Pandora Report 10.12.2018

 GMU Biodefense Master’s Open House 
On Thursday, November 15th, at 6:30pm, we’ll be hosting an Open House on the MS programs within Schar School. This is a great chance to learn about the online and in-person biodefense MS programs, admission criteria, and chat with faculty. Make sure to RSVP here!

Review of the Blue Ribbon Study Panel “Fits and Starts: Reactionary Biodefense” 
GMU Biodefense graduate students Alexandria Tepper and Michael Krug review the latest Blue Ribbon Study Panel event in case you missed it on October 9th. “The event kicked off with an in-depth recollection by Sen. Daschle of October 16th, 2001; the day that letters containing Bacillus anthracis spores were opened in the Hart Senate Building. “Confusion and chaos” were the words the senator used to describe the situation that ensued when one of his interns opened the letter and aerosolized the fine white powder, exposing 28 staff members to the deadly B. anthracis. He expressed the helpless feeling that overcame him when he received a phone call describing the situation. As he rushed to the Hart Senate Building, he recalled the disorganization of the federal investigators during the bio-threat, as responders were devastatingly unprepared for such an event. The lack of standardized protocols became startlingly evident when the exposed staff members were cleared to return home in the same clothes worn during the attack. Fortunately, no one was killed in this specific attack and Sen. Daschle attributed that to a select few individuals who stepped up to lead the treatment and recovery process.”

Event Summary and Analysis for “The Implications of Chemical Weapons Use in Syria”
George Washington University graduate student Wardah Amir discusses the IISS event hosted last week regarding CW use in Syria. “The 2013 deal would not have been possible without Russian cooperation. At the time U.S.-Russian interests overlapped on eliminating Syria’s chemical weapons program. Unfortunately, U.S. and Russian cooperation did not last long enough to hold users of chemical weapons in Syria accountable. While the OPCW Executive Council believes in working towards accountability, Russia’s unwillingness is shown by its failure to cooperate.The deal was proof that international cooperation could help achieve results. The framework inevitably led to the creation of the OPCW Fact-Finding Mission, the Declaration Assessment Team, and the OPCW-UN Joint Investigative Mechanism.  Without Russian cooperation, or the active participation of the international community on addressing chemical weapons use, results will be harder to achieve.”

 Technologies to Address Global Catastrophic Biological Risks 
The Johns Hopkins Center for Health Security has just released a new report that discusses how investment in 15 promising technologies could make us more prepared and better at responding to biological incidents. “While systems to respond [to an outbreak] are in place in many areas of the world, traditional approaches can be too slow or limited in scope to prevent biological events from becoming severe, even in the best of circumstances,” wrote the Center authors. “This type of response remains critically important for today’s emergencies, but it can and should be augmented by novel methods and technologies to improve the speed, accuracy, scalability, and reach of the response.” The technologies were grouped into 5 categories – disease detection, surveillance, and situational awareness, infectious disease diagnostics, distributed medical countermeasures manufacturing, medical countermeasure distribution, dispensing, and administration, and medical care and surge capacity. Within the report, there is a focus on technologies like remote sensing for agricultural pathogens, hand-held mass spectrometry for diagnostics, synthetic biology for manufacturing medical countermeasures, etc. The authors note that “To realize the promise of these technologies will require significant dedicated effort and investment. While this is occurring for vaccine development, and to some extent for surveillance, other needs for pandemic and GCB event prevention and response must be addressed if we are to confront these threats in a serious way. One possible approach to closing these gaps would be through the formation of a consortium of technology developers, public health practitioners, and policymakers aimed at understanding pressing problems surrounding pandemic and GCB risks, and jointly developing technology solutions.”

Blue Ribbon Study Panel Report – Holding the Line on Biodefense: State, Local, Tribal, and Territorial Reinforcements Needed
The Blue Ribbon Study Panel on Biodefense just released their latest report, which underscores the need for first responders. “How we respond to biological events – especially those large in scale and impact – is now out of balance with how we prepare,” said former Secretary of Health and Human Services Donna Shalala, Panel Member, who co-chaired the January 2018 meeting in Miami that informed many of the report’s recommendations. “There are a number of steps we can take right now to better position SLTT governments, as well as hospitals, pharmacies, and other private sector organizations to respond immediately and then in tandem with federal support.” Within the report, there are eight recommendations, including – Unify and establish a new National Emergency Medical Services system, including the creation of a National Emergency Medical Services Agency at the Department of Health and Human Services,  Improve distribution of the Strategic National Stockpile and other stores of pharmaceuticals, equipment, and essential medical supplies, with enhanced training and assured access to pharmacy readiness data, etc.

Post-Florence Giant Mosquitoes
Like something out of a horror movie, North Carolina is getting hit with “mega-mosquitoes” following Hurricane Florence. “‘These giants have zebra-striped legs and are two to three times as big as the normal bloodsuckers encountered during summer, said Michael H. Reiskind, an assistant professor in the Department of Entomology at North Carolina State University. ‘Definitely noticeably bigger,’ he said. ‘If you see mosquitoes often, then you’re going to say, ‘Wow, that’s a big mosquito’.” While they don’t carry human diseases, these massive mosquitoes can carry dog heart worm.

Bacteriophages and Their Application For Fighting Antimicrobial Resistance
Researchers and medical providers alike are searching for the next effective tool against antibiotic resistant infections. One such tactic is bacteriophage therapy – a natural enemy to bacteria. Laura H. Kahn writes that “In addition to minimal governmental research funding, the pharmaceutical industry hasn’t been interested in developing phage therapies because of regulatory and patentability concerns. But these concerns can be readily addressed. Phages adapted to newly evolved, resistant bacteria could be analogous to updated influenza vaccines that get approved each year without undergoing time-consuming Investigational New Drug (IND) approval processes. Novel technologies to isolate, bioengineer, and produce phages at scale could be patented. For example, phages have been engineered to reduce bacterial biofilms.”

 Ebola Outbreak Update
Seven additional cases were announced in the DRC on Wednesday, bringing the total to 188 and 118 deaths. “The DRC’s ministry of health said the recent spike in cases in these areas confirms that case contacts during the initial wave of cases in August and September who avoided follow-up and vaccination have now been infected. Beni has been a hotbed of anti-response activity, especially the neighborhood of Ndindi. ‘The factors contributing to this situation are mainly misinformation, non-collaboration of the population with the response teams and insecurity,’ the Health Ministry said in its daily update. ‘More than two months after the declaration of the epidemic, the community continues to prevent the safe and dignified burial, and at-risk contacts still refuse vaccination and 21-day follow-up.'” As of Wednesday, “four administrative measures will be put in place in Beni, the new epicenter of the outbreak, the health ministry said. The steps include making it illegal to harbor a suspected Ebola patient, using security forces to monitor and implement safe burials, requiring families to show official death certificates before obtaining a burial certificate, and obligating all health professionals (including traditional healers) to report suspected cases to Ebola treatment centers.”

Stories You May Have Missed:

  • Poliolike Illness Found in Children – “Health officials in Minnesota and Colorado are among the states investigating acute flaccid myelitis (AFM) cases in children, raising concerns about another possible uptick in the rare condition, similar to steep rises seen in 2014 and 2016. The hallmark of AFM is a sudden onset of limb weakness associated with spinal cord inflammation. In 2014, a large outbreak coincided with a national outbreak of severe respiratory illness causes by enterovirus D68 (EV-D68), but intensive investigations have not consistently found a specific pathogen in spinal fluid samples. In an Oct 5 statement, the Minnesota Department of Health (MDH) said it is investigating six AFM cases that have occurred in children since the middle of September. Health officials are collecting information about the cases from health providers and are in contact with the CDC, the MDH said.”

 

Pandora Report 10.5.2018

TGIF! This week has been pretty busy in the world of biodefense, so before we get into ricin, Insect Allies, the new Biodefense Strategy, and all the other stuff in between, make sure you’ve got a cup of coffee or tea because you won’t want to miss anything.

Attempted Ricin Attack Via Mail?
On Monday, federal authorities responded to suspicious envelopes sent to senior U.S. officials, including President Trump. “The Pentagon Force Protection Agency on Monday detected a suspicious substance, believed to be the poison ricin, on two envelopes at a mail facility on Pentagon grounds in Northern Virginia, the officials said. Initial tests indicated that the envelopes, addressed to Mattis and Adm. John M. Richardson, the chief of naval operations, contained the toxic material.” The Secret Service later noted that a letter was also addressed to President Trump. However, on Wednesday “U.S. investigators have nearly ruled out terrorism after envelopes sent to a Pentagon mail sorting facility were falsely flagged for the possible presence of the deadly poison ricin, U.S. officials said on Wednesday. A Pentagon spokeswoman said tests so far showed that the alert was triggered by castor seeds, which ricin is derived from, as opposed to the deadly substance itself.” Late Wednesday, the FBI arrested a Navy veteran who is suspected to have sent the envelopes containing castor beans. “Defense officials had suspected that the letters contained ricin, but a Pentagon spokeswoman said on Wednesday that they actually contained castor beans, the raw material from which ricin is made. She said the F.B.I. was investigating.”

