Pandora Report: 2.25.2022

As the world focuses its attention on Russia’s invasion of Ukraine, we begin this week by trying to understand what this evolving event means for global health security. This comes as much of the US and world continue to try to find ways to “get back to normal”, turning away from masking in hopes of treating COVID-19 like an endemic threat, which has not gone without criticism. Finally, in addition to our varied coverage this week, we are sad to also cover the death of Dr. Paul Farmer, a legendary figure in global health and pioneer of social medicine.

What Russia’s Invasion of Ukraine Means for Global Health Security

In his new piece in Think Global Health, David Fidler, Senior Fellow for Global Health and Cybersecurity at the Council on Foreign Relations, argues that Russia’s decision to invade Ukraine has nothing to do with the COVID-19 pandemic, but it does have implications for global health. He states, “The COVID-19 pandemic has wrought all kinds of havoc, but it has played no role in producing the threat of a Russian invasion of Ukraine that would reset the balance of power in Europe,” before continuing on to argue that Russia’s troop build up does not seem to have been timed to exploit any challenges brought by the pandemic to the US and her NATO allies. He also asserts that, “Arguments that stronger pandemic preparedness and response (PPR) capabilities produce meaningful strategic advantages in a world subject to balance-of-power politics do not hold up.” In support of this, he offers the example of US and Taiwanese officials becoming worried earlier in the pandemic that the Chinese would invade Taiwan, something that he notes could only be prevented if the US defended the island. As Taiwan has done fairly well throughout the pandemic, he concludes this means, “…international cooperation on PPR produces outcomes that are not responsive to the strategic threats that balance-of-power politics create.” He builds on this by discussing the Russian calculation to invade Ukraine, which he notes is based on the belief the US and her NATO allies will not send their forces into Ukraine, not on how it perceives the US military has managed the pandemic.

The Motherland Monument in Kyiv. Photo by Petkevich Evgeniy on Pexels.com

He discusses too the impact this conflict is likely to have on Ukrainians’ health outcomes, particularly as the conflict interrupts ongoing medical care and the damaged system becomes burdened by military and civilian casualties. Though he notes war historically helps facilitate the spread of disease, he writes ” A Russian invasion would disrupt Ukraine’s efforts against COVID-19, but in a delta- and omicron-saturated world, such a disruption is unlikely to change the course of the pandemic.” Importantly, he explains how this conflict will not just have acute ramifications for Ukraine’s healthcare system, but the vulnerability of displaced Ukrainians and the impact on their economic status and other social determinants of health will be of consequence in the long term.

The WMD angle to this is also incredibly important. Dr. Hanna Notte and Sarah Bidgood recently discussed the nuclear concern in War on the Rocks, writing, “The consequences of a Russian military escalation against Ukraine could well be catastrophic from an arms-control perspective. While Washington would probably find it extremely difficult to continue its Strategic Stability Dialogue with Moscow — commenced last summer in the wake of the U.S.-Russian presidential summit — the deleterious impact on global nonproliferation efforts would not likely be confined to the two countries’ bilateral agenda, should there be a war. And even if military escalation can be avoided, protracted tensions between Russia and the West are set to further frustrate efforts to prevent the spread of nuclear weapons across the board.”

Online rumors have also again circulated false information asserting Russia is targeting US BW labs near its borders, a notion the US has dispelled time and time again. It is important now to recall Russia’s attempts to sow disinformation regarding DTRA’s Cooperative Threat Reduction program, including false claims the US is supporting biological weapons laboratories in Ukraine and Georgia. The United States’ Biological Threat Reduction Program‘s work in Ukraine, as the Bulletin of the Atomic Scientists highlighted recently, involves “consolidat[ing] and secur[ing] pathogens of concern” and helping the country “detect and report outbreaks caused by dangerous pathogens before they pose security or stability threats.” This program has helped Ukrainian government agencies manage everything from the country’s COVID-19 response to helping them conduct work on agricultural pathogens and mentor scientists pursuing One Health- related research. To be clear, these facilities are run by the Ukrainian government, not the United States.

