Pandora Report: 11.15.2019

We’re back and we’ve got quite a packed newsletter for you, so grab a beverage and get ready for the warm fuzzies of biodefense news.

Failing to PREDICT the Next Pandemic
A few weeks back, it was announced that funding for the PREDICT program would cease after $207 million was sunk into the initiative. GMU biodefense MS student Michael Krug has provided a deep-dive into what PREDICT worked towards, the debated success, and what its cancellation means. “However, even with the billions of dollars spent on ensuring a robust global biosurveillance network, it remains unknown if this network can predict what the next disease will be or where the next outbreak will occur.” Read more here.

An Antibiotic Eclipse – Scenario or Future?
GMU Biodefense doctoral alum and infection preventionist Saskia Popescu discusses the looming threat of antibiotic resistance and what a future with little to no treatment options would look like. From dwindling options for secondary infections related to influenza to declining surgeries, a future without antibiotics is dim. Popescu highlights what this looks like and how we’re quickly approaching it through both the drying antibiotic pipeline, but also limited surveillance, and challenges in changing both stewardship and infection control measures. The existential threat of antimicrobial resistance is very real and Popescu provides a scenario portraying the economic and human costs that antimicrobial resistance could impose on society 30 years from now, if it is not addressed soon. You can read the full article here. This is an especially relevant topic as the CDC just released new data, finding that annually, 2.8 million resistant infections and 35,000 related deaths occur in the United States. The CDC report notes that “However, deaths decreased by 18 percent since the 2013 report. This suggests that prevention efforts in hospitals are working. Yet the number of people facing antibiotic resistance in the United States is still too high.”

Event Recap – People, Pigs, Plants, and Planetary Pandemic Possibilities 
If you happened to miss this November 5th event, no worries – GMU biodefense doctoral student Stevie Kiesel has provided an in-depth summary of the panel and discussions. Kiesel notes that the panel had insightful discussions on the need to understand local context and empower people and local public health communities. Local context is important for combating misinformation and getting a more accurate understanding of conditions on the ground. For example, the public health community must understand why a country may be disincentivized to report a disease outbreak in its early stages, when it is more easily controlled. Authoritarian governments who maintain tight messaging control may not want to admit to an active outbreak, or the economic drawbacks of announcing an outbreak may be so severe that leaders try to hide what’s going on. You can read more here.

Pandemic Policy: Time To Take A Page Out Of The Arms Control Book
Rebecca Katz is holding back no punches in her latest article on the broken policy approaches we have to international outbreak accountability, and frankly, it’s long overdue. Full disclosure, the first line is one of my favorites – “Last month, the World Health Organization (WHO) was reduced to the equivalent of playground pleading: ‘But you promised!’” Katz highlights that in the face of countries failing to meet their obligations within the International Health Regulations (IHR), the WHO has little recourse to act and frankly, the path to accountability isn’t particularly clear. Ultimately, this problem could be solved though, if instead of rewriting the IHR, we modeled such treaties in the image of the Biological Weapons Convention (BWC) to help convene regular review conferences, discuss developments, and establish a regulatory response that could help drive accountability. “As the former US representative to the BWC, Charles Flowerree, wrote, treaties ‘cannot be left simply to fend for themselves’.”

The 5th Annual Pandemic Policy Summit at Texas A&M University
GMU Biodefense doctoral student Rachel-Paige Casey has provided an in-depth review of this important summit earlier this week. 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. You can read more about the summit here.

Catalyst- A Collaborate Biosecurity Summit 
Don’t miss this February 22, 2020 event in San Francisco. “Catalyst will be a day of collaborative problem-solving for a broad range of people invested in the future of biotechnology, including synthetic biologists, policymakers, academics, and biohackers. We aim to catalyze a community of forward-looking individuals who will work together to engineer a future enhanced by biology and not endangered by it.The summit is free to attend for everyone accepted, and the application only takes a few minutes. We expect participants to come from diverse backgrounds, and welcome applicants who do not work professionally in biosecurity or biotechnology, who are early in their careers, and who are skeptical of how biosecurity discussions are typically framed. You can apply to attend here.

Firehosing – the Antivaxxer Strategy for the Transmission of Misinformation
Researchers Christopher Paul and Miriam Matthews of Rand introduced this idea in 2016 and it’s proving to be pretty accurate for how anti-vaccine advocates are pushing out their opinions. Lucky Tran of The Guardian recently made the link between antivaxxers and the strategy of firehosing, which entails a massive flow of disinformation to overwhelm the audience. Just like it sounds, firehosing involves pushing out as many lies as frequently as possible to overwhelm people with information and making it nearly impossible for a logical response to combat that much disinformation. Tran stumbled across this application by seeing it on a television show with anti-vaccine influencers like Jay Gordon and he employed this strategy. “Anti-vax influencers such as Jay Gordon and Andrew Wakefield can keep repeating disproved claims – and in the case of Wakefield, doing so despite having had his medical license revoked – because their lying effectively debases reality and gains them followers and fame in the process.” The Rand study can be found here, which originally discussed firehosing in the context of Russian propaganda – as it has two “distinctive features: high numbers of channels and messages and a shameless willingness to disseminate partial truths or outright fictions. In the words of one observer, ‘[N]ew Russian propaganda entertains, confuses and overwhelms the audience’.” In the face of this relatively new tactic, there is a desperate need to remove false anti-vaccine content from social media and websites, and to put more pressure on media and news platforms to not provide support for such guests/conversations.