 Insect Allies – Agricultural Friend or Biosecurity Foe?
A DARPA project, Insect Allies, has come under fire this week regarding its potential for spiraling out of control, but also the chance it could be perceived as a biological weapon. “Darpa launched the Insect Allies research program in 2016, budgeting $45 million over four years to transform agricultural pests into vectors that can transfer protective genes into plants within one growing season. That would be exponentially faster than modifying crops through a gene drive, which would breed specific traits into a species over several generations. (Gene drives have been proposed to reduce mosquito fertility, halting diseases like malaria.)” A recent publication in Science drew attention to the concerns for such technology being used for nefarious purposes. The authors underscored that the profound implications of releasing a horizontal environmental genetic alteration agent range from regulatory to economic, biological, and even to societal. “In the context of the stated aims of the DARPA program, it is our opinion that the knowledge to be gained from this program appears very limited in its capacity to enhance U.S. agriculture or respond to national emergencies (in either the short or long term). Furthermore, there has been an absence of adequate discussion regarding the major practical and regulatory impediments toward realizing the projected agricultural benefits. As a result, the program may be widely perceived as an effort to develop biological agents for hostile purposes and their means of delivery, which—if true—would constitute a breach of the Biological Weapons Convention (BWC).” Following this publication, DARPA Program Manager of Insect Allies, Dr. Blake Bextine, released a statement. Bextine notes that “Technologies dealing with food security and gene editing certainly do have a higher bar than most for transparency, research ethics, and regulatory engagement, and I believe Insect Allies meets that raised standard. DARPA structured Insect Allies as a university-led, fundamental research program, and has invited in representatives from U.S. regulatory agencies from the very beginning of the program to offer perspectives and learn about the work. The researchers working with DARPA are free to publish their results, encouraged to discuss their efforts, and coordinate with regulatory agencies to facilitate the transition of their technologies from laboratory demonstrations to—someday in the future—powerful new tools that can bolster the toolkit for responding to fast-moving or unanticipated threats to the global food supply.” The UDSA, EPA, and FDA have been involved throughout DARPA’s project as regulatory bodies, but there are are concerns that the requirements (a minimum of three kill switches) are not enough. Many worry that this is an example of a dangerous project done simply to prove we have the capabilities instead of asking if we should (cue Ian Malcolm line from Jurassic Park).

Horsepox Synthesis – A Biosecurity Zombie
We’re not quite done with DURC and since this resurrected poxvirus news occurred in October, we’ll stick with a zombie theme. 2017 was the year of the horsepox synthesis (here’s a refresher), but a recent PLOS Pathogens publication by David Evans and Ryan Noyce stoked the embers of the debate. Within their opinion piece, Evans and Noyce discuss the DURC implications of their work and note that their interest in testing the horsepox virus “as a potentially safer vaccine was prompted by phylogenetic and historical evidence suggesting that smallpox vaccines might have originated in horses.” They also note that ” the authors respect the concerns that have been expressed about this work, but note that our lives have been profoundly improved by technologies, like genetic engineering, that were once viewed as threats to humanity”. Ultimately, Evans and Noyce state that the bigger challenge is actually education. On the heels of their comments, Ed Yong from The Atlantic discusses how this study revealed some flaws in DURC and genome synthesis experiments. Yong discusses the claims Noyce and Evans make regarding the benefits of the horespox synthesis and that while some may not agree with the flurry of concern, there are others that worry the tacit knowledge barriers are deteriorating. Filippa Lentzos noted the intensity of academia and the pursuit of funding/publications that can encourage moral hazard and a lack of transparency. Bioethicist Kelly Hills remarked that she “sees a sense of impulsive recklessness in the interviews that Evans gave earlier this year. Science reported that he did the experiment ‘in part to end the debate about whether recreating a poxvirus was feasible.’ And he told NPR that ‘someone had to bite the bullet and do this.’ To Hills, that sounds like: I did it because I could do it. ‘We don’t accept those arguments from anyone above age six,’ she says.” Much of the debate highlights the lack of training for scientists to anticipate the consequences of their work. “More broadly, Hills says, there’s a tendency for researchers to view ethicists and institutional reviewers as yet more red tape, or as the source of unnecessary restrictions that will stifle progress.” As Lentzos emphasized, these topics need to be addressed and discussed with scientists starting earlier on in their careers – at the undergrad level.

ETA of the Next Pandemic: Shorter Than You’d Think
If you’re reading a biodefense newsletter, you’re likely some one who understands and appreciates the potential threat that infectious disease outbreaks pose. Unfortunately, not everyone truly comprehends this issue. “Pandemic disease is arguably one of the greatest threats to global stability and security. But investments to contend with such outbreaks have declined to their lowest levels since the height of the Ebola response in 2014, with U.S. federal dollars cut by over 50 percent from those peak levels.” Hits to funding, personnel gaps in departments, elimination of the NSC Global Health Security Office, and a general lack of focus have raised concerns for the current state of U.S. biodefense. From Ebola in the DRC to H7N9 in China, and even the quarantined flights in NYC, it’s becoming increasingly difficult to ignore the impending pandemic. While the White House released their strategy, the biodefense community awaits the execution of such efforts.

 A Multi-Disciplinary Approach to Multi-Disciplinary Threats
GMU Biodefense MS student Janet Marroquin discusses the latest Biodefense Strategy. “A new Biodefense Steering Committee is now housed under HHS and supported by various other agencies including the Dept. of State, Dept. of Defense (DOD), U.S. Drug Administration, Dept. of Homeland Security (DHS), and the Environmental Protection Agency, in order to ensure implementation. Additionally, there is an interagency Biodefense Coordination Team that also engages with non-governmental stakeholders for a multi-disciplinary effort in implementing the Strategy. Reassuringly, this interagency stakeholder collaboration began with the drafting of the Strategy by DOD, DHS, HHS, and Department of Agriculture that ensured support for a comprehensive One Health approach to health security.”

Dutch Expel Four Russian GRU Members Attempting to Hack OPCW
Don’t mess with the OPCW – “Dutch security services say they expelled four Russians over a cyber attack plot targeting the global chemical weapons watchdog. The operation by Russia’s GRU military intelligence allegedly targeted the Organisation for the Prohibition of Chemical Weapons in The Hague in April. The OPCW has been probing the chemical attack on a Russian ex-spy in the UK.” British Prime Minister May and Prime Minister Rutte released a joint statement, noting that “This attempt, to access the secure systems of an international organisation working to rid the world of chemical weapons, demonstrates again the GRU’s disregard for the global values and rules that keep us all safe.” The Dutch Ministry of Defence has released a detailed account of the operations and their findings, which you can access here, revealing the use of cell phone records, taxi receipts, and more to track the GRU team. This comes after it was a revealed that the Dutch had also expelled Russians over plans to hack into a Swiss chemical laboratory where the novichok “nerve agent samples from the Salisbury attack were analysed”. The OPCW released a statement on Thursday regarding the incident, noting that “The Netherlands is the OPCW’s host country and, as such, is in charge of ensuring and exercising due diligence in protecting the OPCW Headquarters. The OPCW thanks the Netherlands for its actions and will remain in contact in regards to any further developments. The OPCW takes very seriously the security of its information systems and networks. Since early 2018, the Organisation has observed increased cyber-related activities. The Director-General has informed OPCW Member States about these activities and the OPCW Technical Secretariat has undertaken measures to mitigate them.”

DRC Ebola Updates
Four additional cases of Ebola were reported over the past few days and security concerns are growing. Nearly 13,000 people have been vaccinated, but all the new cases were in the recent hot spot of Beni. This area has challenged response efforts due to civil unrest. “Tthe DRC outbreak coordinator held a press conference in Beni to detail the impact the recent community protests had on the outbreak response. He said contact tracing dipped from 98% to 50% during the protest days, held in the wake of deadly violence between rebels and DRC armed forces, and that the actions slowed active case finding and port-of-entry monitoring. Ndjoloko Tambwe Bathe, MD, said the protest sidelined vaccination activities for 3 days and brought sample testing to a halt on Sep 25. Also, he said the actions hurt disinfection efforts and impeded the supply of personal protective equipment for health providers.” The outbreak has now resulted in 161 cases and 105 deaths. On Wednesday, it was announced that three volunteers with the International Committee of the Red Cross, were injured in an attack by villages. This attack prompted “the ICRC to suspend burials in the area, health officials said on Wednesday. The attack on an ambulance transporting the body to a cemetery in North Kivu province’s Beni region is the latest disruption to efforts to control the current outbreak, which is believed to have killed 106 people since July.”

GMU Biodefense Journal Club
Current GMU biodefense students – check out the newly formed journal club! Check your email from Thursday, but keep the evening of Monday, October 15th open if you’d like to geek out with some of your fellow biodefense classmates. This will be a great, stress-free (a journal article is way more fun than a book club!) environment to get your health security nerdom on.

UNODA BWC October Newsletter
The BWC Implementation Support Unit has just released the latest newsletter, where you can get the scoop on the recent Meeting of Experts. “Up to 100 States Parties, two Signatory States and one Non-Signatory State participated in the MXs. In addition, various UN entities, international and regional organizations and 26 non-governmental organizations and research institutes also attended. The proceedings of the MXs were livestreamed via UN Web TV.” As you read the letter, it’s important to remember the importance of the BWC and the ISU, as funding has been problematic. U.S. Ambassador to the BWC, Robert Wood, recently tweeted that “Unfortunate news from the BWC Chair today that there are insufficient funds for the December Meeting of States Parties and the BWC Implementation Support Unit“.

 Achieving the Trump Administration’s National Biodefense Strategy
GMU Biodefense PhD alum Daniel M. Gerstein discusses the recent release of the biodefense strategy and how it can be successful. “In addressing this bipartisan issue, the administration largely builds on the biodefense strategies of the George W. Bush and Barack Obama administrations. Common areas across the three strategies include recognition of the global nature of biological threats; the need to collaborate with a range of key stakeholders including foreign partners, state and local authorities and industry; and the need for risk-based decisionmaking in preparedness and response activities. Like those of his predecessors, the Trump strategy was accompanied by an implementation document which provided additional details on how the goals and objectives would be achieved.”

