Pandora Report 7.6.2018

 

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

Pandora Report 6.29.2018

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report 6.22.2018

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

Pandora Report 6.15.2018

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

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

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

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report: 6.1.2018

Happy Friday! We’re excited to announce that the early registration discount for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security has been extended to July 1st, so don’t miss out on the chance to attend at a discounted rate. Before we dispense our weekly dose of all things biodefense, just a friendly reminder that the Pandora Report will be on hiatus next week, but will return the week of June 15th.

Ebola Outbreak in DRC: Updates
Community resistance and mistrust have been reported in the DRC as response efforts and vaccination are underway. Similar issues were also seen during the 2014 West Africa outbreak. Thankfully, cases are reportedly dropping following additional testing capacity. The latest WHO situation report announced a total of 54 cases and 24 deaths, with a case fatality rate of 46.3%. International response to the outbreak is being evaluated and the role of the United States is reportedly less dominant, which have many pointing to the lack of a NSC point person. “The United States has played much less prominent role in the latest Ebola outbreak, raising some questions about the nation’s commitment to global health security but also reflecting that the global capacity to respond to such an outbreak has become much more robust following West Africa’s massive outbreak, the Kaiser Family Foundation (KFF) said today in a policy brief.” The KFF report also notes that “The Trump Administration had installed a well-known global health expert, Admiral Tim Ziemer, as the lead on biosecurity and global health at the National Security Council (NSC) in 2017, but his position was recently eliminated as part of an overall reshuffling of NSC staff under the leadership of new National Security Advisor John Bolton; the move was coincidentally announced the same week the DRC Ebola outbreak was declared. Without this position, other NSC staff have been tapped to lead the U.S. response to the outbreak but have not made any public statements, and no public statements have been made by the current CDC Director. Whether and how to designate a point person on outbreaks is a debate that predates the DRC Ebola outbreak, but the ongoing outbreak has added some urgency to this discussion.” As the deployment of the vaccine is ongoing, many are wondering – what took so long? Schar biodefense PhD alum Christopher K. Brown discusses the barriers to vaccine development and deployment to the public in Africa. Brown notes that”Vaccine development is a complex process. It involves both public and private partners and requires that a variety of funding issues be considered. Competing market forces influence how a vaccine project advances—from discovery to laboratory and clinical trials, and later to registration, regulatory approval, and large-scale manufacturing and implementation.” Further more, Brown highlights that “even comparing Ebola to other diseases that disproportionately affect African countries, it is hard to argue that Ebola is, or ever has been, the best disease on which to focus vaccine research and development resources.”

 GAO Report: Funding and Performance of Key Preparedness and Capacity-Building Programs
The latest GAO report is evaluating the preparedness efforts of HHS to protect the U.S. against infectious disease threats. “Over a 15-year period, HHS awarded about $3 billion to states and others to respond to specific disease threats, such as Zika, Ebola, and H1N1 pandemic influenza. HHS awarded an additional $18 billion for more general public health preparedness and capacity-building activities, such as getting ready for infectious disease threats and terrorist events. We assessed preparedness efforts of states and others and found mixed results. For example, most responder protection and coordination efforts met goals, while efforts in other areas were less consistent.” The GAO report assessed three major preparedness and capacity-building programs within HHS – Epidemiology and Laboratory Capacity for Infectious Diseases (ELC), Hospital Preparedness Program (HPP), and Public Health Emergency Preparedness (PHEP). The preparedness capacity areas were electronic lab reporting, epidemiology capacity, laboratory capacity, and responder protection. “The majority of awardees (states and other jurisdictions) that reported on performance measures in the responder protection area met all performance targets in this area. However, awardee performance in the other three preparedness capacity areas was mixed.”

Economic Burden of Seasonal Flu
Need more reason to get your seasonal flu shot? A new study assessed the economic burden of seasonal flu in the United States through health outcome rates from 2015. The results? “The estimated average annual total economic burden of influenza to the healthcare system and society was $11.2 billion ($6.3–$25.3 billion). Direct medical costs were estimated to be $3.2 billion ($1.5–$11.7 billion) and indirect costs $8.0 billion ($4.8–$13.6 billion). These total costs were based on the estimated average numbers of (1) ill-non medically attended patients (21.6 million), (2) office-based outpatient visits (3.7 million), (3) emergency department visit (0.65 million) (4) hospitalizations (247.0 thousand), (5) deaths (36.3 thousand) and (6) days of productivity lost (20.1 million).” Not surprisingly, seasonal flu is responsible for considerable economic burden, on top of morbidity and mortality within the United States. Just another reason to get your flu shot and encourage others to do the same.

Insufficient Infection Prevention Staffing in Healthcare
A new study finds that hospital infection prevention and control programs are woefully understaffed in the United States. Schar Biodefense PhD student and infection preventionist Saskia Popescu, discusses why this is problematic, not just for healthcare-associated infections, but ultimately hospital preparedness for infectious disease threats. “The 2014 Ebola cluster in Dallas, Texas, underscored the importance of infection prevention practices and preparedness in health care, which adds another layer of complexities to health care programs. Infection preventionists (IPs) who make up the back-bone of these teams are responsible for a range of duties that include surveillance and investigation of health care-associated infections, environment of care rounding, national reporting for quality metrics, isolation rounding, communicable disease reporting, and more.”

CRISPR – Could It Make Jurassic World?
The latest Jurassic Park movie, Jurassic World, is being released soon, and within this installment lurks a genetically modified dinosaur. But just how realistic is it for scientists to bring back an extinct animal…or modify one? “The idea of resurrecting extinct creatures using CRISPR has been discussed at length since the technology was developed. These conversations have largely focussed on the woolly mammoth, which last roamed the Earth 3,300 years ago. In 2015 a team of researchers working at Harvard University took a significant step toward the creation of a creature that would, on an initial approximation, look like a woolly mammoth – a woolly mammoth 2.0 of sorts. Researchers have clearly not yet triggered the live birth of a woolly mammoth, but we have already seen the birth of a living creature previously declared extinct. The Pyrenean ibex, or bucardo goat, was once found in the mountains of northern Spain. The last ever bucardo, affectionately named Celia, died in the year 2000.”

