Pandora Report: 12.18.2022

We hope you don’t have the Sunday scaries, but this issue will either help them or make them way worse–there is no in between. We start off this week with discussion of the unfolding situation in China as the realities of the sudden absence of the country’s Zero-COVID policies continue to unfold. We also cover a number of updates from the US government, including the formation of a new bureau in the Department of State and the release of several reports from the House of Representatives. As always, we have a number of new publications and upcoming events. This week also includes an announcement from the GHSA Consortium, so be sure to read to the end.

First, a Sunday comic just like back in the day (well, kind of)

Ten-Points to a Million Deaths? China Exits Zero-COVID

What Started All This?

It has been a confusing few weeks in regards to the PRC’s management of COVID-19, with policy reversals coming rapidly in the aftermath of mass protests over the country’s strict Zero-COVID policies of the last couple years. For a brief re-cap, the State Council released a ten-point plan on December 7 that accelerated the country’s shift away from Zero-COVID. The plan marked a number of critical national shifts, including the prohibition of “arbitrary expansion of high-risk areas”, calling for delineating high risk areas in a scientific manner and ceasing to designate these areas based on residential compounds, communities, and towns in favor of targeting buildings, units, floors, and households. It also ended mass testing according to administrative regions while also reducing the scope and frequency of testing, requiring that quarantine measures imposed on high-risk areas be lifted in the absence of new infections after five days, and prohibiting willful closures of pharmacies. Importantly, these points also allow for home quarantine for those with asymptomatic or mild infections.

On December 8, the State Council also released guidelines for home treatment of COVID-19 for asymptomatic and mild COVID-19 cases. These guidelines also indicate that patients with stable underlying medical conditions who are infected with COVID-19 but do not require hospitalization may recover at home. These guidelines also call on local governments to establish channels for rapid transfer of patients between upper-level hospitals and communities, while allowing homebound patients to monitor their own symptoms. Finally, these guidelines indicate “…that the quarantine period ends for homebound patients if all the following requirements are met — their symptoms improve significantly or if they have no obvious symptoms, they test negative in antigen self-test applications and take two consecutive nucleic acid tests with the cycle threshold values not smaller than 35.”

However, provinces are introducing rollbacks at different paces, so Zero-COVID is not being exited uniformly across China. The Center for Strategic and International Studies has an interactive map available detailing which provinces have implemented which rollbacks as of December 14 that is very helpful in visualizing where policies are the most liberal. Currently, Beijing is the most relaxed, having implemented eleven rollbacks as of December 14, including: release home care instructions for patients; resume provincial group tours; open more fever clinics; distribute test kits; end temporary lockdowns; reduce checking of test results; reduce checking of health codes; ease restrictions on cold and flu medicine purchases; allow increased at-home quarantine; ease processes for domestic travel; and encourage vaccination for seniors.

The WHO Health Emergencies Programme Director Dr. Michael Ryan said on Wednesday that COVID-19 cases in the country were already exploding before the State Council effectively abandoned the Zero-COVID policies. Ryan said, “There’s a narrative at the moment that China lifted the restrictions and all of a sudden the disease is out of control…The disease was spreading intensively because I believe the control measures in themselves were not stopping the disease. And I believe China decided strategically that was not the best option anymore.”

The View on the Ground

Whether or not it is true that the initial uptick in cases was or was not caused by the loosening of these policies no longer seems to be relevant. Anecdotally, many in Beijing have said they knew of hardly anyone who had been infected with COVID-19 domestically in the last three years. However, now, many are claiming that most people in the city either have COVID-19 themselves or know someone who does. On December 11 alone, over 22,000 outpatient fever clinic visits were recorded in Beijing, more than sixteen times that of a week prior, in addition to over 31,000 calls to 120 (similar to 911 or 999), which is six times the average. This comes amid reports of soaring infection rates among healthcare workers, driving up hospital and clinic wait times for those who do choose to try and seek treatment outside the home. Treatment facilities, pharmacies, and nursing homes are asking staff to continue working despite testing positive in order to sustain operations.

