Pandora Report: 9.24.2021

This week we have a new student writer, Lauren Eichberger (Reynolds), a Biodefense Certificate student, shares her summary and takeaways a virtual event held by from the Association of State and Territorial Health Officials (ASTHO). Progress has been made over the last several days toward bringing justice to victims of the Kremlin’s campaign of assassination on British soil. A former US ambassador to the OPCW explains how the body is the “epicenter of a global chemical weapons crisis and a front line in a broader confrontation between the West and Russia.”

Commentary – Two Decades After 9/11: What We’ve Learned About Public Health Preparedness and Leadership

September 11th, 2001 is a date the United States will never forget. Following this tragedy, there were calls to improve our national security against “physical” attacks and amend preparedness plans. Now, in 2021, two years into the COVID-19 pandemic, the nation finds itself in a comparable situation with a call for greater biosecurity and health care preparedness. The Association of State and Territorial Health Officials (ASTHO) held a virtual event, “Two Decades After 9/11: What We’ve Learned About Public Health Preparedness and Leadership” that discussed these two calls-to-action. Lauren Eichberger (Reynolds), a Biodefense Certificate student, shares her summary and takeaways from the event. Read Lauren’s commentary here.

Worldwide Threats to the Homeland: 20 Years After 9/11

Christopher Wray, Director of the Federal Bureau of Investigation (FBI), made a statement before the House Homeland Security Committee about the threats facing the US. Director Wray shared that the FBI is currently investigating over 100 types of ransomware, has recently arrested over 600 gang members in a single month, and that the Bureau is opening a new China counterintelligence investigation every 12 hours. According to Wray, the greatest terrorist threats to the US are lone actors, largely because they move quickly from radicalization to action. In the wake of 9/11, 20 years ago, the FBI underwent a transformation that dramatically expanded national security operations, and changed the focus to “disrupting attacks before they occur and on working with and through our partners around the world and at every level of government here at home.” His testimony covers the violence and destruction of property at the US Capitol building on 6 January, top terrorism threats, cyber attacks, foreign malign influence, and lawful access. Read Wray’s testimony here.

New Book – Denying the Obvious: Chemical Weapons and the Information War Over Syria

Brian Whitaker, a former Middle East Editor of the Guardian newspaper, wrote a new book, Denying the Obvious: Chemical Weapons and the Information War Over Syria. In 2011 mass demonstrations broke out in Syria calling for an end to the regime of President Bashar al-Assad. The regime responded brutally and within months what had begun as political unrest turned into a full-scale war between government forces and a variety of armed groups. In the midst of that turmoil, the regime began using chemical weapons – banned under international law. The regime’s guilt was beyond reasonable doubt though it denied responsibility and Russia, as its chief ally, weighed in with vigorous support. So, too, did a number of small groups and individuals in the west – apparently sincere people who convinced themselves that one of the Middle East’s most oppressive regimes was the innocent victim of a plot to discredit it. Among them were an assortment of university professors, retired spies, “independent” journalists, “anti-imperialists” and more than a few habitual conspiracy theorists. They accused rebel groups of faking the chemical attacks – a claim that became the starting point for a disinformation campaign stretching far beyond Syria. This is the story of that campaign: how it originated, the ideas that drove it, and how it was choreographed with assistance from Russia. Read the new book here.

