Pandora Report: 3.20.2020

Policy vs. Pandemics: Polarization and Public Health Emergency Preparedness
Could there be a better time to discuss partisanship in pandemic response? Join us virtually on March 26th from 6-7:30pm EST. Due to the COVID-19 pandemic, this event will be held as a live webinar instead of an in-person talk. Blackboard Collaborate Ultra works best with Google Chrome and does not work with Internet Explorer. Participants will be able to use the “Raise Hand” function in Blackboard Collaborate to ask questions at the end of Dr. Myer’s prepared remarks. Everyone who registers for the webinar will receive a 30% discount on his book. This webinar will be recorded and the video will be posted to the YouTube channels for The Pandora Report and the Schar School of Policy and Government. Event info -The sweeping effects of the COVID-19 pandemic on the social, economic, and political framework of the United States highlights the vital importance of a resilient public health infrastructure. In the aftermath of this pandemic, the United States will need to reconsider its approach to biosurveillance, public health emergency preparedness, intergovernmental coordination, and the development of countermeasures in advance of the next health crisis. In the past, such efforts have been hindered by partisan polarization between Republicans and Democrats, even as some crucial public health emergency policy was only made possible through bipartisan cooperation. While considering lessons from the past, this discussion will address bipartisan efforts to move forward on approaches to protect the American people in the future, such as the implementation of the National Biodefense Strategy. Dr. Nathan Myers is an associate professor of political science and public administration at Indiana State University. His research interests include public health policy, U.S. executive branch politics and administration, emergency planning and preparedness, and regulation of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies(Lexington Books, 2019). Register for the event here. Keep reading for an in-depth interview with Dr. Myers.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
From July 13-16, 2020, GMU Biodefense will be hosting a workshop on all things global health security. Leaders in the field will be discussing hot topics like vaccine development, medical countermeasures, synthetic biology, and healthcare response to COVID-19. This is also a great networking opportunity as past participants come from a range of government agencies, NGOs, universities, think tanks, and foreign countries. Don’t miss out on the early-bird discount for this immersive workshop – you can register here.

Modeling SARS-CoV-2
A model for the spread of the SARS-CoV-2 virus for the Eclipse Spatio-Temporal Epidemiological Modeler (STEM) framework has been produced Dr. James Kaufman of IBM Research Almaden. The model divides the population into four compartments: people susceptible to the disease, those who have the disease but don’t show symptoms, people infected and showing symptoms, and those who have recovered or died, from the population. When plugged into STEM, various hypothetical scenarios can be generated using the modeling framework. For example, the model could allow researchers to study the effect of the presence of pre-symptomatic infectious individuals on the spread of the virus. In particular, the model, which can be downloaded for free from the STEM website, comes with a pre-built scenario of SARS-CoV-2 global outbreak which includes a travel shutdown in or out mainland China after 60 days of the pandemic. Additional scenarios can be built using the framework to model other public health interventions, including quarantine, global travel restrictions, and the implementation of various vaccination policies.

Risks, Trade-offs, and Responsible Science
Dr. Gregory Koblentz, GMU’s Biodefense Graduate Program Director, and Dr. Fillipa Lentzos, Senior Research Fellow at King’s College London, published an article in 2016 showcasing the heightening safety and security risks as the number of laboratories and scientists working on dangerous pathogens and toxins increases substantially. These risks are greater today than even three years ago as technological innovations and improvements in synthetic biology continue at a record rate. Beneficially, leaps in synthetic biology enable quicker and deeper research into pathogens in order to reduce their collective risk to humanity. But this comes at a cost that must be balanced. Recent articles in The New Yorker and the Bulletin of the Atomic Scientistsdebate the benefits and risks associated with increasing laboratory facilities and capabilities, and reference the expertise of Koblentz and Lentzos.  The “biodefense boom,” ongoing since the turn of the century, increases risk in four primary areas: biosecurity, biosafety, dual-use research of concern (DURCs), and compliance with the Biological Weapons Convention (BWC). These risks must be weighed into any decisions regarding new or advanced laboratories, especially those for extremely virulent pathogens that require stringent safety and security to prevent misuse, theft, or accidental release. The authors urge biodefense policymakers to regularly evaluate the risk trade-off as they make decisions about prevention, preparedness, and response to existing and emerging biological threats. To that end, Koblentz and Lentzos encourage responsible science, recommend forming a BWC science advisory group to develop well-defined international guidelines managing DURC, establish a Confidence Building Measures working group, guarantee that biodefense activities are subject to strict biosafety and biosecurity regulations supported by

