assessment by the Panel of Experts left many with a dismal feeling. “This assessment detailed several shortcomings in global sanctions implementation that have allowed North Korea to stay connected to international banking channels. The report concluded that North Korea is ‘flouting the most recent resolutions by exploiting oil supply chains, complicit foreign nationals, offshore company registries, and the international banking system’.” The report highlights North Korean actions to skirt financial sanctions, but many are pointing the task force guidance as being misaligned with the findings from the panel. The UNSC resolutions underscore two approaches to proliferation financing – the first is found in Resolution 1540 and requires member states to implement prevention measures for non-state actors, and the second requires states to create and maintain processes to implemented targeted financial sanctions. Implementing targeted financial sanctions and monitoring activities can be challenging though, so what should be done? Information-sharing relationships could be hugely beneficial. “In fact, Sonia Ben Ouagrham-Gormley—an associate professor at George Mason University’s Schar School of Policy and Government, and one of the first to write about the challenges of addressing proliferation financing—recommended in 2012 that governments increase information-sharing relationships with the private sector. This recommendation has since been championed in several other outlets, including an April 2017 report by the Royal United Services Institute and an October 2017 report by King’s College London.” Ultimately, as Aaron Arnold noted, “To make real gains in countering proliferation financiers, policy makers need a fresh approach—one that addresses the institutions that enable proliferation financing and allow proliferator networks to hide behind anonymous corporate registries. Perhaps a good place to start is at home—the United States is one of the world’s biggest secrecy jurisdictions.”

Health Security Workshop – Are You Prepared For The Next Pandemic?
Worried you’re not prepared for the next zombie apocalypse or pandemic influenza? Attend our workshop on health security, bioterrorism, and pandemics to understand the full spectrum of biological threats. We can’t guarantee you’ll survive zombies, but we can guarantee you’ll walk away with more biodefense knowledge and a healthy dose of excitement for all things health security. Don’t miss the early bird registration discount that ends on May 1st!

Attacking Health Facilities – Syria
Critical health infrastructure is vital to national stability and security. Just as we view laboratory capacity and surveillance as crucial components to health security, the ability for people to seek medical care comes into play. What if these facilities were targeted though? A public health research team from UC-Berkley has been monitoring reports in Syria of attacks on healthcare facilities since 2016. “Over 2016 that averages out to more than one attack every other day, says Haar. In the attacks her team analyzed, 112 health-care staff and 185 patients died. Haar and her team found that the majority of attacks occurred via aerial bombing, so it was difficult to identify a perpetrator. These attacks from above nearly always damaged structures. As a result of the attacks, eight clinics and hospitals were permanently closed; 41 other health-care facilities closed temporarily.” You can read the publication here. The researchers were shocked to find out how many health care facilities were attacked. 33 of the hospitals experienced more than one attack in 2016 alone. In fact, two hospitals in Aleppo were attacked over ten times. The notion of health security is a newer one and as threats and technology evolve, attacks like these may come into the dynamics of what it means to establish global health security. As Filippa Lentzos noted – perhaps it’s time to expand the definition of biosecurity to include deliberate threats to healthcare infrastructure.

The Relationship Dynamics of Public Health, Health Care, and Journalism
GMU Biodefense PhD student Saskia Popescu recently sat on a panel at the Association of Health Care Journalists regarding pandemic preparedness. Discussing outbreaks like Ebola and the 1918 influenza pandemic, the panel included physicians and journalists who brought forth experiences in the field and working with the press. “In a world that is led by eye-catching headlines, how can we relay the necessary (and critical) information that may not be as ‘headline-worthy’? Moreover, how can we provide information to the public that can help stop both disease transmission and the spread of fear? There are 2 sides to this challenge; for journalists, they need to understand the basics of epidemiology and infectious diseases transmission, and also the impact of their words. For health care providers and public health officials, ensuring that you emphasize the critical points that can help dissuade fear (ie, specifics of exposures, incubation times, etc) and work with journalists to ensure the right message is being put out.”

 Cargo Ships – The Trojan Horse of Antibiotic Resistance
I fear the cargo ships, even when they bring gifts?  In hindsight, it’s not surprising to think that ships that travel around the world bringing cargo from all over, would also carry germs with them. Buried in the bowels of cargo ships, researchers found 44 species of bacteria and 10 antibiotic resistant genes. It doesn’t help that in some cases, antibiotics are actually painted into the hulls of the ships to reduce growth of barnacles. “Dame Sally Davis, the British Chief Medical Officer, told the ministers that the common antibiotic Tetracycline, which is used to treat common infections in patients, was being added to paint for use on the hulls of ships to prevent the build up of algae and barnacles, known as fouling.” In the larger struggle against antimicrobial resistance, things like this are no longer surprising – the battle against the resistant bug is complex, challenging, and almost humorously persistent.

Stories You May Have Missed:

• Australia Battles HTLV-1 – “B is talking about a sickness that has killed her family member and is a potential tragedy facing Aboriginal communities in central Australia, who have the world’s highest rates of a fatal, human immune virus for which there is no current cure, no treatment and no coordinated public health response. Human T-lymphotropic virus type 1 (HTLV-1) is transmitted through sexual contact, blood transfusion and from mother to child by breastfeeding. It can cause a rapidly fatal form of leukaemia. Some people die within weeks of diagnosis. HTLV-1 also causes inflammation of the spinal cord leading to paralysis, severe lung disease known as bronchiectasis and other inflammatory disease. In five communities around Alice Springs, more than 45% of adults tested have the virus, a rate thousands of times higher than for non-Indigenous Australians.”