The U.S. Government Engagement in Global Health – A Primer
The Henry J Kaiser Family Foundation just released their report on how the U.S. is responding to global health threats. “This primer provides basic information about global health and U.S. government’s response in low- and middle-income countries. Although it focuses primarily on the U.S. government, it is important to acknowledge the role played by other countries, multilateral organizations, and private sector actors such as non-governmental organizations (NGOs), foundations, corporations, and others, in the global health response. The first several sections provide an overview of the field of global health and describe current global health issues.” Overall, the report underscores the long history of U.S. engagement in global health and the myriad of agencies and programs that facilitate such efforts. Given this long history and the investment in global health, the U.S. has a critical role in responding to existing and future health events on a global level.

Infection Preventionists and Antimicrobial Stewardship Programs, A Marriage in Progress
GMU Biodefense doctoral student and infection preventionist Saskia Popescu discusses the relationship between infection prevention practitioners and antimicrobial stewardship programs. “These findings shed light into the existing antimicrobial stewardship program structure within health care facilities, as well as the challenges of incorporating infection preventionists into these programs. Although the role of infection prevention is obvious within the antimicrobial stewardship program, infection preventionists lack a clear set of responsibilities. The integration of the infection preventionists into antimicrobial stewardship programs should be evaluated and strengthened to establish a more wholistic and responsive program.”

Stories You May Have Missed:

  • Officials Worried About African Swine Fever – “Humans are suspected to have caused the recent spread to Belgium, where eight cases were confirmed, as of September 25, according to the World Organisation for Animal Health.
    The most recent cases, however, were reported September 25 in a Chinese slaughterhouse in Hohhot, the capital of Inner Mongolia, according to the organization. There have been 29 outbreaks in China since the first case was reported August 3. China has culled nearly 40,000 pigs in response, according to the the organization’s database.”
  • Beef Recall Due to Salmonella and Listeria Outbreak – “The US Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced two meat-related recalls raw beef because of possible contamination with Salmonella Newport, and ready-to-eat ham products that may be tainted with Listeria monocytogenes. Today the FSIS said JBS Tolleson, Inc., of Tolleson, Ariz., is recalling about 6.5 million pounds of raw beef products that may be contaminated with SalmonellaNewport. This includes ground beef, chuck, and burgers sold through several retailers, including Walmart, Cedar River Farms Natural Beef, and Showcase.”

Pandora Report 9.28.2018

Happy Friday biodefense gurus! October is right around the corner, which means the flu vaccine will be available soon. Make sure to get vaccinated this season, as the CDC just announced that 80,000 people died of the flu during the 2017/2018 season, which is the highest death toll in 40 years.

GMU Global Health Security Ambassador
We’re excited to announce that two graduate students from the Schar biodefense program will be attending the 5th GHSA Ministerial Meeting in Bali, Indonesia. The two students, Annette Prieto and Saskia Popescu, will observe the Global Health Security Agenda in action and the the GHSA 2024 planning. Following their attendance in early November, we’ll be providing a report out on the events. Meet our two GMU Global Health Security Ambassadors – Annette Prieto has a background in Microbiology and Immunology and is currently a Biodefense student in the Master’s Program here at George Mason University. Before coming to George Mason, Annette focused on medical Microbiology at the University of Miami before moving into the laboratory and becoming a Teacher’s Assistant. From there, Annette became an Adjunct Instructor at Daytona State College and taught for a year before entering the Biodefense Program. Annette is also a part of the Next Generation Global Health Security Network. Saskia Popescu is a biodefense doctoral candidate at GMU and infection preventionist. She worked as an infection preventionist during the Dallas Ebola cluster, a 2015 measles outbreak, and is an external expert for the ECDC. She is a 2017 ELBI fellow and trained infectious disease epidemiologist. Saskia’s research focuses on the utilization of infection control in the U.S. healthcare system and it’s impact on biodefense. Make sure to check back in the weeks following their trip to learn about their experiences at the ministerial meeting.

Why Poor Pandemic Preparedness is Deadly
Ebola response efforts in the DRC are struggling and were suspended earlier this week, after violence between rebels and armed forces. While outbreak response in Beni have resumed, events like these are a prime example of why outbreaks can quickly spread beyond control and ultimately emphasize the need for pandemic preparedness. Drs. Tom Inglesby and Eric Toner from the Johns Hopkins Center for Health Security recently discussed the importance of investing in biopreparedness and how their Clade-X tabletop revealed many of the existing weaknesses. “Could a natural or man-made pandemic happen today? Yes. New lethal viruses are emerging from nature, and dizzying developments in biotechnology mean that biological weapons no longer are the sole province of a few state-sponsored programs — a manufactured pandemic could be unleashed by a rogue regime or by terrorists utilizing one of the thousands of laboratories around the world capable of making a dangerous pathogen. If the worst-case scenario unfolds, strong pandemic preparedness planning would save millions of lives. But progress is possible only with effective leadership.”

Rebuilding Health Security in the Wake of Ebola
GMU Biodefense graduate student Stephen Taylor discusses the latest talk from Georgetown University on global health security following the 2013-2016 Ebola outbreak. “In the midst of this disaster, the U.S. Centers for Disease Control turned to health security experts at the Georgetown Center for Global Health Science and Security to support the expansion and augmentation of the Guinean public health infrastructure.  Dr. Alpha Barry, Dr. Erin Sorrell, Dr. Claire Standley, and Ms. Aurelia Attal-Juncqua supported on-the-ground efforts to develop and implement improved health security policy that would make Guinea more resilient against future infectious disease outbreaks.  The Guinean government’s priorities for capacity and capability building were to prevent further outbreaks of zoonotic diseases, improve the capacity of surveillance laboratories and capabilities of the healthcare workforce to identify outbreaks, and to better respond to outbreaks by streamlining and coordinating emergency response operations.  On September 14th, 2018, as part of its Global Health Security Seminar Series, Georgetown University hosted a panel discussion of Dr Sorrell, Dr. Standley, and Ms. Attal-Juncqua on their efforts in Guinea.”

 The AMR Challenge
The United Nations (UN) General Assembly was held this week and one particular topic captured our attention – antimicrobial stewardship and a new initiative to combat resistance. “The AMR Challenge is a way for governments, private industries, and non-governmental organizations worldwide to make formal commitments that further the progress against antimicrobial resistance. The challenge encourages a One Health approach, recognizing that the health of people is connected to the health and animals and the environment. The AMR Challenge launches at the United Nations (UN) General Assembly in September 2018. Organizations can make commitments beginning September 25, 2018 until September 2019. CDC will feature commitments throughout the year. At the 2019 UN General Assembly, antimicrobial resistance will continue to be a priority topic for world leaders.” Within the Challenge, there are commitments to tracking and sharing data, reducing the spread of resistant germs through infection prevention and control, improving antibiotic use, decreasing antibiotics and resistance in the environment, and investing in vaccines, therapeutics, and diagnostics.

NASEM – Review & Assessment of Planetary Protection Policy Development Processes
How do we protect the Earth from contamination following space exploration? How can we avoid bringing microorganisms from Earth to other planets and solar system bodies? The latest NASEM report discusses how scientists tackle these issues and implement such policies. As you read the text, you’ll also see one of the Center for Health Security’s ELBI fellows in there – Betsy Pugel of NASA. “For decades, the scientific, political, and economic conditions of space exploration converged in ways that contributed to effective development and implementation of planetary protection policies at national and international levels. However, the future of space exploration faces serious challenges to the development and implementation of planetary protection policy. The most disruptive changes are associated with (1) sample return from, and human missions to, Mars; and (2) missions to those bodies in the outer solar system possessing water oceans beneath their icy surfaces.” This gives new insight into a field we may not be considering in health security – what about interstellar health security?

The Spanish Flu, Epidemics, and the Turn to Biomedical Responses
We already discussed the impact of poor pandemic preparedness, but what about biomedical efforts? A recent article from AJPH discusses the role of the 1918/1919 pandemic in bringing biomedical approaches to the forefront of outbreak response. “A century ago, nonpharmaceutical interventions such as school closings, restrictions on large gatherings, and isolation and quarantine were the centerpiece of the response to the Spanish Flu. Yet, even though its cause was unknown and the science of vaccine development was in its infancy, considerable enthusiasm also existed for using vaccines to prevent its spread. This desire far exceeded the scientific knowledge and technological capabilities of the time. Beginning in the early 1930s, however, advances in virology and influenza vaccine development reshaped the relative priority given to biomedical approaches in epidemic response over traditional public health activities. Today, the large-scale implementation of nonpharmaceutical interventions akin to the response to the Spanish Flu would face enormous legal, ethical, and political challenges, but the enthusiasm for vaccines and other biomedical interventions that was emerging in 1918 has flourished.”

HHS Sponsors TPOXX
Speaking of biomedical measures…the Department of Health and Human Services (HHS) just announced its sponsorship of a new formulation of the world’s first approved smallpox treatment – TPOXX. This purchase will be used for the Strategic National Stockpile and will work with Siga Technologies to develop an IV formulation of the drug. “Purchase of TPOXX in pill form and development of an IV formulation will be completed under a contract between Siga Technologies and the Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response. BARDA will use funding from the Project BioShield Special Reserve Fund. The contract can be extended for up to 10 years and $629 million if necessary to complete development of the IV formulation.”