As case counts grow, concerns about the country’s capacity to handle widespread infection worsen as the Omicron variant rips through China’s population of 1.4 billion people. This is especially dangerous as serious cases requiring advanced care will continue to develop. As Chen Chen explains in Think Global Health, “A Fudan University study from late 2020 utilized data from the “2015 Third Nationwide ICU Census”—China’s most recent ICU census—to forecast the 2021 ICU capacity for different regions around the country. It showed disparities in ICU bed availabilities, with many less developed provinces like Jilin, Guangxi, and Tibet seeing less than half the rate of ICU beds than more developed regions like Zhejiang, Beijing, and Shanghai. Overall, the study concluded that “the number of comprehensive ICU beds per 100,000 residents in China is 4.37.”

She continues, “Data on hospital bed availability in 2021 from the National Bureau of Statistics showed that nearly every province, except Guangdong and Chongqing, had significantly fewer beds per 10,000 people in rural regions. For the twenty-eight provinces in China, urban areas had an average of 25 percent more beds per 10,000 residents than rural areas. Nearly 40 percent of Chinese people reside in rural areas. In comparison, the U.S. rural residents makes up less than 20 percent of the total population.”

Furthermore, the Ministry of Industry and Information Technology is failing in its promise to maintain adequate supply of key drugs and supplies to treat COVID-19. Demand for fever reducers, cold and flu medicines, and COVID-19 test kits surged on the mainland with the announcement of the rollbacks, as lines formed outside pharmacies and online platforms quickly sold out. In Hong Kong and Macau, as well as internationally, people were trying to buy these supplies to mail them to their friends and family in mainland China. Health authorities in Macau have imposed strict purchasing limits on antivirals as Xiangxue Pharmaceutical, a producer of COVID-19 antivirals, promised it was “going all out” to increase its output in response to shortages. Pfizer’s Paxlovid sold out almost immediately on 111, Inc., an online pharmacy, which priced the antiviral at almost 430 USD.

In light of this, the Party has again turned to promotion of traditional Chinese medicine (TCM) as an alternative prevention and treatment amid antiviral and painkiller shortages. The Party is not advertising these remedies strictly as potential methods of relieving symptoms, but as ways of preventing and treating COVID-19 cases. Furthermore, the Party has been relying on TCM as a fallback throughout this pandemic, typically while failing to acknowledge the role of modern medicine in treating COVID-19. For example, in 2020, the State Council claimed that 90% of confirmed COVID-19 cases in Hubei province “received TCM treatment that proved effective.” This also happened during the SARS outbreak in the early 2000s, during which the Party touted the fact that 40-60% of patients were treated with TCM remedies, largely failing to include the fact that those patients by and large received TCM treatments alongside modern medical treatments.

Specifically, the Party is pushing Lianhua Qingwen (LQ) and Shuanghuanglian, the former of which was developed in 2003 by Shijiazhuang Yiling Pharmaceutical amid the SARS outbreak. It was listed by the National Health Commission in 2004 as a treatment not just for SARS, but also for influenza and other respiratory diseases. LQ is available in both capsule and granular forms and is made with several TCM ingredients, including apricot kernel and its active ingredient-Lonicera japonica, or Japanese honeysuckle. LQ was approved for use against COVID-19 by the PRC in January 2020 and was distributed throughout Shanghai during a particularly bad outbreak in March 2022. Questionable studies claim that LQ can “block viral replication and change the virion morphology”, despite not identifying a mechanism of action. Shuanghuanglian on the other hand has been used for the treatment of acute respiratory tract infections since the 1970s. It also includes Japanese honeysuckle in its formulation, alongside Baikal skullcap and weeping forsythia. Su et al. claimed in a July 2020 study in Acta Pharmacologica Sinica that the medication is cytotoxic “against a clinical isolate of SARS-CoV-2”. The Chinese government has claimed throughout this pandemic that Shuanghuanglian is effective in preventing COVID-19 infection, driving up sales of the TCM remedy.

This has not been confined to the sale of packaged TCM remedies either. For example, Jin Riguang, a scholar of Marxism at the Chinese Academy of Social Sciences, has recommended chewing Sichuan peppercorns and drinking ginger-licorice tea as an effective means of treating COVID-19 infection. Products like canned peaches and lemons have also sold out nationally after being promoted as natural remedies for the disease. All of this points to a serious breakdown of planning and a potentially devastating winter ahead.