Progress Towards Accountability for Putin’s Use of Poison

On 21 September, two announcements brought justice a little bit closer to victims of the Kremlin’s campaign of assassination on British soil. The first announcement, from the European Court of Human Rights (ECHR), dealt with the case of Alexsandr Litvinenko, the former Russian spy, who was poisoned in London with the radioactive substance polonium-210 in 2006. The British government has accused two Russian citizens, Andrey Lugovoy and Dmitriy Kovtun, of being responsible for the poisoning. The ECHR ruled 6-1 that “there was a strong prima facie case that, in poisoning Mr. Litvinenko, Mr. Lugovoy and Mr. Kovtun had been acting as agents of the Russian State.”  Furthermore, the court noted that the Russian government had “failed to provide any other satisfactory and convincing explanation of the events or counter the findings of the UK inquiry” and that “the Russian authorities had not carried out an effective domestic investigation capable of leading to the establishment of the facts and, where appropriate, the identification and punishment of those responsible for the murder.” The court granted the plaintiff, Maria Anna Carter aka Marina Litvinenko, payment from Russia – 122,500 euros in non-pecuniary damages and costs – but rejected her claim for punitive damages. The same day, the BBC reported that the British authorities were ready to charge a third person, Denis Sergeev, in the use of Novichok nerve agent in the attempted murder of Sergei Skripal, another former Russian spy, and his daughter Yulia. This botched attack led to the poisoning of two police officers and two civilians, one of whom, Dawn Sturgess, died. Sergeev had been previously identified by Bellingcat as a high-ranking GRU officer who oversaw the Skripal operation. According to the Crown Prosecution Service, there was “sufficient evidence to provide a realistic prospect of conviction” and that it was in the public interest to charge Sergeev even though Sergeev is in Russia and Russia refuses to extradite its citizens. Also, this week, a third man known as ‘Sergey Fedotov’ was identified and prosecutors from the Crown Prosecution Service (CPS) concluded that available evidence is sufficient “to provide a realistic prospect of conviction and that it is clearly in the public interest to charge Sergey Fedotov.” Authorized charges against Fedotov include: conspiracy to murder Sergei Skripal; attempted murder of Sergei Skripal, Yulia Skripal and Nick Bailey; causing grievous bodily harm with intent to Yulia Skripal and Nick Bailey; and possession and use of a chemical weapon, contrary to the Chemical Weapons Act 1996.

Syria, Russia, and the Global Chemical Weapons Crisis

Kenneth D. Ward, former US ambassador to the Organisation for the Prohibition of Chemical Weapons (OPCW), explains how the OPCW is the “epicenter of a global chemical weapons crisis and a front line in a broader confrontation between the West and Russia.” Indeed, he emphasizes that the “world is now precariously perched on the knife’s edge of a new era of chemical weapons use.” In August 2013, the Syrian military launched sarin attacks against the opposition-controlled town of Ghouta, killing 1,400 people. By the end of the next month, “the international community had legally anchored the US-Russian joint framework in a decision of the OPCW Executive Council and in a UN Security Council resolution, which included measures to address any Syrian failure to comply with the resolution’s provisions or with the prohibitions of the CWC.” In 2014, Syria’s declared stocks of chemical weapons were being removed for destruction, but signs emerged that the regime would not “comply fully with its commitments under the CWC and the UN resolution.” It was around this time that the joint framework began to unravel. In the following years, attacks with chemical weapons continued, both by the Assad regime against the Syrian people and by other nations, such as Russia’s use of nerve agents in attempted assassinations. After Russia used a chemical weapon in the United Kingdom, the UK initiated a special session of CWC states-parties to forge an international response, which resulted in the adoption of the decision, “Addressing the Threat from Chemical Weapons Use.” This decision “dealt with Syria’s continued possession and use of chemical weapons,” “clarified the mandate of the OPCW Technical Secretariat in the context of the CWC,” and “authorized the release of OPCW information to any entities established under the auspices of the UN investigating chemical weapons use in Syria.” Ward states that the “United States must accord high priority to defending the CWC and lead an international effort to hold perpetrators accountable in all relevant forums.” He also emphasizes that “to successfully weather the assault on the convention and the norm, diplomacy must be paired with concerted international investment in the OPCW.” Read Ward’s full article here.

Terrorist Attacks Against Vaccinators: A Review

Vaccinators fulfill an important role in a nation’s public health by reducing the burden of disease on the population. Understanding patterns of attack employed against vaccinators is important to determine how to protect them. A new study conducted a search of the Global Terrorism Database for terrorist attacks against vaccinators that occurred between the years 1970 and 2018. Using the search terms “hospital,” “healthcare,” “clinic,” “doctor,” “nurses,” “vaccinators,” and “vaccinations,” 2,322 healthcare-related entries were identified. The researchers then manually searched the dataset for incidents related to attacks on vaccinators, which resulted in the identification of 133 attacks against vaccinators. The majority (128 out of 133) of attacks occurred during or after 2010. Every attack except one has occurred in the Middle East, South Asia, or sub-Saharan Africa. Pakistan has seen the most attacks against vaccinators, with 112 incidents recorded. Vaccinators continue to be vulnerable to terrorist attacks. Protection of healthcare personnel during mass vaccination efforts is critical so that they can continue their life saving mission. Read the article in Health Security here.