DPRK-U.S. Summit: Back On
The summit between the U.S. and DPRK is back on and is scheduled for June 12th in Singapore. “‘The key outcome of this meeting is to specify what the U.S. and North Korea mean by ‘denuclearization’ and if there is any overlap between these definitions,’ said Gregory Koblentz, associate professor at the Schar School of Policy and Government at George Mason University. ‘If not, then summit still in doubt’.” President Trump is reportedly looking forward to the summit, but many are anxious to see the outcome of such a meeting.

Stories You May Have Missed:

  • Hot Temperatures & Antibiotic Resistance – A “new paper in Nature Climate Change that explores the role that climate and other factors play in the distribution of antibiotic resistance in the United States. The study, conducted by researchers with the University of Toronto, Harvard Medical School, and Boston Children’s Hospital, shows that increasing local temperatures are associated with higher levels of antibiotic resistance in three common bacterial pathogens—Escherichia coli, Klebsiella pneumoniae,and Staphylococcus aureus. The researchers also found that higher population densities and antibiotic prescribing rates are associated with higher rates of drug resistance.”
  • Netflix Zombie Movie Cargo – Looking for a new zombie summer flick? Netflix has just released a new one that offers an interesting twist on the struggle to survive. “Written by Yolanda Ramke and directed by Ramke and Ben Howling, based on their 2013 short film of the same name, Cargo takes place in a world where a pandemic has decimated the population. Once infected, people have 48 hours before they turn into bloodthirsty maniacs. The government has helpfully issued emergency packets to the populations, which include a stylish watch with a 48-hour countdown mode, and a DIY suicide kit.”

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

Pandora Report: 5.25.2018

Ebola Vaccine Deployment in DRC and Nipah Virus Takes Hold in India 
The Ebola vaccine has been deployed and many are holding their breath to see if not only this new tool works, but if lessons were truly learned from the last outbreak. As of May 21st, there were a totally of 58 cases, including 27 deaths. 28 of these cases were confirmed and 21 were probable. So far, five healthcare workers have been infected, with four of them confirmed and two deaths. “Currently, WHO considers the public health risk to be very high at the national level due to the serious nature of the disease, insufficient epidemiological information and the delay in the detection of initial cases, which makes it difficult to assess the magnitude and geographical extent of the outbreak. The confirmed case in Mbandaka, a large urban centre located on major national and international river, with road and air transport axes, increases the risk both of local propagation and further spread within DRC and to neighbouring countries. The risk at the regional level is therefore considered high. At the global level, the risk is currently considered low.” In response to the outbreak spreading to a larger, metropolitan area, many are wondering what cities nearby should start preparing for potential cases. Such concern is especially pertinent as it was reported that three infected patients fled an isolation ward and posed a potential threat for disease transmission. In efforts to identify potential areas at an increased risk due to travel, researchers used “flight data from the airports in Mbandaka, Kinshasa, and Brazzaville–those nearest Bikoro–EcoHealth Alliance has found the following cities to be most closely connected to the point of origin of the ongoing Ebola outbreak – Pointe-Noire, Republic of Congo, Adidas Ababa, Ethiopia, Brazzaville, DRC, etc.” Border closure is also frequently discussed during outbreaks, but realistically, how would it work? “Researchers who have studied earlier border-crossing outbreaks say the checks amount to little more than political theater. They do little to curb the spread of a disease, but they are likely to apprehend uninfected travelers, slow down commerce, and most importantly, impede the delivery of relief supplies. In a worst-case scenario, health stops may cause infected people to sneak to border crossings where checks haven’t been set up, spreading disease as they go.”  Money is starting to trickle in as the World Bank, the United States, and Germany, have contributed a joint $25 million to the DRC outbreak. The WHO is reportedly working with nine neighboring countries of the DRC to help contain the outbreak and prevent its spread. While all eyes have been on this outbreak, many are trying to draw attention to a very serious outbreak of Nipah virus in India. 10 people have died so far in the outbreak, including a nurse who was treating patients. “The first cases were reported Saturday in a family from Kozhikode, and then India’s Ministry of Health and Family Welfare and the World Health Organization were contacted, Vijayan’s office said Monday via Twitter. Two brothers in their late 20s and their aunt, 50, died from the virus, while their father, 56, remains on life support.” These outbreaks will surely be a topic of conversation during this week’s World Health Assembly at the WHO.

Worrisome White House Actions Surrounding Global Health Security
As Ebola burns through the DRC and India struggles with Nipah virus, the ability (or increasing inability?) for the U.S. to respond to such biological threats is becoming a seriously topic of concern. Within the span of a few days, the Ebola outbreak was declared in the DRC, the White House eliminated the Office of Global Health Security at the NSC, and the White House requested to rescind the $252 million in leftover Ebola response funds. These are just a handful of the the most recent red-flags for the Trump administration and its worrisome approach to health security. Kenneth W. Bernard asks “Has our national security leadership forgotten that, in 2001, anthrax-laced letters killed five and sickened 17 others in multiple states? Or that in 2014, 11 people were treated for Ebola in the United States, resulting in two deaths and widespread panic that nearly shut down the city of Dallas? Or that smallpox killed more people in the 20th century than all the wars of that century combined?” The Editorial Review Board at the New York Times has also cited concerns surrounding the amnesiac approach to Ebola the administration has taken– “The Trump administration has also failed to seek renewed funding from Congress for a global health security initiative begun after the 2014 epidemic. The goal of that initiative was to help high-risk countries prepare for future disease outbreaks in order to prevent pandemics. The White House has touted the success of those efforts but has done nothing to keep them going. And as funds have dried up, the C.D.C. has been forced to scale back or discontinue programs in some of the most vulnerable countries.”

WHO and World Bank Group Team Up for Global Health Security
In response the global threat of infectious diseases, the WHO and Work Bank Group have launched a new monitoring/reporting mechanism. “WHO Director-General Dr Tedros Adhanom Ghebreyesus and World Bank Group President Dr Jim Yong Kim co-led the creation of the Global Preparedness Monitoring Board, launched today on the margins of the 71st Session of the World Health Assembly. The Board will be co-chaired by Dr Gro Harlem Brundtland, former Prime Minister of Norway and former WHO Director-General, and Mr Elhadj As Sy, Secretary General of the International Federation of the Red Cross and Red Crescent Societies. It will include political leaders, heads of UN agencies and world-class health experts, serving in their individual, independent capacities. ‘The ongoing Ebola outbreak in the Democratic Republic of the Congo is a stark reminder that outbreaks can happen anywhere, at any time,’ said Dr Tedros. ‘Part of being prepared is having a means of assessing progress made at all levels, by all actors, identifying gaps, including in financing, and making sure all actors are working together, pulling in the same direction. I’m proud of the work we’ve done together with the World Bank Group to establish the Global Preparedness Monitoring Board, and delighted that it will be led by such exceptional global health leaders,’ he added.”

