By Rachel-Paige Casey, GMU Biodefense PhD student
Earlier this week, the 5th annual Pandemic Policy Summit was hosted at Texas A&M University by the Scowcroft Institute of International Affairs in the Bush School of Government and Public Service. Most of the Summit’s events were conducted under Chatham House rule, prohibiting attribution of comments and insights to an individual or organization. The objective of each Summit is to convene researchers, medical professionals, practitioners, private sector experts, NGO representatives, and political leaders to examine issues in pandemic preparedness and response, health security, and biodefense. The foci of this year’s Summit were the promises and perils of technology; BARDA leadership through its history and today; the effect of the anti-vaccine movement on pandemic preparedness and response; and ongoing outbreaks. Key discussions included the inadequacy of biopreparedness, worries regarding emerging biotechnologies, the modern vaccine hesitancy movement in the US, and the leadership and future of BARDA.
A commonly recited phrase throughout the panels underscored a concern shared throughout attendees and speakers – “lessons learned to lessons observed.” Over the many health crises, lessons were largely observed and not learned, maintain the distressing paradox of inadequate biopreparedness despite clear evidence of the emerging and re-emerging pathogens threatening human, animal, and environmental health. The 2014-15 West Africa Ebola Virus Disease (EVD) epidemic was a gruesome showcase of failures in imagination, policy, capabilities, and management; however, it was just one among many in recent history. Since the turn of the century, the same failures were apparent in the SARS, H1N1, and Amerithrax events. Four primary causes of the aforementioned failures were proposed: complacency, competing priorities, confusion about risk, and overdependence on government capabilities and capacities. Though not necessarily easy to fix or adjust, the underlying roots of preparedness and response failures can be thwarted. The goal of the Summit is to discern how to address these failures and improve policy, collaboration, and leadership for quicker and more successful prevention, detection, and response to health crises like outbreaks and bioterror attacks. Simply put, how do we learn lessons instead of just observing them?
Emerging technologies in synthetic biology, which bear potential for dual-use, are of great concern to current and future practices and standards in medicine, biosecurity, and policy. For example, anyone can simply purchase a do-it-yourself (DIY) CRISPR kit on Amazon and edit bacterial genomes at home. Though this kit is, hopefully, primarily used by inquisitive individuals with benign intentions, there is the risk that someone with nefarious intentions is using the same kit to create a new threat. Additionally, a well-intended user could cause harm accidentally to themselves or others. The rise in DIY and garage bio-users highlights the lack of biotechnology governance and norms. Of greater concern is the rise of China as a biotechnology powerhouse, overshadowing the United States in biological research and innovation. China’s focus on biotechnology positions it to fill the gap in its governance given the failure of the US to do so. Panelists stressed the criticality of the US to step up its research and development for biotechnologies but also to lead the way for the ethics and governance of the data extracted from these innovations. Genomic sequencing for ethnicity and prenatal testing yields private data that can compromise safety and security. For example, such data are used to target the Uyghurs, a marginalized ethnic group in China. Finally, experts urge the US to better teach our public, starting with our students, about security and doing business with China, arguably our greatest economic and geopolitical rival. China controls much if the generic drugs and active ingredients purchased by the US. As a nation mired in chronic diseases, the US risks further dependency on China as China makes significant headway in biotechnology and the bioeconomy while the US dawdles behind.
Vaccine hesitancy is the reluctance or refusal to get vaccinated or to get one’s children vaccinated, and it is one the World Health Organization’s top ten threats to global health. Experts fear that vaccine hesitancy will continue to rise among adults and children in 2020, a prospect that threatens public health as herd immunity is impaired by the efforts of the modern anti-vaccination movement in the US. The modern movement began in the late 1990s with the publication of a junk-science study that erroneously linked the measles, mumps, and rubella (MMR) vaccine with autism. Despite its retraction, the study spurred misconceptions on the safety and efficacy of vaccines to prevent diseases. Today, there are over 500 anti-vaccination websites and Amazon is now the largest promoter of anti-vaccine books. Further fueling the fire, research found that Russian entities are promoting anti-vaccine propaganda via social media in the US. The motivations behind the movement are not restricted to fears of medical research and practice inadequacies but are also related to citizens’ distrust of government and its leaders but also of science. Panelists stated that new tactics are needed beyond that of scientific evidence and classical public health promotion in order to curb growing rates of vaccine hesitancy.
The Biomedical Advanced Research and Development Authority (BARDA) is an office within the US Department of Health and Human Services (HHS) tasked with the procurement and development of medical countermeasures. To date, BARDA is responsible for 52 FDA-approved medical countermeasure (MCM) devices and therapeutics to combat chemical, biological, radiological, and nuclear (CBRN) threats; pandemic influenza (PI); and emerging infectious diseases (EID) threats. BARDA’s current leadership recognizes the importance of innovation and the need for speed in research and development as today’s biological threats grow at alarming rates. The goal of BARDA is facilitate the production of sufficient quantities of efficacious MCMs with minimal delay at the locations in need. The importance of the MCM supply chain’s efficiency and security were stressed. In order to protect our citizens with rapidly available and effective MCMs, the US should work to increase the domestic manufacturing of these products and drugs. This further emphasizes the need for the US to better focus on investment in biotechnology advancements and education. BARDA Ventures is a new program under development that will provide investment for auspicious health security products and technologies that help enhance national health security preparedness and response.
An after-action white paper regarding the Summit’s topics, recommendations, and key takeaways is forthcoming from the Scowcroft Institute of International Affairs in the Bush School of Government and Public Service at Texas A&M University. Last year’s white papers can be found here and here.