The Future of Zoonotic Risk Prediction

In the light of the urgency raised by the COVID-19 pandemic, global investment in wildlife virology is likely to increase, and new surveillance programmes will identify hundreds of novel viruses that might someday pose a threat to humans. To support the extensive task of laboratory characterization, scientists may increasingly rely on data-driven rubrics or machine learning models that learn from known zoonoses to identify which animal pathogens could someday pose a threat to global health. A new article synthesizes the findings of an interdisciplinary workshop on zoonotic risk technologies to answer the following questions. What are the prerequisites, in terms of open data, equity and interdisciplinary collaboration, to the development and application of those tools? What effect could the technology have on global health? Who would control that technology, who would have access to it and who would benefit from it? Would it improve pandemic prevention? Could it create new challenges? Read the article here.

Here’s What We’ve Learned About COVID-19—An Update

The Science and Technology Directorate (S&T)’s Master Question List (MQL) is a resource that consolidates recent and accurate COVID-19 information, and is regularly updated with the latest results and data relevant to the pandemic. The latest MQL update includes answers to some new questions covering the efficacy of the COVID-19 vaccines, the Delta variant of SARS-CoV-2, and the long-term symptoms of COVID-19 infection. According to the Centers for Disease Control and Prevention (CDC), the vast majority of US COVID-19 hospitalizations and deaths are occurring in unvaccinated individuals, at 95-99.9% and 94-99.8%, respectively. The Pfizer/BioNTech and Moderna vaccines were found to be 88% effective overall in a study published by the US National Library of Medicine. Long-term infections persist for more than four weeks, and affects 5-10% of patients. The most common chronic symptoms include fatigue, loss of taste or smell, shortness of breath, and headache. Find the current MQL here.

Leader of WHO’s New Pandemic Hub: Improve Data Flow to Extinguish Outbreaks

Chikwe Ihekweazu, an epidemiologist and former leader of the Nigeria Centre for Disease Control (NCDC), talks about his exit from NCDC and shares his hopes and fears for the new Hub for Pandemic and Epidemic Intelligence in Berlin. Upon his departure, the NCDC staffed about 700 people, included two emergency operation centers, and maintained surveillance teams to detect and respond to infectious disease incidents. In his new leadership role at the Hub, Ihekweazu says that he wants to “make the mechanics of reporting disease-related information easier, and also demonstrate that the World Health Organization can use that data to help countries that share it.” His main source of anxiety is that “expectations are so high that people will expect us to demonstrate results immediately — to, you know, identify a single case of a new virus anywhere in the world and stop it.” The aim of the Hub is to “offer [its] leadership, knowledge, systems for data sharing and analytics to help countries be more confident in the decisions they have to make.” Though Ihekweazu has physically left Nigeria, the country is always in his heart, and he is “always thinking about how to make Nigeria better, and how to make the continent work better.”

The Latest COVID-19 Figures

As of 23 September, worldwide, there have been 230,351,063 COVID-19 cases; 4,723,172 deaths; and 6,012,794,821 vaccine doses administered. According to STAT’s COVID-19 Tracker, COVID-19 deaths have now exceeded 675,400 in the US. To put that figure in perspective, in 1918, the Spanish flu caused a pandemic that claimed the lives of an estimated 675,000 Americans across about two years. At present, deaths in the US account for about 14% of the 4.7 million losses worldwide from the pandemic; the US population accounts for only 4.2% of the global population. In the US, 99% of new COVID-19 cases are of the Delta variant. Dr. Saskia Popescu, an assistant professor in the Biodefense Graduate Program as well as an alumna, said the fact that new cases are overwhelmingly caused by the Delta variant is “not unexpected, because it’s more transmissible, but it is also a strong reminder that we need to have continuous vigilance.” Popescu emphasizes, “don’t let your guard down,” because we still need “continuous surveillance, genomic sequencing, access to testing and public health interventions.” For everyone, this includes wearing a mask to curb transmission.

