Pandora Report: 11.27.2015

We hope you’re having a lovely holiday week and recovering from a day of full of tryptophan overload! This week we’re starting off with a look at the Government Accountability Office’s review of the BioWatch program. We’re discussing another panel review of the WHO Ebola response efforts, the role of tacit knowledge in bioweapons development, and how the Beagle Brigade is fighting bioterrorism one belly-rub at a time. Fun history fact Friday: on November 26, 1940, President Franklin Roosevelt declared the government would bar strikes “at plants under government contract to provide war materials for the US military and its allies” and on November 25, 1915, Albert Einstein published his equations on the Theory of General Relativity!

Government Accountability Office Finds BioWatch Unreliable
The BioWatch program was introduced in 2003 to perform active environmental surveillance for potential bioweapon use. The struggle has been to accurately discern between organisms that are naturally occurring and those that are being intentionally released. With several false alarms, the program has been under heavy scrutiny. Timothy M. Persons, chief scientist of the Government Accountability Office (GAO), states that authorities “need to have assurance that when the system indicates a possible attack, it’s not crying wolf. You can’t claim it works”. DHS official Jim H. Crumpacker, points out that the system is used as an early warning and there is an inherent level of uncertainty and limitation. The report (published in October but not publicly released until November 23, 2015), which you can read here, states that from 2003-2014, BioWatch made 149 mistaken detections that were “false positives”. The report says that “GAO recommends DHS not pursue upgrades or enhancements for Gen-2 until it reliably establishes the system’s current capabilities.”

Expert Review of Ebola Outbreak Response
A 19 member review panel, convened by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, reviewed the Ebola outbreak response as a gateway to “public debates alongside reports on outbreak response and preparedness”. Led by Dr. Peter Piot, one of the scientists to discover Ebola in 1976, the group pointed to several issues needing attention on a global scale. Findings pushed for the WHO to reorganize their disease outbreak functions and streamline processes to “avoid political pressure, build country core capacities, and ensure adequate funding”. The ten suggested reforms heavily emphasize the importance of core capacities within countries to be able to detect and respond to outbreaks. Strengthening a country’s capacity to do surveillance, response, and prevention is crucial in reducing the risk of multi-national outbreaks that spread like wildfire. The report also suggests incentives for early outbreak reporting and more science-based justifications for economic impacts like travel restrictions, etc.

Tacit Knowledge and the Bioweapons Convention
GMU Biodefense Professor, Dr. Sonia Ben Ouagrham-Gormley, takes on the August 2015 Biological Weapons Convention and the exciting inclusion of tacit knowledge in bioweapons development. Dr. Ben Ouagrham-Gormley has contributed heavily to the field of biodefense, specifically on the role that tacit knowledge plays as a key determinant of bioweapons development. In past nonproliferation efforts, tacit knowledge has been widely neglected. Tacit knowledge “consists of unarticulated skills, know-how, or practices that cannot be easily translated into words, but are essential in the success of scientific endeavors.” Simply put, it takes more than a manual or YouTube video to truly perform a scientific experiment, etc. Tacit knowledge is seen in scientists that have spent years not only learning, but experiencing the quirks and challenges of performing experiments. The lessons of failed endeavors, teachings of fellow scientists, and instincts built by years of experience, are all components in tacit knowledge. Dr. Ben Ouagrham-Gormley points to the role tacit knowledge has played in the history of failed bioweapons programs (state and non-state). While some analysts believe the advancing biotechnologies will “de-skill” the field and lower the bar for bioweapons development, Dr. Ben Ouagrham-Gormley highlights that tacit knowledge is a massive roadblock. Pointing towards the new focus on tacit knowledge, she notes that this will only help “advance key mandates of the bioweapons convention, naming the assessment of new technologies, the improvement of national implementation, and the strengthening of cooperation among member states.”

The New Line of Biodefense: Adorable Dogs

Courtesy of BarkPost
Courtesy of BarkPost

There are few times when I get to combine a love of rescue dogs and biodefense nerdom and fortunately, today is that day! The Beagle Brigade is a group of rescue beagles that have been specially trained “to sense for items used for bioterror which include contraband money, pests, and unlawful wildlife”. Even more, the Beagle Brigade is part of the USDA’s Animal and Plant Health Inspection Service (APHIS). They work in baggage-claim areas at international airports, wearing green jackets, to help identify any meat, animal byproducts, fruit, or vegetables that could be carrying any diseases or pests that have the potential to cause a devastating outbreak in the US. They’ve been specially trained to pick up “restricted” (fruit, vegetable, etc.) versus non-restricted items and have a 90% success rate! I think we can safely say the Beagle Brigade wins the award for “most adorable biodefense strategy”.

Genetically Engineered Mosquitoes Battle Malaria 
Recently published work shows how researchers used “a controversial method called ‘gene drive’ to ensure that an engineered mosquito would pass on its new resistance genes to nearly all of its offspring – not just half, as would normally be the case.” These “mutant mosquitoes” are engineered to resist the parasite that causes malaria infections. This particular work solves the issue that many were facing when it came to passing down resistant genes through a species. While this may mark the end of a long battle against malaria, many are pointing to the ethical and dual-use concerns of such work. The growing concern surrounds the high speed of such technological innovation and the lagging of regulatory and policy guidelines, especially regarding work in wild populations. The potential to alter an entire ecosystem has many concerned over the ramifications of such work. The research team is currently working to prepare mosquitoes for field tests, however they are non-native mosquitoes.

Stories You May Have Missed:

  • Stories From A Biodefense PhD Student- GMU Biodefense PhD student, Craig Wiener, discusses his journey from master’s student to PhD candidate. Craig explains what sparked his interest in not only biodefense, but GMU’s program, and how that’s translated into real-world experiences. “Mason has provided me the depth and breadth of knowledge that I needed to converse with senior policymakers, technologists, and scientists,” he says. “It bridged the gap between science and policy so I could be respected in both worlds because I knew what I was talking about.”
  • East Bronx Legionnaires’ Outbreak Traced to Psychiatric Center–  The New York City Health Department announced that the cooling tower at  the Bronx Psychiatric Centre was the likely source of the break that hit East Bronx earlier this fall. Samples from four cases matched those taken from the water tower. Remediation and disinfection is being performed on the water tower.
  • Liberia Reports Death of Boy – A boy who was part of the family cluster of Ebola cases in Liberia, has died of the disease. The 15-year-old boy was one of the three confirmed cases reported on November 20th, which marked the end of the Ebola-free period for Liberia since September 3rd. There are currently 153 contacts and 25 healthcare workers being monitored.