NASEM – Engaging the Private-Sector Health Care System in Building Capacity to Respond to Threats to the Public’s Health and National Security
Don’t miss the latest NASEM report on the intersection of preparedness and healthcare. From Ebola patients to natural disasters, and even terrorism, the private-sector healthcare system plays a critical role in response. “As a result, disasters often require responses from multiple levels of government and multiple organizations in the public and private sectors. This means that public and private organizations that normally operate independently must work together to mount an effective disaster response. To identify and understand approaches to aligning health care system incentives with the American public’s need for a health care system that is prepared to manage acutely ill and injured patients during a disaster, public health emergency, or other mass casualty event, the National Academies of Sciences, Engineering, and Medicine hosted a 2-day public workshop on March 20 and 21, 2018. This publication summarizes the presentations and discussions from the workshop.”

USDA ARS 5th International Biosafety & Biocontainment Symposium
ABSA has just announced this event being held on February 11-14, 2019 in Baltimore, Maryland. “The focus of the symposium will be Biorisk and Facility Challenges in Agriculture. Seven professional development courses will address topics including life science security, facility maintenance and operational issues, agricultural risk assessment, emergency response and preparedness for livestock disease outbreaks, waste management, and strategic leadership. Courses will be held on Monday, February 11. There will be 2 1/2 days of scientific presentations covering various topics including; governance updates, design methodologies, deferred maintenance, rabies, occ health laboratory to the field, gene editing, risk management and communication, and many others. The poster and networking reception will be held on Wednesday, February 13, attendees will have the opportunity to meet with presenters and discuss their presentations. Exhibits showcasing the latest biosafety, biosecurity, and biocontainment products and services will be open February 12-13.”

Next Generation Biosecurity Webinar 
Don’t miss this webinar today, Friday 9.28, at 11am (CDT, Mexico City). Hosted by Next Generation GHSA, this webinar will be with Luis Alberto Ochoa Carrera, Coordinator of Biosafety and Biochemistry of the GHSN and Coordinator of the Biosafety Laboratory Level 3 of the National Reference Laboratory (InDRE) of Mexico.

Stories You May Have Missed:

  • Airplanes and Airports – Hubs for Germs: GMU biodefense doctoral candidate Saskia Popescu discusses the latest on germ transmission during air travel. “Most people have a general sense that air travel tends to involve exposure to germs. Whether it’s through the thousands of people we will come into contact with, the sick person next to us on the plane, or the dirty surfaces, many of us get a sense of unease knowing there is a real chance we may arrive at our destination with a microscopic companion.”

 

Pandora Report: 9.21.2018

U.S. National Biodefense Strategy
On Tuesday, President Trump released the National Biodefense Strategy, which “sets the course for the United States to combat the serious biothreats our country faces, whether they arise from natural outbreaks of disease, accidents involving high consequence pathogens, or the actions of terrorists or state actors. The strategy enables risk awareness to inform decision-making across the biodefense enterprise; ensures biodefense enterprise capabilities to prevent bio-incidents; strives for biodefense enterprise preparedness to reduce the impacts of bio-incidents; enables rapid response to limit the impacts of bio-incidents; and facilitates recovery to restore the community, the economy, and the environment after a bio-incident.” The strategy is implemented through a National Security Presidential Memorandum (NSPM), “Support for National Biodefense“. A Biodefense Steering Committee is to be established, which will be chaired by the Secretary of Health and Human Services. Robert Kadlec, HHS Assistant Secretary for Preparedness and Response, released a statement here, noting that “Coordination of such complex actions requires a sound strategy, commitment, and governance structure. As an initial step in implementing the strategy, leaders from every federal department involved in biodefense formed a steering committee, led by Secretary Azar, that provides strategic guidance in preparing for, countering, and responding to biological threats. I am honored that Secretary Azar asked me to lead the day-to-day coordination team that supports this committee in improving biodefense readiness.” The new strategy includes goals related to enabling risk awareness to inform decision-making, ensuring biodefense enterprise capabilities to prevent or reduce the impact of bioincidents, rapidly respond to limit the impacts of bioincidents, etc. Each goal has a series of measures regarding implementation and strategies. A personal favorite is Goal 2 (Ensuring Biodefense Enterprise Capabilities to Prevent Bioincidents) 1.1 and 1.2 – strengthening infection prevention measures domestically and internationally, and reducing the spread of antimicrobial-resistant pathogens domestically and internationally. Ultimately, the new strategy will “better coordinate the often overlapping efforts of 15 departments and agencies and 16 branches of the intelligence community.” Biodefense Twitter is also a great source for feedback on this – Check out Greg Koblentz here or simply search #biodefense.

 Passing of Raymond Zilinskas
The biodefense world is mourning the loss of Dr. Raymond Zilinskas this week – a man whose work helped to lay the foundation for the field. “Zilinskas was one of the world’s foremost experts on chemical and biological weapons. He directed the Chemical and Biological Weapons Program at the James Martin Center for Nonproliferation Studies (CNS) and taught courses on the subject since joining the Institute in 1998. Working as a clinical microbiologist, Zilinskas became interested in ‘the area where microbiological science meets policy and ethics,’ as he recounted in a 2016 interview in Communiqué. Much of what is now known about the Soviet biological weapons program from its inception in the 1920s comes from the 11 years of research Zilinskas and Milton Leitenberg conducted for their book The Soviet Biological Weapons Program: A History.” The Middlebury Institute of International Studies at Monterey also released this statement regarding Zilinskas – “As my CNS colleague Sandy Spector recalls, Ray was always ready to take his research into the field, even if that meant plucking fleas from a captured rodent in search of bubonic plague or inspecting the dilapidated storage facility of a post-Soviet Anti-Plague Institute. He also had a knack for writing about overlooked dimensions of the BW problem, including agro-terrorism, synthetic biology, and a major article in Scientific American on counterfeit Botox.”

Emerging Infectious Disease Issue – Influenza – The Mother of All Pandemics 
The latest CDC publication brings forth images of the 1918/1919 influenza pandemic with a colorful cover – a painting by John Singer Sargent of the interior of a hospital tent during the pandemic. The issue contains a wide variety of articles from Candida auris in healthcare facilities, to influenza epidemic predicting in Sweden, and more. City Lab‘s Linda Poon underscores 1918/1919 flu as the mother of all pandemics, noting that “When the first wave crept up in New York City during the spring, residents and officials alike saw it as just another round of the seasonal flu. By mid-summer, the number of related deaths waned, and that first wave barely received a mention in the health department’s weekly bulletins. A century later, though, historians remember the 1918 Spanish flu as the ‘mother of all pandemics‘.”

FDA Plan – Antibiotic Development & Stewardship
The FDA has released their goals for supporting antimicrobial stewardship in veterinary settings for FY2019-2023. “‘We can’t count on outracing drug resistance,’ FDA Commissioner Scott Gottlieb, MD, said in announcing the strategy. ‘But we can use stewardship and science to slow its pace and reduce its impact on human and animal health.’ Noting the agency’s role in overseeing and regulating drug development, safety, and use, Gottlieb said the strategy aims to combat AMR by addressing the ‘full continuum’ of antibiotic development and use in both humans and animals. ‘Because of the FDA’s statutory responsibility for assuring safe and effective products that promote and protect both human and animal health, we have a unique vantage point for coordinating all of these aspects of a product’s development and application to health,’ Gottlieb said.” The FDA release includes several goals – align antimicrobial drug product use with the principles of antimicrobial stewardship, foster antimicrobial stewardship in veterinary settings, enhance monitoring of antimicrobial resistance and antimicrobial drug use in animals, etc. Pew Charitable Trusts also released updated information regarding the pipeline of antibiotic development – “Of the 42 antibiotics in development, 15 were in Phase 1 clinical trials, 12 in Phase 2, 11 in Phase 3, and four have had new drug applications submitted. Two drugs had been approved by the FDA since Pew’s last analysis. Historically, about 60 percent of drugs that enter Phase 3 will be approved. (See the glossary of terms for descriptions of each phase.)” You can also read some of the live Tweeting from the FDA/Pew event that discussed this report here (or by searching #FDAatPew).

DARPA- Defense Advanced Research Projects Agency 1958-2018
Check out where we’ve been and where we’re going with this overview of DARPA’s history and innovative future plans. The online magazine includes a reflection from former directors, a mosaic of warfare, inventions of new materials for national security, future plans, and the tactical edge. Don’t miss the section on page 102 regarding security and surprise at biological scales, which focuses on biotechnologies and the threat of outbreaks. Goals of halting a pandemic within 60 days are discussed within this section, as are the medical countermeasures and diagnostics of responding to biological threats.

 Blue Ribbon Study Panel Meeting – Fits and Starts: Reactionary Biodefense
The next Blue Ribbon Study Panel On Biodefense meeting is on October 9th at 10am. “The Panel will examine our national experience with the anthrax events of 2001, Hurricane Katrina, Ebola, a primate research laboratory, and the H1N1 pandemic, to answer the question – are we better positioned today to defend the nation against today’s biological threats?” The panel meeting will include a section on dealing with anthrax, preparedness for the future, dealign with dangerous diseases, etc. Make sure to RSVP before October 2nd here, or watch via the live webcast!

