Pandora Report 8.17.2018

Happy Friday fellow biodefense nerds! Welcome to your weekly roundup of all things global health security. If you’re finding yourself a food source for mosquitoes and ticks this summer, just a friendly heads up – the associated diseases are on the rise (hint: climate change may be a big reason).

The Lingering Scare of Smallpox
The recent FDA approval of TPOXX to treat smallpox, a disease eradicated since 1980, has many wondering, especially those of us born in a time where the vaccine was not necessary, why so much attention is being raised. It’s an easy thing to forget – the peril of a disease long since eradicated, but the threat of smallpox is very much still a concern in biodefense. Between the concerns of a laboratory biosecurity/biosafety incident at the two remaining stockpile locations or the chance that a frozen corpse (aka corpsicle) who died of smallpox could defrost as the Arctic permafrost melts. Did I mention the risk of a de novo synthesis like the horsepox one in Canada? These are the reasons we haven’t been able to shake the nightmare that is smallpox. “The greatest threat is advances in synthetic biology, which could permit a rogue lab to re-engineer a smallpox virus. In 2016, researchers in Canada announced that they had created horsepox using pieces of DNA ordered from companies. A synthetic smallpox virus could be even more dangerous than the original, because it could be designed to spread more easily or with ways to survive new therapies.” While we eradicated smallpox and proved that such a feat was possible, there is the painful reality that such efforts left an unvaccinated and inherently vulnerable population.

Biological Events, Critical Infrastructure, and the Economy: An Unholy Trinity
Biodefense graduate student Stephen Taylor is reporting on the latest Blue Ribbon Study Panel. “At its recent meeting about resilience, the Blue Ribbon Study Panel on Biodefense explored the potential impacts of a biological event on critical infrastructure in the United States, as well as the best way to approach risk mitigation.  Ann Beauchesne, former Senior Vice President of the National Security and Emergency Preparedness Department at the U.S. Chamber of Commerce, summed up critical infrastructure as ‘the critical services for our society and the backbone our economy.’  Projected increases in global travel, trade, and development all rely on critical infrastructure, magnifying the potential impact of insults to infrastructure systems.  Concurrently, biological threats are also on the rise. As the world warms and urbanizes, natural infectious disease outbreaks manifest in unexpected places.”

Ebola, Healthcare Workers, and the Pandemic Potential in Vulnerable Countries 
Every day brings news of the Ebola virus disease outbreak along the eastern border of the DRC. On Thursday, cases jumped by seven – one of whom is a healthcare worker. The outbreak is up to 73 cases, 46 of which are confirmed and 27 are probable. 43 deaths have been reported. Nearly a thousand people are under surveillance as contacts of cases and healthcare workers are again, experiencing increased risk of transmission. On Tuesday, it was reported- “that health worker Ebola infections could amplify the current outbreak in the Democratic Republic of Congo (DRC), the country’s health ministry today reported five more confirmed cases, including four involving health workers at a health center in Mangina. The other is a patient recently treated at that facility.” The hope is that the new vaccine can help put an end to the outbreak and curb the risk for healthcare workers. The recent outbreak draws attention yet again, to the inherent danger that infectious disease outbreaks pose in vulnerable countries. We’ve seen how fast and unexpectedly such outbreaks can spread beyond international borders (SARS, MERS, Ebola, etc.), which means that these are global health security issues. The 2013-2016 Ebola outbreak taught us a “great deal about how to respond in a fragile state setting. Traditional leaders and faith leaders played an important role in communicating necessary information and behavior change requirements to isolated groups who did not necessarily trust the government or health care workers.” Preventative measures like stronger public health and healthcare infrastructure can make a world of difference. “Preventative investments can mean the difference between life and death for people in those countries and the difference between an outbreak being contained or becoming an epidemic. As we face repeated outbreaks of infectious diseases, including new pathogens, it is essential that U.S. policy-makers continue funding the operations that make containment possible.”

BWC Meeting of Experts
Don’t miss out on the daily reports from Richard Guthrie on the latest MX. You’ll definitely want to check out days six and seven, where national implementation and preparedness were discussed. How would countries respond to a potential act of bioterrorism? Guthrie notes that “Concerns were raised about whether bodies such as the World Health Organization should be engaged with any assessment of the cause of an outbreak if there were indications it was deliberate in case this brought the health body into the security realm with potential negative consequences for other health work. A number of contributions to the discussion noted that health officials would have different roles to officials looking to attribute the cause of an attack and there was a need to ensure that effective ways of operating together were established. An example of the challenges was given in WP.10 from the USA in the section on ‘preservation of evidence’.” The response and preparedness measures for each country can be complex and challenging when considering the global context of the BWC. For example, Saudi Arabia discussed its own preparedness measures for natural events during times when influxes of people were expected (pilgrimages).

 The Economic Burden of Antimicrobial Resistance and the Drive For Intervention
A recent study enumerated the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Their model utilized three components – correlation coefficient between human antibiotic consumption and resulting resistance, economic burden of AMR for five key pathogens, and the consumption data for antibiotic classes driving resistance in these organisms. “The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins.” Ultimately, they found that the cost of AMR per antibiotic frequently exceeded the purchase cost, which should encourage policy and consumption changes.

NASEM Report: Cooperative Threat Reduction Programs for the Next Ten Years and Beyond
The latest report from the National Academies is now available regarding the Cooperative Threat Reduction (CTR) Program. “The Cooperative Threat Reduction (CTR) Program was created by the United States after the dissolution of the Soviet Union to provide financial assistance and technical expertise to secure or eliminate nuclear weapons delivery systems; warheads, chemical weapons materials, biological weapons facilities, and nuclear, biological, and chemical weapons technology and expertise from the vast Soviet military complex. In a 2009 report, Global Security Engagement: A New Model for Cooperative Threat Reduction, the National Academy of Sciences (NAS) recommended adoption of a modified approach to thinking about CTR, including the expansion of CTR to other countries and specific modifications to CTR programs to better address the changing international security environment.” The report has insight from some of the time minds in the field of biological threats – Elizabeth Cameron, David Franz, James Le Duc, etc.

Stores You May Have Missed:

  • Key Global Health Positions and Officials in the USG – Have you ever wondered who is in charge for global health programs throughout the government? Look no further than this comprehensive list by the Kaiser Family Foundation.
  • CEPI Collaborative for Lassa Fever Vaccine“In a deal worth up to $36 million to advance the development of a vaccine against Lassa fever, the Coalition for Epidemic Preparedness Innovations (CEPI) today announced a new partnership with Profectus BioSciences and Emergent BioSolutions.”

Thank you for reading the Pandora Report. If you would like to share any biodefense news, events, or stories, please contact our Editor Saskia Popescu (biodefense@gmu.edu) or via Twitter: @PandoraReport

Pandora Report 8.10.2018

Biological Weapons Convention – Meeting of Experts
The 2018 Biological Weapons Convention Meeting of Experts (MX) is underway and we’ll be reporting out, but if you need a daily dose of news, check out the latest via these great sources – the Implementation Support Unit’s Twitter @BWCISU, live UN video feed, and the detailed daily reports from Richard Guthrie. In his first report of the MX, Guthrie discusses the new set up of meetings – “This series of meetings is the most recent iteration of work programmes held between the five-yearly Review Conferences of the Convention that are commonly known as the ‘inter-sessional process’.  The Eighth BWC Review Conference in 2016 was unable to agree on the contents of a new inter-sessional process but was able to agree to delegate further discussion on what might be in such a process to the Meeting of States Parties (MSP) held in December 2017.  The 2017 MSP agreed to the holding of five distinct MXs in each of 2018, 2019 and 2020.  Each year would also include a week-long MSP towards the end of the calendar year.” You can also read the Joint NGO Position Paper to the BWC, which was organized by Filippa Lentzos and underscores not only the importance of NGO involvement, but outlines several key components to strengthen cooperation and assistance, development in science and technology, etc. You can watch the delivery of the statement here (starting at 03:02:00). The Meeting of Experts will continue through August 16th, and we’ll be sure to keep you posted about any updates in the mean time!.

DRC Ebola Outbreak Update
The DRC continues to manage an outbreak in North Kivu, with 44 reported cases of Ebola virus disease. Of these cases, 17 are confirmed and 27 are probable. 54 suspected cases are also being investigated. “The health ministry said officials are putting contingency plans in place in Goma, in case the virus reaches the city. Elements of the plan include identifying an isolation unit at the city’s North Kivu Provincial Hospital, putting border officers at city entry points, and beginning social mobilization activities.”

The June 2018 Cologne Ricin Plot 
In June, German police unearthed a ricin plot by a Tunisian extremist in Cologne. “German intelligence had learned that Sief Allah H. had bought various materials via the internet, including more than a thousand castor beans and an electronic coffee grinder. During the police raid, a powdery substance was found, which subsequently tested positive for ricin. Holger Münch, head of Germany’s Federal Criminal Police Office (BKA), stated shortly after the raid, ‘There were pretty specific preparations for such a crime, using, if you want, a bio-bomb. This is a unique case, at least for Germany’.” There has been increasing counterterrorism concerns regarding the use of ricin by terrorists and extremists. The Cologne incident is particularly unique in that if the main suspect, Sief Allah H, is proven guilty, it will be the first time a jihadi terrorist has produced ricin in the West. “Equally troublingly, the case suggests radicalized individuals are indeed able to produce a biological weapon using internet tutorials. Though the Islamic State is in rapid decline in Syria and Iraq, the manuals and how-to instructions for explosives and other weapons are still available online. This material, which is being shared via Telegram channels and other forms of communication, still has the potential to inspire jihadis across the globe.” Make sure to also read the interview with British CBRN expert Hamesh de Bretton-Gordon in which he notes the greatest CBRNE concerns he has, from “the continued active use of chemical weapons against civilians in Syria” to “the Novichok attack in Salisbury. We now know that the Russians have an asymmetric capability in Novichok that overmatches NATO’s ability to defend against it. If the Russians used it tomorrow, we would certainly be found wanting and that will continue to be the case until we’ve got necessary defensive measures in place.”

