Pandora Report: 3.1.2019

Happy Friday! We’ve got a lot of biodefense news to start the month of March off right, so buckle up.

 Sen. Tom Daschle Takes to the Classroom to Discuss the Future of Biodefense
If you missed our event with Sen. Daschle, you can get a recap here- “Oftentimes, we are reactive instead of proactive, but you all are being proactive,” said Tom Daschle, in praising Schar School and George Mason University students for studying biosecurity. Daschle opened his remarks by recalling the horror and the uncoordinated response to an anthrax attack in his Capitol Hill office a month after 9/11. Daschle, then Senate Majority Leader, and his staff received letters laced with deadly anthrax spores. More than two dozen individuals in his office tested positive for the disease. There were no deaths. Schar School students asked questions on a variety of biodefense related topics including the anthrax attack on Congress, never-before-seen diseases, and what governments can do to defend citizens against future biowarfare. Daschle spoke passionately about the importance of biosecurity breaches, stressing the urgency to take meaningful steps towards stronger biodefense policies. ‘You all are the leaders that we will turn to when this [biological threat] happens, and it will happen in your lifetime. When it happens, we are going to need you’.”

Human Error in High-Biocontainment Labs and Concern Over the Quiet U.S. Decision to Fund Dangerous Experiments
Exposures to infectious diseases in BSL-3 and BSL-4 environments can be pretty scary…but they do happen. Concern has always extended beyond the safety of the laboratory worker, but also that a pathogen of pandemic potential could be released. “Human error is the main cause of potential exposures of lab workers to pathogens. Statistical data from two sources show that human error was the cause of, according to my research, 67 percent and 79.3 percent of incidents leading to potential exposures in BSL3 labs. These percentages come from analysis of years of incident data from the Federal Select Agent Program (FSAP) and from the National Institutes of Health (NIH). Three of the seven FSAP incident categories involve skill-based errors: 1) needle sticks and other through the skin exposures from sharp objects, 2) dropped containers or spills/splashes of liquids containing pathogens, and 3) bites or scratches from infected animals. Some skill errors, such as spills and needle sticks could be reduced with simple fixes.” Review of the human errors and if they are singular events or process failures gives insight into how possible these events are and how we can go about avoiding them. While this article focuses on a small portion of pathogen research, it provides a very comprehensive and detailed account for many of us who are not familiar with working in these environments. In another aspect of lab safety and experiment concern..more attention has been raised regarding the GoF research. Dr. March Lipsitch and Dr. Tom Inglesby recently wrote regarding the implications of this research and the quiet green-lighting that occurred for two projects recently. “Apparently, the government has decided the research should now move ahead. In the past year, the U.S. government quietly greenlighted funding for two groups of researchers, one in the United States and the other in the Netherlands, to conduct transmission-enhancing experiments on the bird flu virus as they were originally proposed before the moratorium. Amazingly, despite the potential public-health consequences of such work, neither the approval nor the deliberations or judgments that supported it were announced publicly. The government confirmed them only when a reporter learned about them through non-official channels. This lack of transparency is unacceptable. Making decisions to approve potentially dangerous research in secret betrays the government’s responsibility to inform and involve the public when approving endeavors, whether scientific or otherwise, that could put health and lives at risk. We are two of the hundreds of researchers, medical and public-health professionals, and others who publicly opposed these experiments when they were first announced. In response to these concerns, the government issued a framework in 2017 for special review of ‘enhanced’ pathogens that could become capable of causing a pandemic. Under that framework, reviewers must consider the purported benefits and the potential risks and, before approving the work, determine ‘that the potential risks as compared to the potential benefits to society are justified’.”

GMU Biodefense Graduate Degree Open Houses
Have you been considering getting a graduate degree in biodefense? From a MS to a PhD, GMU Schar school has it all. We’ve got several open houses coming up if you’re looking to get more information on our programs. You can attend a PhD Open House   on Wednesday, March 20th at 7pm in Arlington or a Master’s Open House on Thursday, March 28th at 6:30pm in Arlington. We’re also hosting a virtual Master’s in Biodefense Webinar on Wednesday, March 20th at 12pm EST online.

Global Biosecurity Journal
A new biosecurity journal has been started and it’s providing a great source of information and even better – it is open access! “The journal Global Biosecurity is a peer-reviewed, open access electronic journal for cross-disciplinary research in all aspects of human or animal epidemics, pandemics, biosecurity, bioterrorism and CBRN, including prevention, governance, detection, mitigation and response. We publish work on risk analysis, outbreak investigation, epidemiology, modelling, bioinformatics, phylogenetics, surveillance, intelligence, strategic foresight, forecasting, ‘One Health’, policy, governance, law, law enforcement, defense, ethics and first responder preparedness. We have a focus on rapid reports of epidemics of concern.”

