Pandora Report: 1.24.2020

ASM Biothreats Coverage
With this three-day conference just around the corner, you’ll want to make sure not to miss our coverage in the coming weeks. GMU Biodefense has been sending graduate students to attend ASM Biothreats since 2016 and we’re always excited to share their insights into the presentations and discussions. Check out our previous coverage here, which will provide you with detailed accounts of this conference and the timely conversations that will likely take place surrounding the 2019-nCoV outbreak.

The Novel Coronavirus Bubbles Out of China 
As the first case of 2019-nCoV was identified in the United States this week, questions continued to bubble up regarding the transmission mechanisms and if human-to-human transmission will be sustained. On Wednesday, the WHO met to discuss a declaration of a PHEIC (public health emergency of international concern) as cases spilled into Japan, Thailand, and South Korea, and case counts surpassed 830 infections and 17deaths. Interestingly, as the emergency committee was split on the decision, it was pushed to review again on Thursday and just before, China decided that the city of Wuhan would effectively have a cordon sanitaire, or quarantine. Ezhou and Huanggang have bene added to this list as of Thursday. Mid-day on Thursday, the WHO announced that they would not be declaring the outbreak a PHEIC. WHO situation reports can be found here. Moreover, as news of infection in 14 healthcare workers, it’s a reminder of previous coronavirus outbreaks. With the news of the Wuhan closure, it draws similarities to the quarantine efforts tried by Toronto in the SARS-CoV outbreak, which were considered widely ineffective and frustrating to the community. While each outbreak requires unique control measures, it is important to also note that it is challenging to truly know the case facility rate at this point in the outbreak, and that sudden bursts of identified cases are likely a result of surveillance efforts. As this outbreak has evolved in recent days though, the initial statements of “there has not been sustained human-to-human transmission” have been questioned. Beyond the initial worries about information sharing from the Chinese that were reminiscent of SARS-CoV, the role of healthcare and super-spreaders has been re-established. Chinese media has been quick though, to deny superspreading events. In 2003, the spread of SARS-CoV throughout Toronto taught us several lessons about not only importation of cases due to international travel, but also how super-spreaders in the right environments, like a hospital, can cause devastating outcomes. A lesson learned from Toronto too, is that of the importance of enhanced infection prevention measures and the questionable efficacy of quarantine efforts..not to mention the importance of communication, both between healthcare/public health, but also to the public. Flash forward nearly 10 years and a novel coronavirus was again causing problems…this time, beginning in Saudi Arabia. Spreading across 27 countries since it was first identified in 2012, MERS-CoV is another lesson in novel diseases and the role of One Health. MERS-CoV gave us new insights in not only why the WHO won’t declare an outbreak a PHEIC, but also a hard lesson in how hospitals can amplify an outbreak. In particular, the 2015 outbreak in South Korea, where it is estimated that 91-99% of cases were related to healthcare transmission and 83% of transmission events were tied to five superspreaders. Health system components like multiple patients per hospital room, family involvement in care, and hospital shopping, encouraged the spread of disease. In Saudi Arabia, small outbreaks have consistently happened since 2012, with links to not only camels, but also hospitals in which busy emergency departments and delays in isolation helped spread the disease. In fact, since 2013, most of the cases have been in Saudi Arabia and 19.1% have been in healthcare workers. There are many lessons to be learned from these previous outbreaks of novel coronaviruses, but as of now there are several discussions that need to happen – with a lower case fatality rate (CFR), will emergency measures need to be taken? How effective is airport screening, especially for international flights in the middle of respiratory virus season? As this outbreak is quickly unfolding and we learn new components to the virus daily, a few things are certain though – efforts have been swift (sequencing of the virus took only a matter of weeks), and the Chinese have worked to maintain diligent information sharing and outbreak investigations..not to mention to amazing and rapid efforts of international public health workers. Also, when we provide people with information, these efforts might prove to be just as effective as screening measures as the first case of 2019-nCoV within the U.S. was not identified through this route, but rather by some one who alerted to the outbreak and sought medical care, informing their healthcare provider of relevant travel history. Here are some valuable sources – regarding what we know and don’t know,  the implications of the quarantine for people in Wuhan, and fatality details.

Vulnerable Hospitals and Federal Funding Cuts for Biopreparedness
GMU Biodefense doctoral alum and infection preventionist Saskia Popescu discusses the tiered hospital approach to special pathogens and how despite its imperfections, the cut to funding should be taken seriously. Despite the flaws with the existing tiered system for dealing with special pathogens, it’s a more comprehensive and better resourced approach than what was in place before the 2014-2016 Ebola epidemic. As it stands, Congress has funded the 10 advanced treatment facilities and the National Ebola Training and Education Center but not the 60 treatment centers included in the tiered network. (The nearly 5,000 frontline hospitals never got much federal funding for their special pathogen-related efforts.) Trump signed the bill into law in December.

Redefining Neuroweapons: Emerging Capabilities in Neuroscience and Neurotechnology
Joseph DeFranco, a graduate of the GMU Biodefense MS program, recently co-authored an article about the emerging capabilities in neuroscience and neurotechnology that may enable new types of neuroweapons. Neuroscience and neurotechnology – lovingly nicknamed neuroS/T – are interwoven fields with research and development spanning medicine and military uses. Neuroscience is the study of the developmental processes, structures, functions, and of the brain and nervous system. The field is often referred to in the plural as neurosciences because of its cross-disciplinary nature encompassing molecular biology, developmental biology, physiology, anatomy, cytology, chemistry, mathematics, engineering, linguistics, computer science, medicine, and psychology. Neurotechnology produces a variety of tools, outputs, and substances that affect or probe the nervous system. DeFranco, DiEuliis, and Giordano consider the swift timeline for advancement in neuroS/T and the dual-use potential of such advancements in warfare, intelligence, and national security (WINS) applications. Certain neuroS/T advancements such as gene editing methods and nanoparticles can modify the central nervous system, providing significant utility and application for WINS. Existing pitfalls in international biological and chemical weapons conventions include the lack of consideration for existing and emerging neuroS/T outputs. Frankly, the inventions of neuroS/T are the redheaded step-child of these treaties, as none claim to cover it. The growth of “neurodata” is another important issue as biology becomes increasingly digitized. Though these data can prove immensely helpful in medicine and performance, they also have the potential to be used to target or alter specific individuals or groups. These data, as with all data, are vulnerable to cyberattacks or nefarious surveillance. Based on these benefits and risks of emerging neuroS/T, the authors outline a series of recommendations to either rectify existing insufficient oversight and governance or develop strong oversight and governance for the future.

Update: Ebola in the DRC
The current Ebola outbreak in the Democratic Republic of the Congo (DRC) is the second largest of its kind with over 1,600 cases from 2018 to mid-2019. This outbreak is mired in the exacerbating effects of conflict. Beyond the almost natural increase in disease transmission in a warzone, the DRC sees targeted attacks against medical workers there to quell the outbreak. Recent research focuses on the effects of violence on Ebola disease incidence. Mueller and Rebmann assessed the relationship between attacks targeting aid workers and the incidence of Ebola during the 2018-19 DRC outbreak in the North Kivu and Ituri provinces, regions characterized by violence. Findings from the analysis showed that the relationship between targeted violence against aid workers and disease incidence may be explained etiologically and logistically given the harmful impact on operations from the targeting of facilities, supply lines, and personnel. Wannier et al. quantified the effects of conflict on disease transmission using transmission rates between health zones that have versus have not experienced recent conflict events during the EVD outbreak. The mean overall R (reproduction number) of the total outbreak was 1.11, the average R for regions unaffected by recent violence was 0.61-0.86, and the average R for regions affected by recent violence was 1.01-1.07. These results indicate conflict contributes to increased transmission of Ebola in this outbreak. Wells et al. provides a timeline and ethnographic appraisal of the violence and disease in eastern DRC using data and information regarding the period from 30 April 2018 to 23 June 2019. Additionally, the authors constructed a model to quantify the strife prior to a conflict event and its ensuing impact on disease control activities in order to reveal the influence of war on the persistence of an epidemic. The gist of this trio of studies is that the Ebola outbreak is being exacerbated by the ongoing violence in eastern DRC as well as the attacks on the personnel in the field to respond to the outbreak.

Epidemics in Movies and Social Response
Need a break from the constant stream of coronavirus news? In perhaps one of our more favorite articles, a research team looked to the way films illustrate epidemics to the public. The authors note that there are two ways these films affect society – ” fear leading to a breakdown in sociability and fear stimulating preservation of tightly held social norms. The first response is often informed by concern over perceived moral failings within society, the second response by the application of arbitrary or excessive controls from outside the community.” If you’re a fan of outbreak or infectious disease themes in films, this is a great article to read on everything from Dallas Buyers Club to Contagion.

How much Should the Public Be Told About Risky Virus Research?
This is definitely a great way to start a fun dinner discussion with your favorite biodefense folks! Nell Greenfieldboyce recently discussed the NSABB meeting that started on Thursday and will conclude today. The news of a new coronavirus outbreak surely will add to this conversation and the future research that will study this novel disease. The argument regarding research on potential pandemic pathogens and gain-of-function experiments is one that has been going on for years. The conversations don’t just stop at if these experiments should exist and what they look like, but also about the publication of such information and just how much should be shared publicly. A new framework for evaluating potential experiments has already had three proposals – two made it and one is currently under review. “There’s a lot of interest out there in how these reviews get done, notes Wolinetz, but “it’s a little bit tricky, because all of these discussions are happening before funding decisions are made. Under current rules and regulations in the government, those conversations, pre-award conversations, are protected.” That’s to ensure, for example, that someone’s idea for a novel experiment doesn’t get stolen by another researcher. It also lets reviewers be candid in their critiques. What’s more, if a proposed study was deemed too alarming to fund, it might not make sense to make that idea available to all. On the other hand, some biosecurity experts argue that the public needs to know who is evaluating the risks and benefits and exactly what their reasoning is.” Confidence-building measures, like including a range of voices and disciplines into this decision-making process, are all ideas that have been raised during this process. Inclusion of risk-mitigation efforts and communication strategies are also measures that several researchers have emphasized. As Dr. Tom Inglesby noted though, “once we publish the mechanisms for making pathogens more dangerous —potentially ‘pandemic dangerous’ — we can’t take that information back. That information will be out there online for good.”

Patient Proximity to Farms and Increased Risk for C-diff Colonization
Talk about a One Health relationship – imagine living close to a livestock farm and having an increased risk for a diarrheal illness? That’s exactly what a new study is showing. The authors found that “the independent effect of residential distance to livestock farms was substantial; regardless of health care exposure, the probability of colonization more than doubled for those living 1 mile from a livestock farm compared with those living 50 miles from a livestock farm. Specifically, the probability of colonization increased from 6.5% among those living 50 miles from a livestock farm to 15.7% among those with previous hospitalization and from 4% to 10.6% among those without a recent hospitalization.”  Comorbidities played a factor in those patients admitted to a non-hematology/oncology unit, increasing the odds of colonization by more than 4 times.

Genetic Modification Could Protect Soldiers from Chemical Weapons
Despite bans on the development and deployment of chemical weapons, their use in conflict continues. Current treatment options are picky as they must be administered immediately and may not be satisfactorily efficacious; however, US Army researchers recently made a breakthrough in toxicant protection for soldiers. Specifically, the researchers developed a type of gene therapy that allows mice to create their own “nerve agent–busting proteins,” which provide protection against the agents, possibly for months. Though this therapy bears the potential for human use, it is risky. Such risks include the development of an adverse immune response to the introduced protein. Lead biochemist Nageswararao Chilukuri called the experiment of a “proof of principle” study. The long-short of the experiment is the livers of mice were reprogrammed as factories pushing out a “bioscavenger” enzyme that quickly incapacitate nerve agents. The team recently reported that the mice survived nine customarily lethal injections for six weeks, a promising but preliminary result.

USAMRIID 2019 Lab Protocol Failures and Findings 
Last year it was announced that the USAMRIID lab at Fort Detrick was temporarily shut following CDC inspections that found failures in their practices. “The lab itself reported that the shutdown order was due to ongoing infrastructure issues with wastewater decontamination, and the CDC declined to provide the reason for the shutdown due to national security concerns.” Documents that were recently obtained found that those violations initially reported were only a handful, but many were labeled as “serious” including – “The CDC reported that an individual partially entered a room multiple times without the required respiratory protection while other people in that room were performing procedures with a non-human primate on a necropsy table. ‘This deviation from entity procedures resulted in a respiratory occupational exposure to select agent aerosols,’ the CDC wrote.” You can read more here on these findings and the serious observations that were identified, triggering the lab’s temporary closure.

 

Pandora Report: 1.17.2020

Happy Friday! We’re glad to start the weekend with a healthy dose of all things biodefense. Before we get too far down the nCoV-2019 rabbit hole…Senator Dianne Feinstein recently wrote a letter to DHHS regarding steps the department is taking to protect the U.S. against pandemics.