Summer Workshop – Global Health Security
Don’t miss the chance to discuss these very issues at the Schar Summer Workshop on Pandemics, Bioterrorism, and Global Health Security. This workshop will include frank discussions with professionals and experts regarding the challenges of global health security, the current Ebola outbreak and vaccine, developing MCM, the democratization of science, and more. The early registration discount will end June 1st, so make sure you register soon!

Pandemic Preparedness in the Wake of Ebola -CSIS Symposium
Schar Biodefense graduate student Stephen Taylor recently attended the Center for Strategic & International Studies (CSIS) event on May 17th, in which global health security leaders from around the world discussed pandemic preparedness. Taylor notes, “Dr. Morrison and Dr. Borio discussed the importance of lessons learned during the 2014-2016 West African Ebola pandemic to global health security. In Nigeria, for instance, where Ebola containment efforts were successful, investments in detection and response capacities made for the Nigerian polio eradication program were instrumental in stopping Ebola. Surveillance systems and trained health care workers were embedded at the community level and field epidemiologists were ready to be deployed.”

 The Smithsonian’s “Outbreak: Epidemics in a Connected World”
Biodefense graduate student Zach Goble is reporting out on the newly opened exhibit at the Smithsonian’s National History Museum of Natural History. The museum “launched Outbreak: Epidemics in a Connected World, a new exhibit highlighting the impact infectious diseases have around the globe. The launching of this exhibit could not be more timely on the 100th anniversary of the 1918 influenza pandemic that shook the world. To officially announce and celebrate the opening of this new exhibit, the American Society for Microbiology (ASM), National Institute of Allergy and Infectious Diseases (NIAID), the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention (CDC), the American Society of Virology (ASV), and Research America all partnered together to brief the public on infectious diseases and the vaccines that stop them in their tracks”

NACCHO Radiation Readiness Twitter Chat
Don’t miss out on this June 5th chat to increase awareness of radiation preparedness. “The NACCHO Twitter handle (@NACCHOalerts) will be hosting the chat using #RadReady. The target audience for the Twitter chat is federal, state, and local health department representatives hoping to learn more about radiation preparedness and engage in conversation with their public health peers on radiation preparedness topics. All Twitter users are also are welcome to participate. Topics scheduled to be covered during this chat include: supporting mass care operations, dispelling common radiation myths, radiation response volunteers, etc.”

2018 George Mason 3MT – Biodefense
You can catch a glimpse at recent biodefense PhD graduate Chris Brown presenting his dissertation in under 3 minutes in the GMU 3MT competition. In the GMU 3-Minute-Thesis competition video, you can watch Chris (5:55-8:50) discussing his work – Protecting Critical US Workers from Occupational Exposure to Emerging Infectious Diseases. Congrats Chris!

Stories You May Have Missed:

  • Surviving the 1918/1919 Pandemic– Jose Ameal discusses what it was like living through the 1918/1919 pandemic and the very real fear that was pervasive across the globe. “‘So many dead’, recalls Mr Ameal, now aged 103, of what he saw that autumn of 1918, when he caught the virus known around the world as Spanish flu – a pandemic that is thought to have killed at least 50 million people.”
  • Theranos and Ebola – The wondrous possibility of rapid disease detection that was promised with Theranos has been dead for a while now, but recently, a report regarding their attempts to interject themselves into the 2014 Ebola outbreak have been shocking. USAID’s Jeremy Konyndyk details Theranos’s attempts to get involved in the outbreak, despite knowing their tests were flawed. “Whatever their motive, by 2014 they were clearly aware their tech didn’t work. And yet they were actively pitching it for use in the biggest outbreak emergency the world had seen in years.”

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

Pandora Report: 5.18.2018

 Ebola Outbreak Update
As the DRC continues work on containing an outbreak of Ebola, the question of response measures and vaccine deployment has come up, especially in light of the recent confirmation of a third case in Wangata, a different health zone. The WHO is calling the confirmation of a patient in a metropolitan area, a “game changer” and has initiated emergency meetings. The recent outbreak data now reports a total of 44 cases, 3 of which are confirmed, 20 probable, and 21 suspected. “‘This is not a health issue alone but a crisis that has negative impact on the socio-economic and political situation of the country and the region at large,’ said Lazare Sebitereko Rukundwa. Rukundwa, is the founder of the Eben-Ezer University of Minembwe in Congo, a Hubert Humphrey Fellow and a visiting scholar at George Mason University’s Schar School of Policy and Government”. In response to these cases, the vaccine (VSV-EBOV) has been deployed to the DRC as of May 16th. 4,000 units of it will be used to help stop the outbreak. “DRC Health Minister Oly Ilunga, MD also tweeted that the vaccines will be kept in special vaccine cold rooms in Kinshasa until they’re ready to be shipped to Mbandaka and Bikoro in the coming days. The Merck-produced unlicensed vaccine will be used to squelch an Ebola virus outbreak currently ongoing in three health zones of the DRC. Health officials will use a ring vaccination strategy, giving the vaccine to close contacts of patients first.”

GMU Workshop on Global Health Security – Don’t Miss Out!
Speaking of an Ebola vaccine…did you know that that Dr. Jens Kuhn (but seriously, he has an MD, PhD, PhD, and MS…so he’s as close to Bruce Banner as you’ll get) will be one of our speakers at the summer workshop? Dr. Kuhn is “a Lead Virologist in the Division of Clinical Research at the National Institutes of Health/National Institute of Allegery and Infectious Diseases Integrated Research Facility at Fort Detrick. Dr. Kuhn specializes in highly virulent viral human and animal pathogens”, specifically filoviruses. “Dr. Kuhn was the first western scientist with permission to work in a former Soviet biological warfare facility, SRCVB ‘Vektor’ in Siberia, Russia, within the US Department of Defense’s Cooperative Threat Reduction (CTR) Program” – which means he’s not only a wealth of knowledge, but has some pretty amazing stories to tell. Don’t miss the chance to learn from and chat with experts like Dr. Kuhn at our workshop in July!