COVID-19 Cited in Significant Increase in Healthcare-Associated Infections in 2020

New data from the Centers for Disease Control and Prevention (CDC) show that there were significant increases in healthcare-associated infections (HAIs) during 2020, the first year of the COVID-19 pandemic. This surge is “quite troubling and must serve as a call to action.” Ann Marie Pettis, President of the Association for Professionals in Infection Control and Epidemiology (APIC), emphasizes that “as a nation we must take significant efforts to bolster our infection prevention and control programs throughout the healthcare continuum.” A new report from the CDC, COVID-19 Cited in Significant Increase in Healthcare-Associated Infections in 2020, analyzes data collected through the National Healthcare Safety Network (NHSN), the country’s largest healthcare-associated infection surveillance system. According to the report, “major increases were found in 2020 compared to 2019 in four serious infection types: central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, and antibiotic resistant staph infections.” This analysis “highlights the need for healthcare facilities to strengthen their infection prevention programs and support them with adequate resources so that they can handle emerging threats to public health, while at the same time ensuring that gains made in combatting HAIs are not lost.”

Mental Health and Social Support for Healthcare and Hospital Workers During the COVID-19 Pandemic

The Johns Hopkins Center for Health Security recently published a new study, “Mental Health and Social Support for Healthcare and Hospital Workers During the COVID-19 Pandemic,” that aims to identify the issues most critical to healthcare workers’ mental health, wellbeing, and motivation during the COVID-19 pandemic. Healthcare and hospital workers providing care and support to infected patients during a pandemic are at increased risk for mental distress. Factors impacting their mental health include high risk of exposure and infection, financial insecurity due to furloughs, separation from and worries about loved ones, a stressful work environment due to surge conditions with scarce supplies, traumatic experiences due to witnessing the deaths of patients and colleagues, and other acute stressors. Finding ways for institutions to support the mental wellbeing of healthcare and hospital workers in an acute pandemic-related crisis situation is of critical importance. The factors affecting mental health are deeply connected to work-related motivation and attendance. Willingness to come to work is multifactorial and is dependent upon an individual’s self-perception of risk, as well as having the skills and resources necessary to perform work tasks given the nature of the public health emergency. Social and material support for healthcare workers in a variety of high-stress and high-risk settings is important for supporting workers’ mental health and in maintaining their commitment in challenging conditions. The impact of the COVID-19 pandemic on healthcare workers has been profound, characterized by death, disability, and an untenable burden on mental health and well-being.

The study was conducted using a cross-sectional survey (1,189 responses) and 73 semi-structured interviews with individuals currently employed at the Johns Hopkins Health System (JHHS) and Johns Hopkins Medicine (JHM) hospitals located in Maryland and the District of Columbia. The study population included healthcare providers and direct support services staff, including workers in frontline environmental services, food services, and security. The responses from the survey and interviews revealed that the trauma of witnessing COVID-19 death was exacerbated by the general stress of working during the pandemic and that the significant mental health burden created by the pandemic/infectious disease environment itself was characterized by the ongoing uncertainty and ambiguity about the scientific understanding of the virus. Additionally, stressors negatively impacting employee mental health stemmed from the workplace, resulting in reduced trust of and increased perceptions of betrayal in the institution. Read the full study here.

In 2020, Maddie Roty, recent graduate of the Biodefense MS program, discussed the psychological effects of the pandemic on healthcare workers in her piece, “Heroes are Human Too: The Toll of COVID-19 on the Mental Health of Healthcare Workers.” Read Maddie’s article here.

