Procuring PPE through Innovation, Evaluation, and Coordination: A Strategy for True Cooperative Procurement

By Dr. Nathan Myers, Advisor to the Continuity of Supply Initiative

As this is being written, vaccines to protect against COVID-19 are being distributed all over the United States and around the world. If the vaccine proves to be the decisive tool for ending the pandemic, it will be the result of innovation, scientific research, collaboration, and coordination in regard to creating, distributing, and dispensing the vaccine. We must never lose sight of the fact, however, that vaccines have become so vital because of critical failures in other areas of the medical and public health systems. The same elements that allowed for the rapid development of vaccines in this pandemic must be applied in other areas to make vaccines less critical for the next major public health emergency. One such area is procurement of personal protective equipment (PPE).

A Forbes.com article by Jessica Gold reports on Center for Disease Control and Prevention (CDC) statistics indicating that 287,010 healthcare workers have been infected with the novel coronavirus with 953 providers succumbing to the illness. The article attributes these deaths, in large part, to inadequate protection, including a shortage of adequate PPE. The article notes that some personnel lacked access to N-95 masks and were forced to create their own makeshift protection. A BMJ study by Liu and colleagues found that 420 healthcare providers who were reassigned to work with COVID-19 positive patients in Wuhan, China did not contract the disease after being provided with proper PPE and the training to use it correctly. The article cites studies indicating that masks, gloves, eye protection, and gowns, if available and used correctly, can provide adequate protection against the virus. The article advises that national leaders must facilitate the ability of healthcare workers to abide by safety guidelines to protect themselves through ensuring a durable supply of PPE.

That is why groups, like the Continuity of Supply Initiative, are working to develop improved models for true cooperative procurement that will leverage innovation in procurement practices, evaluation research, as well as collaboration and coordination among suppliers and providers to create a more efficient, effective, and resilient system for the continued procurement of PPE during a major emergency. Access to PPE has been a major challenge to the US response to COVID-19 since the beginning. When PPE was available, the pricing could prove prohibitive for some healthcare institutions. The Continuity of Supply Initiative (CoSI) is working to create a framework for a master agreement between suppliers and healthcare providers in which PPE would remain available at reasonable prices during normal circumstances and across a range of emergency situations. To be resilient and effective, the true cooperative procurement advocated by CoSI must result in sufficient market clout to incentivize and assure a continuous supply in all circumstances. That same sufficient market clout and the willingness on the part of the group or coalition to pay reasonably higher prices in non-routine circumstances motivate competitors to craft, commit to (in their proposals and contracts), and honor creative, nontraditional supply solutions. 

Organizations like the National Association of County and City Health Officials (NACCHO) recognized in a 2013 report the benefits of cooperative purchasing for public health organizations. They noted “piggy-backing” as being the most useful in an emergency, because organizations could join existing contracts and save time by not having to negotiate their own arrangements. Through the use of true cooperative procurement, CoSI seeks to remove the need for piggy-backing by creating efficient, effective, and resilient systems during normal times that can flex to meet the challenges of emergencies. A 2014 article by Rego, Claro, and de Sousa notes that improvement of purchasing strategies in the healthcare field usually involves increased centralization facilitated by information sharing using current communication technologies. Costs are reduced through order consolidation. In their view, this makes horizontal cooperation between healthcare institutions to reduce cost and pool supply chain knowledge a reasonable approach. Rego, Claro, and de Sousa go on to cite sources regarding the advantages of cooperative purchasing at the supply chain level, which include more favorable terms with suppliers, reduced purchasing efforts, development of purchasing expertise, better informed selection and standardization, and improved ability to respond to emergency situations. The one disadvantage noted at the supply chain level was coordination costs when the size of the cooperative increases.  

Healthcare institutions as well as state and local governments found themselves in fierce competition for limited resources when the pandemic hit. Healthcare institutions had been placing themselves in a precarious situation for years by relying on “just in time” purchasing and a thinly stretched, international supply chain to meet their needs. Rather than trying to address the situation to allow for more effective and equitable distribution, the federal government sought to outbid those entities to which they should have been offering aid. Some suppliers opted to provide PPE to the highest bidder rather than honoring contracts, leaving institutions at the mercy of unscrupulous profiteers who provided substandard material at hugely inflated prices. Hospital systems, public health organizations, and governments at all levels, as well as suppliers of PPE, must recognize that it is in the interest of everyone that a stable and resilient procurement system is in place to prevent the disruption seen during COVID-19 in the future.

During the pandemic, some state governors formed procurement coalitions to leverage the combined purchasing power of their states to obtain better pricing for equipment as well as better performance in the provision of goods. States also shared unneeded resources with states more heavily impacted by COVID-19. As chair of the National Governors Association, Governor Andrew Cuomo of New York is in a position to advance the idea of creating a national procurement coalition. Such proposals speak to the need to extensively review and revise the legal framework and resourcing of healthcare procurement agencies that hindered the COVID-19 response. It should be emphasized that CoSI is not proposing a “one-size-fits-all” approach to procurement, but rather a model for a master agreement that different regions, states, and localities can modify to meet their particular needs.

Nevertheless, a true cooperative procurement agreement will require considerable work on the part of the lead procurement agency in regard to procurement planning, proposal evaluation, and contract administration. While group purchasing will be used, each individual healthcare provider must be held responsible for upholding their part of the agreement. As previously noted, innovative scientific research, as well as collaboration and coordination, will be just as vital in regard to improving procurement as it has been in developing, distributing, and dispensing a vaccine.

For one, procurement agencies can employ surveillance techniques and use data collected by a variety of stakeholders to identify signals or trends indicating that a greater supply of PPE will be needed. Additionally, program evaluation techniques can be employed to evaluate supplier performance in a range of circumstances, as well as the degree to which the procurement system works after an emergency event. Healthcare institutions must collaborate to determine the metrics by which suppliers’ performance will be evaluated, as well as coordinate to effectively administer contracts and make sure that individual institutions are meeting their commitments.

One of the many important lessons from the COVID-19 pandemic is that the American healthcare system cannot afford to rely on procurement systems that function well during routine operations, but are not designed to facilitate adequate supplies at a reasonable cost during a public health emergency. That is why the Continuity of Supply Initiative is working to design and promote procurement master agreements that will facilitate true cooperative procurement in which suppliers and purchasers will honor the terms of the agreement in routine and emergency situations, while the market leverage created by institutions banding together will allow supplies to be purchased at the best price. In order for the system to be sustainable, (1) both suppliers and healthcare providers will need to maintain consistent vigilance for emergencies, (2) supplier performance needs to be evaluated using evidence-based techniques and consistent metrics, and (3) healthcare institutions must regularly coordinate on the administration of the contract.

It is important to honor the memories of the healthcare providers lost during the COVID-19 pandemic. Part of that will be reforming the healthcare system in the US to make sure that supplies of PPE will be adequate when the next emergency occurs.  The Continuity of Supply Initiative will continue to promote the concept of true cooperative procurement as an efficient, effective, and resilient way to achieve that goal.

Pandora Report: 12.18.2020

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

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

Good Riddance, 2020!

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

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

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

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

Playing Politics in a Pandemic

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

Accelerated Advances in Biotech and the Bioweapons Threat

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

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

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

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

MedicalCountermeasures.Gov

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

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

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

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

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

The Latest from Lentzos

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

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

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

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

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

US Nuclear Warhead Modernization and “New” Nuclear Weapons

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

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

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

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

Read the report here.

Pandora Report: 12.4.2020

The ball is rolling for COVID-19 vaccines with two very promising candidates in the pipeline. The pandemic continues to surge, bringing with it continued opportunities for exploitation by malign actors – extremists and hackers. A recently released research paper explores the ethical and legal implications related to the use of performance-enhancing drugs by the military. This fall, four students from the Biodefense Graduate Program attended a virtual version of the Medical Management of Chemical and Biological Casualties Course held by US Army Medical Research Institute of Infectious Diseases and the US Army Medical Research Institute of Chemical Defense. Read about their experiences and takeaways!  

Medical Management of Chemical and Biological Casualties Course

The Medical Management of Chemical and Biological Casualties (MMCBC) Course is the premier chemical and biological defense training offered by the US Army. It is a six-day, two-part course offered jointly by the US Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick and the US Army Medical Research Institute of Chemical Defense (USAMRICD) at Aberdeen Proving Ground, both in Maryland. MMCBC covers topics such as the history and current threat of chemical and biological weapons, the characteristics of chemical and biological threat agents, the pathophysiology and treatment of agent exposure, and the principles of field management of chemical and biological casualties. On October 18-23, 2020, four students from the Biodefense Graduate Program at the Schar School of Policy and Government at George Mason University attended a virtual version of the course: Deborah Cohen, Madeline Roty, Marisa Tuszl, and Ishaan Sandhu. You can read about their experiences and takeaways from the MMCBC course here.

COVID-19 Vaccine Update

This week, the United Kingdom granted emergency approval to a COVID-19 mRNA vaccine developed by Pfizer and BioNTech, a German biotechnology company. In the US, the Food and Drug Administration (FDA) will consider granting the same vaccine candidate regulatory approval next week. Pfizer and BioNTech applied for emergency authorization of their coronavirus vaccine in mid-November, following the release of data showing it to be “remarkably effective.” Shortly after, Moderna announced that its candidate was showing “similarly spectacular results.”

HyungJung Kim, a PhD candidate in Biodefense, recently published a new article with the Bulletin of the Atomic Scientists about emergency use authorizations (EUA) for new vaccines. The Food and Drug Administration (FDA) is responsible for issuing such authorizations for medical countermeasures, including vaccines, therapeutic drugs, diagnostic tests, and other medical devices. Initially, the emergency use policy was exclusively aimed at the threat posed by weapons of mass destruction (chemical, biological, radiological, and nuclear weapons), but the scope was expanded to include all hazards to public health. Since the start of the COVID-19 pandemic, the FDA has issued more than 250 emergency use authorizations for antiviral drugs, diagnostic kits, ventilators, and other medical equipment. Though the EUA could provide a vaccine relatively quickly, there are also significant disadvantages to using the emergency use authorization as the legal basis for approving a COVID-19 vaccine for widespread use. Read Kim’s analysis of the pros and cons of an EUA for COVID-19 vaccines here.