Rhodesia’s Chem-Bio Warfare History
Have you gotten the dirt on the Rhodesian chemical and biological warfare program? If you’re looking for a summer read to boost your knowledge on it, GMU Biodefense PhD alum Glenn Cross’s new book, Dirty War: Rhodesia and Chemical Biological Warfare 1975-1980, is just for you. “Glenn Cross’s Dirty War: Rhodesia and Chemical Biological Warfare 1975–1980 is a welcome addition to the small, but growing scholarly literature on the history of chemical and biological warfare. In 1965, the minority white community in the British territory of Rhodesia (officially Southern Rhodesia) rejected demands that it transfer political power to the majority black population. By the mid-1970s, white Rhodesians found it increasingly difficult to counter the growing power of native African nationalists fighting the government. As with many insurgencies, the guerrillas lacked the resources to defeat government security forces in direct combat, but Rhodesian forces were stretched too thin to suppress the insurgents, especially once they had established base camps in neighboring countries. Amidst the conflict, Rhodesian military and intelligence services employed what would now be considered chemical and biological agents against the guerillas with unknown results.”

 Dangers of the Rising DIY Biohacking
It’s likely not the first time you’ve heard about growing concerns regarding the rising popularity of do-it-yourself (DIY) gene editing. From the horsepox de novo synthesis to public stunts at conventions where biohackers injected themselves with HIV treatment, it’s becoming difficult to ignore why these actions are dangerous. The concern regarding the DIY gene editing community is that there are very little restrictions or regulations surrounding what they can or can’t do in a homemade lab. Sure, you can’t go buy Ebola online, but you can start stitching together horsepox, which is pretty scary. “The study’s publication in the journal PLOS One included an in-depth description of the methods used and — most alarming to Gregory D. Koblentz, the director of the biodefense graduate program at George Mason University — a series of new tips and tricks for bypassing roadblocks. ‘Sure, we’ve known this could be possible,’ Dr. Koblentz said. ‘We also knew North Korea could someday build a thermonuclear weapon, but we’re still horrified when they actually do it’.” NYTimes reporter Emily Baumgaertner points to several DIY biohackers who show an unsettling willingness to inject themselves with things they’ve made in their garage labs and that there are fundamentally large gaps in any kind of regulatory system. It’s important to remember that the stop-gap measures in place, imperfect as they are, are for academic researchers, and don’t pertain to those DIY’ers doing it at home. “Authorities in the United States have been hesitant to undertake actions that could squelch innovation or impinge on intellectual property. The laws that cover biotechnology have not been significantly updated in decades, forcing regulators to rely on outdated frameworks to govern new technologies. The cobbled-together regulatory system, with multiple agencies overseeing various types of research, has left gaps that will only widen as the technologies advance. Academic researchers undergo strict scrutiny when they seek federal funding for ‘dual-use research of concern’: experiments that, in theory, could be used for good or ill. But more than half of the nation’s scientific research and development is funded by nongovernmental sources.” As Baumgaertner notes, there are, of course, those in the DIY community who want to ensure biosecurity/biosafety and are just experimenting however, even biohacker celebrity Josiah Zayner has admitted an accident could happen, which would lead to negative outcomes. Whether you’re at home with your mail-order CRISPR kit or you’re working on policies to implement regulations on the biotech industry, we can all admit that the potential for nefarious actors or laboratory accidents is one that warrants safety measures and a hardcore cultural evaluation within the DIY biohacking community. Check out the latest BBC Radio5Live with Rhod Sharp, in which Dr. Koblentz discusses genome editing, biodefense, CRISPR, and biosecurity issues

GMU Biodefense May Graduates and Awards
Congrats to our graduating GMU Bidoefense graduate students – we’re so proud of your hardwork and are excited to see what kind of amazing biodefense work you’ll do in the future! Congrats to two new Biodefense PhDs – Christopher K. Brown (Protecting Critical U.S. Workers from Occupational Exposure to Emerging Infectious Diseases: Toward A Universal Personal Protective Equipment Selection Matrix for Early Outbreak Response) and Jomana Musmar (The Path to PAHPRA: The Evolution of Pediatric Biodefense Legislation and Medical Countermeasure Development). We’re also excited to announce the following Biodefense MS graduates – Zamawang Almemar, Mariam Awad, Laramie Bradford, Michael Conway, Alexander Dowsett, Sarah Doyle, Stephanie Ellis, Haziq Ghani, Zachary Goble, Stephanie Kiesel, Alexander Rowe, Stephanie Smith, and Alexandra Williams. We’d also like to congratulate three of our biodefense graduate students for their student achievements – Stephanie Smith (Outstanding Biodefense Student), Saskia Popescu (Frances Harbour Award- Biodefense Community Leadership), and Christopher Brown (Outstanding Doctoral Student in Biodefense).

Broad-Spectrum Antibiotic Use in Sub-Saharan Africa: Risk Versus Reward
GMU Biodefense PhD student Saskia Popescu evaluated a recent study that analyzed childhood mortality following a widespread distribution of Azithromycin. Popescu not only looks to the experiment and long-term implications of prophylactic antibiotic use, but she also interviewed the PI of the study. “What this study ultimately shows is the considerable impact that mass distribution of a broad-spectrum antibiotic can have against childhood mortality in Sub-Saharan Africa. Following the publication of the study, however, many have flagged the moral dilemma that follows such results. Although the authors make note of the need for policy implementation for future practices and the potential for antimicrobial resistance, the study has nonetheless posed unique ethical questions. The benefits of mass distribution were supported by their research; however, what sort of long-term costs will such communities pay?”

Restoring Restraint: Enforcing Accountability for Users of Chemical Weapons – Event
Don’t miss out on this panel discussion hosted by the Center for Strategic & International Studies on June 19, 2018 from 9:30-11:30am. The keynote address will be given by H.E. Mr Ahmet Üzümcü, Director-General of the Organization for the Prohibition of Chemical Weapons. “In 2012 a 20-year moratorium on state employment of chemical weapons use was broken. Since then there have been more than 200 uses – against civilians, military targets, and political enemies. These attacks have broken norms against the use of weapons of mass destruction and create a gap in the nonproliferation fabric – despite the robust international architecture of laws, treaties, agreements, and norms designed to restrain the proliferation and use of these weapons. Accountability for these recent attacks has been limited or non-existent, which threatens the credibility of the nonproliferation regime and only encourages further use. Leaders must find the political and moral strength to use a full spectrum of tools to re-establish this system of restraint. This event will discuss ways in which the international community is working to rebuild the system of restraint against chemical weapons, and CSIS will also launch on a report on this topic.”