Potential Outcomes: Party Policy Challenges, a Wave of Deaths, and More Global Supply Chain Disruptions

There are also two critical issues at play here for the CCP: 1) The messaging about COVID-19 now, in the absence of Zero-COVID policies, is fundamentally different than it has been for the last three years in justifying continuous lockdowns and strict testing regimens, and 2) Questions will abound regarding what the Party has actually done in the years of Zero-COVID to prepare to resume normal living. The Party spent the last couple of years treating small outbreaks of COVID-19 as serious threats, implementing harsh lockdowns of entire cities and requiring testing as often as every 48 hours to enter different venues. The shift to what the policy is now, then, has required portraying the Omicron variant as weak and unlikely to cause more than mild illness. While that might be broadly true in a sense, this fails to account for the lack of quality vaccinations across China as well as long-term risks like Long COVID.

Furthermore, the Party pitched Zero-COVID as the Chinese way of handling this virus, almost certainly aiming to stamp it out quickly so that the quick suffocation of COVID-19 could be touted internationally as a uniquely Chinese success story. In the years since the pandemic began, China focused more on lockdowns and strict testing requirements, neglecting other mitigation strategies, most notably vaccines. As we discussed last week, while the government initially claimed it was close to producing its own mRNA offerings and that it would approve the BioNTech offering, today there are no mRNA COVID-19 vaccines approved for use in the PRC. China’s vaccination campaign has instead depended on two domestically-produced inactivated offerings-Sinopharm BIBP and CoronaVac. This brand of nationalism is especially troubling as people in Beijing scramble to acquire western antivirals and fever reducers from loved ones abroad. Furthermore, as all of this unfolds, President Xi Jinping, who styles himself as a hyper-capable leader and who has predicated much of his work in the last few years on his Zero-COVID policy, is silent.

Furthermore, while the PRC has not reported any COVID-19 deaths since December 4, reports of untallied COVID-19 deaths continue to grow. For example, staff at the Dongjiao Funeral Home in Beijing claim to be receiving the bodies of COVID-19 victims, numbering as high as 30-40 per day, with those who died of COVID-19 being prioritized for cremation. Body bags have also been observed being taken from COVID-19-specific hospitals in the country, casting further doubt. Throughout this pandemic, China’s COVID-19 case and death counts have been called into question repeatedly. Now, with the population left largely unprotected, it seems even more unlikely that there are not more cases and deaths than the government is letting on. Furthermore, the government announced last week that it would stop reporting asymptomatic infections, which have historically been the bulk of positive test results in the country. This represents yet another potentially critical reduction in data sharing and risk communication. Finally, even if this current wave is fueled by transmission that predates the policy rollbacks, how could deaths be so low, all things considered? This question is fueling concerns that Beijing is concealing important data on this outbreak.

Of course, this is not very far into what is setting up to be a horrific winter in China. Estimates vary heavily with the University of Washington’s Institute for Health Metrics and Evaluation predicting that China will suffer one million COVID-19 deaths through 2023. The projections include a peak around April 1, with deaths reaching about 322,000 by then when roughly 1/3 of the PRC’s population has been infected. The Economist released a more conservative estimate predicting 680,000 COVID-19 deaths in the absence of Zero-COVID policies in China. However, this model depends on everyone who needs an ICU bed getting one, which is just not possible in the scenario likely to unfold. Researchers from the University of Hong Kong released a preprint recently that estimates lifting Zero-COVID restrictions and reopening all provinces in December and January without further mitigation would result in 684 deaths per million people, or about 964,400 deaths. The point is, from all angles, this is a looming catastrophe.

While reports indicate many are electing to stay home on their own, this may cease to be the case as the country approaches Chunyun, or the Spring Festival travel period. This period begins about two weeks before Lunar New Year (January 22 this year), lasting for about 40 days. It is traditionally the busiest travel time in the country. In 2020, Chunyun travel and Wuhan’s status as a major regional transit hub were large drivers of the initial decision to lock the city down. In anticipation of this year’s rush, some universities in China are allowing students to complete the winter term virtually from home, offering some attempt to curtail the potential explosion of cases mass travel could lead to.