AMR Awareness

World Antimicrobial Awareness Week was 18-24 November, and it was celebrated with the slogan, “Antimicrobials: handle with care.” Antimicrobial resistance (AMR) is the characteristic in which microorganisms – viruses, bacteria, and fungi – change over time and exposure in ways that that render antimicrobial medicines futile against them. Globally, about 700,000 people die from these infections annually. The combination of growing resistance across microbes to multiple therapeutics with the lagging creation of new drugs has made AMR a global issue. In the US, there are over 2.8 million antibiotic-resistant infections and 35,000 deaths each year. PEW interviewed Erin Duffy, a chemist with more than 20 years of experience in drug discovery and current Chief of R&D at CARB-X, about the urgent need for innovations to combat superbugs. Duffy pointed out that there is a critical need for economic incentives to “slow the exodus of companies from antibiotic development and stimulate development of urgently needed drugs.” She warns that we are taking antimicrobials for granted and that we may end up in a situation without safe and effective drugs.

The American Society for Microbiology (ASM) shared some good news in regard to AMR. Researchers in Montréal, Canada found that 28% of 324 unique methicillin-susceptible S. aureus (MSSA) isolates from bloodstream infections were also susceptible to penicillin, a marked occurrence given that penicillin resistant strains have persisted for several decades. There have been improvements in antibiotic subscribing: a group of epidemiologists, physicians, and public health experts from the Centers for Disease Control and Prevention (CDC) reported that fluoroquinolone (ciprofloxacin and levofloxacin) prescription rates decreased by 30% between 2011 and 2018.

Cyberattacks Targeting Health Care Must Stop

Tom Burt, Corporate Vice President of Microsoft’s Customer Security and Trust (CST) team, asserts that COVID-19 and the growing use of the internet by malign actors to disrupt society are the two issues that will shape the history of our era. This year, three nation-state actors have carried out cyberattacks targeting seven companies directly involved in vaccine and treatment research for COVID-19. The targets included premier pharmaceutical companies and vaccine researchers in Canada, France, India, South Korea, and the United States, and the attackers originated from Russia and North Korea. Sadly, these are not the first occurrences of cyberattacks targeting the health care sector. In COVID-19, there have been ransomware attacks on hospitals and healthcare organizations across the United States. The Paris Call for Trust and Security in Cyberspace is an invitation to all cyberspace actors to work together and encourage States to cooperate with the private sector, the research world, and civil society. The Paris Call includes organizations like Merck working on vaccines, top hospitals like Hospital Metropolitano in Ecuador, and government health institutes like Poland’s National Institute of Public Health. The Oxford Process, a 136-strong group of the world’s top international law experts, issued a statement emphasizing that international law protects medical facilities at all times. Microsoft announced in April that it would make AccountGuard, a threat notification service, available to health care and human rights organizations working on COVID-19. Burt implores world leaders to “unite around the security of our healthcare institutions and enforce the law against cyberattacks targeting those who endeavor to help us all.”

Stopping the Spread: Pandemics, Warning, and the IC

The National Security Institute at George Mason University’s Antonin Scalia Law School released a new law and policy paper, Stopping the Spread: Pandemics, Warning, and the IC. The paper summarizes the Intelligence Community’s (IC) focus on the national security threat posed by infectious diseases; argues that the IC, with its unique collection and analytic capabilities, can help the public health community with threat monitoring and containment efforts; and proposes actionable recommendations to enhance the US ability to detect global pathogenic outbreaks in order to implement effective mitigation measures. The recommendations include enhancing IC intelligence collection to improve early detection and forewarning of pathogenic outbreaks, increasing information sharing between the IC and Centers for Disease Control and Prevention (CDC), and improving warning mechanisms to assist pandemic preparedness and response. Read the paper here.

‘It will change everything’: DeepMind’s AI Makes Gigantic Leap in Solving Protein Structures

An artificial intelligence (AI) network developed by Google AI offshoot DeepMind is able to accurately determine the 3D shape of some proteins based on their amino-acid sequences, a giant step toward solving one of biology’s biggest challenges. The specific program, AlphaFold, outperformed 100 other teams in the Critical Assessment of Structure Prediction (CASP), a biennial protein-structure prediction challenge. Proteins are the building blocks of life, and their functions are largely determined by the 3D shape. For proteins, “structure is function.” Unraveling a protein’s structure enables a better understanding of how it works, thereby allowing better understanding of how to affect it, control it, or modify it. AlphaFold may enable the use of lower quality and easier-to-collect experimental data to determine a structure. Janet Thornton, a structural biologist at the European Molecular Biology Laboratory-European Bioinformatics Institute, hopes that the approach could “help to illuminate the function of the thousands of unsolved proteins in the human genome, and make sense of disease-causing gene variations that differ between people.”

COVID Outbreaks in the World’s Largest Office Building

The Pentagon moved to a higher health protection level last week (now at Bravo Plus), cutting its maximum occupancy to 40% and bumping up the number of temperature checks on personnel. The building has been below 50% occupancy for the last several months and meetings are regularly conducted by phone or virtually. Brig. Gen. Anthony Tata, the temporary Pentagon policy chief, tested positive for the coronavirus last week as well, though the decision to heighten the protection level was made beforehand. The Pentagon is struggling to contain the virus as new daily cases reach a record 1,300 and another outbreak occurs aboard a Navy ship. The expected surge associated with Thanksgiving celebrations contributed to the decision to up the protection level. A DOD dashboard shows that more than 73,000 coronavirus cases have been confirmed among members of the military with tens of thousands more recorded among DOD family members, contractors, and civilian personnel.

Exploiting the Pandemic

The United Nations Interregional Crime and Justice Research Institute (UNICRI) found that criminals and violent extremists are exploiting the pandemic to expand their networks, undermine trust in government, and weaponize the virus. UNICRI detected an exponential increase in the malicious use of social media to reinforce extremist narratives, ramp up recruitment, and expand territorial control. Social media incitement is a common method of exploitation to “inspire terrorism.” The European External Action Service (EEAS) report provides a snapshot overview of the current trends and insights into disinformation activities related to the coronavirus pandemic. According to the latest analysis, online misinformation and disinformation related to COVID-19 decreased and shifted focus towards vaccines; however, their spread and reach remain troublingly high. EEAS expects the pandemic to continue providing plenty of opportunities for the spread of misinformation and disinformation, especially for actors like China and Russia, who are maximizing on the effect of “vaccine diplomacy” in their campaigns. Sarah Jacobs Gamberini, a Policy Fellow in the Center for the Study of Weapons of Mass Destruction at the National Defense University, expounds on Russia’s weaponization of social media through disinformation campaigns. According to Gamberini, Russia is “drilling deeper into the preexisting fault lines of American society,” especially in regard to the pandemic and recent election. Specifically, Russia is turning the best features of the US – diversity, pluralism, and democracy – into weaknesses ripe for exploitation. Russia is using social media as its weapon by identifying a contentious issue and employing bots and trolls on various platforms to spread divisive rhetoric and amplify debates falsities. Then, it takes advantage of the divisions created by disinformation to augment discord in the US and undermine its institutions.

Pharmacological Performance Enhancement and the Military

Chatham House, a world-leading policy institute based in London, published a research paper, Pharmacological Performance Enhancement and the Military: Exploring an Ethical and Legal Framework for Supersoldiers, which explores the ethical and legal implications related to the use of performance-enhancing drugs (PEDs) by the military. This topic is often overshadowed by concerns regarding side effects and safety. In the armed forces, PEDs could be employed to improve soldier strength, mental capacity, recovery, and resistance to fatigue and trauma; however, the effects of these drugs on the human nature of soldiers remains largely undetermined. This paper avows that administering such drugs in a conflict scenario requires a different cost-to-benefit calibration and it identifies three scenarios in which pharmacological interventions would be ethically permissible: (1) in life or death situations; (2) in situations with strategically exceptional mission requirements; and (3) within restorative limits. Beyond these scenarios, the output does not support the routine use of performance-enhancing drugs in the armed forces. Further, given that the military does not exist in isolation from civil society, attitudes regarding such use of drugs will ultimately be determined by societal opinion. Read the research paper here.

Apocalypse How with Dr. Koblentz

On 7 December, Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, will be featured on the final episode of a BBC radio documentary talking about synthetic biology and smallpox. The documentary series, Apocalypse How, explores the threats beyond COVID-19 that the world may soon face. Such existential threats to humanity include an electromagnetic pulse bomb, a worldwide decline in pollinating insects, and an engineered deadly pathogen. Tune in here.

The Wuhan Files

Leaked documents from the Hubei Provincial Center for Disease Control and Prevention show that China mishandled the early days of the COVID-19 pandemic. Among the 117 leaked pages, an internal and confidential document states a total of 5,918 newly detected cases on 10 February, which is more than double the official public number of confirmed cases. These files belie the Chinese government’s resolute rejection of accusations it deliberately concealed information related to the novel coronavirus. The documents span the period October 2019 to April 2020 and reveal the inflexibility of the Chinese healthcare system and the critical gaps in their preparedness. An October audit states that a “huge gap in staff and operating funds at the [Hubei] provincial CDC has seriously affected the normal performance of public health functions.” Another page says, “the rapid identification and detection of unexplained pathogens is obviously insufficient…the information infrastructure is poor, [Provincial] CDC and medical institution data are still not open to each other, infectious disease surveillance and early warning capacity is not sensitive and accurate.” In December 2019, there were reports of surges in influenzas cases. A spike in influenza and the emergence of SARS-CoV-2 are not linked to the documents, but the data about flu-like outbreaks in several cities in Hubei province will likely be of interest to those researching the origins of the disease. Speaking of the origins of the virus, there are two efforts to determine how it hopped into humans. The World Health Organization (WHO) published the rules of engagement for a multinational team of researchers to investigate the origins of SARS-CoV-2. Recently, a commission created by The Lancet and headed by Jeffrey Sachs, announced the formation of a task force of 12 experts from nine countries who will also look into the how the novel coronavirus leaped species. The goal is not to uncover patient zero, but to “elucidate the ecosystem—physical, but also viral—in which the spillover happened and ask what could make it likely to happen again.” Both teams are faced with solving a very complex problem, compounded by the possibility that the trail to the pandemic’s origin may have gone cold.     

Who Votes with Russia at the OPCW?

