Pandora Report: 3.8.2019

Behold – your weekly dose of all things biodefense! But first- here’s the NIH commitment to transparency on research involving potential pandemic pathogens..

 Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
From Ebola outbreaks to the approval of GoF research, we’ll be talking about all things health security at our summer workshop this July. Threats to global health security continue to evolve due to the changing nature of conflict, advances in science and technology, globalization, and the growing threat posed by emerging infectious diseases and pandemics. Pandemics, Bioterrorism and Global Health Security: From Anthrax to Zika is a three and a half-day, non-credit summer workshop designed to introduce participants to the challenges facing the world at the intersection of national security, public health, and the life sciences. The workshop faculty are internationally recognized experts from the government, private sector, and academia who have been extensively involved with research and policy-making on public health, biodefense, and national security issues.  From historical biodefense approaches to future threats, this is where you’ll want to be for all things health security.

Syrian Chemical Weapons Use – OPCW Issues Fact-Finding Mission Report 
You can now read the Fact-Finding Mission report from the OPCW on the use of chemical weapons in Duoma, Syria. Between delayed entry into the area and hostile crowds, this investigation was not easy. This report is a detailed account of their investigation and critical information that only leads to one culprit – the Syrian government. “Many of the signs and symptoms reported by the medical personnel, witnesses and casualties (as well as those seen in multiple videos provided by witnesses), their rapid onset, and the large number of those reportedly affected, indicate exposure to an inhalational irritant or toxic substance. However, based on the information reviewed and with the absence of biomedical samples from the dead bodies or any autopsy records, it is not currently possible to precisely link the cause of the signs and symptoms to a specific chemical.” For a frank discussion on what this report and its findings mean, listen to GMU bioweapons/chemical weapons expert and graduate program director Gregory Koblentz explain the significance and who will be held accountable. “So they fit the pattern and then the other kind of neat piece of detective work they did, was able to find some very unique markers that chlorine had been in these bombs and released when they fell on these buildings. Because even though chlorine is a very reactive chemical, and it disperses very quickly in the environment, the OPCW figured out that, chlorine would react with certain materials like wood, that would create new compounds that are not — don’t occur naturally and are very stable. And so by looking for evidence of these chlorine derivatives in the wood, in the two attack sites, they would have found these markers that this would have been exposed to chlorine, in high concentrations and therefore they conclude that these bombs were filled with chlorine when they were dropped on these two buildings.” You can also find a great Twitter thread from Dr. Koblentz on his thoughts regarding this report and the findings here. “An important limitation in investigating alleged uses of chlorine as a weapon is that the chemical is highly reactive so it is difficult to detect in the environment and there are limited biomakers for exposure. But @OPCW was very clever and took advantage of the fact that when chlorine reacts with certain other chemicals and materials it can produce new compounds that are stable and not found naturally in the environment. These compounds then provide a strong signature of chlorine exposure. In particular, @OPCW looked for the presence of borynl chloride which is produced when alpha-pinene, a chemical found in coniferous wood (i,e., pine), is exposed to hydrogen chloride, a common decomposition product of chlorine.”

Chatting With Sen. Daschle on Biodefense
If you missed this event, no worries, we’ve got a great recap from two of GMU’s biodefense graduate students. Stephen Taylor and Michael Krug note that “The events of October 2001 forced political leaders to reconsider how biodefense fit into the national security agenda. Sen. Daschle reflected on three lessons learned throughout this process, which included: 1) revamping mail security, 2) rethinking large-scale emergency responses, and 3) developing contingency plans for biological events.  Despite efforts to harden America’s biosecurity posture, however, our national biodefense enterprise today remains fractured, inefficient, and largely dysfunctional. One such example is the application of the BioWatch program. Technical shortcomings and false-positives have plagued the program from its conception. However, while the frustration of the program has been clear, there must remain a drive for innovation from all involved in the biodefense network.”

Mapping the Cyberbiosecurity Enterprise
Frontiers is looking for work on cyberiosecurity for their new research topic – don’t miss out! “‘Cyberbiosecurity’ has been proposed as an emerging hybridized discipline at the interface of cybersecurity, cyber-physical security and biosecurity. This term has been defined as ‘understanding the vulnerabilities to unwanted surveillance, intrusions, and malicious and harmful activities which can occur within or at the interfaces of comingled life and medical sciences, cyber, cyber-physical, supply chain and infrastructure systems, and developing and instituting measures to prevent, protect against, mitigate, investigate and attribute such threats as it pertains to security, competitiveness and resilience.’ Mapping the topology of cyberbiosecurity has just begun, but proponents have realized that, potentially, it has expansive applications across the life sciences, biomedical sciences and medicine, agriculture and food systems and natural resource protection and management, and from genomics, bioinformatics and ‘AI’, to large-scale complex systems such as ‘farm to table’. As biotechnologies continue to advance and evolve, cyberbiosecurity will be a key consideration in critical infrastructure related to these arenas. In addition to identifying or developing and implementing solutions to vulnerabilities and shortfalls, awareness and training, guidelines and standards and the interfacing of disparate expert communities awaits. Further, the interfaces with or creation of national strategies, policies, regulations and the legal implications need investigation and resolution. With this Research Topic we aim to collect relevant articles which characterize various aspects of cyberbiosecurity. Target categories for the Research Topic will include science and technology, risk analysis, training and education, guidelines and standards, community fusion, and strategy and policy.”

 Hackers Listen in on What Synthetic DNA Machines Are Printing
No, that’s not a quote from Blade Runner or a futuristic sci-fi movie, but the realities of synbio and cyberbiosecurity. “In new work they presented at last week’s Network & Distributed System Security Symposium, a team of researchers from UC Irvine and UC Riverside unveiled a so-called acoustic side-channel attack on a popular DNA-making machine, a vulnerability they say could imperil the up-and-coming synthetic biology and DNA-based data storage industries. It could also have important potential counterterrorism applications—for monitoring suspect machines to see if they’re manufacturing deadly pathogens or other biological weapons.T wo days’ worth of recordings was enough to train algorithms that could surmise unknown strings of DNA with 86 percent accuracy. By combining them with off-the-shelf DNA sequencing software, the researchers boosted the accuracy to almost 100 percent, especially for longer sequences. Some members of the team tested the hack, which they call Oligo Snoop, on DNA sequences chosen by the other members. They included genetic instructions for making human insulin, a binding peptide commonly used in drug development, and conotoxin, a lethal protein found in the venom of cone snails. While the eavesdropping attack is far from practical for any run-of-the-mill corporate spy or would-be bioterrorist, it’s one the researchers warn could become more likely over time, as biology emerges as a powerful computing platform, and hackable listening devices like Nest cams and voice assistants become increasingly pervasive in automated lab settings. And perhaps more to the point, it’s a provocative demonstration of the ways in which the walls between the physical biological world and the digital one are crumbling toward one another.”

The Supportive Role of Tech Platforms in Disease Outbreaks
GMU biodefense doctoral student Saskia Popescu discusses the latest measles outbreaks and how tech platforms are increasingly playing a role. “Fueling the debate is the anti-vaccine (or anti-vaxxer) movement on social media platforms like Facebook and Twitter. As these platforms have increased in popularity, so, too, has the ability to spread misinformation related to health care. It’s become a real problem, and now many are calling for the tech industry to own its role. For public health proponents, it can be frustrating and exhausting trying to correct the misinformation in these anti-vaxxer posts. A recent investigation by The Guardian found that even neutral search terms (think “vaccination” or “immunizations”) on social media yields a startling amount of anti-vaccine context on both Facebook and YouTube.”

Trust for America’s Health – Health Security and Preparedness Update
TFAH will be hosting a congressional briefing to discuss the findings of their Ready or Not report on March 18th at 12:30 pm in 2044 Rayburn. Invited speakers include TFAH CEO John Auerbach, former Surgeon General and Secretary of the Florida Department of Health Celeste Philip, Director of Regional Preparedness and Operations at the SouthEast Texas Regional Advisory Council Lori Upton, with remarks by Rachel Fybel, staff for Rep. Anna Eshoo, co-chair of the Congressional Biodefense Caucus. Lunch will be served, so please RSVP.

Colonialism, Blood Samples, and Where Pathogens Fall Into Things
Sure blood samples were being shipped out of West Africa at top speed for analysis during and after the 2014/2016 EVD outbreak but where are they? Surely they’re being turned into vaccines and treatments options, which is great, but will those countries afflicted by the outbreak ever be able to pay for the treatments developed from their patients? Maryn McKenna is pulling back the curtain on the asymmetry of biological samples and pharmaceutical developments. “Developing nations have protested before that richer countries and their corporations should compensate them for their biological resources. They consider it colonialism for the bioprospecting age: Instead of stripping the developing world of its precious metals, timber, or minerals, the nations of the West are mining for microbes and other biological source materials. Often the developing world’s objections go nowhere. But in a few cases, bolstered by an evolving body of international rules, the countries who feel their patrimony has been stolen have fought back and won.” From flu strain and vaccine clashes to a developed commitment that WHO member countries would equitably share viruses and vaccines made from them, recent history has been fraught with these issues. “The protocol—formally, the Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization—became effective in 2014. It’s a subsidiary agreement to the Convention on Biological Diversity, in force since 1993. Among the things the convention covers is fair treatment when it comes to biological resource extraction; the protocol goes further by defining enforcement. Most of the countries in the world have signed and ratified the convention, and a little more than 100 have signed and ratified the protocol. Those numbers include most of the big vaccine-making nations, but notably not the United States, which signed but never ratified the convention, and thus has not endorsed the protocol. The protocol commits signers to sharing the benefits of commercializing “any material of plant, animal, microbial or other origin containing functional units of heredity” with the country the material came from” Furthermore, McKenna notes that “It’s crucial that outbreak detection and response not be compromised. But in the aftermath of outbreaks, it’s equally important that the public health establishment honor the contributions of the countries that were victims of outbreaks—whether those contributions are their blood and tissue or their minerals and plants. Uncompensated resource extraction is a sin of the past, and it should be consigned to there.”

The MMR Vaccine and Autism – A Nationwide Cohort Study to Assess the Hypothesized Link
Findings from studying 657,461 children: there isn’t an increased risk…..go get vaccinated.

 

Risk Communication Strategies for the Very Worst of Cases: How to Issue a Call to Action on Global Catastrophic Biological Risks
“A new report by a team of researchers at the Johns Hopkins Center for Health Security reframes the discussion of the most severe biological threats to provide policy advocates with an additional tool to help them catalyze expansive international support for work on pandemic prevention and response. The report, Risk Communication Strategies for the Very Worst of Cases: How to Issue a Call to Action on Global Catastrophic Biological Risks, outlines current awareness gaps—present inside and outside the scientific community—and identifies opportunities for communication to close them. GCBRs represent a special category of risk defined previously by the Center as threats from biological agents that could lead to sudden, extraordinary, widespread disaster beyond the collective capability of national and international organizations and the private sector to control.”

Stories You May Have Missed:

  • Ebola Treatment Center Reopens After Arson- As cases reach 900, the Butembo Ebola treatment center has reopened after rebel forces set fire to the building. “So far 12 patients confirmed to have Ebola have been admitted. Without Doctors Without Borders, who staffed the ETC before the attack, the center is being run by workers from the ministry of health, the Word Health Organization (WHO), and UNICEF. The ministry of health also said construction is set to begin today on a new ETC in Katwa. The former ETC was also targeted by arsons last week. The DRC also noted today that it has implemented an action plan to end community disruptions to officials’ outbreak response efforts.”
  • CDC Reports Stalled Progress Against MRSA and Staph Infections– The battle against the resistant bug is hitting a roadblock. “The US Centers for Disease Control and Prevention said today that bloodstream infections caused by Staphylococcus aureus remain a significant and deadly problem in US hospitals, and that progress on reducing the most dangerous type of staph infection has stalled. According to the agency’s latest Vital Signs report, more than 119,000 people suffered from S aureus bloodstream infections in 2017, and nearly 20,000 died. In addition, the report found that while the rate of methicillin-resistant S aureus (MRSA) bloodstream infections in US hospitals fell by more than 17% annually from 2005 through 2012, the rates of decline has slowed since then.”
  • Four Decades of Women in Nuclear Security – “While women have been working in the nuclear policy field at leadership levels for decades, the space is still overwhelmingly white and male. For this study, we interviewed 23 women who have worked at senior levels in the nuclear, arms control, and non-proliferation fields, their careers ranging from the 1970s to the present day. In this report, we explore the gender dynamics surrounding hierarchy, language, and ideology, and how women working in these fields responded personally and professionally. We document and analyze the “gender tax” facing women in nuclear policy, consider how gender diversity affects policymaking, and explore the ways in which the more hyper-traditional subfields respond to new ideas—creating what former Under Secretary of Defense Michèle Flournoy calls a “consensual straitjacket” in which gender and substantive taxes combine to restrict innovation.”

Pandora Report: 3.1.2019

Happy Friday! We’ve got a lot of biodefense news to start the month of March off right, so buckle up.

 Sen. Tom Daschle Takes to the Classroom to Discuss the Future of Biodefense
If you missed our event with Sen. Daschle, you can get a recap here- “Oftentimes, we are reactive instead of proactive, but you all are being proactive,” said Tom Daschle, in praising Schar School and George Mason University students for studying biosecurity. Daschle opened his remarks by recalling the horror and the uncoordinated response to an anthrax attack in his Capitol Hill office a month after 9/11. Daschle, then Senate Majority Leader, and his staff received letters laced with deadly anthrax spores. More than two dozen individuals in his office tested positive for the disease. There were no deaths. Schar School students asked questions on a variety of biodefense related topics including the anthrax attack on Congress, never-before-seen diseases, and what governments can do to defend citizens against future biowarfare. Daschle spoke passionately about the importance of biosecurity breaches, stressing the urgency to take meaningful steps towards stronger biodefense policies. ‘You all are the leaders that we will turn to when this [biological threat] happens, and it will happen in your lifetime. When it happens, we are going to need you’.”

