Pandora Report: 1.18.2019

Welcome to your weekly dose of all things biodefense – we’ve got a lot of health security goodies for you this week!

OPCW Agrees to Ban Novichok
The Organization for the Prohibition of Chemical Weapons (OPCW) Executive Council approved adding two families of chemical compounds (Novichok) to the list of Schedule 1 chemicals that are subject to verification. “The 41 members of the decision-making body within the Organisation for the Prohibition of Chemical Weapons (OPCW) adopted a joint proposal by the United States, the Netherlands and Canada, member states said. They agreed ‘to add two families of highly toxic chemicals (incl. the agent used in Salisbury),’ Canada’s ambassador to the agency, Sabine Nolke, said on Twitter. ‘Russia dissociated itself from consensus but did not break,’ she wrote. Western allies ordered the biggest expulsion of Russian diplomats since the height of the Cold War in response to the attack on former Russian secret service agent Sergei Skripal and his daughter Yulia in Salisbury in March.” You can read the OPCW decision release on January 14th here. The Novichok family of chemical warfare agents were developed by the Soviet Union in the 1970s. In 2018, a Novichok CW agent was used in the attempted assassination of Sergei Skripal in Salisbury and led to the contamination of him, his daughter, a police officer, and two private citizens in the nearby town of Amebury, one of who died.

GMU Biodefense Alum Spotlight – Tam Dang
We love to show off the amazing alumni of GMU Biodefense and we’re excited to tell you about Tam Dang – epidemiologist and communicable disease all-star at the Dallas County Department of Health and Human Services. Tam works as an epi for the acute communicable disease division, helping to lead epidemiological investigations for outbreaks or potential bioterrorism events, monitors local/regional/state data sources related to infectious diseases, helps develop outbreak/bioterrorism plans to help support public health preparedness, and analyzes data collected as part of a vector control/bioterrorism surveillance team. Whether it be West Nile, enteric diseases or tuberculosis, Tam’s working to help improve communicable disease preparedness and response. Tam started in the biology world but her Schar Biodefense MS degree “introduced me to the public health field, and offered a unique perspective from a biosecurity and bioterrorism standpoint. It helped me stand out from the pile of applications my supervisor received. In addition, my biology background and prior employment experiences also played a large part in rounding out my graduate education and narrowing my professional field of interest. Overall, past experience and the added education and skills I obtained from the Biodefense Program were a critical factor in helping me pursue my career goals.” Her work is at the intersection of public health and health security. When asked what she felt was the biggest health security threat we’re facing in 2019, Tam noted that “I think some significant health security threats we are facing in the US in 2019 are related to the potential for importations or outbreaks of high-consequence emerging infectious diseases (HCID) such as Ebola and avian influenza. In a metropolitan area like Dallas/Fort Worth, our Public Health Emergency Preparedness (PHEP) division is keenly aware that our proximity to the Dallas/Fort Worth (DFW) International Airport confers particular risk for international importations of infectious diseases. The DFW airport is the twelfth busiest airport internationally, and received the highest number of travelers from countries affected by Ebola outbreaks in 2014-2015, of any airport within Texas. The local health security impact of such global interconnectivity was highlighted in Dallas during the 2014 Ebola outbreak, when a patient from Liberia was diagnosed with Ebola, and two nurses involved in his medical care were subsequently infected with Ebola. Because of this past experience, the current Ebola outbreak affecting the Democratic Republic of Congo has been watched closely by our PHEP epidemiologists over the past year, and this team has been busy participating in drills with area hospitals, and facilitating planning meetings with area hospitals and other community agencies to ensure appropriate measures are in place to rapidly identify, isolate, and evaluate possible cases.”

Revisiting the 2001 Anthrax Attacks and Investigation
The impact of the 2001 anthrax attacks may be slowly fading from memory but the truth is that it had profound implications for American perception of biological threats and fueled a booming biodefense initiative. GMU Biodefense PhD alum Glenn Cross discusses the new book from Scott Decker on the attacks and the evolution of forensics in the FBI. “Scott Decker’s book on Amerithrax is the first and, so far, only insider account of the science involved in the investigation. Decker served as an FBI special agent, one of very few in the bureau with a PhD in the life sciences. His strong academic background and experience in the FBI’s then-fledgling bioforensics effort ensured his rise to a prominent role in the Amerithrax investigation. In time, Decker became the supervisory special agent overseeing Amerithrax’s Squad 2, which was responsible for the scientific and forensics work of the task force. Thus, Decker is perhaps one of only a handful of people capable of providing comprehensive insight into the inner workings of Amerithrax’s bioforensics effort. His book likely will be the only one to offer such a detailed and unique perspective into the U.S. government’s response to the first deadly bioterrorism attack on American soil in peacetime”.

Bill Gates Warns About Gene Editing
Bill Gates recently spoke about gene editing technologies and that we simply are not having enough public debate regarding the ethical implications. “It also raises ‘enormous’ ethical questions, Bill Gates recently warned, and ‘could make inequity worse, especially if it is available only for wealthy people.’ ‘I am surprised that these issues haven’t generated more attention from the general public,’ he said in a December blog post, adding that ‘this might be the most important public debate we haven’t been having widely enough’.”