New FDA Strategy to Improve Food Safety
The FDA has just unveiled a new approach to detecting unsafe foods that were imported. “… ‘the U.S. imports about 15 percent of its overall food supply from more than 200 countries or territories representing about 125,000 international food facilities and farms,”’ according to an announcement this afternoon from FDA Commissioner Scott Gottlieb and Frank Yiannas, the agency’s deputy commissioner for food policy and response. ‘Over the past 15 years alone, we’ve seen a trend of rising imported foods. Other countries now supply about 32 percent of the fresh vegetables, 55 percent of the fresh fruit and 94 percent of the seafood that Americans enjoy’.” In response to these challenges the FDA announced a new approach that integrates technological advances to help provide better FDA food safety oversight. “‘Our new strategy is designed to meet four important goals: preventing food safety problems in the foreign supply chain prior to entry into the U.S.; effectively detecting and refusing entry of unsafe foods at U.S. borders; responding quickly when the FDA learns of unsafe imported foods; and measuring our progress to ensure that our imported food safety program remains effective and efficient,’ Gottlieb and Yiannas said.”

Flying with Dangerous Pathogens on Commercial Flights- A Great Way to Be Fined $20,000
Are you planning to travel with dangerous pathogens on your next vacation? Let’s take a step back because that may not be the best decision. “Gang Li of Guelph, Ontario, was convicted on Feb. 20 in the Ontario Court of Justice of violating Canada’s Health of Animals Act and the associated Health of Animals Regulations. He was ordered to pay fines totaling $20,000. The Canadian Food Inspection Agency (CFIA) brought the legal action against Li. According to court documents, Li arrived at the Lester B. Pearson International Airport in Mississauga, Ontario, on Jan.24, 2017. The Canadian Border Services Agency (CBSA) intercepted Li’s flight and found he was transporting seven undeclared test tubes of an unknown substance in his checked baggage, which he did not declare upon arrival. Laboratory testing later confirmed the items included the following viruses; Peste des Petits Ruminants, Newcastle disease, Duck Adenovirus 1, and Parainfluenza Virus 5.” Sure, this may be the beginning of an apocalyptic plague movie…or we can make it a great learning experience to encourage smarter decisions when it comes transporting pathogens. Also, props to CFIA and CBSA for catching this potentially devastating action!

US Government and Multilateral Health Engagement
The Kaiser Family Foundation just released this report on 5 key facts regarding how the US government participates in health engagement. “Global health donors, such as the U.S., provide funding and other support primarily through two types of channels: bilateral (i.e., country-to-country) and/or multilateral (i.e., multi-country, pooled support often directed through an international organization). Donors make different choices about the distribution of their global health support between these two mechanisms, and these choices may change over time due to political, technical, or other considerations. While the U.S. has decidedly been a bilateral donor to global health (channeling 81% of current global health assistance bilaterally), it has helped to found, and serves as a key donor to, several major multilateral health organizations. These include some of the first international health organizations, such as the Pan American Health Organization (PAHO) in 1902 and the World Health Organization (WHO) in 1948, and newer partnerships, such as Gavi, the Vaccine Alliance (Gavi) in 2000 and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in 2002. These multilateral organizations have contributed significantly to improvements in global health and, in some cases, serve as key components of the U.S. global health response. This response includes financing, governance, oversight, and technical assistance.”

Why Were Scientists Silent Over Gene-Edited Babies?
When news hit that babies had been born with CRISPR gene edits, the world was shocked. After the initial surprise faded and several researchers admitted they knew of the work by Dr. He Jiankui, many are asking why more people didn’t come forward to raise a red flag. “Scholars who have spoken publicly about their discussions with He described feeling unease. They have defended their silence by pointing to uncertainty over He’s intentions (or reassurance that he had been dissuaded), a sense of obligation to preserve confidentiality and, perhaps most consistently, the absence of a global oversight body. Others who have not come forward probably had similar rationales. But He’s experiments put human health at risk; anyone with enough knowledge and concern could have posted to blogs or reached out to their deans, the US National Institutes of Health or relevant scientific societies, such as the Association for Responsible Research and Innovation in Genome Editing (see page 440). Unfortunately, I think that few highly established scientists would have recognized an obligation to speak up. I am convinced that this silence is a symptom of a broader scientific cultural crisis: a growing divide between the values upheld by the scientific community and the mission of science itself.”