The Rise of Resistant Staphylococcus Epidermis 
GMU Biodefense doctoral student Saskia Popescu discusses why the increasing resistance of a common skin bug is raising concern. “Staphylococcus epidermidis is a skin bacteria that is so prevalent, the US Centers for Disease Control and Prevention (CDC) classifies it as a common commensal for certain health care-associated infections. Its presence can cause infections, especially in patients with invasive procedures and compromised immune systems; however, the bacteria often fail to get the kind of attention that would make headlines. The results of a new study may soon change the wallflower status of S epidermidis. The results of this study reveal not only the genomic mutations and different lineages that result in resistant S epidermidis, but also the global spread. Given that resistance to rifampicin encourages resistance to other antibiotics, these findings should be weighed seriously as we consider what bacteria are considered normal and often ignored.”

Stories You May Have Missed:

  • UK Monkeypox Healthcare Worker Exposure – A friendly reminder of why infection control is so important – “Because monkeypox was not immediately suspected in the most recent UK monkeypox case, healthcare workers (HCWs) were not wearing adequate personal protective equipment (PPE) and may have been exposed to the virus, UK officials reported today in Eurosurveillance. They also noted that the patient—the second recently reported by Public Health England (PHE), on Sep 11—had two potential exposures. The patient had contact with a person who had a “monkeypox-like rash,” and he also ate bush meat while visiting Nigeria. Nigeria has had 262 suspected and 113 confirmed monkeypox cases since September 2017.”
  • Navy Researchers Work to Reduce Risk of Melioidosis Among Deployed Military – “Dr. Kevin Schully, contractor and chief science officer with Naval Medical Research Center’s (NMRC) Austere environments Consortium for Enhanced Sepsis Outcomes Department (ACESO) recently returned stateside after screening Sailors and Marines deployed to Darwin, Australia, who are at risk of developing melioidosis. While in Darwin, Schully used a tool he developed with colleagues to continuously screen U.S. forces serving in B. pseudomallei endemic areas. He asked volunteers to fill out a brief questionnaire and give blood samples at the beginning of their deployment, mid-deployment, and again post-deployment. Each time, samples were screened for serological evidence of infection and then compared to the questionnaire responses to identify potential risk factors.”
  • Cyclospora Surges Linked to Tainted Produce – “The US Centers for Disease Control and Prevention (CDC) said yesterday that 2,173 lab-confirmed domestically acquired Cyclospora cases in 33 states were reported from May through August, markedly higher than the past 2 years, and that some of the illnesses reflect several restaurant clusters linked to contaminated basil and cilantro.”

Pandora Report: 9.14.2018

Happy Friday fellow biodefense gurus – we’re happy to have you read our weekly report on all things from anthrax to Zika.

George Mason Global Health Security Ambassadors Program
The Schar Biodefense program is excited to announce an opportunity for two current biodefense students (MS or PhD) to attend the  5th Annual Global Health Security Agenda (GHSA) Ministerial Meeting in Bali, Indonesia from November 6-8, 2018. The GHSA Ministerial Meeting provides an unparalleled opportunity to share experiences and engage in meaningful discussions on global health security with senior government officials from the GHSA member states and implementing partners from civil society and the private sector. One of the main goals of this year’s summit is to launch the GHSA 2024 Framework to guide GHSA members and partners in their collective effort to tackle current and future global health security issues. Therefore the theme of this year’s meeting is Advancing Global Partnerships. The two lucky biodefense students will participate in the meeting as members of a delegation representing the Next Generation Global Health Security Network which is led by Dr. Jamechia Hoyle. The Biodefense program is grateful to Dr. Hoyle and Dean of the Schar School, Mark Rozell, for providing this opportunity. If you’re interested in attending, please make sure to reference the email that was sent out on Friday as this opportunity is only available for current GMU Biodefense MS/PhD students. 

South Korean Man Infected With MERS
South Korea’s preparedness against MERS is being tested again as a man hospitalized in Seoul has tested positive for MERS following a trip to Kuwait. “‘As far as found by now, 20 people including flight attendants and medical staff have been in close contact with the patient and they are under isolation at home,’ KCDC director Jeong Eun-kyeong told a press briefing. The patient, who was suffering from diarrhea, headed directly to Samsung Medical Center from the airport, Jeong said. He is now in an isolation ward at Seoul National University Hospital. The KCDC director said all flights from Middle East countries have been put into quarantine. ‘The KCDC and local governments will do our best to prevent spread of the MERS,’ Jeong noted.” The last time South Korea experienced a MERS case, in 2015, a significant outbreak occurred due to poor infection control and hospital practices. A recent update found that the number of contacts was higher, at 21 people, all of whom are being monitored and are currently asymptomatic.

GMU Biodefense Master’s Open House
Next Thursday, September 20th, is your chance to learn about Schar School’s MS in Biodefense. Located in Arlington, this is a great chance to learn about the program requirements, curriculum, and how you can study biodefense online or in person! The session will provide an overview of our master’s degree programs, an introduction to our world-class faculty and research, and highlights of the many ways we position our students for success in the classroom and beyond. Our admissions and student services staff will be on hand to answer your questions.

Medical Countermeasures: Mission, Method, and Management
The latest issue of AJPH focuses on medical countermeasures (MCMs) and future innovations. “Medical countermeasures (MCMs) are critical for minimizing morbidity and mortality in the event of a large-scale public health emergency. MCMs involve a broad spectrum of medical assets, including biological products and personal protective equipment. Whether the emergency results from a chemical, biological, radiological, or natural disaster or from widespread infectious disease and contagions, a well-prepared public health community will readily access and deploy lifesaving MCMs. Ensuring appropriate distribution and dispensing of MCMs can be logistically complex, but coordinated planning between local, state, and federal agencies facilitates an efficient public health response.” The issue includes articles on MCM history, lessons learned by rapid deployment force 3, planning considerations, Taiwan’s annual seasonal flu mass vaccination program, etc.

ABSA International Call for Abstracts
“ABSA International announces the CALL FOR ABSTRACTS for posters for the USDA Agricultural Research Service (ARS) 5th International Biosafety & Biocontainment Symposium to be held February 11-14, 2019, in Baltimore, Maryland. We are anticipating over 200 attendees and over 30 vendors showcasing the latest biosafety and biocontainment products and services. ABSA International is pleased to offer funding support to help selected students and young professionals* (see definition at end of announcement) to attend the symposium. The selection will be made by a panel of judges who will evaluate the submitted abstracts and identify the top submissions. In addition, ABSA International/USDA ARS will present a Student and Young Professional Poster Award* and a Professional Poster Award for the best posters in the categories listed below. The awards will be announced during the reception on Wednesday, February 13th.”

Responding to Airline Outbreaks – A Hidden Safety Net
Helen Branswell lifts back the curtain on the hidden safety net we have regarding ports of entry and infectious diseases. The Emirates flight that was quarantined at NYC last week due to reports of 100 passengers becoming sick mid-flight, raised several questions regarding how we respond to such events. “The fact that a rapid and aggressive response involving a number of agencies and response teams could be pulled together so quickly is thanks to work that has been underway to build this safety net since the early 1990s. That’s when a seminal report from the Institute of Medicine — now called the National Academy of Medicine — issued a clarion call of the threat emerging infectious diseases posed to the U.S. Many such incidents happen over the course of any given year, but in most cases, the CDC does not get immediate word that someone who was on a plane had a disease such as active tuberculosis or measles. In those scenarios, the agency or its partners work to track down passengers who might have been at risk.” While the news of such events much be worrisome, it’s nice to know we have a strong response in place.

Releasing Genetically Modified Mosquitoes 
Africa will see its first release of GMO mosquitoes by researchers sometime this year or next, as the government of Burkina Faso granted permission for the experiment. “The release, which scientists are hoping to execute this month, will be the first time that any genetically engineered animal is released into the wild in Africa. While these particular mosquitoes won’t have any mutations related to malaria transmission, researchers are hoping their release, and the work that led up to it, will help improve the perception of the research and trust in the science among regulators and locals alike. It will also inform future releases. Teams in three African countries—Burkina Faso, Mali, and Uganda—are building the groundwork to eventually let loose “gene drive” mosquitoes, which would contain a mutation that would significantly and quickly reduce the mosquito population. Genetically engineered mosquitoes have already been released in places like Brazil and the Cayman Islands, though animals with gene drives have never been released in the wild.” Success isn’t just based off the scientific outcomes of the project, but also the consent of those living in the areas. 10,000 mosquitoes will be released and are not planned to have a lasting impact on the insect population as they have a “sterile male” mutation meaning that they are unable to procreate.

Skin Bacterium Gets Feisty With Antibiotics
Well, maybe not feisty, but the common skin commensal, Staphylococcus epidermis, has recently become resistant to almost all antibiotics and has spread around the world. “The researchers also found that some of the genetic mutations identified in these lineages confer resistance not only to an antibiotic called rifampicin but also to last-resort antibiotics such as vancomycin. Clinical guidelines often recommend co-administering both rifampicin and vancomycin for the treatment of Staphylococcus infections to prevent the development of drug resistance. But the authors’ findings suggest that the combination may instead fuel resistance in S. epidermidis.”

Stories You May Have Missed:

  • Bionic Bug Podcast with Natasha Bajema – Looking for a new podcast where fiction meets reality? Check out Dr. Natasha Bajema’s podcast on the latest tech news. The most recent episodes (19 & 20) discuss gene drive, mosquitoes, exoskeletons, and artificial intelligence!

Pandora Report: 9.7.2018

This was a pretty busy week in the world of global health security, so we’ll start with something that’s supposed to be relaxing – a CW coloring book?  Look no further than the OPCW one that explains the importance of the OPCW and the elimination of chemical weapons, which is available here! We’re also watching the latest Amazon show, Jack Ryan, which might just have an infectious disease/biological weapon event in the plot….