Pandora Report: 11.20.2015

Much has happened since we reported last week, and with so many tragedies that have occurred, we look towards future preparedness efforts to prevent such misfortunes. The French Prime Minister warned on Thursday, “we must not rule anything out, there is also the risk from chemical or biological weapons.” French emergency medical services are also being supplied with sarin gas antidotes. Check out the CBRN Policy Brief by Dr. Garza, GMU Biodefense Affiliate Research Scientist and former Assistant Secretary for Health Affairs and Chief Medical Officer at the Department of Homeland Security. Dr. Garza provides an extensive look into US federal preparedness, which will be increasingly relevant given the Paris attacks and ISIS interest in chemical weapons. In looking towards the future, we’re celebrating World Antibiotic Awareness/Get Smart About Antibiotics Week to better appreciate the importance of microbial stewardship. Do you ever find yourself reading the Pandora Report and wondering, “all this biodefense stuff is so fascinating, I wonder how I could go more of it?” Good news, GMU has an entire Master’s program (and PhD if you really want to venture down the rabbit hole) in Biodefense! Fun History Fact Friday: On November 19, 1863, President Abraham Lincoln gave the Gettysburg Address at the dedication of the military cemetery in Gettysburg, Pennsylvania.

World Antibiotic Awareness Week 2015
Whether you want to call it the World Antibiotic Awareness Week (via WHO) or Get Smart About Antibiotics Week (via CDC), the importance of antimicrobial stewardship can’t go unnoticed. The threat of antibiotic resistance is growing and we can all play a vital role in stopping it. Did you know in the US alone, 2 million people a year become infected with an antibiotic resistant organism? At least 23,000 people a year will die as a result of resistant organisms. There is a growing list of infections that are becoming harder to treat, like tuberculosis, pneumonia, gonorrhea, etc. The CRE outbreak earlier this year is just one example of a highly resistant and deadly multi-drug resistant organism (MDRO). While many think global health security issues are acts of bioterrorism and lab safety failures (which they are!), the threat of MDRO’s is also a looming danger. Imagine a world where we have no effective antibiotics. Pretty scary, isn’t it? The WHO provided recommendations for healthcare workers and policymakers, but here are a few things you can do:

  • always take the full prescription (don’t just stop when you feel better!)
  • Have left-over antibiotics? Don’t take them.
  • Don’t share antibiotics.
  • Prevent infections before they happen – wash your hands, use safe food practices, avoid close contact with sick individuals, and keep your vaccinations up to date!

GMU Master’s in Biodefense
Have a passion for biodefense and global health security? Hoping to take your education and experience to the next level? GMU’s MS in Biodefense can help bridge those gaps. Did I mention we also have an online biodefense MS? Our program connects the worlds of science and policy, furthering students’ understanding of the complexities within global health security through classes on homeland security, biodefense strategy, specific threat agents, etc. One of our graduates, Kathleen Danskin, is actually working with GAP Solutions Inc., supporting the US Department of Health and Human Services (HHS) Office of the Assistant Secretary of Preparedness and Response (ASPR). Kathleen’s experience is a perfect example of GMU’s multifaceted approach to biodefense and support for work experience. The MS in Biodefense requires the completion of 36 credits (18 credits of core classes like those listed above, 9-15 credits in a field of specialization, electives, and 3 credits in a Capstone Course). Perhaps one of the program’s greatest strengths is its faculty. They’re not only subject matter experts with an amazing range of experiences and knowledge, but also extremely supportive and encouraging of their students. If you happened to miss our Open House on Wednesday, check out our recorded webcast that specifically discusses the Biodefense MS program. If you plan to apply, make sure to get your Spring 2016 application in by December 1st!

Putting the Global in Global Health Security
Dr. Stephen Redd, Director of the CDC’s Office of Public Health Preparedness and Response, writes about a holistic approach to global health security. Dr. Redd discusses the challenges of improving both domestic and global health security “by preventing avoidable epidemics, detecting threats early, and responding rapidly and effectively to any public health event.” The 2014 Ebola outbreak brought the realities of emerging infectious diseases and global outbreaks to the frontline of US concerns. This particular outbreak emphasized the importance of surveillance and response on a global scale. A disease outbreak in one country can quickly stretch beyond the borders of another. Dr. Redd points out that epidemics know no boundaries and we must stop thinking of outbreaks in terms of individual country responsibilities. Mirroring these sentiments, I believe the concept of One Health plays a growing role in global health security and our future practices. Dr. Redd notes that the US must continuously adapt to prepare for these threats. As emerging infectious disease outbreak occur, the role of spillover between the human, animal, and environmental sources makes prevention, surveillance, and response that much more vital.

Officials: IS Is Determined to Develop Chemical Weapons
Iraqi and US intelligence officials are reporting that the Islamic State group is on the quest to develop chemical weapons. Sources state that they are setting up branches specifically for chemical weapon efforts and experimentation. This wouldn’t be a far reach considering IS was reported to use mustard gas in Syria against Kurdish fighters. Intelligence officials are also pointing to IS efforts of finding and employing chemical weapons experts from a range of international venues. “Still, U.S. intelligence officials say they don’t believe IS has the technological capability to produce nerve gas or biological agents, and that the militants were more likely to harm themselves trying to make them. A European official privy to intelligence on the extremist group’s programs agreed, saying so far even IS production of mustard gas was in small quantities and of low quality.”

Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) 2016 Stakeholders Workshop
PHEMCE helps coordinate Federal efforts to better prepare the US with medical countermeasures to combat CBRN and EID threats. Attend their January 6-7, 2016 workshop at the NIH Natcher Conference Center to address where we’re at and how we can work to be better prepared in the future.

