Pandora Report: 3.15.2019

TGIF or beware the Ides of March? Either way, we’ve got some health security news for you, so grab your Caesar salad and enjoy this weekly dose of all things biodefense.

Summer Workshop – Are You Registered?
We’re offering an early-bird discount for registration prior to May 1st – have you signed up? Threats to global health security continue to evolve due to the changing nature of conflict, advances in science and technology, globalization, and the growing threat posed by emerging infectious diseases and pandemics. Pandemics, Bioterrorism and Global Health Security: From Anthrax to Zika is a three and a half-day workshop, non-credit summer workshop designed to introduce participants to the challenges facing the world at the intersection of national security, public health, and the life sciences. The workshop faculty are internationally recognized experts from the government, private sector, and academia who have been extensively involved with research and policy-making on public health, biodefense, and national security issues. Don’t miss out on an additional discount if you’re a returning attendee, GMU employee/student, or are registering with a large group.

Germline Gene-Editing – Do We Need a Moratorium?
In the wake of He Jiankui’s gene-edited babies, many are calling for a moratorium on germline gene-editing. In fact, the Chinese health ministry released draft guidelines at stopping rogue efforts with unapproved biotech. This topic is so important that Nature published a call for a moratorium by several top ethicists and researchers. “Whether or not a moratorium receives more widespread support, several things need to be done to ensure that germline gene-editing studies, done for the purposes of research only, are on a safe and sensible path. As a starting point, proposals for all ethically vetted and approved basic research studies that use gene-editing tools in human embryos and gametes, including those aimed at assessing efficacy and safety, should be deposited in an open registry. Second, researchers need to develop a system that allows early recognition of any research that risks overstepping predefined boundaries. A useful model to follow could be the WHO guidance for regulating research with a potential biosecurity risk. The system should include a mechanism — perhaps affiliated with the open registry — that allows researchers to flag up potentially dangerous research. Analysing whether He’s work could have been prevented will help. It’s important to hammer out whether, how and to whom scientists and ethicists who became aware of the project could have voiced their concerns — and how they could do so more easily in future. Raising the alarm would require a change of practice for researchers who, for the sake of scientific independence, often do not intervene in the choice of research projects undertaken by their peers.” In the joint statement, the researchers noted that “By ‘global moratorium’, we do not mean a permanent ban. Rather, we call for the establishment of an international framework in which nations, while retaining the right to make their own decisions, voluntarily commit to not approve any use of clinical germline editing unless certain conditions are met.”

Taking A Step Back in Staph
This common skin bug is becoming increasingly resistant to not only intervention efforts, but also antimicrobials. Saskia Popescu, GMU biodefense doctoral student and infection preventionist, discusses the latest CDC report on the concerning state of Staphylococcus aureus infections, including MRSA. “Staph infections can either be methicillin-resistant or methicillin-sensitive (MSSA) but, overall, staph is the leading cause of infections in US hospitals. Infection preventionists have been zeroing in on MRSA for decades in the health care industry, working tirelessly to stop the spread. Unfortunately, according to the CDC, progress in curbing MRSA has slowed, and findings indicate that MSSA rates are also not declining. One theory is that the opioid crisis may be connected, as 9% of all serious staph infections in 2016 occurred in patients who used injection drugs, a statistic that represented an increase from 4% in 2011. Consider this—right now, nearly 1 in 10 staph infections that occur are in people who use intravenous drugs.”

 MERS-CoV Outbreak
Speaking of healthcare-associated infections…Saudi Arabia’s Ministry of Health reported two more cases in an ongoing outbreak in Wadi ad-Dawasir. Unfortunately, most of these cases are linked to healthcare exposures and a handful are related to contact with camels. One particular study assessed camel infections, noting that “The investigators focused on 53 studies published from 2013 to December 2018, of which 33 were from the Middle East, 13 from Africa, and 7 from Spain, Australia, Japan, Bangladesh, and Pakistan. The team reported its findings yesterday in the preprint server bioRxiv. The team said another group unknowingly carried out a similar review, which covered studies published from 2013 to April 2018 and was published Feb 21 in Epidemiology and Infection by a team from Qatar and the Netherlands. The authors of the bioRxiv said their study confirms and updates the findings of the other study.The authors of the new review found that MERS-CoV seroprevalence in camels increases with age, up to 80% to 100% in adult dromedaries, which the team says suggests that the virus is widely endemic in camels on the Arabian Peninsula and in African countries that export dromedaries. However, they note variable patterns within some countries. Also, the experts found a high prevalence of active infection in juvenile animals and at sites where the animals mix, such as livestock markets and slaughterhouses. Other findings from the longitudinal studies they examined include reinfection despite high MERS-CoV antibody titers.”