 GMU Biodefense Master’s and PhD Open Houses
Don’t miss out on the chance to chat with faculty and students about the Schar Biodefense graduate programs. The GMU Schar PhD Open House is next Wednesday (9/12) at 7pm in Arlington and is a great way to learn about the doctoral process and why our PhD students are the ultimate biodefense nerds. The next Master’s Open House is on September 20th at 7pm and is a great way to learn about the in-person and online biodefense MS program. These are informative opportunities to learn about expanding your biodefense knowledge through graduate school and provides wonderful insight into why our program is the place for all things health security, from anthrax to Zika.

Suspects Identified in Salisbury Novichok Attack 
This week, Prime Minister Theresa May reported that two members of the Russian military intelligence (GRU) were considered responsible for carrying out the attack in March. Sufficient evidence has been found to name the GRU members- Alexander Petrov and Russian Boshirov. May noted that “The GRU is a highly disciplined organization with a well-established chain of command, so this was not a rogue operation, it was almost certainly also approved outside the GRU at a senior level of the Russian state.” Following this announcement, Russia has been under heavy scrutiny from the international community. The United States, Canada, France, and Germany, joined in supporting the UK, urging “Russia to disclose in full its novichok programme. The case against Moscow laid out on Wednesday by the UK ‘further strengthens our intent to continue to disrupt together the hostile activities of foreign intelligence networks on our territories’, they said. One notable European country was missing from the declaration supporting the UK: Italy.” Foreign Policy‘s Mark Galeotti notes that “Although Russia’s various security services (and its other instruments of geopolitical struggle against the West) are granted considerable operational autonomy, major operations with potentially serious international implications need a green light from the Kremlin. Besides, there have been none of the usual indications—from mysterious resignations to well-sourced and damning leaks—which usually show that an individual or agency overstepped the mark. Whether Putin instigated the attack or, more likely, simply approved it, it was surely a state operation.”

Tackling Antimicrobial Resistance
This week two important articles were run on the battle of the resistant bug. The first was an article in the Lancet Planet Health, that evaluated the anthropological and socioeconomic factors that facilitate antimicrobial resistance. Pulling from several sources, researchers sought to understand the elements that contribute to global AMR – from prescribing habits to contributing factors like governance, education, GDP, healthcare-spending, community infrastructure, corruption, etc. “In the univariate analysis, GDP per capita, education, infrastructure, public health-care spending, and antibiotic consumption were all inversely correlated with the two antimicrobial resistance indices, whereas higher temperatures, poorer governance, and the ratio of private to public health expenditure were positively correlated. In the multivariable regression analysis (confined to the 73 countries for which antibiotic consumption data were available) considering the effect of changes in indices on E coli resistance (R2 0·54) and aggregate resistance (R2 0·75), better infrastructure (p=0·014 and p=0·0052) and better governance (p=0·025 and p<0·0001) were associated with lower antimicrobial resistance indices. Antibiotic consumption was not significantly associated with either antimicrobial resistance index in the multivariable analysis (p=0·64 and p=0·070).” Their findings underscore the obvious importance of antimicrobial stewardship, but ultimately the socioeconomic and cultural factors that encourage the transmission of these resistant infections. Better regulation in the private healthcare sector, improving sanitation, increasing access to clean water, etc., are all things that impact antimicrobial resistance on a global scale. A new article by NPR’s Richard Harris, looked to the predatory bacteria that might be harnessed to “eat” the bad bacteria causing resistant infections. “They’re even living inside us, but at levels so low that they aren’t effectively battling back against dangerous germs. DARPA has been funding research to see if these predatory bacteria can be harnessed as our allies. ‘It’s been very exciting,’ Ringeisen says, as this exploratory phase of research is gradually coming to a successful conclusion.Lab studies that his agency has funded show that the predatory bacteria will attack all sorts of nasties, including bacterial lung infections, the plague and deadly germs that have developed resistance to antibiotics. And the star of this show is an organism called Bdellovibrio, a bacterium that swims around with the aid of a corkscrew tail, and attacks common germs six times its size.”

Blue Ribbon Study Panel on Biodefense – Fits and Starts: Reactionary Biodefense
The next Blue Ribbon Study Panel event will be on Tuesday, October 9th from 10am-3:30pm at the Hudson Institute in Washington, D.C. The meeting will “reexamine the anthrax events of 2001 and other biological events that have occurred in the years since. We want to know where things stand now and how we can better defend the nation against biological threats. Former Senate Majority Leader Tom Daschle will talk about his personal experience with the 2001 anthrax attacks. Among the academic, law enforcement, media, industry, and governmental experts joining us that day are: Dr. Sheri Fink – correspondent, New York Times, and author, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital; Dr. Scott Lillibridge – Founding Director, Bioterrorism Preparedness Program, Centers for Disease Control and Prevention; Dr. Tara O’Toole – former DHS Under Secretary for Science and Technology; andRear Admiral Stephen Redd – Director, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention.”

International Flight Quarantined in New York
On Wednesday, there was considerable excitement surrounding a plane that landed from Dubai at JFK International Airport. In mid-air, a reported 100 people became sick, complaining of unknown illness. Following air traffic control notification by the pilots, the plane was met with officials from the CDC to collect information and evaluate symptoms. On Thursday it has been reported that the majority of those sick during the flight were experiencing influenza and other common respiratory illnesses. Perhaps the most entertaining part for those of us watching it unfold was the presence of one 90’s musician – Vanilla Ice. Indeed, the rapper was onboard and quickly became a source for news as he live-tweeted the event. In the words of Global Biodefense‘s Stephanie Lizotte, “Contaminate and glisten”.

Food Insecurity as a Security Challenge
The Center for Strategic and International Studies will be hosting this event on Monday, September 17th, from 6-7pm. “Please join the Center for Strategic and International Studies for a Smart Women, Smart Power conversation with Ambassador Ertharin Cousin. She will discuss global food insecurity and hunger and the role they play in other security issues, including violent extremism.” The discussion will be moderated by Nina Easton, Senior Associate at CSIS and Chair of the Fortune for Powerful Women International. You can register here.

Securing the U.S. From Its Most Dangerous Invader – Infectious Disease
Ashley Arabasadi of STAT news discusses why the United States has a pivotal role in global health security and that the latest Ebola outbreak in the DRC is a not-so-gentle reminder of this. Preventing a pandemic is costly though, so where do we start? “First, it’s imperative to continue funding the overseas operations of the Centers for Disease Control and Prevention. These investments help conduct disease surveillance of human and animal populations, which is vital in the low-income countries where the next deadly virus is likely to originate. CDC operations also include training frontline health workers, improving laboratory testing for faster detection, and building efficient reporting systems so disease outbreaks can be caught early and at the source, all vital elements in preventing epidemics and responding to them.” Arabasadi also underscores the importance of supporting global health efforts like USAID, the GHSA, and ultimately establishing a “well-funded, centralized coordinating body for global health security”.

Women Building Bio Conference 
The 2018 Women Building Bio Conference will take place on October 17th, from 7:30am-4:30pm at the Inova Center for Personalized Health in Fairfax, VA. “Challenge new ideas. Discover cutting-edge innovations. Revolutionize best practices. Build a powerful community of collaboration. Women Building Bio is where the vision is transformed into reality. Women advancing the industry with all stakeholders, men and women, front and center joining forces. Come join us for the Third Annual Women Building Bio October 17 at the Inova Center for Personalized Health. Be a part of the vision with Thought Leaders and Change Agents steering the Industry. This is a one-day regional conference converging extraordinary men and women, industry and academia, researchers and innovators, professionals and decision-makers gathering together to cultivate relationships and making an impact.”

Super-Resistant Gonorrhea On the Horizon
Just like a resistant infection, the AMR news isn’t over…the reports of a highly resistant gonorrhea (resistant to both azithromycin and ceftriaxone) swept across the globe earlier this year. Resistant to several other antimicrobials, this case was considered the first reported super-resistant gonorrhea. “It certainly won’t be the last. In the following months, two similar cases would be reported in Australia. Ultimately, the British man’s infection was cured. But not until the patient had received 3 days of intravenous (IV) treatment with ertapenem, a ‘last-resort’ antibiotic normally reserved for severe, life-threatening infections and not intended for garden-variety sexually transmitted diseases (STDs).” Such medical interventions are extremely costly, resource intensive, and prone to issues with patient compliance for those lost to follow-up. The painful truth is that this super-resistant gonorrhea will become more common and a norm. “And that’s where the certainty ends. Because after that happens, a disease that effects 78 million people globally—and has mostly been an unpleasant nuisance since the discovery of antibiotics—will no longer have any known effective antibiotics to treat it. As was seen in the UK case, clinicians may have some weapons in their arsenal for treatment of individual cases, but those options aren’t ideal, nor have they been extensively studied. And new antibiotics for gonorrhea are, at best, still a few years away.”

Stories You May Have Missed:

  • Modernizing the National Disaster Medicine System to Meet the Health Security Threats of the 21st Century – Get the latest from the ASPR blog regarding the NDMS. “In 2017, our nation suffered three back-to-back hurricanes that caused catastrophic damage in Florida, Texas, Puerto Rico, and the U.S. Virgin Islands. That experience highlighted the importance of the National Disaster Medical System (NDMS) – a federally coordinated system that augments the Nation’s medical response capability during times of disasters or public health emergencies. ASPR, the government agency overseeing NDMS, deployed more than 4,600 personnel and 944 tons of medical supplies and equipment to treat approximately 40,200 patients affected by the hurricanes.”
  • Still looking for biodefense news? Check out our Twitter account @PandoraReport

Pandora Report: 8.31.2018

As the summer winds down, here’s a new podcast series on biohacking to get you back into the swing of things or over the holiday weekend.