Charting a Strategic Path Forward for DHS in an Evolved Threat Landscape

Dr. Daniel Gerstein, alumnus of the Biodefense PhD Program and an adjunct professor at the Schar School, discusses why the upcoming Quadrennial Homeland Security Review (QHSR) and Department of Homeland Security (DHS) strategic plan should take on new importance given the challenges the nation and DHS are facing. The QHSR is due to Congress by the end of calendar year 2021 and the Strategic Plan by February 2022. Together, they will articulate DHS’ missions and goals, the strategies to achieve each goal, and long-term performance measures to evaluate the progress. There are two possible paths for DHS with these documents. The first approach is to “dust off and update the 2014 QHSR and the DHS Strategic Plan for Fiscal Years 2020-2024. The core values and guiding principles could be revalidated and minor changes made to the five operational missions and enterprise support functions.” Gerstein offers a second approach for developing the QHSR report and DHS Strategic Plan: “recognize that fundamental and profound changes have occurred in the threats and risks confronting our nation and are continuing to stretch the department in its key mission areas.” The second approach recognizes the “need for charting, or at least considering, a new operational and organizational path forward.” Gerstein argues that the latter approach is most prudent to follow given the length of time that has passed since the establishment of the Department and the changing threats and risks. Read the article here.

After-Action Findings and COVID-19 Response Revealed Opportunities to Strengthen Preparedness

The COVID-19 pandemic shows how catastrophic biological incidents can cause substantial loss of life, economic damage, and require a whole-of-nation response involving multiple federal and nonfederal entities. The 2018 National Biodefense Strategy outlines specific goals and objectives to help prepare for and respond to such incidents. The CARES Act includes a provision for GAO to conduct monitoring and oversight of federal efforts to prepare for, respond to, and recover from COVID-19. GAO’s report, After-Action Findings and COVID-19 Response Revealed Opportunities to Strengthen Preparedness, addresses: (1) interagency plans key federal agencies developed, and exercises they conducted, to help prepare for biological incidents; and (2) the extent to which exercises and real-world incidents revealed opportunities to better achieve National Biodefense Strategy objectives. GAO reviewed biological incident plans and after-action reports from exercises and real-world incidents from calendar years 2009 through 2019, including a non-generalizable sample of 19 reports selected based on threat scenario and other factors. GAO interviewed federal and state officials to obtain their perspectives on plans, exercises, and the COVID-19 response. GAO outlines 16 recommendations to the Secretaries of Homeland Security, Defense, Health and Human Services, and Agriculture. These recommendations center largely around the secretaries working through the Biodefense Steering Committee to define the set of capabilities that each agency needs to prepare for and respond to nationally significant biological incidents, and to periodically assess and communicate exercise priorities among the capabilities they identify. Read the report here.

European Health Emergency Preparedness and Response Authority (HERA): Getting Ready for Future Health Emergencies

On 16 September, the European Commission launched the European Health Emergency preparedness and Response Authority (HERA) to prevent, detect, and rapidly respond to health emergencies. HERA will anticipate threats and potential health crises, through intelligence gathering and building the necessary response capacities. When an emergency hits, HERA will ensure the development, production and distribution of medicines, vaccines and other medical countermeasures – such as gloves and masks – that were often lacking during the first phase of the coronavirus response. It will be fully operational early 2022. Its functioning will be reviewed and adapted on an annual basis until 2025, when a full review will be carried out. HERA is a key pillar of the European Health Union announced by President von der Leyen in her 2020 State of the Union address and will fill a gap in the EU’s health emergency response and preparedness.

Event – The US Food and Drug Administration’s Emergency Use Authorization: Lessons Learned from the Past to Guide the Future

The National Academies of Science, Engineering, and Medicine is offering a workshop on 5-6 October that will look at the past, present, and possible future of the FDA’s Emergency Use Authorization. The workshop will examine the US Food and Drug Administration’s historic and recent use of the Emergency Use Authorizations (EUAs) for diagnostics, therapeutics, and vaccines. It will also provide an overview of the current regulatory framework for EUAs and discuss whether any possible revisions would help to ensure that EUAs are based upon the best and most reliable scientific evidence or enhance public confidence and trust in the EUA process and products.  The workshop will also examine EUAs and similar mechanisms used by other entities within the global health regulatory system, lessons that US and global regulatory and public health partners can learn from one another, and ways to enhance international cooperation between the FDA and its global partners. Register here.