Russian has attempted to prevent the Organization for the Prohibition of Chemical Weapons (OPCW) from holding it and other states accountable for their use of chemical weapons prohibited under the 1993 Chemical Weapons Convention (CWC). Specifically, Russia seeks to prevent the OPCW from investigating its use of a military-grade chemical nerve agent, Novichok, to poison enemies of the state, along with the al-Assad regime’s use of chemical weapons against civilians in Syria. The OPCW’s voting process, which uses open ballots and requires a two-thirds majority, has allowed the organization to function more effectively than a number of other international bodies. To counter Russia’s obstruction, the US will have to preserve and widen the coalition of OPCW member states committed to holding violators accountable. Andrea Stricker, a research fellow at the Foundation for Defense of Democracies, recommends that the United States leverage its positive relations with many countries that frequently abstain to broaden the coalition of member states committed to upholding the integrity of the CWC and the OPCW.

COVID-19 Interferes with CWC and BTWC Meeting Schedules

Dr. Jean Pascal Zanders, an independent researcher/consultant on disarmament and security based in France, highlighted the interference of COVID-19 on the meeting schedules for the Chemical Weapons Convention (CWC) and Biological and Toxin Weapons Convention (BTWC). The Organisation for the Prohibition of Chemical Weapons (OPCW) just held the 25th session of the Conference of the States Parties (CSP) on 30 November and 1 December and will reconvene for the remainder of its work by the end of April 2021. The 2021 programme and budget is the most significant agenda item for the first part of the CSP, and the programme and budget proposal are expected to be voted against by Russia and Syria, among others. These nations object to the financing of the Investigation and Identification Team, which was established in 2018 to determine the culprits of the chemical weapon attacks in Syria. For the BTWC, the Meetings of Experts (MXs) have been rescheduled for April 2021, the latest postponement among many. This may result in further delay of the Review Conference.

Pandora Report: 11.13.2020

The Pandora Report thanks veterans of the US military for their service! As the country awaits Biden’s presidency, a number of concerns arise regarding the remainder of the Trump administration as we continue to battle the COVID-19 pandemic. Biden has already named 13 health experts to his COVID-19 Transition Advisory Board. Join the Biodefense Graduate Program for a distinguished panel of international experts in a discussion about how to restore the taboo against the use of chemical weapons and how the Organization for the Prohibition of Chemical Weapons (OPCW) can prevent the further misuse of chemistry.

Friday the 13th

Jason Voorhees, the fictitious killer in the “Friday the 13th” slasher movies and comic series, is the star of a new advertising campaign aimed at encouraging mask-wearing to prevent the spread of SARS-CoV-2. In it, he points out that even though masks may be scary, “not wearing one can be deadly.” Watch Jason’s PSA here.  

Upcoming Event – The Resurgent Chemical Weapons Threat: Current Challenges to the Chemical Weapons Convention (CWC)

The Biodefense Graduate Program is sponsoring an event, The Resurgent Chemical Weapons Threat: Current Challenges to the Chemical Weapon Convention, in preparation for the 25th Session of the Conference of the States Parties on 30 November – 4 December, 2020. The chemical weapons nonproliferation regime is at a crossroads. Chemical weapons have made a comeback with deadly nerve agents being used by Russia, Syria, and North Korea against perceived “enemies of the state.” A new generation of chemical weapons that incapacitate, instead of kill, their victims are also under development. At their next annual meeting, members of the 1993 Chemical Weapons Convention (CWC), which bans the development, production, and use of chemical weapons, will confront this resurgence in the chemical weapons threat. Please join a distinguished panel of international experts in a discussion about how to restore the taboo against the use of chemical weapons and how the Organization for the Prohibition of Chemical Weapons (OPCW) can prevent the further misuse of chemistry.

Dr. Stefano Costanzi is an Associate Professor of Chemistry at American University in Washington DC. Dr. Malcolm Dando is a Leverhulme Trust Emeritus Fellow in the Department of Peace Studies at the University of Bradford in the UK. Dr. Jean Pascal Zanders is an independent researcher/consultant on disarmament and security based in France. The event will be moderated by Dr. Gregory D. Koblentz, Associate Professor and Director of the Biodefense Graduate Program at the Schar School of Policy and Government at George Mason University. The event will be held as a live webinar on 17 November from Noon to 1:30 EST. Register at https://bit.ly/34vDJRQ.

Biden Names 13 Health Experts To COVID-19 Transition Advisory Board

As infections continue to surge, president-elect Joe Biden has named 13 health experts to his Transition COVID-19 Advisory Board. The board will be co-chaired by three people: Dr. David Kessler of the University of California, San Francisco and former Food and Drug Administration Commissioner; Vivek Murthy, former Surgeon General; and Dr. Marcella Nunez-Smith, an associate professor of medicine and epidemiology at Yale University. In a statement on Monday, Biden said, “The advisory board will help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.” Biden acknowledged that the ongoing pandemic is one of the greatest challenges that his administration must tackle, and he has committed to being “informed by science and by experts.” The board will also include Dr. Rick Bright, former director of the Biomedical Advanced Research and Development Authority (BARDA); Luciana Borio, a biodefense and disease specialist who has worked for the National Security Council; and Eric Goosby, the UN Special Envoy on Tuberculosis and former United States Global AIDS Coordinator.

Counties with Worst Virus Surges Overwhelmingly Voted Trump

An analysis conducted by the Associated Press (AP) found that nearly all (93%) of the 376 counties with the highest number of new cases per capita went for Trump in the recent election. Most were rural counties in Montana, South Dakota, North Dakota, Nebraska, Kansas, Iowa and Wisconsin. Lower rates of adherence to mandates for mask-wearing and social distancing tend to be seen in rural areas. Given this trend, state health officials are pausing to contemplate how to reframe their messaging to improve compliance in communities resisting the public health measures for COVID-19. According to AP VoteCast, 36% of Trump voters described the pandemic as completely or mostly under control, and 47% said it was somewhat under control. In contrast, 82% of Biden voters said the pandemic is not at all under control.

‘It’s going to be very, very scary’: Before Biden Takes Office, a Precarious 10 Weeks for Escalating COVID-19 Crisis

Dr. Saskia Popescu, a Term Assistant Professor for the Biodefense Graduate Program, shared her worries that the Trump administration will assume a scorched-earth approach in response to losing the election to Joe Biden. She says, “it’s going to be very, very scary.” A number of public health experts fear for the crisis that the election results may incite: a transition period of skyrocketing COVID-19 cases and deaths. Election week saw record high numbers of cases, even as Trump downplayed the pandemic. Though it is not the convention to publicly challenge the outgoing president on basic matters of governance until the president-elect’s inauguration, Biden’s health care advisers are already reaching out to mayors and governors. Biden’s team is also already planning for a transition of power at health agencies like the Centers for Disease Control (CDC) and Prevention and the Food and Drug Administration (FDA). But until Inauguration Day, Biden lacks the formal power to institute mask mandates, affect the manufacture of protective equipment for medical workers, or impact COVID-19 testing. Until then, Biden and his incoming administration are taking a public-facing role to encourage caution and compliance with public health guidelines.

America’s Poised for a 180-Degree Turn on Climate Change with a Biden Victory

The incoming Biden administration aims to shift the US away from fossil fuels and expand protections for public lands, but these efforts will face serious opposition from the Senate GOP. Biden is expected to “restore dozens of environmental safeguards President Trump abolished and launch the boldest climate change plan of any president in history.” Despite the anticipated pushback from Senate Republicans and conservative attorneys general, Biden plans to make a 180-degree turn on climate change and conservation policy in the US. Indeed, he identified climate change as one of his top presidential priorities, and plans to “restrict oil and gas drilling on public lands and waters; ratchet up federal mileage standards for cars and SUVs; block pipelines that transport fossil fuels across the country; provide federal incentives to develop renewable power; and mobilize other nations to make deeper cuts in their own carbon emissions.”

Upcoming Event – Outreach 2.0: Emerging Technologies and Effective Outreach Practices

The Strategic Trade Research Institute (STRI) is hosting an event, “Outreach 2.0: Emerging Technologies and Effective Outreach Practices,” sponsored by the United Nations Office for Disarmament Affairs (UNODA). The event will feature discussion on emerging technology outreach challenges as well as outreach tools and good practices to raise awareness among private sector stakeholders in industry, research, and academia. The speakers, Scott Jones and Andrea Viski of STRI, will present an advanced outreach model – Outreach 2.0 – built on input from international stakeholders from the public and private sectors. Andrea Viski is also an Adjunct Professor in the Schar School’s Master’s in International Commerce and Policy program. During the event, the speakers will introduce Outreach 2.0 and conduct an exchange with three renowned discussants: Todd Perry of the US Department of State; Katherine Wyslocky of Public Safety Canada; and Kevin Cuddy of IBM. Sign up here.

Lessons from the Roosevelt: A Call for Improving the US Navy’s Preparedness for Biological Threats

Lt. Cmdr. Brian L. Pike, leader of the Navy unit that detected the first cases of COVID-19 onboard the USS Theodore Roosevelt, and Dr. Gregory D. Koblentz, Director of the Biodefense Graduate Program, published a commentary in War on the Rocks about important lessons to be learned from the outbreak of COVID-19 aboard USS Theodore Roosevelt. In late March, SARS-CoV-2 snuck aboard USS Theodore Roosevelt to infect its sailors. Kasper et al. assesses the COVID-19 outbreak on the aircraft carrier, finding that SARS-CoV-2 spread quickly among the crew. Given the confined work environment of Navy ships, an outbreak is devastating to the crew and operations. Indeed, on the Teddy Roosevelt, 25% of the crew was ultimately infected, one sailor died, and the ship was forced out of operation for 10 weeks. Pike and Koblentz recommend mitigating the fleet’s vulnerabilities to biological threats of the future and enhancing the Navy’s shipboard capabilities. If an infectious disease cannot be contained and managed, then the advantages of early detection are lost. The authors encourage a comprehensive review of the Navy’s response procedures as an important step for ensuring that it is prepared to mitigate future biological threats.