COVID-19 Pandemic Updates
Every day feels a bit longer during the midst of the COVID-19 pandemic especially as so many are working remotely or actively quarantining to help prevent the spread of SARS-CoV-2. For many in healthcare, the overwhelming amount of people coming into emergency departments is stressing the system even more – New York City public health syndromic surveillance data found that ED visits for adults seeking care for influenza-like-illness is 50% higher than the last three years of flu, however this is likely “care-seeking behavior – not all COVID.” As many cities initiate restaurant and bar limitations, there has been increased focus on the role of the CDC and how their messages and efforts have been somewhat sidelined. “The CDC, which has come under fire because of protracted delays in the rollout of agency-developed test kits, has not conducted its own telephone briefings for reporters in more than a week. Recent CDC recommendations on school closures and mass gatherings were overtaken by different guidelines issued by the coronavirus task force, creating confusion, experts and officials said.” Tom Inglesby of the Johns Hopkins Center for Health Security noted that “It is confusing for the public to have CDC say no gatherings of more than 50 people, and the next day, the task force says no gatherings of more than 10 people If the information has changed, tell everyone why. Let’s make sure everyone is on the same page.” Many are underscoring though, that the continued funding cuts to critical agencies, like the CDC, and the disbanding of the White House’s National Security Council Directorate for Global Health Security and Biodefense, created a perfect storm that would leave the United States vulnerable to biological threats and limited response. NTI’s Dr. Beth Cameron discusses the impact here, noting that “When President Trump took office in 2017, the White House’s National Security Council Directorate for Global Health Security and Biodefense survived the transition intact. Its mission was the same as when I was asked to lead the office, established after the Ebola epidemic of 2014: to do everything possible within the vast powers and resources of the U.S. government to prepare for the next disease outbreak and prevent it from becoming an epidemic or pandemic. One year later, I was mystified when the White House dissolved the office, leaving the country less prepared for pandemics like covid-19. The U.S. government’s slow and inadequate response to the new coronavirus underscores the need for organized, accountable leadership to prepare for and respond to pandemic threats.” In response, National Security Advisor Bolton has been quick to defend his decision though, claiming streamlining, while many feel that this was just poor prioritization of global health security. The truth is that that there have been several warnings of what might happen in this situation, including government exercises. One in particular was the “Crimson Contagion” exercise, held last year by DHHS, which simulated an influenza pandemic. If that name sounds familiar, it’s because we reported on the event late last year. In an effort to tackle the pandemic and community-level response, experts are working to commit to COVID-19 efforts, like the biomedical meeting held this week in Boston. In building response, should we look to those countries that have already dealt with COVID-19? GMU Biodefense student HyunJung (Henry) Kim asks what lessons we can learn from Japan and South Korea for the coming cases. “For example, Japan and South Korea have taken very different approaches to restrictions on travelers from China. Since February 1, Japan has denied entry to foreign nationals who had visited China’s Hubei province, which includes a home of Wuhan city, and later, on February 13, expanded that travel ban to eastern provinces including Zhejiang province. In contrast, South Korea does not prevent the entry of any foreigners who had visited China.” Lessons learned will be critical now, as hospitals in the United States struggle with supplies and additional cases are identified via growing testing capabilities. The capabilities of our healthcare system are limited and now is the time, as so many have pointed out, to reinforce social distancing, staying home when you’re sick, and engaging in infection prevention basic. Flattening the curve can help preserve hospital capacity and capabilities. “Just 11 weeks into a pandemic crisis expected to last months, the nightmare of medical equipment shortages is no longer theoretical. Health-care workers, already uneasy about their risk of infection amid reports of colleagues getting sick and new data showing even relatively young people may become seriously ill, are frustrated and fearful.” Despite a need to start developing strategies for vaccines, facilities previously funded to help rapidly develop medical countermeasures are sitting it out. Having $670 million invested into these four sites, none of the locations though (Florida, Maryland, North Carolina and Texas) “have developed or are close to delivering medicines to counter the outbreak, according to records, government officials and others familiar with the facilities. Instead of leading the rush to find and mass manufacture a vaccine or lifesaving treatment, two of the sites are taking no role, while the other two expect to conduct small-scale testing of potential coronavirus vaccines.” Don’t miss the Global Health Security Agenda’s COVID-19 Chair, Roland Driece’s statement on the role of GHSA2024 in the pandemic, here.