In terms of the economic consequences of this rollback, China, the world’s second largest economy, is staring down what will probably be the world’s biggest COVID-19 surge ever. The last few years saw China’s frequent lockdowns cause an economic slowdown that had global impacts. China’s 2Q GDP growth slowed to .4% this year, in large part because of the constant lockdowns. This certainly hampered national objectives and created global problems in a world economy already bogged down by inflation, energy crises, and food supply disruptions–and that was when case counts were much lower than they are right now. In major financial centers like Hong Kong, the harsh COVID-19 policies has fueled an exodus of the business community as expats seek to escape the restrictions (though, of course, the National Security Law and changes in Hong Kong’s governance structure also fueled this in recent years). The switch to rolling back Zero-COVID, then, seems like a good step in reopening and growing China’s economy but, again, that is unlikely to work in the absence of widespread, effective vaccination efforts and other long-term mitigation strategies.

Joshua Cohen explains some of this in Forbes, writing “China’s scrapping of its Zero Covid policy is viewed by some as a pragmatic step aimed at reviving economic growth. But, in the short term it may backfire by exacerbating already existing supply chain and labor shortage issues. China is the world’s largest producer and exporter of consumer goods. Disruptions across the Chinese manufacturing sector are likely to impact the global supply chain of goods and the world’s economy as a whole. Multinational companies in China are already feeling the effects of the outbreak, and are straining to keep operations running normally.”

In short, this is a spectacular mismanagement of a pandemic. While no country, particularly the United States, was perfect in responding to COVID-19, China has seemingly both delayed the inevitable while setting itself up for even worse failures. This has consequences not just for the PRC and its people, but the entire world given Beijing’s push in recent decades to grow its economy and international influence. The Party has consistently opted to take whatever was perceived to be the most politically convenient, profitable route, clinging to public health nationalism and ultimately setting many up for unspeakable suffering. This kind of behavior on the part of the CCP has to be taken into consideration when planning for future pandemics and global crises.

The Biological Weapons Convention Review Conference Wraps Up

The BWC’s Ninth Review Conference wrapped up this week, culminating in the adoption of the Draft Final Document of the Ninth Review Conference. Major outcomes of this include growth of the BWC Implementation Support Unit (ISU), establishment of goals to strengthen international cooperation and assistance under Article X and to review scientific and technological advancements relevant to the BWC, and improvements the 2023-2026 intersessional process. One new full-time staff position will be added in the ISU for the period from 2023 to 2027. As of the ISU’s latest annual report, the unit had just three full-time staff members. Importantly, the ISU is funded by BWC States Parties’ contributions, rather than the UN’s regular budget, so States Parties are encouraged to contribute financially where possible.

The 2023-2026 intersessional program will include the creation of a working group on the strengthening of the BWC, which will aim to “identify, examine and develop specific and effective measures, including possible legally-binding measures, and to make recommendations to strengthen and institutionalise the Convention in all its aspects, to be submitted to States Parties for consideration and any further action” Specifically, the working group will address measures on international cooperation and assistance under Article X; on scientific and technological developments relevant to the Convention; on confidence-building and transparency; on compliance and verification; on national implementation of the Convention; on assistance, response, and preparedness under Article VII; and on organizational, institutional, and financial arrangements.

Regarding strengthening international cooperation under Article X (which deals with States Parties abilities, to facilitate “exchange of equipment, materials and scientific and technological information for the use of bacteriological (biological) agents and toxins for peaceful purposes”), the document reads “The Conference decides to develop with a view to establishing a mechanism open to all States Parties to facilitate and support the full implementation of international cooperation and assistance under Article X. In order for this mechanism to be established, the Working Group on the strengthening of the Convention will make appropriate recommendations.”

All of this has not gone without criticism, of course, with many a critique focused on the BWC’s still comparatively toothless nature in light of its lack of a verification regime. Izabella Kaminska discussed this in her piece for The Post, “Why is the Biological Weapons Convention not getting attention?,” explaining “Unlike its chemical and nuclear cousins, the treaty has never been accompanied by a verification regime. This has been a source of concern for some parties because it has made it difficult to determine whether a state is engaging in prohibited activities.” She also notes that, in addition to Russia’s Formal Consultative Meeting under the BWC earlier this year, “Today, the states calling most loudly for a verification mechanism (Russia and Iran) are also the ones undermining verification missions in the BWC’s chemical counterpart.”