North Korea and Biological Weapons: Assessing the Evidence

North Korea’s announcement that it is working on a COVID-19 vaccine has revived attention on Pyongyang’s ostensible biological weapons (BW) program. The Stimson Center released a report, North Korea and Biological Weapons: Assessing the Evidence, which reviews the public statements from the United states and South Korea regarding the suspected program. These two nations have the greatest security interests on the Korean Peninsula. The report also examines the policy responses adopted by the two governments and whether those actions have been consistent with concerns that North Korea has an advanced BW program. Five themes emerge from this review: (1) the US government uses several terms to discuss the possibility of BWs that are highly ambiguous; (2) there is a high degree of uncertainty regarding the specifics of North Korea’s suspected BW program; (3) public assessments between the US and South Korea are inconsistent; (4) some assessments into the North Korean BW issue between government agencies have been contradictory; and (5) the US government possesses fragmented insight into North Korea’s BW capabilities and intentions.

73rd World Health Assembly

The 73rd Session of the World Health Assembly (WHA), the decision-making body of the World Health Organization (WHO), is ongoing in a virtual format. Unsurprisingly, one of the major topics of the WHA is charting the course for the COVID-19 response and setting global health priorities. Many nations and cities have successfully prevented and controlled transmission of SARS-CoV-2 with comprehensive and evidence-based approaches. Other nations and areas are still struggling to achieve the same results, but the WHO maintains that we can beat COVID-19 with science, solutions, and solidarity. The WHA is also covering the critical health goals that cannot be allowed to backslide amidst the COVID-19 pandemic. Given that health is foundational to social, economic, and political stability, session will discuss a 10-year plan for addressing neglected tropical diseases, as well as efforts to address meningitis, epilepsy and other neurological disorders, maternal infant and young child nutrition, digital health, and the WHO Global Code of Practice on the International Recruitment of Health Personnel.

Last week, an oversight panel called for reforms to the WHO that encompasses “predictable and flexible funding and setting up a multi-tiered system to warn countries earlier about disease outbreaks before they escalate.” A “significant discrepancy between member states’ financial contributions and their expectations” of WHO’s Emergency Programme was found, raising concerns. In regard to declaring a public health emergency of international concern (PHEIC), COVID-19 raised concerns that the one-level system is inadequate, with experts recommending a graded system with clear criteria.

The CDC Chief Lost His Way During COVID-19. Now His Agency Is in the Balance.

Former acting director of the Centers for Disease Control and Prevention Dr. Richard Besser said, “The integrity of the agency has been compromised. That falls to the director of CDC.” In a letter sent in September, Dr. William Foege, a former CDC director, encouraged Dr. Robert Redfield, the current director of the CDC, to orchestrate his own firing. Records show that Redfield pressured local health officers to grant favors to politicians and businesses and he allowed political appointees outside of the CDC to draft and publish information on the agency’s website, regardless of the objections from his top scientists and without technical review. USA TODAY interviewed dozens of current and former colleagues of Redfield; interviewees included his supporters and critics. One of the interviewed officials stated that agency employees felt like they had no choice but to publish the school reopening guidelines in August, which were revised by the White House. CDC staff has largely lost respect for their leader and recent CDC employee surveys show that morale has fallen severely. CDC employees indicated that they view the White House Coronavirus Task Force as a “black box, where the agency’s guidance goes in one way and mysteriously comes out another.” In fact, Redfield is typically in the meetings held by the task force, but without his deputies or subject matter experts. The ongoing crisis at the CDC occurring parallel to the pandemic is eroding trust as the outputs of the agency are increasingly questioned.

Mobility Network Models of COVID-19 Explain Inequities and Inform Reopening

A new article in Nature uses mobility network models to simulate the spread of SARS-CoV-2 to explain inequities and inform reopening activities. The authors introduce a metapopulation Susceptible-Exposed-Infective-Recovered (SEIR) epidemiological model to simulate the spread of SARS-CoV-2 in 10 of the largest US metropolitan statistical areas. Using cell phone data, the mobility networks map the hourly movements of 98 million people from neighborhoods to points of interests like restaurants and religious facilities. Using these integrated networks, this research shows that a relatively simple SEIR model is able to accurately fit the trajectory of real cases. Their model predicts that a small minority of points of interest served as “superspreader” sites, accounting for a majority of infections. This finding supports the notion of restricting maximum occupancy at these types of sites is more effective than uniformly reducing mobility. Their model also accurately predicts higher rates of infection within disadvantaged racial and socioeconomic groups based on differences in mobility. The authors found that members of disadvantaged groups have not been able to reduce mobility as significantly and that the points of interest they visit tend to be more crowded, thus higher risk.

AAAS Kavli Science Journalism Awards

This year, the Kavli Science Journalism Award administered by the American Association for the Advancement of Science (AAAS) celebrates its 75th year! Since 1945, the AAAS Kavli Science Journalism Awards have honored professional journalists for distinguished reporting on the sciences, engineering, and mathematics. The 2020 AAAS Kavli Science Journalism Award winners include six submissions featuring notable explanatory and investigative reporting on the COVID-19 pandemic. Lauren Weber, Laura Ungar, Hannah Recht, Anna Maria Barry-Jester and Michelle R. Smith from Kaiser Health News and The Associated Press won the Gold Award for Science Reporting – Large Outlet with “Hollowed-Out Public Health System Faces More Cuts Amid Virus.” Sarah Kaplan from The Washington Post won the Silver Award for “The Storm Inside.” Ed Yong from The Atlantic won the Gold Award for Science Reporting – In Depth with “How the Pandemic Will End,” “Why the Coronavirus Is So Confusing,” and “America’s Patchwork Pandemic Is Fraying Even Further.” Joss Fong, Áron Filkey and Joey Sendaydiego from Vox won the Silver Award for Video Spot News/Feature Reporting with “How Covid-19 can be more and less deadly than we knew.”  Wendy Zukerman, Rose Rimler, Meryl Horn, Michelle Dang and Blythe Terrell of the Science Vs podcast from Gimlet Media won the Gold Award for Audio with “Coronavirus: Will Chloroquine Save Us,” “Coronavirus: Was It Made In a Lab,” and “Coronavirus: How Many Silent Spreaders Are There?” Yunanto Utomo, Gregorius Jovinto, Bayu Adi Prakoso, Anggara Kusumaatmaja and Haman Hama from Kompas.com (Indonesia) won the Silver Award for Children’s Science News with “Virion: A Tale of Coronavirus for Old School Comic Fans,” “Virion: A Tale of Coronavirus for Old School Comic Fans – Part 2,” and “Virion: An Interactive Quest to Find Covid-19 Vaccine.”

Diana Davis Spencer Foundation Scholarship

The Schar School of Policy and Government is pleased to offer $250,000 in scholarships, made possible by the Diana Davis Spencer Foundation Scholarship, to eligible master’s students admitted to a security studies-related program for the Spring 2021 semester. Students in the Master’s in Biodefense program are eligible. The mission of the Diana Davis Spencer Foundation is to “promote national security, entrepreneurship, and enhance quality of life by supporting education and global understanding.” These scholarships are intended to support future national security professionals and leaders. “The Diana Davis Spencer Foundation gift makes it possible for many students to attend our high-ranked security studies programs and prepare for careers in intelligence and security policy,” said Schar School Dean Mark J. Rozell. “We are grateful for this new partnership that will advance our shared goal of educating and training future policy professionals in these fields.” Distinguished Visiting Professor and former Director of the CIA and NSA Michael V. Hayden touted the gift:

“There has never been a time when the national security threats facing our nation have been as diverse. The Schar School is growing to meet those challenges, be they from peer rivals, persistent terrorist threats, or the consequences of technological developments. This scholarship fund will enhance the Schar School’s already stellar reputation in attracting a strong and diverse pool of graduate student candidates who will serve as our next generation of hands-on, solutions-driven national security leaders.”

Applications are due by 15 November 2020. To apply, click here.

Driven to Extremes: Vehicle Ramming as a Terrorist Tactic

By Stevie Kiesel, Biodefense PhD Student

On Halloween 2017, a horrific terrorist attack took place in New York City. Sayfullo Saipov, a 29-year-old man inspired by the Islamic State, drove a rented pickup truck down a crowded bike path along the Hudson River. After crashing into a school bus, he got out of the truck and began chasing after pedestrians with two guns – later determined to be a paintball gun and a pellet gun. This attack killed 8 and wounded 11, the deadliest terrorist attack in New York City since September 11. Vehicle ramming attacks are brutal, effective, and hard to anticipate or defend against.

In this article, the term “vehicle ramming attacks” (hereafter, VRAs) encompasses any terrorist attack that utilizes the kinetic force of a vehicle to strike its target. This excludes vehicle-borne explosive devices. Some data sets use a broader definition of “vehicle” than I will use here. For example, the University of Maryland Global Terrorism Database considers the September 11th attacks an example of a VRA because the kinetic force of an airplane was used against several targets. This article examines attacks with land vehicles, such as cars, trucks, tractors, and buses, in order to understand how extremists with limited means can still perpetrate a devastating attack with relatively few resources.

The publicly available information from the Global Terrorism Database contains records of VRAs from 1970 through 2018. Because the scope of this analysis is limited to attacks with land vehicles, records that involved planes and helicopters were eliminated, leaving a total of 146 incidents. The charts below show key trends in the number of attacks over time, as well as perpetrators and locations.

VRAs were a relatively rare occurrence from 1970 to 2013. The first spike in VRAs took place in Israel and the West Bank from 2014-2015, followed by a second spike with origins in North America and Western Europe in 2016. The 2014-2015 spike can be attributed to a larger “wave of terror,” where a combination of deteriorating economic conditions and setbacks in Israel-Palestine peace negotiations led to a sharp increase in attacks by Palestinians against Israeli targets. A trend toward unsophisticated tactics and weapons led to a rise in vehicular attacks, perpetrated by individuals motivated by a nationalist struggle.

The second spike captured by the Global Terrorism Database can be attributed mainly to jihadists, particularly those claiming allegiance to the Islamic State. References to vehicle ramming attacks can be found in jihadist sources going back, at least, to 2010, when al-Qaeda in the Arabian Peninsula called on supporters via their magazine Inspireto use this tactic. However, such attacks were sporadic until the Islamic State began losing territory and encouraging its supporters to conduct retaliatory strikes in Western countries. The first attack in this vein was the 2016 attack in Nice, France, which killed 12 and wounded 67. The Islamic State claimed responsibility for this attack and used it as an example for what its followers could achieve. This attack kicked off a wave of similar attacks in countries around the world, including the United States, Sweden, Austria, Spain, the United Kingdom, and Germany.