Impact of the Global Medical Supply Chain on SNS Operations and Communications: Proceedings of a Workshop
The latest report from the National Academies of Science is out regarding supply chains and strategic national stockpile operations. “The Centers for Disease Control and Prevention (CDC) established the Strategic National Stockpile (SNS) with a focus on procuring and managing medical countermeasures (MCM) designed to address chemical, biological, radiological, and nuclear events and attacks by weapons of mass destruction. The stockpile is a repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other medical materiel organized to respond to a spectrum of public health threats. Over time, the mission of the SNS has informally evolved to address other large-scale catastrophes, such as hurricanes or outbreaks of pandemic disease, and rare acute events, such as earthquakes or terror attacks. When disaster strikes, states can request deployment of SNS assets to augment resources available to state, local, tribal, or territorial public health agencies. CDC works with federal, state, and local health officials to identify and address their specific needs and, according to the stated mission of the SNS, ensure that the right resources reach the right place at the right time.” Within the report, there are discussions on the gaps within the global medical chain, supply chain issues related to the SNS, the role of strategic communication, etc.

MERS & The Role of Hospitals
The latest World Health Organization (WHO) global summary and risk assessment on Middle East respiratory syndrome-coronavirus has reinforced the notion that hospitals are amplifiers for the disease. While little has changed epidemiologically, the ongoing healthcare-related outbreaks are worrisome for longterm infection control. Of the six recent clusters reported from Saudi Arabia (hit the hardest with 83% of all cases), three were related to healthcare transmission. “Maria Van Kerkhove, PhD,  an epidemiologist who is the WHO’s technical lead for MERS-CoV, said the report’s findings are a reminder that the disease remains a global health threat. ‘This high threat respiratory pathogen has shown the potential to cause large outbreaks with substantial public health, security, and economic consequences,’ she told CIDRAP News.”

How CMS Rules Impact Infection Prevention Programs
Speaking of infection control and hospitals….GMU biodefense doctoral student and infection preventionist Saskia Popescu breaks down the concerning role that policy changes for healthcare reimbursement from the Centers for Medicaid and Medicare (CMS) have on infection prevention programs. “Moreover, these changes would not change much in terms of burden and workload for infection preventionists. The same types of reporting are required, and high rates of HAIs are still linked with financial penalties. In fact, there is concern that these proposed changes could give the impression that less work will occur, leading to a reduction in staffing for infection control programs, which has, ironically, already been cited as the cause of high HAI rates and even referred to by union leaders and workers as proof of staffing needs.” The strength of infection control programs within hospitals is critical to stopping not only the spread of spread of multi-drug resistant organisms, but also working to combat healthcare-associated infections, and making sure hospitals are better prepared for infectious disease threats like MERS, SARS, and Ebola.

Stories You May Have Missed:

  • Aggressive New Tick Species Moves Through The U.S. – “The tick (Haemaphysalis longicornis), referred to as the ‘longhorned tick’ or the ‘bush tick,’ was first identified in New Jersey in November 2017 on a sheep in Hunterdon County. Recently, the tick has been detected in Union and Middlesex counties of New Jersey as well, according to the New Jersey Department of Agriculture. However, New Jersey is not the only state to have identified the tick—it has now been reported in 8 US states.”

Pandora Report: 8.3.2018

 Ebola Returns to the DRC and A Lesson in Outbreak Response Failures 
Unfortunately, days after declaring the outbreak over, the DRC has reported four laboratory-confirmed cases of Ebola. The Ministry of Health is also reporting 26 people with hemorrhagic illness signs and symptoms. At this point, there has not been connective evidence between the new outbreak and the last one. The concerning aspect of this outbreak is its location – Beni, within the Magina health district, which is an active conflict zone and poses unique challenges for response efforts. “This new cluster is occurring in an environment which is very different from where we were operating in the northwest,” said Peter Salama, MD, WHO Deputy Director-General, Emergency Preparedness and Response. “This is an active conflict zone. The major barrier will be safely accessing the affected population.” As the DRC continues work to implement control and response measures, a new book from British physician Oliver Johnson and Irish Diplomat Sinead Walsh, is lifting the lid on the botched response to the 2014-2016 outbreak in west Africa. “In Getting to Zero, the duo show how a litany of mistakes made in distant offices in New York, Washington, London and Geneva, combined with poor leadership in Sierra Leone and a weak health service, created a catastrophe that could have been prevented. Among those coming under fire are the British army, the Department for International Development and the US Center for Disease Control. The sharpest criticism is levelled at the WHO, which was slow to declare the Ebola outbreak an international emergency, but also failed to heed early alarm calls made by medics who were working in horrific conditions in the Kenema hospital, where British nurse Will Pooleycontracted the virus.” The news comes just after a new species of Ebola virus was found in bats in the northern part of Sierra Leone.

UK Biological Security Strategy 
The latest policy paper from the British Department for Environment, Food & Rural Affairs, Department of Health and Social Care, and Home Office, has just been released. Outlining everything from the strategy to main assumptions of 2020 and beyond, the policy paper focuses on a response plan that includes understanding the threat, mechanisms for prevention, detection, response, and building a strong science base inclusive of industry and academia. “The strategy also recognises the importance of intervening early to prevent biological threats from emerging, or from spreading once they emerge. To this end, it sets out how we will make best use of our international activity to help reduce the risks to the UK and our interests, at home and overseas. This includes our engagement with international partners (at local, regional and national levels) and forums.” Some of the main assumptions to 2020 and beyond include: the world will continue to become more physically interconnected through travel and migration – affecting both natural health security and deliberate threats, advances in medical technology, genetic engineering and biotechnology will hold significant potential for UK prosperity and growth, etc. Their strategy is also inclusive of relevant national and international programs like the National Counter-Proliferation Strategy to 2020, the Global Health Security and UK Antimicrobial Resistance Strategy, etc.

Three Days Delving into Pandemics, Bioterrorism, and Global Health Security 
If you missed our three-day workshop last month, here’s a quick recap – be warned though, once you read it, you’ll want to join us at the 2019 workshop! “Attendees included people from Health and Human Services, the Department of Defense, and private industry such as Merrick & Company and Emergent Biosolutions. I was surprised to also see people from Sandia National Labs, the Pentagon Force Protection Agency, and even other universities. The diversity of the group led to some thought-provoking conversations surrounding topics like cyberbiosecurity and responding to biosecurity as ‘a wicked problem’. The workshop participants were an engaging group that left me re-thinking how I approach many of these biodefense topics.The workshop began with conversations surrounding how we might analyze biological threats not only from a social and cultural ecological perspective, but also through the resiliency of prevention practices. If we can’t always prevent, how do we respond? MIT’s Sanford Weiner posed such questions to the group, followed by a presentation on the swine flu pandemic of 1976 and discussion on how much the U.S. has learned from mass immunization history, especially compared to the UK.”

CRISPR Woes
CRISPR-Cas9 has been hailed as a revolutionary genome editing tool that will help cure disease. Unfortunately, cell repair following CRISPR enzyme snips isn’t working like we had hoped. “The discovery gives insight into why CRISPR-Cas9 gene editing works remarkably well in nearly every cell attempted, though not with equal success in all cells. ‘If you want to treat sickle cell anemia, your chances of success are inextricably tied to the efficiency with which you can replace the mutated sickle cell gene with the correct one,’ said UC Berkeley postdoctoral fellow Chris Richardson, first author of a paper describing the findings.” While CRISPR can be extremely precise in its ability to target specific DNA sequences, the tricky part is what comes after, when the cell has to repair the damage. “The enthusiasm for using CRISPR-Cas9 for medical or synthetic biology applications is great, but no one really knows what happens after you put it into cells,” Richardson said. “It goes and creates these breaks and you count on the cells to fix them. But people don’t really understand how that process works.”

The High Cost of A Measles Outbreak
Have you ever wondered how large the bill might be for responding to an outbreak of measles? This vaccine-preventable disease is a particularly troublesome foe for public health and infection prevention efforts as its airborne transmission makes control efforts extremely difficult. A new study has just reported the $395,000 price-tag for the New York City health department’s efforts during a 2013 measles outbreak that sickened 58 people. “The first patient was an unvaccinated adolescent who returned to New York City while infectious after visiting London. The outbreak, centered in the orthodox Jewish community, marked the city’s biggest measles outbreak since 1992. With the first case reported in March, health officials spent the next 4 months fielding reports of suspected cases, interviewing patients, reviewing medical and immunization records, tracing contacts, and doing community outreach. The 58 cases came from two neighborhoods of Brooklyn, many of them members of eight extended families, and involved six generations of transmission. Of the total, 45 (78%) were at least 12 months old and weren’t vaccinated due to parental refusal or intentional delay. Twelve patients were younger than 12 months old and were too young to be immunized with measles, mumps, and rubella (MMR) vaccine. One patient was an adult who reported a history of receiving a measles-containing vaccine as a child.” You can read more about the financial impact of a measles outbreak here, where GMU biodefense doctoral student Saskia Popescu was a part of the response efforts.

News You May Have Missed:

  • Trump Taps New White House Science Adviser – Meteorologist Kelvin Droegemeier has been tapped to take over the position and end the void at the White House for the Office of Science and Technology Policy. “Droegemeier would be the first non-physicist to serve as White House science adviser since Congress established the OSTP in 1976. “I think he is a very solid choice,” says John Holdren, who led the OSTP for eight years as Obama’s science adviser. “He is a respected senior scientist and he has experience in speaking science to power.” An expert on extreme-weather events, Droegemeier has been vice-president for research at the University of Oklahoma in Norman since 2009. Last year, Oklahoma Governor Mary Fallin, a Republican, appointed him as the state’s secretary of science and technology.”

Pandora Report: 7.27.2018

Happy Friday! While everyone is celebrating the last few weeks of summer, your favorite source for all things biodefense isn’t slowing down. Make sure to read Laurie Garrett’s comments on why we’re in the next HIV pandemic and how the global strategy is seriously flawed.

 NASEM Report: Biodefense in the Age of Synthetic Biology
GMU Biodefense student and Research Fellow for Institute for Philosophy and Public Policy, Sarah W. Denton, recently attended the NASEM public briefing on their new report – Biodefense in the Age of Synthetic Biology. Denton notes that “While the framework draws on previous works (e.g., Tucker 2012and the 2004 Fink report), what makes this report unique is its use of the Design-Build-Test (DBT) process as the foundation for its capability-assessment. DBT is the ‘iterative process of designing a prototype, building a physical instantiation, testing the functionality of the design, learning from its flaws, and feeding that information back into the creation of a new, improved design’.” Check out her detailed recap of the event and the report, including the noticeable absence of “the potential benefits and safety concerns related to developments in synthetic biology”.