MITRE’s Recommendations to Stop COVID-19
The MITRE Corporation’s infectious disease analytics team published a white paper comprising recommendations of specific actions that US leaders should immediately take to quell the COVID-19 pandemic. Many of MITRE’s recommendations revolve around continuing to encourage and incentivize social distancing through non-pharmaceutical interventions (NPIs). MITRE estimates that we must reduce the human-to-human contact rate of Americans by 90% to stop COVID-19. These NPI include immediately closing all schools; incentivizing remote work among the private center enterprise; immediately closing establishments for social gatherings (restaurants, bars, theaters, concert and sports venues); and incentivizing individuals to remain at home except for those with emergent medical needs or those who are part of the maintenance of critical infrastructure. Beyond social distancing, recommendations also encompass support for sanitary maintenance of transport and logistics operations, financial support to counteract sudden losses in income and/or business revenue, and travel restrictions into and out of the US until the pandemic passes. The full white paper with its 14 detailed recommendations is available here.

Interview with Nathan Myers, PhD
Dr. Nathan Myers is an associate professor of political science and public administration at Indiana State University. His research interests include public health policy, US executive branch politics and administration, emergency planning and preparedness, and regulation of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies (Lexington Books, 2019). GMU’s Biodefense, MPA, and MPP programs are hosting a webinar with Dr. Myers focusing on his new book and the ongoing pandemic. In advance of his presentation, an interview with Dr. Myers took a number of twists and turns about preparedness politics and its role in COVID-19, in terms of US preparedness and response. Or lack thereof. Myers emphasizes the need for a One Health approach to preparedness policies and actions. Additionally, he advocated that the relationship between health and socioeconomic status be considered in preparedness policies and actions. In the thick of responding to a crisis, we must all pull together to do what is necessary to contain and mitigate the threat. Before such a crisis emerges is when political debates establish the degree to which America will be prepared. To this end, there is a long and important history of bipartisan actions on issues of public health emergency preparedness (PHEP) and biodefense: passage of the Pandemic and All-Hazards Preparedness Act (PAHPA), enactment of select reforms recommended by the Bipartisan Commission on Biodefense, and the development of the National Biodefense Strategy. An area of budding bipartisanship is the One Health movement. The One Health approach to health policy issues emphasizes the symbiosis between human health, animal health, and the environment – improving the health of one creates a ripple effect improving the health of the other two.  The COVID-19 pandemic, along with previous health emergencies over the last 20 years, have highlighted the need to recognize the public health implications of policy domains outside the traditional preparedness and response framework. This may require confronting the health security implications of some highly partisan issues. For example, the Zika virus outbreak, a vector-borne infectious disease, supports a strong relationship between climate change and human health. It is encouraging that both Republican and Democrats have been embracing the One Health framework, as it highlights the interconnectedness of several policy domains. However, Republicans and Democrats remain deeply divided on the degree to which humans affect climate change and the level at which climate change affects human health. Ebola showed that access to affordable and reliable health care can make the difference between containment and outbreak, as people may not go for treatment or be turned away. Income inequality is a driver of continuing inequities in health care and a risk factor across a range of communicable and non-communicable diseases. Zika highlighted access issues regarding contraception and abortion services around the world. It is important to keep in mind that the largest burden from caring for Zika-affected children falls on poor women in Brazil and other Latin American nations. If reproductive services are restricted, nations, including the US, must be prepared to offer economic and social assistance to help women who give birth to children with profound physical or developmental disabilities. COVID-19 is highlighting the fact that we need to provide a safety net for vulnerable groups like low-wage, working parents who are likely to experience loss of income and/or increased child care expenses during a public health emergency. Strategic bipartisan discussions need to come to grips with not only how emergency preparedness and response is funded, but also how we fund basic public health services. Population health should be regarded as not only on par with individual medical care, but as a matter of national security. Myers expects that the COVID-19 pandemic will result in bipartisan improvements in technocratic areas like disease surveillance and the development of countermeasures. Hopefully, improvements in incorporation of a One Health framework, efforts to improve population health, and measures to counteract the disproportionate burden emergencies place on out lower income households are forthcoming as well. After the immediate danger is passed, elected officials must address some tough political questions related to US preparedness and response for the next emergency. As many have noted, public health and how we address infectious disease is political. So, politicians must find a way to come together and answer hard political questions about how we avoid policy obstacles to managing public health emergencies in the future.


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