Pandora Report: 5.3.2019

Happy Friday and welcome to May! To start the month off right, here’s the download of the Max Brooks graphic novel, Germ Warfare: A Very Graphic History. 

Summer Workshop – Discount Extended!
We’re excited to announce that the early registration discount for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security has been extended to June 1st. In this 3.5 day workshop, you’ll hear from experts in the field on virology, public health response, biosecurity, vaccine development, synthetic biology, and so much more. Make sure to register prior to June 1st for an early discount and if you’re registering as a returning student, GMU alum/student/faculty, or part of a large group, you’re eligible for an additional discount. Join us in July for this exciting biodefense event!

U.N. Issues Warning on Growing Antimicrobial Resistance
In a new report from the United Nations, the threat of antimicrobial resistance is front and center. Citing a World Bank simulation that notes deaths due to AMR could rise to 10 million by 2050 if no action is taken, the U.N. highlighted a desperate need to innovate, invest, and accelerate progress in countries. “This is a silent tsunami,” said Dr. Haileyesus Getahun, director of the U.N. Interagency Coordination Group on Antimicrobial Resistance, which spent two years working on the report. ‘We are not seeing the political momentum we’ve seen in other public health emergencies, but if we don’t act now, antimicrobial resistance will have a disastrous impact within a generation’.” “Health officials are struggling to understand the scope of the problem because many countries are ill-equipped to monitor drug-resistant infections. In a survey the United Nations conducted for the report, 39 of 146 nations were unable to provide data on the use of antimicrobials in animals, which experts say is a major driver of resistance in humans as resistant bacteria get transferred to people through contaminated food and water. ‘We are flying pretty blind and working hard to get some clear vision,’ said Sally Davies, the chief medical officer of England and a leader of the United Nations panel. As a first step, the report calls on member states of the United Nations to create national stewardship plans to reduce the unnecessary use of antimicrobials.”

Measles Updates and Why Anti-vaxxers Should Face Isolation and Fines
The U.S. topped 700 measles cases this week as 78 cases were reported in the last week. “Thirteen outbreaks—defined as three more related cases—have now been reported in 2019 so far, and account for 94% of all cases. Nine outbreaks are currently active, up from six reported the previous week. The CDC today spelled out all the details and implications of this year’s surge in cases in an early report in Morbidity and Mortality Weekly Report (MMWR) and in its weekly case update.” Juliette Kayyem is taking a stand on anti-vaxxers, noting that they are dangerous and should face isolation, fines, and arrests. “It is time we stop viewing the anti-vax movement and its adherents’ responsibility for the measles outbreak as a public health problem. With more than 700 reported cases confirmed in 22 states, it is now a public safety crisis, and the tools of public safety — arrests, fines, isolation — are absolutely necessary. The initial steps we have taken are essential: prohibit non-vaccinated children from public spaces, including schools; promote educational efforts; and, in extreme cases, force isolation on pockets of populations that might have been exposed to the outbreak, as is happening now in the University of California system. But these efforts impact the children who might have been put at risk by the decision of individuals not to vaccinate. Viewed through the lens of public safety, it is the parents who should be punished. Why not make them pay for the harms they are causing?Fines for the increased public safety burdens put on these communities by a few ought not to be the responsibility of all. In many states, when hikers ignore warnings that certain trails are too dangerous and then have to be rescued, the fees for the rescue must be paid by the hikers. It’s a fine for making a self-centered decision that placed an unreasonable burden on a larger community. Measles should be no different.”

Are Frontline Hospitals Ready for a Patient With Ebola?
GMU biodefense doctoral student and infection preventionist Saskia Popescu, discusses the gaps in frontline healthcare facilities and what this means for bioprpearedness efforts. “Now fast forward to 2019…how prepared are these frontline facilities today? Unlike the treatment centers, they do not receive funding or undergo assessments of their biopreparedness and frankly, there are a lot of competing interests for hospital administrators to invest in the costly PPE for Ebola. Although some hospital systems have run drills on their preparedness for high-consequence pathogens, they are also typically the systems that maintain a heightened level of readiness, and for most of the other facilities it is less likely Ebola or other special pathogens are getting much attention. Investigators sampled 5 major frontline hospitals in Maricopa County, Arizona, to perform a gap analysis in how their response would be for a patient with Ebola or another high-consequence pathogen. From entering the hospital through the emergency department to cleansing and disinfecting protocols, the investigators evaluated whether health care workers could still answer the questions that were heavily drilled into these hospitals in 2014.”