Human Error in High-Biocontainment Labs and Concern Over the Quiet U.S. Decision to Fund Dangerous Experiments
Exposures to infectious diseases in BSL-3 and BSL-4 environments can be pretty scary…but they do happen. Concern has always extended beyond the safety of the laboratory worker, but also that a pathogen of pandemic potential could be released. “Human error is the main cause of potential exposures of lab workers to pathogens. Statistical data from two sources show that human error was the cause of, according to my research, 67 percent and 79.3 percent of incidents leading to potential exposures in BSL3 labs. These percentages come from analysis of years of incident data from the Federal Select Agent Program (FSAP) and from the National Institutes of Health (NIH). Three of the seven FSAP incident categories involve skill-based errors: 1) needle sticks and other through the skin exposures from sharp objects, 2) dropped containers or spills/splashes of liquids containing pathogens, and 3) bites or scratches from infected animals. Some skill errors, such as spills and needle sticks could be reduced with simple fixes.” Review of the human errors and if they are singular events or process failures gives insight into how possible these events are and how we can go about avoiding them. While this article focuses on a small portion of pathogen research, it provides a very comprehensive and detailed account for many of us who are not familiar with working in these environments. In another aspect of lab safety and experiment concern..more attention has been raised regarding the GoF research. Dr. March Lipsitch and Dr. Tom Inglesby recently wrote regarding the implications of this research and the quiet green-lighting that occurred for two projects recently. “Apparently, the government has decided the research should now move ahead. In the past year, the U.S. government quietly greenlighted funding for two groups of researchers, one in the United States and the other in the Netherlands, to conduct transmission-enhancing experiments on the bird flu virus as they were originally proposed before the moratorium. Amazingly, despite the potential public-health consequences of such work, neither the approval nor the deliberations or judgments that supported it were announced publicly. The government confirmed them only when a reporter learned about them through non-official channels. This lack of transparency is unacceptable. Making decisions to approve potentially dangerous research in secret betrays the government’s responsibility to inform and involve the public when approving endeavors, whether scientific or otherwise, that could put health and lives at risk. We are two of the hundreds of researchers, medical and public-health professionals, and others who publicly opposed these experiments when they were first announced. In response to these concerns, the government issued a framework in 2017 for special review of ‘enhanced’ pathogens that could become capable of causing a pandemic. Under that framework, reviewers must consider the purported benefits and the potential risks and, before approving the work, determine ‘that the potential risks as compared to the potential benefits to society are justified’.”

GMU Biodefense Graduate Degree Open Houses
Have you been considering getting a graduate degree in biodefense? From a MS to a PhD, GMU Schar school has it all. We’ve got several open houses coming up if you’re looking to get more information on our programs. You can attend a PhD Open House   on Wednesday, March 20th at 7pm in Arlington or a Master’s Open House on Thursday, March 28th at 6:30pm in Arlington. We’re also hosting a virtual Master’s in Biodefense Webinar on Wednesday, March 20th at 12pm EST online.

Global Biosecurity Journal
A new biosecurity journal has been started and it’s providing a great source of information and even better – it is open access! “The journal Global Biosecurity is a peer-reviewed, open access electronic journal for cross-disciplinary research in all aspects of human or animal epidemics, pandemics, biosecurity, bioterrorism and CBRN, including prevention, governance, detection, mitigation and response. We publish work on risk analysis, outbreak investigation, epidemiology, modelling, bioinformatics, phylogenetics, surveillance, intelligence, strategic foresight, forecasting, ‘One Health’, policy, governance, law, law enforcement, defense, ethics and first responder preparedness. We have a focus on rapid reports of epidemics of concern.”

New FDA Strategy to Improve Food Safety
The FDA has just unveiled a new approach to detecting unsafe foods that were imported. “… ‘the U.S. imports about 15 percent of its overall food supply from more than 200 countries or territories representing about 125,000 international food facilities and farms,”’ according to an announcement this afternoon from FDA Commissioner Scott Gottlieb and Frank Yiannas, the agency’s deputy commissioner for food policy and response. ‘Over the past 15 years alone, we’ve seen a trend of rising imported foods. Other countries now supply about 32 percent of the fresh vegetables, 55 percent of the fresh fruit and 94 percent of the seafood that Americans enjoy’.” In response to these challenges the FDA announced a new approach that integrates technological advances to help provide better FDA food safety oversight. “‘Our new strategy is designed to meet four important goals: preventing food safety problems in the foreign supply chain prior to entry into the U.S.; effectively detecting and refusing entry of unsafe foods at U.S. borders; responding quickly when the FDA learns of unsafe imported foods; and measuring our progress to ensure that our imported food safety program remains effective and efficient,’ Gottlieb and Yiannas said.”

Flying with Dangerous Pathogens on Commercial Flights- A Great Way to Be Fined $20,000
Are you planning to travel with dangerous pathogens on your next vacation? Let’s take a step back because that may not be the best decision. “Gang Li of Guelph, Ontario, was convicted on Feb. 20 in the Ontario Court of Justice of violating Canada’s Health of Animals Act and the associated Health of Animals Regulations. He was ordered to pay fines totaling $20,000. The Canadian Food Inspection Agency (CFIA) brought the legal action against Li. According to court documents, Li arrived at the Lester B. Pearson International Airport in Mississauga, Ontario, on Jan.24, 2017. The Canadian Border Services Agency (CBSA) intercepted Li’s flight and found he was transporting seven undeclared test tubes of an unknown substance in his checked baggage, which he did not declare upon arrival. Laboratory testing later confirmed the items included the following viruses; Peste des Petits Ruminants, Newcastle disease, Duck Adenovirus 1, and Parainfluenza Virus 5.” Sure, this may be the beginning of an apocalyptic plague movie…or we can make it a great learning experience to encourage smarter decisions when it comes transporting pathogens. Also, props to CFIA and CBSA for catching this potentially devastating action!

US Government and Multilateral Health Engagement
The Kaiser Family Foundation just released this report on 5 key facts regarding how the US government participates in health engagement. “Global health donors, such as the U.S., provide funding and other support primarily through two types of channels: bilateral (i.e., country-to-country) and/or multilateral (i.e., multi-country, pooled support often directed through an international organization). Donors make different choices about the distribution of their global health support between these two mechanisms, and these choices may change over time due to political, technical, or other considerations. While the U.S. has decidedly been a bilateral donor to global health (channeling 81% of current global health assistance bilaterally), it has helped to found, and serves as a key donor to, several major multilateral health organizations. These include some of the first international health organizations, such as the Pan American Health Organization (PAHO) in 1902 and the World Health Organization (WHO) in 1948, and newer partnerships, such as Gavi, the Vaccine Alliance (Gavi) in 2000 and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in 2002. These multilateral organizations have contributed significantly to improvements in global health and, in some cases, serve as key components of the U.S. global health response. This response includes financing, governance, oversight, and technical assistance.”

Why Were Scientists Silent Over Gene-Edited Babies?
When news hit that babies had been born with CRISPR gene edits, the world was shocked. After the initial surprise faded and several researchers admitted they knew of the work by Dr. He Jiankui, many are asking why more people didn’t come forward to raise a red flag. “Scholars who have spoken publicly about their discussions with He described feeling unease. They have defended their silence by pointing to uncertainty over He’s intentions (or reassurance that he had been dissuaded), a sense of obligation to preserve confidentiality and, perhaps most consistently, the absence of a global oversight body. Others who have not come forward probably had similar rationales. But He’s experiments put human health at risk; anyone with enough knowledge and concern could have posted to blogs or reached out to their deans, the US National Institutes of Health or relevant scientific societies, such as the Association for Responsible Research and Innovation in Genome Editing (see page 440). Unfortunately, I think that few highly established scientists would have recognized an obligation to speak up. I am convinced that this silence is a symptom of a broader scientific cultural crisis: a growing divide between the values upheld by the scientific community and the mission of science itself.”

Image source: The Guardian

 WHO Calls for More Funds to Fight Ebola
The situation is increasingly dire in the DRC as the Ebola outbreak continues but MSF has had to suspend activities after an attack. “In a statement, MSF said the attack began at 10 pm on Feb 24 when unidentified assailants began throwing rocks at the 70-bed MSF-managed treatment center, which has admitted 602 patients, including 49 confirmed cases, since December. Then the group set parts of the structure on fire, which destroyed medical wards and equipment. The brother of a patient died while trying to escape, though the exact circumstances of his death are still unclear, the group said. Six patients with suspected Ebola and four with confirmed infections were transferred to other facilities, and all treatment center staff were evacuated.” Worse yet, on Wednesday, it was reported that another attack took place at the Butembo Ebola treatment center. “Today Doctors Without Borders (MSF) said an Ebola treatment center (ETC) in Butembo in the Democratic Republic of the Congo (DRC) was attacked, and reports on social media suggested the building had been set on fire. ‘Tonight another deplorable attack on an Ebola treatment facility has taken place, this time in the city of Butembo,” said Hugues Robert, MSF emergency desk manager, in a news release. “This follows the attack last week on another MSF Ebola treatment center in nearby Katwa. This attack has not only put the lives of Ebola patients and their families in danger, but also those of MSF and Ministry of Health staff’.” The arson attack devastated MSF response efforts and makes future work extremely challenging. In response to this situation, funding has become an increasingly tenuous topic of conversation. While many point to the reported “Pandemic Fund” created by the World Bank, Laurie Garrett has called out that they promised $1 billion but only raised $320 while providing zero funds until the virus crosses borders. The WHO is asking for more funding to help support outbreak response efforts. “Dr Tedros said the situation was unprecedented. ‘There has never been an Ebola outbreak in these conditions, with such a highly mobile population and with many gaps in the health system. The security context is another major concern. I am deeply saddened by reports that a health facility run by Médecins Sans Frontières in Katwa was attacked on Sunday night,’ he said. He added that, despite the setbacks, major gains in the fight against the disease had been made. ‘But the outbreak is not over and we urgently need additional funding to see it through,’ Dr Tedros added. WHO has asked for $148 million (£112m) to fund the response until July but so far just under $10m has been pledged’.”

Tech Platforms and Anti-Vaxxers
As measles continues to spread and the role of anti-vaccine movements becomes increasingly under the spotlight, many have also looked to tech platforms and social media. “The ongoing and increasingly contentious debate about whether technology companies have a responsibility to moderate harmful content takes on a new dimension when faced with such an urgent domestic and international public health emergency. The question we should ask in this case is: Do technology companies have the responsibility to moderate their content when there is a public health risk involved? This month, several large technology companies have implicitly, and correctly, answered yes. All the companies in question should embrace this affirmative response and explore two possible methods to address this misinformation on their platforms. The Guardian unleashed a furor of activity around vaccines with an investigation into how anti-vaxer content is ranked and spread online. The Guardian found that neutral searches of the word “vaccine” by a new user with no friends or likes yielded overwhelmingly anti-vaccine content, unsupported by science, on both Facebook and YouTube.”

State Reporting Laws and Infection Prevention Efforts
GMU Biodefense doctoral student and infection preventionist Saskia Popescu discusses the implications of HAI reporting efforts and how these laws may negatively impact the hospital programs working to reducing healthcare-associated infections. “In the face of this problem, many states have implemented mandatory HAI reporting laws. Unfortunately, these laws can negatively impact the individuals conducting the surveillance and reporting: the infection prevention and control programs. For many of us in infection prevention, the mandated reporting for Medicare reimbursement through the Center for Medicare and Medicaid Services is time consuming and can account for 5 hours of our work day. Now, adding in the required state reporting increases the work load. Although most states have mandated reporting requirements, the association between state laws and HAI rates have been mixed, and few states have addressed the overall burden these laws place on the infection preventionists.”

Special Feature – Progress in High-Level Isolation for Care of Patients with High-Consequence Infectious Diseases
The Health Security journal has a special issue on managing patients with diseases like Ebola and the healthcare preparedness approach. “In April 2018, NETEC, in conjunction with the Johns Hopkins Center for Health Security and the National Institute of Allergy and Infectious Diseases (NIAID), hosted the International Workshop on High-Level Isolation in Washington, DC. The workshop convened experts from around the world to discuss ongoing and future efforts related to treating patients with high-consequence infectious diseases in high-level isolation settings. Participants represented high-level isolation units from 11 countries, including all 10 RESPTCs, and presentations and discussions addressed high-level isolation criteria and principles, high-level isolation unit operations and design, clinical care and research considerations for patients with high-consequence infectious diseases, and international collaboration between high-level isolation units. This meeting illustrated the considerable progress made in the wake of the West Africa Ebola epidemic, but the myriad of remaining challenges also underscored the need for continued investment and research in this field.”

Stories You May Have Missed:

  • MERS Transmission in Saudi Hospital – “Nine healthcare workers are among the 39 MERS-CoV patients identified in a hospital-based outbreak of the virus in Wadi ad-Dawasir, Saudi Arabia, and according to the World Health Organization’s (WHO) technical lead, and the outbreak features both human-to-human transmission patterns and spread from animals.”
  • Views from Funeral Directors Managing Disasters– “During Hurricane Katrina, Vigil and 100 colleagues traveled around Baton Rouge placing bodies in 22 refrigerated trucks and ferrying them to a temporary morgue “the size of a football field,” according to a contemporaneous New York Times report, where they helped perform nearly a thousand autopsies. DMORT teams also play an important role in one of the most intensely political parts of the federal government’s response to a natural disaster: the body count. Although DMORT does not decide which deaths are caused by disasters and which just happened concurrently, their assistance frees up local officials who are responsible for answering those questions. The Trump administration infamously undercounted the number of dead after Hurricane Maria —placing the number at just 64 for months, while follow-up assessments pegged it at 1,000 to more than 5,000but without DMORT, that botched response could have been much worse.”

 

Pandora Report: 2.22.2019

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security: From Anthrax to Zika
Are you registered for our summer workshop on all things health security? From July 15-18, we’ll be hosting an engaging and informative workshop on everything from bioterrorism to global health security and what it’s like working in a BSL-4 lab with some of the deadliest diseases. Register before May 1st and get an early-bird discount. You can also get a discount by registering as a large group, returning as a student, or registering with your GMU email.

Replacing BioWatch
The questionable efficacy of BioWatch hasn’t exactly been a quiet conversation and many have suggested doing away with the system all together. The Trump administration though, is pushing to replace it with BioDetection 21, which will apparently be deployed across the United States in the form of 9,000 devices by 2025. A report though has put the real capabilities of this new system into question. “The report also showed that four trigger devices failed in testing last year to detect tiny, unclumped anthrax spores — the type that experts say a skilled terrorist or state-sponsored biowarfare program might produce.Moreover, the triggers correctly detected small particles of viral material — simulating smallpox or other deadly viruses that could be weaponized — in just eight of 168 attempts, a success rate of less than 5%. Trigger devices have ‘clear limitations … for detection of smaller particles and some biological threat categories,’ the report said.The Times obtained a copy of the report, which was produced by the Johns Hopkins University Applied Physics Laboratory. The findings were consistent with Homeland Security’s earlier evaluations of triggers, according to current and former federal scientists.” In a nutshell, this means that an already questionable system would be replaced by one even less beneficial.