ASM Biothreats 
It’s almost that time of year and if you can’t make the January 28-30 ASM Biothreats conference, don’t worry – we’ll have great coverage. GMU Schar School Biodefense is sending graduate students to the conference to report out on these three days of all things biothreats. Check out previous years of our coverage here, where we provide detailed overviews of the talks and events. “ASM Biothreats is a one-of-a-kind meeting offering professionals in biodefense, biosecurity and biological threats the opportunity to exchange knowledge and ideas that will shape the future of this emerging field. ASM Biothreats offers a unique program that explores the latest developments and emerging technologies in the industry.”

AI Weapons
The end of 2019 and the start of 2020 sees an uptick in discussion regarding artificial intelligence-driven weapons. Three of the world’s biggest plays – the United States, Russia, and China – are all strongly indicating that artificial intelligence (AI), considered a transformative technology, will be dominant in their respective national security strategies. Recent headlines on the topic include terms like “killer robots” and “Terminator-style war.” Indubitably, we are in an era of rapid and momentous technological advancement and discovery; however, the true application of these technologies is fairly narrow and now necessarily nefarious. Larry Lewis, a senior advisor for the State Department in the Obama administration and a member of the US delegation in the UN deliberations on lethal autonomous weapons systems, recently published an article in the Bulletin of the Atomic Scientists about the utility of AI in reducing the collateral damage of war. Lewis spent the last decade working to reduce the civilian casualties in war, and he found that such casualties were largely the result of inaccurate indicators regarding civilian presence or the misclassification of civilians as combatants. Though military applications of AI include autonomous weapons, this technology can also be employed to optimize automated processing to detection and as a decision aid to helping personnel interpret complex or vast sets of data. Though discussion tends toward the risks of AI technology, especially its military applications, Lewis endorses adding a new facet to the discussion that focuses on the benefits of AI technology in minimizing civilian casualties in warfare.

nCOV-2019 and the Wuhan Outbreak
The past few weeks have been busy with the news of this novel coronavirus cluster in Wuhan, China. Following the identification of it as a novel strain and the temporary name of nCoV-2019, public health authorities have been working to better understand the epidemiological aspects of the virus and how we can prevent further transmission. News of a case in Thailand, following travel to the affected region in China, quickly spread as it meant that cases were no longer contained in China. Interestingly, the Chinese woman whose infection was detected after her arrival in Thailand, had no exposure to the market that is considered to be the epicenter of the outbreak. “A new statement from the World Health Organization (WHO) today had several new details, including that the woman had not visited the Wuhan seafood market, which also sold live animals such as chickens, bats, and marmots, where most patients are thought to have been exposed. However, she reported regularly visiting a local fresh market before her symptoms began on Jan 5. That illness onset is later than that of the others infected in the outbreak, which ranged from Dec 8 to Jan 2, according to a Jan 12 update from the WHO. The incubation period for nCoV-2019 isn’t known, and authorities closed the seafood market on Jan 1.” 182 contacts are being monitored related to this case and eight febrile travelers at the Suvarnabhumi Airport have been isolated and tested (all were negative). Japan also confirmed their first case in a 30-year-old man who tested positive following a visit to Wuhan. On Thursday, officials released more information regarding a second family cluster in Wuhan (likely exposed via the same source), as well as findings from environmental testing at the market in Wuhan.

Antibiotic Tolerance Can Affect Combo Treatments, Study Finds
A team of scientists in Israel found evidence that antibiotic resistance in microbes may render combination therapies ineffective, a long-held fear that may now be reality. Combination drug therapy is a commonly used clinical method for treating infections caused by resistant microbes and to prevent the progression of resistance. This team monitored the evolution of Staphylococcus aureus strains in patients undergoing combination treatment and exposed the swift emergence of tolerance mutations trailed by the emergence of resistance. Tolerance mutation in antibiotics is a general term “used to describe the ability, whether inherited or not, of microorganisms to survive transient exposure to high concentrations of an antibiotic without a change in the MIC, which is often achieved by slowing down an essential bacterial process,” whereas antibiotic resistance is “the inherited ability of microorganisms to grow at high concentrations of an antibiotic, irrespective of the duration of treatment, and is quantified by the minimum inhibitory concentration (MIC).” After the discovery of tolerance to combination treatments in the S. aureus case, the scientists were able to expand the finding by measuring bacterial growth in Escherichia coli after drug combinations from four different antibiotic classes. Isolates with tolerance to norfloxacin and ampicillin promoted resistance in some of the combinations for treating E. coli. Therefore, the authors conclude that “rescue of resistance mutations by tolerance is a general phenomenon that may have crucial implications for the evolution of resistance in patients treated with combinations of antimicrobials.” A short article summarizing the study can be found here and the original publication can be found here.

WHO- Urgent Health Challenges for the Next Decade
The World Health Organization has released their list for the new decade – which was “developed with input from our experts around the world, reflects a deep concern that leaders are failing to invest enough resources in core health priorities and systems.” The list does not place challenges by priority, as they are all urgent and includes elevating health in the climate debate, delivering health in conflict and crisis, making healthcare fairer, expanding access to medicines, stopping infectious diseases, and more. Within each challenge, the WHO discusses what it is and what they are doing to help correct it.

Outbreak Dashboard 
While much attention has been to the novel coronavirus outbreak, more Ebola cases have been identified in the DRC. The latest situation report from The Who reports 8 new cases, including 3 in Beni.

Pandora Report: 1.10.2020

Novel Coronavirus Identified in Clustered Pneumonia Outbreak – Wuhan, China
Growing case counts and rising concern have plagued the international public health community as a cluster of an unusual pneumonia began bubbling up in China. While SARS-CoV was already ruled out, early on Wednesday morning, it was reported that Chinese researchers discovered a novel strain of coronavirus from a sample of one patient. The CDC reported that as of January 5th, there have been a total of 59 cases, but no deaths. Early in the outbreak, the evolving situation and limited information about the causative agent stirred memories of the SARS-CoV outbreak in 2003. Delayed reporting and accusations of government cover-ups are never a good sign for outbreak response, but the hope is that transparency will not be an issue as researchers continue to work to understand the causative agent. Hong Kong has worked diligently though to ensure reporting occurs from hospitals and into public health programs through the existing regulatory inclusion of “Severe Respiratory Disease associated with a Novel Infectious Agent”. On Thursday, The WHO released a statement regarding the outbreak, noting that “Chinese authorities have made a preliminary determination of a novel (or new) coronavirus, identified in a hospitalized person with pneumonia in Wuhan. Chinese investigators conducted gene sequencing of the virus, using an isolate from one positive patient sample. Preliminary identification of a novel virus in a short period of time is a notable achievement and demonstrates China’s increased capacity to manage new outbreaks.” The WHO emphasized that as more epidemiological investigations and efforts produce information on disease transmission, sources, etc., the information will be made available. The CDC is encouraging travelers to protect themselves through several measures, like avoiding animals and animal markets, as well as contact with sick people.

GHSA Next Generation Network 2019 Mentorship Program Flash Conference
Don’t miss this great web-based event next week (10am EST, January 16th) to see the hard work of the NextGen GHSA proteges and even find inspiration for your own work in health security. Join the WebEx here (Meeting number (access code): 643 949 112).

I opened an envelope filled with anthrax
In 2001, Casey Chamberlain a 23-year-old was doing an apprenticeship at NBC Nightly News. One of her tasks was going through the mail of a veteran newscaster and host Tom Brokaw. About a week after the 9/11 tragedy, Casey opened a piece of mail containing a cryptic scrawling of misspelled words and a foreign substance that looked like a mixture of sand and brown sugar to her. Casey had no idea that peculiar but seemingly harmless powder was anthrax. Within two weeks of opening this odd piece of mail, Casey awoke with severely swollen lymph nodes, and thinking it was an adverse reaction to acne medication, she took the prescribed antibiotic and soon returned to work. After a photojournalist from another media outlet died from inhalation anthrax, she was interrogated by the FBI and sent into hiding. 100 days of antibiotics helped make Casey one of the survivors of the Amerithrax attacks; however, the trauma from deadly exposure is something for which she will never have closure. Read Casey’s full story here.Next week you can attend this great online event to see the hard work from the proteges and get inspired for your own future global health security efforts. At 10am EST on January 16th, you can joint via webbed

How Should The WHO Guide Access/Benefit Sharing During Outbreaks?
Not the type of question you’ll likely be able to answer in a quick elevator ride, but Nicholas Evans, Kelly Hills, and Adam Levine, have worked to address this critically important topic. You can read the full article here, in the AMA Journal of Ethics, in which they assess The WHO’s Guidance for Managing Ethical Issues in Infectious Disease Outbreaks following the 2013-2016 Ebola outbreak in West Africa. The researchers evaluate “the Guidance’s recommendations on research and long-term storage of biological specimens during infectious disease outbreaks and argues that the Guidance does not provide adequate direction for responders’, researchers’, and organizations’ actions. It considers local persons’ access to benefits of research in the aftermath of outbreaks and preparedness for outbreaks, drawing on lessons from both the 2013-2016 EVD outbreak and ongoing research in the Democratic Republic of the Congo.” This is a highly necessary and relevant article, as we often fail to discuss the ethical aspects of biodefense, outbreak preparedness, and overall infectious disease response. As the authors note, “There is therefore an obligation to ensure redress so that vulnerable populations can negotiate contracts on fair terms, keeping in mind that leaving a people with only their bodies (including their blood) as resources to be sold seems to violate Article 4 of the United Nations Universal Declaration on Human Rights. (“No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms”).”

NSABB Meeting
It’s been a beat since the last meeting of the National Science Advisory Board for Biosecurity (NSABB), but this federal advisory committee is coming together on January 23rd and 24th to discuss: (1) considerations regarding security and public transparency when sharing information about research involving enhanced potential pandemic pathogens; (2) other business of the Board; and (3) a charge to the committee will be presented. The meeting will be open to the public, with attendance limited to space available. The meeting will also be videocast. If you’d like to attend in person – make sure to register. Since this is the first meeting in over a year, it will likely be highly engaging as “The NSABB has up to 25 voting members with a broad range of expertise including molecular biology, microbiology, infectious diseases, biosafety, public health, veterinary medicine, plant health, national security, biodefense, law enforcement, scientific publishing, and other related fields.”

The State of the Nuclear Deal with Iran
Every 60 days since last May, Iran has taken gradual steps back from its agreed compliance. The most recent backstep was made on 5 January with the announcement that Iran will no longer observe restrictions on the number of centrifuges that it uses to enrich uranium. Though this is not particularly encouraging news for those working to strengthen global nuclear control and nonproliferation, it is not surprising news given the past many months. The recent killing of Iranian Major General Qasem Soleimani, head of the Iranian Revolutionary Guards Corps Quds Force, adds further fuel to the fire regarding the current state and future of the nuclear deal. Though recent events elicits fear in retaliation and war with Iran, the latest announcement was likely already intended and not a decision solely made for retribution. That said, the killing of Soleimani raises concerns regarding future violations of the agreement that are greater in occurrence or more severe in type. Soon, European members of the JCPOA will deliberate over the whether or not to initiate the dispute resolution mechanism to address Iran’s violations of the nuclear agreement. Triggering the mechanism may spur a readjustment – perhaps an alarming one – in Iran’s existing intentions for its compliance with the deal.

Outbreak Dashboard
The Ebola outbreak in the DRC has now hit 3,391 cases over the course of 17 months. 568 suspected cases are under investigation. Sadly, this is not the only outbreak the DRC is battling, as there have been 6,000 deaths related to measles in an outbreak that has topped 310,000 cases since the beginning of 2019.

Biosecurity Innovation and Risk Reduction – World Economic Forum Develops a Framework 
The WEF has now released their framework for accessible, safe, and secure DNA synthesis. With the development and proliferation of new biotech and synthetic biology, risk increasingly has become a topic of concern. This new framework “endorsed by an international expert Working Group, recommends a global system to expand synthetic DNA screening practices by developing an international, cost-effective, and sustainable mechanism to prevent illicit DNA synthesis and misuse. The new framework offers an improvement on existing voluntary guidelines because it standardizes screening processes, is accessible to new players in the market, and provides valuable feedback data to evaluate the screening – all at lower costs.” You can access the report here, which includes sections on developing a common DNA sequence mechanism, as well as oversight and policies for establishing synthetic DNA screening as a global norm. Moreover, the WEF framework includes points on the importance of partnerships in these efforts.

Event: Battling Insecurity, Mistrust, and Disease: Are We Capable of Reining in Epidemics in Complex Environments
Don’t miss this January 15th event regarding reigning in epidemics in complex environments. Featuring Dr. Wilmot James, Visiting Professor of Political Science and Pediatrics at Columbia University, “The fight to stem the rapid spread of an infectious disease is a fight against an infectious agent, as well as a struggle with the conditions that enable outbreaks to persist, such as political instability, insecurity, and economic uncertainty. Most recently, the 2018 Ebola virus disease outbreak in eastern Democratic Republic of Congo has proved to be wickedly durable for reasons beyond the outbreak itself. Health workers have been attacked and killed, limited government efforts have been stymied due to mistrust, and communities have struggled to find the confidence to mount an effective response – resulting in an outbreak that continues to this day.” You can register for this event in Washington, D.C. here.

