Pandora Report: 4.17.2020

A Strategic Vision for Biological Threat Reduction: The U.S. Department of Defense and Beyond
The Committee on Enhancing Global Health Security through International Biosecurity and Health Engagement Programs of the National Academies of Sciences, Engineering, and Medicine (NAS) published its 5-year strategic vision for international health security programs along with its findings and recommendations regarding how to optimize the impact of the Department of Defense (DOD) Biological Threat Reduction Program (BTRP) in achieving its mission for biosafety and biosecurity. Since BTRP is just one of the many US government programs involved in international health security engagement, coordination across the government and with its international partners is critical to achieving the biosafety and biosecurity mission of improving capacity to detect, diagnose, and respond to dangerous pathogens and other biological threats. Though BTRP is not the only cog in the biodefense wheel, it is a vital one, and, as such, should be granted “as much geographic and programmatic flexibility as possible to understand and address broadly the biosafety and biosecurity needs of its partner nations as the program serves US interests.” The 5-year vision aims to develop a durable interagency mechanism, encompassing BTRP and its DOD partners, that tackles the entire set of biological threats and risks affecting US military forces, foreign interests, and homeland. The proposed interagency mechanism would work to disrupt, mitigate, or eliminate risks as efficiently and effectively as possible by the agency or agencies befitting the needs of the mission. Their seven primary recommendations for BTRP include establishing stronger relationships with the combatant commands, CDC, NIH, and other relevant governmental partners; selecting technical engagement professionals to represent the USG; and acquiring more scientific expertise within its staff to proactively engage with the broader scientific community to improve its understanding of technical and scientific developments in emerging infectious diseases. Read the full consensus study report with its detailed findings and recommendations here.

COVID-19 Updates: From WHO to Healthcare Worker Infections
There have been over 600,000 cases and 24,582 deaths in the United States, while the worldwide case count has surpassed 2 million. This week, the CDC released new research via the Morbidity and Mortality Weekly Report (MMWR) regarding healthcare worker cases of COVID-19, shedding light on data gaps and the need to understand the impact of potential healthcare exposures and PPE challenges. “Of 9,282 U.S. COVID-19 cases reported among HCP, median age was 42 years, and 73% were female, reflecting these distributions among the HCP workforce. HCP patients reported contact with COVID-19 patients in health care, household, and community settings. Most HCP patients were not hospitalized; however, severe outcomes, including death, were reported among all age groups.” Of the 315,000 cases reviewed, data on job role was only available for 16%, and of those with occupational data, 19% were healthcare workers. 55% of those healthcare worker cases reported exposure to a confirmed case in a healthcare setting, while fewer noted community exposures, which is likely due to testing gaps. As GMU Biodefense alum and infection prevention epidemiologist Saskia Popescu noted, “This data is really helpful because it’s giving us those first indicators of health care worker risks and exposures,” says Dr. Saskia Popescu, an epidemiologist at a large health system in Phoenix. “But ultimately we need to be collecting more on this because we have to understand the failures, so we can correct them in the future.” In Washington, D.C., President Trump has worked to shift blame of COVID-19 response to The WHO, noting that the administration would be halting funding for the organization. “In effect, Mr. Trump was accusing the world’s leading health organization of making all of the mistakes that he has made since the virus first emerged in China and then spread rapidly. As of Tuesday, there had been about two million cases of the virus worldwide, and nearly 125,000 deaths. In the United States, there have been over 600,000 cases and 25,000 deaths from the virus.” These announcements come just as more light is shed on the woefully inadequate testing within the U.S.

Faculty Spotlight: VOA (Korean Service)
Earlier this week, Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, was interviewed for and quoted in an article published by the Korean VOA outlet about the latest use of the Defense Production Act (DPA) to produce 39 million N-95 masks in the next 90 days. Koblentz points out that the DPA will do little to overcome the shortage in diagnostic kits because the lack is not the result of underutilized production capacity but the result of the difficulty in producing safe and reliable tests. Koblentz also acknowledges the potential abuse of the president’s powers via the employment of the DPA. Specifically, since the conclusion of the Cold War, the lawful definition of defense has been increasingly broadened to include “matters not directly related to armed conflict.” In fact, President Trump recently commented that he would stop exports of PPE based on the DPA. The full article is available here.