Trends in Foodborne Pathogen Transmission in the U.S.
Just how much foodborne illness are we seeing in the United States? The CDC just released a new study in their MMWR regarding surveillance from 10 sites across the U.S. from 2015-2018. “During 2018, FoodNet identified 25,606 cases of infection, 5,893 hospitalizations, and 120 deaths. The incidence of infection (per 100,000 population) was highest for Campylobacter (19.5) and Salmonella (18.3), followed by STEC (5.9), Shigella (4.9), Vibrio (1.1), Yersinia (0.9), Cyclospora (0.7), and Listeria (0.3). Compared with 2015–2017, the incidence significantly increased for Cyclospora (399%), Vibrio (109%), Yersinia (58%), STEC (26%), Campylobacter(12%), and Salmonella (9%). The number of bacterial infections diagnosed by CIDT (with or without reflex culture§) increased 65% in 2018 compared with the average annual number diagnosed during 2015–2017; the increase ranged from 29% for STEC to 311% for Vibrio. In 2018, the percentage of infections diagnosed by DNA-based syndrome panels was highest for Yersinia (68%) and Cyclospora (67%), followed by STEC (55%), Vibrio (53%), Shigella(48%), Campylobacter (43%), Salmonella (33%), and was lowest for Listeria (2%).”

The Future of the SNS
While most of us know of the Strategic National Stockpile (SNS), for much of the population, this critical aspect of preparedness and biodefense is likely an unknown. A new article addresses what the SNS is and its future in biodefense. “Consequently, one of the most surprising features about the stockpile is that in all likelihood, it is probably incomplete. The reason for this is that although the stockpile includes what are presumed to be the best medical countermeasures for a broad range of potential biothreats—we don’t know the exact inventory because the identity of the contents are closely held —there is an even broader range of potential biothreat agents that an adversary could use in an attack. And stockpiling countermeasures for every conceivable individual agent is currently not feasible because countermeasures for some biothreat agents do not even exist yet—and even if they did, the continuous maintenance of copious countermeasures may not be logistically or financially feasible. There is also the possibility that an adversary could select or engineer an agent that is simply resistant to all-known medications.”

Ebola in the DRC- What’s the Latest News?
Officials from the WHO recently visited the frontlines of the Ebola outbreak in the DRC. Both WHO Director-General Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa Matshidiso Moeti visited Butembo, following deadly attacks and 14 new cases. “In a statement, the two said they were profoundly worried about the situation and acknowledged that recent surges in infections are the result of setbacks each time the response sustains violent attacks. Most of the response activities—such as community engagement, vaccination, and case investigation—have restarted following a slowdown after the attacks that killed Mouzoko and injured two others, the WHO said. It notes, however, that the torrent of cases in recent weeks is further straining resources.” As the situation worsens in the DRC, financial concerns are growing as only half of the response budget is funded. “In a statement issued 30 April 2019, WHO Director-General Dr. Tedros Adhanom Ghebreyesus expressed his worries about handling increasing cases counts in a volatile ground situation while under-funded. ‘We are entering a phase where we will need major shifts in the response,” said Dr. Tedros. WHO and partners cannot tackle these challenges without the international community stepping in to fill the sizeable funding gap.’ Dr. Tedros made these remarks during a WHO delegation visit to Butembo, the site of the 19 April killing of WHO epidemiologist Dr. Richard Mouzoko by armed men while he and colleagues were working on the Ebola response.”

Rapid Response Teams- 10 Years of Collaborating on Public Health Emergencies
“In 2008, to enable faster, more efficient responses to emergencies, the FDA launched a network of state-based Rapid Response Teams (RRT), comprised of multi-agency, multi-disciplinary teams that operate by the principles of the Incident Command System/National Incident Management System to respond to human and animal food emergencies. In an emergency, the Rapid Response Teams coordinate efforts to align the response activities of agencies that may have overlapping jurisdiction to prevent harm to consumers as quickly as possible. These teams have become valued partners in responding to outbreaks from contaminated human and animal foods, conducting large-scale recalls, and ensuring availability of safe foods during a natural disaster. The FDA can respond more rapidly during an emergency by leveraging the relationships and resources with local, state, and federal partners for the common public health goals we share.”