Stories You May Have Missed:

  • An Ancient Legend Could Provide a Weapon in Fight Against Deadly Bacteria – “According to the Swansea researchers, the soil over Father McGirr contains a previously unknown strain of Streptomyces, a genus of the phylum Actinobacteria, which has produced about two-thirds of all currently prescribed antibiotics. Soil bacteria secrete chemicals to inhibit or kill competing bacteria, and this particular strain of Streptomyces happens to mess with several disease-causing pathogens that have become impervious to conventional antibiotics.”

Pandora Report: 1.3.2020

Welcome to 2020! We’re excited to start the new year with a short newsletter to keep you up to date on all things biodefense.

 Alcatraz of Viruses
The Island of Riems in the Baltic Sea, once inhabited by the Nazis for biological weapon research, is now a heavily restricted site for German scientists to develop vaccines against viruses. The island hosts the Friedrich Loeffler Institute, Germany’s National Institute for Animal Health, which is a hub for the study of pathogens like rabies, African swine fever, and Ebola, and maintains the primary objective of preparing for future infectious disease outbreaks. The deputy head of the Friedrich Loeffler Institute, Franz Conraths, dubbed the island to be the “Alcatraz of Viruses.” Given its nickname-sake, the island is subject to stringent security protocols in order to safely contain all pathogenic samples and protect researchers and visitors. Since 2008, the German government has invested over $300 million in the Institute for infrastructural upgrades; there are now 89 laboratories and 163 stables for the research animals within the facility. Animal welfare is an important pillar for the Institute, hence their efforts to minimize animal research and minimizing the suffering of any tested animal. That said, the potential for their vaccine research to save millions of human and animal lives, protect the livelihoods of farmers, and alleviate global hunger, according to the head of the diagnostics department, outweighs the desire to eliminate animal testing.

NAS Workshop Proceedings: Improving International Resilience and Response to Chemical, Biological, Radiological, and Nuclear Events
In October 2017, the National Academies of Sciences, Engineering, and Medicine (NAS) coordinated an international, science-based workshop in Tokyo regarding resilience to Chemical, Biological, Radiological, and Nuclear (CBRN) events. The CBRN resilience workshop, in collaboration with Niigata University and the Japan National Research Institute for Earth Sciences and Disaster Resilience (NIED), aimed to “increase understanding of the communication, interoperability, and coordination issues that arise among various international stakeholders who are responsible for responding to CBRN event.” Partakers included experts and representatives from the government/public sector, private sector and industry, international organizations, academia, and NGOs. The event included a simulation as well as various plenaries covering topics such as lessons from past CBRN events and strengthening collaborative capacity. The workshop included a Resilience Exercise that used an explosion created by the collision of a large Liquid Natural Gas Tanker into a chemical depot on the shore near the Tokyo Motor Show as its base scenario. The explosion was compounded when the adjacent industrial complex ignited and debris oil was launched into Tokyo Bay. The flames and smoke of the chemical fire travelled inland toward Tokyo, home to about 14 million people, and smoke is further spreading toward the Tokyo Big Sight complex. Additional simulation components include the challenges of responding to a cascading CBRN event and the difficulty stimulating multi-party discussion for rapid response and international cooperation. Examples of some of the issues recognized during the workshop include delayed information sharing, incongruent definitions and terminologies across organizations, and the lack of defined roles and responsibilities for response.

Antimicrobial Resistance – A New Plan For A New Year?
Since the CDC announced their latest report and findings that each year 2.8 million Americans are infected with a drug-resistant organism, 35,000 of whom later die, we can safely say we’ve got a big problem. Antimicrobial resistance (AMR) isn’t new though and the problem has been boiling up for decades however it seems that we’re starting to truly take it seriously. From rivers to traveling patients, it’s hard to escape resistant microbes. New efforts to invigorate surveillance/reporting, as well as stewardship initiatives and even addressing the drying pipeline of antibiotics, are all tactics that have been employed. In fact, this latest piece is the one that is perhaps the most damning – big pharma has all but fled the antibiotic R&D field and those start-ups courageous enough to try, are increasingly falling upon financial ruin. “Antibiotic start-ups like Achaogen and Aradigm have gone belly up in recent months, pharmaceutical behemoths like Novartis and Allergan have abandoned the sector and many of the remaining American antibiotic companies are teetering toward insolvency.” Sadly, this is only adding to the issue as it paints a grim image for those considering any investment in antibiotic R&D. Many are calling for government intervention to help address the push-pull dynamics of antibiotic development – noting that “If this doesn’t get fixed in the next six to 12 months, the last of the Mohicans will go broke and investors won’t return to the market for another decade or two,” said Chen Yu, a health care venture capitalist who has invested in the field. Another component though is the heavy push on stewardship and prescribing practices, which often makes hospitals and providers weary against using new antimicrobials. Adding to this sentiment, Dr. Rick Bright, BARDA Director and Deputy Assistant Secretary for Preparedness and Response, wrote on the need for better diagnostics for resistant infections. Dr. Bright shares his own experiences with a simple-turned-complex infection that required several antibiotics. From delays in diagnostics/treatment, to being on six antibiotics, this is a great personal account of what it’s like to have a resistant infection and the inherent limits of existing diagnostics. “The gardening incident gave me personal insight into the many challenges that confront medical professionals and every patient fighting a resistant infection. I am more committed than ever to overcoming this challenge, to identifying solutions, and to partnering with private sector to get ahead of antimicrobial resistant infections and protect our nation’s health security. I hope more potential industry partners will look closely at the problem and join me by partnering through programs like CARB-X, BARDA DRIVe and other BARDA-supported initiatives.”

Senate Passes Bipartisan One Health Awareness Month Resolution
On December 20th, the Senate unanimously passed a bipartisan resolution to promote January as “National One Health Awareness Month”. Since more than 74% of emerging infectious diseases are zoonotic, the awareness to One Health and the role we all play is critical in addressing current and future biological threats.The One Health Commission is working to promote this new resolution, including a guide to help raise awareness for this critical initiative. You can read the full resolution here.  Happy National One Health Awareness Month!

Outbreak Dashboard
Flu activity continues to rise in the United States, as the CDC reported 4.6 million flu illnesses, 39,000 hospitalizations, and 2,100 deaths in this season. The Ebola outbreak in the DRC has also been growing, as 4 new cases were recently reported in Kalunguta, which is frustrating as the area had previously gone 63 days without a new case.

Pandora Report: 12.20.2019

Happy Friday fellow health security friends! We will be on holiday next week, but rest assured, your favorite source for all things biodefense will be back right after the New Year. We hope you have a lovely holiday – remember, wash your hands!

Speeding Ahead- the Pace of Biotech Democratization
Gryphon Scientific researchers recent discussed in Nature the fast pace of biotech development and the challenges of establishing regulatory oversight and policies. They underscored that to set about such a course would require considerable dedication and resources – both in terms of financial and personnel. But what really does the investment into democratizing biotech look like? In this novel approach, researchers analyzed the exact pace of biotech and what those timeframes for democratization of novel techs look like. “Our assessment provides evidence that novel technologies currently can complete this transition in less than 4.5 years from their discovery and may do so in less than 3.5 years by the end of the next decade.” Investigating 22 biotechnologies, they highlighted milestones that point to the spread of such tech from lab to easily accessible. This is a highly enlightening article and includes data on reproduction of biotechnology trends and regression analysis that helps predict current and future trends in both the development and spread of these biotechnologies. “These results underpin the necessity for constant review of the security implications of the democratization of powerful biotechnologies, and the proactive development of policies, oversight and guidance systems, to ensure that they are leveraged responsibly by those outside the established scientific community.” You can find the article here.

GMU Class on Medical Countermeasures
Spring semester is fast approaching and if you’re a GMU biodefense student, don’t miss out on the chance to take BIOD766: Development of Vaccines and Therapeutics with Dr. Robert House. The course analyzes the process of developing new medical countermeasures against biological weapons and emerging infectious diseases such as SARS and pandemic influenza. Special attention is paid to the scientific, technical, political, regulatory, and economic obstacles to developing new vaccines and therapeutics. Examines the causes and potential solutions of public and private sector failures. Dr. House is an expert in the field of MCMs and worked for more than 11 years at DynPort Vaccine Company in Frederick, Md., where he held the positions of VP of Science and Technology, Chief Scientific Officer and President. During this time he developed extensive experience in winning and managing large USG-funded programs for developing medical countermeasures. He previously worked at Covance Laboratories in Madison, Wis. and IIT Research Institute in Chicago, Ill., where he managed highly successful programs in immunotoxicology assessment. Don’t miss out on your chance to take this engaging class with one of the top minds in the field.

Smallpox Virus Stocks
9 December 1979 was the historic day on which smallpox was confirmed as eradicated. A few months later, the World Health Assembly (WHA) officially declared that “the world and all its peoples have won freedom from smallpox.” Yet, four decades later, two nations maintain a stockpile of the variola virus that causes smallpox: The United States and the Russian Federation. Smallpox is an infectious and disfiguring viral disease that plagued humans for thousands of years, so its eradication is, arguably, one of the greatest achievements of our species and the greatest achievement of modern medicine. These specimens are stored under high-security conditions at the US Centers for Disease Control and Prevention (CDC) laboratory in Atlanta and at Russia’s State Research Centre of Virology and Biotechnology (Vector) in Novosibirsk, a town in Siberian. The decision to maintain a store of the virus is based on the completion of five fundamental goals goals: (1) further research in case of disease reemerge, (2) vaccine improvement, (3)creation of new treatments, (4) development of antivirals, and (5) improvements in diagnostics methods. According to guidance by the WHO, the stocks will be maintained until those goals are realized; however, disagreement exists on the status of their completion. Last year, the US Food and Drug Administration (FDA) approved a new drug for smallpox treatment; however, the WHO’s Advisory Committee on Variola Virus Research concluded that another antiviral treatment is needed. Arguments against keeping these stockpiles include the risk of variola being used as a weapon of bioterrorism and the risk that an accident could spur an accidental release of the pathogen. Additionally, there exist fears of undeclared stocks and the intentions with those potential samples. David Relman, professor of microbiology and immunology at Stanford University, asserts that the arguments in favor of maintaining the stockpiles outweighs those of destroying them. Another expert, Grant McFadden, director of the Biodesign Center for Immunotherapy, Vaccines, and Virotherapy at Arizona State University, who remains on the fence about retaining or destroying stockpiles, states “A great deal has been achieved on the original research goals, but the argument that more remains to be done is hard to refute…It is important to have these debates about whether mankind should deliberately eliminate feared pathogens, or study them.” As the debate continues, the future of the US and Russian variola virus stockpiles remains to be seen.

Biodefense Books 
Tis the season of giving and here are some great books to buy as a gift for others or keep for yourself. Mark Kortepeter’s Inside the Hot Zone: A Soldier on the Front Lines of Biological Warfare is being released soon – “During Kortepeter’s seven and a half years in leadership at USAMRIID, the United States experienced some of the most serious threats in modern germ warfare, including the specter of biological weapons during the Iraq War, the anthrax letters sent after 9/11, and a little-known crisis involving a presumed botulism attack on the president of the United States. Inside the Hot Zone is a shocking, frightening eye-opener as Kortepeter describes in gripping detail how he and his USAMRIID colleagues navigated threats related to anthrax, botulism, smallpox, Lassa, and Ebola.” Nathan Myers’ Pandemics and Polarization – Implications of Partisan Budgeting for Responding to Public Health Emergencies is also out, “Partisan divisions over policy in the U.S. Congress and rising disease threats put millions of Americans at risk. The Zika public health emergency is used to illustrate the key functions of coordination, providing countermeasures, and engaging in disease surveillance which the government must engage in during such an emergency. The author looks at how the standoff over Zika funding negatively affected the government’s response within federal agencies, as well as at the state and local level. Also examined in the book are serious threats still on the horizon that are expected to require strong government action in the future. Possible policies to avoid future gridlock are considered.”

PhD graduate Katherine Paris and her dissertation chair, Dr. James Conant

GMU Biodefense December Graduates
We’re so excited to celebrate the graduation of several students from the Schar School biodefense graduate and certificate programs. PhD graduates include Margaret D.M. Barber           (Dissertation Title: Call of Duty? How Insurgent Organizations Choose to Provide Social Services) and Katherine V. Paris (Dissertation Title: An Assessment of the Risk of Misuse of Genome Editing Technologies). Congrats to Rubi Izquierdo on graduating with a MS in biodefense. We’re also happy to announce several students who completed their graduate certificates in Biodefense: Global Health Security and Terrorism and Homeland Security – Kelly Choic, Dianna Del Valle, Hiwot Yohannes, Joe Bob Merriman, and Gula Tang. Congrats! Read more about our biodefense graduate programs here.