Event – 2021 BSL4ZNet International Conference

The Biosafety Level 4 Zoonotic Laboratory Network (BSL4ZNet) invites you to attend the 2021 BSL4ZNet International Conference, a four-day, online event that will be held virtually on 23 and 29 September as well as 7 and 14 October. 
The conference will convene under the overarching theme of Preparing and Responding to New Post-Pandemic Challenges. The conference aims to enhance knowledge and best practices, and promote collaboration and cooperation with participants from around the world.

The 2021 BSL4ZNet International Conference will be organized into four thematic sessions focused on the post-pandemic era and driving science forward.

  1. Emerging and re-emerging pathogens, on September 23, 2021
  2. BSL3 and BSL4 biosafety and biosecurity: international perspectives, on September 29, 2021
  3. One Health perspectives, on October 7, 2021
  4. Zoonotic outbreaks and pandemics: science policy and science diplomacy perspectives, on October 14, 2021 

The diverse line-up of international keynote speakers and panelists include scientific experts and leading science professionals from government, academia, industry, and non-profit organizations, working in the areas of research, emerging and re-emerging bio-threats laboratory management, biosafety and biosecurity, science diplomacy and policy. Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, will be speaking on the “Science policy perspectives in the future of biodefense and biosecurity” panel on 14 October. Expect to hear and engage in discussions on how to leverage the experience of the COVID-19 pandemic, and other zoonotic outbreaks, through reflections and lessons learned to navigate a post-pandemic era.

Register here.

Upcoming Meeting of the National Biodefense Science Board

The National Biodefense Science Board (NBSB or the Board) is authorized under Section 319M of the Public Health Service (PHS) Act, as added by Section 402 of the Pandemic and All-Hazards Preparedness Act of 2006 and amended by Section 404 of the Pandemic and All-Hazards Preparedness Reauthorization Act. The Board is governed by the Federal Advisory Committee Act, which sets forth standards for the formation and use of advisory committees. The NBSB provides expert advice and guidance on scientific, technical, and other matters of special interest to the Department regarding current and future chemical, biological, nuclear, and radiological agents, whether naturally occurring, accidental, or deliberate.

The NBSB will meet in public (virtually) on September 28, 2021, to discuss high priority issues related to national public health emergency preparedness and response. A more detailed agenda will be available on the NBSB meeting website.

Event – Africa CDC Inaugural One Health Conference

The Africa CDC, a specialized technical agency of the African Union (AU), is working to strengthen Africa’s public health institutions to detect and respond quickly and effectively to disease threats and outbreaks on the continent. Africa CDC recognizes that a One Health approach is critical to this mission and for the accelerated implementation of the International Health Regulations (IHR 2005) and to achieve the AU Agenda 2063: The Africa We Want.

Increasing globalization, urban density, ease of travel, animal movement, environmental changes and habitat overlap between humans and animals, all provide opportunities for the emergence and spread of diseases that adversely impact both human and animal health, prosperity, and food security. COVID-19 and Ebola virus disease are two recent examples of how these various factors have directly impacted Africa. To combat these current outbreaks and get ahead of the next, a One Health approach must be taken.

One Health is a collaborative, multisectoral and transdisciplinary approach used to attain optimal health outcomes for people, animals, plants, and their shared environment. Practically, One Health involves the collaboration between human, animal, and environmental health sectors as well as other relevant stakeholders, in the design and implementation of programs, policies, legislation, and research intended to achieve better health outcomes for all.

To celebrate and share the various One Health work taking place on the continent, the Africa Centres for Disease Control and Prevention (Africa CDC) is hosting a 3-day virtual One Health Conference from 1-3 November 2021. Presenters will include representatives from Africa Union Member States, RECs, Africa Union technical agencies, Africa CDC RCCs, research institutions and technical partners. Register here.

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