Measles and How We’re Fighting A Vaccine-Preventable Disease
At this point, you’ve probably heard a lot about the growing measles outbreak in the state of Washington, or the extensive one that occurred in Minnesota in 2017. Or maybe the one that happened in Disneyland in 2015. Those are just a few of the ones that occurred in the past couple of years, but you get the gist of it. This latest one has reportedly been traced to a family that did not vaccinate and traveled abroad. In fact, this recent outbreak has brought the anti-vaccine movement to the forefront, with many discussing the implications of this community of supporters for vaccine declinations and even the children going behind their parents back to get vaccinated. “These outbreaks will cost states and the federal government millions of dollars to contain. They’ll distract from other important public health programs. Most importantly, they’ll put people who can’t be immunized — people allergic to vaccines, newborn babies — at risk. But here’s the most frustrating part: This is all entirely avoidable. By 2000, thanks to the measles vaccine, the virus had been eliminated in the US. It’s absurd that outbreaks have reappeared, yet there’s a single reason why: Too many states make it way too easy for parents to avoid vaccines on behalf of their kids. In other words, measles is making a comeback because of a policy failure.” You can find the latest info on the outbreak here.

China’s Biotech Development – the Role of U.S. and Other Foreign Engagement 
You can now read the latest report by Gryphon Scientific and Rhodium Group, prepared for the U.S.-China Economic and Security Review Commission. “The U.S.-China Economic and Security Review Commission released a report entitled China’s Biotechnology Development: The Role of U.S. and Other Foreign Engagement, prepared for the Commission by Gryphon Scientific and Rhodium Group. The report examines the development of China’s biotechnology industry and the role foreign trade, investment, and other linkages—particularly with the United States—have played in its evolution.”

Nowhere to Hide: The Logic of CW Use in Syria
Over the course of the Syrian civil war, there have been 336 chemical weapons attacks, of which 98% were attributed to the Assad regime and 90% occurring after the “red line” incident. “It is clear that the Syrian military has consistently prioritized striking population centers over rebel positions on the frontlines, even in the face of defeat on the ground. Indeed, the Syrian regime’s persistent and widespread use of chemical weapons is best understood as part of its overall war strategy of collective punishment of populations in opposition-held areas. Chemical weapons are an integral component of its arsenal of indiscriminate violence, alongside sieges and high-explosive weapons such as ‘barrel bombs.’ We show that the Assad regime did not merely ‘get away’ with its use of these banned weapons, but succeeded in using them for strategic ends. More than two-thirds of Syria’s population are internally or externally displaced, and opposition-held communities have been buckling and surrendering under the cumulative weight – and eventually the mere threat – of violence, including the use of chemical weapons.”

 Using CRISPR for Disease Detection
Gene editing tools have been marked with great potential but also concern for misuse, and a new article discusses the potential for use as a diagnostic tool in infectious diseases. “Researchers in Nigeria are trying out a new diagnostic test based on the gene-editing tool CRISPR. The test relies on CRISPR’s ability to hunt down genetic snippets ― in this case, RNA from the Lassa virus ― that it has been programmed to find. If the approach is successful, it could help to catch a wide range of viral infections early so that treatments can be more effective and health workers can curb the spread of infection.” Estimates put the reduction of Lassa fever deaths as high as 60% if a user-friendly test could be utilized. Since infectious disease diagnostics can be costly and have significant requirements with expertise/resources, there are many outbreaks and places that have limited chances to utilize them. “The CRISPR tests offer the tantalizing possibility of diagnosing infections as accurately as conventional methods, and almost as simply as an at-home pregnancy test. And because CRISPR is engineered to target specific genetic sequences, researchers hope to develop a tool based on the technology that can be fine-tuned to identify, within a week, whatever viral strain is circulating. ‘This is a very exciting direction for the CRISPR field to go in,’ says Jennifer Doudna, a biochemist at the University of California, Berkeley, who is developing some of these tools.”

How Nigeria’s CDC Is Preventing the Next Pandemic
As leader of the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu works to combat disease and build critical public health infrastructure within the country. “Ever since the Ebola crisis of 2014–16 — from which Nigeria was largely spared — global-health leaders have been fretting about the possibility of an epidemic exploding in Lagos and spreading to London, New York, Mumbai or Beijing. Many argue that the best hope of mitigating such a catastrophe will come from the capacity of African nations to catch outbreaks early and stem their spread. Ihekweazu had written about this necessity long before it was in vogue — but he never imagined leading the effort himself. Yet just two years after his appointment, he has more than doubled the size of the NCDC staff, set up a network of molecular-biology labs across the country and become the steward of multimillion-dollar grants intended to diffuse the threat that an epidemic in Nigeria poses for the rest of the world. On his watch, the nascent agency has battled about a dozen outbreaks, which have infected more than 70,000 people (see ‘Keeping tabs’). ‘We are building the ship while we are sailing,’ Ihekweazu says. Now he has another two years to transform the NCDC into an organization that will operate successfully long after he’s gone.” Dr. Ihekweazu is making considerable strides in fighting disease in Nigeria through the now independent agency, which allows him to have better control over reporting and hiring processes. “Ihekweazu takes heart in seeing Africans such as WHO director-general Tedros Adhanom Ghebreyesus step onto the global stage. Sipping on a cheap beer during a quiet moment one night, Ihekweazu says he could imagine working at a multinational health agency when his appointment at the NCDC ends in 2020. ‘As Africans, we need to be stronger participants in the organizations leading the responses to challenges concentrated in our part of the world,’ he says.”

USAID-funded Prepared & Response Project Event
Don’t miss this March 21st event at the National Press Club in Washington, D.C. “Over the past four and a half years, the USAID-funded Preparedness & Response project has worked across 16 countries to spread the vision of a multisectoral One Health approach — where human, animal, and environmental health assets join forces — becoming the standard way to prevent, detect, and respond to emerging pandemic threats. As the project approaches the end of its tenure, please join us as we bring together the One Health community of practice to share key learning, demonstrate successful approaches to country ownership, and discuss the future of multisectoral coordination for preparedness and response.”

Australia Works to Change Up Their Dual-Use Research Control
“A review of Australian export laws has pushed back against the government’s effort to tighten controls on technologies and research that might have dual military and non-military uses. Australian researchers, who were concerned that sweeping controls would restrict collaborative research, have welcomed the findings. Existing laws require academics working on ‘dual use’ research to apply for a Department of Defence permit before they communicate the work to anyone outside of Australia. But the department wanted those laws, introduced in 2012 and amended in 2015, strengthened to reflect changes in national security risk since then.” Australia isn’t the only country considering controls on international research collaboration, as many have encouraged the government to work with other universities, industries, and agencies to reduce the impact on trade/research, but also limit uncertainty.

WMD Detector Selector 
If you’ve been looking for a catalogue of the latest detection and diagnostic technologies for CBRN, check out the WMD Detector Selector. “In order to capture the usefulness of each technology, four scenarios of use were devised: Field/Man portable; Mobile laboratory/Field laboratory; Diagnostic laboratory/Point of care; and High sensitivity, high throughput analytical laboratory. The four scenarios are designed to summarize the entire spectrum of detector and diagnostic utilization. Employing this approach, the Global CBRN Detector Market Survey can more accurately describe the usefulness of each system based on its specific characteristics.” Once you’ve reviewed the four scenarios, you can check out the fact sheet and contact the manufacturer for more info.

Stories You May Have Missed:

  • Outpatient Infection Control – Managing Microbial Transmission“Outpatient clinics are not traditionally focused on infection control initiatives. Despite 990 million physician office visits and 125.7 million hospital outpatient visits each year in the United States, these clinics are often overlooked when it comes to controlling the transmission of harmful pathogens. Until recently, acute and long-term care facilities have been viewed as common sources for microbial transmission. Fortunately, focus has slowly been moving to outpatient clinics and the importance of infection prevention measures for patient and health care provider safety. A new study, published in the American Journal of Infection Control, sought to evaluate outpatient clinic microbial transmission and a disinfecting spray’s role in reducing the spread of germs.”

Pandora Report 2.15.2019

Summer Workshop on Pandemics, Bioterrorism, and Health Security
We’re excited to announce that the Summer Workshop is now open for registration! From July 15-18, you can participate in 3.5 days filled with topics ranging from vaccine development to bioterrorism response, cyber biosecurity, global health security, biosecurity implications of CRISPR and GoF research, and so much more! Even better, if you register before May 1st, you can get the early-bird discount. We also have discounts available for returning attendees, large groups, and GMU affiliates. This is a great opportunity to learn from the top minds in the field – we hope to see you there!

Talking Biodefense with Senator Daschle
Next week GMU Schar School of Policy and Government at George Mason University will be hosting an informal discussion about key issues in biodefense with former Senator Thomas Daschle, founder of the Daschle Group and a Panel Member on the Blue Ribbon Study Panel on Biodefense. The event will be held on February 19 but is open only to Schar/GMU faculty, students, and alum. If you haven’t registered, feel free to email biodefense@gmu.edu with your GMU account for a registration link.

GMU Biodefense Student Named ELBI Fellow
For a fourth year, Schar Biodefense has a graduate student selected for the Johns Hopkins Health Security Emerging Leaders in Biosecurity (ELBI) program. Congrats to biodefense doctoral student Justin Hurt on being selected for this prestigious fellowship! In addition to his part-time studies, he is an active duty officer in the United States Army, specializing in chemical, biological, radiological, and nuclear (CBRN) matters and is currently detailed to the Federal Bureau of Investigation as a Defense Liaison in the Weapons of Mass Destruction Directorate (WMDD), where he advises the Assistant Director and WMDD staff on interagency operations and capabilities and assists in policy development. His recent experience includes positions as a section leader for the Defense Threat Reduction Agency’s CBRN/WMD Military Advsory Team program, the Army’s WMD programs manager and capabilities development coordinator with the Manuever Support Center of Excellence at Fort Leonard Wood, and as a CBRN Technical Escort Response Detachment Commander, as well as command of both chemical and infantry organizations. Justin also originated and leads the Intergancy Counter-WMD Training and Education Working Group, a collaborative inter-departmental organization dedicated to sharing WMD-related training programs and opportunities throughout the government service. His primary research interests lie in improving public-private sector education and cooperation in mitigating international spread of pandemic disease and improving biosafety procedures and training in the expanding number of pathogenic organism research facilities around the world. On being selected, Justin noted that “ELBI represents an annual cohort of future thinkers, advisors, and policy makers in biodefense that come from a wide variety of unique backgrounds and skills that bring together new viewpoints and knowledge applied to tackling some of the nation’s biggest emerging challenges, such as the illicit use of new biotechnologies or the threats to a growing bioeconomy. To be able to participate with such a highly qualified group of developing leaders in this nascent field is really humbling and I will endeavor to contribute and learn as much as I can along the way. I believe the education and perspectives I have gained from studying in George Mason University’s Biodefense Program and the interactions I have beeen fortunate enough to have had during the past two years with the Schar School have prepared me well for contributing in a significant way to the EBLI Fellowship. GMU’s Biodefense students are likewise an incredibly diverse, motivated, and highly intelligent group of future scholars and I’m proud to be able to represent them as a group and the outstanding faculty and staff of the Schar School in this opportunity, and I want to thank my professors, fellow students, and the school’s staff in supporting not only my educational development but also my desire to broaden – and I know that participating in the ELBI program will be a fantastic adjunct to my challenging and rewarding studies at GMU.” Dr. Gregory Koblentz, GMU biodefense graduate program director stated that “Justin is an outstanding student who combines a wealth of practical experience with a passion for biodefense policy. I know Justin will make an important contribution to the Center for Health Security’s objective of building a network of professionals working at the nexus of health, science, and security. This is the fourth year in a row that a student from the Schar School’s Biodefense Program has been selected to participate in the ELBI program. I am gratified to see that the excellence of our students and their unique ability to bridge the gap between science and policy is recognized and valued by the biosecurity community.”

Gain of Function H5N1 Research Resumes 
GoF research involving H5N1 is set to resume…without review comments as the review panel has kept mum. “HHS cannot make the panel’s reviews public because they contain proprietary and grant competition information” – regarding the two labs approved to run such experiments. “The outcome may not satisfy scientists who believe certain studies that aim to make pathogens more potent or more likely to spread in mammals are so risky they should be limited or even banned. Some are upset because the government’s review will not be made public. ‘After a deliberative process that cost $1 million for [a consultant’s] external study and consumed countless weeks and months of time for many scientists, we are now being asked to trust a completely opaque process where the outcome is to permit the continuation of dangerous experiments,’ says Harvard University epidemiologist Marc Lipsitch.” One of the experiments- “Kawaoka’s grant is the same one on H5N1 that was paused in 2014. It includes identifying mutations in H5N1 that allow it to be transmitted by respiratory droplets in ferrets. He shared a list of reporting requirements that appear to reflect the new HHS review criteria. For example, he must immediately notify NIAID if he identifies an H5N1 strain that is both able to spread via respiratory droplets in ferrets and is highly pathogenic, or if he develops an EPPP that is resistant to antiviral drugs. Under the HHS framework, his grant now specifies reporting timelines and who he must notify at the NIAID and his university.” Overall, many are concerned regarding the lack of transparency surrounding the decision to approve such research, especially with the amount of work that has gone into collaborative and informative discussions to help guide policy.

Ebola Outbreak Updates & Hot Zone Drama
On Wednesday, four more cases of Ebola were identified in the DRC and close-calls have prompted testing in Uganda. “A family’s transport of a Ugandan man who died on Feb 8 in the DRC’s outbreak region across the border and back into Uganda sparked intensive contact tracing, location of the body, and sample testing, according to a statement yesterday from the World Health Organization (WHO) African regional office. The 46-year-old man was a construction worker who had been living and working the DRC for the past 8 years. He was first admitted to the hospital in Bunia, one of the towns in Ituri province that has reported Ebola cases, in November 2018 with symptoms that included chest pain and a sometimes-bloody cough. After learning of the incident, Uganda’s health ministry—with support from the WHO—intercepted the man’s relatives and the vehicle with the dead body in it before they reached their village in Tororo district. A ministry burial team and surveillance officer took oral swabs, conducted a verbal autopsy, and made plans to conduct a safe and dignified burial.” If you’re still not getting enough Ebola conversations in your life, watch out for the latest National Geographic series – The Hot Zone. Adapted from the book by Richard Preston, this prime-time drama will likely provide the eagle-eyed biodefense nerd some good scientifically inaccurate depictions of the disease and response measures.

