Pandora Report: 12.18.2020

As the holidays approach, we encourage mask-wearing, social distancing, and the holiday gathering guidelines of the CDC. 2020 has been the year of zoombombing, social distancing, and doomscrolling. On a happy note, 2020 is also the year that wild polio was eradicated in Africa and a major leap in HIV treatment research was made. To end the year on an interesting note, Filippa Lentzos shares her expertise about bioweapons.

The Pandora Report wishes everyone a happy holiday and New Year! We will see y’all in 2021!

Good Riddance, 2020!

In just two weeks, we will be bidding adieu to 2020 as the New Year begins. In 2021, Joe Biden will take office as president and the rollout of COVID-19 vaccines will expand, hopefully turning the tide of the pandemic. TIME released a list of terms that embodies 2020, which includes antiracist, blursday, covidiot, defund, doomscroll, Karen, on mute, quarantini, social distancing, superspreader, and zoombombing.

The Johns Hopkins Bloomberg School of Health highlighted 2020’s top global health moments, many of which, but not all, have been unfavorable. The WHO-UNICEF-Lancet Commission produced a report that emphasized the dangers ahead for children – climate change, migrating populations, conflict, inequality, and predatory commercial practices – that threaten their health and their futures. Of course, in March, the COVID-19 pandemic was declared by the World Health Organization, and a subsequent severe health worker shortage – including 5.9 million nurses – was revealed. Adding insult to injury, the Trump Administration announced that the US will withdraw from the WHO, a move that many global health leaders deem reckless. During the pandemic, the murder of George Floyd in Minneapolis, Minnesota, “sparked outrage, anguish, and a newfound urgency among Americans and American organizations to face the generations of systemic oppression and trauma Black Americans have endured.” The pandemic’s disproportionate effects on people of color and women helped put race and gender in the international spotlight.

Switching gears, in 2020, the Democratic Republic of the Congo (DRC) is better managing Ebola, even enjoying a temporary end to cases. Despite a reappearance of Ebola cases in the DRC, as of November, the country is again case-free. After four years without a case, Africa was certified as wild polio-free as a result of vaccination campaigns, pressure from the international community, and determined health workers. A welcome announcement in September shared that the HIV Prevention Trials Network study stopped their trial early because results were so effective. The trials include over 3,000 women at risk for acquiring HIV across seven countries in sub-Saharan Africa and have found that a single shot given every two months could be more effective at preventing HIV in women than a daily pill.

Despite the achievements of 2020, this year has been largely defined by SARS-CoV-2, the lackluster pandemic response of the US, and systemic prejudice. In short, 2020 has accurately been dubbed a dumpster fire.

Playing Politics in a Pandemic

Speaking of dumpster fires, more information has emerged regarding President Trump’s mishandling of the response to the pandemic. This week, Representative James E. Clyburn, Chairman of the Select Subcommittee on the Coronavirus Crisis, sent a memorandum to Members of the Select Subcommittee referring to new documents acquired in the investigation of political interference by senior Trump Administration appointees in the work of career officials at the Centers for Disease Control and Prevention (CDC). These documents revealed that officials at the Department of Health and Human Services (HHS) “repeatedly discussed pursuing a ‘herd immunity’ strategy and were aware that Administration policies were causing an increase in virus cases—but tried to hide the true danger of the virus and blame career scientists for the Administration’s failures.” Specifically, the memorandum explains evidence that Senior Advisor Paul Alexander, a Trump Administration appointee at HHS, privately planned with other Administration officials to follow a “herd immunity” strategy that advocated infecting “infants, kids, teens, young people, young adults, middle aged with no conditions etc. have zero to little risk….so we use them to develop herd…we want them infected.”

Accelerated Advances in Biotech and the Bioweapons Threat

Yong-Bee Lim, a Biodefense PhD candidate, published a short piece, “Accelerated Advances in Biotech and the Bioweapons Threat,” with the Council on Strategic Risks (CSR). In 2018, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a report highlighting how “nefarious actors may use technical advances in delivering genetic information like messenger RNA (mRNA) to generate a new class of biological weapons: weapons that modify human cell protein expression.” Given that two of the leading COVID-19 vaccines – one by Pfizer with BioNTech and another by Moderna – are mRNA-based, it is no surprise that mRNA has recently received heightened attention. Lim notes that these two vaccine candidates speak to the remarkable advances in biotechnology and the life sciences since 2018, a mere two years ago. National security experts must realize that biotechnology moves quickly and we must readily adapt to the swiftly-changing circumstances around us, or we will miss critical opportunities to avert the emergence and use of novel bioweapons.