Clade X Exercise
If you missed out on the live-stream of this table-top exercise hosted by the Johns Hopkins Center for Health Security, don’t worry, you can check out the recording or  awesome live-stream Twitter activity by searching #CladeX. This was a wonderful exercise involving experts like Tara O’Toole, Julie Gerberding, Tom Daschle, etc. Responding to a biological incident, whether intentional, natural, or accidental, is challenging on a good day, but Clade X revealed very serious complications and gaps in our response measures. The Clade X exercise showed real-time decisions and questions that occurred during such an event. From quarantine to MCM and even healthcare worker refusals to work, there were several injects that made this an evolution in infectious disease response across multiple sectors and agencies. Even wild card moments occurred, like Arizona trying to close itself off, which is what made this exercise so engaging and rewarding.

Stories You May Have Missed:

  • Hotel Pools – Icky: it’s something we all knew but didn’t want to admit…hotel pools are pretty dirty. “Today’s report is based on data from the last 15 years said that hotel pools and hot tubs are to blame for one third of waterborne disease outbreaks. The parasite Cryptosporidium and the bacteriaPseudomonas and Legionella cause most outbreaks that begin in swimming venues in the United States. Though chlorine can kill Cryptosporidium, both Pseudomonas and Legionella can survive disinfectants in slimy areas (called biofilm) of hot tubs, pools, and water playgrounds, the CDC said. From 2000 to 2014, public health officials from 46 states and Puerto Rico recorded 27,219 illnesses associated with 493 outbreaks (two or more cases) that originated in treated recreational water. Included in those illnesses were eight deaths.”

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

Pandora Report 5.11.2018

Have you registered for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security? Don’t miss out on the early registration discount if you sign up before June 1st! Wondering if it’s safe to go back to romaine lettuce? Make sure to check the farm location as officials are saying this E. coli outbreak has a bigger footprint than that of the 2006 spinach outbreak.

White House Nixes Global Health Security in NSC
Just as Ebola hits the DRC, the National Security Council team responsible for global health security has been disbanded. “The top White House official responsible for leading the U.S. response in the event of a deadly pandemic has left the administration, and the global health security team he oversaw has been disbanded under a reorganization by national security adviser John Bolton. The abrupt departure of Rear Adm. Timothy Ziemer from the National Security Council means no senior administration official is now focused solely on global health security.” Following comments from Bill Gates about our lack of pandemic preparedness and Michael Osterholm’s on the challenges of predicting the next pandemic, a lack of health security coverage in the NSC is extremely worrisome. “Two members of Ziemer’s team have been merged into a unit in charge of weapons of mass destruction, and another official’s position is now part of a unit responsible for international organizations. White House homeland security adviser Tom Bossert, who had called for a comprehensive biodefense strategy against pandemics and biological attacks, is out completely. He left the day after Bolton took over last month.” Global health security threats, whether it be outbreaks, bioterrorism, or laboratory incidents, are only growing in complexity, which makes this particular shake-up deeply concerning for many in the biodefense world.

 New Ebola Outbreak in the DRC
Unfortunately, Ebola is rearing its head again in the DRC. Over the past five weeks, there have been reports of 21 suspected cases and 17 deaths. Two cases have been laboratory confirmed as Ebola and there are dozens of people under observation and contact tracing. “The DRC has become very good at controlling Ebola. The INRB in Kinshasa is more than capable of doing diagnostic tests without having to ship samples out to the United States. Its director, Jean-Jacques Muyembe Tamfum, was the first scientist to encounter Ebola at a time when he was the DRC’s only virologist, and has been involved in every outbreak response since. He and his colleagues have also trained a crack-team of researchers and disease detectives. ‘We’re advanced in public health,’ said Gisèle Mvumbi, a CDC-trained Congolese epidemiologist at the INRB, whom I met when I visited the DRC earlier this year. ‘If you compare us with Europe or the United States, eh, but here in Africa, we are high. We have experience’.” The WHO has officially declared the DRC cases as an outbreak, so now many are wondering if the vaccine will be deployed. The timing of the outbreak though, coincides with Trump’s plans to rescind $252 million that was set aside for Ebola response, citing that the outbreak was declared over in 2016 and that it is excessive spending.

The Characteristics of Pandemic Pathogens
The Johns Hopkins Center for Health Security has just released their new report on the characteristics of naturally occurring microorganisms that could cause a global catastrophic biological risk (GCBR). “The overarching aim of the study was to provide an inductive, microbe-agnostic analysis of the microbial world to identify fundamental principles that underlie this special category of microorganisms that have potential to cause global catastrophe. Such principles could refine pandemic preparedness by providing a new framework or lens through which to survey the threat landscape of infectious diseases in order to better anticipate, prepare for, and respond to GCBR threats.” Within the report, they compile information from 150 experts to discuss modes of transmission, host population dynamics, how human factors and/or complex disasters can elevate pathogens to GCBR, etc.

The Slow Death of Nonproliferation Norms
Charles Blair is taking a hard look at the global shifts in norms regarding the possession and use of chemical weapons. Blair, a GMU biodefense adjunct professor, points to two specific events over the span of just under two weeks, that challenged how the U.S. responds to foreign leaders who take a relaxed approach to CW. Trump’s congratulations to Putin on his re-election and the willingness to meet Kimg Jung-un are “in line with a broad, ominous shift in international attitudes toward chemical weapons and their use. The shift is alarming enough in its own right—but changes in norms that stigmatize chemical weapons directly affect other, and collectively far more important, pillars of the nonproliferation regime.” The rapid international degradation within the nonproliferation regime is surprising, notes Blair, but there were signs starting in 2012 that may have given us a heads up as to the future fissures. Telling moments for norms erosion has been repeatedly seen in the use of chemical weapons in the Syrian civil war and how the international community handles the continued possession and utilization of chemical weapons by the Assad regime. Russia, especially, has been an enabler for Assad and whose actions have been corrosive to the nonproliferation regime. Blair’s interviews include “Gregory Koblentz—director of the Biodefense Graduate Program at George Mason University— (who) discussed ‘just how little Russia cares about these norms and treaties.’ As evidence he cited Russia’s willingness to discount Syrian violations of international norms and to actively shield Damascus from the consequences of violations—by, for example, undermining the Joint Investigative Mechanism, the Fact-Finding Mission, and the overall investigative process in Syria. Koblentz said that because of Russia’s willingness to undermine the chemical weapons regime, he is concerned that Moscow might also be willing to undermine the International Atomic Energy Agency and the Nuclear Non-Proliferation Treaty. Russia, Koblentz said, is ‘the principle vector for the erosion of norms across all the nonproliferation regimes’.” Lastly, Blair underscores the important role the United States has in enforcing nonproliferation norms and the potential for Trump’s recent withdrawal from the Iran nuclear deal, to become a trigger for proliferation. “The irony, of course, is that any US military action against Iran, North Korea, or both would come wrapped in the cloak of norm enforcement—when, quite likely, Trump’s own pursuit of non-normative policies would cause North Korea to keep its nuclear weapons program and Iran genuinely to pursue a program of its own.”

