Month: May 2018

Ebola Vaccine Deployment in DRC and Nipah Virus Takes Hold in India 
The Ebola vaccine has been deployed and many are holding their breath to see if not only this new tool works, but if lessons were truly learned from the last outbreak. As of May 21st, there were a totally of 58 cases, including 27 deaths. 28 of these cases were confirmed and 21 were probable. So far, five healthcare workers have been infected, with four of them confirmed and two deaths. “Currently, WHO considers the public health risk to be very high at the national level due to the serious nature of the disease, insufficient epidemiological information and the delay in the detection of initial cases, which makes it difficult to assess the magnitude and geographical extent of the outbreak. The confirmed case in Mbandaka, a large urban centre located on major national and international river, with road and air transport axes, increases the risk both of local propagation and further spread within DRC and to neighbouring countries. The risk at the regional level is therefore considered high. At the global level, the risk is currently considered low.” In response to the outbreak spreading to a larger, metropolitan area, many are wondering what cities nearby should start preparing for potential cases. Such concern is especially pertinent as it was reported that three infected patients fled an isolation ward and posed a potential threat for disease transmission. In efforts to identify potential areas at an increased risk due to travel, researchers used “flight data from the airports in Mbandaka, Kinshasa, and Brazzaville–those nearest Bikoro–EcoHealth Alliance has found the following cities to be most closely connected to the point of origin of the ongoing Ebola outbreak – Pointe-Noire, Republic of Congo, Adidas Ababa, Ethiopia, Brazzaville, DRC, etc.” Border closure is also frequently discussed during outbreaks, but realistically, how would it work? “Researchers who have studied earlier border-crossing outbreaks say the checks amount to little more than political theater. They do little to curb the spread of a disease, but they are likely to apprehend uninfected travelers, slow down commerce, and most importantly, impede the delivery of relief supplies. In a worst-case scenario, health stops may cause infected people to sneak to border crossings where checks haven’t been set up, spreading disease as they go.”  Money is starting to trickle in as the World Bank, the United States, and Germany, have contributed a joint $25 million to the DRC outbreak. The WHO is reportedly working with nine neighboring countries of the DRC to help contain the outbreak and prevent its spread. While all eyes have been on this outbreak, many are trying to draw attention to a very serious outbreak of Nipah virus in India. 10 people have died so far in the outbreak, including a nurse who was treating patients. “The first cases were reported Saturday in a family from Kozhikode, and then India’s Ministry of Health and Family Welfare and the World Health Organization were contacted, Vijayan’s office said Monday via Twitter. Two brothers in their late 20s and their aunt, 50, died from the virus, while their father, 56, remains on life support.” These outbreaks will surely be a topic of conversation during this week’s World Health Assembly at the WHO.

Worrisome White House Actions Surrounding Global Health Security
As Ebola burns through the DRC and India struggles with Nipah virus, the ability (or increasing inability?) for the U.S. to respond to such biological threats is becoming a seriously topic of concern. Within the span of a few days, the Ebola outbreak was declared in the DRC, the White House eliminated the Office of Global Health Security at the NSC, and the White House requested to rescind the $252 million in leftover Ebola response funds. These are just a handful of the the most recent red-flags for the Trump administration and its worrisome approach to health security. Kenneth W. Bernard asks “Has our national security leadership forgotten that, in 2001, anthrax-laced letters killed five and sickened 17 others in multiple states? Or that in 2014, 11 people were treated for Ebola in the United States, resulting in two deaths and widespread panic that nearly shut down the city of Dallas? Or that smallpox killed more people in the 20th century than all the wars of that century combined?” The Editorial Review Board at the New York Times has also cited concerns surrounding the amnesiac approach to Ebola the administration has taken– “The Trump administration has also failed to seek renewed funding from Congress for a global health security initiative begun after the 2014 epidemic. The goal of that initiative was to help high-risk countries prepare for future disease outbreaks in order to prevent pandemics. The White House has touted the success of those efforts but has done nothing to keep them going. And as funds have dried up, the C.D.C. has been forced to scale back or discontinue programs in some of the most vulnerable countries.”