NASEM Lunch Series on Biodefense and Biosecurity
Did you miss this event hosted by the National Academies on August 21st? We’ve got you covered with two GMU Biodefense student summaries of the talks. Carlos Alvarado writes that “a key point in these slides were to remember that as technology and science advances, so do the potential threats. Dr. Berger used examples of research, development, institutions, applications, and countries as the driving factors of influencing advances on science and technology. Dr. Berger also illustrated how these factors are constantly changing and shifting the biotechnology landscape. An example that was used is how engineering, biology, chemistry, and even health and safety, are a wide variety of disciplines that are growing within the biotechnology realm and that it is no longer just a single discipline of biology. ” Next, Justin Hart noted that “The researchers used a systems-based approach to looking at biosecurity policy in the United States, and considered factors like changes in the structure of organizations with policy responsibility, such as the Department of Homeland Security’s Science and Technology Directorate, the advent of the Congressional Biodefense Caucus, and the development of the forthcoming national health security policy and biodefense strategy. Using these, a review of pertinent regulation, and other factors, they built a basic understanding of all of the prior and existing biodefense policies, discovering that many were reactionary in nature. From this they developed key questions and a roadmap to address such questions as, ‘How can we implement a national biodefense policy with the most relevant emerging technologies, while addressing the real and tangible associated risks?'”

The Hajj is A Perfect Lab for Testing Syndromic Surveillance Systems
Maryn McKenna points to the hajj pilgrimage, one of the largest mass gathering in the world, as a potential for testing an early warning system for infectious diseases. Syndromic surveillance is a tool public health utilizes to pick up the first signs of an outbreak before it boils over, and in the case of field testing it, the hajj would be the perfect setting. “Syndromic surveillance systems, as they’re called, aren’t perfect; they’ve rung false alarms before. But Saudi Arabia’s willingness to create one doesn’t just signal an awareness of disease risks. It also indicates new transparency from a government that has been less than forthcoming about diseases in the past. If that transparency continues, it could create a rich data source for public health officials to predict the risks of gatherings to come.” The influx of people, close quarters, shared food and drink, and close contact that occurs during such an event is a perfect environment for an outbreak, which is why the Saudi Ministry of Health requires vaccinations for people (meningitis, flu, yellow fever, and polio). “The new system created by the Saudi health ministry and the WHO’s eastern Mediterranean region aims to boost the kingdom’s own infrastructure by installing an extra—and extra-sensitive—apparatus for the detection of diseases. It pings an alarm at the government’s public health command center for the hajj, based on automated sifting through medical records from hospitals and clinics.”

China Withholds H7N9 Avian Flu Samples
Sharing samples of strains that pop up around the world is a pivotal part of public health and infectious disease response. Unfortunately, for over a year, Chinese officials have been holding onto lab samples of the deadly avian influenza strain H7N9. “Despite persistent requests from government officials and research institutions, China has not provided samples of the dangerous virus, a type of bird flu called H7N9. In the past, such exchanges have been mostly routine under rules established by the World Health Organization. Now, as the United States and China spar over trade, some scientists worry that the vital exchange of medical supplies and information could slow, hampering preparedness for the next biological threat.” In terms of withholding samples, this is similar to what occurred in 2008, in which the Indonesian officials withheld H5N1 influenza samples. Such actions go against an international agreement established by the WHO to share influenza samples in efforts for pandemic preparedness. When asked about the reason for withholding the samples, “the Chinese embassy in Washington did not respond to multiple requests for comment. The Chinese Center For Disease Control and Prevention also did not reply to inquiries regarding the transfer.”

DRC Ebola Virus Disease Outbreak
The latest counts list a single new infection confirmed in the DRC, which brings the outbreak to 112 people, 84 of whom are confirmed. 3,714 contacts have been registered and 1,219 follow-ups have been completed. “On Twitter yesterday, Peter Salama, MD, the WHO’s director-general of emergency preparedness and response, said the majority of new cases are from known contact lists and most are still confined to an area within 20 kilometers (km) to 30 km of the outbreak’s epicenter. However, if responders can’t turn the outbreak around over the next 7 to 10 days, the risk of the disease spreading to more dangerous conflict-ridden areas becomes greater, posing more difficult challenges for health teams.

 The Scary Link Between Resistant E. coli in Poultry and UTIs
The threat of antimicrobial resistance is a lot bigger than people realize. For many, resistance is only a product of prescription antibiotics, but it’s much broader and more sinister that that. A new study underscores the One Health aspects of antimicrobial stewardship and how even resistant bacteria in poultry can cause urinary tract infections in people. “After analyzing thousands of E coli samples from retail meat products and human urine and blood samples collected over the course of a year in a single town, the researchers concluded that E coli ST131-H22, a sublineage of a pandemic, multidrug-resistant E colistrain that has caused serious UTIs worldwide, is prevalent in chicken and turkeys meat and could be responsible for a small percentage of human UTIs. ‘Our results suggest that one ST131 sublineage—ST131-H22—has become established in poultry populations around the world and that meat may serve as a vehicle for human exposure and infection,’ the authors wrote.” If you want to learn more about the link between poultry and antimicrobial resistance, check out Maryn McKenna’s wonderful book on how the use of antibiotics became a norm within the poultry world.

STIs On the Rise
Bad news: sexually-transmitted infections (STIs) are on the rise within the United States. “Nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States in 2017, according to preliminary data released today by the Centers for Disease Control and Prevention (CDC) at the National STD Prevention Conference in Washington, D.C. This surpassed the previous record set in 2016 by more than 200,000 cases and marked the fourth consecutive year of sharp increases in these sexually transmitted diseases (STDs).” The CDC reports that since 2013, there has been a 67% increase in gonorrhea, primary and secondary syphilis diagnoses have increased by 76%, and chlamydia has remained the most common condition reported. Not only is this news concerning for control efforts, but the three STIs on the rise are treated with antibiotics, which creates new concerns for antimicrobial resistance.

Stories You May Have Missed:

  • The History of Quinine – If you’re a lover of history and infectious diseases, make sure to check out this delightful history on the anti-malarial medication, quinine. “Quinine is an alkaloid extracted from the bark of the Cinchona, or ’fever’ tree (Cinchona spp.) and if you’ve ever had a gin and tonic, you will be familiar with the bitter taste of the tonic which is provided by quinine. While it is now mainly used to add a flavour to the nation’s favourite tipple, the Cinchona tree bark once held a place as one of the most important drugs in history.”

Pandora Report: 8.24.2018

Welcome to your weekly dose of biodefense news. Boston’s BSL-4 lab, the NEIDL (not the best choice of a name…) is now open!

GMU Biodefense Graduate Degrees – Open Houses & Back to School
Interested in advancing your biodefense education to the Master’s or PhD level? Check out one of our upcoming open houses to chat with faculty and current students to learn more about the curriculum, admission requirements, and why GMU’s biodefense program is the place for all things health security, from anthrax to Zika. The next MS Open House will be on Thursday, September 20th at 6:30pm and the PhD Open House is on Wednesday, September 12th at 7pm – both are at the Arlington Campus. Already a biodefense student? Make sure you’re registered for classes as the fall semester is just around the corner. This fall brings about some great biodefense courses at GMU – don’t miss out on Dr. Andrew Kilianski’s course on biosurveillance (FYI – as a participant in the summer workshop on health security, his presentation was among the best, so you’ll want to get an entire semester learning from him!), Dr. Phillip J. Thomas’s Food Security course (after all, food safety is really America’s soft underbelly), and NextGen GHSA’s Jamechia Hoyle’s course on global health security policy (Jamechia has traveled the globe working on the GHSA, so her stories alone will make this a truly captivating class). Those are just a few of the courses offered this fall, so make sure you take advantage of the amazing faculty we have.

Ebola Outbreak – Updates
Case counts from the DRC outbreak have grown as the latest WHO situation report revealed 102 cases and 59 deaths. “As of 20 August 2018, a total of 102 confirmed and probable EVD cases, including 59 deaths, have been reported. Of the 102 cases, 75 are confirmed and 27 are probable. Of the 59 deaths, 32 occurred in confirmed cases and 27 remain probable. A total of 13 cases have been reported among health workers, of which, 12 are confirmed and one has died. Since the onset of the outbreak, a total of 10 case-patients have recovered from the disease and were discharged and re-integrated into their communities.” The WHO also reports that 95% of the 1,782 case contacts have been traced and a total of 2,179 people have been vaccinated.

Conference Report: Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
East Bay Biosecurity’s Brian Wang is not only a doctoral student studying synthetic organic chemistry at UC Berkley, but also a purveyor of biosecurity. In his recent write-up of the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security, he gives insight into the workshop through the eyes of a synthetic biology researcher. “The Summer Workshop on Pandemics, Bioterrorism, and Global Health Security was a testament to how such communication between stakeholders can be effective, as it brought together participants from a diverse set of backgrounds to discuss a multitude of difficult biosecurity-related issues. While speakers often mentioned how the isolation of different perspectives on how to confront biosecurity challenges has led to needless conflict in the past, the environment of the workshop itself provided a clear contrast to that historical backdrop, as participants with different backgrounds frequently interacted in lively discussions.”