 

DARPA’s Prepare Program 
Filippa Lentzos and Jez Littlewood are asking – what exactly does DARPA’s Prepare program actually prepare for? “Called ‘Prepare’ (short for ‘Pre-emptive Expression of Protective Alleles and Response Elements’), the program aims to develop programmable modulators that temporarily boost protective genes, either before or after exposure, to biological, chemical, or radiological health threats. Inadvertently, however, the project may contribute to rising international tensions in the biological field. The program might push the limits of what is allowable under international security treaties, particularly the 1972 Biological and Toxin Weapons Convention (BTWC).” Underscoring the importance of the US being a role model for BTWC compliance, they note that programs like Prepare further the gray zone of biodefense that makes communication of intent that much more important. “The Prepare program continues to expand US biodefense gray-zone activities—and states keeping a close eye on the US biodefense enterprise may well question the program’s intent. Some might feel threatened by it. A small number—concerned about new threats highlighted by US activities, or in preparation for a sudden change in the US attitude toward the absolute prohibition of biological weapons—might even take reciprocal action, initiating additional gray-zone biodefense activities of their own. The result could be a downward security spiral in which greater offensive know-how on all sides leads to increased danger of biological attack against more states.” Lentzos and Littlewood note that programs of this nature must work to proactively disclose information regarding intent through compliance reports and encourage the peer review of national biodefense programs as a confidence-building measure.

DRC Declares Ebola Outbreak Over
The DRC has officially declared the end of the outbreak after it was initially identified in early May. This outbreak marks the 9th that the DRC has seen and involved 54 cases and 33 deaths. “Though the country is experienced in managing Ebola outbreaks, health minister Oly Ilunga Kalenga, MD, said in a statement today that officials noted early warning signs that the outbreak had the potential to evolve into a major crisis. Illnesses emerged in two remote, heavily forested health zones at the same time and health workers were infected, a factor known to intensify the spread of the virus.” This news comes as scientists announced that women may be able to transmit the disease well over a year after infection. The trigger for this realization was a female patient in Liberia at the end of the outbreak in 2015. The woman fell ill after giving birth, which has raised questions regarding the immune suppression that occurs during pregnancy and how that may trigger Ebola relapses. This finding has raised considerable concern for not only the spread of the disease, but also stigma for survivors.

The Hot Zone Turns Into A TV Show
We’ve all read, or at least heard of, the infamous Ebola book, The Hot Zone, by Richard Preston. While the theatrics of its more dramatic moments can be laughed at, for many, it inspired us to get into the field of biodefense or infectious diseases. National Geographic is now working to bring it to the small screen with a scripted miniseries. It’s been a disappointing road for those of us yearning for a decent infectious disease show, but I’m cautiously optimistic based off National Geographic’s recent efforts to bring truth to TV in their Genius series. Production begins this fall in Toronto and South Africa.

 The Frustrating Predicament of PPE Compliance
GMU Biodefense doctoral student and infection preventionist Saskia Popescu is shedding light on some painful truths about healthcare worker PPE compliance. “I’ve heard lectures on Clostridium difficile where the presenters commented on how prevalent isolation failures are when caring for C diff patients, noting that it’s often best to just accept this reality and instead emphasize environmental cleaning and good hand hygiene to combat the spread. The truth is that health care workers, especially nurses, are moving a million miles a minute and running in and out of patient rooms, which makes the burden of PPE understandable. Unfortunately, this doesn’t mean lax isolation precautions should be accepted or encouraged.” Popescu points to a recent study that evaluated PPE failures and that “a total of 280 failures were observed, including 102 violations (deviations from practice), such as entering an isolation room without PPE or not wearing the PPE correctly, etc.”

Blue Ribbon Study Panel – The Cost of Resilience: Impact of Large-Scale Biological Events on Business, Finance, and the Economy
Don’t miss this event next week regarding biothreats and economic impacts. “Despite recognition of the important role of industry and other private sector elements in defending the nation against biological threats, the United States has yet to adequately plan for and support private sector engagement in preparing for biological incidents. To examine private sector roles and responsibilities before, during, and after the response to large-scale biological events, the Blue Ribbon Study Panel on Biodefense will hold a public special focus meeting on July 31, 2018 to address The Cost of Resilience: Impact of Large-Scale Biological Events on Business, Finance, and the Economy.”

Low Antibiotic Levels in the Environment Encourage Resistance 
It doesn’t get more One Health than antimicrobial resistance. AMR is the perfect example to reveal how the environment, animal, and human health are all tied together and a new study is highlighting this through the role of environmental antibiotic levels and their role in resistance. “In a study published in the journal mBio, researchers with the University of Exeter Medical School, the University of Hong Kong, and drug-maker AstraZeneca report that even when bacterial communities in wastewater are exposed to small amounts of the antibiotic cefotaxime, selection pressure for clinically important antibiotic-resistant genes occurs. Moreover, they also found that the selection pressure for resistance may be just as strong as when exposed to high concentrations of the drug. The findings are important because they suggest that environments that are commonly found to have trace amounts of antibiotics, such as hospital effluent and rivers and streams that receive wastewater, could be an important, and overlooked, breeding ground for antibiotic-resistant bacteria”. You can read the study here.

Stories You May Have Missed:

  • 23andMe Teams Up With Glaxo – If you’ve used 23andMe, your DNA is likely to be used for the development of new drugs due to a new partnership (with consent of course.). “Home DNA test results from the 5 million customers of 23andMe will now be used by drug giant GlaxoSmithKline to design new drugs, the two companies announced Wednesday. It’s the biggest partnership yet aimed at leveraging the increasingly popular home genetic testing market, in which customers pay for mail-in saliva tests that are analyzed by various companies.”

Pandora Report: 7.20.2018

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
This week Schar Biodefense hosted a three-day workshop on all things health security, from anthrax to Zika. Highlights from the first two days include a rousing discussion by Dr. Robert House surrounding medical countermeasures and the potential for nefarious actors to highjack the immune system, Sandy Weiner delving into the history of the 1976 influenza pandemic, GMU professor and virologist Dr. Andrew Kilianski breaking down some hard realities of biosurveillance, and Edward You of the FBI discussing the importance of working with the DIY biohacker community and protecting the bioeconomy. While the workshop continues through today, make sure to check back next week for more coverage.

 Vaccine Causing Polio in Africa? Context From An Expert
GMU Biodefense PhD alum Christopher K. Brown sat down with Lucien Crowder of the Bulletin of the Atomic Scientists to discuss vaccine derived polio and the implications of these outbreaks. Brown discussed the vaccine production process, how they can cause an “infection light”, and the current outbreak in the DRC. “In the Democratic Republic of the Congo, a vaccine-derived type 2 poliovirus is responsible for the current outbreak, even though it is no longer a component of the live, attenuated oral vaccine that most countries use (when, that is, an oral, attenuated vaccine is used instead of a fully inactivated injectable formulation that is safer but potentially less effective). Despite a World Health Organization–led switch from the three-type, or trivalent, vaccine to a bivalent preparation, the vaccine-derived type 2 virus continued to spread from person to person undetected, slowly mutating to regain the neurovirulence that can cause paralysis in those who are infected. Now, to stop the current outbreak, health officials are deploying a monovalent vaccine formulated specifically for type 2 poliovirus. The key is to reach susceptible individuals—namely, those who did not receive the trivalent option previously—with the vaccine before the virulent strain of the virus does. If enough people are vaccinated, the mutated, vaccine-associated strain will not continue to infect new people and the outbreak will subside.” Brown took care to discuss how these incidents are high-jacked by the anti-vaccination movement, but that “the argument that vaccines cause injury often focuses on the myth that certain chemicals in vaccines—including preservatives, like Thiomersal, that are no longer used in vaccine formulations—cause autism. The polio outbreak in the Democratic Republic of the Congo is a case in which a strain of virus that was rendered safe for vaccinating most people has regained some of its disease-causing abilities through genetic mutation. That’s sort of similar to why bugs that are more common problems in developed countries, like staphylococcus and gonorrhea, stop responding to antibiotics: They acquire genetic mutations that make them resistant to certain drugs. What is most important here is to consider the level of risk associated with vaccine-linked outbreaks, or cases of paralysis, compared to the effects of polio in an unvaccinated population. While the attenuated poliovirus in the vaccine itself may lead to no more than four or five cases of paralysis among every million individuals vaccinated, there would likely be thousands of cases of serious disease among a million exposed, unvaccinated people.”

Why Aren’t We More Worried About The Next Epidemic?
In the past couple of months, we’ve seen outbreaks of Ebola, MERS, Zika, Nipah virus, Rift Valley fever, and Lassa fever – so why aren’t we more worried about the next epidemic? Globalization makes the movement of people and goods easier and faster – consider that 107 countries received frozen vegetables now being recalled for Listeria. The good news is that information technology allows us to know about these outbreaks and have the ability to notify necessary agencies and resources at a rapid pace. “Several major factors are to blame for why the world is seeing more of these increasingly dangerous pathogens. The combination of massive widespread urbanization, explosive population growth, increased global travel, changing ecological factors, steady climate change and the exploitation of environments is driving an era of converging risk for outbreaks, experts say.” Dr. Thomas Inglesby, director of the Johns Hopkins Center for Health Security, noted that ‘We don’t know when the next Ebola outbreak will come but we do know it will come again, and again, and again’.” Outbreaks like SARS and Ebola have shown the devastating impact outbreaks have on not only the healthcare system, but also the economy. Unfortunately, emergency preparedness and healthcare response is a tough problem to fix. The CDC director of the Center for Global Health, Rebecca Martin, stated that “Gaps in public health emergency response capabilities remain a serious vulnerability for the entire world,” she added. “While we don’t know when or where the next pandemic will occur, we know one is coming”. We know the next pandemic is coming, the unknowns are from where, when, and what it will look like. This makes response, including medical countermeasures, that much more difficult. R&D is a critical component to this, but as Dr. Inglesby noted, “The problem with public health in particular and with R&D is what we’re ultimately trying to do is prevent bad things from happening. When you succeed, it’s relatively invisible ― so the public doesn’t get to see why investment is so important.” Inglesby also recently highlighted the six ways countries can prepare for the next pandemic. From enhancing capabilities to develop new vaccines/medical countermeasures, to investing in more robust public health systems, there are several ways we can facilitate stronger national capacity to respond to pandemics.