Several researchers have suggested that vehicle ramming as a tactic has spread like a virus, largely through media and social media networks: “the coverage of VRAs in the media and in online discussion forums on websites has encouraged others, often with wholly different political and religious motives, to engage in VRAs.” This theory may explain why jihadists were responsible for the second spike of VRAs across North America and Western Europe in 2015, and why white supremacists and other far-right extremists in the US have shown increasing interest in the tactic since 2017.

In 2017, white supremacist James Fields drove into a crowd of anti-racism demonstrators in Charlottesville, Virginia, killing one. This incident was a harbinger of vehicle-based violence against protestors in the United States. Ari Weil, a researcher with the University of Chicago’s Project on Security and Threats, has found at least 104 incidents of people driving vehicles into protests in the United States from May 27 (the start of protests against police brutality sparked by George Floyd’s death) through September 5. While all these actions have targeted anti-racism protestors, the motivations of the perpetrators differ from case to case, and more will become known as these cases are investigated and prosecuted. The image below presents a meme that circulated widely across Facebook in favor of these attacks against protestors.

Using a vehicle as a kinetic weapon has several key advantages that will continue to be attractive to violent extremists. First, vehicles are more accessible than numerous other types of weapons – many people own a vehicle or can easily rent one. There is no assembly require, unlike with vehicle-borne explosives, where the bomb must be manufactured and the vehicle may need to be modified. Additionally, no special expertise is required other than the ability to operate the car, and generally the attack can be carried out with little expense. These features make vehicles particularly appealing to lone-actor terrorists, who can easily carry out such an attack on their own. Vehicles are also chosen because they are effective, both in casualties and psychological impact. Several VRAs recorded in the Global Terrorism Database caused double-digit fatalities, and in one case over 100 people were injured. A final attractive aspect of VRAs is that they allow for follow-up attacks. In several cases, after the vehicle was driven into its target, the perpetrator exited the vehicle with another weapon and attacked the crowd.

Defending against VRAs is difficult. Vehicles are highly accessible and used by millions of people every day. Additionally, there are generally very few indicators that someone is planning to commit a VRA. More complex terrorist attacks tend to have multiple points of interception – perpetrators discussing the attacks online, conducting surveillance, or making purchases of suspicious materials. But VRAs are generally conducted by a single person, with little forewarning and little opportunity to interdict the attack. Therefore, risk mitigation tends to focus on hardening security by identifying likely targets and adding barriers and additional security personnel.

Meet Dr. Lauren Quattrochi: Multidisciplinary Pharmacologist, Virologist, Electrophysiologist, and New Adjunct Faculty Member for the Biodefense Graduate Program

This spring, the Schar School welcomes a new course with new adjunct faculty member Dr. Lauren Quattrochi! Dr. Quattrochi (aka, Dr. Q) is a classically trained as an electrophysiologist and neuro-pharmacologist. Over the evolution of her career, she has worked within the biopharma industry, non-profits and for the past 4 years, in support of the government. She is currently a principal biotechnologist leading national level scientific and biosecurity initiatives within the US government. At the moment, Dr. Quattrochi serves as a technical advisor on both Hantavirus and COVID-19 vaccine development and manufacturing. She has led key projects within the National Institute for Allergy and Infectious Disease (NIAID) on rapid vaccine preparedness, the Biomedical Research and Advanced Development Authority (BARDA) on medical countermeasure sustainability, as well as the NIH’s Office of Extramural Research (OER) on accelerating breakthrough medical technologies from start-up biotechs. Prior to her current work, she spearheaded projects at Pfizer on drug delivery, pharmacokinetics, pharmacodynamics and metabolism for Schizophrenia, depression and Alzheimer’s. Dr. Quattrochi has had the pleasure to teach STEM on infectious diseases in partnership with Brown University at the NIH, Centers for Disease Control (CDC) and overseas in Greece. In her spare time, she teaches power vinyasa yoga and is a small business owner of scientifically-inspired jewelry.

Dr. Q’s course, Biotechnology and Society (BIOD 762), will examine the growing role of biotechnology in modern society, including benefits to human and animal health, industrial applications, and potential for misuse. Students will analyze key variables influencing the revolution in biotechnology and impact both nationally and internationally. Additionally, the course will explore the political, economic, social, legal, security, and ethical implications of advances in life sciences and biotechnology. This course will be delivered in an asynchronous online format, so to facilitate more colloquial interaction, Dr. Q will host informal fireside chats – bring your cocoa!

Dr. Q has enjoyed a lifelong interest in science. In high school, her first science project focused on brain activity, the idea sparked by the grand mal seizures her grandmother suffered. Her interest in neuroscience & desire to understand how the brain functions spurred Dr. Q to major in physiology and neurobiology with a minor in microbiology. Throughout undergrad, she worked in an analytical chemistry lab that worked with the US Coast Guard to fingerprint oil spill culprits using in-field Raman Spectroscopy. Dr. Q said that this experience working outside her field of study was very valuable, and led to her work at Pfizer in their drug formulation as well as absorption, distribution, metabolism and elimination (ADME) divisions. While working full time at Pfizer, she earned a master’s in biology with a focus in intranasal brain drug delivery. Dr. Q later earned another master’s in pharmacology.

Dr. Q decided to pursue a PhD in Molecular Pharmacology, Physiology and Biotechnology at Brown University. With a PhD, Dr. Q could be one of the scientists crafting tools for medical doctors’ toolboxes by working on new biotechnologies and therapeutics.  Though she did not commence her program intending to study retinal neuroscience, Dr. Q discovered the M6 cell type in the eye, which is a type of cell tied to the body’s circadian rhythm and pupillary constriction. Her own unexpected academic journey in retinal neuroscience taught her a valuable lesson she passes on to her students: school is not necessarily about what you think you want to know, but about being open to what you could know. Do not close yourself off to unanticipated opportunities!

After earning her PhD, Dr. Q served as a director at Sense About Science USA, leading a national initiative advocating for clinical trial data sharing and strong biostatistical design. Dr. Q urges that we need continuity across longitudinal data and we need to share null results. The lack of sharing data and the disincentives to publish null results leads to wasted time and money, but also unnecessary risk for trial subjects.  

In 2016, Dr. Q transitioned to the MITRE Corporation, a federally-funded R&D center operator, working with the Department of Health and Human Services (HHS) and the Department of Defense (DoD). At HHS, she has engaged with the NIH Big Data to Knowledge (BD2K) program, which was launched to move scientific data into a cloud-based platform to improve transparency. Ideally, every scholar will upload their data to the platform, so other academics can use it and better inform their own research. Presently, 88% of NIH data are “dark data” – there data are not housed in widely accessible repositories. Engaging with the NIH National Institute for Allergy and Infectious Diseases (NIAID), Dr. Q has led work for Dr. Anthony Fauci, in conjunction with Dr. Barney Graham and Dr.  Nick Bushar, to design a framework for rapid vaccine preparedness. The framework covered six high priority pathogens, to include MERS, and devised a landscape for breakthrough vaccines, therapeutics, and diagnostics to address outbreak scenarios. The idea was to construct a platform that allowed the “plug and play” of a new infectious disease into the framework to guide development of a quick and easy vaccine.

As a vital component of the federal COVID-19 response, Dr. Q focuses on novel methods of manufacturing COVID-19 vaccines. Over these many months of the ongoing pandemic, she has investigated creative options for vaccine manufacturing, such as the potential for biofermentation at breweries. COVID-19 highlighted the lack of sustainability in the medical countermeasure (MCM) ecosystem, impeding the maintenance of the Strategic National Stockpile (SNS). At the Office of Extramural Research of the NIH, she led a team spearheading advancing small biotechnology firms with orphan drugs, vaccines or diagnostics for diseases that are not lucrative once products enter the market. Dr. Q is currently leading efforts with the DoD focused on manufacturing COVID-19 biotherapeutics. One of the hurdles in this project centers on the administration method, electroporation, which uses an electronic pulse to temporarily expand pores in cell membranes to allow for permeation. Electroporation injection devices are rather difficult to come by, and this form of inoculation is foreign to the population, sparking worry about the acceptability of this method. Speaking of the public, Dr. Q expects many people will struggle to decide which vaccine to take, complicating vaccine and serious adverse event (SAE) tracking for the public health sector.

Pivoting to Dr. Q’s advice to biodefense students and budding experts, she encourages those wanting to work in government to get a security clearance ASAP. Internships with government agencies in defense, intelligence, national security, and law enforcement often facilitate obtaining a clearance.

Being a biodefense professional often means being a “jack of all trades” and “master of none.” On the research side, you will always have to learn, so embrace your status as a lifelong learner. In general, a graduate degree is often more about how to think and self-teach, and less about being a specialist.

At Brown University, Dr. Q established the first group for graduate women in science (GWISE). Prior to this group, there was no forum or platform for women in the sciences. Now, the club is nearly 300 strong! Dr. Q stresses that we should leave our biases at the door. When she walks into a room or zooms into a meeting, everyone is human. She values folks for their contribution to problem solving.

She also wants to remind all students and budding professions to leave your ego at the door. Finally, Dr. Q points out that we all make mistakes, the key is to learn from them.

Commentary – Countering New Threats to the Homeland: The Future of the Department of Homeland Security

By DeeDee Bowers, Biodefense MS Student

Since its creation in November of 2002 prompted by the September 11, 2001 terrorist attacks, the Department of Homeland Security (DHS) has been an all-encompassing entity for protecting America from threats to national security. After almost two decades, the national security landscape has changed, and the role of DHS has been challenged and must evolve. As Charles Darwin once stated, survival of the fittest does not refer to the ones that are the strongest or smartest but rather the ones most adaptable to change. If DHS is going to continue to thrive, regardless of the presidential administration in place, it must adapt from the landscape it was born into to the current unpredictable times of 2020 and beyond.

Black swan events, or unpredictable events, require a new perspective and imagination within DHS in order for it to better handle the responsibilities of protecting the American people. During the Gulf War, the American Military displayed a strong force to deter our enemies from confronting America on the modern battlefield. Non-state actors instead chose to take alternative actions to inflict damage on America using commercial airliners and the US Postal Service.  Since the early 2000s, threats to America now encompass the “homeland security enterprise.” The homeland security enterprise is a partnership between state, local, tribal, and territorial (SLTT) governments, private sectors, the public, and the federal government. The homeland security enterprise now has the enormous undertaking of assuring security of the homeland from events such as terrorist attacks through nonmilitary means, natural disasters, immigration concerns, cybersecurity threats, election security, and pandemics such as COVID-19. All of this must be done in a tactful way to instill confidence in the American people that DHS can indeed adapt to the threats of the time while in a highly politicized environment and remain apolitical.