Safeguarding the Bioeconomy Event 
The NextGen Global Health Security Network & GMU Biodefense Discussion Group are hosting an event with guest speaker FBI Supervisory Special Agent Edward You. This event will be held on February 21st at 7:30pm in Arlington, and is exclusive to current Schar students and faculty. Seating is limited and to reserve your spot (RSVP is required), please contact jmarroq2@gmu.edu or staylo30@gmu.edu

Fighting Tuberculosis in the Wake of Hurricane Maria
GMU Biodefense doctoral student Saskia Popescu discusses the challenges of continuing TB control in the wake of a natural disaster. “Responders from the US Centers for Disease Control and Prevention (CDC)’s Division of Global Migration and Quarantine, Puerto Rico Department of Health, and the CDC’s Division of Tuberculosis Elimination have provided insight into their experiences following Hurricane Maria via notes from the field published in a January CDC Morbidity and Mortality Weekly Report. The authors emphasized several unique facts that challenged public health efforts in Puerto Rico. For example, less than a week after the hurricane, 84% of hospitals there had no electrical power or fuel for generators, and within the span of 2 weeks there had been 2 declarations of major disasters due to Hurricane Maria and Hurricane Irma, which passed 57 miles north.
Prior to the storms, the Puerto Rico Department of Health Tuberculosis Control Program (PRTB) worked to prepare at its six regional clinics. The department “provided all patients receiving treatment for active TB with a 1-month supply of anti-TB medications before the hurricane and encouraged patients to tell health officers at shelters about their diagnosis if they had to be relocated from their homes.” Furthermore, the Puerto Rico Health Department worked to educate and inform shelters of the potential risk for tuberculosis transmission. They also provided guidance for screening procedures that extended beyond tuberculosis. ”

The True Burden of Resistant Infections
We’ve been basing the burden of resistant infections in the U.S. on data that might not be accurate anymore. “For several years now, the most frequently cited number has been 23,000 deaths a year, a figure put forward by the US Centers for Disease Control and Prevention (CDC) in a 2013 report on the most dangerous antibiotic-resistant pathogens. The CDC calculated that number—and the estimate of more than 2 million illnesses a year caused by antibiotic-resistant bacteria—using data from the National Healthcare Safety Network, the Emerging Infections Program, the National Antimicrobial Resistance Monitoring System, the National Center for Health Statistics, and hospital surveys.” For many of us in infection prevention, this number has always seemed smaller than what we really saw on the hospital units. The CDC is working though, to update this as it’s likely these are quite conservative numbers. “Michael Bell, MD, deputy director of the Division of Healthcare Quality Promotion at the CDC, agrees. He contrasts death data with birth data, which is based on an event that generally happens in a controlled setting, with people present to record it. ‘Death data is very different,’ he said. ‘We don’t have that degree of control about understanding when someone dies, how they die, where they die, and with whom they die.’ There are other challenges in estimating US deaths from drug-resistant infections, including a lack of universal reporting of antibiotic-resistant pathogens and the absence of ICD-10 codes—the alpha-numeric codes used by physicians, health insurers, and public health agencies—that specifically denote diagnoses of multidrug-resistant infections, which are the most severe and life-threatening forms of bacterial infection.”

Zika As An Occupational Hazard for Laboratory Biomedical Research Workers
GMU Biodefense doctoral alum Chris Brown is addressing the risk that Zika poses for laboratory workers. In a letter to the editor, he and Jill Shugart describe “several reports of laboratory and biomedical research workers having been potentially exposed to Zika virus, including as a result of sharps injuries. Also emphasizes the importance of implementing appropriate controls, including proper PPE and worker training, to prevent future Zika exposures.”

Stories You May Have Missed:

  • FDA Takes New Steps to Secure Drug Supply Chain– “A key element of the U.S. Food and Drug Administration’s mission is focused on helping to ensure that all products we regulate, including drugs available to consumers, are safe and of high quality. This means working to ensure greater accountability in our nation’s drug supply chain. As part of these efforts, today, the agency is launching a new pilot project in which participants representing the drug supply chain (e.g., manufacturers, repackagers and other stakeholders) can pilot the use of innovative and emerging approaches for enhanced tracing and verification of prescription drugs in the U.S. to ensure suspect and illegitimate products do not enter the supply chain. Eligible entities may apply to participate in the program. The pilot will inform the development of the enhanced electronic, interoperable track-and-trace system for industry set to go into effect in 2023 as part of the Drug Supply Chain Security Act. This new program will pilot technologies that may become part of our enhanced expectations for reliable track-and-trace systems. The new system will be aimed at reducing diversion of drugs distributed domestically and will help keep counterfeit drugs from entering the supply chain, and ultimately, reaching patients.”

Pandora Report: 2.8.2019

Happy Friday and welcome to our weekly biodefense round-up! This is our favorite time of year as we get to provide some great summaries of ASM Biothreats 2019 from our student reporters.

ASM Biothreats 2019
We’re excited to present our student coverage from the ASM Biothreats conference. This was an engaging few days with lots of discussion surrounding high consequence pathogen research, biotechnology, and the threat of infectious disease. From converging technologies and biorisks to global perspectives on biodefense, we’ve got coverage of some great panels and sessions with the world’s top biodefense experts. Check out the landing page here, which provides insight into our student reporters and links to their individual summaries of the events.

Ebola in the DRC – Time to Sound the Alert?
Is it time to sound the global alarm for the DRC Ebola outbreak? As two more cases were reported and cases have reached nearly 800, many wonder if the outbreak should be declared a Public Health Emergency of International Concern (PHEIC). This outbreak has been particularly challenging – from an election to armed conflict and mass displacement, it has challenged response efforts in new ways. A new article in The Lancet discusses this very issue, noting that “The legal criteria for a PHEIC have been met. The International Health Regulations (2005) (IHR) empower the WHO Director-General to declare a PHEIC. A PHEIC is an extraordinary event with public health risk to other countries that requires a coordinated international response. IHR criteria include public health impact, novelty and scale, and movement of persons. The WHO Director-General must also consider health risks, potential international spread, and EC guidance, among other factors.The report of the EC in October, 2018, expressed concern about armed conflict and new cases without known links, but advised against a PHEIC ‘at this time’. Unlike past statements, the EC did not say ‘the conditions for a PHEIC have not been met’. The DRC epidemic meets PHEIC criteria and has for some time. The IHR empower a PHEIC for ‘potential’ cross-border transmission, without waiting until international spread has occurred. The Ebola epidemic in DRC is unfolding amid regional conflict, as attacks on medical staff coincide with subsequent spikes in cases. As the authors emphasize, the WHO and its partners must work together and with others to ensure success, as international solutions to these events are only becoming more challenging and complicated. “We must plan for a future in which political violence and instability become the new abnormal.” You can also see photos from the frontline of this outbreak here.

Removing Non-medical Obstacles in the Pursuit of Global Health Security 
Speaking of strengthening global health security…GMU biodefense alumni Dr. Jennifer Osetek discussed this very issue in her doctoral dissertation. Jen received her Bachelor of Arts from Drew University in 2003. She has been a commissioned officer in the Coast Guard Reserve since 2007, teaches with Penn State University, and works as a CBRNE analyst with the Coast Guard. She received her Master of Homeland Security in Public Health Preparedness from the Pennsylvania State University in 2008. Her dissertation focused on the very real issue of non-medical obstacles – While traditional public health responses are typically focused on pharmaceutical interventions, historically there have been outside obstacles that have a major influence on the success or failure of a response. Despite their importance, these impediments are typically studied retroactively instead of being a major component of pre-planning and execution considerations. This dissertation proposed a new framework introducing four major classes of Non-Medical Obstacles (NMOs): security, logistics, communications, and social/cultural issues. When the impact of these NMOs are better understood and incorporated into future public health responses, it will be possible to provide more effective and efficient care to populations in need.

 U.S. Experiment Aims to Created Gene-Edited Human Embryos
Despite the scrutiny over He announcing he had used CRISPR to edit the DNA of human babies, a scientist in New York is working to create gene-edited human embryos. “In contrast, Dieter Egli, a developmental biologist at Columbia University, says he is conducting his experiments ‘for research purposes.’ He wants to determine whether CRISPR can safely repair mutations in human embryos to prevent genetic diseases from being passed down for generations. So far, Egli has stopped any modified embryos from developing beyond one day so he can study them. Egli hopes doctors will someday be able edit embryonic human DNA to prevent many congenital illnesses, such as Tay-Sachs disease, cystic fibrosis and Huntington’s disease. In the lab, Egli is trying to fix one of the genetic defects that cause retinitis pigmentosa, an inherited form of blindness. If it works, the hope is that the approach could help blind people carrying the mutation have genetically related children whose vision is normal.”

Antimicrobial Resistance – A Neglected Biodefense Focus
It’s easy to think that biodefense is about defending against bioterrorism or the next pandemic…or even some laboratory accident..mostly because it is all these things but also so much more. Antimicrobial resistance isn’t a flashy topic and it certainly isn’t getting its own apocalyptic outbreak movie anytime soon (hint for Hollywood, this is the topic we’re missing) but it’s been a largely growing microbial threat since antibiotics were first discovered. Pew Charitable Trusts has been working hard to combat AMR and recently discussed the role it has in U.S. biodefense efforts. “Antibiotic-resistant bacteria are not only a threat to public health in the United States, but also to national security. The federal government has recognized that antibiotic-resistant pathogens complicate soldiers’ wounds, exacerbate casualties associated with both natural and manmade emergencies, and can be weaponized by our nation’s enemies. Consequently, the first U.S. National Biodefense Strategy, released last year, highlights the need to reduce the emergence and spread of such superbugs both domestically and internationally, and accelerate the development of new drugs, diagnostic tests, and vaccines. Rick Bright, director of the Biomedical Advanced Research and Development Authority(BARDA)—part of the Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response—is among those leading the strategy’s implementation.”

One Health-Social Sciences Initiative (OHSS) Webinar in Spanish – El enfoque de “Una Salud”
The One Health Social Sciences (OH-SS) Initiative is hosting a free webinar series to feature inspirational speakers addressing the role of the social sciences in advancing animal, human, and environmental health systems. We are pleased to offer a webinar to our Spanish-speaking colleagues working to promote One Health and social science concepts in research, practice, and policy in Latin America. El Enfoque de “Una Salud” en Latinoamérica: Perú y México, A focus on “One Health” in Latin America: Peru and Mexico, will be held on Tuesday, Feb 26, 2019, from 10:00 AM – 11:00 AM EST (UTC-5). The Webinar is free to attend but you must RSVP.

Stories You May Have Missed:

  • Letter Pushes for Congressional Action to Stimulate Antibiotic Development – “A coalition of drug makers, infectious disease experts, and public health advocates yesterday called on US lawmakers to pass measures that could “jumpstart” the development of critically needed antibiotics. In a letter sent to lawmakers in the Senate and the House of Representatives, stakeholders from large and small pharmaceutical companies and organizations including the Infectious Diseases Society of America, the Pew Charitable Trusts, and Trust for America’s Health asked Congress to ‘swiftly enact a package of incentives that would sustainably reinvigorate the pipeline of antibiotics while ensuring patient access and appropriate stewardship’.”
  • Concerns for Resistant Flu Medications – “Microbial resistance is not reserved solely for bacteria and antibiotics; the truth is that viruses are wholly capable of mutating to become resistant against medications. Consider HIV—the virus has the ability to mutate and continue viral production in the presence of the antiretroviral drugs that are used to kill it. The same concerns exist for influenza viruses, which already mutate quite rapidly.  In late January, investigators published findings that a new influenza antiviral drug may not be as effective as originally anticipated. Marketed as a competitor for existing medications Tamiflu (oseltamivir) and Relenza (zanamivir), this new medication is called Xofluza (baloxavir marboxil) and is recommended for flu treatment. Although Xofluza doesn’t prevent the flu like the vaccine, if taken within 48 hours of becoming sick with symptoms, such antiviral drugs can help lessen the symptoms and shorten the duration of sickness. The driving point of Xofluza is that it is offered as a single dose while Tamiflu requires twice daily doses for 5 days.”

Pandora Report: 2.1.2019

We’re in the middle of a polar vortex and Gov. Jay Inslee just announced a state of emergency in Washington due to a measles outbreak, but the world of biodefense doesn’t rest, so we’re here to keep you up to date.

Talking Biodefense with Senator Daschle
The Biodefense Graduate Program at the Schar School of Policy and Government at George Mason University invites you to an informal discussion about key issues in biodefense with former Senator Thomas Daschle, founder of the Daschle Group and a Panel Member on the Blue Ribbon Study Panel on Biodefense. The event will be held on February 19 but is open only to Schar/GMU faculty, students, and alum. Look for an email coming soon if you’re able to attend with details regarding registration.

Recap of the National Defense University’s “Digitization of WMD” Symposium 
Schar Biodefense doctoral student Justin Hurt attended this January 17th event and has provided a recap in case you missed it. He notes that “Some trends that have been notable, especially in terms of synthetic biology, is that automation is becoming increasingly critical and pertinent for emerging biological technologies. The associated computational systems and machinery have inherent cyberbiosecurity risks, including privacy risks, system operation issues, manufacturing risks (that include issues with attributing who made what), and the risk of possible sabotage. As genomics grows, it becomes increasingly automated, thus increasing the system risks. As an emerging consumer product, genomics becomes harder to control and secure at scale. In addition, as an internet connected technology, firewalling becomes variable and not generally standardized. Modeling appropriate measures for large-scale genomics is important because it helps to understand the effects of big data, the similarities and differences between the plethora of different open source bioinformatics software systems which don’t always adhere to security best practices.”