Crucial Steps Forward: the National Academies of Science’s 2018 Study, “Enhancing Global Health Security through International Biosecurity and Health Engagement Programs”
GMU biodefense MS student Alexandra Williams recently attended the NASEM meeting regarding global health security through international biosecurity and health engagement programs. Within her recap, Williams discusses the background of CBEP (Cooperative Biological Engagement Program) and CTR (the DoD’s Cooperative Threat Reduction program), noting their efforts to strengthen health security within the U.S. and abroad. “As challenges continue to arise in timely and accurately detecting and responding to disease outbreaks—as we saw in 2014 with Ebola in West Africa, and in 2016 with Zika—U.S. health and security agencies are working to better meet these challenges, and examine how they need to evolve to meet unforeseen hurdles that lay ahead. This NASEM study is timely and critical because it addresses and examines these issues head-on, and will serve as the launch point for how the U.S. can rethink, reshape, and improve its already critical and successful work in biosecurity and global health security.”

Book Review – Dirty War: Rhodesia and Chemical Biological Warfare
Glenn Cross, GMU biodefense PhD alum, has taken great care to investigate and detail the history of Rhodesia’s chemical and biological warfare program against insurgents from 1975 to 1980. If you’re on the fence about adding a new book to your reading list, check out Ryan Shaffer’s latest review. “Organized topically, the book’s preface offers a brief overview of Rhodesia’s colonial history and demographics, discussing the ethnic and racial divisions arising from a white minority’s control of the government over a disenfranchised and mostly rural black African population. Cross describes the Rhodesian War with emphasis on “the regime’s inability to defeat decisively a growing guerrilla insurgency through conventional arms alone.” (39) He explains the conflict’s evolution in the context of post-war British decolonization and the manner in which the Unilateral Declaration of Independence was designed to maintain white minority rule, as well as the ensuing international sanctions that isolated Rhodesia. By the late 1960s, government opponents shifted strategy, believing the only way to change the country was to forcibility seize control. Meanwhile, the CIO had penetrated the opponents’ ranks, gathering intelligence and setting up the Selous Scouts to work against the guerrillas.” Shaffer notes that “the book is a well-researched study that sheds light on the reasons a government broke international norms to use CBW, a tactic more likely to target local non-state actors than foreign militaries.”

 Antibiotic Prescribing Failures in Urgent Care Centers
Disrupting antibiotic resistance is challenging due to not only the vast array of sectors that play a role, but also the cultural components. Prescribing habits are one of those culturally-engrained practices that can be difficult to alter. A new study has found that antibiotic stewardship is desperately needed in urgent care facilities. “Researchers with the Centers for Disease Control and Prevention (CDC), the University of Utah, and the Pew Charitable Trusts report that 45.7% of patients who visited urgent care centers in 2014 for respiratory illnesses that don’t require antibiotics end up with prescriptions for those conditions, followed by 24.6% of patients treated in emergency departments (EDs), 17% of patients who went to medical offices, and 14.4% of patients who visited retail clinics. The findings are based on analyses of 2014 claims data from patients with employer-sponsored health insurance. Previous estimates of outpatient antibiotic prescribing by some of the same researchers had pegged the amount of unnecessary prescribing at 30%, a number that some experts believe is conservative. Study coauthor David Hyun, MD, a senior officer with Pew’s antibiotic resistance project, said the findings suggest that could very well be the case.” The sad reality is that these numbers are likely to be higher across the U.S. as inappropriate prescribing practices are a systemic issue. This finding is one piece of the puzzle, which underscores the progress that needs to be made. Fortunately, countries are working to reduce antimicrobial resistance and while it’s slow, some movement forward is better than none at all.

Rift Valley Outbreak in Uganda
Uganda has reported an outbreak of Rift Valley fever across two districts. Rwanda is also reporting cases in animals and potential cases in humans. “The WHO said the affected districts are in the ‘cattle corridor’ that stretches from the southwest to the northeast regions of the country. ‘The outbreak in Uganda is occurring at a time when Kenya is having a large RVF outbreak and Rwanda is experiencing an epizootic, with suspected human cases,’ the WHO said. In Kenya, where an outbreak has been under way since May, four more Rift Valley fever cases have been reported, raising the outbreak total as of Jul 4 to 94, 20 of them confirmed. Ten deaths have been reported. Illnesses have been reported in three counties: Wajir, Marsabit, and Siaya. The country’s agriculture ministry has reported several outbreaks in animals over the past few months, especially in areas that had experienced flooding after heavy rainfall.”

Stories You May Have Missed:

  • The Strange and Curious Case of the Deadly Superbug Yeast- Maryn McKenna discusses the latest resistant bug we’re worrying about – “It’s a yeast, a new variety of an organism so common that it’s used as one of the basic tools of lab science, transformed into an infection so disturbing that one lead researcher called it “more infectious than Ebola” at an international conference last week. The name of the yeast is Candida auris. It’s been on the radar of epidemiologists only since 2009, but it’s grown into a potent microbial threat, found in 27 countries thus far.”

Pandora Report – 7.13.2018

Workshop on Pandemics, Bioterrorism, & Health Security – From Anthrax to Zika
The Summer Workshop on Pandemics, Bioterrorism, and Health Security is next week and if you’re not able to attend, make sure to check out our Twitter @PandoraReport and look for a recap in next week’s newsletter. Fair warning though- after you’ve read about it, you’ll want to attend in 2019!

Biodefense Scholars – Meet the Faces of GMU’s Biodefense: Greg & Saskia
If you’ve ever talked to one of our Schar biodefense graduate students, you know one thing for certain – they’re passionate about the field. This week, we’re excited to show off two of our biodefense doctoral students – Saskia and Greg. “Greg Witt is a fourth-generation engineer who, just three years after graduating with a bachelor’s degree from Penn State, worked his way up to being the lead reactor systems engineer on new nuclear plants for Westinghouse Electric Company in Pittsburgh.” That’s right, Greg came from the world of nuclear reactors and if you’re wondering how that works in a program that focuses on catastrophic biological incidents, program director Gregory Koblentz sums it up like this – “Greg’s experience working at Westinghouse as a nuclear systems engineer might seem to make him an odd fit for the Biodefense Program, but biodefense is a highly interdisciplinary field, so he fits right in.” Next, there’s Saskia Popescu, who is an “epidemiologist working to control infections in Phoenix-area pediatric hospitals. Popescu still volunteers there when she’s at home in Arizona, but her career is on hold as she works on her doctoral dissertation in the Biodefense Program in the Schar School of Policy and Government at George Mason University, where she’s also a graduate research assistant.” Saskia’s dissertation work focuses on healthcare utilization of infection control and how that might leave us vulnerable when it comes to the next outbreak. Dr Koblentz pointed out that “the continuing threat of emerging infectious diseases and rise of antimicrobial resistance around the world means we need people like Saskia who can skillfully bridge the gap between science and policy now more than ever.” These are just two examples of the passionate students at Schar Biodefense – what can we say, the biodefense nerdom is strong at GMU!

AAAS Science Diplomacy & Leadership Workshop 2018                        GMU Biodefense MS student Christopher Lien recently participated in the Science Diplomacy & Leadership Workshop hosted by the American Academy for the Advancement of Science, and his account of the five-day experience will get you thinking about the complexities of international science cooperation. The first day highlighted the three main questions the workshop would address – how does science inform diplomacy, how does diplomacy inform science, and what does science in diplomacy look like today? Lien noted that “Aligning educational policy with science, gaining talent from abroad, facilitating networking across the diaspora communities – these are some of the tasks the scientists are working toward.” In his recap, Lien discusses that following a simulation game regarding international cooperation and science diplomacy, “it became ever clearer to the group that mixing science with diplomacy, and vice-versa, is no easy feat – it takes tactful negotiation, the will to make concessions, and a mutual understanding to bring about meaningful and effective results.”

The Digitization of Biology: Understanding the New Risks and Implications for Governance                                                                          Email viruses? We’re not talking about the spam ones, but rather the ability to send genomes of pathogens via email. If you’re confused, GMU biodefense doctoral student Yong-Bee Lim (I told you they were a passionate group!), Charles Lutes, Diana DiEullis, and Dr. Natasha Bajema, from the WBD Center are here to help clarify with their latest researcher paper – The Digitization of Biology: Understanding the New Risks and Implications for Governance. While everyone is focusing on CRISPR, this team led by Dr. Bajema, sought to address an issue we may be neglecting – the digitization of biology. “The volume of digitized genomic data is on the rise. Over the past several years, scientists have responded to dramatic reductions in the cost of DNA sequencing and synthesis, computing power, and data storage by sequencing greater numbers of gene sequences and the genomes of living organisms and digitizing this information for storage in online databases and analysis on computers. To simplify the creation and modification of living organisms, scientists are identifying standard, interchangeable DNA sequences that code for certain functions, and are building online catalogs to make this information available.” The paper discusses the rapid movement of biological information between the physical and digital worlds and how this exacerbates traditional security risk analysis with select agents. Within the paper, the authors discuss data storage, the information life cycle, and implications for governance, noting that “Developing effective governance to simultaneously manage the risks and promote the opportunities of the life sciences is a difficult undertaking. To address emergent genomic data issues, policymakers must strike a balance between two factors: the perceived risks of genomic data and the incentives to share and use genomic data to foster innovation.”

NTI | bio Competition
Looking to help improve global health security? NTI | bio and the Next Generation Global Health Security Network just announced the 2018 competition for those looking to make a difference. “The NTI | bio program and the Next Generation Global Health Security Network announce the 2018 Next Generation for Biosecurity Competition. This year, NTI | bio will invest up to $15,000 to allow the winning team to implement their proposal with mentorship from experts in the field. Team members also will attend the 5th Annual High Level Global Health Security Agenda (GHSA) Ministerial in Bali, Indonesia on November 5-6, where they will present their proposal to health security leaders from around the world. Each 2018 Next Generation for Biosecurity Competition team can include up to three people and should propose either: (1) develop training and networking opportunities for professionals of all levels to develop an interest and further proficiency in the biosecurity and biosafety fields; or (2) an educational outreach project to raise public awareness around the importance of biosecurity and biosafety. Each team is also asked to engage one or more experts in biosecurity and/or biosafety to assist in implementing their project proposal.”