Image source: The Guardian

 WHO Calls for More Funds to Fight Ebola
The situation is increasingly dire in the DRC as the Ebola outbreak continues but MSF has had to suspend activities after an attack. “In a statement, MSF said the attack began at 10 pm on Feb 24 when unidentified assailants began throwing rocks at the 70-bed MSF-managed treatment center, which has admitted 602 patients, including 49 confirmed cases, since December. Then the group set parts of the structure on fire, which destroyed medical wards and equipment. The brother of a patient died while trying to escape, though the exact circumstances of his death are still unclear, the group said. Six patients with suspected Ebola and four with confirmed infections were transferred to other facilities, and all treatment center staff were evacuated.” Worse yet, on Wednesday, it was reported that another attack took place at the Butembo Ebola treatment center. “Today Doctors Without Borders (MSF) said an Ebola treatment center (ETC) in Butembo in the Democratic Republic of the Congo (DRC) was attacked, and reports on social media suggested the building had been set on fire. ‘Tonight another deplorable attack on an Ebola treatment facility has taken place, this time in the city of Butembo,” said Hugues Robert, MSF emergency desk manager, in a news release. “This follows the attack last week on another MSF Ebola treatment center in nearby Katwa. This attack has not only put the lives of Ebola patients and their families in danger, but also those of MSF and Ministry of Health staff’.” The arson attack devastated MSF response efforts and makes future work extremely challenging. In response to this situation, funding has become an increasingly tenuous topic of conversation. While many point to the reported “Pandemic Fund” created by the World Bank, Laurie Garrett has called out that they promised $1 billion but only raised $320 while providing zero funds until the virus crosses borders. The WHO is asking for more funding to help support outbreak response efforts. “Dr Tedros said the situation was unprecedented. ‘There has never been an Ebola outbreak in these conditions, with such a highly mobile population and with many gaps in the health system. The security context is another major concern. I am deeply saddened by reports that a health facility run by Médecins Sans Frontières in Katwa was attacked on Sunday night,’ he said. He added that, despite the setbacks, major gains in the fight against the disease had been made. ‘But the outbreak is not over and we urgently need additional funding to see it through,’ Dr Tedros added. WHO has asked for $148 million (£112m) to fund the response until July but so far just under $10m has been pledged’.”

Tech Platforms and Anti-Vaxxers
As measles continues to spread and the role of anti-vaccine movements becomes increasingly under the spotlight, many have also looked to tech platforms and social media. “The ongoing and increasingly contentious debate about whether technology companies have a responsibility to moderate harmful content takes on a new dimension when faced with such an urgent domestic and international public health emergency. The question we should ask in this case is: Do technology companies have the responsibility to moderate their content when there is a public health risk involved? This month, several large technology companies have implicitly, and correctly, answered yes. All the companies in question should embrace this affirmative response and explore two possible methods to address this misinformation on their platforms. The Guardian unleashed a furor of activity around vaccines with an investigation into how anti-vaxer content is ranked and spread online. The Guardian found that neutral searches of the word “vaccine” by a new user with no friends or likes yielded overwhelmingly anti-vaccine content, unsupported by science, on both Facebook and YouTube.”

State Reporting Laws and Infection Prevention Efforts
GMU Biodefense doctoral student and infection preventionist Saskia Popescu discusses the implications of HAI reporting efforts and how these laws may negatively impact the hospital programs working to reducing healthcare-associated infections. “In the face of this problem, many states have implemented mandatory HAI reporting laws. Unfortunately, these laws can negatively impact the individuals conducting the surveillance and reporting: the infection prevention and control programs. For many of us in infection prevention, the mandated reporting for Medicare reimbursement through the Center for Medicare and Medicaid Services is time consuming and can account for 5 hours of our work day. Now, adding in the required state reporting increases the work load. Although most states have mandated reporting requirements, the association between state laws and HAI rates have been mixed, and few states have addressed the overall burden these laws place on the infection preventionists.”

Special Feature – Progress in High-Level Isolation for Care of Patients with High-Consequence Infectious Diseases
The Health Security journal has a special issue on managing patients with diseases like Ebola and the healthcare preparedness approach. “In April 2018, NETEC, in conjunction with the Johns Hopkins Center for Health Security and the National Institute of Allergy and Infectious Diseases (NIAID), hosted the International Workshop on High-Level Isolation in Washington, DC. The workshop convened experts from around the world to discuss ongoing and future efforts related to treating patients with high-consequence infectious diseases in high-level isolation settings. Participants represented high-level isolation units from 11 countries, including all 10 RESPTCs, and presentations and discussions addressed high-level isolation criteria and principles, high-level isolation unit operations and design, clinical care and research considerations for patients with high-consequence infectious diseases, and international collaboration between high-level isolation units. This meeting illustrated the considerable progress made in the wake of the West Africa Ebola epidemic, but the myriad of remaining challenges also underscored the need for continued investment and research in this field.”

Stories You May Have Missed:

  • MERS Transmission in Saudi Hospital – “Nine healthcare workers are among the 39 MERS-CoV patients identified in a hospital-based outbreak of the virus in Wadi ad-Dawasir, Saudi Arabia, and according to the World Health Organization’s (WHO) technical lead, and the outbreak features both human-to-human transmission patterns and spread from animals.”
  • Views from Funeral Directors Managing Disasters– “During Hurricane Katrina, Vigil and 100 colleagues traveled around Baton Rouge placing bodies in 22 refrigerated trucks and ferrying them to a temporary morgue “the size of a football field,” according to a contemporaneous New York Times report, where they helped perform nearly a thousand autopsies. DMORT teams also play an important role in one of the most intensely political parts of the federal government’s response to a natural disaster: the body count. Although DMORT does not decide which deaths are caused by disasters and which just happened concurrently, their assistance frees up local officials who are responsible for answering those questions. The Trump administration infamously undercounted the number of dead after Hurricane Maria —placing the number at just 64 for months, while follow-up assessments pegged it at 1,000 to more than 5,000but without DMORT, that botched response could have been much worse.”

 

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