Meet the Virus Hunters
In the face of this mounting Ebola outbreak in the DRC, Bill Gates has written about the “real-life Sherlock Holmes who helped discover Ebola” and the response team (RST) that helped control the outbreak. “But identifying a virus on a microscope is only the first of many steps to stopping an outbreak. So, with no real idea of what he was up against, Peter headed to Zaire to hunt for patient zero. He and his colleagues drove from village to village in a Land Rover, collecting information about who was sick and where they had been before symptoms appeared. Peter’s experience with Ebola was just the beginning of a long career fighting infectious disease. He was one of the first microbiologists to study AIDS, and in 1995, he became the founding executive director of UNAIDS. During his 13-year tenure, he coordinated the global response to HIV/AIDS through the discovery of the first treatments for the disease and the peak of the pandemic. After a brief stint at the Imperial College London and as a fellow with our foundation, he became the director of the London School of Hygiene and Tropical Medicine where he still teaches today.” “In just a little more than two years since it was created, the RST has already assisted in controlling 11 outbreaks in seven countries. The team has deployed to scenarios ranging from a diphtheria outbreak at a Rohingya refugee camp in Bangladesh to a plague flareup (yes, that plague) in Madagascar. Here’s how the RST works: as soon it becomes clear that an outbreak is underway, the local government (or, in rare cases, the WHO) requests their help. Not every team member is needed for every outbreak—sometimes you need an epidemiologist and a data scientist but not a microbiologist—so the first step is to identify who needs to go. The chosen team then has 48 hours to get their visas squared away, pack up any special equipment, and get to the airport for their flight to the outbreak zone.”

Beyond the Biocontainment Unit: Improving Pathogen Preparedness for Health Workers
“These specialized designations within hospitals have allowed for 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs) that not only work to enhance preparedness for high-consequence diseases, but have also taught us some critical lessons and provided novel insight into what this level of preparedness means for hospitals.  A recent article published in Health Security focused on the impact that the creation of the BioContainment Unit (BCU) at Johns Hopkins Medical Center brought to infection prevention, preparedness, and evening nursing. The investigators found that beyond ensuring they could care for multiple patients with high-consequence pathogens, the BCU supported institutional efforts including research, educational training, and strengthening infection prevention practices. The BCU also facilitated preparedness networks and collaborative efforts. Within their article, the investigators pointed to several specific examples of how the hospital’s investment in the BCU impacted other facets of health care efforts.”

Stories You May Have Missed:

  • Dr. Frances Kelsey vs. Chemie Grünenthal – “In 1960, Frances Kelsey was a recently appointed medical reviewer at the U.S. Food and Drug Administration. The new drug application (NDA) for Kevadon, or thalidomide as it is better known, was her second file. ‘They gave it to me because they thought it would be an easy one to start on,’ she said. ‘As it turned out, it wasn’t all that easy.’ The applicant was William S. Merrell Inc. of Cincinnati, an American pharmaceutical company with plans to manufacture thalidomide under license from Chemie Grünenthal, a family-owned West German company. As it turned out, Grünenthal had a record of rushing bad and inadequately tested drugs to market.”

Pandora Report: 4.26.2019

Summer Biodefense Workshop – From Anthrax to Zika
The May 1st early registration discount is nearly here – have you registered for the summer workshop on pandemics, bioterrorism, and health security? Our 3.5 day workshop will be discussing everything from biosecurity as a wicked problem to synthetic biology and the challenges of responding to Ebola. If you’re part of a large group, GMU faculty, or current/past GMU student, you also qualify for an additional discount, so reserve your spot ASAP.

The Impact of Synthetic Biology and Genome Editing on Biosecurity 
If you’ve ever wanted to learn more about the biosecurity implications of synbio and genome editing, check out a lecture by GMU Biodefense Associate Professor and Graduate Program Director Dr. Gregory Koblentz, who recently spoke at the James Martin Center for Nonproliferation Studies in Middlebury Institute of International Studies at Monterey. You can watch the video here, which also includes the powerpoint.