Former Secretaries of DHS Michael Chertoff, Jeh Johnson, and Janet Napolitano spoke during the Atlantic Council’s webinar to share their thoughts on how the DHS will or should evolve. All agreed that a more stable appointment by the presidential administration would be necessary for quality DHS operation and response. In addition, Secretary Jeh Johnson, suggested an apolitical administration to remind Americans of all of DHS’s goals and a change in policy direction would be necessary to include more threats. Experts such as Thomas Fanning, and Amy Rall suggested these threats include biological as illustrated by COVID-19, physical assaults on critical infrastructure, and cybersecurity concerns such as ransomware. Fanning also stressed that vulnerabilities due to ignorance may gain clarity through the homeland security enterprise, where the less restricted private sector works in close collaboration with DHS to convey joint security. In addition, Fanning, recommended a national campaign to inform and teach the public about how to protect themselves from threats they may not be aware of. In the beginning of the webinar, Max Brooks, described how the strength of the American society and governmental departments such as DHS come from the American people whom are presently fractured. To overcome this, Brooks suggested “new ideas [to combat future threats] are useless without the courage to champion them and a society to support these champions.”

Pandora Report: 8.14.2020

Commentary – COVID-19 Data and Modeling: Applications and Limitations

Biodefense PhD student Stevie Kiesel discusses the importance of well-represented statistics and the danger of misrepresented statistics in COVID-19. Kiesel also provides her insights on the recently published Government Accountability Office (GAO) report, COVID-19 Data Quality and Considerations for Modeling and Analysis. Read Kiesel’s commentary here.

Beirut Explosions

On 4 August 2020, two explosions involving over 2,700 tons ammonium nitrate occurred in Beirut, Lebanon, a tragedy that has killed over 200 people and impacted several thousand more. Ammonium nitrate is chemical compound that is often used as a component in explosive formulas for mining, quarrying, and civil destruction. The chemical had been in storage for the last 6 years in a warehouse that likely combusted after a nearby fire reached it. The blast is one of the largest industrial accidents involving the explosive compound. The disaster is exacerbated by the lack of available medical care for those injured, either due to hospitals near the blast site that suffered damage or medical facilities already stretched thin under the demands of COVID-19. Additionally, the port in Beirut and the country’s primary grain silo were destroyed, so the entire nation will face economic consequences from the explosions. Lebanon now faces a several concurrent crises impacting their public health, economy, and political stability.

US Seizes Fake Website, Cryptocurrency Assets from Terrorist Groups

The US seized of millions of dollars in cryptocurrency assets is the largest ever of terrorist organizations’ cryptocurrency accounts. The seizure also included fake websites, such as FaceMaskCenter.com, that claimed to sell protective equipment like fake N95 masks and 4 Facebook pages. This was part of an interagency operation targeting the financial foundations of 3 terrorist networks: al Qaeda and the al-Qassam Brigades, Hamas’s military wing, and the Islamic State in Iraq and the Levant. The entities involved in the operation include the US attorney’s office in Washington, the Federal Bureau of Investigation (FBI), the Internal Revenue Service (IRS), and the Department of Homeland Security (DHS). The case could help justify a desire by the US Department of Treasury to tighten regulations on the cryptocurrency sector.

COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis

A new study published in The American Journal of Tropical Medicine and Hygiene analyzes the infodemic of COVID-19 information. An infodemic is “an overabundance of information—some accurate and some not—that makes it hard for people to find trustworthy sources and reliable guidance when they need it.” An infodemic is comprised of rumors, stigmas, and conspiracy theories and monitoring social media data is the best method for tracking these inaccuracies in real time in order to help “dispel misinformation and reduce stigma.” Islam et al. extracted COVID-19–related misinformation shared on online platforms – fact-checking agency websites, Facebook, Twitter, and online newspapers – and assessed their impacts on public health. The researchers identified 2,311 reports of rumors, stigma, and conspiracy theories in 25 languages from 87 countries. Claims covered illness, transmission and mortality (24%), control measures (21%), treatments (19%), as well as causes of disease including the origin (15%), violence (1%), and miscellaneous (20%). Eighty-two percent of the analyzed claims were false. These findings are quite concerning because of the potentially serious health implications of misinformation fueled by rumors, stigma, and conspiracy theories.

The COVID-19 Global Response Index

Foreign Policy Analytics released its COVID-19 Global Response Index, which provides an assessment of government responses to the pandemic for 36 countries. This is the first effort to “to track national leaders’ responses in critical policy areas, including public health directives, financial responses, and fact-based public communications.” Additionally, the Index tracks policy response on an ongoing basis. The Index and country profiles are based on data tracked from 31 December 2019 through 1 August 2020. The composite score of the Index contains major policy choices and actions and it reflects government decisions and actions to contain the spread of the virus and to provide financial support during the financial shock. This project was developed with expertise from social scientists, public health experts, and top epidemiologists working at the forefront of the pandemic response.

Virtual Workshop: Airborne Transmission of SARS-CoV-2

The National Academies of Science, Engineering, and Medicine (NASEM) is offering a virtual workshop about the airborne transmission of SARS-CoV-2 on 26-27 August 2020. This workshop is from the Environmental Health Matters Initiative and will delve into the rapidly evolving science on the transmission of the virus that causes COVID-19.” The event will serve as an opportunity for interdisciplinary discussion, explanations about the basic foundational science, and clarification of terminology used differently among the relevant fields, all in relation to the state of the science on SARS-CoV-2 transmission. Register here.

Tracking Lost Healthcare Workers in COVID-19

Among the gaps in the COVID-19 information is the lack of limited availability of data regarding frontline healthcare workers and their risk of contracting the novel virus. A new article in The Lancet by Nguyen et al. assessed the risk of COVID-19 among front-line healthcare workers compared to the general public and estimated the effect of personal protective equipment (PPE) on risk. The authors conducted a prospective, observational cohort study in the United Kingdom and the United States of the general community and frontline healthcare workers using self-reported data from the COVID Symptom Study smartphone application from late March to late April 2020. They found that compared with the general population, frontline healthcare workers in the UK and the US were at higher risk for reporting a positive COVID-19 test. In the US, a joint database, Lost on the Frontline, created by The Guardian and Kaiser Health News has catalogued over 900 healthcare workers who have perished from COVID-19. The Lost on the Frontline database was created to count, verify, and memorialize every US healthcare worker – doctor, nurse, paramedic, hospital custodian, administrator, support staff – who dies during the pandemic. At present, the project has added the profiles of 167 workers to the database. The database also tracks the disparities among lost frontline workers. For instance, among those 167 profiles, the majority were people of color and nearly one-third were reported to have had inadequate PPE. Anesthesiologist Claire Rezba started tracking lost healthcare workers by tracking news reports and recent obituaries. Rezba posts memorials on her COVID-19 Physicians Memorial and, similar to the Lost on the Frontlines database, has posted 900 names of US healthcare workers who died from COVID-19. To stop the growing count of healthcare worker deaths to COVID-19, healthcare systems must ensure adequate availability of PPE and develop improved strategies to protect healthcare workers from COVID-19.

NACCHO Releases Comprehensive Survey of US Local Health Department Funding, Programs, and Partnerships

The National Association of County and City Health Officials (NACCHO), an organization that represents the country’s 3,000 local health departments, released its 2019 National Profile of Local Health Departments report. The report is drafted every three years as a census of local health departments regarding the “state of local health department funding, workforce programs, and partnerships, as well as how these factors have changed over time.” The latest profile includes the impacts of COVID-19 on local health departments. The key findings include: (1) workforce capacity is down, (2) resources are limited, and (3) services have been impacted by the demands of the pandemic. Read the full report here.

The Era of DNA Database Hacks is Here

Last month, GEDMatch, an online DNA database that generates DNA profiles for genetic testing services, was breached. The hackers seemed to have gotten their hands on user emails, to which they sent out phishing emails in order to steal the passwords of recipients. The motivation of the hack is not yet clear; the culprits may have been targeting passwords, emails, or credit card information, or they have been seeking access to genealogical data or genetic information. Of course, this attack has likely compromised users’ trust of in the database, a valuable law enforcement tool for solving cold cases, such as the Golden State Killer case. Even if these hackers were not specifically after genetic data, the incident highlights the risk of insufficient privacy protection and security of such sensitive information. Genetic data is “valuable if you know how to use it,” according to genealogist and genetic privacy advocate Dr. Leah Larkin. In the online world of today, companies who maintain databases containing sensitive information should improve their cybersecurity to better protect their customers.

Pandora Report: 4.3.2020

Not even a pandemic can stop your weekly dose of biodefense news. We’d like to take a moment to thank all who are working in COVID-19 response – from healthcare workers to those in lab, public health, and everyone working in essential services, thank you for all you do!

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Are you registered for the summer workshop yet? From July 13-16, 2020, GMU Biodefense will be hosting a three and a half-day workshop on all things global health security. Leaders in the field will be discussing hot topics like COVID-19, pandemic preparedness, vaccine development, medical countermeasures, synthetic biology, and healthcare response to COVID-19. This is also a great networking opportunity as past participants come from a range of government agencies, NGOs, universities, think tanks, and foreign countries. Don’t miss out on the early-bird discount for this immersive workshop – you can register here.

Updating the CWC: How We Got Here and What is Next
Make sure to check the April 2020 edition of Arms Control Today as GMU Biodefense Graduate Program Director (and CW/BW guru) Dr. Gregory Koblentz has a new article with Stefano Costanzi. Russia’s attempted assassination of Sergei Skripal in Salisbury, United Kingdom with a Novichok nerve agent in March 2018 triggered the first-ever update of the Chemical Weapons Convention (CWC). In November 2019, parties to the CWC agreed to add Novichok agents, as well as carbamate nerve agents, to the Schedule 1 list of chemicals subject to the treaty’s most stringent declaration and verification requirements. The article describes the process that led to the first ever modification to the treaty and offers some recommendations for strengthening the treaty’s coverage of these nerve agents. For more detailed technical information on Novichok agents and further background on the Schedule 1 revision process, please refer to our article, “Controlling Novichoks After Salisbury: Revising the Chemical Weapons Convention Schedules,” which was published in The Nonproliferation Review in September 2019.