Lim will soon be a Fellow for the Nolan Center on Strategic Weapons at the Council on Strategic Risks, working on the Making Biological Weapons Obsolete project. This program emerges as countries such as North Korea, Syria, and Russia are weakening norms against WMDs by increasing the use and testing of chemical weapons and nuclear weapon capabilities. Given the current and emerging technological advances as well as the current geopolitical climate, biological weapons are a ripe target for a new WMD. As a Fellow, Lim will conduct research, help develop an actionable vision of a world where bioweapons are obsolete, and build bridges and engage with stakeholders.

Moderna’s COVID-19 Vaccine Gets the Thumbs Up for VRBPAC

On 17 December, the Vaccines and Related Biological Products Advisory Committee (VRBPAC) convened to discuss and provide recommendations on whether the benefits of the mRNA-1273 COVID-19 Vaccine outweigh its risks for use in individuals 18 years of age and older. The VRBPAC voted 20-0 with one abstention to support mRNA-1273. This endorsement all but guarantees that the vaccine will receive emergency use authorization from the Food and Drug Administration. The Moderna vaccine will be approved for use in adults only.

MedicalCountermeasures.Gov

The Biomedical Advanced Research and Development Authority (BARDA) hosts a helpful website, MedicalCountermeasures.Gov, which facilitates communication between federal government agencies and public stakeholders to enhance the Nation’s public health preparedness. The site offers information and resources on the coronavirus response, federal initiatives, approvals from the Food and Drug Administration (FDA), emergency use authorizations (EUAs) from the FDA, stockpiles, and more.

The Strategic and Geo-Economic Implications of the COVID-19 Pandemic

The International Institute for Strategic Studies (IISS) published the Manama Dialogue 2020 Special Publication, which explores the regional and global implications of the pandemic, including essays on Gulf defense economics, global and great-power politics, the Gulf states’ development models, strategy and geo-economics. The pandemic will have enduring effects on geopolitics as international suspicion rises and trust wanes. The pandemic hit at a time when US-China relations were deteriorating during a trade war. Additionally, the US and China are battling for dominance in the technological space. The report asserts that economic power, sanctions and regulatory innovations will “evolve to be part of the strategic arsenal of other states.” At the same time, violent transnational actors are increasingly at work outside the scope of modern international law. These actors have exploited the “spaces between the law, and the state system has not responded by rendering their activities illegal.” Many elements of international law are also in need of review, including cyberspace, space, agreements governing asylum and refugees, and the regulation of private military companies and their activities. Read the report here.

The Coronavirus at 1: A Year into the Pandemic, What Scientists Know About How It Spreads, Infects, and Sickens

STAT outlined a portrait of SARS-CoV-2 based on what scientists learned about the virus as it infected the world and sabotaged economies, societies, and health systems. SARS-CoV-2 is an RNA virus with spike proteins that latch onto a receptor, called ACE2, on human cells. This latching allows the virus to enter the cell, take over the host’s cellular machinery, and churn out copies of itself that can burst out of the cell and seek out new cells to infect. SARS-CoV-2 can interrupt the desired immune response and cloak itself in ways that generate a harmful immune response. COVID-19 is the illness created by a SARS-CoV-2 infection. COVID-19 is characterized by respiratory issues, fever, headache, fatigue, and body aches as well as other, stranger symptoms such as a loss of smell and taste. Viruses evolve, and SARS-CoV-2 is no exception. One mutation of the spike protein, referred to as D614G, seems to have rendered the virus more transmissible, but it does not seem to have had an impact on the severity of illness. Learn more about the novel coronavirus here.