Health Security Downgraded at the White House
A new commentary from the Center for Strategic & International Studies is drawing attention to the diminishing focus that health security is getting within the Trump Administration. Pointing to the lack of representation within the NSC regarding health security and the dismantling of the global health security and biothreats directorate, J. Stephen Morrison noted that “The decision was simultaneously a slap at Obama’s legacy of elevating health security, investing $1 billion in building capacity to detect and respond to dangerous outbreaks in weak states, under the auspices of the international alliance, the Global Health Security Agenda. With the directorate gone, Trump could be Trump. No longer in his midst is a senior official who might argue on public health grounds for a regular flow of health workers and travelers in the event of another outbreak like Ebola. How big will the price be for eliminating the White House global health security and biothreats directorate?”

Startup Does Gene Editing In-House
For those looking to do in-house gene editing, the lack of experience and laboratory space can be a hindrance. A new company is looking to change that. Hoping to make gene editing and CRISPR more accessible, Synthego will send people a CRISPR-modified cell via mail. Buyers have to provide credentials to show their affiliation with a university or institution, but this removes a lot of the tacit barriers. “For researchers who want to do their own gene editing, the company also makes kits to simplify that. A researcher chooses the gene they want to knock out, and the startup uses its own software and automated factory to make one step in the process–the synthetic guide RNAs that direct a protein to the right place in DNA to make a cut. For those who don’t want to edit cells, Synthego’s scientists use the same guide RNAs to quickly perform edits themselves. The company works on human cells, rather than plant or animal cells, for researchers who want to develop cures and treatments for disease, and in the future, potentially develop ways to prevent disease.”

Novichok Exposure
Sadly, one of the two people exposed to the nerve agent, died on July 8th. “’We have seen a small but significant improvement in the condition of Charlie Rowley. He is in a critical but stable condition, and is now conscious,’ said Lorna Wilkinson, Director of Nursing at Salisbury District Hospital. ‘While this is welcome news, clearly we are not out of the woods yet. Charlie is still very unwell and will continue to require specialist, round-the-clock care here at Salisbury District Hospital.’ Russian double agent Sergei Skripal and his daughter Yulia fell ill after being targeted with the nerve agent in Salisbury on 4 March. Scientists at the UK’s Defence Science and Technology Laboratory Porton Down confirmed on 4 July that Sturgess and Rowley had been exposed to novichok.”

 How Anti-Vaxxers Might Bring Back Hendra
Hendra virus is an ugly disease and one that can brutally take down humans and horses alike. The good news is that we have a vaccine for horses to prevent the transmission. Unfortunately, the anti-vaxxer movement has extended to veterinary vaccines now, which leaves many to worry that this BSL-4 virus could pose a larger public health threat. Starting with the history of the vaccine for horses, this latest article provides a detailed account of the disease and the current issues when getting horse owners to vaccinate, especially in the era of anti-vaxxer belief in vaccine-induced autism. “Similarly inflated concerns have begun to turn some pet owners away from mainstream veterinary medicine. An article last year in the Brooklyn Paper quoted a vet who had an owner refuse to vaccinate her dog for fear it would develop autism. ‘We’ve never diagnosed autism in a dog,’ the vet said. ‘I don’t think you could.’ No anti-vaccine movement among animal owners has ever gained quite as much traction—or posed such a threat—as the one surrounding the Hendra cases in Australia. Initially, Australian horse owners were reluctant to vaccinate simply because of the cost—about $100 every six months, a significant burden for breeders and rural owners with dozens of animals. But when horse owners began to feel that they were being forced to do something that might just harm the animals they loved, a full-fledged anti-Hendra-vaccine movement blossomed.”

Stories You May Have Missed:

  • Rescued Thai Soccer Team in Quarantine – “In addition to treating the boys for potential dehydration, malnutrition and oxygen deprivation, their doctors also plan to closely monitor them for symptoms of diseases that may have been transmitted by animals living in the cave system. The boys and their family members have been told to watch for symptoms such as headache, nausea, muscle pain or difficulty breathing, the reports added.”
  • Post-Campylobacter Infection Guillain Barre Syndrome– A new study has reported the incidence of GBS following campylobacter infection. Guillain Barré syndrome (GBS), which is triggered by autoantibodies produced in response to antigenic stimuli such as certain infections and vaccinations, is the most common cause of acute flaccid paralysis worldwide. Campylobacter, the most common bacterial enteric infection in the USA, is reported to be the most commonly diagnosed antecedent of GBS, yet little information is available about the risk of post-Campylobacter GBS.”

Pandora Report 7.6.2018

 

We hope you had a lovely holiday this week and are ready to get back into the world of biodefense! News is still unfolding regarding the two British citizens who were hospitalized after exposure to the nerve agent, Novichok, but we’ll keep you updated as more information becomes available.

Summer Biodefense Workshop – Pandemics, Bioterrorism, and Global Health Security
In less than two weeks the summer workshop on all things health security, from anthrax to Zika, will be taking place – are you registered? This three-day workshop will cover everything biodefense from the most recent Ebola outbreak, to DIY biohackers and vaccine development, and also the challenges of defending against biothreats. Speakers include experts in the field like David R. Franz, who was the chief inspector on three United Nations Special Commission biological warfare inspection missions to Iraq and served as technical advisor on long-term monitoring. His current standing committee appointments include the Department of Health and Human Services National Science Advisory Board for Biosecurity (NSABB), the National Academy of Sciences Committee on International Security and Arms Control, the National Research Council Board on Life Sciences, and the Senior Technical Advisory Committee of the National Biodefense Countermeasures Analysis Center. Jens H. Kuhn will also be speaking on filoviruses and what it was like to be the first western scientist with permission to work in a former Soviet biological warfare facility, SRCVB “Vektor” in Siberia, Russia, within the US Department of Defense’s Cooperative Threat Reduction (CTR) Program. These are just two of our speakers who will be leading discussions over the three days – come join the conversation at our workshop from July 18-20!

All Hands on Deck – U.S. Response to Ebola in West Africa
Princeton University’s Innovations for Successful Societies has just released their report on the quality of the U.S. response to Ebola. The case study is part of a series on Liberian response to the outbreak and includes great information on coordination, political response, and the challenges of international outbreak management. “Although the deployment, which scaled up earlier assistance, took place five months after the first reported cases and required extensive adaptation of standard practices, it succeeded in helping bring the epidemic under control: the total number of people infected—28,616—was well below the potential levels predicted by the CDC’s models. This US–focused case study highlights the challenges of making an interagency process work in the context of an infectious disease outbreak in areas where health systems are weak.”

Bats and Military Defense
Sure, your first inclination might be a vampire or Batman joke, but there’s actually a significant history regarding the U.S. military and utilization of these mammals. Historically, efforts focused on employing them as bombs in Japan but a more modern plan focuses on their uncanny ability to carry deadly diseases. “‘What we are trying to do is to study bat immunology, but that turned out to be a very difficult thing to do when starting from scratch,’ said Thomas Kepler, a professor of microbiology at Boston University. It took decades to create the reactive substances necessary to study human or mouse antibodies. With bats, he explained, they were starting from zero.” Battling potential Russian bioweapons means thinking outside of the box, right? The truth is that fruit bats have a pretty amazing weapon of their own – a super immunity that might just lend itself to curing Marburg and other devastating infections. “The Marburg virus is classed as a Category A bioterrorism agent by the Centers for Disease Control and Prevention, and Kepler’s study was supported by the Defense Threat Reduction Agency, a Defense Department division established during the Manhattan Project era to combat weapons of mass destruction. If the virus is ever deployed as biological warfare, the fruit bat’s super-immunity may hold the answer to preventing its spread. But it may also go some way toward redeeming the bat in the eyes of the U.S. military — and could even make the animal an unlikely hero.”

 NASPAA Pandemic Simulation
How would you handle a pandemic? GMU’s Schar School team qualified for the final round of the Network of Schools of Public Policy, Affairs, and Administration (NASPAA) pandemic simulation, in which student teams had to respond to a constantly evolving situation and make real-time decisions regarding quarantine, trade, etc. “‘The simulation is an especially valuable experience for the biodefense students since the pandemic crisis provided students with complex problems like those that they will tackle in their professional careers,’ said director of the Schar School’s biodefense graduate program, Gregory Koblentz. ‘These exercises also test the students’ ability to bridge the gap between the science and policy-making, a key goal of the biodefense programs’.”

Gene Editing – Last Week Tonight With John Oliver and How DARPA Wants to Boost Body Defense Through Gene Editing
This week’s episode of Last Week Tonight featured one of our favorite topics – gene editing! While there’s only so much you can cover in the span of 20 minutes, it was nice to see some of the complexities, personalities, and technical hurdles, covered by John Oliver. From biohackers to germline edits, Oliver mixed humor into a discussion on the very real issues surrounding gene editing technologies like CRISPR (although his version of the acronym is much more comical – Crunchy Rectums In Sassy Pink Ray-bans). Make sure to check out the episode to get a humorous overview on this gene-editing technology. Meanwhile, DARPA (the Defense Advanced Research Projects Agency) is actually working to harness gene editing to make your body’s natural defenses that much stronger through specific gene expressions. The project is called PREPARE (PReemptive Expression of Protective Alleles and Response Elements) and works to provide temporary boots to your natural defenses. “In contrast to recent gene-editing techniques, such as CRISPR, which focus on permanently changing the genome by cutting DNA and inserting new genes, the PREPARE program will concentrate on techniques that don’t make permanent changes to DNA. These techniques target the ‘epigenome,’ or the system that controls gene expression. Genes can be turned on or off by making external modifications to DNA, which don’t change the DNA sequence, but instead affect how cells ‘read’ genes. To start, the PREPARE program will focus on four key health challenges: influenza viral infection, opioid overdose, organophosphate poisoning (from chemicals in pesticides or nerve agents) and exposure to gamma radiation, the statement said.” While there are a lot of hurdles to overcome, the overall goal is to extend the platform to known and unknown threat application.