California Releases New Pandemic Plan

Late last week, California released its new SMARTER Plan: The Next Phase of California’s COVID-19 Response, which the Newsom administration bills as being designed to take the state from “pandemic to endemic”. SMARTER stands for Shots, Masks, Readiness, Testing, Education, and Rx, highlighting the core features of the state plan. Key points include maintaining a state capacity to provide at least 200,000 vaccines per day, maintaining a stockpile of at least 75 million high quality masks, increasing community engagement with over 150 relevant community-based organizations, continuing to sequence at least 10% of all positive COVID-19 test specimens, maintaining the capacity to administer 500,000 of COVID-19 tests per day, and using federal partnerships to ensure Californians can access necessary therapeutics in under 48 hours. This plan marks the first release of what some are calling “state endemic virus plans”. This comes amid waves of US state and foreign governments, including those of blue states, changing course on mask mandates in favor of a “return to normal”. Despite changes like these, as GMU Biodefense Assistant Professor Dr. Saskia Popescu recently explained to The Washington Post, travel remains a murky area, a negative test is required to return to the United States, and it is important for travelers to still be cautious and aware of the risk they are taking and creating. It is important to consider too that the Omicron variant surge in the US has driven up the rate of COVID-19 patients who acquired their infection in the hospital while seeking treatment for other conditions. This peaked at a record 4,700 hospital acquired infections per day in January, compared to the peak of 1,100/ day during the Delta wave and 2,050 during the first winter surge. While policies are changing, the threat is still present and it is important to take these very real risks into consideration when making these personal choices now.

Global Health and the National Security Council at a Critical Juncture

Dr. Beth Cameron is transitioning from her post as the National Security Council’s (NSC) Senior Director for Global Health Security and Biodefense, with Dr. Raj Panjabi, a PCP, former CEO of Last Mile Health, and President Biden’s current US Global Malaria Coordinator, taking her place. As Stat recently highlighted, this is a critical point for Panjabi as the moment is very uncertain. The pandemic has absolutely unearthed serious deficiencies in US public health preparedness, compounded by factors like climate change and widening socioeconomic inequities, but the world is fatigued from this pandemic and “International negotiations to bolster pandemic preparedness have been delayed by contested normative and pragmatic approaches to health security.” Arush Lal of London School of Economics highlighted recently three potential priorities for Panjabi as he joins the NSC, including shifting focus from one-off disease events to building functioning health systems, focusing on building up equity globally to help prepare for future emergencies, and focusing on addressing fragmentation in critical public health emergency leadership. He concludes by arguing that Panjabi should tie COVID-19 investments to local health systems specifically, helping address some of the challenges of patch-work public health funding in the US. This holistic approach, Lal argues, will help the US better deal with complex, ever-changing public health threats, including COVID-19 as the situation continues to evolve.

Republic of Korea Named WHO Global Biomanufacturing Training Hub

Outgoing South Korean President Moon Jae-in and the WHO Academy announced this week that the country was selected to be the WHO’s global biomanufacturing training hub. This will serve low- and middle- income countries interested in producing biologicals, like vaccines, insulin, monoclonal antibodies, and various cancer treatments. Echoing the successful establishment of a global mRNA vaccine technology transfer hub in South Africa, this program will see the WHO and ROK coordinate to create a comprehensive general biomanufacturing curriculum for attendees to help build stronger workforces and regulatory systems in targeted countries. The South Korean Minister of Health and Welfare, Kwon Deok-cheol, stated, “Just 60 years ago, Korea was one of the poorest countries in the world…With the help and support of WHO and the international community, we have transitioned into a country with a strong public health system and bio-industry. Korea deeply cherishes the solidarity that the international community has shown us during our transition. By sharing these lessons we’ve learnt from our own experience in the past, we will strive to support the low- and middle-income countries in strengthening their biomanufacturing capabilities so that we could pave the way together towards a safer world during the next pandemic.”

US Fast Tracks Proposals to Alter WHO International Health Emergency Response Rules

Amid calls that the WHO was underpowered when the COVID-19 pandemic began, the US has issued a proposal for major changes to the rules of the International Health Regulations. According to Health Policy, these have been discussed in a number of closed-door meetings of WHO member states who are considering ways to reform the existing IHRs and possibly advance an entirely new WHO convention or other international framework for pandemic prevention and response. The US proposal includes changes to the WHO’s early warning reporting criteria, updates to the time allotted to report outbreaks of international concern and acceptable methods of communication, and the time in which the WHO must seek verification and begin coordinating next steps of action. Other potential changes to the IHRs include improved sharing of data and genome sequences of emerging pathogens, rules on equitable vaccine distribution, and incentives for reporting new pathogens and variants. The EU is also pushing for a ban on wildlife markets. The US opposed creation of a new binding treaty overall, though it is still taking part in the talks, particularly concerning IHR amendments.