Meeting of the Blue Ribbon Study Panel on Biodefense: Fighting the Next War- Defense Against Biological Weapons
You can join the latest Blue Ribbon Study Panel event “on February 5th, 2019, when we hold a meeting to get a better understanding of the responsibilities and requirements for federal biodefense efforts that are unique to the U.S. Department of Defense. Participants will share their experiences regarding the current threat environment, research and development programs, the Department’s biodefense policies, and implementation of the National Biodefense Strategy. Speakers will include: Congressman Jim Langevin (D-RI) – Chairman, Subcommittee on Intelligence, Emerging Threats and Capabilities; Committee on Armed Services, U.S. House of Representatives, and Derek Maurer, Deputy Assistant Secretary of Defense for Countering Weapons of Mass Destruction, Department of Defense”

 Trust Issues Worsen Outbreak Response
A lack of trust in politicians, public health, and even healthcare, are all critical for responding to an outbreak. Consider if you didn’t trust public health responders knocking on your door to ask questions about contact with a potentially infected person. Or the physicians to give you a treatment. Even more so, consider if you didn’t trust the government to provide you with accurate information and do their best to stop the outbreak. If all of these were true, the chances of getting you to seek care or provide information…well, they’d be pretty abysmal. Laura Kahn discusses the implications of this trust breakdown  during an outbreak. “There are many examples of what can happen to public health when trust breaks down. The ongoing Ebola outbreak in the Northeastern part of the Democratic Republic of Congo is a case in point. The current outbreak, centered in North Kivu province, was first identified last August. Since then, the outbreak has spiraled out of control—despite new diagnostics, experimental treatments, and a vaccine that mostly wasn’t avaible during the 2014-2016 Ebola outbreak in West Africa. The problem is, the people living in violence-plagued North Kivu don’t trust anybody or anything. Rumors and hatreds spread easily, residents have refused to cooperate with outbreak responders, and some don’t necessarily even believe that an Ebola virus exists.” Consider even the anti-vaccination websites and posts you see on social media – this promotes a lack of trust in scientists and the CDC. “One result is that scientific experts are no longer widely trusted. The situation is made worse by politicians who legitimize falsehoods, spreading them in an attempt to peddle fear or hate for political gain. US President Donald Trump has tweeted about there being a link between vaccines and autism more than 20 times, the Independent reported last year. The results of spreading medical disinformation can be deadly.”

Why We Should Be Skeptical About Recent Reports on North Korea’s BW Program
John Parachini talks frankly about that recent and sensational news story regarding North Korea’s bioweapons program. “Many assessments of North Korea’s biological capabilities draw heavily from South Korean sources. These are legitimate sources of information, but like any stream of information, they are imperfect. In a 2012 white paper, the South Korean Ministry of National Defense (MND), assessed that North Korea ‘likely has the capability to produce a variety of biological weapons including anthrax, smallpox, pest, francisella, tularensis, and hemorrhagic fever virus,’ but provided no supportive documentation or evidence. In 2016, the MND altered the language to ‘sources indicate that North Korea is capable of cultivating and producing various types of biological agents such as anthrax, smallpox, and pest on its own’.” Pointing to the bias of defector-based information, he notes that “During 2003–04 and again in 2009, several defectors claimed that North Korea tested poisonous materials on political prisoners. However, these charges refer to the use of chemicals on humans and not biological agents. In 2014, a group of scientists, Korea experts and human rights advocates attempted to verify these claims by speaking with South Koreans working with the North Koreans who made these allegations. The group was unable to corroborate the allegations and discovered inaccuracies discrediting the defectors’ claims” Overall, Parachini underscores the need for greater transparency and dialogue with North Korea. Lastly, he stresses that “As one scholar noted in a historical review of state biological weapons programs ‘Intelligence assessments of foreign BW programs often have been wrong, sometimes overestimating, sometimes underestimating, and sometimes missing them altogether’.”

Discord in Venezuela and the Impact on Infectious Diseases
Venezuela has been spiraling into an increasingly dangerous and precarious state, fueled by the election of Nicolás Maduro. As Juan Guaidó proclaimed himself the rightful head of state last week after over a million Venezuelans protested Maduro’s presidency, there is much at stake. Between the political and economic crisis, roughly 3 million have fled the country and estimates have found that maternal mortality has risen by 65% while malaria cases have increased by 76%. The state of Venezuela is chaotic and teetering on a dangerous brink. Unfortunately, in this environment, infectious diseases also thrive. Civil unrest, large bodies of people fleeing the country, and a collapsing infrastructure all create a ripe situation for the transmission of disease. A new article from the CDC’s Emerging Infectious Disease journal points to this very issue and the resurgence of vaccine-preventable diseases in Venezuela. “The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region.”

Resistant Genes Found in Arctic
A team of researchers reported that they detected antibiotic resistant genes in soil samples collected from islands in the High Arctic. “Among the genes found by the team was blaNDM-1 (New Delhi metallo beta-lactamase-1), which confers resistance to a broad range of antibiotics and has been associated with highly resistant bacterial pathogens and severe, multidrug-resistant infections. The blaNDM-1 gene was first discovered in a patient treated at an Indian hospital in 2008 and subsequently in Indian surface waters. Since then, it has spread to hospitals in more than 70 countries. The genes were found in soil from the Kongsfjorden region of Svalbard, an archipelago in the Arctic Ocean roughly midway between Norway and the North Pole. While many resistance genes have spread around the world, and it’s a known fact that antibiotic resistance isn’t limited by borders, finding a multidrug-resistance gene in such a remote location, the scientists write, highlights ‘how rapidly AR [antibiotic resistance] can globalize’.”

 UNSC 1540 – The  Importance of Regional Coordination
GMU Biodefense doctoral alum Ashley Hess discusses the importance of regional coordinators for UN Security Council Resolution 1540. “United Nations Security Council resolution (UNSCR) 1540, adopted unanimously under Chapter VII of the UN Charter in 2004, is a key component of the global security architecture, enumerating specific obligations for states, which ultimately aims to reduce the overall risk of weapons-of-mass-destruction proliferation. However, although nearly fifteen years have passed since the adoption of the resolution, many states have still not implemented many of its requirements and obligations—meaning that at least some of the vulnerabilities and risks identified over a decade ago likely still exist, or have changed and expanded over time. This viewpoint discusses the establishment of dedicated UNSCR 1540 coordinators in regional organizations as an example of an effective practice that may contribute toward achieving full implementation of the resolution, fully consistent with established US policy. Since some regional organizations may not have the financial and administrative capacity, or political will, to host such a position, this viewpoint also proposes a variety of ways to address these shortfalls.”

ABSA Course Discount
The Association for Biosafety and Biosecurity has announced a discount on their courses. “Due to the difficulties of the current government shutdown we are now offering the Symposium Courses at 1/2 price. Half day courses will now be $150 and full day courses will be $255. The courses are listed below. The Symposium will proceed as planned, even if the government shutdown continues. Professional Development CoursesScenario-based Agricultural Risk Assessment, Animal Disease Response Training, Biosecurity 101, Risks of Deferred Maintenance in High-Containment Facilities, Implementing Biosecurity Solutions, Introduction to Strategic Leadership Principles for Biorisk Management”

DRC Ebola Outbreak Recap
Despite more than 70,000 people being vaccinated, there have been 7 new cases, which makes the total 759, including 468 deaths. You can also check out two interesting articles (you’ll need Google translate) – the first discusses the handling and safety practices (and some ethics) surrounding the blood samples. “During the epidemic, which killed more than 11,000 people in West Africa between 2014 and 2016, scientists collected thousands of blood samples for their research. Without always respecting ethics. September 2017, tarmac at Conakry Airport, Guinea. A small gray plane of the American company Phoenix Air is preparing to take off towards the United States. On board, a mysterious cargo: twenty sealed boxes, shipped by a team of American scientists. In a few hours, they will land on the other side of the Atlantic before being transported to Atlanta, to the headquarters of the Centers for Disease Control and Prevention (CDC), the agency in charge of public health in the United States. Inside, hundreds of biological samples, all contaminated by Ebola, one of the deadliest viruses on the planet. Taken to diagnose patients during the epidemic that hit West Africa between 2014 and 2016 (more than 11,000 deaths), they had been in the US Department of State’s line of sight for several months. His fear? That these vials, hitherto stored in Conakry in freezers closed by simple padlocks, end up in the wrong hands; terrorists wanting to panic, or inexperienced lab technicians who might accidentally spread the virus.” The second article is in regards to the military aspect of Ebola and concerns for weaponizing the disease. “We are here at the Center for Research in Epidemiology-Microbiology and Medical Care (Crems), built by Russia during the 2014-2016 Ebola outbreak, and funded to the tune of $ 10 million ($ 8.8 million euros) by the Russian mining company Rusal, which operates in Guinea the largest bauxite deposit in the world. Shortly after the outbreak of the epidemic in August 2014, Russia dispatched two mobile laboratories and specialists to test for Ebola in the blood of patients. A few months later, a permanent treatment center was built, as well as a laboratory, where a dozen scientists are currently working to test a new vaccine against the virus. This research is done in secret. Even the senior officials of the Guinean Ministry of Health complain that they can not visit the premises. ‘With the Russians, it’s the total blackout,’ regrets one of them. A regular Cremean Guinean agrees to share the bits of information available to him, but says he ignores what has become of the many blood samples taken during the epidemic. ‘The Russians are doing what they want,’ he says, adding that they alone have the right to access the laboratories where research on the virus takes place. For him, there is no doubt that these researchers are military.” In terms of decontamination, MSF International’s Thomas Compigne recently discussed the role it has in controlling the outbreak.

 Tackling African Swine Fever Through Wild Boar Movement
While it doesn’t pose a risk to human health, African swine fever has considerable implications for the agriculture industry. An outbreak on a farm could mean culling the entire herd, which could cost billions across Europe. “As U.S. politicians continue to spar over the idea of building a border wall, Denmark is preparing its own controversial southern border-control barrier. The target is wild boars — specifically, wild boars from Germany. But environmentalists warn the planned 5 ft.-high, 40-mile fence will harm the region’s wildlife and may not even serve the function for which it’s intended. Understanding the rationale for spending $12 million on a fence that may not even work requires understanding the enormity of the Danish pig industry. At any given moment, Denmark is home to at least twice as many pigs as people (roughly 12 million pigs to not quite 6 million Danes). The country’s export market for pigs amounts to about $5 billion a year. At Berith Nissen’s farm in southern Denmark, visitors must change their clothes and socks, wash their hands and slip into borrowed shoes before she’ll open the door to reveal some of her 10,000-plus pigs.”

Stories You May Have Missed:

  • Hedgehogs …Harbingers of Salmonella– “Since October, 11 people across eight states have been infected with a particular strain of salmonella, the Centers for Disease Control and Prevention reported, and all but one of those infected said they had contact with a hedgehog. ‘Don’t kiss or snuggle hedgehogs because this can spread salmonella germs to your face and mouth and make you sick,’ the agency warned. No deaths have been reported and one person has been hospitalized, the C.D.C. said. Three cases have been reported in Missouri and two in Minnesota. Infections have also been reported in Colorado, Maine, Mississippi, Nebraska, Texas and Wyoming.”

 

 

Pandora Report: 1.25.2019

Need a Dirty Tissue? You Can Pay $80 For a Box of Them
In what we’re hoping is a joke, a new start up has released a product to help spread germs – Vaev Tissue.“We believe using a tissue that carries a human sneeze is safer than needles or pills,” read the note that came with the product, written by the founder of the company. Wipe your nose with the sullied tissue, and you’ll “get sick on your own terms.” Similar to the chicken pox lollipops being spread around a few years back, this is basically the adult version of trying to pick your poison and get sick when you want to versus by surprise. In the case of Vaev Tissue, the founder emphasizes that this is a luxury product -“That kind of freedom, that kind of luxury to choose—I mean, we customize everything in our lives and we have everything the way that we want it, so why not approach sickness that way as well?” Since there are so many jokes to be made at this ridiculous “luxury product”, we’re just going to let you run with it…

Making Sense of the 2018 National Biodefense Strategy
The National Biodefense Strategy was released in September and “continues to reinforce the broad scope of the biological threat, including naturally occurring infectious disease, the deliberate use of bioweapons by states, and the growing presence of non-state actors—and now acknowledges new stakeholders within biodefense: the enthusiast community, which includes do-it-yourself biologists.” Last week though, Pacific Northwest National Laboratory released a publicly available (and free!) tool, B-PLAT, which stands for the Biodefense Policy Landscape Analysis Tool. Called the “spaghetti monster”,  this tool helps visualize the relationships between agencies, their responsibilities, and the complexity of preparing for and responding to biological threats. “B-PLAT 2.0 aims to tackle a mountain of useful information that, unfortunately, can be cumbersome to navigate. For instance, responsibilities are frequently assigned to multiple designees; it is not uncommon to find one responsibility assigned to five or more agencies, with no delineation of specific roles. It is also common for seemingly overlapping responsibilities to be assigned to disparate agencies. For example, we identified more than 20 responsibilities for disease surveillance across all sources, assigned to at least five federal agencies and all state, local, tribal, and territorial governments. One federal law directs the Department of Health and Human Services to ‘establish a near real-time electronic nationwide public health situational awareness capability,’ while another law tasks the Department of Homeland Security with detecting any ‘biological event of national concern’ by integrating data from human health, animal, plant, food, and environmental surveillance. In B-PLAT 2.0, both of these responsibilities are tagged with the new strategy goal (‘Enable Risk Awareness to Inform Decision-Making’), the old pillar (‘Surveillance & Detection’), and the activity (‘surveillance’) to help users identify similar responsibilities.” In truth, the dynamics of biodefense can be confusing – with so many agencies, programs, products, etc. The effort by B-PLAT to help bring clarity to national biodefense strategies is wholly appreciated.

New Era of Epidemics- A Rival to Climate Change in Risk to Global Businesses
The World Economic Forum recently collaborated with the Harvard Global Health institute to provide a white paper on the impact of infectious disease outbreaks on the business community and society. You can read the report – Outbreak Readiness and Business Impact: Protecting Lives and Livelihoods across the Global Economy here, which notes that “Economists estimate that, in the coming decades, pandemics will cause average annual economic losses of 0.7% of global GDP – a threat similar in scale to that estimated for climate change. As this report makes clear, this is a level of risk that businesses can no longer afford to ignore.” As the Global Risks Report noted last week, the world is considerably vulnerable to emerging infectious disease threats and risks posed by biotechnologies. “‘Outbreaks are a top global economic risk and – like the case for climate change – large companies can no longer afford to stay on the sidelines. Business leaders need to better understand expected costs of epidemics, mitigate these costs and strengthen health security more broadly,’ said Vanessa Candeias, Head of the System Initiative on Shaping the Future of Health and Healthcare and Member of Executive Committee at the World Economic Forum.”