Chinese Gangs Spreading African Swine Fever
African Swine Fever (ASF) is a viral infectious disease that is fatal for pigs, domestic and wild, and it is obliterating the Chinese pork industry, which is the largest in the world. To put the severity into perspective, certain estimates indicate that the number of pigs in China that have died from ASF exceeds the number of pigs in the entire US pork industry. Recent reports by PRC state media claim that Chinese criminals are intentionally propagating the ASF outbreak in an effort to drive down domestic pork prices so that these criminals can smuggle the meat and sell it as safe product. These criminal efforts range from spreading rumors about ASF to using drones that drop fomites into healthy farms. ASF-related losses plummeted China’s herd stock by over 40% to date, both as a result of infections and mass culling to contain the disease. Shortages in pork products, a cultural and nutritional protein staple in China, surged prices to over double the pre-outbreak prices. The price drops provided opportunities for the criminals to exploit the situation. Gang members traffic pigs or meat, regardless of its health and safety, to regions with especially high prices and sell it. The profit margin can reach 1,000 yuan (US$143) per pig for smugglers, and estimates fear a further rise of ¥65-75 per kilogram in the near future. Further price surges are expected as the Lunar New Year approaches, further incentivizing criminal meddling in China’s already suffering pork industry.

Investigations into Chinese Lab Outbreaks
A painful truth: biosafety failures do occur…it’s the name of the game when working with dangerous pathogens. While we have the proper practices and safety processes to avoid exposures, human mistakes do happen. Currently, two Chinese agriculture research facilities are assessing how over 100 staff and students were not only exposed, but ultimately infected with Brucella. One institute, the Lanzhou Veterinary Research Institute reported 96 asymptomatic infections. Despite their forthcomings about the numbers, the institute has not released where the source of the exposure occurred. In the Harbin Veterinary Research Institute, it was reported last week that 13 students were infected with the zoonotic disease. “The outbreak at the Lanzhou Veterinary Research Institute was first uncovered in November when some students in the institute‘s foot and mouth disease research unit noticed that large numbers of their lab mice were infertile, according to The Beijing News. The mice tested positive for Brucella, as did four students. The institute then tested 317 people, and found that 96 had been infected.” Lab-associated infections with Brucella do occur frequently, as it is the most commonly reported bacterial infection in labs and the ease of aerosol transmission facilitates such cases. Sadly, this is not the first exposure and it will likely not be last, but it does give insight into the risks of such work and a clear need for heightened biosafety measures. You can read more here.

Mobile Lab Created Out of Ebola Frustrations
Often the greatest developments are created out of sheer frustration during situations – vaccines, biocontainment units, etc. In this case, a lab-on-wheels was developed to help combat outbreaks in countries that have limited laboratory resources. “A prototype was recently displayed at the annual American Society of Tropical Medicine and Hygiene (ASTMH) conference. The company that developed it, Greensboro, North Carolina–based Integrum Scientific, says the first vehicle may soon be tested in Uganda. Integrum Scientific’s lab units can be configured to provide on-site diagnostic capabilities for known pathogens or experimental diagnostics. This configuration also supports standard care during an outbreak or attack, providing routine chemistry, hematology, and blood products.” Check out the mobile lab here.

Outbreak Dashboard
Samoa has extended its state of emergency during the measles outbreak that has impacted a considerable amount of the island’s population. “In its update on cases today, officials said on Twitter that 57 more cases were reported over the last day, boosting the outbreak total to 5,267 cases. The number of related deaths has risen to 73, and as of Dec 15, 93% of the population has been vaccinated.” Ebola outbreak response efforts in Beni continue to be challenged with violence as 43 people were killed in attacks by the rebel terrorist organization Allied Democratic Forces. The outbreak has now reached 3,348 cases with 2,210 deaths.

A Deep-Dive Into Samoa’s Measles Outbreak
Recent estimates put the outbreak on the small island at over 5267 cases with 73 associated deaths. Vaccination rates had dropped dramatically over the years, and were recently estimated at 31% prior to response efforts. The herd immunity threshold for measles is 93-95%, which means that the low rates of vaccination in Samoa were essentially a ticking time bomb. Thankfully, response efforts have gotten the islands vaccination rate up to 93%, which will hopefully slow the deadly outbreak. Currently, the island continues to be in a state of emergency, which was first declared in mid-November. The government has barred children 0-14 years of age from attending public gatherings and requires children of that age to also show proof of immunization prior to boarding inter-island ferries. “The government has also closed its offices (with the exception of public utilities) so that civil servants can aid in the response efforts. Response efforts have continued to pour in to help halt this devastating outbreak. The population of Samoa is just over 196,000 individuals and when there are more than 5000 cases, more than 2.6% of the population have been infected.” Read more here.

Pandora Report: 12.13.2019

A Tribute to Jeanne Guillemin
Recently, the world of biodefense lost one of our cherished members, Jeanne Guillemin. A champion of biological disarmament, health security, and women in the intelligence field, Guillemin is an inspiration to us all and will be dearly missed. For many of us, her books on the Amerithrax attacks and biological weapons were a staple in our studies and what helped inspire passion for combatting the threat of microbes. In fact, Dr. Guillemin’s work was instrumental in revealing the 1979 Sverdlovsk anthrax outbreak was in fact a biosafety failure from a nearby military facility, thus violating the BWC. “Gregory Koblentz, director of the biodefense graduate programs at George Mason University, lauded Dr. Guillemin for what he described as ‘pioneering work’ spanning ‘all the major episodes in the history of biological weapons.’ He credited her with dismantling some of the ‘myth and misperception’ that has surrounded the topic and with making it accessible to general readers as well as specialists.” She will be dearly missed and we are truly grateful for her dedication to the field and her role in inspiring the next generation of biodefense students and professionals.

Event Summary: The Nexus Between Nuclear Energy & Nuclear Security
GMU Biodefense doctoral student and nuclear expert Greg Witt has provided us with a detailed review of this event, discussing the nexus of nuclear energy and security. Witt’s recap is particularly insightful as he explains the complexities of both aspects as an insider in the nuclear industry, noting that “Despite the plentiful and relatively cheap energy available in the upper-income countries, nearly 1 billion people worldwide have no consistent access to electricity, with another 1 billion having reduced access to healthcare due to energy poverty and a further 2.7 billion relying on biomass as their primary source of energy. Any program hoping to ameliorate these challenges would almost certainly require a radical expansion in global electricity generation, a development that until now has mostly relied on the increased extraction and burning of fossil fuels, such as coal and petroleum.” Witt highlights the discussion related to security and political opposition in the face of safety concerns, pointing to comments about the technical side of nonproliferation being only a portion of the battle. You can read more about the event and Witt’s insight as a nuclear specialist here.

New eBook: Mapping the Cyberbiosecurity Enterprise
Cyberbiolosecurity is defined as the “understanding the vulnerabilities to unwanted surveillance, intrusions, and malicious and harmful activities which can occur within or at the interfaces of comingled life and medical sciences, cyber, cyber-physical, supply chain and infrastructure systems, and developing and instituting measures to prevent, protect against, mitigate, investigate and attribute such threats as it pertains to security, competitiveness and resilience.” Frontiers in Bioengineering and Biotechnology just released an open-access eBook amalgamating the collection of articles from their Cyberbiosecurity research topic series. Contributors to the Cyberbiosecurity special collection include experts from the United States and abroad. Specifically, the collection includes articles about regarding the following topics as they relate to cyberbiosecurity, respectively:

  • Risks
  • National Security Implications
  • Vulnerabilities
  • Infrastructural Resilience
  • Biological Data
  • Food Agriculture
  • Biopharmaceutical Products
  • Advanced Manufacturing Models
  • Dual-Use Potential
  • DNA Synthesis
  • Training

Schar School Launches Certificate in Strategic Trade
From biodefense to strategic trade, Schar School is the place to be. We’re excited to report that a new Graduate Certificate has been announced at GMU – “Strategic trade policy implies a strategic relationship between firms, countries, and export control regimes. It includes arms control, nuclear nonproliferation, and a variety of national security issues plaguing all nation states.” The strategic trade certificate program is the ninth graduate certificate in the Schar School’s portfolio of programs. Completion of the certificate requires five courses (15 credits), including one core course in Strategic Trade Controls, and the choice of four electives in a range of topics including nuclear nonproliferation, national security technology, illicit trade, arms control, and global trade relations. “One of the academic benefits of the Schar School’s certificate programs is how easy it is to begin with a certificate, earn that credential to bolster your resume, and then continue your studies by pursuing a master’s degree with those five completed certificate courses counting towards your master’s program,” said Reinert. “That complimentary curriculum between the graduate certificate programs and master’s degree programs provides such value with time and tuition expense.” You can learn more about the certificate here.

2019/2020 Flu Season- Worrisome Trends and Ways to Prepare
GMU Biodefense doctoral alum and infection preventionist Saskia Popescu discusses what the beginning of this flu season is looking like and what this means for healthcare. You can read more here. The US Centers for Disease Control and Prevention (CDC) provides weekly updates to help keep healthcare providers, public health officials, and the public up to date on the latest flu activity. Since September 29, 2019,  there have been more than 227,000 specimens tested by clinical labs, with 4.8% positive for influenza. In the most recent week (Week 48, ending November 30, 2019), there were more than 26,000 specimens tested, with 10.2% being positive for influenza, and 71.1% of those positive in Week 48 were positive for influenza B, according to CDC. The predominant subtypes have been (H1N1) pdm09 for those influenza A specimens, and the Victoria lineage for those influenza B specimens. Popescu notes that “these early signs are deeply worrisome, as data from last year showed that during the same week in 2018, there were 21,851 specimens tested but only 4.2% were positive. Influenza A was also the predominant type (91.5%). In 2017, with over 20,000 specimens tested in Week 48, 6.7% were positive, with 76.3% being influenza A.” She emphasizes that in addition to vaccination, it’s important hospitals work with staff and families to ensure working or visiting while sick is avoided and rapid isolation of symptomatic patients is done.

A Quick Synopsis: The Accelerating Pace of Biotech Democratization
This month, Jackson et al. published a correspondence piece in Nature Biotechnology titled The Accelerating Pace of Biotech Democratization, which posits an analytical approach to produce supportable estimates regarding the pace of innovation in biotechnologies. Specifically, this approach generates extrapolated future estimates to predict timeframes for the democratization of nascent biotechnologies. The article investigates 22 development milestones between 1937 and 2012 with innovations ranging from protein purification to clustered regularly interspaced short palindromic repeats (CRISPR) genome editing. The assessment considered accessibility of each biotechnology to a hypothetical individual based on metrics regarding the speed, cost and technical skill required to successfully employ the tool. The nitty-gritty of the analysis entailed an exponential regression model with the dependent variable being the predicted time (years) required for a biotechnology to reach progression milestones in future years. The model determined that the pace of biotechnology progression is accelerating over time. The authors state, “the robust relationship (R2 = 0.81) between initiation year and time required to develop fee-for-service companies indicates that the progression of new biotechnologies to fee-for-service companies is already very rapid, currently taking less than 2.5 years.”

A Tour with Dr. Daniel Lucey – Outbreak: Epidemics in a Connected World Exhibit at the Smithsonian Museum of Natural History
GMU biodefense doctoral student Rachel-Paige Casey is taking us on a guided tour of the Outbreak Exhibit and it’s one you won’t want to miss. Her detailed account of this tour with Dr. Daniel Lucey will make you feel like you’re walking the through the exhibit, learning about the microbial threats that surround us. Casey discusses how she “got an augmented visit with hearing his firsthand account of working in an outbreak, treating patients, and working with other responders. Continue reading to learn more about Dr. Lucey, the Outbreak Exhibit he inspired, and his insights and experiences as an infectious doctor who regularly responds to outbreaks all over the world. As you read, imagine progressing slowly but vociferously through the Exhibit with Dr. Lucey as he sports an Médecins Sans Frontières vest and a custom-made ballcap listing all eight viruses of the Exhibit.” Read the full article here.

DARPA Launches the Personalized Protective Biosystem (PPB)
Personal protective equipment (PPE) is one of our best tools against biological and chemical threats, and DARPA is working to help rapidly produce better protection. “The current [chemical and biological] threat environment consists of broadly acting, highly pathogenic, and sometimes immediately lethal threats that are capable of entering the body via multiple pathways, including skin, airway, ocular, and the gastrointestinal tract,” officials wrote in the announcement. The DARPA initiative recognizes the stagnant nature of PPE despite advances and considerable financial support towards development, hinting at a desperate need for a revitalization. In healthcare, we often struggle with PPE as it’s hot, bulky, and can be uncomfortable for long periods of time. Fortunately, this PPB initiative is working to reduce the bulky nature of PPE and help make it more adaptable and modernized to truly be effective and efficient. “Through its duration, insiders aim for the program to usher in a modern ensemble to be worn in both military and disaster relief operations that can provide 100% survival against lethal exposure from 11 separate chemical and biological agents, including nitrogen dioxide, malaria, influenza and others.” If you’re interested, make sure to submit your proposal by January 7th.

