Pandora Report: 4.26.2019

Summer Biodefense Workshop – From Anthrax to Zika
The May 1st early registration discount is nearly here – have you registered for the summer workshop on pandemics, bioterrorism, and health security? Our 3.5 day workshop will be discussing everything from biosecurity as a wicked problem to synthetic biology and the challenges of responding to Ebola. If you’re part of a large group, GMU faculty, or current/past GMU student, you also qualify for an additional discount, so reserve your spot ASAP.

The Impact of Synthetic Biology and Genome Editing on Biosecurity 
If you’ve ever wanted to learn more about the biosecurity implications of synbio and genome editing, check out a lecture by GMU Biodefense Associate Professor and Graduate Program Director Dr. Gregory Koblentz, who recently spoke at the James Martin Center for Nonproliferation Studies in Middlebury Institute of International Studies at Monterey. You can watch the video here, which also includes the powerpoint.

 Max Brooks Introduces His New Graphic Novel on the History of Germ Warfare at Awesome Con
“Max Brooks, the best-selling author of “World War Z” and non-resident fellow at the Modern War Institute at West Point, has partnered with the Blue Ribbon Study Panel on Biodefense on GERM WARFARE: A Very Graphic History. This highly stylized and engaging graphic novel, set for release beginning this Saturday, reminds us never to take public health for granted. It’s all part of an effort by the bipartisan Study Panel to not only work with the federal government to strengthen our national biodefense, but also to educate Americans about the risks, and why a strong biodefense is critical to our individual health and safety. Germ Warfare will officially be released this weekend (4.27.2019) at Awesome Con, Washington DC’s Comic Con event, at the Walter E. Washington Convention Center. Brooks, along with Study Panel member Ken Wainstein and Panel Executive Director Asha George, will host a panel discussion and hand out free copies of the graphic novel at 12pm this Saturday in Panel Room 146.”

Ebola Outbreak Update 
This past weekend saw 23 new cases reported in the DRC and two deadly hospital attacks. “The Katwa attack came 1 day after a hospital attack in Butembo took the life of a World Health Organization (WHO) epidemiologist deployed to the outbreak region. Both Katwa and Butembo have been hot spots of virus activity in the last several months—more than half of all cases reported in recent weeks originated in Katwa.According to officials, the attack in Katwa took place around 3 a.m. local time on Apr 20 at the sub-coordination office located at the Katwa Reference General Hospital. Police controlled the attack, and three assailants were wounded in addition to the assailant that the police killed. The attacks are another challenge to response efforts in the region, which have been hindered by community resistance and earlier violent attacks.” The violence against healthcare workers has gotten so bad that they are threatening to strike. “The doctors and nurses who work in the heart of the Ebola outbreak zone in Democratic Republic of the Congo say they’ve had enough. For weeks they’ve been subjected to threats of violence and even actual assaults. On Wednesday they gave the government an ultimatum: Improve security within one week or we’ll go on strike. The workers making these demands include the Congolese staff of two government-run treatment centers for patients with Ebola, but the demand mostly comes from about 200 doctors and more than 1,000 nurses who work at hospitals and health centers across Butembo, a city that’s the current hot spot of the outbreak.”

GMU Biodefense Students in Health Security Journal
We’re proud to share that two doctoral students from the GMU Biodefense program were published in the latest Health Security issue. Alum Christopher Brown discusses respiratory protection in his article “Respiratory Protection Against Emerging Infectious Diseases: Face Masks, Respirators, and Tools for Choosing Between Them“. Brown writes that “Previous reviews have called for more information, chiefly in the form of clinical trials, to better inform decision making about RPDs. However, alternative approaches to respirator selection, including control banding tools that match groups of similar hazards to appropriate control measures, may be useful in choosing RPDs for workers with potential bioaerosol exposures on the job. These tools, while offering more streamlined approaches to RPD selection, come with challenges of their own, including questions about how to allocate different RPDs to different workers. This article reviews arguments on both sides of the face mask–respirator divide and considers the use of control banding tools in the context of preparedness for serious emerging infectious disease outbreaks.” Doctoral student Saskia Popescu discussed frontline healthcare biopreparedness in “Identifying Gaps in Frontline Healthcare Facility High-Consequence Infectious Disease Preparedness” – “While certain hospitals were designated as EVD treatment facilities, the readiness of most American hospitals remains unknown. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the existing US healthcare system. Hospital infection disease preparedness gaps were revealed during the 2013-2016 Ebola virus disease outbreak. The ability of US hospitals to rapidly identify, isolate, and manage patients with potentially high-consequence pathogens is a critical component to health security. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the US healthcare system.”