Kaminska also includes discussion of issues in this surrounding S&T advancements, explaining that Biodefense Program Director Dr. Greg Koblentz told her “…progress in recent years has been further hindered by documented cases of Russia, China, Iran and North Korea attempting to hack into companies and university labs working on Covid treatments to spread disinformation about these US-developed medical countermeasures.” She quoted Koblentz saying “That is why we need more in-depth discussion about what is possible given scientific and technical developments and political constraints, which is why the US willingness to have expert-level discussion on issues such as transparency and compliance reassurance would be so useful.”

Criticisms also focus on the BWC ISU’s tiny full-time employee roster in comparison to the International Atomic Energy Association’s 2,560 employees and the Organisation for the Prohibition of Chemical Weapons’ approximate 500 employees. Dr. Richard Cupitt wrote about this issue for the Stimson Center in 2020, arguing “Unfortunately, all of this work, including efforts to address assistance requests through an on-line database, must be serviced by a talented but pathetically small support staff, i.e., the BWC – Implementation Support Unit (BWC-ISU), which consists of three full-time staff members located at the United Nations offices in Geneva.  Moreover, even before the pandemic shortfalls in the budget for the BWC and the BWC-ISU have been significant enough to raise questions about even having a meaningful MSP [Meeting of States Parties].”

While this RevCon has been praised as a meaningful step in the right direction for verification and diplomacy, there is still an incredible amount of work to be done to make the BWC an effective piece of international law.

State Department Announces Plans for Bureau of Global Health Security and Diplomacy

US Secretary of State Antony Blinken announced this week his intention to establish a new Bureau of Global Health Security and Diplomacy to help strengthen the Department of State’s ability to ” strengthen global health security and to address the growing national security challenges presented by global health crises,” and his intention to ask current US Global AIDS Coordinator, Dr. John Nkengasong, so lead the new bureau. Secretary Blinken continued his announcement by clarifying what the new bureau would do, saying “Specifically, the establishment of the new Bureau would bring together the Office of International Health and Biodefense in the Bureau of Oceans and International Environmental and Scientific Affairs (OES/IHB) and the functions of the Coordinator for Global COVID-19 Response and Health Security (S/CRHS) with the Office of the U.S. Global AIDS Coordinator (S/GAC), which leads and coordinates the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and is home to the Office of Global Health Diplomacy. These teams, along with critical partners throughout the government, are already leading our international global health security efforts, and their indispensable functions will continue. This new structure would allow our health security experts and diplomats to work more effectively together to prevent, detect, and respond to existing and future health threats.”

This would add a key health security position to the federal government while consolidating many of the Department’s efforts into a more cohesive team. Currently, apart from the State Department’s Coordinator for Global COVID-19 Response and Health Security, the only other federal position that is explicitly and primarily global health security focused is the National Security Council’s Senior Director for Global Health Security and Biodefense (currently occupied by Dr. Raj Panjabi), though many positions are tasked with global health assignments.

House Permanent Select Committee on Intelligence Releases COVID-19 Reports

This week, the US House of Representatives’ Permanent Select Committee on Intelligence (HPSCI) released its declassified report on the Intelligence Community’s (IC) response to the COVID-19 pandemic following a two-year-long investigation. The report “…examines the IC’s posture to support global health security policymakers, the IC’s performance in the early months of the COVID-19 pandemic, and the steps the IC must take to strengthen any future pandemic response.” The report finds that the IC was initially not well-positioned or prepared to provide early warnings and analysis of the pandemic because of an inconsistent focus on health security and pandemics as national security threats. The report finds, however, that “…by the end of January, the IC was providing clear and consistent warning about a potential pandemic – including a classified briefing to the Intelligence Committee in mid-February – well in advance of former President Trump’s declaration of a national emergency on March 13, 2020.”