Improving Mass Casualty Management: The Role of Radiation Biodosimetry 
How would we handle the medical response of large-scale radiological exposure? GMU Biodefense PhD student Mary Sproull presented on this very topic and the work she and her team are doing, which is aimed at making testing more efficient and effective. “Drs. Sproull and Camphausen are working to make the medical management process more efficient and effective in the event of a mass casualty radiation exposure. Specifically, they are developing a dosimetry dose prediction model to determine how radiation biodosimetry diagnostics can help physicians estimate just how much radiation exposure a patient has experienced. (Radiation biodosimetry diagnostics estimate a person’s radiation exposure by measuring changes in biological markers that include cytogenic assays like dicentric chromosome assay.)”

Everything You Need to Know About Ricin
A few weeks back a Tunisian man was arrested by German police regarding suspected plans for a bioterrorism attack with ricin. German police were searching his residence in Cologne and found enough ricin for 1,000 toxic doses. During the fervor of the news, it was reported that such a a plot could have been more devastating than 9/11 – but what’s the reality behind ricin? Check out this comprehensive review of what ricin is (a naturally occurring biological poison), its history as a biological weapon and WMD, and more. “In summary, ricin’s status as a biological weapon is quite mixed. In terms of actual potential for harm, it is more at the level of knives than bombs. Its status as a WMD is a legal one, not so much a practical one. It would be useful to the public debate and our general social assessment of risk if the media could reflect this, rather than churn out hysterical reporting.”

Stories You May Have Missed:

  • VA Study Reveals Antibiotic Prescribing Habits – “A team of researchers establishing baseline data on antibiotic use by the Veterans Administration (VA) healthcare system in Pittsburgh found that about 75% of all antibiotic prescriptions were inappropriate, meaning they were either not indicated or were used for a duration that’s not recommended. The study, which took place over 12 months, looked at prescribing information, medical records, and charts of 40,734 patients, who were written 3,880 acute antibiotic prescriptions by 76 primary care providers (PCPs). The median antibiotic index was 84 antibiotic prescriptions per 1,000 patients per year.”
  • Drone Crashes Into French Nuclear Plant – “GREENPEACE activists say they have crashed a drone into a French nuclear plant to highlight the lack of security around the facility. The drone, which was decked out to resemble a tiny Superman, slammed into the tower in Bugey, 30 kilometers (20 miles) from the eastern city of Lyon, according to a video released Tuesday by Greenpeace. The environmental group says the drone was harmless but it showed the lax nuclear security in France, which is heavily dependent on nuclear power, using it for about 75 percent of its energy needs.”

Pandora Report 6.29.2018

The month of June is nearly over, which means there’s only a few more weeks to register for the Workshop on Pandemics, Bioterrorism, and Global Health Security. Don’t miss out on the early registration discount if you sign up before July 1st!

Cost Analysis of 3 Concurrent Public Health Response Events: Financial Impact of Measles Outbreak, Super Bowl Surveillance, and Ebola Surveillance in Maricopa County
Have you ever wondered the cost of public health response for local health departments during a crisis? Imagine that within the course of six months, your county sees a measles outbreak, super bowl surveillance requirements, and Ebola surveillance. A new article is addressing the cost of this trifecta for the largest county health department in Arizona. GMU biodefense PhD student Saskia Popescu was a part of not only this response, but also aided in developing the research so that we can truly address the financial burden of public health events. “Maricopa County Department of Public Health (MCDPH) in Arizona. The nation’s third largest local public health jurisdiction, MCDPH is the only local health agency serving Maricopa’s more than 4 000 000 residents. Responses analyzed included activities related to a measles outbreak with 2 confirmed cases, enhanced surveillance activities surrounding Super Bowl XLIX, and ongoing Ebola monitoring, all between January 22, 2015, and March 4, 2015. Total MCDPH costs for measles-, Super Bowl-, and Ebola-related activities from January 22, 2015, through March 4, 2015, were $224,484 (>5800 hours). The majority was for personnel ($203,743) and the costliest response was measles ($122,626 in personnel costs). In addition, partners reported working more than 700 hours for these 3 responses during this period.” Public health is chronically underfunded, but the response efforts can be immensely expensive. Based off these events and the cost of response, perhaps it’s time we start investing more in public health.

Forget RoboCop, Meet the DNA Cops
Biotechnology is moving at a rapid pace and the ability for DIY biohacking means that frank conversations need to be had regarding the potential for someone to build a lethal biological weapon. Ginkgo Bioworks has just the team to overcome this herculean task. Remember that horsepox synthesis last year? “The study’s publication ‘crosses a red line in the field of biosecurity,’ wrote Gregory Koblentz, a professor in the biodefense department at George Mason University, in a public comment to the journal. ‘The synthesis of horsepox virus takes the world one step closer to the reemergence of smallpox as a threat to global health security’.” Hoping to get a leg up on the threat, the intelligence community is working with Ginkgo Bioworks to address the science, security, and safety. “Gingko quickly saw the potential security risks in its work. It began working with Weber, the former Obama administration official, in 2016 to get advice on how to best preserve national security.  ‘We are doing more of this genetic engineering than anybody, we think we’re going to get better at it than anybody, so we have a responsibility to be keeping our eye on both sides of that coin,’ Kelly said. ‘How do we protect and defend against that while protecting our ability to get all the positive outputs of biotechnology?’” Synthetic biology has the potential to do damage, but also the chance to counter these threats (and even emerging infectious diseases) through vaccine development. Joint efforts like those between Ginkgo Bioworks and agencies like IARPA, are critical during this time when the technology is still spreading and evolving.

Genome Editing and Security: Governance of Non-Traditional Research Communities?
GMU Biodefense doctoral student Katherine Paris has provided a detailed account of the latest National Academies webinar on gene editing and biosecurity/biosafety developments. Paris notes that “at the workshop, concerns were expressed over the extent that advancements in technology allow a greater range of people to access, and possibility misuse, genome editing technologies.  Dr. Millet and Dr. Kuiken addressed these concerns during the webinar by describing what two non-traditional research communities—the International Genetically Engineered Machine (iGEM) competition and do-it-yourself biology (DIYbio) community laboratories—are doing to foster biosafety and biosecurity.” Check out her account of this informative talk to learn more about how iGEM is demonstrating real-world application of biosecurity and biosafety practices.

The Culture of Biosafety, Biosecurity and Responsible Conduct in the Life Sciences
Curious about biosecurity, biosafety, and what it means to have a culture of responsibility in the life sciences? Look no further than this amazingly comprehensive literature review by ABSA International, which happens to include former GMU Biodefense student Kathleen Danskin and current doctoral student Elise Rowe. Identifying over four thousand unique articles published between 2001 and 2017, they reviewed 326 articles to truly evaluate the literature on ways to strengthen the biosafety/biosecurity culture. “We found that while there were discussions in the literature about specific elements of culture (management systems, leadership and/or personnel behavior, beliefs and attitudes, or principles for guiding decisions and behaviors), there was a general lack of integration of these concepts, as well as limited information about specific indicators or metrics and the effectiveness of training or similar interventions. We concluded that life scientists seeking to foster a culture of biosafety and biosecurity should learn from the substantial literature in analogous areas such as nuclear safety and security culture, high-reliability organizations, and the responsible conduct of research, among others.”

Roadmap for Implementing Biosecurity and Biodefense Policy in the U.S. 
This new report and roadmap from Gryphon Scientific, National Defense University, and Parsons, analyzes biosecurity and biodefense policy within the United States. “We developed a framework for analyzing opportunity costs of new or changing regulations (the opportunity cost analysis framework), and a framework for evaluating the successful implementation of biosecurity and biodefense policies. These analyses enabled the development of a roadmap for implementing U.S. biosecurity and biodefense policy to maximally leverage science and technology advances while simultaneously, minimizing risks. This project was funded by a generous grant from the U.S. Air Force Academy and Defense Threat Reduction Agency under their Program on Advanced Systems and Concepts for Countering Weapons of Mass Destruction.” The report includes policy and opportunity cost case studies, as well as evaluation metrics framework.

How Will Trump Lead During A Pandemic and How Well Prepared Is Your Country?
Between several science vacancies within the administration and the fundamental truth that a global epidemic is on the horizon, many are concerned about what a response would be like under Trump. “’There is a real reason for us to be scared of the idea of facing this threat with Donald Trump in the White House,’ said Ron Klain, who served as President Obama’s Ebola czar, at the Spotlight Health Festival, which is co-hosted by the Aspen Institute and The Atlantic. Klain said the ‘president is anti-science’ and ‘trades in conspiracy theories. All those things would lead to the loss of many lives in the event of an epidemic in the United States, where we need the public not to trade in conspiracy theories, not to believe that the news was fake, but to respect scientific expertise,’ said Klain, a veteran Democratic operative who served in both the Clinton and Obama administrations.” Klain underscores the importance of having pro-science leadership, which isn’t exactly something the current administration is known for. He points to several gaps within U.S. preparedness – funding, leadership, science, policy, etc. “But the biggest gap, he said, is the global gap: ‘We can’t be safe here in America when there’s a risk of pandemics around the world,’ Klain said. ‘The world’s just too small. Diseases spread too quickly … There is no wall we can build that is high enough to keep viruses and the disease threat out of the United States. We have to engage in the world’.” If you’re curious about the current state of preparedness around the globe, check out the latest site from Resolve to Save Lives, the initiative run by former CDC director Dr. Tom Frieden. Prevent Epidemics is a tool that rates countries from 0-100 on their ability to find, stop, and prevent outbreaks. “ReadyScore is calculated using data from the Joint External Evaluation (JEE), a rigorous, objective and internationally-accepted epidemic preparedness assessment developed by the World Health Organization (WHO) and other partners. The ReadyScore consolidates key information from the JEE about a country’s preparedness in the form of a simple and easy-to-understand number that makes it easy for countries to measure their preparedness gaps and fill them”

UK, Allies – Empower Chemical Arms Watchdog to Assign Blame For Attacks
The UK, US, and EU are pushing a new proposal to increase the powers of the Organization for the Prohibition of Chemical Weapons (OPCW) in efforts to strengthen the ban on chemical weapons and the ability to hold countries, like Syria, accountable for use. “‘The widespread use of chemical weapons by Syria in particular threatens to undermine the treaty and the OPCW,’ said Gregory Koblentz, a non-proliferation expert at George Mason University, in the United States. ‘Empowering the OPCW to identify perpetrators of chemical attacks is necessary to restoring the taboo against chemical weapons and the integrity of the chemical weapons disarmament regime’.”