Clade X Table Top
The Johns Hopkins Center for Health Security will be hosting the Clade X exercise next week “to illustrate high-level strategic decisions and policies that the United States and the world will need to pursue in order to diminish the consequences of a severe pandemic. It will address a pressing current concern, present plausible solutions, and be experientially engaging. Clade X is designed for national decision-makers in the thematic biosecurity tradition of the Center’s two previous exercises, Dark Winter (2001) and Atlantic Storm (2005).” The event will run from 9am to 5pm on Tuesday May 15th and while seats are invitation only, you can livestream it on their Facebook page.

North Korean Ties with Hamas?
Following the assassination of a Palestinian academic with ties to the Hamas resistance, Malaysian police are working to find two Israeli Mossad agents who are considered the culprits.”With elections underway in Malaysia, the murder has been downplayed, but the investigation is in full-on mode. ‘If Israel is behind it, that seems to be an extension of their policy regarding Iranian nuclear scientists,’ said Sonia Ben Ouagrham-Gormley, associate professor at the George Mason University Schar School of Policy and Government’s Biodefense Program in Virginia, via email. ‘In the past few years, several Iranian nuclear scientists were killed, and many suspected Israel of being behind those killings. The problem with assassination is that it is counterproductive: it can cause the scientists to work harder at reaching a working weapon’.”

NASEM Bio, Chem, and Health Security Luncheon – May
Don’t miss out on this May 21st luncheon held by the National Academies. “May’s event will be chaired and moderated by the National Academies’ Board on Health Sciences Policy. Itfeatures Greg Measer, Regulatory Counsel in the Food and Drug Administration (FDA)’s Office of Counterterrorism and Emerging Threats. He will discuss FDA’s initiative to build a national capacity for post-dispensing monitoring and assessment of medical countermeasures. The session also builds on issues discussed at a 2017 National Academies’ workshop on Building a National Capacity of Monitor and Assess Medical Countermeasure Use in Response to Public Health Emergencies.” If you’re unable to attend the event, we’ve got you covered, as one of our GMU Biodefense graduate students will be attending and reporting out.

Stories You May Have Missed:

  • Clinical Outcomes and Trends of Patients with Carbapenem-Resistant Infections – What are the outcomes of patients with carbapenem-resistant infections? GMU biodefense PhD student Saskia Popescu discusses a recent study that evaluates similarities between those with such resistant infections. “The study was conducted in a single-center tertiary-care hospital in St. Louis, Missouri, at which researchers reviewed differences between patients with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenem-resistant non-Enterobacteriaceae (CRNE). Patients with positive CRE or CRNE cultures found from January 2012 to December 2015 were analyzed. However, researchers sought to avoid inclusion of those with colonization instead of true infection, so patients without sepsis and cystic fibrosis were excluded, as were those who were discharged without having received targeted antimicrobial therapy.”

  • Experts Discuss 1918 Pandemic and Global Flu Threat – The CDC and Emory University partnered up to hold a symposium in celebration of the 100th anniversary of the 1918 pandemic, to discuss the next pandemic and how we can prepare. Michael Osterholm and Arnold Monto debated regarding a universal flu vaccine. “Nancy Messonnier, MD, head of CDC’s National Center for Immunization and Respiratory Diseases, said that despite gaps in preparedness, the CDC is better equipped to handle a flu pandemic now than it was in 2009, when a novel H1N1 flu strain first emerged. Technologies, including mobile apps that help consumers find flu shots, and antivirals are putting the power to prevent and fight flu into patients’ hands, she said.

 

Pandora Report – 5.4.2018

Happy Friday and May the Fourth Be With You!

Bill Gates Talks Universal Flu Vaccine, Pandemic Preparedness, and Bioterrorism
Bill Gates has been making the rounds this week discussing the slow progress that has been made in terms of pandemic preparedness. Gates recently spoke at the New England Journal of Medicine’s Shattuck Lecture, where he noted that “We are on the verge of eradicating polio. HIV is no longer a certain death sentence. And half the world is now malaria-free. So usually, I’m the super-optimist, pointing out that life keeps getting better for most people in the world.There is one area, though, where the world isn’t making much progress, and that’s pandemic preparedness. This should concern us all, because if history has taught us anything, it’s that there will be another deadly global pandemic. We can’t predict when. But given the continual emergence of new pathogens, the increasing risk of a bioterror attack, and how connected our world is through air travel, there is a significant probability of a large and lethal, modern-day pandemic occurring in our lifetimes.” You can find the full transcript here, but in his speech, Gates also underscores the risk of biological weapons, noting that “biological weapons of mass destruction become easier to create in the lab, there is an increasing risk of a bioterror attack. What the world needs – and what our safety, if not survival, demands – is a coordinated global approach. Specifically, we need better tools, an early detection system, and a global response system.” He also recently sat down with STAT News to discuss a new initiative he is supporting to facilitate the development of a universal flu vaccine, as well has his time in the Oval Office. “The Gates Foundation is offering $12 million in seed money for projects that would help the world develop a universal flu vaccine. Gates said he thinks that when a universal flu vaccine is developed, it will be made in one of the newer vaccine constructs attracting so much research attention these days.” Gates also noted that when meeting with President Trump, he discussed the need for a universal flu vaccine and sparked the president’s interest through the notion of inspiring American innovation. While Gates isn’t likely to take on a scientific advisor role, he continues to vocalize concerns about global health security and the gaps in preparedness/response efforts.