Improving Global Health Security Through One Health Platforms
Don’t miss out on this March 21st even at the National Press Club, hosted by the USAID -funded Preparedness and Response project. “Over the past four and a half years, the USAID-funded Preparedness & Response project has worked across 16 countries to spread the vision of a multisectoral One Health approach — where human, animal, and environmental health assets join forces — becoming the standard way to prevent, detect, and respond to emerging pandemic threats. As the project approaches the end of its tenure, please join us as we bring together the One Health community of practice to share key learning, demonstrate successful approaches to country ownership, and discuss the future of multisectoral coordination for preparedness and response.”

Biodefense MS and PhD Open Houses
Looking to improve your biodefense knowledge while obtaining a graduate degree? The Schar school Biodefense program is the place for it – from anthrax to Zika, we’ve got you covered. We’ve got two events coming up that you won’t want to miss if you’re looking to invest in your education. On Wednesday, March 20th you can attend a Master’s in Biodefense Webinar (online) at 12pm EST and at 7pm there will be a PhD Open House at the Arlington campus. These are great opportunities to hear about the biodefense programs, meet faculty and students, and learn how you can become a biodefense guru through our in-person and online programs.

Ebola Outbreak Updates and An Epidemic of Suspicion 
On Tuesday, two new cases were reported, as well as two new deaths, bringing the case counts to 925, including 584 deaths. Vinh-Kim Nguyen recently wrote in NEJM regarding the violence and turmoil surrounding outbreak response efforts in the DRC. “As a medical team leader for Médecins sans Frontières (MSF), I work halfway between Butembo and Goma, North Kivu’s capital city and a transport hub. In late January, five Ebola cases were identified in Kayna and Kanyabayonga; MSF opened a center in Kayna to isolate patients with suspected cases and test them for Ebola virus disease (EVD). I soon suspected that most patients would turn out to have diseases other than EVD. The standard “isolate and test” model often leads to expectant management for such patients — the tendency is to “cover” patients with antimalarials and broad-spectrum antibiotics, wait for EVD test results, and then discharge patients without Ebola. We instead took a more active approach, treating severe cerebral malaria, typhoid, sepsis, and even cholera. I have witnessed how such active clinical management for all patients, along with MSF’s long-term presence in North Kivu, has contributed to the community’s acceptance of our Ebola unit. Having patients emerge from isolation in improved health is powerful evidence that we aim to make everyone better, not just to stop Ebola’s spread.” Nguyen further discusses the labeling of attacks as “resistance” are fundamentally wrong and how they are actually a bigger issue – persons against prevention activities aimed at them and those orchestrated, armed attacks against symbols of the international response. “The mistrust of authority in the DRC also reflects a growing global mistrust of experts and science. Vaccine refusals are a growing problem worldwide, and they have already resulted in measles epidemics in the United States and France and in outbreaks elsewhere. Mistrust of public health authorities may thus be the new norm, and smoldering epidemics merely a symptom.”

 Ambitious American AIDS Initiatives & Cutting Foreign Aid Programs
In the February State of the Union, President Trump pledged to end the HIV epidemic by 2030. This re-invigoration of HIV efforts was shocking, but exciting. The official pledge of $291 million to help end transmission of HIV within the United States will hopefully bring us closer to that goal through initiatives that increase access to pre-exposure prophylaxis (PrEP). While Congress still needs to approve the 2019 budget, there is a concerning proposal within it. Beyond the cuts to Medicare and Medicaid ($845 billion and $241 billion respectively) which are deeply worrisome, the budget seeks to drop US contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria by one billion. “The US will contribute $3.3bn between 2020 and 2023, a reduction on its previous contribution of $4.3bn. In a statement the global fund said: ‘The United States is the leading supporter of the Global Fund, and we are confident that the U.S. Congress will continue the strong funding that is urgently needed to improve global health security by ending epidemics. Various proposals are being considered and we look forward to final budget decisions taken by Congress in the coming months.’ The fund is looking for at least $14bn for the next year and, as the US donates around a third of the total, its contribution will mark a significant reduction on previous years. Mr Trump also proposes a $12.3bn cut to the State Department and USAID, marking a 23 per cent cut from the previous year. USAID, through the President’s Emergency Programme for Aids Relief, is a key player in the United Nations programme to eliminate HIV around the world.”

WHO Launches New Global Influenza Strategy
Influenza continues to be not only an annual issue, but the lack of preparedness for severe seasons and potentially pandemic strains is also an international issue. The WHO released their Global Influenza Strategy for 2019-2030. “The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals to humans and potentially causing a pandemic is real.   The question is not if we will have another pandemic, but when.  We must be vigilant and prepared – the cost of a major influenza outbreak will far outweigh the price of prevention.” This new strategies “is the most comprehensive and far-reaching that WHO has ever developed for influenza.  It outlines a path to protect populations every year and helps prepare for a pandemic through strengthening routine programmes. It has two overarching goals: 1. Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness. To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security. 2. Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals and treatments, with the goal of making these accessible for all countries.”