Post-Exposure Ebola Vaccine Use: Real-World Examples
Prior to this most recent outbreak, there had been deployments of the experimental vaccines in real-world exposures. One of the vaccines rVSV-ZEBOV, a recombinant vesicular stomatitis virus-Zaire Ebola virus vaccine, had a trial run in 2015 when it was still unlicensed. Developed by Canadian scientists and licensed to Merck in 2014, the vaccine has been deployed for the most recent outbreak and has shown 97.5% efficacy during utilization in a large-scale ring vaccination effort. Prior to the large-scale deployment though, it was used for an exposure in 2015 involving 65 people who had direct contact with a health care worker who presented with a viral reactivation (i.e. previously infected, the health care worker recovered and experienced a reactivation of the virus and even reinfection) in the United Kingdom.

Outbreak Dashboard
4 new cases of Ebola were reported on Monday, bringing the total to 3,324 and 391 suspected cases are under investigation. There has also been concern regarding the relapse or reinfection seen for the second time this outbreak. The outbreak of measles continues to grow in Samoa, with the health ministry announcing that over 4,693 people had been infected (112 over the course of 24 hours), and 70 measles-related deaths.

Stories You May Have Missed:

  • Medical devices and drug-resistant infections – “In the face of growing antimicrobial resistance and the rise of medical tourism extremely resistant organism are spreading. The latest report from the US Centers for Disease Control and Prevention (CDC) notes that each year in the United States, there are more than 2.8 million antibiotic-resistant infections and more than 35,000 people die as a result. A new study assessing data reported into the CDC’s National Healthcare Safety Network (NHSN)—which is where infection prevention and health care-associated data is reported by hospitals—found that resistant pathogens are found at a higher rate among those patients with device-associated infections.”
  • Lyme Prevalence in U.S. – “survey of health insurance claims made in the United States from 2007 through 2018 shows that claim lines with a diagnosis of Lyme disease increased 117%. The information is included in a white paper published today by FAIR Health, an independent nonprofit organization dedicated to healthcare costs and health insurance information. Lyme disease was the predominate tick-borne disease on health insurance claims, representing 94% of tick-borne claims, and, in 2018, 0.058% of all medical claims.”

Pandora Report: 12.6.2019

Are We Making Progress on the Antibiotic Resistance Front?
Antibiotic resistance is a problem that crosses sectors, industries, species, and frankly, requires a widespread effort to make a dent in the problem. Whether it be stewardship among medical providers, surveillance and rapid isolation, or use within agriculture, this is a global issue that we’re just not doing that well in. While the latest CDC report shows that annual deaths due to drug-resistant infections is decreasing since their last analysis, the number of infections occurring is still quite high. In 2013 it was reported that 2.6 million infections occur annually and in this latest report, they found that each year there are 2.8 million antibiotic-resistant infections resulting in 35,000 deaths. Moreover, the 2019 report shows 5 new urgent threats and 2 new threats, which emphasizes the role of stewardship initiatives and One Health. “But there is plenty to worry about. Though hospitals are making headway, the agency found some of the greatest increases in infections are acquired outside hospitals. Also, the threat of antibiotic resistance is remarkably fluid; new threats arise even as old ones are mitigated. For example, the CDC has raised the alert level to ‘urgent” for Candida auris, a multi-drug-resistant yeast that can cause invasive infection and death’.” At a global level, the World Health Organization (WHO) has worked to guide national action plans, which countries can employ and modify to their specified needs. Hint: we’ll be doing a spotlight on resistant fungal infections within this newsletter so make sure to keep reading.

The Mystery and the Truth Surrounding the Explosion at Vektor
Since the explosion in September, there’s been  growing conversation around what really happened at Vektor, but also the immediate media coverage that was often over-hyped and opportunistic. Dr. Filippa Lentzos has broken down the facts and ultimately, the implications of those rapid reports. Citing inspections from the WHO-led team, she notes that previously, the site had met international biosecurity and biosafety standards as a smallpox repository. While Vektor’s history includes being an offensive weapons site during the era prior to the Biological Weapons Convention (BCW) and some time after, it has been transformed to a site for research and biodefense. Truly, the biggest issue, Lentzos notes, is the biosafety issues that frequent such research. “Jens Kuhn, a German virologist who was part of a Pentagon-sponsored program that sent young scientists to work in former bioweapons labs, was the first Western scientist through the door at VECTOR in July 2001. Getting in was anything but easy, but once inside he found that contrary to fears he had heard expressed in the West, the high-containment units operated both safely and securely. ‘The Russians don’t want to kill themselves any more than Western scientists,’ Kuhn is quoted as saying in a Nature news story.” While the facility has been upgraded and repaired in recent decades, the Russian government declares biodefense activities and confidence-building measures through the BWC regularly. Sure, they’re doing research with deadly disease like Ebola and Marburg, not to mention storing smallpox, but it’s important to remember that not only is Russia following the International Health Regulations (IHR), which would require them to report risky public health events, but they also did communicate the explosion (although, mostly through the media) and that it happened in the decontamination room – an incident that did not warrant such IHR reporting. As Lentzos underscores, some of the reactions to the event were overblown but this is a prime example of why transparency during such events is critical to avoid misinformation and opportunistic reporting.

Synopsis of the Crimson Contagion 2019 Functional Exercise After-Action Review
This week, the National Biodefense Science Board convened a meeting focusing on the after-action review of the Crimson Contagion 2019 Functional Exercise, a national level exercise series conducted to detect gaps in mechanisms, capabilities, plans, policies, and procedures in the event of a pandemic influenza.  Current strategies include the Biological Incident Annex to the Response and Recovery Federal Interagency Operational Plans (2018), Pandemic Influenza Plan (2017 Update), Pandemic Crisis Action Plan Version 2.0, and CDC’s Pandemic Influenza Appendix to the Biological Incident Annex of the CDC All-Hazard Plan (December 2017). These plans, updated over the last few years, were tested by the functional exercise with emphasis on the examination of strategic priorities set by the NSC. Specifically, examined priorities include operational coordination and communications, stabilization and restoration of critical lifelines, national security emergencies, public health emergencies, and continuity. The Crimson Contagion 2019 Functional Exercise included participation of almost 300 entities – 19 federal departments and agencies, 12 states, 15 tribal nations and pueblos, 74 local health departments and coalition regions, 87 hospitals, 40 private sector organizations, and 35 active operations centers. The scenario was a large-scale outbreak of H7N9 avian influenza, originating in China but swiftly spreading to the contiguous US with the first case detected in Chicago, Illinois. Continuous human-to-human transmission of the H7N9 virus encourages its spread across the country and, unfortunately, the stockpiles of H7N9 vaccines are not a match for the outbreak’s strain; however, those vaccines are serviceable as a priming dose. Also, the strain of virus is susceptible to Relenza and Tamiflu antiviral medications. The exercise was intended to deal with a virus outbreak that starts overseas and migrates to the US with scant allocated resources for outbreak response and management, thereby forcing the Department of Health and Human Services (HHS) to include other agencies in the response. To do so, the exercise began 47 days after the identification of the first US case of H7N9 in Chicago, otherwise known as STARTEX conditions. Then, the HHS declared the outbreak as a Public Health Emergency (PHE), the World Health Organization (WHO) declared a pandemic, and the President of the United States declared a National Emergency under the National Emergencies Act. As was the case in the 1918 Great Influenza, transmissibility is high and cases are severe. At STARTEX, there are 2.1 million illnesses and 100 million forecasted illnesses as well as over half a million forecasted deaths. As the pandemic progresses along the epidemiological curve, the overarching foci of the federal-level response adjusts across four phases:

  1. Operational coordination with public messaging and risk communication
  2. Situational awareness, information sharing, and reporting
  3. Financing
  4. Continuity of operations

The outcome of the Crimson Contagion is that vaccine development is the silver bullet to such an outbreak, but there are complications beyond its formulation. Namely, the minimization of outbreak impact prior to vaccine development and dispersal, strategy for efficient dissemination of the vaccine across the country, allocation of personal protective equipment (PPE), and high expense of vaccine development and PPE acquisitions. The exercise concluded that HHS requires about $10 billion in additional funding immediately following the identification of a novel strain of pandemic influenza. The low inventory levels of PPE and other countermeasures are a result of insufficient domestic manufacturing in the US and a lack of raw materials maintained within US borders.  Additionally, the exercise revealed six key findings:

  1. Existing statutory authorities, policies, and funding of HHS are insufficient for a federal response to an influenza pandemic
  2. Current planning fails to outline the organizational structure of the federal government response when HHS is the designated lead agency; planning also varies across local, state, territorial, tribal, and federal entities
  3. There is a lack of clarity in operational coordination regarding the roles and responsibility of agencies as well as in the coordination of information, guidance, and actions of federal agencies, state agencies, and the health sector
  4. Situation assessment is inefficient and incomplete due to the lack of clear guidance on the information required and confusion in the distribution of recommended protocols and products
  5. The medical countermeasures supply chain and production capacity are currently insufficient to meet the needs of the country in the event of pandemic influenza
  6. There is clear dissemination of public health and responder information from the CDC, but confusion about school closures remains

A final report with greater detail of the after-action review of the Crimson Contagion 2019 Functional Exercise is forthcoming. Stay tuned.

Biosecurity Insight
The latest Biosecurity Insight is out, which is a great source for information from the Centre for Biosecurity and Biopreparedness (CBB) established by the Danish Parliament. In this new volume, you can read about the control of CRISPR, fake news and biological weapons (“Pathogens are impossible to see and their effects difficult to understand. This makes the fear of them a dangerous device to be exploited through fake news. In a world where more than half of the population is online, social media can become a device to spread panic and mistrust, and hamper responses to natural disease outbreaks.”), and how the internet enables bioterrorism. You can read more here.

The Nuclear Balancing Act – Energy and Security
On November 14th, the GMU Schar School of Policy and Government hosted a panel conversation on the intersection of nuclear energy and security. “Students and faculty members from the Schar School of Policy and Government, as well as representatives from government agencies and nongovernmental organizations, joined Brent Park, Deputy Administrator for Defense Nuclear Nonproliferation at the U.S. Department of Energy’s National Nuclear Security Administration, and Mikhail Chudakov, Deputy Director General for Nuclear Energy at the International Atomic Energy Agency (IAEA)” to have frank conversations about the future state of nuclear energy and how to address “energy poverty”. Moderated by GMU biodefense professor and graduate program director Dr. Gregory Koblentz, the group discussed the marriage between these two nuclear components and that we ultimately need to continue having these conversations. As Dr. Koblentz noted, “Given the growing demand for carbon-free energy and the dynamic geopolitical situation, it was very informative to hear about how the IAEA and the United States work together to promote safe and secure nuclear energy.”

Biological Weapons Convention Meeting of States Parties (MSP)
This week the MSP began, bringing together states parties engaged in the prohibition of biological weapons. You can read Richard Guthrie’s daily summaries of the meetings here or even watch the livestream on UN Web TV. Hot topics will likely include funding and the current financial state, national implementation, verification, etc. The United Nations Institute for Disarmament Research (UNIDIR) has provided a 30-page overview of compliance and enforcement in the BWC, which you can access here. Written by Filippa Lentzos “this paper takes stock of the mechanisms that are currently available for attempting to determine and ensure compliance with the Biological Weapons Convention (BWC). It presents three conceptual layers of BWC compliance: one legally binding, one politically binding, and one wholly voluntary. The paper also describes a fourth, elusive layer—the verification layer—which remains one of the fundamental challenges of biological disarmament and non-proliferation.” On day 5 of the MSP, Guthrie noted that during the science and technology meeting of experts  “there was broad agreement of a need for some form of review arrangement, but with very little detail in the discussion. In the past, for example, some delegations have favoured a small committee of experts while others have favoured some form of arrangement that would allow all states parties to contribute to it. The lack of expressions of support for specific models may be a positive sign as many delegates would seem to prefer achieving consensus on some form of review mechanism rather than pressing for their ideal.”