GMU Biodefense – Food Security 
Interested in biodefense and food security? GMU’s Biodefense graduate program is just the place, as we’re proud to announce that Philip Thomas will be teaching BIOD726 this fall. This course “analyzes threats to food security globally including those related to climate change and environmental degradation; animal and plant diseases; access to clean water; agricultural terrorism; and antimicrobial resistance. Explores the national and global health, economic, social, and ethical impacts of these disruptive forces. Examines strategies for enhancing the security of the global food production and supply systems.”

Avoiding Soviet-Era Disarmament Mistakes With North Korea’s Bioweapons Program
GMU Biodefense professor Sonia Ben Ouagrham-Gormley is trying to get the United States to avoid making the same mistakes when it comes to disarmament. Ouagrham-Gormley notes that with new talks between North Korea and the United States, it is important for the Trump administration to learn from our historical failures and previous disarmament talks. She points to the Cooperative Threat Reduction Program (CTR), which was launched in 1991 and worked to secure weapons, like nuclear and chemical, that were stored in former Soviet states. Unfortunately, the CTR program was only mildly effective in regards to biological weapons. Ouagrham-Gormley provides some “do’s and don’ts” for our bio-engagement with North Korea. Do engage as many facilities as possible. Don’t adopt a cookie-cutter approach to bio engagement – “Probably the greatest failure of the CTR program was its adoption of a one-size-fits-all approach that did not take into account the particular circumstances of the facilities and individuals engaged. For example, the CTR usually provided former Soviet facilities with biosafety equipment, which was much needed, as scientists sometimes worked with dangerous agents with no ventilation system to prevent the spread of disease should a laboratory accident occur.” She also notes that “without strategies to help scientists exit the bioweapons field and efforts to erode their expertise, a bio-engagement program in North Korea risks maintaining a bioweapons threat and possibly allowing resumption of the program in the future.”

Summer Workshop – Early Registration Discount Extended!
We’re happy to announced that the early registration discount for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security, has been extended to June 1st. Register before then get the reduced rate for this 3-day workshop on all things health security. Join the conversation with experts regarding pandemic preparedness policy, dual-use research oversight, CRISPR, protecting the bio-economy, and more.

15 Years of Hospital Preparedness
It’s interesting to think that the Hospital Preparedness Program (HPP) has been working to strengthen U.S. healthcare preparedness for 15 years now. Check out this infographic for some interesting facts – HPP is the only source of federal funding for health care delivery system readiness and 98% of those awarded funds have said that the funding was critical to their response and preparedness efforts. From Hurricane Katrina to the bombings at the Boston Marathon, to Ebola in Dallas, and Zika virus, there is an utter need for supporting healthcare response and preparedness efforts within the United States.

Maryland Branch ASM Annual Poster Session & Student Oral Presentation
Don’t miss out on this chance to attend the Maryland ASM branch meeting on Monday, June 4th from 5:30-8:30pm. This is a great opportunity for students to present posters, meet other ASM members, and learn more about the organization.

Trends in Reported Vectorborne Disease Cases
Mosquitos and ticks are major trouble-makers in the United States.  The threat of vectorborne diseases is becoming an increasing issue within the United States, according to a new CDC report. Researchers reviewed data reported through the National Notifiable Diseases Surveillance System for 16 notifiable vectorborne diseases (West Nile virus, Rocky Mountain Spotted Fever, etc.) from 2004 to 2016. “A total 642,602 cases were reported. The number of annual reports of tickborne bacterial and protozoan diseases more than doubled during this period, from >22,000 in 2004 to >48,000 in 2016. Lyme disease accounted for 82% of all tickborne disease reports during 2004–2016.” Tickborne diseases accounted for more than 75% of reports and West Nile virus was the most commonly transmitted mosquitoborne disease. “During 2004–2016, nine vectorborne human diseases were reported for the first time from the United States and U.S. territories. The discovery or introduction of novel vectorborne agents will be a continuing threat.”

Stories You May Have Missed:

  • FDA Recommends Approval for TPOXX– The FDA Advisory Committee recently voted unanimously to recommend approval for TPOXX for the treatment of smallpox. “While TPOXX is not yet approved as safe and effective by the U.S. Food & Drug Administration, it is a novel small-molecule drug of which 2 million courses have been delivered to the Strategic National Stockpile under Project BioShield.”
  • Biodefense World Summit– Don’t miss this June 27-29 event in Bethesda, MD! “Biodefense World Summit brings together leaders from government, academia, and industry for compelling discussions and comprehensive coverage on pathogen detection, point-of-care, biosurveillance, sample prep technologies, and bio recovery. Across three days of programming, attendees can expect exceptional networking opportunities in the exhibit hall, engaging panel discussions, and shared case studies with members of the biodefense community from technology providers to policy makers. The 2017 summit saw more than 250 participants with 35% of attendees titled as scientist/technologist, 30% as executive/director, and 11% as professor.”

Pandora Report 4.27.2018

Happy Friday! To start the weekend right, let’s take a walk down memory lane with this list of deadly epidemics throughout history. In fact, March 25th, was World Malaria Day!

 Inside the Strategic National Stockpile
Warehouses filled with millions of doses of medical countermeasures to protect Americans against infectious disease outbreaks or bioterrorism – that’s what makes up the SNS. The national stockpile is not new, but ownership will soon change as the Trump administration moves oversight from the CDC to a separate department within HHS. ASPR (Office of the Assistant Secretary for Preparedness and Response) is set to take charge of choosing and purchasing what products go into the SNS, come October. “But some public health officials and members of Congress in both parties worry the move will disrupt a complex process that relies on long-standing relationships between the federal program and the state and local agencies responsible for distributing the medicine. During a congressional hearing last week, lawmakers expressed concern that a change could risk the government’s ability to deliver lifesaving medical supplies to what public health officials call ‘the last mile’ — to people in need during a disaster.” While some are opposed to the shift in oversight, others say it will streamline processes. Unfortunately, there is also increasing concern that this move will encourage biotech companies to lobby for specialized, more expensive drugs.