WHO Says BA.2 is Not More Virulent

The BA.2 subvariant now accounts for more than one third of global COVID-19 cases, based on recently submitted samples to GISAID. While it does seem to be up to 30% more infectious than the original Omicron, BA.1, the WHO says it is not actually more virulent than the original subvariant and it does not merit a separate designation with its own Greek letter. Importantly, the WHO also stressed that Omicron is not “mild”. Rather, it is less severe than Delta generally. There are about 40 mutations between BA.1 and BA.2 relative to the original strain of SARS-CoV-2, which some scientists argue is enough to label BA.2 as its own independent variant of concern. This all comes amid numerous studies and reports that Omicron does not increase the risk of hospitalization, despite a pre-print Japanese study showing the opposite in hamsters bringing concern in some circles.

Finafloxacin Shows Promise in Treating Both Plague and UTIs

Finafloxacin, a novel 5th generation fluoroquinolone, has shown success against plague and melioidosis in studies coordinated by academia, industry, and DTRA. Finafloxacin currently is already approved for its systemic and topical formulations to treat conditions caused by Pseudomonas aeruginosa and Staphylococcus aureus bacteria. Though research is ongoing, if successful, this will offer an alternative medical countermeasure to help combat diseases globally, which is incredibly important as antimicrobial resistance continues to rise globally. It is also rare to find an antibiotic that works against multiple pathogens, as Dr. Sarah Harding explained to Global Biodefense, so finafloxacin demonstrating potential as prophylaxis and treatment against both F. tularensis and Y. pestis. has some folks very excited.

Biotechnology Innovation Organization- The State of Innovation in Antibacterial Therapeutics

The Biotechnology Innovation Organization, or BIO, recently released its new report, “The State of Innovation in Antibacterial Therapeutics”, assessing the insufficiencies of the clinical antibacterial pipeline in meeting the growing threat of antibiotic-resistant pathogens. BIO has previously published research indicating that, “…drug development investment for many common chronic diseases was found to be declining and low relative to total healthcare burden on society,” according to the new report, further adding to these concerns. Highlights of this report include the facts that only one new molecular target NCE (new chemical entity) has been approved by the FDA in the last 35 years even though 164 direct-acting antibacterial NCEs have been approved since the early 1990s, clinical trial success rates are more than double the overall industry success rate (7.8% vs. 16.3%) for antibacterial NCEs from 2011-2020, and clinical trial initiations for these NCEs declined 33% in recent years. There are only 64 NCEs in clinical trials right now, 20 of which are candidates for tuberculosis and Clostridioides difficile, compared to the 260 COVID-19 antivirals and 158 breast cancer oncology drugs in clinical development in 2020-2021. The Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, introduced in the House and Senate in 2021, is designed to combat this by aiming “…to incentivize antibiotic development by creating a subscription-style model for new antibiotics, under which companies that develop critically needed antibiotics for resistant infections would receive a contract from the federal government ranging from $750 million to $3 billion.” This would decouple the ROI for new antibiotics from the volume actually sold, helping incentivize companies to pursue such research. Solutions such as this are discussed at length in the report, including a number of government and non-profit funding solutions, regulatory incentives, and market-based solutions to this critical challenge.

The President’s Malaria Initiative Operations Plans, Fiscal Year 2022

The President’s Malaria Initiative (PMI) has released its FY 2022 Malaria Operational Plans (MOPs), which are detailed one-year implementation plans for each PMI country program. These outline USAID’s support to national malaria strategic priorities and try to complement investments made by other partners by expanding malaria-related services. PMI operates in 24 focus countries in Africa and also supports three programs in the Greater Mekong Subregion of Southeast Asia, which combined represent about 90% of the world’s malaria burden. This year’s MOPs are available here on the PMI website.