Missing Links – Understanding Sex- and Gender-Related Impacts of Chemical and Biological Weapons
A new report released via UNIDIR is also addressing the interest that “has grown in gender as a useful analytical perspective to examine the impact of particular means and methods of warfare. Multilateral debates on chemical and biological weapons, however, have not systematically considered the relevance of sex- and age-disaggregated data on the effects of these weapons, nor knowledge of gender dynamics, in the implementation of the Biological and Chemical Weapons Conventions (BWC and CWC, respectively).” Written by Renata Hessmann Dalaqua, James Revill, Alastair Hay, and Nancy D. Connell, this is an extremely detailed and thorough look into the sex and gender dynamics that we often fail to address when it comes to CBW. The report is broken down into several sections – like sex and gender specific effects of chemical and biological weapons, which delves into the social roles and exposure as women are often the primary caregivers, as well as the social stigma and discrimination associated with exposure. Perhaps one of the most interesting sections was on health-seeking behaviors, noting that in some areas, the potential for stigma often impacts if medical care is sought. “Evidence from South Asia, Africa, and Vietnam suggests that the potential for stigmatization affects women’s help-seeking more than men”. Overall, this report was extremely informative and helpful in understanding those roadblocks for not only accurate reporting, but also building the most effective response in the event of an attack.

Using Genome Sequencing to Combat Healthcare Outbreaks 
GMU Biodefense doctoral alum Saskia Popescu discusses how genome sequencing can change response to outbreaks in healthcare settings. Infection prevention epidemiologists work hard to identify spikes in usual case counts or rapidly respond to single cases of unusual organisms. Unfortunately, identifying a source or transmission mechanism isn’t always that easy and we often don’t find the proverbial “smoking gun”.  However, a study assessed the use of genome sequencing in real-time as a tool to help give hospital epidemiologists and infection control an advantage against microorganisms. Investigators across several universities discussed how they employed the rapid and cost-efficient tool during an outbreak of Acinetobacter baumannii at the Queen Elizabeth Hospital Birmingham in 2011. The source of the outbreak was found to be a military patient from Afghanistan who was being treated for a blast injury. This specific case is unique in that the outbreak lasted an incredibly long time—80 weeks, which is the longest ever studied for Acinetobacter baumannii. 

Antimicrobial Resistant Fungal Infections
Fungi are eukaryotic organisms like molds, yeasts, and mushrooms that can be pathogenic in humans. Antifungal medications treat dangerous fungal infections, but antifungal resistant microbes are on the rise, just like antibiotic resistant bacteria. For example, antifungal resistance is increasingly common in severe Candida (a yeast) infections, which often causes nosocomial bloodstream infections. The Centers for Disease Control and Prevention (CDC) released a report on antibiotic resistance threats in the US, which includes a warning about drug-resistant fungi as a serious public health issue. According to the report, 18 microorganisms cause three million antibiotic resistant infections and 35,000 deaths each year. This is the first CDC report to include antibiotic-resistant fungi to include Candida auris along with other resistant Candida species and azole-resistant Aspergillus fumigatus, a mold. Resistance is inherent to certain fungi but can also develop through the misuse and overuse of antifungal and antibiotic drugs in human medicine and agriculture. As with antimicrobial resistance at large, the ubiquitous use of stronger and stronger antimicrobial medications is contributing to the spread of resistance while struggling to combat ongoing infections. The CDC is taking several steps and actions to prevent and reduce resistance:

  • Tracking trends in antifungal resistance through the Emerging Infections Program (EIP)
  • Supporting a network of regional public health laboratories through the Antibiotic Resistance Laboratory Network (ARLN) to perform antifungal susceptibility testing for Candida
  • Using genetic sequencing and developing new laboratory tests to identify and study specific mutations associated with antifungal resistance in Candida
  • Summarizing antifungal prescribing patterns across different healthcare facilities to promote appropriate use of antifungals

The CDC’s warning also includes suggestions about what can be done to curb the threat of antifungal resistance:

  • Healthcare facility executives and infection control staff can:
    • Assess antifungal use as part of their antibiotic stewardship programs
    • Ensure adherence to guidelines for hand hygiene, prevention of catheter-associated infections, and environmental infection control
  • Doctors and other hospital staff can:
    • Prescribe antifungal medications appropriately
    • Test for antifungal resistance for patients with invasive disease who are not improving with first-line antifungal medications
    • Stay aware of resistance patterns, including antifungal resistance, in your facility and community
    • Document the dose, duration, and indication for every antifungal prescription
    • Participate in and lead efforts within your hospital to improve antifungal prescribing practices
    • Follow hand hygiene and other infection prevention and control guidelines with every patient

Outbreak Dashboard
More attacks have plagued Ebola outbreak response efforts in the DRC, as case counts reach 3,313. Flu activity is also continuing to grow, as B/Victoria viruses are the most common and the CDC reported 8% of respiratory specimens tested by clinical labs were positive for influenza. The CDC is continuing to advise people not to consume romaine lettuce from the Salinas, CA, growing region due to an E. coli O157:H7 outbreak.

News of the Weird
A controversial fence, African swine fever, and Danish critics. In the realm of ASF outbreak response, some are calling the latest efforts in Denmark a waste of money. “On Monday, Denmark completed the fence along the border with Germany to protect its nearly 5,000 pig farms that export 28 million pigs annually, according to the Danish Agriculture and Food Council in a DW.com article. The 1.5-meter tall and half-meter deep fence runs from the Wadden Sea in the west to the Flensburg Fjord in the east. The fence construction cost Denmark around $12 million.” From potentially disrupting migration and an impact on the ecosystem, critics are saying the real threat is the importation of contaminated swine.

Stories You May Have Missed:

Pandora Report: 11.29.2019

During this holiday time, we’d like to take a moment to thank our readers – we are truly grateful for your support and continued engagement over the years!

USAMRIID Resumes Select Agent Research…Sort Of
In August it was made public that the U.S. Army Research Institute of Infectious Disease (USMARIID) BSL-4 lab had research halted after failing to meet several Federal biosafety requirements. CDC inspectors identified several shortcomings in USAMRIID’s ability to keep safe the BSL-3 and BSL-4 labs it utilizes to study special pathogens. The implications of this were huge, as USAMRIID’s Special Pathogens lab is not only part of the Laboratory Response Network (LRN), but ultimately a huge piece of American biodefense. “Alongside the disruptions to critical medical countermeasure research projects, impaired BSL-3 and BSL-4 laboratory support to national public health emergencies should not be overlooked as USAMRIID works to correct biosafety issues, regain Federal Select Agent Program certification, and answer accountability questions. ‘We have had conversations with the Army’s LRN Liaison at Ft. Sam Houston and the CDC’s Chief, Laboratory Preparedness and Response Branch LRN to let them know what our capabilities and limitations are under the current constraints,’ stated Vander Linden.” Thankfully, USAMRIID has spent the past few months working to correct these failures and restore compliance, leading to a optimistic November site visit from CDC inspectors. Limited research is now allowed to resume and hopefully will be fully restored as CDC inspectors continue their review of personnel, practices, and processes.

CSIS Report: Ending the Cycle of Crisis and Complacency in U.S. Global Health Security
The health security of the United States – frankly, the entire world – is under severe threat as we remain woefully unprepared for outbreaks and other health crises. The recently released Global Health Security Index further confirms the gaps in prevention, preparedness, and response to public health threats. This month, the Center for Strategic and International Studies (CSIS) released its final report of the CSIS Commission on Strengthening America’s Health Security, Ending the Cycle of Crisis and Complacency in U.S. Global Health Security. The Commission advises Congress and the Administration enact the following seven recommendations:

  1. Restore health security leadership at the White House National Security Council.
  2. Commit to full and sustained multi-year funding for the Global Health Security Agenda to build partner capacity.
  3. Establish a Pandemic Preparedness Challenge at the World Bank to incentivize countries to invest in their own preparedness.
  4. Ensure rapid access to resources for health emergencies.
  5. Establish a U.S. Global Health Crises Response Corps.
  6. Strengthen the delivery of critical health services, including immunizations and health services for women and girls, in disordered settings.
  7. Systematically confront two urgent technology challenges: the need for new vaccines and therapeutics and the public health communications crisis.

The full report includes details for each of the recommendations regarding programs and funding needs, with a request for an increase in funding from the current levels to $905 million.  Read the report in its entirety here.

National Biodefense Science Board – Public Meeting
Don’t miss this December 3rd event regarding pandemic influenza preparedness and enhancing medical countermeasures against various biological threats. The public agenda can be found here, which includes emerging topics in biodefense, like Eastern Equine Encephalitis.

Chemical Weapons Convention (CWC) Conference of States Parties (CSP)
This week saw the 24th CSP (Conference of States Parties) of the Chemical Weapons CON Convention – you can watch the live-stream courtesy of the OPCW (Organization for the Prohibition of Chemical Weapons). Richard Guthrie has also provided daily reports of the CSP, which are a highly valuable resource and available here. Since it will run through the rest of this week, make sure to not only check out the daily recaps, but also his summary. Moreover, you can also read last year’s CSP coverage. On the second day of the CSP, one can read the general debate, which revealed the positions different delegates shared – “here were a number overarching themes; some of which will be examined here and some in the next daily report. There were also some notable points from individual statements. The session started with group statements from: the European Union; Azerbaijan on behalf of the CWC states parties that are members of the Non-Aligned Movement (NAM) and China; and Sudan on behalf of the Africa Group.” On Wednesday, it was announced that at the 24th CSP, the CWC adopted two decisions to amend for the first time the Annex on Chemicals to the Convention. “The first decision was jointly proposed by Canada, the Netherlands, and the United States of America while the second decision was proposed by the Russian Federation. Both decisions call for Technical Changes to Schedule 1 of the Annex on Chemicals to the CWC.” Highlighting the adaptability of the CWC, these proposals added families to Schedule 1. This is especially pertinent in the wake of the use of a Novichok agent in Salisbury last year, and the need to revise the the CWC schedules to control for Novichoks. As Stefano Costanzi and Gregory Koblentz noted, “the joint proposal and the portions of the Russian proposal upon which consensus can be reached would significantly strengthen the CWC by considerably expanding the coverage of its Schedule 1 and bringing Novichok agents firmly within the CWC’s verification system. We also argue that, since the OPCW Technical Secretariat did not deem the fifth group of chemicals proposed by Russia to meet the criteria for inclusion in Schedule 1, Russia should withdraw this part of its proposal from consideration. The proposals have also served an important purpose in clarifying the identity of the chemical agent used in the Salisbury incident, squarely placing it within one of the two families of Novichok agents described by the Russian chemical-weapons scientist and whistleblower Vil Mirzayanov.”

Tracking Trends in Toxoplasmosis Transmission 
Too often associated with feline exposures, toxoplasmosis is a neglected parasitic infection that is carried by 40 million people in the U.S. alone. A new study though, broke down decades of outbreaks to better understand the transmission dynamics of toxoplasmosis in humans. The authors note that on a global level, exposure is so high that serologic prevalence varies between 10% and 94% in the adult population. Infection is dependent upon factors like environmental conditions, eating habits, and prevalence of the parasite in the geographical area, among other factors. Transmission mostly occurs through the ingestion of oocyst-contaminated water or vegetables. Reviewing publications on toxoplasmosis outbreaks since 1967, the study team excluded cases in nonhuman species. A total of 573 articles were further analysis was conducted on 33 articles covering 34 reported outbreaks. The highest concentration of outbreaks reported (73.5%) occurred in the Americas, with Brazil having the highest number of published outbreaks. “The authors note, “’the incidence of cyst-related outbreaks from contaminated meat and its derivatives was 47.1% (16/34), and oocysts were implicated in 44.1% (15/34) of the outbreaks. Transmission through the intake of oocysts in water occurred with a frequency of 20.6% (7/34), through contact with sand and soil with a frequency of 17.6% (6/34), and through consumption of vegetables with a frequency of 5.9% (2/34)’.”

Outbreak Dashboard
Influenza activity is picking up as the CDC Flu Tracker noted that 7.3% of respiratory specimens tested by clinical labs were positive for influenza viruses. No new cases of Ebola virus disease were reported in the DRC on Wednesday, but the ongoing conflict has made response in hot spots (Mabalako and Beni) difficult.

Pandora Report: 11.22.2019

Happy Antibiotic Awareness Week! Are you being a good steward of antimicrobials during this respiratory virus season?

When A Lab Explosion Ruins Your Day – Stories of Vector 
A few months back, an explosion at the Russian laboratory complex known as the State Research Centre of Virology and Biotechnology (Vector), raised a red flag regarding the stockpiling of smallpox and realistically, biosafety/biosecurity. Not surprisingly, stories about where the explosion occurred, what was kept in that area, and all manner of horror movie-esque plots began to swirl. Gwyn Winfield though, has broken down the rumors, the realities, and the challenges of understanding what exactly happened when well, there’s not a lot of trust in Russian explanations. Gwyn takes care to highlight how fast speculation occurred though, and that while it may not have been easy to get answers right away, the theatrics of lab-to-bioweapon speculation does little good. Noting that the blast occurred on the 5th floor of building one – “The floor had been under repair since July, and since there was no research in progress there, and the area was not secure, there were no pathogens on that floor to be released.” As Winfield notes, the lack of information makes things challenging and while experts might make guesses, “the individuals that need to take the most lessons from this are exercise planners, globally but especially in Russia”. You can read the full article here.