 Max Brooks Introduces His New Graphic Novel on the History of Germ Warfare at Awesome Con
“Max Brooks, the best-selling author of “World War Z” and non-resident fellow at the Modern War Institute at West Point, has partnered with the Blue Ribbon Study Panel on Biodefense on GERM WARFARE: A Very Graphic History. This highly stylized and engaging graphic novel, set for release beginning this Saturday, reminds us never to take public health for granted. It’s all part of an effort by the bipartisan Study Panel to not only work with the federal government to strengthen our national biodefense, but also to educate Americans about the risks, and why a strong biodefense is critical to our individual health and safety. Germ Warfare will officially be released this weekend (4.27.2019) at Awesome Con, Washington DC’s Comic Con event, at the Walter E. Washington Convention Center. Brooks, along with Study Panel member Ken Wainstein and Panel Executive Director Asha George, will host a panel discussion and hand out free copies of the graphic novel at 12pm this Saturday in Panel Room 146.”

Ebola Outbreak Update 
This past weekend saw 23 new cases reported in the DRC and two deadly hospital attacks. “The Katwa attack came 1 day after a hospital attack in Butembo took the life of a World Health Organization (WHO) epidemiologist deployed to the outbreak region. Both Katwa and Butembo have been hot spots of virus activity in the last several months—more than half of all cases reported in recent weeks originated in Katwa.According to officials, the attack in Katwa took place around 3 a.m. local time on Apr 20 at the sub-coordination office located at the Katwa Reference General Hospital. Police controlled the attack, and three assailants were wounded in addition to the assailant that the police killed. The attacks are another challenge to response efforts in the region, which have been hindered by community resistance and earlier violent attacks.” The violence against healthcare workers has gotten so bad that they are threatening to strike. “The doctors and nurses who work in the heart of the Ebola outbreak zone in Democratic Republic of the Congo say they’ve had enough. For weeks they’ve been subjected to threats of violence and even actual assaults. On Wednesday they gave the government an ultimatum: Improve security within one week or we’ll go on strike. The workers making these demands include the Congolese staff of two government-run treatment centers for patients with Ebola, but the demand mostly comes from about 200 doctors and more than 1,000 nurses who work at hospitals and health centers across Butembo, a city that’s the current hot spot of the outbreak.”

GMU Biodefense Students in Health Security Journal
We’re proud to share that two doctoral students from the GMU Biodefense program were published in the latest Health Security issue. Alum Christopher Brown discusses respiratory protection in his article “Respiratory Protection Against Emerging Infectious Diseases: Face Masks, Respirators, and Tools for Choosing Between Them“. Brown writes that “Previous reviews have called for more information, chiefly in the form of clinical trials, to better inform decision making about RPDs. However, alternative approaches to respirator selection, including control banding tools that match groups of similar hazards to appropriate control measures, may be useful in choosing RPDs for workers with potential bioaerosol exposures on the job. These tools, while offering more streamlined approaches to RPD selection, come with challenges of their own, including questions about how to allocate different RPDs to different workers. This article reviews arguments on both sides of the face mask–respirator divide and considers the use of control banding tools in the context of preparedness for serious emerging infectious disease outbreaks.” Doctoral student Saskia Popescu discussed frontline healthcare biopreparedness in “Identifying Gaps in Frontline Healthcare Facility High-Consequence Infectious Disease Preparedness” – “While certain hospitals were designated as EVD treatment facilities, the readiness of most American hospitals remains unknown. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the existing US healthcare system. Hospital infection disease preparedness gaps were revealed during the 2013-2016 Ebola virus disease outbreak. The ability of US hospitals to rapidly identify, isolate, and manage patients with potentially high-consequence pathogens is a critical component to health security. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the US healthcare system.”