The Latest from Lentzos

Dr. Filippa Lentzos, a mixed methods social scientist researching biological threats, recently published two articles about bioweapons: “How to Protect the World from Ultra-Targeted Biological Weapons” and “How Russia Worked to Undermine UN Bioweapons Investigations.” The former article points out that as genomic technologies develop and converge with artificial intelligence, machine learning, automation, affective computing, and robotics, increasingly refined records of biometrics, emotions, and behaviors will be captured and analyzed. These data will enable game-changing developments that will significantly impact how we view health and treat disease, but also how we consider our place on the biological continuum. Further, these developments will radically transform the dual-use nature of biological research, medicine, and healthcare, producing the possibility of novel bioweapons that target specific groups of people or individuals. New governance structures that draw on individuals and groups with cross-sectoral expertise are required to manage the fast and broad technological advances already underway. The latter article focuses on Russia’s efforts to thwart investigations into allegations of chemical or biological weapons use. In fact, Russia has managed to garner aligning votes from China, India, Iran, Syria and Venezuela, who all voted against investigations into the sarin attacks in Ghouta, Syria. In October, Russia introduced a resolution to the General Assembly for updating procedures related to the secretary-general’s investigative mandate; however, beneath the surface of the resolution, it was apparent that the motive was to weaken the ability of the secretary-general to investigative chemical and biological weapons use. Russia’s underhanded proposal to give more power to the Security Council over chemical and biological weapons investigations is a signal that Russia, and the nations that supported the Russian resolution, fear the possibility that an independent impartial process might be beyond their control and veto.

Five Questions on New Data from China-WHO Showing 124 Confirmed Coronavirus Patients in December 2019

Dr. Daniel Lucey poses five key questions regarding the 124 COVID-19 cases from December 2019:

  1. Who are these 124 cases, and how many were linked to the Seafood Market and other specific locations in Wuhan?
  2. Where were the 5/124 cases who were not from Wuhan?
  3. What is the timeline for the day-by-day illness onset for each patient?
  4. How many “isolated” cases are known from before December even if no “unusual clusters” were reported?
  5. How many, if any, additional cases (more than 124) are known in December, and before December (back at least to Nov. 17, 2019 as reported by Josephine Ma, in the South China Morning Post March 13, based on “Government records”)?

On 24 January, there were 40 reported confirmed cases in December 2019, but days later, on 29 January, that number increased to 46. By 17 February, the reports claimed 100 cases. Finally, the count is now up to 124 confirmed cases. Why does this figure keep rising?

US Nuclear Warhead Modernization and “New” Nuclear Weapons

Rebecca Hersman, director of the Project on Nuclear Issues (PONI) at the Center for Strategic and International Studies (CSIS), and Joseph Rodgers, program manager of PONI, published a CSIS brief about US nuclear warhead modernization.  These briefs are based on a series of “deep dive” workshops convened by PONI that bring together next generation technical, operational, and policy experts from across the nuclear community to debate and discuss these nuclear challenges. The majority of workshop participants recognized the need for modernization programs for US and UK nuclear-warheads. Most also agreed that these modernization projects pose considerable fiscal and geopolitical challenges. Such challenges include how to maintain political support, fund modernization work with lengthy acquisition time horizons, compete with the nuclear modernization programs of adversaries, and adequately address nonproliferation challenges. Additionally, participants agreed that the tight coupling of the US and UK nuclear programs demands “greater consistency among policy statements regarding these programs and greater appreciation of the required timeframes for modernization in both countries.” To tackle these obstacles, the nuclear community must develop effective and informed expertise on warhead modernization and cultivate a common understanding of the benefits and risks associated with various warhead modernization approaches.

Crisis Standards of Care: Lessons from NYC Hospitals’ COVID-19 Experience

Last month, the Center for Health Security at Johns Hopkins University released a report, Crisis Standards of Care: Lessons from New York City Hospitals’ COVID-19 Experience. New York City experienced an unprecedented surge of COVID-19 patients from April to June 2020, which was characterized by the extraordinary use of critical care resources and high case fatality ratios. During this surge period, hospitals were overwhelmed and conventional standards of care could not be maintained, forcing hospitals and healthcare workers to adjust their methods of care in order to help the greatest number of patients. The report is the output of a forum convened to allow critical care physicians from a number of hospitals across New York City to frankly discuss their experiences with implementation of crisis standards of care (CSC). The following six major themes arose from the forum:

  • Pre-pandemic CSC planning did not necessarily align with the realities and clinical needs of the pandemic as it unfolded
  • The COVID-19 surge response was effective, but often chaotic
  • Interhospital collaboration was an effective adaptive response
  • Situational awareness, especially related to information about patient load and resource availability, was a challenge for many clinicians
  • Multiple CSC challenges had to be overcome, especially around decision-making for triage or allocation of life-sustaining care
  • Healthcare workers were profoundly psychologically affected by dealing with CSC issues amid the surge

Read the report here.

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