Stories You May Have Missed:

  • Pull Incentives – A New Strategy for AMR – The World Economic Forum is supporting these initiatives to help spur the development of new antibiotics and facilitate their profitability. The financial challenges for antibiotic development can be significant hurdles – demand is unpredictable, stewardship efforts seek to decrease use which decreases sales, and clinical trials are costly. “Existing incentives for developing new antibiotics are mostly of the ‘push’ type, the report notes. Push incentives provide support for research and development, but they don’t ensure that a company can get an adequate return on a new antibiotic once it wins approval. The concept of pull incentives has attracted increasing attention in recent years. A chart in the report shows that 10 current research and development initiatives on antimicrobial resistance (AMR) involve push incentives, while no such initiatives involve pull incentives exclusively. Combinations of push and pull incentives are being used to support four existing R&D initiatives, the chart indicates, but it doesn’t give any details on those.”

Thank you for reading the Pandora Report. If you would like to share any biodefense news, events, or stories, please contact our Editor Saskia Popescu (biodefense@gmu.edu) or via Twitter: @PandoraReport

Pandora Report 6.22.2018

 US Military Asks – What Would A SynBio Weapon Look Like?
A new study ordered by the DoD seeks to evaluate the potential for synthetic biology to be a biodefense threat. The report, Biodefense in the Age of Synthetic Biology, was issued by the National Academies of Sciences, and provides an actual ranking of national security threats that genetic engineering technology, like CRISPR, pose. “’Synthetic biology does expand the risk. That is not a good-news story,’ says Gigi Gronvall, a public health researcher at Johns Hopkins and one of the report’s 13 authors. ‘This report provides a framework to systematically evaluate the threat of misuse’.” The report includes a framework for assessing synbio capabilities as well as concerns related to the production of chemicals or biochemicals, bioweapons that alter the human host, pathogens, etc. The report also includes a section on related developments that impact the ability to effect an attack using a synthetic biology-enabled weapon, where the authors note several mitigation challenges posed by synbio. Some of the challenges to deterrence and prevention include accessibility of biotechnology, pointing to DIY biohackers, the iGEM competition, and traditional pathways like academic laboratories. Regarding the challenges in recognizing and attributing an attack, they note that “synthetic biology could also confound the ability to identify the causative agent in a biological attack. Despite the breadth and depth of available repository resources, there would not always be a reference specimen to use as comparator, particularly if the agent is markedly different from natural pathogens or toxins.” “According to the report, the US must now also track ‘enabling developments’ including methods, widely pursued by industry, to synthesize DNA strands and develop so-called chassis’ organisms designed to accept genetic payloads.” Consider the recent de novo synthesis of the horsepox virus by researchers in Canada that has opened up Pandora’s box regarding synbio and biosecurity. GMU Biodefense professor and graduate program director Gregory Koblentz noted that “Synthetic biology has provided the tools necessary to recreate the smallpox virus,” and “Safeguards against the misuse of those tools are weak and fragmented.”  “The US government should pay close attention to this rapidly progressing field, just as it did to advances in chemistry and physics during the Cold War era,” says Michael Imperiale, a microbiologist at the University of Michigan. The recent tabletop hosted by the Center for Health Security (Clade-X) even presented some real-world scenarios and gaps for dealing with a bioterrorism event that involved an engineered organism.

Gene Drives and Frank Discussions With CRISPR Scientists
Speaking of gene editing…GMU Biodefense professor Sonia Ben Ouagrham-Gormley recently sat down with Vox to discuss the good and bad side of gene drives in the context of genetically modified mosquitos and their place in the fight against malaria. Malaria kills hundreds of thousands a year and despite eradication efforts, it’s still a monumental task for public health. “We have eliminated malaria from the rich world; it used to be endemic to France just as it is to Mali today. And now, with CRISPR gene drives, we have the potential to wipe it out globally and save millions of lives. Gene drives allow humans to change the genetic makeup of a species by changing the DNA of a few individuals that then spread the modification throughout an entire population. In the case of malaria, the idea is to change the three species of mosquito most responsible for its transmission — Anopheles gambiae, Anopheles coluzzii, and Anopheles arabiensis — so that all their offspring would be male, effectively leading to the species’ extinction.” The debate though is that if gene drive was used poorly, it could cause irreversible changes in the ecosystem. Many worry about the potential for weaponization of gene drives or nefarious actors using it, but several biosecurity experts have pointed to the limitations of gene drive when it comes to making diseases more potent. “The biosecurity experts I talked to are deeply skeptical of those nightmare scenarios. Sonia Ben Ouagrham-Gormley, a professor in the biodefense program at George Mason University, says she doubts gene drives will be militarily effective in targeting rival countries’ harvests. ‘Animals and plants that are raised for food are generally monitored, and a gene drive can be easily detected in the genome of the animal,’ she explained. ‘Because of that regular monitoring, I don’t think gene drives would be a good tool for affecting a country via agriculture.’ Biosecurity experts like Ben Ouagrham-Gormley and Filippa Lentzos have concerns that are more social. “What happens if one of the few thousand fruit fly biologists around the world decides to act unilaterally and throws international talks on the matter into chaos? What if a grad student creates a gene drive that can’t reliably hurt people but can reliably terrify them?” If she wasn’t busy enough, Sonia Ben Ouagrham-Gormley recently returned from a research trip to China where she met with several CRISPR scientists and toured their laboratories. She discussed CRISPR developments in China and gave a talk at the University of the Chinese Academy of Sciences in Beijing (UCAS) on the technological, regulatory and technical challenges of CRISPR.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
We’re less than a month away from the workshop on all things health security, are you registered? Since we’re on the topic of biotechnology and biosecurity, our workshop is a great chance to hear from Supervisory Special Agent Edward You of the FBI’s WMD Directorate, Biological Countermeasures Unit. “Mr. You is responsible for creating programs and activities to coordinate and improve FBI and interagency efforts to identify, assess, and respond to biological threats or incidents. These efforts include expanding FBI outreach to the Life Sciences community to address biosecurity. Before being promoted to the Weapons of Mass Destruction Directorate, Mr. You was a member of the FBI Los Angeles Field Office Joint Terrorism Task Force and served on the FBI Hazardous Evidence Response Team.” Don’t miss Mr. You’s talk on the bioeconomy and biosecurity threats during this three-day workshop on all things biodefense!

WHO Releases New International Classification of Disease (ICD11)
The World Health Organization (WHO) released the latest ICD-11, which includes 55,000 codes for specific injuries, diseases, and causes of death. “The ICD is also used by health insurers whose reimbursements depend on ICD coding; national health programme managers; data collection specialists; and others who track progress in global health and determine the allocation of health resources. The new ICD-11 also reflects progress in medicine and advances in scientific understanding. For example, the codes relating to antimicrobial resistance are more closely in line with the Global Antimicrobial Resistance Surveillance System (GLASS). ICD-11 is also able to better capture data regarding safety in healthcare, which means that unnecessary events that may harm health – such as unsafe workflows in hospitals – can be identified and reduced.”

Ebola Virus Disease Outbreak Updates
The DRC has reported 5 more suspected cases in the Iboko health zone, which brings the total to 60 cases, included 28 deaths (38 confirmed, 14 probable, and 8 suspected) as of June 19th. The case fatality rate for this outbreak is at 47% and “‘The number of contacts requiring follow-up is progressively decreasing, with a total 1,417 completing the mandatory 21-day follow-up period,’ the WHO said. As of Jun 17, a total of 289 contacts were still being monitored.” WHO Director General Tedros Adhanom Ghebreyesus recently tweeted “Just over a month into the response in , further spread has largely been contained. In spite of progress, there should be no room for laxity and complacency until it’s finally over. This is a collaborative effort led by

 MERS Trends in Saudi Arabia – Hospitals and Households
Since January of this year, the WHO has reported 75 laboratory confirmed MERS-CoV cases and 23 deaths in Saudi Arabia. 21 of these cases were involved in four clusters (2 household and 2 healthcare) – “Cluster 1: From 2 through 4 February, a private hospital in Hafer Albatin Region reported a cluster of three (3) health care workers in addition to the suspected index case (four [4] cases in total). Cluster 2: From 25 February through 7 March, a hospital in Riyadh reported six (6) cases, including the suspected index. No health care workers were infected. Cluster 3: From 8 through 24 March, a household cluster of 3 cases (index case and 2 secondary cases) was reported in Jeddah. No health care workers were infected. Cluster 4: From 23 through 31 May, a household cluster was reported from Najran region with eight cases including the suspected index case. This cluster is still under investigation at the time of writing. As of 31 May, no health care workers have been infected and the source of infection is believed to be camels at the initial patient’s home.” The total number of MERS cases since 2012 is now 2,220. These clusters underscore the role of hospitals as amplifiers for MERS transmission during outbreaks and the importance of infection prevention efforts.

Infection Prevention Gaps Found Across Critical Access Hospitals
GMU Biodefense doctoral student Saskia Popescu addresses infection prevention failures and gaps within the United States and specifically in critical access hospitals. “These findings are not novel as staffing issues are problematic across the country in all types of hospital systems. The importance of having IPs within health care and ensuring they have access to training and the ability to focus on infection control activities—not just reporting tied to CMS reimbursement—is critical. IPs need time for activities such as education, rounding, antibiotic stewardship, and more. This study supports the notion that not only should hospitals be ensuring proper staffing and support for infection prevention programs, but that significant gaps exist across CAHs. In the areas where CAHs are the only health care patients may access, it is vital that infection prevention processes be supported and followed”

How Ready Is the United States For The Next Anthrax Attack?
This week the CDC reviewed their recommendations for mass vaccination in the event of an anthrax attack. “The way that people think about [nuclear weapons] is on a much, much grander scale than biological weapons, and I think that’s a misperception,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “If you use a contagious infectious disease, you really could create havoc on a different scale.” The Amerithrax attack was in 2001 and since then we’ve seen SARS, MERS, and Ebola as potential infectious disease threats that reveal a rather large spectrum of avenues for microbial events. “But there’s still a long way to go in terms of preparedness, Redlener said, adding that no city is fully prepared. Questions remain about what dosage of the vaccine to use for children, the safety of the vaccine for the general public, delivery and distribution of the vaccine and medications. ‘I think a vaccination program would be a nightmare. Who would administer it? Who would pay for it? Who would manufacture it? The cost of complications that may occur. I don’t think it would be practical,’ Redlener said.”