Are Philanthropy Funds Shifting the Focus in Biosecurity?
Filippa Lentzos is drawing attention to a possible shift in the biosecurity field and if splashy philanthropy funding is driving the focus towards the wrong risks. “While biosecurity experts critically examine the funding sources of cutting-edge biological research like the Insect Allies program, they rarely turn their gaze inward on their own community of biosecurity experts. This should change. A new actor with deep pockets and a cause has entered the scene. Established in 2017, Open Philanthropy Project (Open Phil) is a limited liability company operating on the basis of donations from Cari Tuna and Dustin Moskovitz, an internet entrepreneur and co-founder of Facebook. Moskovitz is reportedly the youngest self-made billionaire in history. He and Tuna are also the youngest couple to sign Bill Gates and Warren Buffett’s Giving Pledge, which commits billionaires to giving way most of their wealth in the form of philanthropy. Open Phil largely operates as a non-profit, despite not legally being one. Unlike a charity, the company also carries out so-called “impact investments,” and these may extend to political contributions in some cases. The main focus of the company, however, is eye-popping grant-giving. It aims to give an average of more than $100 million a year to “accomplish as much good as possible” by giving effectively and openly to important and neglected causes. One of those is global catastrophic risks. The two risks Open Phil considers most likely to permanently worsen humanity’s long-term future or lead to human extinction are pandemics and advanced AI. Open Phil has gifted over $100 million to work on managing potential risks from advanced AI since 2017, and nearly $40 million in biosecurity and pandemic preparedness grants in the same time frame. While the company is enabling a great deal of good work in the biosecurity field, it should not be beyond critical scrutiny. It matters where research funding comes from.”

The Impact of Chronic Underfunding of America’s Public Health System: Trends, Risks, and Recommendations
Trust for America’s Health has just released their 2019 report on public health funding trends and recommendations. “A rapid rise in deaths from drugs, alcohol, and suicide represent an urgent crisis. Weather-related emergencies are becoming more frequent and intense, as the world begins to feel the effects of climate change. And across most health outcomes, socioeconomic, racial, and ethnic disparities persist. Tackling these issues requires a strong, well-resourced public health system focused on prevention, preparedness, wellness, and community recovery for all Americans. But chronic underfunding has presented a consistent obstacle. In 2017, public health represented just 2.5 percent — $274 per person — of all health spending in the country. Such underfunding flouts overwhelming evidence of the life-saving cost-effectiveness of programs that prevent diseases and injuries and prepare for disasters and health emergencies. Public health interventions, such as childhood vaccinations, school-based violence prevention programs, and indoor smoking bans, improve health outcomes and prevent illness and death. Moreover, many such interventions save money; a 2017 systematic review of the return on investment of public health interventions in high-income countries found a median return of 14 to 1.”

We Ignore the Disaster in the Antibiotics Market at Our Peril and Why The Antibiotic Business is Broken 
In a perfect world, the pursuit of novel antimicrobials would be a top priority. Of course, in a perfect world, we also wouldn’t need them as antimicrobial stewardship would be in full force. The recent announcement of Achaogen’s bankruptcy is alarming for a company few have heard of, let alone used a product. “The few who have (used a product) probably don’t know the company either, even if its product saved their life. And yet its recently announced bankruptcy is one of the most significant — and worrying — corporate failures of this decade. In the global struggle against superbugs, Achaogen is a biotech at the front line. Its failure is the latest symptom of an ailing antibiotics market. Decades of disinvestment have left perilously few companies active in antibiotic development. Those remaining are often dependent on support from philanthropic or public funders — such as the Wellcome Trust, the medical research charity, or the US government. Without external investment, small biotechs cannot carry prospective drugs through the complex and expensive later-stage trials they must pass. Against the odds, Achaogen appeared to have succeeded. Its antibiotic, plazomicin, was approved by the US Food and Drug Administration in 2018 for treating complex urinary tract infections caused by drug-resistant bacteria. It is a vitally needed drug and just one of the many new antibiotics we need to replace drugs that are rapidly losing their effectiveness against superbugs. Achaogen was a leading example of what could be achieved by a smart start-up working in partnership with government and philanthropic funders.” Beyond investors losing money, the hard truth of this bankruptcy is that there are fewer and fewer routes for new drug development in the field of antimicrobials. Now we must consider if in the face of antibiotic resistance, we really are ok with with killing innovation while not being able to kill superbugs. Maryn McKenna also addresses the broken business of antibiotics – “Last year, a European coalition known as DriveAB that has been examining antibiotic production and distribution drew up a menu of possible pull incentives and evaluated how powerful each might be. They too concluded that market entry rewards hold the most promise, though they recommended spacing payments out over the life of the drug, to ensure that companies keep manufacturing them. A raft of studies written over the past few years have recommended other possibilities, such as transferrable exclusivity vouchers, essentially allowing companies that develop a successful antibiotic to keep another drug under patent for extra years, or purchase commitments between governments and companies in which a certain amount of drugs is bought and shelved until needed. Some thinkers have recommended changes in reimbursement, in which Medicare would pay more for an antibiotic deployed after a diagnostic test has been performed—a maneuver that makes the drug intrinsically more valuable, slowing its use and keeping resistance at bay.”