Crowd-Control Weapons – Are They Really Non-Lethal?
The term “non-lethal” or “less-than-lethal” gets thrown around a lot when it comes to crowd/riot-control weapons but just how non-lethal are these methods if they’re overused? Physicians for Human Rights (PHR) dug into this very issue because frankly, the use of these weapons is quite common and if they’re not used properly, or with the proper training, they can be devastating. Routine use or misuse of agents like tear gas can be deadly. The PHR conducted several investigations into their use by governments in Bahrain, Georgia, Kashmir, Turkey, and other countries and ultimately, what they found was some pretty startling misuse that can result in long-term health outcomes or even death. They put together a report and factsheets on specific “non-lethals” like acoustic weapons, rubber bullets, stun grenades, tear gas, and even water cannons. Within each factsheet, you can read about the history, how they work, device types, health effects, legality of use, and considerations and policy recommendations. Within the report, they reviewed usage of the weapons including things like people who suffered injuries or even death. As protests occur in China, the use of sonic weapons for crowd control are a very real reminder of the fine line we walk when using “non-lethals”.

Ebola Outbreak Updates and Vaccine Approval 
This week, the European Medicines Agency (EMA) approved the V920 vaccine for Ebola Virus Disease (EVD) and it is already being administered in the Democratic Republic of the Congo. The ongoing EVD outbreak in the Democratic Republic of the Congo (DRC) started in August 2018 and has now exceeded 3,000 cases and 2,000 deaths. Since the 2014-15 outbreak in West Africa, advances in medical research produced new vaccination and therapeutic options. The V920 vaccine, developed and produced by Merck, was tested during the outbreak and showed a 97% efficacy rate and protects against the Zaire species, which is the strain responsible for the current outbreak. Johnson-and-Johnson is also beginning trials for its investigational EVD vaccine. Johnson-and-Johnson’s vaccine requires two doses, a barrier for patient compliance, and does not contain any antigens from the Ebola Bundibugyo species of the virus. Dr. Dan Lucey, professor of medicine at Georgetown University, wrote an editorial in the British Medical Journal about the new treatments for EVD. Dr. Lucey’s article reviews the findings and shortcomings of the four-arm randomized controlled trial (RCT) evaluating the efficacy of four potential EVD treatments: ZMapp, remdesivir, mAb114, and REGN-EB3. The RCT was discontinued when a strict statistical threshold for decreased mortality was reached REGN-EB3, a monoclonal antibody drug. The punchline for the efficacy of REGN-EB3 is that it is efficacious if administered during the early stage of the disease but not as the diseases progresses. Lucey recommends continuing research on EVD treatments that are successful at later stages of the diseases. Last but not least, the article applauds the rigor and difficulty of this randomized-controlled trial given it was conducted during the outbreak, making it a precedent-setting achievement.

GMU Biodefense Alum Changing the Face of Aerospace Physiology 
We’re excited to share some of the achievements of one of GMU’s biodefense alum – Nereyda Sevilla, a May 2017 doctoral graduate in Biodefense, who is a civilian aerospace physiologist for the Defense Health Agency working as Acting Director of the Military Health System Clinical Investigations Program. She was also recently awarded the Air Force Medical Service Biomedical Specialist Civilian of the Year Award and the Air Force Meritorious Service Medal. If you’d like to see more of Nereyda’s hard work in action, check out the article she and the Spatiotemporal Epidemiologic Modeler (STEM) Team published in the Sept 2019 edition of Health Security,  “STEM: An Open Source Tool for Disease Modeling.” (Volume 17, Number 4, 2019).

Phase 3 Trial of Modified Vaccinia Ankara Against Smallpox
In the last Pandora Report, we discussed the FDA approval of the new smallpox vaccine JYNNEOS, that was tested by USAMRIID. The vaccine, developed by biotechnology company Bavarian Nordic, will enter the market under the name JYNNEOS. You can read about the Phase 3 efficacy trial of JYNNEOS (a modified vaccinia Ankara, MVA) as a possible vaccine against smallpox in the latest New England Journal of Medicine. GMU Biodefense professor and director of the graduate program, Dr. Gregory Koblentz noted that one of the key findings of this Phase 3 efficacy trial is that even though the FDA has approved a two-dose regimen for MVA (since it is a non-replicating vaccine that uses an ), a single dose of MVA provided the same level of protection as a single dose of the replicating vaccinia vaccine ACAM 2000. “At day 14, the geometric mean titer of neutralizing antibodies induced by a single MVA vaccination (16.2) was equal to that induced by ACAM2000 (16.2), and the percentages of participants with seroconversion were similar (90.8% and 91.8%, respectively).” An additional advantage of MVA over ACAM 2000 is that the former can be administered by a subcutaneous injection while the latter requires scarification through the use of a bifurcated needle. The article concludes that “No safety concerns associated with the MVA vaccine were identified. Immune responses and attenuation of the major cutaneous reaction suggest that this MVA vaccine protected against variola infection.”

Key Global Health Positions – A Who’s Who in the U.S. Government
Have you ever wondered who helps support global health within the U.S. government?  The Kaiser Family Foundation (KFF) has created a substantial list on not only the positions, but also who (if anyone) is occupying them. From the Department of Health and Human Services to the Department of the Treasury, you’ll want to utilize this list to not only realize the scope of global health efforts within the USG, but also who you might need to get in touch with.

Stories You May Have Missed:

• African Swine Fever Continues to Spread in Asia – Unfortunately, this outbreak isn’t showing signs of letting up… “The update shows new outbreaks in Vietnam, Cambodia, Laos, the Philippines, South Korea and on the Russian side of the Chinese border reported during the first week of November. Meanwhile, formal confirmation is awaited of ASF outbreaks in Indonesia. The FAO reports that more than 4,500 pigs are said to have died in 11 regencies/cities in North Sumatra. Dead pigs were also found in a river. FAO is liaising with the Indonesian authorities to ‘confirm the cause and explore needs’.”