WHO and World Bank Group Team Up for Global Health Security
In response the global threat of infectious diseases, the WHO and Work Bank Group have launched a new monitoring/reporting mechanism. “WHO Director-General Dr Tedros Adhanom Ghebreyesus and World Bank Group President Dr Jim Yong Kim co-led the creation of the Global Preparedness Monitoring Board, launched today on the margins of the 71^st Session of the World Health Assembly. The Board will be co-chaired by Dr Gro Harlem Brundtland, former Prime Minister of Norway and former WHO Director-General, and Mr Elhadj As Sy, Secretary General of the International Federation of the Red Cross and Red Crescent Societies. It will include political leaders, heads of UN agencies and world-class health experts, serving in their individual, independent capacities. ‘The ongoing Ebola outbreak in the Democratic Republic of the Congo is a stark reminder that outbreaks can happen anywhere, at any time,’ said Dr Tedros. ‘Part of being prepared is having a means of assessing progress made at all levels, by all actors, identifying gaps, including in financing, and making sure all actors are working together, pulling in the same direction. I’m proud of the work we’ve done together with the World Bank Group to establish the Global Preparedness Monitoring Board, and delighted that it will be led by such exceptional global health leaders,’ he added.”

Summer Workshop – Global Health Security
Don’t miss the chance to discuss these very issues at the Schar Summer Workshop on Pandemics, Bioterrorism, and Global Health Security. This workshop will include frank discussions with professionals and experts regarding the challenges of global health security, the current Ebola outbreak and vaccine, developing MCM, the democratization of science, and more. The early registration discount will end June 1st, so make sure you register soon!

Pandemic Preparedness in the Wake of Ebola -CSIS Symposium
Schar Biodefense graduate student Stephen Taylor recently attended the Center for Strategic & International Studies (CSIS) event on May 17th, in which global health security leaders from around the world discussed pandemic preparedness. Taylor notes, “Dr. Morrison and Dr. Borio discussed the importance of lessons learned during the 2014-2016 West African Ebola pandemic to global health security. In Nigeria, for instance, where Ebola containment efforts were successful, investments in detection and response capacities made for the Nigerian polio eradication program were instrumental in stopping Ebola. Surveillance systems and trained health care workers were embedded at the community level and field epidemiologists were ready to be deployed.”

 The Smithsonian’s “Outbreak: Epidemics in a Connected World”
Biodefense graduate student Zach Goble is reporting out on the newly opened exhibit at the Smithsonian’s National History Museum of Natural History. The museum “launched Outbreak: Epidemics in a Connected World, a new exhibit highlighting the impact infectious diseases have around the globe. The launching of this exhibit could not be more timely on the 100th anniversary of the 1918 influenza pandemic that shook the world. To officially announce and celebrate the opening of this new exhibit, the American Society for Microbiology (ASM), National Institute of Allergy and Infectious Diseases (NIAID), the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention (CDC), the American Society of Virology (ASV), and Research America all partnered together to brief the public on infectious diseases and the vaccines that stop them in their tracks”

NACCHO Radiation Readiness Twitter Chat
Don’t miss out on this June 5th chat to increase awareness of radiation preparedness. “The NACCHO Twitter handle (@NACCHOalerts) will be hosting the chat using #RadReady. The target audience for the Twitter chat is federal, state, and local health department representatives hoping to learn more about radiation preparedness and engage in conversation with their public health peers on radiation preparedness topics. All Twitter users are also are welcome to participate. Topics scheduled to be covered during this chat include: supporting mass care operations, dispelling common radiation myths, radiation response volunteers, etc.”

2018 George Mason 3MT – Biodefense
You can catch a glimpse at recent biodefense PhD graduate Chris Brown presenting his dissertation in under 3 minutes in the GMU 3MT competition. In the GMU 3-Minute-Thesis competition video, you can watch Chris (5:55-8:50) discussing his work – Protecting Critical US Workers from Occupational Exposure to Emerging Infectious Diseases. Congrats Chris!

Stories You May Have Missed:

• Surviving the 1918/1919 Pandemic– Jose Ameal discusses what it was like living through the 1918/1919 pandemic and the very real fear that was pervasive across the globe. “‘So many dead’, recalls Mr Ameal, now aged 103, of what he saw that autumn of 1918, when he caught the virus known around the world as Spanish flu – a pandemic that is thought to have killed at least 50 million people.”
• Theranos and Ebola – The wondrous possibility of rapid disease detection that was promised with Theranos has been dead for a while now, but recently, a report regarding their attempts to interject themselves into the 2014 Ebola outbreak have been shocking. USAID’s Jeremy Konyndyk details Theranos’s attempts to get involved in the outbreak, despite knowing their tests were flawed. “Whatever their motive, by 2014 they were clearly aware their tech didn’t work. And yet they were actively pitching it for use in the biggest outbreak emergency the world had seen in years.”