Stories You May Have Missed:

  • Paris Attacks Point to Preparedness Needs GMU Biodefense alum, Dr. Daniel M. Gerstein, discusses the preparedness fallout of the 11/13 Paris attacks. While many news outlets are reporting on the attacks, Dr. Gerstein addresses the collective roles for homeland security and how strategies like “DHS’s ‘see something, say something’ campaign provides recognition of the importance of individual vigilance and reporting of suspicious behavior.”17779_lores
  • CDC Lowers Initial Chipotle E coli Case Count– Public health officials working on the outbreak associated with Chipotle restaurants in Washington and Oregon have dropped the case count from 50 to 37. Officials stated that “the CDC is now only reporting ill people that have been confirmed by PulseNet as being infected with the outbreak strain of E coli 026.” Of the 37 cases, 13 have been hospitalized.
  • Ebola Drug Protects Mice- FDA-approved Gamma interferon is showing promise in studies by University of Iowa researchers. When given 24 hours before or after exposure to the virus, it was able to fully protect mice from death from Ebola. While the team is still working to see how late the gamma interferon can be given after exposure, the success so far as a prophylaxis and post-exposure treatment is a huge breakthrough. With reports of a new case in Liberia, an effective ebola drug will be necessary to help stop the outbreak.
  • Cameroon is Experiencing a Measles and Cholera Outbreak There have been 858 documented measles cases, with a surge in the past six weeks. The Mokolo health district has experienced the greatest number of cases (587). 36 cases of cholera have also been reported over the last four weeks. Public health officials are working to contain both outbreaks.
  • Hawaii Dengue Fever Update- The National Guard has been called in to assist with the Dengue fever outbreak as case numbers hit 79 infections.

 

The Candidates on Nonproliferation Part III

The Candidates on Nonproliferation – Part 3
By Greg Mercer

I initially set out to write this as a candidate-by-candidate look at what the 2016 crop had to say about an issue near and dear to Biodefense students’ hearts: nonproliferation. As it turns out, though, not many candidates have well-developed stances on highly specific policy issues (or any issues, depending on how serious a candidate we’re talking about) more than a year from the general election. Lucky for us though, there’s been a major nonproliferation news event to drive the foreign policy debate: the Iran nuclear deal. So this is a rundown of what’s been said and is being said about nonproliferation and WMD policy in the 2016 election.

See part 1 here
And part 2 here

I’m spending even more time on campaign sites to see what the 2016 election looks like for nonproliferation.

This time, I’ll take a look at top Democrat contenders. In contrast to the Republicans, most Democrats support the Iran deal, and generally tend to favor international arms control regimes.

Hillary Clinton:
In the Democratic debate, Hillary Clinton named loose nukes among the paramount threats to the US.  This issue is commonly understood to hinge on loose radiological material from the former Soviet Union (which is notoriously poorly controlled) and other states maintaining poor control of their nuclear weapons.  The Associated Press recently released an investigation into the Moldovan nuclear black market and Islamic extremists.  She has also strongly endorsed the Iran deal, and has a unique role in the debate, having helped to implement sanctions and launch negotiations with Iran as former Secretary of State.  The Politico story linked notes that she was more hawkish than Obama on Iran in the past.  (Her support of the Iraq War in Congress has been a recurring talking point for opponents).  Now, though, their views seem to be pretty closely aligned.  Hillary’s national security issues page also leans heavily on her experience at the State Department (in addition to being pretty relentlessly on-brand).  Among the usual issues- ISIS, Russia, Israel, the Iran deal- is a very interesting one: “Highly contagious diseases are a constant threat. Warmer and drier conditions caused by global climate change, along with our increasingly interconnected world, enable germs to spread more quickly across the globe. America must remain vigilant and do more to prevent and contain outbreaks.”   This is an uncommonly specific stance, and is placed alongside cyberattacks and climate change to make up an emerging threats triumvirate.  So far, though, there hasn’t been much elaboration on actual policy options to combat this threat, or what makes it a defense issue versus, say, an international development one.

Bernie Sanders:
In 2009, Bernie Sanders echoed President Obama’s call for “a world without nuclear weapons.”  While this obviously hasn’t happened, Sanders released a statement calling for an end to the production of weapons-grade uranium and stopping the spread of nuclear weapons.  In March of 2015, Sanders cosponsored a bill to reduce American spending on nuclear weapons by $100 billion over 10 years (in grand Congressional naming convention, the Smarter Approach to Nuclear Expenditures Act, aka SANE).  A House and Senate version have been introduced, but are part of a much larger budget fight.  Sanders’ issues page supports the Iran deal, though it interestingly says the “agreement is not perfect,” but ultimately concludes that it is a far superior option to military action. As usual, Sanders officially gives his support to Obama and Secretary of State Kerry’s negotiations.  This page also does the thing where a first-person snippet introduces a long set of third-person position statements, but the personal statement highlights Sanders’ votes against the first and second Gulf Wars.  This casts him pretty clearly as anti-military intervention to prevent proliferation, but with the caveat that it remains an option.  There is also a separate, editorial-style section on just the Iran Deal, which offers more detail about uranium and centrifuge reductions.  Once again, it calls war “the last option.”  Much of Sanders’ campaign so far has hinged on economic and social issues, however, and he even said in the most recent debate that climate change is the most pressing national security threat.  When looking for threats to security, Sanders mostly looks beyond weapons of mass destruction.

Continue reading “The Candidates on Nonproliferation Part III”

Pandora Report 9.25.2015

You didn’t think a Papal visit would slow us down, did you? Even in the event of a zombie apocalypse, we GMU Biodefense folks would still find a way to get out the weekly report – perhaps pigeon carrier? Until that happens, don’t forget to check us out on Twitter! This week saw a lot of great focus on collaborations to fight public health threats like antimicrobial resistance and epidemics. Schools in Chicago were closed for concerns over Legionnaires’ disease, yours truly provided a piece on Ebola infection prevention, and we have a wonderful opportunity to contribute to World Medical & Health Policy regarding women’s health on a global stage.

Learned Lessons from Ebola in the US
Sylvia Burwell, Secretary of Health & Human Services, discusses the clinical complexity and reality that “our clinical approach to treating Ebola in a hospital setting posed different challenges.” Several key US health experts weighed in on the pivotal first patient, Thomas Duncan, to unknowingly bring Ebola to the US. The implications for healthcare and preparedness sent a tidal wave of response across US hospitals. Dr. Tom Frieden, director of the Centers for Diseases Control and Prevention (CDC), also highlights three main lessons from not only the cases in Dallas, but also the Ebola epidemic as a whole. He points to the necessity of a strong surveillance and response system, need for rapid international aid, and better infection control in hospitals….which segues beautifully into our next story.