Telemedicine and Antimicrobial Stewardship
Speaking of antimicrobial stewardship…how common is it in the world of telemedicine? “One of the more impressive medical advances in recent years has been the development of telemedicine, which allows a medical provider to interact remotely with patients. Using video equipment to allow providers and patients to maintain face-to-face consultations, telemedicine allows people to get a medical consultation if they don’t have immediate access to a health care facility or provider or just need a quick consult. Imagine you’ve got a fever and cold but are traveling and may not be able to go to a doctor. Skyping your primary care physician who could evaluate your symptoms, and provide a face-to-face consult would be helpful, right? Even in medical facilities, telemedicine has allowed specialty practitioners to consult on cases and provide an extra layer of care if a specialized provider isn’t available. While there are inherent limitations in what can be done via telemedicine, especially if the patient is not in a medical facility, a new article in Pediatrics is calling to light some worrying antimicrobial prescribing practices.”

Next Steps for Access to Safe, Secure DNA Synthesis
How can we incorporate biosecurity/biosafety into DNA synthesis without stifling innovation? “Informed by guidance from the U.S. government, several of these companies have collaborated over the last decade to produce a set of best practices for customer and sequence screening prior to manufacture. Taken together, these practices ensure that synthetic DNA is used to advance research that is designed and intended for public benefit. With increasing scale in the industry and expanding capability in the synthetic biology toolset, it is worth revisiting current practices to evaluate additional measures to ensure the continued safety and wide availability of DNA synthesis. Here we encourage specific steps, in part derived from successes in the cybersecurity community, that can ensure synthesis screening systems stay well ahead of emerging challenges, to continue to enable responsible research advances. Gene synthesis companies, science and technology funders, policymakers, and the scientific community as a whole have a shared duty to continue to minimize risk and maximize the safety and security of DNA synthesis to further power world-changing developments in advanced biological manufacturing, agriculture, drug development, healthcare, and energy.”

Stories You May Have Missed:

  • E coli Ground Beef Outbreak and Recall – “In an outbreak update, the Centers for Disease Control and Prevention (CDC) said the 47 new cases boosts the outbreak total to 156 cases, with 4 more states reporting cases, expanding the outbreak to 10 states. The newly added states include Florida, Illinois, Minnesota, and Mississippi. The already-affected states are Indiana, Georgia, Kentucky, Ohio, Tennessee, and Virginia. The latest illness onset is Apr 7, and patients range in age from less than 1 year to 83. Fifty percent of them are female. Of 127 people with available information, 20 (16%) were hospitalized. No deaths or cases of hemolytic uremic syndrome (HUS)—a potentially fatal kidney complication—have been reported.”
  • First Malaria Vaccine Launches– “Developed by GlaxoSmithKline, the RTS,S vaccine has been in the making for 30 years and has shown partial protection against Plasmodium falciparum in young children. Clinical trials found that the vaccine prevent 4 of 10 malaria cases, as well as 3 in 10 cases of severe malaria. The vaccine also cut the level of severe anemia—the most common reason kids die from the disease—by 60%. In a World Health Organization (WHO) statement today on  the launch of the pilot program, designed to assess its role as a control tool alongside other interventions, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said tremendous gains against malaria have been made over the past 15 years with the use of bed nets and other measures, but progress has stalled or even reversed in some areas.”