In addition to its investigative findings, the report makes a number of unclassified recommendations, including:

1. The creation of a designated center in ODNI with a global health security mission;
2. Major investments in open-source intelligence;
3. Enhancements to the IC’s capability to pivot collection faster when a new disease emerges;
4. Additional resources and support for NCMI;
5. Better collaboration and integration of the IC with public health agencies;
6. Recognition that health security is national security;
7. Additional steps to create a sustainable demand signal for collection on global health security.

HPSCI Republicans also released their report on the origins of COVID-19 this week. The Republican report reads in part: “Every person in America has been directly or indirectly impacted by the COVID-19 pandemic. Lives were taken. Livelihoods destroyed. The mismanagement of the response to COVID-19 has led to societal crises like massive education loss for children, drug overdoses across communities, and a stark rise in mental health issues.

“Americans are owed answers about the origins of COVID-19 and future health threats, and they deserve leaders in Washington who remain steadfast in finding the truth.

“Today’s HPSCI report led by Rep. Wenstrup marks significant progress toward that objective. The findings identify more culpability from the Chinese Communist Party, highlight the failures of the Intelligence Community to share pertinent information with the American public and their authorized representatives, and give more credibility to the lab leak theory – which many government officials, Big Tech platforms, and media outlets were quick to label a ‘conspiracy theory.’

“A Republican majority will continue this critical work across all committees of jurisdiction and we commit to finding the facts on a pandemic that negatively impacted millions of American families. By doing so, our policies going forward will strive to ensure that our country is never vulnerable to these threats in the same way again.”

House Select Subcommittee on the Coronavirus Crisis Releases Final Report on Nation’s COVID-19 Response

The House Committee on Oversight and Reform’s Select Subcommittee on the Coronavirus Crisis recently released its final report, building on previous Select Subcommittee findings and revealing “…new findings from several of the committee’s investigations, including findings related to the Trump Administration’s failure to recognize and prepare for the threat posed by the coronavirus in early 2020, which resulted in inaccurate testing and insufficient personal protective equipment (PPE). The report also includes new information from the Select Subcommittee’s investigations into right-wing purveyors of coronavirus misinformation, and into the practices of for-profit nursing home chains and their toll on their vulnerable residents.” The final report also includes 30 recommendations to strengthen the nation’s ability to prevent and respond to public health and economic emergencies, including “accelerating development of next-generation coronavirus vaccines and therapeutics; investing in improved financial relief and public health infrastructure; combating misinformation; and protecting relief programs from fraud.”

Dr. Robert Kadlec’s May 2022 interview with the Select Subcommittee was also recently released to the public. Kadlec, a career USAF physician and former Director for Biodefense and Special Assistant to President George W. Bush for Biodefense Policy, served as Assistant Secretary of Health and Human Services for Preparedness and Response (ASPR) from August 2017 to January 2021. Dr. Kadlec previously testified that the US was unprepared for a pandemic prior to the COVID-19 pandemic. Despite this, he was heavily criticized for focusing his office’s efforts on preparing for acts of bioterrorism (and potentially failing to reveal a conflict of interest in doing so). Kadlec was also criticized for focusing on repatriation flights for Americans abroad early in 2020, rather than focusing on preparing for COVID-19’s arrival in the United States.

Kadlec told the Select Subcommittee in this interview about a number of problems in the federal government’s response, including a lack of information sharing. Kadlec said he struggled to acquire critical information about SARS-CoV-2 in early 2020, saying “My information from our intelligence sources in HHS were, quite frankly, lousy.” He also told the Select Subcommittee that the country was too focused on planning for pandemic influenza, with that planning being premised on symptomatic detection rather than diagnostic testing, which he described as “a significant hallmark and a flaw.” Importantly, Kadlec also discussed how a 2019 simulation run by the federal government identified a number of problems in pandemic response, including a lack of integration across federal agencies and findings that “everything that we probably would need in a pandemic … were sourced from China” and “the likelihood would be the supply chains would be disrupted and we just have just-in-time supplies.” The 329-page transcription is available here on the Select Subcommittee’s site.