The Infection Prevention Angle of the 2014 Ebola Crisis
Reports and analyses from a range of responders to the crisis have been trickling out for several months now, but there’s a constant in all of them – infection control. Given my background and experiences in this field, I wanted to take our readers down the rabbit hole of what exactly it was like to be an Infection Preventionist during this time. A hopeful start to a series of pieces on this subject, it will give you a taste of not only the daily struggles, but the brevity of what potential Ebola patients meant for US healthcare preparedness.

Partnerships to Support Antibiotic Development
564px-Penicillin_Past,_Present_and_Future-_the_Development_and_Production_of_Penicillin,_England,_1943_D16963The ASPR’s (Office of the Assistant Secretary for Preparedness and Response) Biomedical Advanced Research and Development Authority (BARDA) is part of a larger initiative to use Other Transaction Authority (OTA – flexible advanced research and development funding instruments) to start developing business relationships between government and private industry. The relationships are mutually beneficial, allowing both parties to invest and develop products for biodefense and the growing threat of antibiotic resistance. Given the slowing of new antibiotic development, this joint agreement comes at a pivotal time for antimicrobial resistance efforts.

Three Chicago-area Schools Close in Response to Legionnaires’ Disease Concerns
Three schools in the Illinois U-46 district were shut down on Wednesday and Thursday after cooling tower test results showed “higher than normal levels of Legionella bacteria”. The OSHA recommended threshold is no higher than 1,000 CFU/ml (colony-forming units per milliliter) and with the outbreak among residents of the Illinois Veteran’s Home, it’s not surprising to see many water towers being frequently tested, etc. The important thing to note is that Legionella pneumophila infections are a result of the intensity of the exposure and the immune status of the exposed person. Legionella can’t be totally eradicated from the water supply and a majority cooling towers will contain some amount of growth.

Call for Papers – Women’s Health in Global Perspective
Papers sought for a special issue and workshop of World Medical & Health Policy on “Women’s Health in Global Perspective,” to contribute to understanding and improve policy related to women’s health and wellbeing.  Forces ranging from the economic to the climactic have human repercussions whose genesis and solutions demand consideration of their global context.  A wealth of recent research and inquiry has considered the particular plight of women, who often suffer disproportionately from lack of education, compromised nutrition, poverty, violence and lack of job opportunities and personal freedom.  The Workshop on Women’s Health in Global Perspective will consider the broad ranging social determinants of health on a global scale that importantly influence health outcomes for women everywhere, which in turn has implications for economic, political and social development.
Abstract submission deadline (250 words): October 16, 2015 
Contact: Bonnie Stabile, Deputy Editor, bstabile@gmu.edu
Notification of selected abstracts: November 13, 2015
Workshop March 3rd, 2016
Completed papers due: March 11, 2016

Stories You May Have Missed:

  • Personal Microbial Cloud – researchers found that a person’s microbiome form a cloud around them, allowing scientists to identify a specific person just by sampling their microbial cloud. Food for thought: would this be our microbial cloud version of a fingerprint?
  • C. Difficile Drug Success – Researchers at Stanford University School of Medicine were successful in their ability to get rid of the deadly gastrointestinal toxin via a drug that didn’t focus on the organism, Clostridium difficile, but rather the toxin itself. C. difficile is responsible for 250,000 hospitalizations and 15,000 deaths per year while costing the US more than $4 billion in healthcare expenses. Yay for successful treatments!
  • EC, EU, and WHO Work To Better Share Private Drug Data – The European Commission, European Medicines Agency, and World Health Organization are working to “step up coordination” on EU medicines regarding safety, quality, and efficacy of new drug candidates. The first step in solving a problem is recognizing you have one, right? The new focus on global public health threats is one we can all appreciate!
  • WHO Makes Changes to Southern Hemisphere Flu Vaccine – The WHO committee recommended changes for two of the three trivalent influenza vaccines for the Southern Hemisphere next year due to changes in the circulating viral strains. They suggested using H1N1, H3N2 an A/Hong Hong/4801/2014-like virus, and for influenza B, the Brisbane/60/2008-like virus. In the quadrivalent vaccine, they recommended adding the influenza B Yamagata lineage component, with the A/H1N1 strain staying.

Ebola 2014: The Infection Preventionist Perspective

By Saskia Popescu

Unlike many infectious diseases, especially ones with a relatively small number of occurrences, the Ebola outbreak that started in 2014 received a sensational amount of attention. While many in public health keep tabs on outbreaks (thanks ProMed!), it’s not uncommon for the rest of society to remain blissfully unaware unless the bug comes knocking on their front door. I’ve been captivated with Ebola (now called Ebola Virus Disease, or EVD) since a young age after Richard Preston’s sensational book, The Hot Zone got passed to me during a family vacation. The first whispers and later emails of the surging cases in West Africa were pretty astounding in early 2014. Usually these outbreaks occur in small blips and then die off a few weeks or months later. I was working in Infection Prevention & Control at a pediatric hospital at the time and, like many, didn’t think too much about the outbreak pertaining to the US and even if it did, our infection control practices should be able to handle an organism that required Contact/Droplet isolation. I put some updates in our monthly newsletter and continued to watch as West Africa became overwhelmed with EVD.

Like many public health issues, no one really starts hitting the panic button until a disease shows up and you’re scrambling (and trust me, most of the time, you find out retrospectively) to do damage control. The IP (infection prevention) world started to get worried in late July when Emory University Hospital accepted and began treatment the first two EVD patients transported into the US from their field assignments in West Africa. Questions about isolation and practices were asked, but again, no one really worried too much since these patients were flown directly to Emory due to their special infectious disease isolation unit. Suddenly, on September 30th, 2014 a media storm announced that a patient being treated at Texas Health Presbyterian Hospital in Dallas, Texas, was positive for EVD. I can personally tell you, this is when the proverbial crap hit the fan for just about every healthcare facility and IP in the US. A visiting your emergency department, being sent home, and then coming back with a highly infectious disease that few physicians know well enough to suspect, let alone diagnose or treat, is pretty much the equivalent of an IP nightmare. So what could we do?