 Biodefense MS and PhD Open Houses
Looking to improve your biodefense knowledge while obtaining a graduate degree? The Schar school Biodefense program is the place for it – from anthrax to Zika, we’ve got you covered. We’ve got two events coming up that you won’t want to miss if you’re looking to invest in your education. Thursday, February 21st (6:30pm) we’ll be hosting a Master’s Open House and on Wednesday, March 20th (7pm) there will be a PhD Open House – both at the Arlington campus. These are great opportunities to hear about the biodefense programs, meet faculty and students, and learn how you can become a biodefense guru through our in-person and online programs.

Chemical Weapons – From Sanctions to ISIS and the Long-term Effects of Sarin
CW news has been quite extensive this week as the EU hit Russia and Syria with sanctions related to chemical weapons use. This is the first time the EU has imposed sanctions for chemical weapons use and are in relation to the ongoing use of chemical weapons in Syria an the poisoning of two in the UK last year. “The EU travel bans and asset freezes target ‘the two GRU [Russia’s intelligence agency] officials … responsible for possession, transport and use in Salisbury (UK) of a toxic nerve agent,’ as well as the head and deputy head of the organization, EU foreign ministers wrote in a statement.” In other news…Iraqi scientist Suleiman al-Afari is reporting that he helped ISIS build chemical weapons when the militants rounded up workers and pressed them into service. While he is a geologist and was hoping to keep his job at the Ministry of Industry and Minerals, they asked him to help make chemical weapons. “Afari knew little about the subject, but he accepted the assignment. And so began his 15-month stint supervising the manufacture of lethal toxins for the world’s deadliest terrorist group. ‘Do I regret it? I don’t know if I’d use that word,’ said Afari, who was captured by U.S. and Kurdish soldiers in 2016 and is now a prisoner in Irbil, the capital of Iraq’s semiautonomous Kurdish region. He frowned, his fingers flicking a gray-stubbled cheek. ‘They had become the government and we now worked for them,’ he said. ‘We wanted to work so we could get paid’.” Afari recounts these events while serving on death row – discussing his recruitment into ISIS and the group’s successful attempt at making sulfur mustard. “Progress on the program appears to have stalled in early 2016, after U.S. and Iraqi leaders launched an aggressive campaign to destroy production facilities and kill or capture its leaders. Yet, the threat has not been entirely erased. Islamic State leaders moved equipment and perhaps chemicals from Iraq to Syria in 2016, Iraqi officials say, and some of it may have been buried or hidden. Moreover, the knowledge and skills acquired from Afari and other veterans of the program undoubtedly still exist, tucked away in computer files, flash drives and in the memories of the surviving participants who scattered as the group’s self-proclaimed caliphate collapsed, Western officials and terrorism experts said.” While there’s a lot of talk about chemical weapons, what are the actual effects? A systematic review was just conducted by the National Toxicology Program (on behalf of the NIH Countermeasures Against Chemical Threats program) regarding the long-term neurological impacts of acute sarin exposure in both humans and animals. For visual and ocular effects- “Case reports or case series have reported that subjects exposed to sarin occupationally or via terrorist attacks complained of vision problems for weeks to years after exposure. There is a consistent pattern of findings that pupil constriction from acute sarin exposure gradually normalizes in the following week to several months. There is a moderate level of evidence from human studies that sarin has negative effects on vision in the intermediate time period including decreases in visual evoked potentials.” For learning, memory, and intelligence- “Experimental studies in rats found consistent sarin-related effects on learning and memory that were apparent for days, weeks, and months after sarin exposure. The evidence from human studies for effects on learning and memory during the initial period is inadequate. In the extended period, there is a moderate level of evidence that sarin exposure is associated with impaired learning and memory based on epidemiological studies and a low level of evidence from experimental animal studies.” The Department of Health and Human Services has also just released resources for fourth generation agents (i.e. Novichoks) – from safety awareness for first responders to medical management guidelines.

Bavarian Nordic Announces Additional Smallpox Vaccine Manufacturing Option
Bavarian Nordic has just announced that BARDA has exercised an option under their contract for smallpox vaccine (freeze-dried MVA-BN). “The option, valued at USD 44 million, will cover qualification of the new fill-finish facility, currently being established at the Company’s manufacturing site in Denmark, as well as transfer and validation of the freeze-drying process. The majority of this contract option is expected to be revenue recognised in 2019 and 2020. This is the second option exercised under the contract. In 2017, BARDA exercised an option of USD 37 million to cover development costs associated with the Phase 3 study required for the eventual approval of the freeze-dried MVA-BN smallpox vaccine. This Phase 3 will be initiated in the first half of 2019.”

Concerns for Flu-drug Resistance
Concerns for resistance to a new flu drug – the antiviral baloxavir marboxil (Xofluza) -are growing as Japanese researchers discussed H3N2 mutations that help support resistance. “Baloxavir is the first novel flu treatment approved by the FDA since it cleared oseltamivir and zanamivir, both neuraminidase inhibitors, in 1999. The FDA approved baloxavir in October 2018. Sporadic resistance to osteltamivir has been reported over the years, and experts have said flu drugs with different mechanisms of action are needed to provide more options for treating resistant flu. The new drug, discovered by Japan-based Shionogi and developed by Roche, is a single-dose treatment approved in the United States for uncomplicated flu in patients ages 12 and older. Japanese researchers who have been monitoring baloxavir’s susceptibility to circulating flu strains said that, during phase 2 and 3 trials, some patients who got baloxavir and were infected with 2009 H1N1 and H3N2 strains containing certain substitutions had longer virus shedding and time to symptom alleviation. The patterns they saw suggested that the incidence of reduced susceptibility to baloxavir was higher than to oseltamivir.”

Ebola Outbreak Updates
Three more cases have been identified in the DRC, bringing the total to 715 cases (49 of which are probable). The DRC Ministry of Health reported 4 more deaths due to Ebola as well. “As part of bat sampling with the US Agency for International Development (USAID) PREDICT project, scientists found Ebola genetic material and Ebola antibodies in a greater long-fingered bat from Nimba district in northeastern Liberia, according to a press release from Columbia University’s Mailman School of Public Health. The project also included researchers from Columbia’s Center for Infection and Immunity and EcoHealth Alliance. The bat species that yielded Ebola evidence is found in West Africa and other regions and is important to agriculture, because they eat insects that damage crops. Unlike other bats, the long-fingered type doesn’t roost in homes or building and instead are found in forests, caves, and mines. According to the report, Liberia’s government is using that information to teach the public about how to avoid exposure and increase their awareness of the animals’ positive impact on the environment.”

Stories You May Have Missed:

  • UK Aims to Cut Antibiotic Use by 15% in 5-year Plan– “The 5-year national action plan calls for a 10% reduction in the number of antibiotic-resistant infections in people by 2025, a 15% decrease in human antibiotic use by 2024, and a 25% decrease in the use of antibiotics in food-producing animals by 2020. To encourage development of new antibiotics, the government will test a new payment model that will reimburse pharmaceutical companies based on how valuable their drugs are to the National Health Service (NHS), rather than on the quantity of antibiotics sold.”
  • Prior Dengue Infection Protects Children Against Zika– “Children who have previously been exposed to dengue virus appear to be protected from getting sick when infected with Zika virus, according to a study published January 22 in PLOS Medicine. The study’s scientific team, led by Aubree Gordon of the University of Michigan and Eva Harris of the University of California, Berkeley, analyzed the large 2016 Zika epidemic in Nicaragua, while focusing on a pediatric cohort with a well-characterized history of exposure to the dengue virus. The cohort, established in 2004 to gather information about dengue in Nicaragua, follows approximately 3,700 children aged two to 14 years old. “What we saw was that having had a prior documented dengue infection in these kids protected them from symptomatic Zika,” Gordon says. “It didn’t protect them from getting infected, but if they got infected, they were less likely to get sick.” Children with prior dengue infection had 38 percent less risk of showing symptoms when infected with Zika than those who were dengue-free. Zika symptoms included fever, rash, conjunctivitis, muscle, joint pain and headache.”

 

Pandora Report: 1.18.2019

Welcome to your weekly dose of all things biodefense – we’ve got a lot of health security goodies for you this week!

OPCW Agrees to Ban Novichok
The Organization for the Prohibition of Chemical Weapons (OPCW) Executive Council approved adding two families of chemical compounds (Novichok) to the list of Schedule 1 chemicals that are subject to verification. “The 41 members of the decision-making body within the Organisation for the Prohibition of Chemical Weapons (OPCW) adopted a joint proposal by the United States, the Netherlands and Canada, member states said. They agreed ‘to add two families of highly toxic chemicals (incl. the agent used in Salisbury),’ Canada’s ambassador to the agency, Sabine Nolke, said on Twitter. ‘Russia dissociated itself from consensus but did not break,’ she wrote. Western allies ordered the biggest expulsion of Russian diplomats since the height of the Cold War in response to the attack on former Russian secret service agent Sergei Skripal and his daughter Yulia in Salisbury in March.” You can read the OPCW decision release on January 14th here. The Novichok family of chemical warfare agents were developed by the Soviet Union in the 1970s. In 2018, a Novichok CW agent was used in the attempted assassination of Sergei Skripal in Salisbury and led to the contamination of him, his daughter, a police officer, and two private citizens in the nearby town of Amebury, one of who died.

GMU Biodefense Alum Spotlight – Tam Dang
We love to show off the amazing alumni of GMU Biodefense and we’re excited to tell you about Tam Dang – epidemiologist and communicable disease all-star at the Dallas County Department of Health and Human Services. Tam works as an epi for the acute communicable disease division, helping to lead epidemiological investigations for outbreaks or potential bioterrorism events, monitors local/regional/state data sources related to infectious diseases, helps develop outbreak/bioterrorism plans to help support public health preparedness, and analyzes data collected as part of a vector control/bioterrorism surveillance team. Whether it be West Nile, enteric diseases or tuberculosis, Tam’s working to help improve communicable disease preparedness and response. Tam started in the biology world but her Schar Biodefense MS degree “introduced me to the public health field, and offered a unique perspective from a biosecurity and bioterrorism standpoint. It helped me stand out from the pile of applications my supervisor received. In addition, my biology background and prior employment experiences also played a large part in rounding out my graduate education and narrowing my professional field of interest. Overall, past experience and the added education and skills I obtained from the Biodefense Program were a critical factor in helping me pursue my career goals.” Her work is at the intersection of public health and health security. When asked what she felt was the biggest health security threat we’re facing in 2019, Tam noted that “I think some significant health security threats we are facing in the US in 2019 are related to the potential for importations or outbreaks of high-consequence emerging infectious diseases (HCID) such as Ebola and avian influenza. In a metropolitan area like Dallas/Fort Worth, our Public Health Emergency Preparedness (PHEP) division is keenly aware that our proximity to the Dallas/Fort Worth (DFW) International Airport confers particular risk for international importations of infectious diseases. The DFW airport is the twelfth busiest airport internationally, and received the highest number of travelers from countries affected by Ebola outbreaks in 2014-2015, of any airport within Texas. The local health security impact of such global interconnectivity was highlighted in Dallas during the 2014 Ebola outbreak, when a patient from Liberia was diagnosed with Ebola, and two nurses involved in his medical care were subsequently infected with Ebola. Because of this past experience, the current Ebola outbreak affecting the Democratic Republic of Congo has been watched closely by our PHEP epidemiologists over the past year, and this team has been busy participating in drills with area hospitals, and facilitating planning meetings with area hospitals and other community agencies to ensure appropriate measures are in place to rapidly identify, isolate, and evaluate possible cases.”

Revisiting the 2001 Anthrax Attacks and Investigation
The impact of the 2001 anthrax attacks may be slowly fading from memory but the truth is that it had profound implications for American perception of biological threats and fueled a booming biodefense initiative. GMU Biodefense PhD alum Glenn Cross discusses the new book from Scott Decker on the attacks and the evolution of forensics in the FBI. “Scott Decker’s book on Amerithrax is the first and, so far, only insider account of the science involved in the investigation. Decker served as an FBI special agent, one of very few in the bureau with a PhD in the life sciences. His strong academic background and experience in the FBI’s then-fledgling bioforensics effort ensured his rise to a prominent role in the Amerithrax investigation. In time, Decker became the supervisory special agent overseeing Amerithrax’s Squad 2, which was responsible for the scientific and forensics work of the task force. Thus, Decker is perhaps one of only a handful of people capable of providing comprehensive insight into the inner workings of Amerithrax’s bioforensics effort. His book likely will be the only one to offer such a detailed and unique perspective into the U.S. government’s response to the first deadly bioterrorism attack on American soil in peacetime”.

Bill Gates Warns About Gene Editing
Bill Gates recently spoke about gene editing technologies and that we simply are not having enough public debate regarding the ethical implications. “It also raises ‘enormous’ ethical questions, Bill Gates recently warned, and ‘could make inequity worse, especially if it is available only for wealthy people.’ ‘I am surprised that these issues haven’t generated more attention from the general public,’ he said in a December blog post, adding that ‘this might be the most important public debate we haven’t been having widely enough’.”

Going Viral- The Transformation of Biological Risks
The World Economic Forum has released a new report on biological risks. In this report, they discuss the growing threat of infectious diseases- regardless of origin. “The frequency of disease outbreaks has been rising steadily. Between 1980 and 2013 there were 12,012 recorded outbreaks, comprising 44 million individual cases and affecting every country in the world. Each month the World Health Organization (WHO) tracks 7,000 new signals of potential outbreaks, generating 300 follow-ups, 30 investigations, and 10 full risk assessments. In June 2018 there were—for the first time ever—outbreaks of six of the eight categories of disease in the WHO’s ‘priority diseases’ list. If any had spread widely, it would have had the potential to kill thousands and create major global disruption. Five main trends have been driving this increase in the frequency of outbreaks. First, surging levels of travel, trade and connectivity mean an outbreak can move from a remote village to cities around the world in less than 36 hours. Second, high-density living, often in unhygienic conditions, makes it easier for infectious disease to spread in cities—and 55% of the world’s population today lives in urban areas, a proportion expected to reach 68% by 2050. Third, increasing deforestation is problematic: tree-cover loss has been rising steadily over the past two decades, and is linked to 31% of outbreaks such as Ebola, Zika and Nipah virus. Fourth, the WHO has pointed to the potential of climate change to alter and accelerate the transmission patterns of infectious diseases such as Zika, malaria and dengue fever.  Finally, human displacement is a critical factor in this regard. Whether due to poverty, conflict, persecution or emergencies, the movement of large groups to new locations— often under poor conditions— increases displaced populations’ vulnerability to biological threats. Among refugees, measles, malaria, diarrheal diseases and acute respiratory infections together account for between 60 and 80% of deaths for which a cause is reported.” The report also points to fewer deaths but higher costs of these outbreaks, like that of MERS in South Korea in 2015 – while it only infected 200 people, it is estimated to have cost $8.5 billion. Furthermore, the new biotechnologies becoming available – like CRISPR – pose unique challenges for a world with already too many biopreparedness gaps.