The Microbiome and AMR
Microbiota bear effects on a variety of chronic diseases such as gastrointestinal, autoimmune, respiratory, neurological, and cardiovascular conditions; however, the microbiome also plays a role with infectious diseases. The growing body of research on the importance of the microbiome to human health links natural flora and the immune system, which are in a largely symbiotic relationship. More specifically, a healthy microbiome aids in the induction, training, and function of the immune system and, in return, the immune system maintains a happy balance between natural flora and the host human. Unfortunately, that relationship is under great threat as the persistent overuse of antibiotics destroys not only the invasive bacteria but also the healthy bacteria that help maintain immune function. Antimicrobial resistance (AMR) is ability of microbes – bacteria, viruses, fungi – to circumvent the mediating effects of antibiotic, antiviral, and antifungal therapeutics. The overuse of antibiotics enables strong, resistant bacteria to survive in the host, so your gut ultimately populates with mostly resistant bacteria, even bacteria resistant to multiple drugs. Disruptions to the microbiome by antibiotic use adds to the spread and strength of antimicrobial resistance in harmful microbes. Our overreliance on the prescription of antibiotics to alleviate bacterial infections, even minor ones that the immune system may be able to overcome, and a lack of medication compliance resulting in misuse are chipping away at the clinical efficacy of these drugs. This is of considerable concern as microbes become cleverer and less susceptible to multiple medications, resulting in infections that are less and less treatable. According to the CDC, there are over 2.8 million antibiotic-resistant infections in the US each year and more than 35,000 people die from those infections. The critical task at hand is to develop alternative therapeutics that can treat infections while, at least, not contributing to further microbial resistance. As a mediator for colonization resistance and a symbiote of the immune system, the microbiome possesses potential as a therapeutic gateway to subvert resistance.

Biodosimetry Biomarkers and Serum Proteomic Signatures – GMU Biodefense Alum Tackles It All 
GMU Biodefense doctoral student Mary Sproull is our resident guru on radiation – she’s a biologist in the Radiation Oncology Branch of the National Cancer Institute at NIH. Here are just two more reasons why Sproull is the go-to person for things like biodosimetry: she has two new publications that you’ll want to check out. The first, Comparisons of Proteomic Biodosimetry Biomarkets Across Five Different Murine Strains (try saying that five times fast) “seeks to compare the expression levels of five previously established proteomic biodosimetry biomarkers of radiation exposure, i.e., Flt3 ligand (FL), matrix metalloproteinase 9 (MMP9), serum amyloid A (SAA), pentraxin 3 (PTX3) and fibrinogen (FGB), across multiple murine strains and to test a multivariate dose prediction model based on a single C57BL6 strain against other murine strains.” Make sure to read this study as it discusses why these strain specific differences exist between expression levels. In the second article A Serum Proteomic Signature Predicting Survival in Patients with Glioblastoma, Sproull and the research team discuss this common brain tumor and how developing adequate biomarkers can help drive stronger patient outcomes. “Analysis of potentially relevant gene targets using The Cancer Genome Atlas database was done using the Glioblastoma Bio Discovery Portal (GBM-BioDP). A ten-biomarker subgroup of clinically relevant molecules was selected using a functional grouping analysis of the 40 plex genes with two genes selected from each group on the basis of degree of variance, lack of co-linearity with other biomarkers and clinical interest. A Multivariate Cox proportional hazard approach was used to analyze the relationship between overall survival (OS), gene expression, and resection status as covariates.”

Gene Editing
Advancements in biotechnology pose potentials and perils as such technology becomes easier to access and use by a wide array of bio-users, not just formally trained scientists at professional laboratories. Gene editing, the alteration of an organism’s DNA, is one such biotechnology. A number of research and government entities are working diligently to maximize the potential benefits of gene editing while simultaneously minimizing its perils. Two such entities are the National Academies of Sciences, Engineering, and Medicine and the Defense Advanced Research Projects Agency (DARPA). The former is concerned with perils of synthetic biology while the latter is trying to unlock its potential. The National Academies of Sciences, Engineering, and Medicine just released Strategies for Identifying and Addressing Vulnerabilities Posed by Synthetic Biology: Proceedings of a Workshop in Brief, which summarizes the key discussions in an October 2018 meeting of experts and policymakers following a report for the DOD, Biodefense in the Age of Synthetic Biology. The meeting’s purpose was to assemble federal personnel and the committee for the DOD report to consider the implications for actions DOD might take to quell potential misuse of synthetic biology capabilities. The committee evaluated 12 capabilities associated with (1) the synthesis and modification of pathogens; (2) production of chemicals, biochemicals, and toxins; and (3) modulation of human physiology. Each of the three capability areas were assigned relative levels of concern in terms of the usability of a technology, its usability as a weapon, its requirements of actors, and the potential for its mitigation. Additional workshop discussions included the potential of delivery mechanisms to serve as a barrier to the misuse of synthetic biology to produce weapons, the possibility to use synthetic biology to modify human physiology in new ways, and opportunities in computational biology to alleviate fears about synthetic biology capabilities through the prevention, detection, and attribution of its misuse. DARPA’s latest biotechnology project is the “Detect It with Gene Editing Technologies” program, more lovingly called DIGET. The primary objective of DIGET is “to provide comprehensive, specific, and trusted information about health threats to medical decision-makers within minutes, even in far-flung regions of the globe, to prevent the spread of disease, enable timely deployment of countermeasures, and improve the standard of care after diagnosis.” The DIGET dream deliverables are two devices: (1) a handheld and disposable point-of-need tool that simultaneously screens 10 or more pathogens or host biomarkers and (2) a multiplexed detection platform that simultaneously screens at least 1,000 clinical and environmental samples. DIGET seeks to incorporate gene editors and detectors biosurveillance as well as swift point-of-need diagnostics for endemic, emerging, and engineered pathogens. DARPA is hosting a Proposer’s Day meeting about the DIGET program on 11 December 2019.

Biological Threats to U.S. National Security – Subcommittee on Emerging Threats and Capabilities 
On Wednesday, Dr. Thomas V. Inglesby, Dr. Tara J. O’Toole, and Dr. Julie Gerberding gave testimony to this subcommittee within the U.S. Senate Committee on Armed Services. During the testimony, Dr. Inglesby “noted the growing threat of biological events that can emerge from nature, deliberate attack, or accidental release and reviewed current US government efforts in this arena. He presented recommendations to improve the government’s response to and preparedness for a major biological event.” You can read his full testimony here.

Revisiting the Biological Weapons Convention Protocol
Lynn Klotz recently wrote on the gaps within the BWC in relation to compliance monitoring. Despite efforts to change this in the past, those pushing for a protocol to randomly select site visits as means to do quality checks, have been disappointed over the years as administrations cite that such additions would not truly verify or provide greater security. As Klotz underscores – this sentiment fundamentally misses the goal of the protocol…which is transparency. “But recent events serve to underscore that a protocol to the convention to address the treaty’s shortcomings is an idea that should be revisited. Unfounded Russian allegations about biological weapons development in former Soviet countries are threatening the effectiveness of the convention. This concern along with strong arguments for the high importance of transparency in international treaties calls for revisiting the protocol, which had provisions for both transparency and for dealing with allegations like Russia’s.” Citing the 2019 meeting in which Russia alleged that several former Soviet states had active bioweapons programs, distrust soon grew and disruption rippled throughout the BWC. Klotz emphasizes that this exact situation is a prime reason why a protocol should be revisited – to help build confidence through increasing transparency. Not a free-for-all, but rather through managed-access rules, such as random visits by inspection teams would help verify the absence of bioweapons. Klotz takes care to discuss why protocol efforts were abandoned in 2001 and the role of transparency in multilateral arms control regimes, which you can read more about here.

Health Security Career Panel (Left to Right): Ashley Grant, Stuart Evenhaugen, Syra Madad, Sapana Vora, Halley Smith, Justin Hurt, and Malaya Fletcher.

GMU Hosts Health Security Career Panel 
Last week, adjunct professor Ashley Grant, a lead biotechnologist at the MITRE Corporation, held a career panel at the Schar School of Policy and Government at George Mason University as part of her course on Global Health Security Policy. To highlight the different paths that graduate students in the Biodefense program can take in the health security field, Professor Grant convened a diverse panel of health security practitioners to discuss their jobs and the skills they have needed to succeed. The panel included professionals from a variety of different backgrounds ranging from local health providers to Federal employees. Students in the Schar School’s Biodefense Graduate Program were able to ask the panelists about the challenges of moving from a technical career path into science policy and opportunities for internships. The panel included Stuart Evenhaugen of the Assistant Secretary for Preparedness and Response (ASPR)’s Strategy Division in the Department of Health and Human Services (HHS); Syra Madad, the Senior Director of System-Wide Special Pathogens Program at NYC Health + Hospitals; Halley Smith, a program lead with the U.S. Department of State Cooperative Threat Reduction Program, on detail from Sandia National Laboratories Global Chemical and Biological Security Program; Sapana Vora, the Deputy Team Chief for the U.S. Department of State’s Biosecurity Engagement Program (BEP) and Iraq Program in the Office of Cooperative Threat Reduction (CTR); and Malaya Fletcher, a Lead Scientist at Booz Allen Hamilton in Washington, DC.  The panel also included LTC Justin Hurt a CBRN/WMD Organizational Integration Officer in the Army G-3/5/7 Office who is currently enrolled in the Biodefense PhD program. As biodefense graduate student Michael Krug noted, “The panel was immensely valuable in providing detailed insights and experiences into each of the panelist’s unique career paths. Emphasizing the demand for multi-disciplined approaches, as well as active communication to answer the many health security questions facing the world.”

A Little Bit of Plague and A Whole Lot of Panic  
Plague – a word that still sparks fear after hundreds of years. Two cases were recently reported in China’s Inner Mongolia and of course, it involved a hunter and butchering/eating a wild animal. Diagnosed on November 5th, there were two additional cases reported in Beijing but from the Inner Mongolia area. “In both cases, the two patients from Inner Mongolia were quarantined at a facility in the capital after being diagnosed with pneumonic plague, health authorities said at the time. The Inner Mongolia health commission said it found no evidence so far to link the most recent case to the earlier two cases in Beijing.” As many have pointed out, the fear around this news has been more damaging to response efforts. Pneumonic plague is not as highly contagious as many news outlets have let on – only requiring Droplet + Standard isolation precautions and plague is easily treatable with antibiotics or prophylaxis.

Should We Be Celebrating CRISPR’s Anniversary?
It’s not many times an expert and innovator writes an article entitled “CRISPR’s unwanted anniversary” about a tech they were instrumental in developing. Dr. Jennifer Doudna recently wrote on those moments that can make or break a disruptive technology and in the case of CRISPR, it was last year, when Hong Kong-based scientist He Jiankui started the CRISPR baby drama. This was a pivotal moment in not only biotech, but also genome editing and its future. As Doudna notes, it’s comforting that scientists around the world reacted with conversations about the need for safeguards and transparency as CRISPR technology grows. In the face of this anniversary though, what has been done? Are there consequences for going against widely accepted norms? Doudna leaves us with the notion that “The ‘CRISPR babies’ saga should motivate active discussion and debate about human germline editing. With a new such study under consideration in Russia, appropriate regulation is urgently needed. Consequences for defying established restrictions should include, at a minimum, loss of funding and publication privileges. Ensuring responsible use of genome editing will enable CRISPR technology to improve the well-being of millions of people and fulfill its revolutionary potential.”

Outbreak Dashboard
In keeping up with the latest outbreaks, here are some quick updates on a handful of the infectious disease events that are going on  – The outbreak of Ebola virus disease in the DRC may be slowing as there were no new cases reported on November 19th but over 400 suspected cases were still being assessed (total case count is 3,296). With the recent approval of the Ebola vaccine by the European Medicines Agency (EMA), the distribution of the vaccine will increase and could impact the outbreak as well. Nigeria is facing a Yellow Fever outbreak, which it has struggled against since 2017. In the past 4 weeks, 839 new cases have been reported. Flu activity is increasing in the United States and the predominant strains are B/Victoria, A(H3N2) and A(H1N1)pdm09. 2.3% of healthcare provider visits in outpatient settings were for influenza-like illnesses. There is also a new E. coli outbreak linked to pre-packaged chicken Caesar salads impacting 17+ people across 8 states.

Hot Spots and Inadequate Monitoring for Bioterrorism – An American Story
Law professor Ana Santos Rutschman of Saint Louis University recently wrote on the usual and unusual biological suspects and how organisms like Salmonella can easily be overlooked as cases of bioterrorism (case in point the 1984 Oregon attack). Rutschman delves into preparedness efforts, like BioWatch, and how “there is a profound lack of coordination between federal agencies and local communities. When asked about what happens after notifications of a possible bioterrorism attack, Dr. Asha George, executive director of the Bipartisan Commission on Biodefense, answered: “They go off but nobody knows what to do.