First, I should say that every hospital with an IP team (most of them have at least one IP) experienced a massive level of panic, anxiety, and stress dedicated to avoiding this, so please, give them a pat on the back. I am fortunate that my IP team consists of not only enthusiastic, ridiculously talented and intelligent people, but they know how to respond to crisis in the flip of a switch. We quickly pulled together a committee to encompass all people that would play a role in the preparedness and response of an EVD patient. Fortunately, by this time, Emory had released an extremely helpful document that discussed their experiences and lessons learned. We met our committee (now filled with people from environmental services, facilities, nursing, medical staff, infectious disease, emergency preparedness, the emergency department, and many others) with this document and everything else the Centers for Disease Control and Prevention (CDC) had on EVD response. For many, the difficulty laid in where do we put this patient, what designated staff will care for them, and what will we do with the waste? You pretty much need to have a specific process for both your emergency department if there is a suspected case, but also a designated wing you can move patients out of and move this potential EVD patient into. Without going too much into detail, one of the trickier components became the PPE (personal protective equipment) and waste process of a potential patient. CDC PPE recommendations were changing almost daily (or at least that’s how it felt). Information was changing so rapidly it was a constant cycle of checking their website, talking with peers, and attempting to update instructional handouts and training tools for staff incase we happened to get a potential patient. Historically, EVD PPE recommendations came from outbreaks in Africa with little access to the equipment and capabilities we’re used to in the US. The ability to intubate a patient or insert a central line opened up a Pandora’s box of potential transmission scenarios, leading to difficulty in establishing a solid PPE process. Acquiring the PPE was another struggle. Our materials management team worked tirelessly to find the ever changing products we would need to not only have PPE kits in our emergency department and urgent cares, but also to sustain care for a patient for several days. The sustainability was a huge concern as staff were changing in and out of PPE every 45 minutes due to heat exhaustion and CO2 build-up from the N-95 masks. Once we were able to obtain the PPE, and this was a constantly changing cycle to follow CDC recommendations, training went into effect. One of the greatest struggles was training enough staff to have a proficient understanding of an extremely complex (and dangerous) process. The unique part about EVD PPE practices is that you utilize a buddy system with a checklist – something healthcare workers are not used to and something we had to remind them of (don’t try and memorize this)! We did several drills involving patients projecting a mixture of chocolate syrup and glitterbug to not only prepare healthcare staff, but also show their cross contamination when doffing the PPE.

Courtesy of USA Today
Courtesy of USA Today

The PPE struggles were one small piece of this EVD pie. Many IP’s could probably write a novel about the struggles and random problems that came up during this time. Our ridiculously long days were filled with preparedness meetings, educational trainings, hospital-wide communication, worried calls from people and staff (the comical relief of people calling to ask for an EVD vaccine but refusing to get their flu shot showcases the ridiculousness of what we experienced), educating physicians on signs and symptoms, identifying routes for patient transportation, and coordinating surveillance mechanisms like electronic mandatory travel history (from the affected countries) questions and alerts in the intake process of patients from the emergency department or urgent cares. The simple truth is that the US became so panicked and so obsessed with a disease no one really worried about a few months before, the amount of preparedness that was initiated simply couldn’t be maintained for an extended period of time. Emergency departments and hospitals are comprised of some of the most hardworking and intelligent people you’ll ever meet, but I can honestly say, something like what happened in Dallas could’ve happened in any hospital. Healthcare is an imperfect system and while we struggle to make it better and more robust, it always comes down to overworked staff and communication gaps. My experiences as an IP during the EVD 2014 outbreak, while exhausting, were truly eye opening to the ability of our healthcare infrastructure to respond to such an event. It revealed a lot of gaps in our practices and the state of our preparedness, but overall, it highlighted the growing need for better disease surveillance, preparedness, and attention to biosecurity.

 

Pandora Report 9.11.15

Miss us? Good news – the Pandora Report weekly update is back! With a new school year comes new faces and some organizational change-up. Dr. Gregory Koblentz is now the Senior Editor of Pandora Report and Saskia Popescu (yours truly) will be taking over from Julia Homstad as the Managing Editor. I come from the world of epidemiology, public health, and infection control. Having just started in the GMU Biodefense PhD program, I look forward to venturing down the rabbit hole that is the Pandora Report!

There’s been some pretty fascinating news over the past few weeks, so let’s try and catch up…

Lab Safety Concerns Grow 

Our very own Dr. Gregory Koblentz, director of the GMU Biodefense program, was interviewed by USA Today regarding the lab security issues that now involve mislabeled samples of plague. “Since there are now concerns about the biosafety practices at multiple DoD labs there needs to be an independent review of the military’s biosafety policies and practices,” Koblentz said Thursday. He said the Critical Reagents Program is an important biodefense resource. “It’s crucial that all problems with handling and shipping inactivated samples be resolved quickly so the program can resume its important role in strengthening U.S. biopreparedness.”

Reviving a 30,000-Year-Old Virus…Isn’t This How the Zombie Apocalypse Starts?

You may recall last year that French scientists stumbled across a 30,000-year-old virus frozen in the Siberian permafrost. Considered to be a “giant virus” (doesn’t that give you a warm, fuzzy feeling inside?), this is actually the fourth ancient, giant viral discovery since 2003. The new plan is to try to revive the virus in order to better study it.

Dr. Claverie told Agency France-Presse, “If we are not careful, and we industrialise these areas without putting safeguards in place, we run the risk of one day waking up viruses such as smallpox that we though were eradicated.” Given the recent concerns over biosafety lab specimen transport, we’re all curious to see how this new organism, coined “Frankenvirus”, turns out!

Cucumbers and A Multi-State Salmonella Outbreak

CDC updates regarding the Salmonella Poona outbreak reveal the brevity of the potentially contaminated product. As of September 9th, there have been two deaths, 70 hospitalizations, and 341 confirmed cases across 30 states. Perhaps the most worrisome is that 53% of affected individuals are children under the age of 18. While the produce company, Andrew & Williamson, issued a voluntary recall of their “slicer” or “American cucumber on September 4th, there have been 56 additional cases reported since then. Isolated samples from cucumbers in question were found in Arizona, California, Montana, and Nevada. The California Department of Public Health issued a warning and pictures of the affected cucumbers. 

Stories You May Have Missed:

The Ebola Vaccine and the Ethics of Drug Trials

By Greg Mercer

The World Health Organization recently announced that a trial of the VSV-EBOV Ebola virus vaccine in Guinea has been “highly effective,” and that randomization in the trial would be stopped to allow for expansion of the range of subjects and protection of more people against the virus.  The trial began in March, and until recently, randomized subjects so that some received the vaccine immediately, while others received it later, after the virus’ gestation period.