Global Health Security and Universal Coverage
A new article addresses this marriage that once started from convenience and is now a strategic partnership. “A consequence of ignoring their individual characteristics is to distort global and local health priorities in an effort to streamline policymaking and funding activities. This paper examines the areas of convergence and divergence between global health security and universal health coverage, both conceptually and empirically. We consider analytical concepts of risk and human rights as fundamental to both goals, but also identify differences in priorities between the two ideals. We support the argument that the process of health system strengthening provides the most promising mechanism of benefiting both goals.”

Are We Normalizing Ebola?
Laurie Garrett discusses the challenges of this current outbreak regardless of the arsenal of tools at hand. Despite the capacity to vaccinate, rapidly detect, and an impressive body of knowledge, this Ebola outbreak is not slowing and the painful truth is that it’s due to human behavior. “But day after day, cases are popping up all over North Kivu that don’t connect to any known chains of transmission—it’s as if they popped out of thin air. The problem: North Kivu is one of the most violent places on Earth, rife with distrust, rumors, conflicts, and multigenerational hatreds. Investigators can’t find the links in the disease chains because the people there do not trust anything, even the very idea that a virus called Ebola exists, and refuse to comply with investigations.” The outbreak continues to pop up and challenge response efforts not because it has become some super strain, “but because of humans and their behaviors in a quarter-century-old war zone.”

National Rights and A Debate Across Science
Helen Branswell of STAT discusses the Nagoya Protocol and that while it aims to protect a country’s control over biological resources, it could pose challenging for scientific collaboration. “More than 100 countries have ratified the protocol. The United States, which is not a party to the Convention on Biodiversity, has not. Some involved in the debate argue genetic sequences aren’t covered by Nagoya, and that the free sharing of digital genetic information is so entrenched in scientific practice — scientific journals require it of their authors — that there’s no going back. Plus, some argue, to subject genetic sequence data to further bureaucracy would be counterproductive to science and dangerous to public health. But a large number of developing countries insist that the protocol gives them as much sovereignty over the genetic sequence data of viruses, bacteria, fungi, and other pathogens found within their borders as it does over plants that are crucial to drug production. In an age of synthetic biology, when a virus can be made from scratch by following a genetic sequencing recipe plucked from a public database, to have the genetic information is to have the bug itself, these countries argue.” You can read about the Nagoya Protocol here, via the Convention on Biological Diversity.

Militaries and Global Health
The role of militaries in global health efforts is not a novel concept but has evolved over time -consider the Ebola outbreak in the DRC as an example of security challenges during an outbreak. A new paper evaluates and summarizes these dynamics and the roles militaries have taken throughout global health efforts over time. “Militaries have many capabilities applicable to global health, ranging from research, surveillance, and medical expertise to rapidly deployable, large-scale assets for logistics, transportation, and security. Despite this large range of capabilities, militaries also have limitations when engaging in global health activities. Militaries focus on strategic, operational, and tactical objectives that support their security and defence missions, which can conflict with humanitarian and global health equity objectives. Guidelines—both within and outside militaries—for military engagement in global health are often lacking, as are structured opportunities for military and civilian organisations to engage one another. We summarise policies that can help close the gap between military and civilian actors to catalyse the contributions of all participants to enhance global health.”

The Threat of North Korea’s Bioweapons
Sure, we worry about nuclear weapons from North Korea, but what about biological weapons? This may not be an entirely new concern, but many experts warn of a growing bioweapons program and that the general lack of attention to it from the Trump administration is worrisome. “Still, Anthony H. Cordesman, a former Pentagon intelligence official now at the Center for Strategic and International Studies, said the North ‘has made major strides’ in all technical areas needed for the production of a major germ arsenal. In unclassified reports, the Trump administration has alluded to the North’s bioweapons program in vague terms. President Trump did not broach the subject of biological weapons during his meeting with Mr. Kim in Singapore, according to American officials. The lack of detail and urgency is all the more surprising given that John R. Bolton, Mr. Trump’s national security adviser, has long described it as a regional and even a global threat.” There have been debates though, about the progress made by North Korea. As GMU Biodefense professor Sonia Ben Ouagrham-Gormley noted, there are several the factors that go into a successful program and “One might ask why, if North Korea has been able to produce a nuclear weapon in the same adverse conditions, it shouldn’t also be successful in the bioweapons field. The answer lies in the decidedly different nature of bio-agents and nuclear weapons. Unlike nuclear material, living microorganisms are fragile and unpredictable. They are more sensitive than nuclear material to changes in work conditions, equipment, laboratory materials, and other disruptions. A country that cannot ensure a stable and continuous work environment is unlikely to operate a successful bioweapons program.”

 Battling Fake News On Top of Ebola
Working against an Ebola outbreak is hard enough, but throw in a conflict zone…and now you’ve really got challenges. Let’s add disinformation and fake news on top of it – making this a chimeric beast of an outbreak. The DRC’s recent election in the middle of the Ebola outbreak has amplified challenges to sharing public health information and guidance to the public for protecting themselves against the disease. “In West Africa, fear kept people away from clinics, meaning Ebola cases, as well as diseases such as measles and malaria, went untreated. Mistrust of governments and aid workers ran high and rumors were rife. That’s even more true in the DRC now. In September 2018, an opposition politician, Crispin Mbindule Mitono, claimed on local radio that a government lab had manufactured the Ebola virus ‘to exterminate the population of Beni,’ a city that was one of the earliest foci of the outbreak. Another rumor has it that the Merck vaccine renders its recipients sterile. On 26 December 2018, the national electoral commission decided to exclude Beni and Butembo from the polls because of the epidemic; the following day, an Ebola evaluation center was attacked during protests. Although opposition organizations condemned the commission’s decision, they called for the Ebola response to be protected—which health workers saw as a small but significant victory. ‘We’ve managed to get communities to separate in their minds Ebola control from the broader political agenda,’ says Michael Ryan, who directs the World Health Organization’s role in the campaign in Geneva, Switzerland. ‘That’s been really helpful.’ Ryan hands much of the credit to social scientists working for the various agencies involved in the response. Along with community engagement workers, they make up one-third of the workforce.” Experts are working to combat the epidemic of rumors by supplying accurate information via WhatsApp or local radio. Responders are hopeful, but this new challenge gives insight into the need for stronger tools against disinformation during an outbreak. Regarding the outbreak – there were 9 new cases identified including one new area. This brings the total case count to 658, with 402 deaths.

Code of the Wild
Interested in joining a public and international conversation on gene-editing? Check out Code of the Wild, which is a communication campaign and upcoming documentary about the social, medical, and ethical issues on genetic engineering. Through the webpage, people can join the conversation by entering a video response to questions raised by the research team. The goal of Code of the Wild is to form a narrative on gene-editing across several industries, sectors, and countries, to help better understand the social and ethical concerns that may or may not exist. You can also find them on Facebook, Twitter, and Instagram.

Stories You May Have Missed:

  • Dermatologists Are Cutting Antibiotic Usage – “Dermatologists have been identified as the most frequent prescribers of oral antibiotics in medicine, handing out more antibiotics per clinician than any other specialty. But a study today in JAMA Dermatology shows that antibiotic prescribing by the specialists has substantially decreased over the past decade. The study, by researchers with the University of Pennsylvania Perelman School of Medicine and the US Centers for Disease Control and Prevention, found that oral antibiotic prescribing by dermatologists fell by 37% from 2008 through 2016. Much of the decrease, they report, has occurred in the extended courses of antibiotics that are typically prescribed for patients with acne and rosacea to lessen inflammation. The researchers estimate that the decrease translates to nearly 480,000 fewer antibiotic courses being prescribed in 2016 than in 2008.”

Pandora Report: 1.11.2019

Happy Friday! If you’re feeling the post-holiday lull about getting back into work, here’s a great podcast on the biology of zombies.

New Bat-borne Virus Discovered by Singapore Researchers
Researchers have identified a new genus of filovirus found in fruit bats. This virus is similar to Ebola and has the potential to cause infection in humans. “The researchers discovered the new virus while analysing the diversity of filoviruses in Rousettus bats. They named it the Mengla virus because it was discovered in Megla County, Yunnan Province, China. They detected the virus from a bat sample and conducted sequencing and functional characterization studies. The results showed that the Menga virus represents a new genus named Dianlovirus within the filovirus group. The Mengla virus is genetically distinct, sharing just 32 percent to 54 percent of its genetic sequence with other known filoviruses. It is found in different geographic locations compared to other filoviruses. This new genus, which could include more than one species, sits in between Ebola virus and Marburg virus on the evolutionary tree.”

House Passes Pandemic Response and All-Hazards Preparedness and Advancing Innovations Act 
The House also passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act 401-17, which organizes programs to react to terrorism, disease outbreaks, and natural disasters. House Energy and Commerce Chairman Frank Pallone, D-N.J., and top-ranking Republican Rep. Greg Walden of Oregon said in a statement that the bill would ‘strengthen our nation’s emergency preparedness and response efforts and modernize the nation’s regulatory framework for over-the-counter drugs. Thanks to this legislation our communities will be safer and better prepared for emergencies, and FDA’s regulatory standards for OTC drugs will be modernized to better ensure consumer safety’.” “U.S. Rep. Anna Eshoo (D-CA) sponsored H.R. 269. U.S. Reps. Susan W. Brooks (R-IN), Bob Latta (R-OH), U.S. House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-NJ) and Ranking Member Greg Walden (R-OR) are among the bill’s seven original cosponsors. Many of the same lawmakers also played key roles in the original law’s 2006 enactment and subsequent first reauthorization in 2013.”

WHO’s Draft Code of Conduct for Open/Timely Sharing of Pathogen Genetic Sequence Data During Outbreaks
WHO has just released their code of conduct to help enable the sharing of pathogen genetic sequence data during infectious disease outbreaks. “Pathogen genetic sequence data (GSD) is an increasingly valuable source of information in understanding and controlling outbreaks of infectious disease. With the advent of next generation sequencing, the depth/extent of available information will expand further. A key concern in recent outbreaks has been variable timelines between the start of an outbreak and the public availability of the first and subsequent genetic sequences. WHO strongly supports public access to sequence data to inform public health and research decision-making during outbreaks, the equitable sharing of benefits derived from the use of such data, and the legitimate interests of data providers. WHO has consulted with many stakeholders and institutions working in the pathogen sequencing arena, including those who have been involved in applications to recent outbreaks. Based on these consultations, and on lessons learned from recent outbreaks as part of the data sharing workstream of the WHO R&D Blueprint, WHO is proposing elements of a code of conduct for GSD sharing in infectious disease outbreaks.” You can access the full draft here.

EU Human Brain Project Opinion on Responsible Dual Use
The Ethics and Society Group of the Human Brain Project has just released their opinion on responsible dual use, which includes recommendations for dealing with concerns in relation to misuse of brain research. “As a consequence, The Human Brain Project has established a project-wide dual use working group to evaluate the research carried out within the project, and to disseminate the recommendations from the opinion, as well as experience accumulated through the work of the group itself. Target audiences include national governments, the European Commission, national and international research associations.” Not only does the report include political, security, intelligence, and military research of concern, but it also includes recommendations for the HBP, the EU, and other social actors. For example, “We recommend that the European Commission addresses the tension between the policy of ‘Open Innovation, Open Science, Open to the World’ and the need to regulate and restrict dual use research of concern.”

Second International Summit on Human Genome Editing: Continuing the Global Discussion
The National Academies have released their proceedings from the second summit held from November 27-29 in Hong Kong. The summit involved over 500 researchers, ethicists, policymakers, etc., to discuss the potential benefits and risks of human genome editing and ethical cultural perspectives. “The second international summit follows the First International Summit on Human Gene Editing, which was held in Washington, DC, on December 1-3, 2015.3 In a statement released at the end of the 2015 summit, the organizing committee of the 2015 summit observed that intensive basic and preclinical research on genome editing was clearly needed and that such research should be subject to appropriate legal and ethical rules and oversight. The statement said that genome editing of somatic cells—that is, cells whose genomes are not transmitted to the next generation— could be “appropriately and rigorously evaluated within existing and evolving regulatory frameworks for gene therapy, and [that] regulators […could] weigh risks and potential benefits in approving clinical trials and therapies.” However, the 2015 organizing committee stated that genome editing of germline cells, which can be passed on to subsequent generations as part of the human gene pool, would be “irresponsible” until safety issues were resolved and until there was broad consensus that the proposed use of genome editing was appropriate.” This summit is especially relevant as it came right after He’s announcement of using CRISPR in human embryos.

Government Shutdown Impacts FDA Food Inspections
It seems almost daily we’re learning more and more about how the government shutdown is impacting just about everything. The wave goes beyond travel and national parks, but now includes the routine food safety inspections of seafood, fruits, vegetables, and other high-risk foods. “F.D.A. inspectors normally examine operations at about 160 domestic manufacturing and food processing plants each week. Nearly one-third of them are considered to be at high risk of causing food-borne illnesses. Food-borne diseases in the United States send about 128,000 people to the hospital each year, and kill 3,000, according to the Centers for Disease Control and Prevention. Domestic meat and poultry are still being inspected by staff at the Agriculture Department, but they are going without pay. The F.D.A. oversees about 80 percent of the nation’s food supply, as well as most overseas imports.” FDA Commissioner Dr. Scott Gottlieb tweeted this week on how the shutdown has impacted several FDA operations.

One Health -Social Sciences Webinar Series
Don’t miss this webinar next Tuesday 1.15 at 11am EST on Addressing Gender Issues in One Health and Infectious Disease Preparedness. Hosted by One Health Commission and presented by Dr. Brigitte Bagnol and Dr. Janetrix Amuguni, you won’t want to miss it!