GMU Biodefense Student Awarded AAUW Grant
We’re excited to announce that GMU biodefense MS student Janet Marroquin received a Career Development Grant from the American Association of University Women. “Marroquin is a mother, first-generation immigrant, the first in her family to go to college and a minority in a male-dominated health security field. She aspires to support female empowerment through continuous community service and alumni mentorship programs. ‘It’s heartwarming to see that women are being recognized as having more barriers in certain academic fields,’ said Marroquin, noting an AAUW study that student debt disproportionately impacts women.” Congrats Janet!

 Anniversary of the Ghouta Sarin Attack
It’s been five years since the horrific and deadly sarin attack in Ghouta, near Damascus in Syria. One of the most horrific chemical attacks in history, estimates put the deaths around 1,400 and roughly 3,500 people displaying neurotoxic symptoms. You can find a comprehensive overview of the attack and intelligence gathering efforts after here. “The UN report said several surface-to-surface rockets capable of delivering significant chemical payloads were identified and recorded at investigated sites. In Muadhamiya, the UN team were filmed inspecting an expended rocket motor found near the Rawda Mosque. In their report, they said the ordnance they found in the area was about 140mm wide and had an engine with 10 jet nozzles. They did not identify it, but arms experts said it was a Soviet-era 140mm surface-to-surface artillery rocket, known as the M-14.” This attack was sadly not the last to take place in warn-torn Syria, as the Assad regime has taken a liking to the use of chemical weapons despite international prohibition. You can also read first-hand accounts from rescue teams on the ground following the attack, to truly understand the horrors of such an event. “On that horrible day, we all became medics. Though I’m a trained dentist, I remember running to the hospital to help where I found a scene worse than any nightmare. Brave civilians came to the hospitals and volunteered to do anything – operate water pumps to wash the gas off the victims’ bodies, supply fuel, and even evacuate casualties. The attack was so massive in its scale that all these volunteers still weren’t enough to care for everyone. Rescue teams entered affected houses and evacuated all those inside with no time to examine them individually. None of them wore protective material; none of them had any.” So where are we now? Despite continued use of chemical weapons, there has been virtually no progress made to punish the Assad regime. Russia has repeatedly protected Syria against inspections and UN efforts, leaving many to call for #noimpunity. The majority of states parties in the Chemical Weapons Convention (CWC) recently adopted a decision to expand the mandate of the Organization for the Prohibition of Chemical Weapons (OPCW). “It paves the way for The Hague-based organisation to later identify or, at least, create the conditions for the identification of those responsible for chemical weapons attacks. It also strengthens chemical weapons control because the OPCW will now hopefully be able make reliable statements on who is responsible for the continuing use of chemical weapons.” The US, UK, and France also just released a joint statement in the wake of the anniversary of the attack- “Our position on the Assad regime’s use of chemical weapons is unchanged. As we have demonstrated, we will respond appropriately to any further use of chemical weapons by the Syrian regime, which has had such devastating humanitarian consequences for the Syrian population. We welcome the establishment of attribution arrangements at the Organization for the Prohibition of Chemical Weapons (OPCW), in accordance with its authority under the Chemical Weapons Convention, as confirmed by the decision of the Conference of States Parties”

The Art of Russian Disease Misinformation 
This week researchers announced that during efforts to improve social media communication for public health workers, they stumbled across a scary finding – “trolls and bots skewing online debate and upending consensus about vaccine safety. The study discovered several accounts, now known to belong to the same Russian trolls who interfered in the US election, as well as marketing and malware bots, tweeting about vaccines. Russian trolls played both sides, the researchers said, tweeting pro- and anti-vaccine content in a politically charged context.” One of the researchers, Mark Dredze, from Johns Hopkins noted that “By playing both sides, they erode public trust in vaccination, exposing us all to the risk of infectious diseases. Viruses don’t respect national boundaries.” Unfortunately, this isn’t a novel event. During the 1980s, the Soviets worked to spread misinformation about HIV/AIDS.  “A few years ago, historian Douglas Selvage discovered the blueprint for a fake news campaign. It was a 1985 cable from the Stasi, the former East German police, outlining how the Soviet Union and its allies were working to promote the idea that AIDS was an American biological weapon. ‘We are carrying a complex of active measures, in connection with the appearance in recent years, of a new, dangerous disease in the United States: Acquired Immuno Deficiency Syndrome, or AIDS’.” The lie that HIV was a biological weapon is even more ironic considering this was at a time when the Soviet bioweapons program was secretly continuing efforts to develop biological weapons, despite agreeing to the 1972 Biological Weapons Convention. “Back in the 1980s, the rumor that AIDS was human-made was based partially on a report written in 1986 by Russian-born biophysicist Jakob Segal. ‘It was very successful,’ explains Selvage. ‘The local press picked up on it. And then also British newspapers picked up on it. It started to spread around the world.’ Even U.S. newspapers picked up the story. Papers read specifically by African-American and gay communities, both of which were being devastated by the epidemic. ‘AIDS/Gay Genocide’ read a headline in the Gay Community News, based in Boston, which quotes Segal extensively.” Efforts to create mistrust in public health, especially vaccines, can be deadly and in the midst of a large measles outbreak across Europe, we can’t afford to ignore these attacks.

Smallpox – The Virus We Can’t Shake
What happens in VECTOR freezers, stays in VECTOR freezers? That’s the hope at least when it comes to smallpox. There will probably always be concern regarding the remaining stockpiles in CDC and VECTOR freezers, but a recent exercise at UNSW Sydney sought to test how frontline responders, researchers, and policymakers would respond to a smallpox outbreak originating in Fiji. Spoiler: we’re not prepared and it didn’t turn out well. “In the event of global spread, first responders would need to isolate 70% of smallpox patients and track and vaccinate at least 70% of their contacts. If this dropped to less than 53%, it would take over four years and 2 billion doses of vaccine to bring the epidemic under control. The existing World Health Organisation stockpile contains 35 million doses of vaccine. The vaccine could be diluted in such an emergency, but resources to effect large scale isolation and quarantine would be the main problem.” GMU biodefense PhD student Saskia Popescu recently emphasized why there is continued concern for smallpox, but also why frontline providers should brush up on this long-forgotten virus. “As such, smallpox and the actuality of its threat is a complex topic for which there is a spectrum of answers. Most medical providers alive today have not seen a case of smallpox outside of a textbook. For this very reason (and all those listed previously) I advise clinicians to take a moment and remind yourself about the disease. Remember the importance of isolation precautions and take 5 minutes to refresh your memory on what smallpox looks like in a patient before the never event of an outbreak becomes a reality.”

CRISPR and Gene Editing: Bio-Security/Safety Considerations and Best Management Practices
Don’t miss out on this webinar from the Next Generation GHSA on Wednesday, August 29th at 1pm ET. The talk will be led by Dr. Sengupta. “Dr. Aparupa Sengupta received her Bachelor and Master of Science degrees in Biotechnology and Microbiology from Bangalore University, India. She then worked  as a Research Assistant in an Indian Council of Medical Research Lab in the field of Immunology and Microbiology in India before coming to the US in 2008 for her graduate studies. She completed her second Master of Science in Plant Molecular Genetics and Biotechnology (specializing in Biofuel research) in 2009 and a doctorate in Biological Sciences (specializing in Environmental Microbiology and Applied Plant Biochemistry) in 2014 , from Michigan Technological University, Houghton, Michigan. During her PhD. studies, in summer 2011, she worked as a Scientist Intern in the Environmental Microbiology Lab of US Army Corps of Engineers in Vicksburg, Mississippi in the field of Biodiesel production.” You can join the webinar here.

China’s African Swine Fever Containment Woes
Just another reason why you should take the Food Security class Dr. Phillip J. Thomas is teaching this semester…. African swine fever (ASF) is causing considerable concerns in the Chinese porcine industry. “’The entry of ASF into China is really a very serious issue,’ says Yang Hanchun, a swine viral disease scientist at China Agricultural University in Beijing. Given the scale of China’s pork sector, the economic impact could be devastating, Yang says, and the outbreak puts a crucial protein source at risk. From China, the virus could also spread elsewhere; if it becomes endemic, ‘it will represent a major threat for the rest of the world, including the American continent,’ says François Roger, an animal epidemiologist at the Agricultural Research Center for International Development in Montpellier, France.”

Stories You May Have Missed:

  • The Junior Disease Detectives: Operation Outbreak – “The Centers for Disease Control and Prevention (CDC) has partnered with the U.S. Department of Agriculture (USDA) and 4-H to develop “The Junior Disease Detectives: Operation Outbreak,” a graphic novel intended to educate youth audiences about variant flu and the real disease detective work conducted by public and animal health experts when outbreaks of infectious diseases occur. This graphic novel follows a group of teenage 4-H members who participate in a state agricultural fair and later attend CDC’s Disease Detective Camp in Atlanta. When one of the boys becomes sick following the fair, the rest of the group use their newly-acquired disease detective knowledge to help a team of public and animal health experts solve the mystery of how their friend became ill.”
  • FDA Challenge: Infectious Disease NGS Diagnostics for Biothreats – “To encourage the development and improvement of Infectious Diseases Next-Generation Sequencing (ID-NGS) analytical methods, precisionFDA – the community platform for NGS assay evaluation and regulatory science exploration – has launched the precisionFDA CDRH Infectious Disease NGS Diagnostics Biothreat Challenge. Professional and citizen scientists are invited to test their bioinformatics skills and software tools in a challenge to identify pathogens from the FDA-ARGOS database within host samples using NGS short-read data.”

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.”