Pandora Report: 7.29.2022

This week we bring more updates on monkeypox and discuss two new publications in Science that indicate SARS-CoV-2 very likely originated in the Huanan Seafood Wholesale Market in Wuhan. We also cover other new publications, upcoming events, and the launch of ASPR TRACIE’s new DASH tool.

Monkeypox Updates

WHO Declares Monkeypox PHEIC, US Cities Declare Local Health Emergencies

The global monkeypox case count has now reached 21,148 cases, with 20,804 of those in countries that have not historically reported monkeypox. In total, 78 countries are reporting cases, with only seven of them having historically done so. This weekend, the World Health Organization officially declared monkeypox a public health emergency of international concern (PHEIC), in an effort to heighten global alarm and improve response efforts. Max Kozlov explains in Nature, “In an unprecedented move, WHO director-general Tedros Adhanom Ghebreyesus declared the PHEIC on 23 July, after a panel of advisers failed to come to a consensus. Although the panel doesn’t formally vote, six members were in favour of declaring a PHEIC, while nine were against, Tedros said at a press conference announcing his decision. The panel had previously met in late June, but at that time only three members were for declaring a PHEIC and 11 were opposed, so Tedros decided against sounding the alarm at the time.”

As of July 28, the US is tracking 4,906 monkeypox cases, making it the highest case count in a non-endemic country, surpassing Spain and the United Kingdom. According to CIDRAP, “Almost all US patients (99%) have experienced a rash, while 70% have reported malaise, 64% fever, and 63% swollen lymph nodes.” In absence of a federal emergency declaration, US cities are considering declaring their own health emergencies. For example, San Francisco declared a local health emergency that will go into effect on Monday. It is a legal action that will ideally help city departments to mobilize against monkeypox more effectively. The State of New York’s Health Commissioner, Dr. Mary T. Bassett, declared an imminent threat to public health recently, citing the rapid spread of the virus. “This declaration means that local health departments engaged in response and prevention activities will be able to access additional State reimbursement, after other Federal and State funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities,” she said in a statement.

Vaccine and Testing Access Remain Limited

These declarations come as the Biden administration is under fire for what many view as a sluggish response to monkeypox and concerns that the window of opportunity to contain the virus is rapidly closing. Specifically, nearly 800,000 doses of vaccine were held as the FDA completed a review of them and, earlier, as the virus spread in New York and other communities, 300,000 doses owned by the US sat in a facility in Denmark waiting to be shipped. Though US federal agencies helped develop the JYNNEOS vaccine, the Strategic National Stockpile held just a few thousand doses initially. As this vaccine is produced by a small company in Denmark, Bavarian Nordic, access to this specific vaccine has been constrained.

The US had a much larger supply of another smallpox vaccine that can be used for monkeypox under an Expanded Access Investigational New Drug application-ACAM2000. However, ACAM2000 shouldn’t be used in people who have things like different immunodeficiency diseases, certain skin conditions, or who are currently pregnant. The immune response takes about 14 days from the second dose of JYNNEOS (taken four weeks after the first dose), as opposed to the four weeks it takes after ACAM2000 (which is just one dose). JYNNEOS in an attenuated live virus vaccine and is replication-deficient, whereas ACAM2000 is replication-competent and uses the vaccinia virus, which can cause serious complications for some, especially those who are immunocompromised.

“We believe we have done everything we can at the federal level to work with our state and local partners and communities affected to make sure we can stay ahead of this and end this outbreak,” Xavier Becerra, head of the Department of Health and Human Services, told reporters on a call. NPR writes that he also “added that local health officials “must do their part. … We don’t have the authority to tell them what to do.””

Some at the local and state level argue that HHS does not understand the full breadth or severity of this crisis. New York, San Francisco, and Washington DC have now stopped scheduling appointments for second Jynneos doses, citing limited supplies and a desire to get first doses into more people. CIDRAP writes, “The CDC maintains that two doses of Jynneos should be administered 28 days apart, with full protection achieved 14 days after the second dose. But some local health officials are changing protocols. In Washington DC, health officials are postponing some second doses of monkeypox vaccine in a strategy to give first doses to more people.”

Social Stigmas Harming the Monkeypox Response

To make matters worse, public discourse on the monkeypox crisis is riddled with blatant homophobia and there continues to be a lack of access to resources in non-western countries currently experiencing outbreaks. NPR explains that, “In fact, the WHO emergency committee that had previously considered whether to issue such a declaration was unable to reach a consensus in part because of concerns about the risk of stigma, marginalization and discrimination against the communities hit hardest by the virus.”