Photo by Pragyan Bezbaruah on Pexels.com

Lentzos and Koblentz on Hybrid Coronaviruses

Dr. Gregory Koblentz, Director of the Biodefense Graduate Program at George Mason University, and Dr. Filippa Lentzos, Co-Director of the Centre for Science & Security Studies at King’s College London, recently published their article, “Have hybrid coronaviruses already been made? We simply don’t know for sure, and that’s a problem“, in The Conversation. In it they discuss the possibility that chimeric coronaviruses have already been made, stating that it unclear as US labs do not have to publicly report such experiments, drawing attention to what they believe is a large problem- lack of opportunity for public discourse on high-risk life science research. They begin by discussing the CDC’s 2021 addition of chimeric viruses, “viruses that contain genetic material derived from two or more distinct viruses”, to the Department of Health and Human Services’ (HHS) List of Select Agents and Toxins. The CDC then designated research pertaining to such viruses as restricted experiments which require approval from the secretary of HHS under the belief that such regulatory oversight is critical to prevent the release of such viruses, according to the authors. They discuss one US lab’s interest in conducting such research before getting into why this reporting structure prevents broader public discourse on the merits and risks of such research. They conclude that, “Knee-jerk regulatory responses to individual experiments, and treating safety, security and dual-use risks in isolation, must stop. It is high time for a new global architecture for life science governance that takes a comprehensive and coherent approach to biorisk management and that revisits how high-risk life sciences research, funding and publication processes are conducted.”

Book Launch Event: New War Technologies and International Law: The Legal Limits to Weaponizing Nanomaterials

King’s College London’s Centre for Science and Security Studies (CSSS) is offering an event introducing Dr. Kobi Leins’ new book, New War Technologies and International Law: The legal limits to weaponizing nanomaterials. This event will include Dr. Leins in conversation with Dr. Helen Durham, Director of the International Committee of the Red Cross (ICRC). The discussion will be moderated by Dr. Filippa Lentzos, Co-Director of CSSS. The event will occur on March 10, 3- 4 pm BST online and in-person. Register here.

Schar School- The Risk of Climate Change to International Security

The Schar School recently hosted a policy exchange on the intersection of climate change and international security issues, featuring a wide variety of faculty members covering unique facets of this nexus. The video of the event is available here. Featured faculty included:

Professor Ken Reinert serves as director of the Master’s in International Commerce and Policy program. He has consulted for the World Trade Organization, the World Bank, the OECD Development Center, and the U.S. Department of Commerce.

Associate Professor Greg Koblentz serves as director of the Biodefense Graduate program.  He is an associate faculty member at the Center for Security Policy Studies at Mason and a member of the Scientist Working Group on Biological and Chemical Security at the Center for Arms Control and Non-Proliferation.

Associate Professor Bonnie Stabile serves as associate dean of student and academic affairs and director of the Master’s in Public Administration program. She is the founder and director of the Schar School’s Gender and Policy (GAP) Center. 

Adjunct Professor Erin Sikorsky is the director of the Center for Climate and Security and the International Military Council on Climate and Security, as well as an adjunct professor at the Schar School.

Dr. Paul Farmer is Dead at the Age of 62

Dr. Farmer, a world-renowned medical anthropologist and physician known for his work in social medicine and global health, passed away on February 21 at the age of 62 due to an “acute cardiac event,” according to The New York Times. Dr. Farmer was the co-founder of Partners in Health, an international non-profit that works to provide direct health services while also working to alleviate poverty conditions of the sick under the idea that such conditions only further exacerbate illness and must be addressed structurally. His work influenced greatly public health strategies to respond to everything from TB, to HIV/AIDS and Ebola. He was also critical of international aid, despite his focus, often preferring to work directly with local providers and populations to achieve the best outcomes, moving his family to Rwanda and Haiti to do so. Many across the world are grieving the loss of Dr. Farmer, including Drs. Anthony Fauci and Peter Hotez, who both fondly recalled Farmer and his impact on so many lives.

Biodefense MS Program Alumna Elected Coordinator of Next Generation Global Health Security Network

Kate Kerr, Biodefense MS Class of 2019, was recently elected as Next Generation Global Health Security Network, an affiliate of the Global Health Security Agenda which is a collaboration founded in 2014 by representatives from 44 countries (now 69) and organizations, including the World Health Organization. NextGen is an international organization of nearly 1,000 early- to mid-stage professionals and students who work on the full spectrum of issues related to global health, ranging from combating antibiotic resistance to preventing the next pandemic. Kate previously served as the organization’s Deputy Coordinator and will now head the entirety of the global organization. The Biodefense Program has a history of producing leaders in this organization, including several country-level coordinators and global leaders. A big congratulations to Kate and all of the other newly elected leadership! We are so proud of you all and cannot wait to see where you take this organization next.

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