Elevating CRISPR-Cas9
GMU Biodefense graduate student Janet Marroquin is delving into a world of CRISPR and artificial intelligence. “The contentious debate regarding the precision of the commercially available gene-editing tool, CRISPR-Cas9, continues as Nature recently retracted a study published last year on the unintended effects of off-target mutagenesis. The 2017 study used CRISPR-Cas9 to edit a genetic mutation causing blindness in mice but the researchers observed CRISPR-induced mutations in other genes due to off-target editing at higher rates than previously documented.” Marroquin asks – what does this mean for evaluating off-target effects on gene editing? “Joining independent research teams in the application of data analytics and machine learning to gene-editing is Microsoft’s artificial intelligence tool, Elevation, designed specifically for the prediction and reduction of off-target effects by CRISPR.”

Facing the Myths Surrounding Proliferation Financing
A recent report from the Financial Action Task Force (FATF) was released regarding the financing of WMD proliferation however, an assessment by the Panel of Experts left many with a dismal feeling. “This assessment detailed several shortcomings in global sanctions implementation that have allowed North Korea to stay connected to international banking channels. The report concluded that North Korea is ‘flouting the most recent resolutions by exploiting oil supply chains, complicit foreign nationals, offshore company registries, and the international banking system’.” The report highlights North Korean actions to skirt financial sanctions, but many are pointing the task force guidance as being misaligned with the findings from the panel. The UNSC resolutions underscore two approaches to proliferation financing – the first is found in Resolution 1540 and requires member states to implement prevention measures for non-state actors, and the second requires states to create and maintain processes to implemented targeted financial sanctions. Implementing targeted financial sanctions and monitoring activities can be challenging though, so what should be done? Information-sharing relationships could be hugely beneficial. “In fact, Sonia Ben Ouagrham-Gormley—an associate professor at George Mason University’s Schar School of Policy and Government, and one of the first to write about the challenges of addressing proliferation financing—recommended in 2012 that governments increase information-sharing relationships with the private sector. This recommendation has since been championed in several other outlets, including an April 2017 report by the Royal United Services Institute and an October 2017 report by King’s College London.” Ultimately, as Aaron Arnold noted, “To make real gains in countering proliferation financiers, policy makers need a fresh approach—one that addresses the institutions that enable proliferation financing and allow proliferator networks to hide behind anonymous corporate registries. Perhaps a good place to start is at home—the United States is one of the world’s biggest secrecy jurisdictions.”

Health Security Workshop – Are You Prepared For The Next Pandemic?
Worried you’re not prepared for the next zombie apocalypse or pandemic influenza? Attend our workshop on health security, bioterrorism, and pandemics to understand the full spectrum of biological threats. We can’t guarantee you’ll survive zombies, but we can guarantee you’ll walk away with more biodefense knowledge and a healthy dose of excitement for all things health security. Don’t miss the early bird registration discount that ends on May 1st!

Attacking Health Facilities – Syria
Critical health infrastructure is vital to national stability and security. Just as we view laboratory capacity and surveillance as crucial components to health security, the ability for people to seek medical care comes into play. What if these facilities were targeted though? A public health research team from UC-Berkley has been monitoring reports in Syria of attacks on healthcare facilities since 2016. “Over 2016 that averages out to more than one attack every other day, says Haar. In the attacks her team analyzed, 112 health-care staff and 185 patients died. Haar and her team found that the majority of attacks occurred via aerial bombing, so it was difficult to identify a perpetrator. These attacks from above nearly always damaged structures. As a result of the attacks, eight clinics and hospitals were permanently closed; 41 other health-care facilities closed temporarily.” You can read the publication here. The researchers were shocked to find out how many health care facilities were attacked. 33 of the hospitals experienced more than one attack in 2016 alone. In fact, two hospitals in Aleppo were attacked over ten times. The notion of health security is a newer one and as threats and technology evolve, attacks like these may come into the dynamics of what it means to establish global health security. As Filippa Lentzos noted – perhaps it’s time to expand the definition of biosecurity to include deliberate threats to healthcare infrastructure.

The Relationship Dynamics of Public Health, Health Care, and Journalism
GMU Biodefense PhD student Saskia Popescu recently sat on a panel at the Association of Health Care Journalists regarding pandemic preparedness. Discussing outbreaks like Ebola and the 1918 influenza pandemic, the panel included physicians and journalists who brought forth experiences in the field and working with the press. “In a world that is led by eye-catching headlines, how can we relay the necessary (and critical) information that may not be as ‘headline-worthy’? Moreover, how can we provide information to the public that can help stop both disease transmission and the spread of fear? There are 2 sides to this challenge; for journalists, they need to understand the basics of epidemiology and infectious diseases transmission, and also the impact of their words. For health care providers and public health officials, ensuring that you emphasize the critical points that can help dissuade fear (ie, specifics of exposures, incubation times, etc) and work with journalists to ensure the right message is being put out.”

 Cargo Ships – The Trojan Horse of Antibiotic Resistance
I fear the cargo ships, even when they bring gifts?  In hindsight, it’s not surprising to think that ships that travel around the world bringing cargo from all over, would also carry germs with them. Buried in the bowels of cargo ships, researchers found 44 species of bacteria and 10 antibiotic resistant genes. It doesn’t help that in some cases, antibiotics are actually painted into the hulls of the ships to reduce growth of barnacles. “Dame Sally Davis, the British Chief Medical Officer, told the ministers that the common antibiotic Tetracycline, which is used to treat common infections in patients, was being added to paint for use on the hulls of ships to prevent the build up of algae and barnacles, known as fouling.” In the larger struggle against antimicrobial resistance, things like this are no longer surprising – the battle against the resistant bug is complex, challenging, and almost humorously persistent.

Stories You May Have Missed:

  • Australia Battles HTLV-1 – “B is talking about a sickness that has killed her family member and is a potential tragedy facing Aboriginal communities in central Australia, who have the world’s highest rates of a fatal, human immune virus for which there is no current cure, no treatment and no coordinated public health response. Human T-lymphotropic virus type 1 (HTLV-1) is transmitted through sexual contact, blood transfusion and from mother to child by breastfeeding. It can cause a rapidly fatal form of leukaemia. Some people die within weeks of diagnosis. HTLV-1 also causes inflammation of the spinal cord leading to paralysis, severe lung disease known as bronchiectasis and other inflammatory disease. In five communities around Alice Springs, more than 45% of adults tested have the virus, a rate thousands of times higher than for non-Indigenous Australians.”