As the US and other countries continue to mostly see cases in those who identify as men who have sex with men, it is important to both acknowledge what risks this poses while also understanding that, “While we may be seeing clusters primarily in certain groups of people, viruses do not discriminate by race, by religion, or by sexual orientation,” as Dr. Boghuma Titanji told NPR. The WHO has asked those in this community to limit their number of sexual partners or reconsider having sex with new partners.

From CDC PHIL: This 1997 image was created during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo (DRC), formerly Zaire, and depicts the dorsal surfaces of the hands of a monkeypox case patient, who was displaying the appearance of the characteristic rash during its recuperative stage. Even in its stages of healing, note how similar this rash appears to be when compared to the recuperative rash of smallpox, also an Orthopoxvirus.

“The Molecular Epidemiology of Multiple Zoonotic Origins of SARS-CoV-2” and “The Huanan Seafood Wholesale Market in Wuhan was the Early Epicenter of the COVID-19 Pandemic”

Two studies we previously discussed as preprints were recently published in Science, one determining that it is unlikely that SARS-CoV-2 was circulating widely in humans prior to November 2019 and that it likely resulted from multiple zoonotic events, and the other finding that the Huanan Seafood Wholesale Market in Wuhan was the cite of its emergence thanks to live wildlife trade. These help put to rest claims that SARS-CoV-2 originated in laboratory facilities, including the Wuhan Institute of Virology. Dr. Angela Rasmussen, one of the scientists who co-authored these papers, discussed their findings in this video with PBS News Hour:

“Regenerate: Biotechnology and U.S. Industrial Policy”

Ryan Fedasiuk of the Center for New American Security and Georgetown’s Center for Security and Emerging Technology recently authored this report, writing “A revolution in biotechnology is dawning at the precise moment the world needs it most. Amid an ongoing climate crisis, fast-paced technological maturation, and a global pandemic, humans must find new ways to reduce greenhouse gas emissions, improve food security, develop new vaccines and therapeutics, recycle waste, synthesize new materials, and adapt to a changing world. But incentive structures in the U.S. private sector are generally biased against risk, and therefore constrain development in ways that do not have the same effect on firms in China and other U.S. competitors. This puts the United States at a relative disadvantage and risks ceding American leadership over one of the most powerful and transformative fields of technology in recent memory.

The United States needs some form of industrial policy to promote its bioeconomy—one that is enshrined in democratic values and focused on improving access to four key drivers of bioeconomic growth: equipment, personnel, information, and capital. This report attempts to measure the health and outlook of the U.S. synthetic biology industry and broader bioeconomy by examining U.S. access to each of these four resources. It concludes that the United States still possesses an advantage in each of these fields—but that, absent a proactive strategy to ensure resource access, and without a significant infusion of capital, the U.S. bioeconomy risks languishing behind competitors such as China in the decades ahead.”

Revisiting Gain of Function Research: What the Pandemic Taught Us and Where Do We Go From Here

The US Senate Committee on Homeland Security and Governmental Affairs’ Subcommittee on Emerging Threats and Spending Oversight will hold this hearing on August 3 at 2:30 pm ET. More information, including the video conference link, will become available here.

Evaluating COVID-19-Related Surveillance Measures for Decision Making

The National Academies are hosting a webinar with the Societal Experts Action Network highlighting new and updated COVID-19-related data measures and surveillance strategies that have emerged. Throughout the COVID-19 pandemic, decision makers have made critical decisions in rapidly changing circumstances, with limited information and uncertainty about the best available data or evidence. As the pandemic has continued to evolve, the types of data available have changed with the identification of new variants, the availability of COVID-19 vaccines, the introduction of new COVID-19 therapeutics, the reopening of the economy, and the relaxing of mitigation measures. In addition to analyzing positive COVID-19 cases, hospitalization data, and vaccination rates, as was common earlier in the pandemic, decision makers may take into consideration surveillance strategies like wastewater surveillance and genome sequence testing and surveillance. This webinar is on August 3 at 3:30 pm ET. Register here.

Disaster Available Supplies in Hospitals (DASH) Tool Launched

ASPR TRACIE’s new tool, DASH, is now available at Hospital emergency planners and supply chain staff can use DASH to estimate supplies categorized in four modules (pharmaceutical, burn, trauma, and PPE) that may need to be immediately available during various mass casualty incidents and infectious disease emergencies based on hospital characteristics. Each module also incorporates pediatric sizes and specific medication needs as appropriate. TRACIE is offering a webinar on the tool August 15 at 11:30 am ET. Register here.

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