A paper published in The Lancet details the study, and finds that the vaccine is highly effective and likely safe to use in the affected population.  The “recombinant, replication-competent vesicular stomatitis virus-based” vaccine is administered in a single dose via the deltoid muscle.  4,123 people received the vaccination immediately, while 3,528 people received the delayed vaccination (more on the study methodology in a moment). The researchers found that no subjects developed a case of Ebola after receiving the immediate or delayed vaccination, meaning that the vaccine proved 100% effective (with p=0.0036 at 95% CI).  These findings are excellent news for researchers, government officials, and those in the affected counties, and are fascinating from a scientific standpoint.

At The New Republic, Timothy Lahey, of Dartmouth, argues that these results, while promising, aren’t necessarily confirmed.  He notes that the lack of a placebo (because of the study’s particular methodology) makes it difficult to determine effectiveness, the vaccine could have failed to protect subjects from infection in a way that the study didn’t detect, and that a statistical aberration could mean that while the vaccine is not actually 100 % effective.  Regardless of whether these potential pitfalls affected the study or not, Lahey raises an important issue in drug testing for a disease like Ebola.  He is concerned that a lower standard for vaccines could mean that lower-income countries might not receive drugs of the same quality as rich countries, and points to past failed vaccines to illustrate the fallacy of believing that all vaccines work as intended.

The ethical dilemmas of drug testing have been front and center in the Ebola crisis.  Back in November, 2014, Nature reported on public health officials weighing the question of whether to use control groups when testing treatments for a disease with 70% mortality.  At the time, some advocated for applying experimental treatments (like the ZMapp antiviral cocktail, which had been used in patients but whose effectiveness was not entirely determined) to all patients, while others argued that these treatments might not be more effective than standard care, and that randomized trials guard against harmful side effects and provide a clearer picture of a drug’s effectiveness.

The VSV-EBOV vaccine was tested in the “ring” method that was previously used in the eradication of Smallpox.  This method eschews the double-blind placebo treatments commonly associated with drug trials.  Instead, this method creates a “ring” around new cases.  Contacts and contacts of contacts were identified by Guinea’s tracking system, and eligible adults were entered into randomization blocks, and received either the immediate or delayed vaccination.  This way, all of the subjects received the treatment, but in varying circumstances to establish effectiveness.  The full study is available via The Lancet.

Ethical drug testing is a crucial consideration, and has an imperfect past.  The National Institutes of Health’s own ethics guide cites a study that led to the United States’ ethics rules: a study that withheld syphilis treatment from 400 African-American men.  And for many, there’s good reason to be concerned about the actions of international organizations and multinational corporations.  In 1996, Pfizer conducted a study of an experimental drug on children with meningitis in Nigeria. While Pfizer maintained that the study was philanthropic, allegations arose from Nigerians and international organizations that children and parents were not informed that they were part of a study, and that Pfizer withheld treatment without consent or administered dangerous drugs.  The incident spawned a series of lawsuits and a panel of Nigerian medial experts condemned Pfizer’s actions in 2006, as reported by The Washington Post.

Epidemics and drug testing present a multitude of practical and ethical concerns, but careful consideration of the issues and sound methodology can, as they did in Guinea, produce exciting scientific and humanitarian results.

Image Credit: Psychonaught

NASA’s Unique Place in American Science and Security

By Greg Mercer

We talk a lot here about the intersection of science, technology, and security studies, and NASA has sat squarely in the center of that relationship since it was called the National Advisory Committee for Aeronautics. The Hill reports that GOP legislation is threatening NASA’s plan to develop its own launch vehicles to carry astronauts to the International Space Station. Currently, the US relies on Russia for this capability. Defunding domestic launch capabilities would result in continued reliance on Russian launch capacity, which has cost $1.2 billion since late 2011. The House and Senate spending measures undercut the $1.24 billion needed for the Commercial Crew Program—which would pay for Boeing and SpaceX to develop manned spacecraft by 2017—by up to $300 million.

Relying on Russia for launch capacity creates an interesting contradiction. First, NASA is not a military organization, and its activities are largely in the spirit of international cooperation, especially when it comes to Russia. However, defense hawks tend to oppose Russia’s ongoing incursions into Ukraine, sometimes loudly. This generally means supporting increased sanctions and avoiding cooperation, so it wouldn’t seem to follow that while scolding Russia for their military actions towards their neighbor, the US should also continue to rely on them for launch capacity. This isn’t the first time this sort of relationship has been framed this way. Foreign oil dependence has been a buzzword for decades, and it’s an issue that combines two different issues- energy and defense- into one. The argument goes that relying on potentially unstable partners for oil is a threat to national security, since the collapse of an oil-exporting partner could require military action to protect American energy interests. Regardless of this argument’s veracity, it has persuaded lawmakers on both sides of the aisle to pursue energy production means other than oil imports. A similar argument follows for Russia: if the US wants to economically punish Russia’s aggression and remain the forefront player in the space industry, why would it pay Russia to transport its astronauts?

I support NASA’s budget pretty vehemently, but for somewhat more optimistic reasons. I’m a strong proponent of space exploration of a national goal and a human endeavor, but I’m not adverse to a simple economic argument. Take a look at the list of NASA spin-off technologies. NASA has developed a huge range of technologies that undeniably benefit technology investors, the US, and the world at large.

For the first time since the shuttle program, NASA’s Orion program is providing the agency with long-term goals for manned spaceflight. And if you want to talk about a real security threat, no organization is better suited to detect and potentially avert objects that pose a threat to Earth. NASA pays science and security dividends in spades. Hopefully the hawks and the doves can come together to support it.

Image Credit: MrMiscellanious

America’s War on Terror: Democracy is No Panacea

Nine days after the attacks of September 11, the President declared America’s war on terror had begun. After the Bush Administration perceived early successes in Afghanistan, spreading democracy became one of the key policies supporting America’s strategy for the war on terror. Over time, the President came to view the promotion of democracy as a positive and transformational change agent for the Middle East and Muslim-majority countries. Empirical analysis, however, suggests democracy promotion did not help America achieve its broad objectives in the war on terror, though democracy indicators did marginally improve.          

This is Part 4 of 4 of Erik Goepner‘s paper. In case you missed them, read Part 1, Part 2, and Part 3; the full paper is available here.