Going Viral- The Transformation of Biological Risks
The World Economic Forum has released a new report on biological risks. In this report, they discuss the growing threat of infectious diseases- regardless of origin. “The frequency of disease outbreaks has been rising steadily. Between 1980 and 2013 there were 12,012 recorded outbreaks, comprising 44 million individual cases and affecting every country in the world. Each month the World Health Organization (WHO) tracks 7,000 new signals of potential outbreaks, generating 300 follow-ups, 30 investigations, and 10 full risk assessments. In June 2018 there were—for the first time ever—outbreaks of six of the eight categories of disease in the WHO’s ‘priority diseases’ list. If any had spread widely, it would have had the potential to kill thousands and create major global disruption. Five main trends have been driving this increase in the frequency of outbreaks. First, surging levels of travel, trade and connectivity mean an outbreak can move from a remote village to cities around the world in less than 36 hours. Second, high-density living, often in unhygienic conditions, makes it easier for infectious disease to spread in cities—and 55% of the world’s population today lives in urban areas, a proportion expected to reach 68% by 2050. Third, increasing deforestation is problematic: tree-cover loss has been rising steadily over the past two decades, and is linked to 31% of outbreaks such as Ebola, Zika and Nipah virus. Fourth, the WHO has pointed to the potential of climate change to alter and accelerate the transmission patterns of infectious diseases such as Zika, malaria and dengue fever.  Finally, human displacement is a critical factor in this regard. Whether due to poverty, conflict, persecution or emergencies, the movement of large groups to new locations— often under poor conditions— increases displaced populations’ vulnerability to biological threats. Among refugees, measles, malaria, diarrheal diseases and acute respiratory infections together account for between 60 and 80% of deaths for which a cause is reported.” The report also points to fewer deaths but higher costs of these outbreaks, like that of MERS in South Korea in 2015 – while it only infected 200 people, it is estimated to have cost $8.5 billion. Furthermore, the new biotechnologies becoming available – like CRISPR – pose unique challenges for a world with already too many biopreparedness gaps.

Global Health Security and Universal Coverage
A new article addresses this marriage that once started from convenience and is now a strategic partnership. “A consequence of ignoring their individual characteristics is to distort global and local health priorities in an effort to streamline policymaking and funding activities. This paper examines the areas of convergence and divergence between global health security and universal health coverage, both conceptually and empirically. We consider analytical concepts of risk and human rights as fundamental to both goals, but also identify differences in priorities between the two ideals. We support the argument that the process of health system strengthening provides the most promising mechanism of benefiting both goals.”

Are We Normalizing Ebola?
Laurie Garrett discusses the challenges of this current outbreak regardless of the arsenal of tools at hand. Despite the capacity to vaccinate, rapidly detect, and an impressive body of knowledge, this Ebola outbreak is not slowing and the painful truth is that it’s due to human behavior. “But day after day, cases are popping up all over North Kivu that don’t connect to any known chains of transmission—it’s as if they popped out of thin air. The problem: North Kivu is one of the most violent places on Earth, rife with distrust, rumors, conflicts, and multigenerational hatreds. Investigators can’t find the links in the disease chains because the people there do not trust anything, even the very idea that a virus called Ebola exists, and refuse to comply with investigations.” The outbreak continues to pop up and challenge response efforts not because it has become some super strain, “but because of humans and their behaviors in a quarter-century-old war zone.”

National Rights and A Debate Across Science
Helen Branswell of STAT discusses the Nagoya Protocol and that while it aims to protect a country’s control over biological resources, it could pose challenging for scientific collaboration. “More than 100 countries have ratified the protocol. The United States, which is not a party to the Convention on Biodiversity, has not. Some involved in the debate argue genetic sequences aren’t covered by Nagoya, and that the free sharing of digital genetic information is so entrenched in scientific practice — scientific journals require it of their authors — that there’s no going back. Plus, some argue, to subject genetic sequence data to further bureaucracy would be counterproductive to science and dangerous to public health. But a large number of developing countries insist that the protocol gives them as much sovereignty over the genetic sequence data of viruses, bacteria, fungi, and other pathogens found within their borders as it does over plants that are crucial to drug production. In an age of synthetic biology, when a virus can be made from scratch by following a genetic sequencing recipe plucked from a public database, to have the genetic information is to have the bug itself, these countries argue.” You can read about the Nagoya Protocol here, via the Convention on Biological Diversity.