Thank you for reading the Pandora Report. If you would like to share any biodefense news, events, or stories, please contact our Editor Saskia Popescu (biodefense@gmu.edu) or via Twitter: @PandoraReport

Have you registered for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security? Don’t miss out on the early registration discount if you sign up before June 1st! Wondering if it’s safe to go back to romaine lettuce? Make sure to check the farm location as officials are saying this E. coli outbreak has a bigger footprint than that of the 2006 spinach outbreak.

White House Nixes Global Health Security in NSC
Just as Ebola hits the DRC, the National Security Council team responsible for global health security has been disbanded. “The top White House official responsible for leading the U.S. response in the event of a deadly pandemic has left the administration, and the global health security team he oversaw has been disbanded under a reorganization by national security adviser John Bolton. The abrupt departure of Rear Adm. Timothy Ziemer from the National Security Council means no senior administration official is now focused solely on global health security.” Following comments from Bill Gates about our lack of pandemic preparedness and Michael Osterholm’s on the challenges of predicting the next pandemic, a lack of health security coverage in the NSC is extremely worrisome. “Two members of Ziemer’s team have been merged into a unit in charge of weapons of mass destruction, and another official’s position is now part of a unit responsible for international organizations. White House homeland security adviser Tom Bossert, who had called for a comprehensive biodefense strategy against pandemics and biological attacks, is out completely. He left the day after Bolton took over last month.” Global health security threats, whether it be outbreaks, bioterrorism, or laboratory incidents, are only growing in complexity, which makes this particular shake-up deeply concerning for many in the biodefense world.

 New Ebola Outbreak in the DRC
Unfortunately, Ebola is rearing its head again in the DRC. Over the past five weeks, there have been reports of 21 suspected cases and 17 deaths. Two cases have been laboratory confirmed as Ebola and there are dozens of people under observation and contact tracing. “The DRC has become very good at controlling Ebola. The INRB in Kinshasa is more than capable of doing diagnostic tests without having to ship samples out to the United States. Its director, Jean-Jacques Muyembe Tamfum, was the first scientist to encounter Ebola at a time when he was the DRC’s only virologist, and has been involved in every outbreak response since. He and his colleagues have also trained a crack-team of researchers and disease detectives. ‘We’re advanced in public health,’ said Gisèle Mvumbi, a CDC-trained Congolese epidemiologist at the INRB, whom I met when I visited the DRC earlier this year. ‘If you compare us with Europe or the United States, eh, but here in Africa, we are high. We have experience’.” The WHO has officially declared the DRC cases as an outbreak, so now many are wondering if the vaccine will be deployed. The timing of the outbreak though, coincides with Trump’s plans to rescind $252 million that was set aside for Ebola response, citing that the outbreak was declared over in 2016 and that it is excessive spending.

The Characteristics of Pandemic Pathogens
The Johns Hopkins Center for Health Security has just released their new report on the characteristics of naturally occurring microorganisms that could cause a global catastrophic biological risk (GCBR). “The overarching aim of the study was to provide an inductive, microbe-agnostic analysis of the microbial world to identify fundamental principles that underlie this special category of microorganisms that have potential to cause global catastrophe. Such principles could refine pandemic preparedness by providing a new framework or lens through which to survey the threat landscape of infectious diseases in order to better anticipate, prepare for, and respond to GCBR threats.” Within the report, they compile information from 150 experts to discuss modes of transmission, host population dynamics, how human factors and/or complex disasters can elevate pathogens to GCBR, etc.

The Slow Death of Nonproliferation Norms
Charles Blair is taking a hard look at the global shifts in norms regarding the possession and use of chemical weapons. Blair, a GMU biodefense adjunct professor, points to two specific events over the span of just under two weeks, that challenged how the U.S. responds to foreign leaders who take a relaxed approach to CW. Trump’s congratulations to Putin on his re-election and the willingness to meet Kimg Jung-un are “in line with a broad, ominous shift in international attitudes toward chemical weapons and their use. The shift is alarming enough in its own right—but changes in norms that stigmatize chemical weapons directly affect other, and collectively far more important, pillars of the nonproliferation regime.” The rapid international degradation within the nonproliferation regime is surprising, notes Blair, but there were signs starting in 2012 that may have given us a heads up as to the future fissures. Telling moments for norms erosion has been repeatedly seen in the use of chemical weapons in the Syrian civil war and how the international community handles the continued possession and utilization of chemical weapons by the Assad regime. Russia, especially, has been an enabler for Assad and whose actions have been corrosive to the nonproliferation regime. Blair’s interviews include “Gregory Koblentz—director of the Biodefense Graduate Program at George Mason University— (who) discussed ‘just how little Russia cares about these norms and treaties.’ As evidence he cited Russia’s willingness to discount Syrian violations of international norms and to actively shield Damascus from the consequences of violations—by, for example, undermining the Joint Investigative Mechanism, the Fact-Finding Mission, and the overall investigative process in Syria. Koblentz said that because of Russia’s willingness to undermine the chemical weapons regime, he is concerned that Moscow might also be willing to undermine the International Atomic Energy Agency and the Nuclear Non-Proliferation Treaty. Russia, Koblentz said, is ‘the principle vector for the erosion of norms across all the nonproliferation regimes’.” Lastly, Blair underscores the important role the United States has in enforcing nonproliferation norms and the potential for Trump’s recent withdrawal from the Iran nuclear deal, to become a trigger for proliferation. “The irony, of course, is that any US military action against Iran, North Korea, or both would come wrapped in the cloak of norm enforcement—when, quite likely, Trump’s own pursuit of non-normative policies would cause North Korea to keep its nuclear weapons program and Iran genuinely to pursue a program of its own.”