America’s efforts in the war on terror have not achieved the desired objectives. Whether measuring the number of global terror attacks, number of attacks against the U.S. homeland, fatalities caused by terrorists, number of Islamist-inspired terror groups or the amount of fighters aligned with Islamist-inspired terror groups, the data suggests U.S. efforts in the war on terror have achieved disappointing results. During the 12 years prior to 9/11, terrorists committed an average of just over 3,200 attacks annually. In 2001, that number dropped to under 1,900 attacks. Since the U.S. initiated its war on terror, however, the average number of attacks has climbed to almost 4,300 per year.[1] Regarding the U.S. homeland, the attacks of 9/11 were a statistical outlier, making it difficult to determine if other similarly sized attacks might have followed. In the 13 years before 2001, there were five Islamist-inspired terror attacks in America. That compares to four attacks in the 13 years since.[2] Another 63 Islamist-inspired terror attacks against the homeland have been thwarted in the past 13 years, as well.[3]

Similar to the rise in worldwide terror attacks, the number of fatalities have likewise climbed, but at a faster rate. Nearly 6,500 people were killed worldwide per year in terror attacks for the decade-plus before 9/11. In 2001, more than 7,700 were killed. Then, in the 12 years since, the annual average has risen to just under 9,500. The before and after numbers for U.S. citizens killed by acts of terrorism are similarly discomforting, with 45 killed per year before 9/11 and 64 each year since.[4]

A final macro measurement for the war on terror examines the number of Islamist-inspired groups identified by the Department of State (DoS) as foreign terrorist organizations and how many fighters comprise those groups. Since 2000, the overall number of foreign terrorist organizations (FTOs) increased by 86 percent, from 29 to 54. The subset comprised of Islamist-inspired FTOs, though, grew by 185 percent, from 13 to 37 groups.[5] Moreover, the number of fighters within those groups has dramatically increased from an estimated 32,200 in 2000 to more than 110,000 in 2013.[6]

Unlike the overall measures of performance for the war on terror which have all worsened since 2001, governance and democracy measures are not as clear-cut. Freedom House’s indicators show a marginal, though statistically insignificant, improvement for the 47 Muslim-majority countries since 2001. The average political rights and civil liberties’ scores for all Muslim-majority states were essentially identical in the years prior to, and including, 2001. Since that time, they have improved by nearly 6 percent (Freedom House scores range from 1 “most free” to 7 “least free”).[7] However, a chi-square statistical analysis indicates the difference in pre- and post-9/11 scores were not statistically significant (X2=7.819, p=0.729). Though insignificant, the modest improvement occurred as average freedom scores declined worldwide for the past nine years.[8]

Afghanistan and Iraq had the lowest possible Freedom House scores for the years prior to 9/11 (i.e., 7). Scores for both countries have improved since, though neither has yet been listed among the 125 countries currently meeting the definition of an “electoral democracy.” The Polity IV Project from the Center for Systemic Peace provides another governance measurement. Their assessment of Afghanistan is unchanged from 2001. Throughout the past 13 years, they have assessed the country as “moderately fragmented,” meaning 10 to 25 percent of Afghanistan is ruled by authorities unconnected to the central government.[9] The assessment of Iraq, though, has changed rather dramatically. In the decade prior to the U.S. invasion, they assessed Iraq as extremely autocratic. Beginning in 2003 and holding for the next six years, they assessed Iraq as seriously fragmented, with between 25 and 50 percent of the country being ruled by authorities that were not connected to the central government. Then, beginning in 2010, Iraq was listed as slightly democratic and that assessment remained through 2013, which was the last year recorded. [10] No assessment has been made since the Islamic State seized sizeable portions of the country, so it is quite likely that the next report will list Iraq as moderately or seriously fragmented.

In conclusion, the decision to include democracy promotion as a key part of the war on terror did not happen immediately. Rather, it appears to have occurred in response to perceived early successes in Afghanistan. Policymakers apparently missed or ignored much of the research and intelligence available at the time that highlighted the numerous challenges to successfully democratizing Afghanistan and Iraq. Additionally, the research since 9/11 largely corroborates the earlier research. Finally, the quantitative analysis indicates democracy promotion did not help achieve the desired outcomes in the war on terror, though modest gains in democracy measures were observed.

Image Credit: Cpl. James L. Yarboro


[1] Data from the Global Terrorism Database, available at http://www.start.umd.edu/gtd/.
[2] National Consortium for the Study of Terrorism and Responses to Terrorism (START). (2013). Global Terrorism Database [globalterrorismdb_0814dist-1.xlsx]. Retrieved from http://www.start.umd.edu/gtd.
[3] David Inserra and James Phillips, “67 Islamist Terrorist Plots Since 9/11: Spike in Plots Inspired by Terrorist Groups, Unrest in Middle East,” The Heritage Foundation, April 22, 2015, http://www.heritage.org/research/reports/2015/04/67-islamist-terrorist-plots-since-911-spike-in-plots-inspired-by-terrorist-groups-unrest-in-middle-east.
[4] Data from the National Consortium for the Study of Terrorism and Responses to Terrorism (START). (2013). Global Terrorism Database [globalterrorismdb_0814dist-1.xlsx]. Retrieved from http://www.start.umd.edu/gtd.
[5] Bureau of Public Affairs Department Of State. The Office of Website Management, “2000 (Patterns of Global Terrorism),” March 23, 2006, http://www.state.gov/j/ct/rls/crt/ 2000/; Bureau of Public Affairs Department Of State. The Office of Website Management, “Country Reports on Terrorism 2013,” U.S. Department of State, April 30, 2014, http:// http://www.state.gov/j/ct/rls/crt/2013/index.htm; Martha Crenshaw, “Mapping Militant Organizations,” Stanford University, accessed March 27, 2015, http://web.stanford.edu /group/mappingmilitants/cgi-bin/groups.
[6] Martha Crenshaw, “Mapping Militant Organizations,” Stanford University, accessed March 27, 2015, http://web.stanford.edu/group/mappingmilitants/cgi-bin/groups. See also Department of State Country Reports and Patterns of Global Terrorism at http://www. state.gov/j/ct/rls/crt/.
[7] Data from https://freedomhouse.org/report-types/freedom-world#.VTwGJBd422k.
[8] Arch Puddington, “Discarding Democracy: A Return to the Iron Fist,” Freedom House, 2015, https://freedomhouse.org/report/freedom-world-2015/discarding-democracy-return-iron-fist#.VRIay2Z422k.
[9] Monty Marhsall, Ted Gurr, and Keith Jaggers, Political Regime Characteristics and Transitions, 1800-2013: Dataset Users’ Manual (Vienna, VA: Center for Systemic Peace, 2014), 13.
[10] Monty Marshall, Ted Gurr, and Keith Jaggers. 2014. Polity IV Project: Political Regime Characteristics and Transitions, 1800-2013. [p4v2013-2.xls]. Retrieved from http://www.systemicpeace.org/inscrdata.html.