Stories You May Have Missed:

  • Ongoing Outbreaks Trigger Laws to Limit Vaccine Exemptions – in the middle of measles outbreaks and pertussis cases occurring frequently, there is a desperate need for reducing vaccine exemptions that protect the anti-vaccine instead of the public’s health. “In 2018, the same research group published a study showing that, despite rising numbers of proposed antivaccine laws, pro-vaccine bills were more likely to become law. For the current study, the team looked at how health data might affect laws. The new findings come following a surge of measles activity in the United States this year, mostly fueled by a few large outbreaks that nearly cost the nation the measles elimination status that it achieved in 2000.”
  • Acinetobacter Baumannii Risk Factors– “After assessing 290 isolates, they found that 169 were endemic (96 of REP-1) and the most common site for isolation was the respiratory tract. In total, 109 patients (37%) had only Acinetobacter baumannii isolated, while some had up to 5 other organisms also identified. In those colonized, 69 were REP-1, and 64 with REP-2-5, the research team found that for those patients with REP-1, there was a 70% increase in carriage per increase in Schmid score (statistically significant), and a 50% increase in REP-2-5. Interestingly, prior colonization, longer lengths of stay, and immunosuppression did now have a statistically significant relationship with Acinetobacter baumannii colonization. “

 

Pandora Report: 11.15.2019

We’re back and we’ve got quite a packed newsletter for you, so grab a beverage and get ready for the warm fuzzies of biodefense news.

Failing to PREDICT the Next Pandemic
A few weeks back, it was announced that funding for the PREDICT program would cease after $207 million was sunk into the initiative. GMU biodefense MS student Michael Krug has provided a deep-dive into what PREDICT worked towards, the debated success, and what its cancellation means. “However, even with the billions of dollars spent on ensuring a robust global biosurveillance network, it remains unknown if this network can predict what the next disease will be or where the next outbreak will occur.” Read more here.

An Antibiotic Eclipse – Scenario or Future?
GMU Biodefense doctoral alum and infection preventionist Saskia Popescu discusses the looming threat of antibiotic resistance and what a future with little to no treatment options would look like. From dwindling options for secondary infections related to influenza to declining surgeries, a future without antibiotics is dim. Popescu highlights what this looks like and how we’re quickly approaching it through both the drying antibiotic pipeline, but also limited surveillance, and challenges in changing both stewardship and infection control measures. The existential threat of antimicrobial resistance is very real and Popescu provides a scenario portraying the economic and human costs that antimicrobial resistance could impose on society 30 years from now, if it is not addressed soon. You can read the full article here. This is an especially relevant topic as the CDC just released new data, finding that annually, 2.8 million resistant infections and 35,000 related deaths occur in the United States. The CDC report notes that “However, deaths decreased by 18 percent since the 2013 report. This suggests that prevention efforts in hospitals are working. Yet the number of people facing antibiotic resistance in the United States is still too high.”

Event Recap – People, Pigs, Plants, and Planetary Pandemic Possibilities 
If you happened to miss this November 5th event, no worries – GMU biodefense doctoral student Stevie Kiesel has provided an in-depth summary of the panel and discussions. Kiesel notes that the panel had insightful discussions on the need to understand local context and empower people and local public health communities. Local context is important for combating misinformation and getting a more accurate understanding of conditions on the ground. For example, the public health community must understand why a country may be disincentivized to report a disease outbreak in its early stages, when it is more easily controlled. Authoritarian governments who maintain tight messaging control may not want to admit to an active outbreak, or the economic drawbacks of announcing an outbreak may be so severe that leaders try to hide what’s going on. You can read more here.

Pandemic Policy: Time To Take A Page Out Of The Arms Control Book
Rebecca Katz is holding back no punches in her latest article on the broken policy approaches we have to international outbreak accountability, and frankly, it’s long overdue. Full disclosure, the first line is one of my favorites – “Last month, the World Health Organization (WHO) was reduced to the equivalent of playground pleading: ‘But you promised!’” Katz highlights that in the face of countries failing to meet their obligations within the International Health Regulations (IHR), the WHO has little recourse to act and frankly, the path to accountability isn’t particularly clear. Ultimately, this problem could be solved though, if instead of rewriting the IHR, we modeled such treaties in the image of the Biological Weapons Convention (BWC) to help convene regular review conferences, discuss developments, and establish a regulatory response that could help drive accountability. “As the former US representative to the BWC, Charles Flowerree, wrote, treaties ‘cannot be left simply to fend for themselves’.”

The 5th Annual Pandemic Policy Summit at Texas A&M University
GMU Biodefense doctoral student Rachel-Paige Casey has provided an in-depth review of this important summit earlier this week. The objective of each Summit is to convene researchers, medical professionals, practitioners, private sector experts, NGO representatives, and political leaders to examine issues in pandemic preparedness and response, health security, and biodefense. The foci of this year’s Summit were the promises and perils of technology; BARDA leadership through its history and today; the effect of the anti-vaccine movement on pandemic preparedness and response; and ongoing outbreaks. Key discussions included the inadequacy of biopreparedness, worries regarding emerging biotechnologies, the modern vaccine hesitancy movement in the US, and the leadership and future of BARDA. You can read more about the summit here.

Catalyst- A Collaborate Biosecurity Summit 
Don’t miss this February 22, 2020 event in San Francisco. “Catalyst will be a day of collaborative problem-solving for a broad range of people invested in the future of biotechnology, including synthetic biologists, policymakers, academics, and biohackers. We aim to catalyze a community of forward-looking individuals who will work together to engineer a future enhanced by biology and not endangered by it.The summit is free to attend for everyone accepted, and the application only takes a few minutes. We expect participants to come from diverse backgrounds, and welcome applicants who do not work professionally in biosecurity or biotechnology, who are early in their careers, and who are skeptical of how biosecurity discussions are typically framed. You can apply to attend here.

Firehosing – the Antivaxxer Strategy for the Transmission of Misinformation
Researchers Christopher Paul and Miriam Matthews of Rand introduced this idea in 2016 and it’s proving to be pretty accurate for how anti-vaccine advocates are pushing out their opinions. Lucky Tran of The Guardian recently made the link between antivaxxers and the strategy of firehosing, which entails a massive flow of disinformation to overwhelm the audience. Just like it sounds, firehosing involves pushing out as many lies as frequently as possible to overwhelm people with information and making it nearly impossible for a logical response to combat that much disinformation. Tran stumbled across this application by seeing it on a television show with anti-vaccine influencers like Jay Gordon and he employed this strategy. “Anti-vax influencers such as Jay Gordon and Andrew Wakefield can keep repeating disproved claims – and in the case of Wakefield, doing so despite having had his medical license revoked – because their lying effectively debases reality and gains them followers and fame in the process.” The Rand study can be found here, which originally discussed firehosing in the context of Russian propaganda – as it has two “distinctive features: high numbers of channels and messages and a shameless willingness to disseminate partial truths or outright fictions. In the words of one observer, ‘[N]ew Russian propaganda entertains, confuses and overwhelms the audience’.” In the face of this relatively new tactic, there is a desperate need to remove false anti-vaccine content from social media and websites, and to put more pressure on media and news platforms to not provide support for such guests/conversations.

Crowd-Control Weapons – Are They Really Non-Lethal?
The term “non-lethal” or “less-than-lethal” gets thrown around a lot when it comes to crowd/riot-control weapons but just how non-lethal are these methods if they’re overused? Physicians for Human Rights (PHR) dug into this very issue because frankly, the use of these weapons is quite common and if they’re not used properly, or with the proper training, they can be devastating. Routine use or misuse of agents like tear gas can be deadly. The PHR conducted several investigations into their use by governments in Bahrain, Georgia, Kashmir, Turkey, and other countries and ultimately, what they found was some pretty startling misuse that can result in long-term health outcomes or even death. They put together a report and factsheets on specific “non-lethals” like acoustic weapons, rubber bullets, stun grenades, tear gas, and even water cannons. Within each factsheet, you can read about the history, how they work, device types, health effects, legality of use, and considerations and policy recommendations. Within the report, they reviewed usage of the weapons including things like people who suffered injuries or even death. As protests occur in China, the use of sonic weapons for crowd control are a very real reminder of the fine line we walk when using “non-lethals”.

Ebola Outbreak Updates and Vaccine Approval 
This week, the European Medicines Agency (EMA) approved the V920 vaccine for Ebola Virus Disease (EVD) and it is already being administered in the Democratic Republic of the Congo. The ongoing EVD outbreak in the Democratic Republic of the Congo (DRC) started in August 2018 and has now exceeded 3,000 cases and 2,000 deaths. Since the 2014-15 outbreak in West Africa, advances in medical research produced new vaccination and therapeutic options. The V920 vaccine, developed and produced by Merck, was tested during the outbreak and showed a 97% efficacy rate and protects against the Zaire species, which is the strain responsible for the current outbreak. Johnson-and-Johnson is also beginning trials for its investigational EVD vaccine. Johnson-and-Johnson’s vaccine requires two doses, a barrier for patient compliance, and does not contain any antigens from the Ebola Bundibugyo species of the virus. Dr. Dan Lucey, professor of medicine at Georgetown University, wrote an editorial in the British Medical Journal about the new treatments for EVD. Dr. Lucey’s article reviews the findings and shortcomings of the four-arm randomized controlled trial (RCT) evaluating the efficacy of four potential EVD treatments: ZMapp, remdesivir, mAb114, and REGN-EB3. The RCT was discontinued when a strict statistical threshold for decreased mortality was reached REGN-EB3, a monoclonal antibody drug. The punchline for the efficacy of REGN-EB3 is that it is efficacious if administered during the early stage of the disease but not as the diseases progresses. Lucey recommends continuing research on EVD treatments that are successful at later stages of the diseases. Last but not least, the article applauds the rigor and difficulty of this randomized-controlled trial given it was conducted during the outbreak, making it a precedent-setting achievement.

GMU Biodefense Alum Changing the Face of Aerospace Physiology 
We’re excited to share some of the achievements of one of GMU’s biodefense alum – Nereyda Sevilla, a May 2017 doctoral graduate in Biodefense, who is a civilian aerospace physiologist for the Defense Health Agency working as Acting Director of the Military Health System Clinical Investigations Program. She was also recently awarded the Air Force Medical Service Biomedical Specialist Civilian of the Year Award and the Air Force Meritorious Service Medal. If you’d like to see more of Nereyda’s hard work in action, check out the article she and the Spatiotemporal Epidemiologic Modeler (STEM) Team published in the Sept 2019 edition of Health Security,  “STEM: An Open Source Tool for Disease Modeling.” (Volume 17, Number 4, 2019).

Phase 3 Trial of Modified Vaccinia Ankara Against Smallpox
In the last Pandora Report, we discussed the FDA approval of the new smallpox vaccine JYNNEOS, that was tested by USAMRIID. The vaccine, developed by biotechnology company Bavarian Nordic, will enter the market under the name JYNNEOS. You can read about the Phase 3 efficacy trial of JYNNEOS (a modified vaccinia Ankara, MVA) as a possible vaccine against smallpox in the latest New England Journal of Medicine. GMU Biodefense professor and director of the graduate program, Dr. Gregory Koblentz noted that one of the key findings of this Phase 3 efficacy trial is that even though the FDA has approved a two-dose regimen for MVA (since it is a non-replicating vaccine that uses an ), a single dose of MVA provided the same level of protection as a single dose of the replicating vaccinia vaccine ACAM 2000. “At day 14, the geometric mean titer of neutralizing antibodies induced by a single MVA vaccination (16.2) was equal to that induced by ACAM2000 (16.2), and the percentages of participants with seroconversion were similar (90.8% and 91.8%, respectively).” An additional advantage of MVA over ACAM 2000 is that the former can be administered by a subcutaneous injection while the latter requires scarification through the use of a bifurcated needle. The article concludes that “No safety concerns associated with the MVA vaccine were identified. Immune responses and attenuation of the major cutaneous reaction suggest that this MVA vaccine protected against variola infection.”

Key Global Health Positions – A Who’s Who in the U.S. Government
Have you ever wondered who helps support global health within the U.S. government?  The Kaiser Family Foundation (KFF) has created a substantial list on not only the positions, but also who (if anyone) is occupying them. From the Department of Health and Human Services to the Department of the Treasury, you’ll want to utilize this list to not only realize the scope of global health efforts within the USG, but also who you might need to get in touch with.

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  • African Swine Fever Continues to Spread in Asia – Unfortunately, this outbreak isn’t showing signs of letting up… “The update shows new outbreaks in Vietnam, Cambodia, Laos, the Philippines, South Korea and on the Russian side of the Chinese border reported during the first week of November. Meanwhile, formal confirmation is awaited of ASF outbreaks in Indonesia. The FAO reports that more than 4,500 pigs are said to have died in 11 regencies/cities in North Sumatra. Dead pigs were also found in a river. FAO is liaising with the Indonesian authorities to ‘confirm the cause and explore needs’.”