Clade X Table Top
The Johns Hopkins Center for Health Security will be hosting the Clade X exercise next week “to illustrate high-level strategic decisions and policies that the United States and the world will need to pursue in order to diminish the consequences of a severe pandemic. It will address a pressing current concern, present plausible solutions, and be experientially engaging. Clade X is designed for national decision-makers in the thematic biosecurity tradition of the Center’s two previous exercises, Dark Winter (2001) and Atlantic Storm (2005).” The event will run from 9am to 5pm on Tuesday May 15^th and while seats are invitation only, you can livestream it on their Facebook page.

North Korean Ties with Hamas?
Following the assassination of a Palestinian academic with ties to the Hamas resistance, Malaysian police are working to find two Israeli Mossad agents who are considered the culprits.”With elections underway in Malaysia, the murder has been downplayed, but the investigation is in full-on mode. ‘If Israel is behind it, that seems to be an extension of their policy regarding Iranian nuclear scientists,’ said Sonia Ben Ouagrham-Gormley, associate professor at the George Mason University Schar School of Policy and Government’s Biodefense Program in Virginia, via email. ‘In the past few years, several Iranian nuclear scientists were killed, and many suspected Israel of being behind those killings. The problem with assassination is that it is counterproductive: it can cause the scientists to work harder at reaching a working weapon’.”

NASEM Bio, Chem, and Health Security Luncheon – May
Don’t miss out on this May 21^st luncheon held by the National Academies. “May’s event will be chaired and moderated by the National Academies’ Board on Health Sciences Policy. Itfeatures Greg Measer, Regulatory Counsel in the Food and Drug Administration (FDA)’s Office of Counterterrorism and Emerging Threats. He will discuss FDA’s initiative to build a national capacity for post-dispensing monitoring and assessment of medical countermeasures. The session also builds on issues discussed at a 2017 National Academies’ workshop on Building a National Capacity of Monitor and Assess Medical Countermeasure Use in Response to Public Health Emergencies.” If you’re unable to attend the event, we’ve got you covered, as one of our GMU Biodefense graduate students will be attending and reporting out.

Stories You May Have Missed:

• Clinical Outcomes and Trends of Patients with Carbapenem-Resistant Infections – What are the outcomes of patients with carbapenem-resistant infections? GMU biodefense PhD student Saskia Popescu discusses a recent study that evaluates similarities between those with such resistant infections. “The study was conducted in a single-center tertiary-care hospital in St. Louis, Missouri, at which researchers reviewed differences between patients with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenem-resistant non-Enterobacteriaceae (CRNE). Patients with positive CRE or CRNE cultures found from January 2012 to December 2015 were analyzed. However, researchers sought to avoid inclusion of those with colonization instead of true infection, so patients without sepsis and cystic fibrosis were excluded, as were those who were discharged without having received targeted antimicrobial therapy.”

• Experts Discuss 1918 Pandemic and Global Flu Threat – The CDC and Emory University partnered up to hold a symposium in celebration of the 100^th anniversary of the 1918 pandemic, to discuss the next pandemic and how we can prepare. Michael Osterholm and Arnold Monto debated regarding a universal flu vaccine. “Nancy Messonnier, MD, head of CDC’s National Center for Immunization and Respiratory Diseases, said that despite gaps in preparedness, the CDC is better equipped to handle a flu pandemic now than it was in 2009, when a novel H1N1 flu strain first emerged. Technologies, including mobile apps that help consumers find flu shots, and antivirals are putting the power to prevent and fight flu into patients’ hands, she said.