America’s War on Terror: Democracy is No Panacea

Since the wars in Iraq and Afghanistan began, the scholarly research has burgeoned, enabling a more thorough examination of the Bush Administration’s policy choice to aggressively promote democracy as part of their overall war on terror strategy. Scholars have advanced a number of compelling findings and arguments about the Bush Administration’s policymaking process, as well as why democracy has proved so problematic in both countries.

This is Part 3 of 4 of Erik Goepner‘s paper. In case you missed them, read Part 1 and Part 2.

James Pfiffner suggests President Bush did not employ a systematic decision-making process with respect to Iraq, and that the president preferred substantive discussions with only a small cadre of his closest advisors.[1] This style could easily result in intelligence and research being overlooked, or the close-knit group unwittingly succumbing to groupthink.

Regarding the challenges of democratizing both countries, researchers point to the historic challenges of Muslim-majority states adopting democratic norms, ethnic and / or religious fractionalization, lack of liberal institutions or culture, poor rule of law, and the animus felt towards the democracy promoter (i.e., the U.S.) by many in the Muslim world.[2]

In addition, two lesser-known arguments are germane and will be addressed further. The first focuses on how the Bush Administration promoted democracy and the second looks at who was being democratized. While the idea of America promoting democracy abroad is nothing new, how it has been promoted over time has changed. Jonathan Monten outlines the two predominate ways in which America has historically sought to export democracy.[3] The first, and preferred choice until the 20th century, relied on America’s example, akin to the shining city on a hill. America’s efforts to win other nations to democratic forms of governance primarily took place within America’s borders, such that other nations could see the example and be enticed to emulate it. Monten refers to the second method as “vindicationism.” It includes setting a positive example, but adds active, external measures to promote democracy. President Bush, Monten argues, embraced a version of vindicationism-plus by also adding a coercive element. Monten goes on to say the U.S.’ hegemonic status not only made coercion possible, but in some respects almost unavoidable.[4] Had U.S. power not been such an overmatch for any would-be competitor, the Bush Administration would likely have been less bold. Policymakers believed their use of power was virtuous. As a result, they did not consider that their use of power might be coercive, unwelcome, or self-seeking.[5]

Moreover, the Bush Administration believed democratic success would beget democratic success, such that bandwagoning would result rather than other nations and actors attempting to balance against U.S. power.[6] Assumed bandwagoning also contributed to the expectation that U.S. military power would facilitate a pacific transition to democracy beyond Iraq and Afghanistan. As the President claimed, a “free Iraq can be an example of reform and progress to all the Middle East.”[7]

The second argument looks at who was being democratized. It does not appear that U.S. policymakers gave any consideration to the mental health status of the Afghan or Iraqi populations prior to pursuing a policy of democratization. Specifically, the effects of decades of severe trauma visited upon both populations were ignored—Afghanistan for 20 of the 21 years preceding the U.S. invasion, and Iraq for the preceding 17 years.

Persons who have been heavily traumatized, similar to the Afghans and Iraqis, are more likely to succumb to learned helplessness.[8] This psychological phenomenon manifests over time, as an individual increasingly perceives no connection between their own efforts and the outcomes that result. Self-efficacy gives way to hopelessness. As a result, the individual no longer puts forth effort, instead they surrender to their circumstances.[9] The behavioral and cognitive changes that frequently accompany severe trauma would appear to inhibit the successful initiation of democracy.

The decision to include democracy promotion as a key part of the war on terror did not happen immediately. Rather, it appears to have occurred in response to perceived early successes in Afghanistan. Policymakers apparently missed or ignored much of the research and intelligence available at the time that indicated the numerous challenges to successfully democratizing Afghanistan and Iraq. Additionally, the research since then tends to corroborate the earlier research.

Next week, part 4 will take a final look at democracy promotion as a key part of America’s war on terror strategy. This last examination will focus on the numbers. How effective has the U.S. been in democratizing Afghanistan, Iraq and the broader region? And, more broadly, how have the efforts to democratize affected the overall achievement of U.S. goals in the war on terror? Erik Goepner’s full paper is available here.


[1] James Pfiffner, “Decisionmaking, Intelligence, and the Iraq War,” in Intelligence and National Security Policymaking on Iraq: British and American Perspectives (College Station, TX: Texas A&M University Press, 2008), 217–8.
[2] Zakaria, “The Rise of Illiberal Democracy”; Bernard Lewis, “The Roots of Muslim Rage,” The Atlantic 266, no. 3 (1990): 47–60; Samuel Huntington, “The Lonely Superpower,” Foreign Affairs 78, no. 2 (March 1, 1999): 35–49; Francis Fukuyama, “Why is Democracy Performing So Poorly?” Journal of Democracy 26, no. 1 (January 2015): 13.
[3] Jonathan Monten, “The Roots of the Bush Doctrine: Power, Nationalism, and Democracy Promotion in U.S. Strategy,” International Security 29, no. 4 (April 1, 2005): 112–115.
[4] Monten, “The Roots of the Bush Doctrine,” 116.
[5] Monten, “The Roots of the Bush Doctrine,” 146.
[6] Monten, “The Roots of the Bush Doctrine,” 148–9.
[7] Monten, “The Roots of the Bush Doctrine,” 150.
[8] Steven Maier, “Exposure to the Stressor Environment Prevents the Temporal Dissipation of Behavioral Depression/learned Helplessness,” Biological Psychiatry 49, no. 9 (May 1, 2001): 763; Neta Bargai, Gershon Ben-Shakhar, and Arieh Y. Shalev, “Posttraumatic Stress Disorder and Depression in Battered Women: The Mediating Role of Learned Helplessness,” Journal of Family Violence 22, no. 5 (June 6, 2007): 268, 272, 274.
[9] Lyn Abramson, Martin Seligman, and John Teasdale, “Learned Helplessness in Humans: Critique and Reformulation,” Journal of Abnormal Psychology 87, no. 1 (1978): 50.

Image Credit: U.S. Navy