“Pathogen Early Warning: A Progress Report & Path Forward”

The Council on Strategic Risks (CSR) recently released this report co-authored by Dr. Saskia Popescu, a Senior Fellow at the Council and an Assistant Professor at the Schar school. It builds on a previous CSR report, “Toward a Global Pathogen Early Warning System: Building on the Landscape of Biosurveillance Today,” by aiming “…to update public understanding of contemporary biosurveillance and pathogen early warning capabilities across three dimensions: the United States government, select regions worldwide, and ongoing efforts toward global pathogen early warning integration. This report also seeks to provide an overview of the structural and technical tools required to create effective early warning systems. In doing so, CSR’s objective is to provide context for understanding the current state of biosurveillance, while also highlighting notable shifts since 2021.”

Emerging Infectious Diseases Supplement Issue

This supplemental issue, “CDC and Global Health Systems and Programs During the COVID-19 Pandemic,” includes an overview from CDC Director Dr. Rochelle Walensky in addition to a host of articles divided between Surveillance, Information, and Laboratory Systems; Workforce, Institutional, and Public Health Capacity Development; Clinical and Health Services Delivery and Impact; and Commentaries.

“Investing in Global Health Security: Estimating Cost Requirements for Country-Level Capacity Building”

Check out this new PLOS Global Public Health article from Eaneff et al.-

Abstract: “The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and respond to infectious diseases. To effectively allocate investments that address these gaps, it is first necessary to quantify the extent of the need, evaluate the types of resources and activities that require additional support, and engage the global community in ongoing assessment, planning, and implementation. Which investments are needed, where, to strengthen health security? This work aims to estimate costs to strengthen country-level health security, globally and identify associated cost drivers. The cost of building public health capacity is estimated based on investments needed, per country, to progress towards the benchmarks identified by the World Health Organization’s Joint External Evaluation (JEE). For each country, costs are estimated to progress to a score of “demonstrated capacity” (4) across indicators. Over five years, an estimated US$124 billion is needed to reach “demonstrated capacity” on each indicator of the JEE for each of the 196 States Parties to the International Health Regulations (IHR). Personnel costs, including skilled health, public health, and animal health workers, are the single most influential cost driver, comprising 66% of total costs. These findings, and the data generated by this effort, provide cost estimates to inform ongoing health security financing discussions at the global level. The results highlight the significant need for sustainable financing mechanisms for both workforce development and ongoing support for the health and public health workforce.”

“Biomanufacturing to Advance the Bioeconomy”

The President’s Council of Advisors on Science and Technology (PCAST) recently released its new report recommending actions to promote the growth of the U.S. bioeconomy in three key areas: “boosting manufacturing capacity, addressing regulatory uncertainty, and updating our national strategy to meet the demands of the 21st century.” The White House press release states that “Specifically, the report recommends that agencies across the government work to establish biomanufacturing infrastructure hubs with the resources and authorities necessary to support new bioproducts moving from prototype to pilot scale production. The relevant agencies should also work together to build a network from new and existing biomanufacturing infrastructure hubs to support further development of biomanufacturing processes and support programs across the spectrum of postsecondary training opportunities in this area.”

Furthermore, “To address regulatory uncertainty that novel, cross-cutting bioproducts face, PCAST recommends that regulatory agencies create both more clear and transparent review and approval processes.  PCAST further recommends establishing a cross-agency rapid response team of regulatory experts that would vet these cross-cutting products, helping those that are safe and potentially transformative reach the market more rapidly…Finally, PCAST believes that a new, data-based, and adaptive national strategy is urgently needed to chart a course for the U.S. bioeconomy for the next decade. This strategy should consider the long-term economic, environmental, and societal benefits and liabilities of biotechnology, as well as the national security implications and ethical and legal issues.”

“ASTHO Unveils Top 10 Public Health Policy Issues to Watch in 2023”

The Association of State and Territorial Health Officials (ASTHO) released its list of the top 10 state public health policy issues to watch in 2023 this week. Their list includes immunization, reproductive health, overdose prevention, public health agency workforce and authority, mental health, data privacy and modernization, health equity, HIV, environmental health, and tobacco and nicotine products. Be sure to check out their list for their discussion of current challenges within each of these topics.