Are Philanthropy Funds Shifting the Focus in Biosecurity?
Filippa Lentzos is drawing attention to a possible shift in the biosecurity field and if splashy philanthropy funding is driving the focus towards the wrong risks. “While biosecurity experts critically examine the funding sources of cutting-edge biological research like the Insect Allies program, they rarely turn their gaze inward on their own community of biosecurity experts. This should change. A new actor with deep pockets and a cause has entered the scene. Established in 2017, Open Philanthropy Project (Open Phil) is a limited liability company operating on the basis of donations from Cari Tuna and Dustin Moskovitz, an internet entrepreneur and co-founder of Facebook. Moskovitz is reportedly the youngest self-made billionaire in history. He and Tuna are also the youngest couple to sign Bill Gates and Warren Buffett’s Giving Pledge, which commits billionaires to giving way most of their wealth in the form of philanthropy. Open Phil largely operates as a non-profit, despite not legally being one. Unlike a charity, the company also carries out so-called “impact investments,” and these may extend to political contributions in some cases. The main focus of the company, however, is eye-popping grant-giving. It aims to give an average of more than $100 million a year to “accomplish as much good as possible” by giving effectively and openly to important and neglected causes. One of those is global catastrophic risks. The two risks Open Phil considers most likely to permanently worsen humanity’s long-term future or lead to human extinction are pandemics and advanced AI. Open Phil has gifted over $100 million to work on managing potential risks from advanced AI since 2017, and nearly $40 million in biosecurity and pandemic preparedness grants in the same time frame. While the company is enabling a great deal of good work in the biosecurity field, it should not be beyond critical scrutiny. It matters where research funding comes from.”

The Impact of Chronic Underfunding of America’s Public Health System: Trends, Risks, and Recommendations
Trust for America’s Health has just released their 2019 report on public health funding trends and recommendations. “A rapid rise in deaths from drugs, alcohol, and suicide represent an urgent crisis. Weather-related emergencies are becoming more frequent and intense, as the world begins to feel the effects of climate change. And across most health outcomes, socioeconomic, racial, and ethnic disparities persist. Tackling these issues requires a strong, well-resourced public health system focused on prevention, preparedness, wellness, and community recovery for all Americans. But chronic underfunding has presented a consistent obstacle. In 2017, public health represented just 2.5 percent — $274 per person — of all health spending in the country. Such underfunding flouts overwhelming evidence of the life-saving cost-effectiveness of programs that prevent diseases and injuries and prepare for disasters and health emergencies. Public health interventions, such as childhood vaccinations, school-based violence prevention programs, and indoor smoking bans, improve health outcomes and prevent illness and death. Moreover, many such interventions save money; a 2017 systematic review of the return on investment of public health interventions in high-income countries found a median return of 14 to 1.”

We Ignore the Disaster in the Antibiotics Market at Our Peril and Why The Antibiotic Business is Broken 
In a perfect world, the pursuit of novel antimicrobials would be a top priority. Of course, in a perfect world, we also wouldn’t need them as antimicrobial stewardship would be in full force. The recent announcement of Achaogen’s bankruptcy is alarming for a company few have heard of, let alone used a product. “The few who have (used a product) probably don’t know the company either, even if its product saved their life. And yet its recently announced bankruptcy is one of the most significant — and worrying — corporate failures of this decade. In the global struggle against superbugs, Achaogen is a biotech at the front line. Its failure is the latest symptom of an ailing antibiotics market. Decades of disinvestment have left perilously few companies active in antibiotic development. Those remaining are often dependent on support from philanthropic or public funders — such as the Wellcome Trust, the medical research charity, or the US government. Without external investment, small biotechs cannot carry prospective drugs through the complex and expensive later-stage trials they must pass. Against the odds, Achaogen appeared to have succeeded. Its antibiotic, plazomicin, was approved by the US Food and Drug Administration in 2018 for treating complex urinary tract infections caused by drug-resistant bacteria. It is a vitally needed drug and just one of the many new antibiotics we need to replace drugs that are rapidly losing their effectiveness against superbugs. Achaogen was a leading example of what could be achieved by a smart start-up working in partnership with government and philanthropic funders.” Beyond investors losing money, the hard truth of this bankruptcy is that there are fewer and fewer routes for new drug development in the field of antimicrobials. Now we must consider if in the face of antibiotic resistance, we really are ok with with killing innovation while not being able to kill superbugs. Maryn McKenna also addresses the broken business of antibiotics – “Last year, a European coalition known as DriveAB that has been examining antibiotic production and distribution drew up a menu of possible pull incentives and evaluated how powerful each might be. They too concluded that market entry rewards hold the most promise, though they recommended spacing payments out over the life of the drug, to ensure that companies keep manufacturing them. A raft of studies written over the past few years have recommended other possibilities, such as transferrable exclusivity vouchers, essentially allowing companies that develop a successful antibiotic to keep another drug under patent for extra years, or purchase commitments between governments and companies in which a certain amount of drugs is bought and shelved until needed. Some thinkers have recommended changes in reimbursement, in which Medicare would pay more for an antibiotic deployed after a diagnostic test has been performed—a maneuver that makes the drug intrinsically more valuable, slowing its use and keeping resistance at bay.”