How Africa Can Quell the Next Disease Outbreaks
How can African nations enable public health institutions (NPHIs) to help stop emerging and re-emerging infectious diseases from springing up and causing large outbreaks? Beyond waiting for outside intervention and emergency help from the West, John N. Nkengasong, head of the Africa Centre for Disease Control and Prevention, calls “on all 55 member states to establish or strengthen NPHIs. And I urge the private sector in Africa and worldwide, and bodies everywhere, to invest in these efforts. According to the World Bank, Africa needs between US$2 billion and $3.5 billion a year for epidemic preparedness; in 2015, 8 African nations received from various donors about $700 million for this cause.” Furthermore, he notes that “NPHIs should prioritize four broad areas. First, providing basic functions such as disease surveillance and coordinating emergency operations, even in remote areas. Second, creating lab networks that can quickly diagnose, track and pinpoint the origin of emerging infections. Third, developing a workforce to collect, assess, share and act on quality data, including advanced technologies such as genetic sequencing and informatics. Fourth, developing a strong capacity for social scientists to engage with communities and change behaviours. Sociologists and anthropologists were crucial in ending the Ebola outbreak in West Africa by, for example, promoting safe burials — which meant modifying long-standing traditions, such as washing the corpse of a loved one.”

Measles and the Threat of the Anti-vaccination Movement
From measles to polio, the threat of vaccine-preventable diseases is a real one that we’re slowly losing our headway in. “The anti-vaccination movement threatens to undo years of progress made against a range of preventable diseases. Mass immunization campaigns helped slash the number of measles deaths worldwide by 80 percent between 2000 and 2017, but that headway may now be stalling. Today, only 85 percent of the world’s infants receive the first dose of the treatment, and even fewer get the second dose. This is well short of the 95 percent vaccination rate that the WHO says is needed to prevent outbreaks. If the anti-vaccination movement continues to gain momentum, there could be more outbreaks in places such as the United States, where measles has been considered eliminated for nearly two decades. With more cases, there will be greater potential for measles to spread across borders. Until governments turn the tide of the anti-vaccination movement, health workers will face the dual challenge of containing measles in both countries where the disease is still endemic and those where it was thought long gone.”

Infectious Diseases Spike Amid Venezuela’s Political Turmoil
The crisis in Venezuela is leaving millions without clean water, access to hospitals,  safe food, and more. Unfortunately, it is also causing a spike in infectious diseases as public health and healthcare efforts have been all but decimated. “These so-called vector-borne diseases—transmitted by mosquitoes or other organisms—have increased by as much as 400 percent in Venezuela in the last decade, according to a review study published in The Lancet in February. Spiraling economic and political turmoil have worsened the situation, as has the government’s apparent hostility toward researchers who publish epidemiological data—with reports of pro-government paramilitary groups smashing labs and even stealing experimental mice. “’Last year we had more than 600,000 cases [of malaria] reported by the government,’ says study co-author Maria Eugenia Grillet, a tropical disease ecologist at Central University of Venezuela in Caracas. She and her co-authors estimated there were actually around 1.2 million cases, taking into account underreporting and disease relapses, Grillet notes. (Relapses occur when a patient has recovered but still carries the malaria-causing parasite and later suffers a recurrence of symptoms.) She blames the increase on a lack of antimalarial surveillance, treatment and control, partly due to funding cuts. ‘Research in our universities and laboratories is almost completely paralyzed because there are no financing programs that allow us to cover the basic needs to carry out our experiments or fieldwork,’ she says.”

Stories You May Have Missed:

  • New Vaccine Manufacturing Innovation Centre Bolsters Pandemic Preparedness – “The first dedicated Vaccines Manufacturing Innovation Centre (VMIC) is coming to the UK in 2022, addressing gaps in late-stage vaccine manufacturing for clinical trials and emergency preparedness for epidemic and pandemic threats. Led by the the University of Oxford’s Jenner Institute, the new centre has been awarded funding by UK Research and Innovation of £66 million ($86 million USD) through the UK Government’s Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing challenge. ‘This is an exceptional opportunity for the UK to lead in the provision of vaccines against a wide range of outbreak pathogens which threaten to cause major epidemics,’ said Adrian Hill, Jenner Institute Director. ‘The lack of commercial incentive to develop these has now led to this exceptional partnership of major academic and industrial players in the vaccine field, to accelerate a range of vaccines towards large-scale manufacture and stockpile provision for vulnerable populations. In parallel, the Centre will develop innovative manufacturing technologies with UK companies and Universities to support the next generation of life-saving preventive and therapeutic vaccines’.”

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