Managing Hazardous and Biohazardous Materials/Waste in the Laboratory Setting

The Chesapeake Area Biological Safety Association recently announced this technical seminar offering from Triumvirate Environmental, which will take place at 6 pm on January 10, 2023 both virtually and in-person in Gaithersburg, MD. “Laboratories can generate biohazardous and hazardous waste. Confusion is not uncommon on what the differences are when it comes to disposal and handling.  This webinar will review the differences and discuss proper handling and disposal of each type of waste.  Potential recycling options will also be discussed.” Learn more and register here.

Closing the Knowledge Gaps

“BIO-ISAC, in partnership with the Department of Homeland Security and Johns Hopkins Applied Physics Laboratory, will host a one-day event (with remote participation available) on January 24, 2023.”

“This gathering of thought leaders across the industry and its partners will address knowledge gaps about the bioeconomy itself. The event is expected to deliver recommendations that demonstrate the scope and breadth of industry impacts, identify specific safety needs and goals, and carve the path forward for a secure future.” Learn more and register here.

Novel Applications of Science and Technology to Address Emerging Chemical and Biological Threats

For the first time since 2019, this Gordon Research Conference is back, this time in sunny Ventura, CA. “The Chemical and Biological Defense GRC is a premier, international scientific conference focused on advancing the frontiers of science through the presentation of cutting-edge and unpublished research, prioritizing time for discussion after each talk and fostering informal interactions among scientists of all career stages. The conference program includes a diverse range of speakers and discussion leaders from institutions and organizations worldwide, concentrating on the latest developments in the field. The conference is five days long and held in a remote location to increase the sense of camaraderie and create scientific communities, with lasting collaborations and friendships. In addition to premier talks, the conference has designated time for poster sessions from individuals of all career stages, and afternoon free time and communal meals allow for informal networking opportunities with leaders in the field.” The conference will be held March 19-24, 2023. Learn more and apply here by February 19.

An Update from the Global Health Security Agenda Consortium

“On 28-30 November 2022, the Republic of Korea hosted the 7th Global Health Security Agenda (GHSA) Ministerial Meeting on the theme “Action for the Next Phase of the GHSA after COVID-19.”

“GHSA Member Countries and Organizations pledged to extend GHSA for another 5-year phase (January 1, 2024 – December 31, 2028), and endorsed the New Seoul Declaration which emphasized the need to continue strengthening multisectoral and multilateral cooperation to prepare for and respond to the ongoing COVID-19 pandemic as well as other infectious disease threats. The GHSA Steering Group will work collaboratively to establish plans outlining the goals and the scope of the next phase of GHSA, including revised targets for 2028, by December 2023.”

“Information on the New Seoul Declaration and other upcoming GHSA activities can be found on the re-launched GHSA website ( https://globalhealthsecurityagenda.org/) as well as via the official GHSA social media channels. The GHSA Consortium will continue to contribute actively to GHSA activities, including participating in Action Packages and co-leading the Task Force on Advocacy and Communications.”

You can also keep up with the GHSA on its website, Twitter, Instagram, LinkedIn, and Facebook.

The Pandora Report Wants to Hear from Biodefense Program Alumni!

Calling all graduates of the Biodefense Program-do you have any news to share from this year? We want to hear from you! The Pandora Report will be creating a year-in-review for our late December issue, and we want to include updates from current students and alumni alike. It can be anything from promotions, publications, new jobs, etc. that you would like to share. Share your updates with us at biodefense@gmu.edu before December 23 to be featured in the year-in-review and anytime you want to stay in touch.

Weekly Trivia Question

You read the Pandora Report every week and now it’s time for you to show off what you know! The first person to send the correct answer to biodefense@gmu.edu will get a shout out in the following issue (first name last initial). This week’s question is: “Who is the longest serving director of the United States’ National Institute of Allergy and Infectious Diseases (NIAID)?”

Shout out to Olivia N. for winning last week’s trivia! The correct answer to “In 1979, there was a suspicious outbreak of anthrax that killed over 60 people in a town located near a military research complex. For years, authorities blamed this outbreak on consumption of contaminated meat, though it was actually the result of an accidental release of Bacillus anthracis. What town did this happen in? (City Name, Country)” is Sverdlovsk, USSR (modern day Yekaterinburg, Russia).

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