Stories You May Have Missed:

  • Gene-edited Farm Animals – “The team edited the animals’ DNA to make them resist the deadly respiratory disease known as PRRS – a move that could prevent billions of pounds in losses each year. However, consumers have traditionally been reluctant to eat genetically altered animals and crops. This poses a significant barrier to farmers owning gene-edited pigs. And because genome, or gene, editing (GE) is relatively new, the absence of regulation currently prevents their sale anyway.”
  • FDA Releases New Food Defense Guidance – “Today the US Food and Drug Administration (FDA) released the first of three installments of draft guidance on the intentional adulteration (IA) rule, part of the Food Safety and Modernization Act (FSMA). The rule is meant to guide the food industry on reducing the risk of exposing food facilities to IA, such as acts of terrorism. Unlike other FSMA rules that address specific foods or hazards, IA will require preventive measures for reducing vulnerabilities at all domestic and foreign companies that are required to register with the FDA as food facilities.”

Pandora Report 6.15.2018

Welcome back to your favorite weekly dose of all things biodefense! We’ve got a lot of health security news to cover this week as microbes just don’t seem to take a break.

Outbreak Updates
The latest data from the DRC has reported four more suspected Ebola cases, which would bring the overall outbreak total to 59 cases (38 confirmed, 14 probable, and 7 suspected), and 28 deaths. You can find the timeline of Ebola response for the DRC outbreak here, that was released by the WHO. In the latest WHO statement on the outbreak, Director-General Dr. Tedros Adhanom Ghebreyesus noted that “’It’s far too early to declare victory, but the signals are positive and we are cautiously optimistic,’. ‘We have new weapons and together with the government and our partners, we have acted with urgency to save lives. We will remain vigilant until this outbreak is over’.” You can also read the latest WHO situation report here. As the DRC works to contain the Ebola outbreak, the Nipah virus outbreak in India is ongoing, as 17 cases have been identified. Kenya is also currently facing a Rift Valley fever outbreak as 10 people were found to be sick and 5 have died. “The disease primarily strikes livestock by the mosquito-borne route. Though humans can be infected by mosquitoes, the virus is more commonly passed by contact with blood or organs of infected animals or drinking milk from sick ones. The disease is usually mild, but some patients experience a severe form.”

 Workshop on Pandemics, Bioterrorism, and Global Health Security
Are you registered for the summer workshop on all things health security? From Anthrax to Zika, we’re talking vaccine development, bioterrorism, the Ebola outbreak, and more. Don’t miss the chance to attend this July 18-20 workshop in Arlington, where you’ll learn from the top minds in the field and chat with others passionate about global health security. Make sure to register before July 1st for an early registration discount. If you’re a GMU student or alum, returning workshop attendee, or large group, you can even get an additional discount!

Clade-X Policy Recommendations
Following the Clade-X pandemic tabletop last month, the Johns Hopkins Center for Health Security has released their policy recommendations. If you missed the chance to observe the tabletop, make sure to check it out on YouTube or read through the resources here. The policy recommendations focus on a strong and sustainable global health security system, a robust, highly capable national public health system that can manage the challenges of pandemic response, etc. The Washington Post noted of the tabletop, “Even though many players in the scenario had decades of experience in health security and national and global policy and law, ‘there were still so many unanswered questions and capability gaps,’ said Beth Cameron, formerly senior director for global health security and biodefense at the National Security Council under President Barack Obama. Cameron, who was in the audience, is vice president for global biological policy at the Nuclear Threat Initiative.”

FEMA Wants Local Governments to Step Up
GMU Biodefense PhD alum Daniel M. Gerstein is pulling back the curtain on FEMA’s new strategic plan and the reality that its capacity doesn’t grow when there are high volumes of natural disasters. Gerstein notes of the FEMA Administrator Brock Long- “Long’s language signals that FEMA’s disaster policy, upon which so many communities may depend, is changing. FEMA’s recently released strategic plan reveals several important shifts in federal disaster relief policy. FEMA is streamlining its mission to focus on coordination with state and local stakeholders before disasters even strike in order to shorten disaster recovery times. Why the changes? 2017 was particularly full of disasters – there were 16 events that exceeded $1 billion in total damage. An estimated $306 billion in losses made 2017 the most expensive year ever for natural disasters. Three hurricanes in succession in August and September combined with the Western wildfires greatly stressed FEMA’s capacity to support these response and recovery operations.” Moreover, Gerstein underscores that this approach is central to getting the message across that FEMA is not a first-responder agency, but rather offers coordination and resourcing for catastrophic disasters.

Characteristics of a Pandemic- The Devil Is In The Details
GMU Biodefense doctoral student Saskia Popescu reviewed the Center for Health Security publication regarding the characteristics of microorganisms that are more likely to cause a global catastrophic biological risk. “The CHS findings pose critical questions as to how we handle global health security and pandemic preparedness, as well as what inherently makes a microorganism likely to cause a pandemic. Moreover, the report speaks to medical providers and those working on the frontline, which is a breath of fresh air for so many of us who are all too often given non-specific guidance that fails to meet the true demands of preparing for pandemics. ”

Book Reviews
Still in need for that book to read during a summer vacation? Here are reviews of two books for anyone interested in antibiotic resistance. First, a review of Superbugs: An Arms Race Against Bacteria, in which Jerome Groopman discusses the importance of understanding this growing threat and the origin of AMR. Groopman notes that “Fleming’s advice to use the antibiotic properly was widely disregarded, not by “the ignorant man” but by “negligent” medical professionals. Prescriptions of penicillin in suboptimal dosages led to the emergence of bacteria resistant to it.” Next, GMU biodefense doctoral student Saskia Popescu reviews Maryn McKenna’s book, Big Chicken, which reveals the truth about antibiotic usage in poultry. Popescu notes that “Showcasing the complexity of this microbial threat and the role of poultry, McKenna chronicles the efforts across the United States and Europe to understand novel outbreaks of common bacterial infections that began springing up in the 1950s and left medical providers struggling to find treatments, but also the scientific work done to provide proof of the problem.”

NTI Presentation – Biosecurity By Design: Getting Ahead of Risk in the World of Designer Operations
GMU Biodefense doctoral student Carlos Alvarado is reporting on the NTI event this week regarding the rapid advances in biotechnology and what that means for biosecurity. Alvarado notes that Dr. Reshma Shetty, co-founder of Ginkgo Bioworks, began with posing a unique scenario for the audience – she “explained how technology and biology are very similar in the fact they’re both made form unique core codes. One of the slides within her presentation contained a photo of a desk with a plant, cell phone, tablet, computer, and other technological devices. She then asked the audience what is the most technological item in this picture,  to which she stated the answer was the plant because the plant was self-replicating, self-cleaning, and self-sensing. She explained that with bio synthesis and bioengineering, Ginkgo Bioworks is working on developing these codes for specific bio synthesized organisms.” Overall, while the presentation mostly focused on the work of Ginkgo Bioworks, it did provide insight into the industry perspective for biosecurity and what such advances might mean for the future.

 Medical Benefits Now Available for Vets Subjected to Chem-Bio Tests
Operation Whitecoat is an infamous example of American soldiers – conscientious objectors, who became the human guinea pigs for biological weapons, and now those soldiers are able to receive medical care. “About 6,000 of the soldiers that the U.S. Army tested potential chemical and biological substances on are still living and may be eligible for medical care. A recent class action lawsuit filed by the Vietnam Veterans of America required the U.S. Army to provide medical care to veterans who volunteered to contribute to the advancement of the U.S. biological and chemical programs.”

ISDS Presentation: Outbreak Observatory
Don’t miss out on the chance to learn about Outbreak Observatory at this presentation held by the International Society for Disease Surveillance (ISDS) on Wednesday, June 27th from 11am-noon EST. “During this presentation, researchers will discuss how Outbreak Observatory, a pilot project initiated by the Johns Hopkins Center for Health Security, will facilitate the conduct of real-time operational research during outbreak responses, helping to improve outbreak preparedness and response capabilities.”

Preventing Pandemics – Spend on Surveillance
Where do we put the funds for pandemic prevention? Despite the inherent importance of these efforts, financial support for prevention is often problematic. Researchers are emphasizing that funding should be put towards surveillance, not prediction, as such efforts can easily be a double-edged sword in terms of public trust. Credibility issues arise for the public when predictions are wrong (H1N1 or Ebola). “In short, there aren’t enough data on virus outbreaks for researchers to be able to accurately predict the next outbreak strain. Nor is there a good enough understanding of what drives viruses to jump hosts, making it difficult to construct predictive models.” Fundamentally, the researchers argue, it is in the surveillance of human populations that is the most effective and realistic approach to fighting outbreaks. Efforts should focus on the vulnerable countries and locations, strengthen detailed screening of those symptomatic, etc. “This will best be achieved through an established global network of highly trained local researchers, such as the WHO Global Outbreak Alert and Response Network (GOARN). Real-time tools for reconstructing and tracking outbreaks at the genomic level, such as portable sequencing devices, are improving fast. Information gathered during recent outbreaks has quickly had tangible impacts on public-health decisions, largely owing to data generation and analysis by many research teams within days of people being infected.” More and more, researchers are also underscoring the importance of including veterinarians in pandemic prevention, in fact, many say to follow the bats when looking for the next Ebola outbreak.

Stories You May Have Missed:

  • Salmonella Outbreak Tied to Pre-Cut Melons – The CDC has announced that the culprit of this multi-state outbreak is pre-cut melon. “As of June 8, 2018, 60 cases of Salmonella Adelaide have been reported spanning 5 states; a little more than half (31) of these individuals have required hospitalization for their infections. To date, no deaths have been reported. The infected individuals range from 1 to 97 years in age, with a median age of 67, according to the CDC. Available data indicate that 65% of those who have fallen ill are female. The reported dates of illness range from April 30 to May 28; however, according to the CDC, Salmonella can take up to 2 to 4 weeks to diagnose and report. As such, any illnesses that have occurred after May 28 may not have been reported yet.”

Thank you for reading the Pandora Report. If you would like to share any biodefense news, events, or stories, please contact our Editor Saskia Popescu (biodefense@gmu.edu) or via Twitter: @PandoraReport