An Infected Economy: Acute & Chronic Economic Considerations of COVID-19
GMU Biodefense doctoral student Rachel-Paige Casey is tackling the painful economic and financial aspects of COVID-19 in her commentary, An Infected Economy, which you can read here. “The commonly recited statement that COVID-19 knows no bounds is not confined to its effects on individual or population health; it is also the instigator of our current and growing economic woes. Prior to COVID-19, it was well-established that an outbreak of a reemerging or novel disease with high communicability would ravage the US economy, along with global economy. A combination of industry shut downs to reduce disease transmission and panic-induced risk averse behavior among consumers and producers turns a pandemic into a pestilence for the economic health of countries and their people. Just as the high probability of a pandemic was foreseen so to were the economic effects of such an event. As the Washington Post stated, COVID-19 is no black swan, nor is it an event for which we were not given warning shots.” Keep reading here.

ASPR TRACIE COVID-19 Resources 
ASPR has now released a Novel Coronavirus Resource Page which provides people with vetted resources to tackle the ongoing pandemic. Within the site, people can find planning resources, federal websites, technical assistance requests, ASPR TRACIE-developed resources, and more. This is a great resource for preparedness efforts and can help a wide range of people looking to enhance preparedness across multiple sectors. They also encourage sharing of info – “If you have any COVID-19 promising practices, plans, tools, or templates to share with your peers, please visit the ASPR TRACIE Information Exchange COVID-19 Information Sharing Page (registration required) and place your resources under the relevant topic area.”

A Frontline Guide for Local Decision-Makers
To help unwind the web of confusion and chaos, a COVID-19 Frontline Guide for Local Decision-Makers was drafted by experts from the Nuclear Threat Institute, the Center for Global Health Science and Security at Georgetown University, and Talus Analytics. The Guide outlines 7 key objectives for local decisionmakers:

  1. Activate Emergency Operations Center and establish a whole-of-community incident management structure
  2. Understand the real-time spread of COVID-19 in your community
  3. Slow and reduce transmission
  4. Focus protection on high-risk groups
  5. Reinforce and expand health system surge capacity to sustain healthcare operations and avoid high mortality
  6. Expand risk communication and community engagement
  7. Mitigate economic and social consequences

They also provide several questions regarding progress to track an area’s improvement in response measures. The contributors for the Guide encourage and welcome feedback. The Guide is available here.

Policy vs. Pandemics: Polarization and Public Health Emergency Preparedness
Did you miss the virtual event last week? Check out our YouTube channel here for the recording. Last week, Dr. Nathan Myers, author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies, gave a virtual presentation at GMU. Dr. Myers’ book was written to be a wakeup call about the politicization of preparedness crippling our efforts to prepare for and respond to pandemics. The book focuses on surveillance, coordination, and countermeasures as key tools for pandemic preparedness and response. Dr. Myers’ book is available here in hardcover and Kindle formats.

Cautionary Results from the Dark Winter Simulation
In 2001, the now-called Center for Health Security at Johns Hopkins University and the Center for Strategic and International Studies designed and hosted a tabletop exercise, “Dark Winter.” Participants in the simulation included US officials and senior policymakers, and it was conducted to assess how senior leaders would respond to a biological weapons attack. The agent in Dark Winter is smallpox. The lessons drawn from the simulated pandemic foreshadowed the struggles we are currently facing with COVID-19. Participants questions and concerns from the exercise ran the gamut. How many Americans are infected? How many are exposed? Where are they located? What health resources are available to treat them? Should any health resources be voluntary or required? Should these resources be provided by local, statewide, or national entities? How should they be enforced? Who will staff pop-up clinics and hospitals? retired Air Force Col. Randall Larsen, one of the designers of the exercise, described as “uncannily accurate.” Exercises like Dark Winter are valuable tools that illuminate important gaps for when an event occurs in reality. Similar to Crimson Contagion, a USG-organized pandemic exercise held last year, which we covered here, these events are indicators for overall pandemic preparedness and response. Hopefully, these lessons will be better heeded as we continue to respond to COVID-19 and as we prepare for the next outbreak. The full article is available here.

BioD Student Spotlight: HyunJung Kim
HyunJung Kim, a BioD PhD student, was recently quoted in a Vox article about the resurgence of COVID-19 cases in Japan. Kim spoke to the importance of personal hygiene and social responsibility in disease prevention. He also pointed out his concerns regarding Japan’s border control approach. Japan limited the entry of foreigners from virus-infections regions; however, many loopholes exist to and foreigners are not the only risk factor for introducing the disease to a population. In South Korea, the majority of cases were introduced by its own citizens returning from trips abroad. The full article is available here.

COVID-19 PPE Challenges and Hard-hit Cities 
New York City is being hit hard by the COVID-19 pandemic with over 42,000 cases and 1,096 fatalities. There have been reports of patients lining the hallways, staff working tirelessly to take care of people, and many of the critically ill patients being of younger age. For many, this is an early warning of what’s to come and how we need to prepare for a surge of patients. In the past week, there has also been a renewed focus on community use of masks and conversations on “airborne” transmission. Ed Yong of The Atlantic recently discussed the controversy and how changing guidance left many confused. “A handful of studies have offered preliminary answers. One team of researchers blasted virus-laden fluids into a rotating cylinder to create a cloud of aerosols. They found that the virus remained stable for several hours within that cloud, raising fears about its ability to persist in ambient air. But as the researchers have noted, the study’s experimental setup was artificial. It doesn’t reflect ‘what’s occurring when you’re just walking down the street,’ says Saskia Popescu of George Mason University, who specializes in infection control and who was not involved in the study. ‘It’s more akin to medically invasive procedures like intubation, which run the risk of aerosolizing the virus, and are unique to the health-care setting.'” These questions have become even more prevalent as mask shortages continue to plague healthcare facilities. Many are reviewing decontamination and reuse efforts for respirators, which the CDC recently provided guidance and communication on. Unfortunately, masks are just the tip of the iceberg when it comes to supply chain issues across the U.S. – from ventilators to gowns, and even disinfecting wipes, things are increasingly becoming strained. These needs go beyond items though and it’s important that we also look to the workforce that supports not only healthcare and public health efforts, but also essential services.

Thoughts on Reopening America from a BioD Alumnus
Daniel M. Gerstein, a graduate of the Biodefense PhD program, is a senior policy researcher at the RAND corporation. This week, Dr. Gerstein and Dr. James Giordano from Georgetown University published an op-ed about the criticality of quick and reliable diagnostic testing in the COVID-19 pandemic. Most experts agree that a vaccine or effective antiviral for COVID-19 is unlikely to be developed for 12-18 months. This is quite a complication as we try to flatten the curve and return to normal life. The authors suggest focusing on diagnostics and grouping populations. Accurate and reliable testing is crucial to containing disease transmission and protecting especially susceptible sub-populations. Current tests take too long to yield a result; we need a real-time, point-of-care diagnostic tool that quickly provides doctors and patients with accurate results. In terms of categorization, they identify three groups: currently infected individuals, vulnerable individuals (such as the elderly), and individuals exposed to or infected with coronavirus and recovered. This grouping will help determine the possibility of reinfection, enable risk-based approaches, and better prioritize testing. Gerstein and Giordano’s full article is available here.

Pandora Report: 3.27.2020

Welcome to your weekly source for all things health security! While Italy is struggling with a high COVID-19 death rate, here’s a bit of good news- the last Ebola patient was discharged in the DRC. In need of a good laugh and a fan of the show The Office? Check out this video on pandemic response as an episode.

GHSA Next Generation Network – Responding to Wuhan
Formed in 2014, this group of global health security researchers and professionals is working across the globe to combat the outbreak. Curious about how to participate? There are some simple things you can do right now to help. The first is to help NextGen with its social media communications. NextGen members are in a unique position to serve as trusted sources of information. “You can follow us on Twitter (@nextgenghs) and retweet or tag us in your #COVID19 tweets. You can also use the hashtag #VirtualHighFivesSaveLives to help campaign for social distancing. The next thing you can do is listen to and spread our podcast, especially our COVID-19 Special, to help people understand what is happening and how we can work together to address the issue.” Check out the NextGen mentorship program or learn about what members are doing in the field of COVID-19 response via the COVID-19 Survey and join the Working Group and WhatsApp group.

Learning from Previous CoV Outbreaks
GMU Biodefense doctoral student HyunJung (Henry) Kim is shedding some light on how we can learn from South Korea’s COVID-19 efforts, but also how South Korea learned strategies from previous MERS-CoV outbreaks. “Korea’s response to Covid-19 is highlighting a strong public health approach to reigning in the outbreak, one that provides a lesson for the rest of the world. For the country’s health officials, however, it’s a lesson they learned the hard way. Korea’s traumatic experience with a 2015 outbreak of Middle East Respiratory Syndrome, or MERS, paved the way for many of the successful strategies the government is deploying this time around.” Kim also discussed how the United States can learn from South Korea and Japan – “It seems evident that South Korea gives more weight to actively searching for and diagnosing coronavirus cases in order to break the chain reaction of disease transmission. At the same time, Japan has focused on building the public health equivalent of a firewall around the country to prevent the influx of coronavirus from overseas. Close scrutiny reveals that both pandemic prevention strategies—South Korea’s active search and Japan’s firewall approach – have advantages and disadvantages.”

Assessing Trump’s COVID-19 Approach – Q&A With Public Health Expert Saskia Popescu 
From the frontlines of healthcare and epidemiology response, GMU Biodefense alum Saskia Popescu discusses how hospitals are responding and what the real implications of poor pandemic response look like. “The harder aspects of disease mitigation and response are having those tough conversations with people about how it’s really important for you to stay home when you’re sick. People don’t like being inconvenienced. And that’s why it’s so challenging and frustrating sometimes, because if people were really good about staying home when they’re sick and engaging in social distancing and infection control measures like hand hygiene and not touching their face, that would be very, very impactful to outbreak response at this point. I think focusing on that travel ban, that travel association is a moot point now. The disease is pretty much everywhere.”