Ebola Outbreak Update
Two additional cases were reported in the DRC, bringing the total case count to 627, of which 579 were confirmed. 98 cases are still being investigated. “Five more deaths were reported: three in Butembo and one each in Beni and Katwa. The fatality from Katwa involves someone who died in the community, a factor known to increase the risk of Ebola transmission. The number of people who received the VSV-EBOV vaccine continues to rise. Since Aug 8, 58,866 people have been vaccinated. The World Health Organization (WHO) African regional office said today in a weekly outbreak and health emergency report that Butembo, Katwa, and Oicha are the current main hot spots in the outbreak, which is now entering its sixth month. It said resumption in response activities in the wake of recent election protest disruptions is encouraging, but more interruptions could pose serious problems for timely containment of the outbreak.”

Ebola Readiness- A False Sense of Security
GMU biodefense doctoral student and infection preventionist Saskia Popescu discusses a recent report on hospital preparedness and how surveyed administrators might have a false sense of security. “For many of us who worked in health care during the 2014-2016 Ebola outbreak, memories of those months are filled with frantic efforts to bring ourselves and staff up to par on personal protective equipment (PPE) guidelines, confirm there were patient movement algorithms, and ensure that if someone with Ebola walked through our doors, we would rapidly identify and isolate them. To say that it was a stressful time would be an understatement. The question is: are we better off than we were in 2014?  The answer? Somewhat. Investigators on a new report by the Office of the Inspector General evaluated hospital preparedness across the United States for emerging infectious diseases (EIDs) after the Ebola outbreak. Administrators from 368 hospitals around the United States were surveyed, of which 10 were Special Pathogens Centers. When surveyed in 2017, 14% of administrators felt their facilities were unprepared for a patient with Ebola or an EID. Conversely, 71% of hospital administrators reported that their facilities were unprepared to receive an Ebola patient in 2014. The financial cost of maintaining competencies, PPE, and other specialized equipment was a challenge for many and ultimately, 79% of hospital administrators reported that other types of emergencies were more likely to occur than EID threats. The challenges of training necessary and often critical staff, obtaining full participation from clinicians, and even combating frequent turnover in staffing, all stressed the capacity for hospitals to maintain readiness.”

Quantum Computing, Biotech, And Other Threats to the U.S.
In the middle of a government shutdown and at the beginning of a new year, there is a lot to worry about. Some concerns are short-term, while others are long-term issues. Elisabeth Eaves discusses the list from the GAO regarding long-range emerging threats. “New and evolving diseases from the natural environment—exacerbated by changes in climate, the movement of people into cities, and global trade and travel—may become a pandemic. –It’s a question of when, not if. As Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, told The Bulletin last year, ‘What we don’t know about flu is exactly when the next flu pandemic will occur, but I think all flu virologists and public health experts believe that it’s a matter of time’.”

Estrogen Receptor Modulators Could Tackle Infectious Diseases
The pursuit of infectious disease treatment options is challenging as they’re not often seen as strong sources of revenue for pharmaceutical companies. “Investigators on a new study have thrown their hat into the ring in this effort to repurpose already approved medications by exploring how estrogen receptor antagonists could be utilized for infectious disease treatments. They evaluated the triphenylethylene class of estrogen receptor modulators related to tamoxifen (ie, tamoxifen, clomiphene/clomifene, and raloxifene) as a potential agent against bacteria, fungi, parasites, and viruses. Tamoxifen has shown analogs effective against HIV, Ebola, hepatitis C, Candida spp, Mycobacterium tuberculosisStaphylococcus aureus, and more. The antifungal activity of tamoxifen has been documented since the 1980s, while studies exploring its antiviral activities have gone back to the 1990s. Investigators reviewed these studies to assess just how much power tamoxifen could offer against infectious diseases. They found that antimalaria activity of tamoxifen and clomiphene was investigated in vitro and study results showed that parasitic growth was inhibited by 80%.”

Rift Valley Fever Endangers Pregnant Women
While many have focused on Zika virus as a danger to pregnant women, new research is showing that Rift Valley fever may cause severe injury to human fetuses if contracted during pregnancy. “In a study published last month in the journal Science Advances, researchers used infected rats and human fetal tissue to discover how the virus targets the placenta. Results showed that the virus may be even more damaging to fetuses than the Zika virus, which set off a global crisis in 2015 and left thousands of babies in Central America and South America with severe birth defects.” While it is primarily in livestock in sub-Saharan Africa, hundreds of human cases occur each year. “Two cases of infected fetuses have been documented. One infant was born with an enlarged liver and spleen, among other symptoms; the other died within a week. Because the disease can be asymptomatic in pregnant women, many more cases of abnormalities and stillbirths may have been misidentified. Among rats used in the study, 65 percent of the pups born to infected mothers died, compared to 25 percent of pups born from uninfected controls. Each infected mother lost at least one pup, and all of the infected mothers’ offspring contracted the virus.”

Stories You May Have Missed:

  • U.S. Flu Season – Looking for the latest trends this flu season? The CDC’s latest report can be found here. The majority of the cases have been Influenza A(H1N1N)pdm09  but H3 have been seen more in the southeastern U.S. “The proportion of outpatient visits for influenza-like illness (ILI) increased to 4.1%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above their region-specific baseline level. The increase in the percentage of patient visits for ILI may be influenced in part by a reduction in routine healthcare visits during the winter holidays, as has occurred during previous seasons.”
  • New York Measles Outbreak – Despite measles being declared from the US in 2000, New York has seen a surge of cases. “Since September 2018, New York state health officials have seen approximately 170 measles cases to include 55 confirmed cases in the Orthodox Jewish community in Brooklyn, 105 cases in Rockland County, 7 in Orange County and one in Monroe County in western NY. According to the New York State Department of Health, the current outbreak is the largest in New York State since the 1990’s, prior to elimination of measles in the United States.”

 

Pandora Report 1.4.2019

Happy New Year! We’re excited to start the new year with a dose of biodefense news. Here’s a good list of what to expect in science this year – hint: you might see some gene-editing and biosafety in there…

 US Healthcare Worker Brought to Nebraska for Ebola Observation
Over the weekend, it was reported that a US healthcare worker was flown from the DRC to  Nebraska Medical Center for close observation following a suspected exposure. “The health worker has no symptoms, the medical center said. If symptoms begin, the patient will be housed in the Nebraska Biocontainment Unit at the center, which was established to treat people who have serious, high-risk diseases. ‘This person may have been exposed to the virus but is not ill and is not contagious,’ said Ted Cieslak MD, infectious diseases specialist with Nebraska Medicine and associate professor of epidemiology in the University of Nebraska Medical Center College of Public Health. The healthcare worker was transported by automobile and private plane to Nebraska. Monitoring could last 2 weeks, but Nebraska Medical Center said it would not provide updates ‘unless the need arises’ or if the person is transferred to the biocontainment unit.” Very little information has been provided about the healthcare worker beyond that they are a 39-year-old physician. The DRC Ebola outbreak continues to stress resources and pose a risk for responders. WHO’s Dr. Tedros tweeted earlier that responders were attacked at Komanda. 10 new cases were reported on Tuesday, bringing the total to 600 cases in this outbreak.

GMU Master’s Open House 
Come learn about how you can earn your MS in biodefense in person or online! We’ll be hosting a Master’s Open House on Thursday, February 21st, at 6:30pm at the Arlington campus. This is a great chance to talk to faculty, learn about the admissions process, and the variety of classes we offer in global health security.

Extensively Drug-Resistant Typhoid Outbreak in Pakistan
The WHO has reported over 5,200 cases of XDR typhoid in an outbreak that began in 2016. “The circulating strain of XDR Salmonella entericaserovar Typhi, which is resistant to five classes of antibiotics, was first reported in the Hyderabad district of Sindh province in 2016 and has been spreading throughout the province since then. After health officials formally agreed to case definitions for non-resistant, multidrug-resistant (MDR), and XDR typhoid, a review of typhoid cases reported from Nov 1, 2016 through Dec 9, 2018 identified 5,274 XDR cases in Sindh province.” Outbreaks of resistant Salmonella Typhi strains have been increasing in frequency in the last few decades, which leaves many without treatment options in resource-stressed areas.

CRISPR and DIY Biohacking – An Infectious Disease Threat to Be Aware of in 2019
Everyone is making lists about which disease or biothreats to look for in 2019, but GMU biodefense doctoral student Saskia Popescu is pushing us not to forget CRISPR and other gene editing technologies. “CRISPR has great potential to improve the human condition through research, medicine, agriculture, etc. With great power though, comes great responsibility; there is a real concern that the technology is moving too fast for its own good and too fast for governance, regulation, and oversight to keep up. Biosecurity experts have been raising the red flag about the disruptive nature of genome editing, pointing out that the manipulation of biological systems and processes can have untold consequences. A recent study published by investigators from George Mason and Stanford universities notes that the technology must be taken seriously and the broader and ever-evolving landscape of biosecurity must be considered. For instance, it is possible that genome editing could one day be used to create biological weapons—think of a totally resistant tuberculosis or an influenza with increased virulence.”

Lisa Monaco Joints Blue Ribbon Study Panel on Biodefense
“The Blue Ribbon Study Panel on Biodefense welcomed former White House Homeland Security Advisor, Lisa Monaco, as a Panel Member. Monaco served as Assistant to the President for Homeland Security and Counterterrorism between 2013 and 2017. She replaces outgoing Panel Member, former Secretary of Health and Human Services Donna Shalala, recently elected to serve as a U.S. Representative for the 27th District in Florida. ‘I am delighted to welcome Lisa Monaco to the Panel. She brings a tremendous wealth of knowledge to our bipartisan team,’ said former Senator Joe Lieberman, Panel Co-Chair. ‘As Homeland Security and Counterterrorism Advisor, Lisa was responsible for advising President Obama on all aspects of counterterrorism policy and strategy, and issues ranging from terrorist attacks at home and abroad to cybersecurity, pandemics, and natural disasters. We have an ambitious agenda for 2019, so Lisa arrives at an ideal time.’ Former Secretary of Health and Human Services Donna Shalala was one of the founding members when the Panel was formed in 2014. She leaves the Panel having played a key role in advancing recommendations for better biodefense preparedness, response, and recovery – particularly at the state, local, tribal, and territorial levels.”

2018 Year in Review – CDC Looks At The Most Pressing Health Threats
The CDC is looking back to name the top health threats of 2018 – from opioid overdoses to Ebola and foodborne illness. One of the listed threats was global health security – “The most effective way to protect Americans from health threats that begin overseas is to prevent, detect, and contain diseases at their source. This year, to advance global health security and protect Americans and U.S. interests, CDC continued to support more than 60 countries in building core capacities in disease surveillance, laboratory systems, public health workforce, and emergency management and operations.” The CDC also discussed the decreasing life expectancy in the United States and challenges of responding to disease outbreaks. Not only is the goal to stop outbreaks, but ultimately prevent them. The ongoing cases of AFM and foodborne outbreaks that halted consumption of romaine lettuce, are all issues the CDC works to understand and prevent in the future.

The Universal Flu Shot Moves Within Reach
This has been almost the holy grail of biodefense – a universal flu shot to potentially halt a pandemic. “How is it possible to protect against a virus that doesn’t yet exist? By looking for the parts that don’t change, says García-Sastre, Professor of Microbiology and Medicine (Infectious Diseases) and Director of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine. ‘The current vaccine is actually very good at inducing response to the variable regions of the virus,’ says García-Sastre. ‘But there are other parts of the structure of the virus that remain unchanged, or conserved. Our idea for the universal vaccine is to induce antibodies against the conserved areas’.” Genome sequencing advances have allowed the research team to more accurately assess the surface proteins of influenza viruses. “How close is the universal flu vaccine to becoming reality? ‘Our initial findings are promising, but we still need to conduct phase II and phase III trials,’ says García-Sastre. ‘Hopefully, the vaccine could be ready in five years’.”

NIH Hospital Battles Resistant Germ in Sinks
Rare and resistant organisms has been wreaking havoc at the NIH Clinical Center for over a decade. “Researchers tracked the superbugs to sinks in patient rooms amid a freaky outbreak in 2016. Searching through genetic sequences of clinical samples collected as far back as 2006—a year after a new inpatient hospital building opened—researchers identified eight other cases for a total of 12 instances where the sink-dwelling germs had splashed into patients. The aquatic germ in these cases was Sphingomonas koreensis. Such sphingomonas species are ubiquitous in the environment but rarely cause infections. In the NIH patients, however, they were found to cause a variety of problems, including pneumonia, blood infections, a surgical site infection, and a potential urinary tract colonization. Some isolates were resistant to 10 antibiotics tested, spanning three classes of drugs. Three of the 12 affected patients died following their infection. However, they were all also suffering from severe, unrelated infections prior to exposure to the sink-based germs, the NIH researchers note.” Researchers found the germ surviving in sink faucets and fixtures, which is unusual. Replacing faucets, aerators, and mixing valves seemed to do the trick, but researchers found the areas re-colonized. Sink deposal was the next step, as well as upping chlorine concentration and hot water temperatures. “In all, the researchers suspect that ‘a single S. koreensis strain entered the water system soon after construction of the new NIH Clinical Center hospital building in 2004′ and colonized pipes before the hospital opened, while water in the plumbing was stagnant. Then, the germ ‘disseminated throughout the hospital and diversified at multiple distinct locations,’ causing a sporadic, decade-long clonal outbreak.”

Stories You May Have Missed:

  • Higher Risk of Meningitis in College Students– just another reason you want to get vaccinated before starting the campus life! “College freshmen have previously been found to have a higher risk of meningococcal disease in general than other adults their age, and several college MenB disease outbreaks have been reported recently, note the authors, a team from the US Centers for Disease Control and Prevention. The investigators used data from the National Notifiable Diseases Surveillance System and enhanced meningococcal disease surveillance to examine the incidence and relative risk of the disease among college students and non-students aged 18 to 24 years between 2014 and 2016. They also used lab methods to characterize meningococcal isolates.”
  • Measles Cases Grow in Europe – Anti-vaccination movements are growing and Europe is feeling the effects of a severe measles outbreak. “A fresh Guardian analysis of WHO data shows that measles cases in Europe will top 60,000 this year – more than double that of 2017 and the highest this century. There have been 72 deaths, twice as many as in 2017. Health experts warn that vaccine sceptics are driving down immunisation rates for measles, HPV against cervical cancer, flu and other diseases – and that their opinions are increasingly being amplified by social media and by rightwing populists equally sceptical of medical authorities.”