Global Health Security & National Security 
On Wednesday, April 15, 2020, more than 2,494 Americans died of COVID-19 according to Johns Hopkins School of Public Health. That is more deaths than occurred on December 7, 1941. Global health security is national security. Sadly, this pandemic and the U.S. response has showed how many gaps we have in national security. Oona Hathaway of Just Security noted “As devastating as the terrorist attacks of 9/11 were, the death toll of COVID-19 is already higher in New York state alone, where more than 4,000 had reportedly died as of April 5. The overall U.S. death toll from coronavirus is now close to 10,000. Estimates suggest that the final death toll could be well over 100,000. Indeed, President Donald Trump recently suggested that 100,000 American deaths would mean’“we all together have done a very good job’. If one believes, as I do, that the fundamental goal of a national security program should be to protect American lives, then we clearly have our priorities out of place. Just as the 9/11 attacks led to a reorientation of national security policy around a counterterrorism mission, the COVID-19 crisis can and should lead to a reorientation of national security policy.” As GMU professors Dr. Gregory Koblentz and Dr. Michael Hunzeker noted last week, the COVID-19 outbreak on the USS Theodore Roosevelt forced the ship’s commander to temporarily scale back operations and now, the USS Ronald Reagan is reporting positive COVID-19 cases and may have no option but to follow the lead of the Roosevelt. These events are warnings to our national security apparatus that pandemic diseases are clear and present threat to our Nation and her allies and interests. Koblentz and Hunzeker urge the US to recognize this threat and adjust to it with urgency and intensity. For more, Koblentz and Hunzeker’s article is available here.

Internal Savings from the Pentagon
According to DefenseNews, DoD identified $5.7 billion in funding – referred to as “savings found through efficiencies” – based on an internal review of the fourth-estate offices, which comprise all the defense agencies not associated with either a service or a combatant command. This funding will be reallocated to new priorities: nuclear modernization, the new US Space Force, hypersonic weapons, artificial intelligence, missile defense, 5G communications technologies, and response force readiness. Mark Esper, the Secretary of Defense, plans to find more savings by continue the review in FY22. Secretary Esper has empowered Lisa Hershman, the department’s chief management officer, to play the role of service secretary for the fourth estate offices, by overseeing their budget development process. Presently, the so-called savings and associated reallocations do not require any terminations, as retirements will free up some of that money; however, personnel reductions remain an option for FY22. Read the full article here.

Embrace Experimentation in Biosecurity Governance
A recent article in Science Magazine implores the scientific and policy communities to rethink and expand the concept of biosecurity governance with the inclusion of new assumptions about the relationships between biology, security, and society. This rethinking will enable improvements in biosecurity governance and in its implementation. Classical governance of biology concentrates on risk management and dual-use research of concern; however, as we are realizing as a global community, not all threats and risks can be precisely foreseen and, therefore, mitigated. Policy lags behind developing tools, like CRISPR, and the potential dual-use dangers they create, both of which are growing at an accelerating rate over the last decade. In an effort to close this gap, the Potential Pandemic Pathogen Care and Oversight policy was established to assess the circumstances under which such research is ethical, but there are no systematic and consistent reviews of the policy’s implications. The onus of biosecurity is increasingly falling to scientists with little training and information about how to assess safety and security concerns of their research. The authors recommend an experimental approach to biosecurity governance in which assessments of research are systematic, transparent, and flexible. Experimentation along with better data collection and sharing are critical for developing a “robust and adaptive governance system.” The full article can be found here.