Telemedicine and Antimicrobial Stewardship
Speaking of antimicrobial stewardship…how common is it in the world of telemedicine? “One of the more impressive medical advances in recent years has been the development of telemedicine, which allows a medical provider to interact remotely with patients. Using video equipment to allow providers and patients to maintain face-to-face consultations, telemedicine allows people to get a medical consultation if they don’t have immediate access to a health care facility or provider or just need a quick consult. Imagine you’ve got a fever and cold but are traveling and may not be able to go to a doctor. Skyping your primary care physician who could evaluate your symptoms, and provide a face-to-face consult would be helpful, right? Even in medical facilities, telemedicine has allowed specialty practitioners to consult on cases and provide an extra layer of care if a specialized provider isn’t available. While there are inherent limitations in what can be done via telemedicine, especially if the patient is not in a medical facility, a new article in Pediatrics is calling to light some worrying antimicrobial prescribing practices.”

Next Steps for Access to Safe, Secure DNA Synthesis
How can we incorporate biosecurity/biosafety into DNA synthesis without stifling innovation? “Informed by guidance from the U.S. government, several of these companies have collaborated over the last decade to produce a set of best practices for customer and sequence screening prior to manufacture. Taken together, these practices ensure that synthetic DNA is used to advance research that is designed and intended for public benefit. With increasing scale in the industry and expanding capability in the synthetic biology toolset, it is worth revisiting current practices to evaluate additional measures to ensure the continued safety and wide availability of DNA synthesis. Here we encourage specific steps, in part derived from successes in the cybersecurity community, that can ensure synthesis screening systems stay well ahead of emerging challenges, to continue to enable responsible research advances. Gene synthesis companies, science and technology funders, policymakers, and the scientific community as a whole have a shared duty to continue to minimize risk and maximize the safety and security of DNA synthesis to further power world-changing developments in advanced biological manufacturing, agriculture, drug development, healthcare, and energy.”

Stories You May Have Missed:

• E coli Ground Beef Outbreak and Recall – “In an outbreak update, the Centers for Disease Control and Prevention (CDC) said the 47 new cases boosts the outbreak total to 156 cases, with 4 more states reporting cases, expanding the outbreak to 10 states. The newly added states include Florida, Illinois, Minnesota, and Mississippi. The already-affected states are Indiana, Georgia, Kentucky, Ohio, Tennessee, and Virginia. The latest illness onset is Apr 7, and patients range in age from less than 1 year to 83. Fifty percent of them are female. Of 127 people with available information, 20 (16%) were hospitalized. No deaths or cases of hemolytic uremic syndrome (HUS)—a potentially fatal kidney complication—have been reported.”
• First Malaria Vaccine Launches– “Developed by GlaxoSmithKline, the RTS,S vaccine has been in the making for 30 years and has shown partial protection against Plasmodium falciparum in young children. Clinical trials found that the vaccine prevent 4 of 10 malaria cases, as well as 3 in 10 cases of severe malaria. The vaccine also cut the level of severe anemia—the most common reason kids die from the disease—by 60%. In a World Health Organization (WHO) statement today on  the launch of the pilot program, designed to assess its role as a control tool alongside other interventions, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said tremendous gains against malaria have been made over the past 15 years with the use of bed nets and other measures, but progress has stalled or even reversed in some areas.”