Operation 50/50: List of Women Health Security Experts Now Available 
Women in Global Health (WGH), and Women of Color Advancing Peace and Security (WCAPS) have partnered to crowdsource a list of female health security experts, intended to address the glaring lack of women represented in the global response to the current coronavirus (COVID-19) outbreak. The list, dubbed “Operation 50/50”, is now available on the WCAPS and WGH websites for organizations seeking leadership for outbreak response efforts, as well as press members seeking outbreak-related commentary. Check out the list and you might see some familiar GMU Biodefense names.

 U.S. Government COVID-19 Response Plan and How An Exercise Should’ve Been The Writing On The Wall 
The recently released USG COVID-19 Response Plan via HHS is now available online. The plan includes a risk assessment, critical considerations, roles and responsibilities, and a ton of information on sustainment and communication/coordination. On March 11, the reported noted that – “For the majority of people, the immediate risk of being exposed to the virus that causes COVID – 19 is thought to be low. There is not widespread circulation in most communities in theUnited States.” More interesting, it notes that a pandemic will last 18 months or longer and could include multiple waves of illness. Check out the report and how it utilizes a pandemic severity assessment framework, but also the approach the U.S. is taking to mitigate further spread. The irony though, is that an exercise last year actually shed light on some of the vulnerabilities we are currently experiencing. You might have seen a few recent reports on the Crimson Contagion exercise hosted by the National Biodefense Science Board however, we actually wrote on this late last year in the Pandora Report, which you can read here. “The exercise was intended to deal with a virus outbreak that starts overseas and migrates to the US with scant allocated resources for outbreak response and management, thereby forcing the Department of Health and Human Services (HHS) to include other agencies in the response.” The truth is that this exercise should’ve been an indicator of what was to come. As we noted in our report, one of the findings was that “The medical countermeasures supply chain and production capacity are currently insufficient to meet the needs of the country in the event of pandemic influenza”. Exercises like these are particularly important as they bring together key stakeholders to identify critical vulnerabilities and opportunities for improvement, which is why so many are frustrated by the fact that DHS opted to stop updating its annual models of pandemics in 2017.

DHS Pandemic Models Sidelined Since 2017
In 2017, the Department of Homeland Security (DHS) shelved the program that maintained annual models of how a pandemic could disrupt America’s critical infrastructure. These models were the foundations of reports drafted to direct policymakers toward areas that would require immediate attention and help in the event of a pandemic. Such areas include transportation and hospital systems. According to Politico, the models consisted primarily of computer simulations that estimate the interactions among millions of Americans and the US infrastructural systems. The parameters of the models were varied to simulate the impacts based on losses in the workforce due to illness or isolation; a valuable consideration given the situation we are currently facing with over 3 million Americans out of work and COVID-19 illness spreading across those in our health workforce and other critical areas. Reportedly, this program, operational from 2005 to 2017, was halted due to a bureaucratic dispute over its utility. In the midst of the COVID-19 pandemic, the value of this program is indisputable. Resources like the DHS pandemic models and analyses may have provided greater insight and enabled swifter decision-making in our current predicament. Perhaps now, the value and criticality of preparedness will be appreciated so that we may better plan for the next biological event.

A New Kind of Domestic Terrorism
As panic and fear abound with the COVID-19 pandemic, pettiness and folly are amplifying into acts that may soon be considered criminal offenses and subject to terrorism laws. A Wegmans shopper in New Jersey was just charged with making a terroristic threat in the third degree – a felony offense – after he deliberately coughed toward grocery staff and claimed to be infected with coronavirus. This act was reported to be the shopper’s response to the request that he move further away from the employee, respecting the social distancing recommendation. Later, a different man in New Jersey coughed at policy and medical personnelwhile being arrested for domestic violence. In response to such behaviors, US Deputy Attorney General, Jeffrey A. Rosen, sent a memo to law enforcement and federal prosecutors warning them to monitor threats to spread the coronavirus. The memo stated that these acts could be prosecuted under federal terrorism laws given that the virus is a biological agent. Rosen explicitly stated that threats or efforts to use COVID-19 as a weapon in any way will not be abided. The memo also addresses other potential crimes related to the pandemic, ranging from advertisement and sales of fake therapeutics and tests to illegally stockpiling scarce products like medical supplies. The full memo can be found here.

US COVID-19 Outbreak Updates
This week the White House COVID-19 task force had to ask those who recently left New York City, to quarantine for 14 days due to the high infection rate within the city. The WHO recently stated that the U.S. could be the new global epicenter of the pandemic, just as India was announcing a nationwide lockdown. More cases are being reported every day, but according to the CDC, there were over 68,440 cases as of Thursday. The U.S. has now surpassed Italy and China as the viral hotspot. New York is especially being hit hard and as the healthcare infrastructure continues to struggle with PPE challenges, many industries are working to donate and manufacture additional supplies. There is worrisome news from New York City that many of the hospitalized COVID-19 patients requiring intensive care are less than 50 years of age. In addition to the growing epidemiological data shedding light on clinical manifestations and case counts, the magnitude of supply chain challenges has been astounding. As the U.S. works to respond to growing case counts, limited testing, and a nervous healthcare infrastructure, many wonder about the true ability for the country to respond to a pandemic. “They also underscore long-standing problems with the health-care system and the lack of preparedness that has resulted from years of governmental neglect, said Saskia Popescu, an epidemiologist with Honor Health, a Phoenix hospital system (and GMU Biodefense alum). ‘This outbreak has revealed systemic weaknesses, but also the challenges of national preparedness built on private industry and how that often means some hospitals are more prepared than others and the desperate need to really strengthen national health-care biopreparedness,’ she said.” Despite quarantine and shutdown efforts only occurring recently, President Trump wants to open the U.S. back up, which counters much of what public health experts have voiced, especially since outcomes due to recent interventions won’t be seen in the case counts for weeks.

COVID-19: Where Are We and Where Do We Need to Go?
Despite only being three months in 2020, it seems like the COVID-19 pandemic has made this feel like the longest year yet. There’s still much work to be done though and it is often important to take a moment and look back at what’s happened and how we got to this point. The New York Times created this extremely detailed visual story of how the virus got out despite travel restrictions. By analyzing the movement of people, it shows out the SARS-CoV-2 pandemic occurred. Ed Yong recently wrote on how the pandemic will end and some of the most surprising roadblocks that have occurred-  like testing. For many in global health security, there are inherent challenges we identify when doing simulations, but the considerable lack of testing was not one ever considered. Pulling from many experts (you’ll see a few familiar names), Yong addresses the very complexities of this pandemic and a hard truth in that we should’ve seen this coming. “A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. Hypotheticals became reality. ‘What if?’ became ‘Now what?'” Helen Branswell from STAT also recently wrote on what we’ve learned and what we still need to know. “The world has been warned about this over and over again. In the mid-2000s, when it looked like a very dangerous bird flu virus, H5N1, might trigger a pandemic, experts including Michael Osterholm, of the University of Minnesota’s Center for Infectious Diseases Research and Policy, warned of the possibility of disaster when it comes to the supply of protective equipment for health workers, essential drugs, and other goods. And here we are.”

Developing Medical Countermeasures (MCM)
There’s been a lot of talk regarding the use of malarial drugs, hydroxychloroquine and chloroquine, as treatments for COVID-19 following President Trump’s comments in recent press conferences. Unfortunately, this isn’t aligning with medical experts. “The study referenced by Trump, and other studies done so far of potential treatments for Covid-19, are small and hastily designed even by the standards of Phase 1 studies.” The comments/tweets by President Trump have been concerning many as supplies of the drugs, often used to treat lupus, are starting to take a hit and the suggestion of efficacy encourages misuse, which resulted in the death of a man in Arizona taking a form of chloroquine. In terms of developing treatment and prevention MCMs, SynBioBeta has recently partnered with Leaps by Bayer to develop a great visual timeline for what this process looks like.

The Deterioration of USAMRIID
Since the Cold War era, the US Army Medical Research Institute for Infectious Diseases (USAMRIID) has been the nation’s premier biodefense laboratory. RIID’s remarkable history includes its roles in subduing several outbreaks since its inception: Venezuelan equine encephalitis virus in South Texas in 1971, Rift Valley Fever in Egypt in 1977, Hantavirus in the southwest in 1993, and Ebola in Reston, Virginia in 1990, as well as in Africa in 1995. In contrast, RIID has not been considered especially active in the efforts to thwart the ongoing pandemic, likely as a result of bad blood from Amerithrax, inconsistent leadership, recent budget cuts, and dissatisfaction with external micromanagement by the Defense Threat Reduction Agency (DTRA). Though the lab contributed to the analysis of the mailed letters and contaminated areas from the 2001 anthrax attacks, the accusation by the FBI that the Amerithrax culprit was one of RIID’s scientists sunk its status and morale. This accusation cascaded into the closing of high-containment labs, dismissal of experienced employees, and the departure of senior scientists across Fort Detrick. Since the Amerithrax accusation, mismanagement and underfunding further deteriorated the status and outputs of RIID. Over the last decade, RIID has been through five commanders, most of whom were not research scientists equipped with the knowledge to fully understand the lab’s work. For many scientific research entities, funding has become unstable and RIID suffers from this as well. DTRA is responsible for chemical and biological defense research under the Department of Defense (DoD), and it provides a third of RIID’s budget. As a primary funder for RIID, DTRA has gradually micromanaged the lab through actions such as abolishing a research unit that developed medical countermeasures against toxins commonly used by domestic terrorists. Beyond the aforementioned issues, RIID is no longer luring young scientists for employment and almost 40% of its staff consists of contractors, who are especially reliant on stable funding streams to maintain projects. According to National Defense Magazine, Army medical experts are working in partnership with public and private organizations on several potential vaccines for COVID-19. A vaccine would protect both our soldiers and out civilian population from the novel virus. As of 20 March, the Army has 21 soldiers, 6 government civilians, 10 contractors, and 8 family members confirmed with COVID-19 infection; thousands of lives have already been lost across the world and over 1,000 lost in the US. It is most unfortunate that an infectious disease research entity that was once one of nation’s most experienced and erudite is in such a state of disarray that its ability to contribute to the ongoing crisis is weakened. We are in an emergency that requires scarce expertise and capabilities to aid in the swift development of efficacious and safe medical countermeasures. USAMRIID is yet another example of the failure to maintain and utilize some of our most productive and successful resources that could have helped the US prepare for and better respond to the COVID-19 pandemic.