Responding to COVID-19 While Reopening A Nation
As America works to “reopen” and loosen restrictions, many have warned that it must not be done too soon or too quickly. On Thursday, Present Trump announced plans to reopen the country – emphasizing criteria for relaxing restrictions in phases that did not include dates and left much to governors. The U.S. is still struggling with widespread access to rapid diagnostics, which many cite as a necessity prior to relaxing national restrictions. Focus has been of late on antibody testing and the potentially for post-infection immunity, which isn’t as easy as people might assume. “The unknowns begin with how much an immune response to SARS-CoV-2—the virus that causes COVID-19—tells us. Early studies suggest the production of IgM and IgG in COVID-19 patients typically occurs between 7 and 11 days after exposure, with IgM antibodies appearing first, followed by IgG antibodies. The presence of these antibodies, which respond to specific antigens on the surface of the SARS-CoV-2 virus, indicate that a person has been exposed and their immune system has reacted. But does that necessarily mean a person is immune to getting re-infected?” As we look to serology and the potential of re-opening efforts, experts have emphasized the incremental relaxation and that there will likely be spikes that occur, requiring contact tracing and isolation efforts. As Ed Yong of The Atlantic asked – when will things go back to normal? “The options are limited. Early inaction left the U.S. with too many new cases, and just one recourse: Press a societal pause button to buy enough time for beleaguered hospitals to steel themselves for a sharp influx in patients. This physical-distancing strategy is working, but at such an economic cost that it can’t be sustained indefinitely. When restrictions relax, as they are set to do on April 30, the coronavirus will likely surge back, as it is now doing in Singapore, China, and other Asian states that had briefly restrained it.” The truth is, and as the White House plan notes, many things need to occur prior to restrictions fully being relaxed and not just better diagnostics, but also a healthcare infrastructure that isn’t overwhelmed and without critical resources, ability to do contact tracing, and continued decline in cases and community transmission.

Good News: Vanquishing the Virus
As some much-needed good news, GEN’s tally of vaccines and treatments under development against COVID-19 has reached 161 candidates and counting. GEN divided the medical countermeasure candidates into four aptly named categories based on current developmental and clinical progress: front runners, definitely maybes, keeping an eye on, and too soon to tell. To date, there are 18 front runners, 17 definitely maybes, 70 candidates they are keeping an eye on, and 56 candidates whose efficacies are too soon to tell. The categorized lists are available here.

Roadblocks to Infection Prevention Efforts in Health Care: SARS-CoV-2/COVID-19 Response
Infection prevention epidemiologist and GMU Biodefense PhD alum Dr. Saskia Popescu discusses challenges to healthcare infection prevention efforts while combatting COVID-19. ” Lessons from the 2003 SARS-CoV outbreak in Toronto and 2015 MERS-CoV outbreak in South Korea have unveiled the critical role that hospitals play in outbreaks, especially of novel coronaviruses. Their ability to amplify the spread of disease can rapidly fuel transmission of the disease, and often those failures in infection prevention and general hospital practices contribute to such events. While efforts to enhance infection prevention measures and hospital readiness are underway in the United States, it is important to understand why these programs were not able to maintain continued, sustainable levels of readiness. History has shown that infection prevention programs are primarily responsible for preparing hospitals and responding to biological events but face understaffing and focused efforts defined by administrators. The current US health care system, though, is built upon a series of priorities that often view biopreparedness as a costly endeavor. Awareness of these competing priorities and the challenges that infection prevention programs face when working to maintain biopreparedness is critical in adequately addressing this critical infrastructure in the face of an international outbreak.” Read more of her article here.

Inventions Birthed by Necessity 
GMU Biodefense PhD alum Dr. Daniel Gerstein is evaluating some of the innovations and invention that the COVID-19 pandemic is stimulating. “If necessity is the mother of invention, the new coronavirus is quickly birthing a lot of innovations. Parts of U.S. society may be forever changed by this pandemic. As of 13 April 2020, the United States had over 550,000 confirmed cases and nearly 22,000 deaths, with emergency preparedness and response agencies preparing for much more to come. Combinations of social distancing, home quarantine, closure of schools and universities, and case isolation are now being extensively practiced. Creativity is being implemented each day to overcome response barriers to those at work and meet the needs of those asked to stay at home.” Read Dr. Gerstein’s article here.

Upcoming Virtual Event: Synthetic Biology and National Security: Risks and Opportunities (Part 2 of 2)
On 21 April 2020 at 1:00 pm, Center for Strategic and International Studies (CSIS) is hosting the second part of its Synthetic Biology: The Ongoing Technology Revolution Series. The series covers several important topics within synthetic biology: present and future potential as a critical emerging technology; economic and societal implications; national security opportunities and risks; and implications for emerging technology policy. This online event features Dr. Megan Palmer, Senior Research Scholar at the Center for International Security and Cooperation at Stanford University; Dr. Alexander Titus, the Chief Strategy Officer of the Advanced Regenerative Manufacturing Institute; and Dr. Rocco Casagrande, the Founder and Managing Director of Gryphon Scientific. The event will be available to view here.

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