Militaries and Global Health
The role of militaries in global health efforts is not a novel concept but has evolved over time -consider the Ebola outbreak in the DRC as an example of security challenges during an outbreak. A new paper evaluates and summarizes these dynamics and the roles militaries have taken throughout global health efforts over time. “Militaries have many capabilities applicable to global health, ranging from research, surveillance, and medical expertise to rapidly deployable, large-scale assets for logistics, transportation, and security. Despite this large range of capabilities, militaries also have limitations when engaging in global health activities. Militaries focus on strategic, operational, and tactical objectives that support their security and defence missions, which can conflict with humanitarian and global health equity objectives. Guidelines—both within and outside militaries—for military engagement in global health are often lacking, as are structured opportunities for military and civilian organisations to engage one another. We summarise policies that can help close the gap between military and civilian actors to catalyse the contributions of all participants to enhance global health.”

The Threat of North Korea’s Bioweapons
Sure, we worry about nuclear weapons from North Korea, but what about biological weapons? This may not be an entirely new concern, but many experts warn of a growing bioweapons program and that the general lack of attention to it from the Trump administration is worrisome. “Still, Anthony H. Cordesman, a former Pentagon intelligence official now at the Center for Strategic and International Studies, said the North ‘has made major strides’ in all technical areas needed for the production of a major germ arsenal. In unclassified reports, the Trump administration has alluded to the North’s bioweapons program in vague terms. President Trump did not broach the subject of biological weapons during his meeting with Mr. Kim in Singapore, according to American officials. The lack of detail and urgency is all the more surprising given that John R. Bolton, Mr. Trump’s national security adviser, has long described it as a regional and even a global threat.” There have been debates though, about the progress made by North Korea. As GMU Biodefense professor Sonia Ben Ouagrham-Gormley noted, there are several the factors that go into a successful program and “One might ask why, if North Korea has been able to produce a nuclear weapon in the same adverse conditions, it shouldn’t also be successful in the bioweapons field. The answer lies in the decidedly different nature of bio-agents and nuclear weapons. Unlike nuclear material, living microorganisms are fragile and unpredictable. They are more sensitive than nuclear material to changes in work conditions, equipment, laboratory materials, and other disruptions. A country that cannot ensure a stable and continuous work environment is unlikely to operate a successful bioweapons program.”

 Battling Fake News On Top of Ebola
Working against an Ebola outbreak is hard enough, but throw in a conflict zone…and now you’ve really got challenges. Let’s add disinformation and fake news on top of it – making this a chimeric beast of an outbreak. The DRC’s recent election in the middle of the Ebola outbreak has amplified challenges to sharing public health information and guidance to the public for protecting themselves against the disease. “In West Africa, fear kept people away from clinics, meaning Ebola cases, as well as diseases such as measles and malaria, went untreated. Mistrust of governments and aid workers ran high and rumors were rife. That’s even more true in the DRC now. In September 2018, an opposition politician, Crispin Mbindule Mitono, claimed on local radio that a government lab had manufactured the Ebola virus ‘to exterminate the population of Beni,’ a city that was one of the earliest foci of the outbreak. Another rumor has it that the Merck vaccine renders its recipients sterile. On 26 December 2018, the national electoral commission decided to exclude Beni and Butembo from the polls because of the epidemic; the following day, an Ebola evaluation center was attacked during protests. Although opposition organizations condemned the commission’s decision, they called for the Ebola response to be protected—which health workers saw as a small but significant victory. ‘We’ve managed to get communities to separate in their minds Ebola control from the broader political agenda,’ says Michael Ryan, who directs the World Health Organization’s role in the campaign in Geneva, Switzerland. ‘That’s been really helpful.’ Ryan hands much of the credit to social scientists working for the various agencies involved in the response. Along with community engagement workers, they make up one-third of the workforce.” Experts are working to combat the epidemic of rumors by supplying accurate information via WhatsApp or local radio. Responders are hopeful, but this new challenge gives insight into the need for stronger tools against disinformation during an outbreak. Regarding the outbreak – there were 9 new cases identified including one new area. This brings the total case count to 658, with 402 deaths.

Code of the Wild
Interested in joining a public and international conversation on gene-editing? Check out Code of the Wild, which is a communication campaign and upcoming documentary about the social, medical, and ethical issues on genetic engineering. Through the webpage, people can join the conversation by entering a video response to questions raised by the research team. The goal of Code of the Wild is to form a narrative on gene-editing across several industries, sectors, and countries, to help better understand the social and ethical concerns that may or may not exist. You can also find them on Facebook, Twitter, and Instagram.

Stories You May Have Missed:

• Dermatologists Are Cutting Antibiotic Usage – “Dermatologists have been identified as the most frequent prescribers of oral antibiotics in medicine, handing out more antibiotics per clinician than any other specialty. But a study today in JAMA Dermatology shows that antibiotic prescribing by the specialists has substantially decreased over the past decade. The study, by researchers with the University of Pennsylvania Perelman School of Medicine and the US Centers for Disease Control and Prevention, found that oral antibiotic prescribing by dermatologists fell by 37% from 2008 through 2016. Much of the decrease, they report, has occurred in the extended courses of antibiotics that are typically prescribed for patients with acne and rosacea to lessen inflammation. The researchers estimate that the decrease translates to nearly 480,000 fewer antibiotic courses being prescribed in 2016 than in 2008.”