Pandora Report: 4.19.2019

Happy Friday all! We hope this morning finds you well and ready for your weekly dose of all things biodefense. As we’re getting closer to the May 1st discount deadline, have you registered for the Summer Workshop on Pandemics, Bioterrorism, and Health Security?

 Measles Cases Continue to Grow and the Implications for Biodefense
90 new cases have been identified in the last week, bringing the 2019 cases to 555 which means we’re on track to see more cases in 2019 than any years since the disease was eradicated in the U.S. in 2000. “So far this year 20 states have confirmed measles, including Maryland, which recorded its first case of the year. Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington, have all recorded cases. The number of affected states is likely to increase to 21, as Iowa today reported that a person from the northeastern part of the state was diagnosed as having measles, and likely contracting the disease on a recent trip to Israel. The Iowa Department of Public Health (IDPH) said the case-patient has been complying with health officials.” Even worse, the WHO has reported that globally, measles cases have risen 300%. The U.S. measles outbreak also has implications for biodefense though, as response efforts are draining resources we depend upon for future outbreaks and even bioterrorism attacks. “This reemergence of measles teaches us two things. First, our public health system needs additional resources if it is to control the occurrence and spread of disease throughout the nation.Second, since local governments — including New York City — are having to spend their limited public health resources to contain diseases like measles, they will not be sufficiently prepared for large-scale biological events such as a bioterrorist attack or an infectious disease pandemic. If measles draws down New York’s resources now, the city will be less able to withstand the next major biological event. Devastation could be vast and swift, followed quickly by an impact on the national economy that we cannot afford.” While many might see vulnerabilities and weaknesses, the measles outbreaks have also shown that these surveillance systems do work and that vaccination programs can be rapidly initiated…so sure, we have work to do, but in many ways we have shown the progress that’s been made.

 Book Review – The Alphabet Bomber: A Lone Wolf Ahead of His Time
Looking for a new book? GMU Biodefense doctoral alum Dr. Keith Ludwick has provided us with a great review of Jeffrey D. Simon’s latest book on the Alphabet Bomber. “While not necessarily a textbook, A Lone Wolf Terrorist Ahead of His Time offers insight of use to a wide variety of individuals including scholars, practitioners, and students. By presenting detailed information about the history of Kurbegovic, his terrorist attacks and plots, and arrest, Simon provides a resource for future investigators and practitioners from which to draw information and details pertinent to their work. Of note, investigators who seek information about the ‘early’ use of chemical weapons by lone wolf terrorists, Kurbegovic’s case, as presented by Simon, would be particularly interested in Simon’s discussion. Kurbegovic’s represents a lone wolf who assimilated one of the largest caches of chemical weapon precursors to date (Simon, 2019, p. 115). While he did not realize his goal of fully developing or deploying a chemical weapon, it is apparent that his terrorist attacks were escalating, he had the necessary material, the motivation, and the knowledge to develop and deploy such a weapon.”

Altering an appreciative system: Lessons from incorporating dual-use concerns into the responsible science education of biotechnologists
“An important instance of this problem is the relationship between the potential of scientific advances which can greatly enhance human well-being but also find application in new or enhanced weapons of mass destruction. Clearly, preventing such weapons from becoming a normal part of conflict during a period of rapid scientific and technological change in the sciences will require an integrated system of laws and regulations implementing the international agreements. Yet it will also require that the scientific community, through their daily practice and norms of professional conduct, support the efforts to maintain and further develop relevant international treaties that seek to limit the spread of and outlaw such weapons. The purpose of this paper therefore is to examine the utility of Vickers’ concept of an Appreciative System for developing a systematic theoretical framework for understanding what change mechanism is efficacious in the education of scientists regarding the extent to which new ideas about ethics and professional responsibility can be grasped, acknowledged and applied.”

First U.S. Patients Treated With CRISPR – Gene-Editing Trials Begin
A new CRISPR study has been approved in the U.S. to help fight cancer at the University of Pennsylvania. “One patient had multiple myeloma, and one had sarcoma. Both had relapsed after undergoing standard treatment. The revelation comes as several other human trials of CRISPR are starting or are set to start in the U.S., Canada and Europe to test CRISPR’s efficacy in treating various diseases.”

 Your Cell Phone is Helping Spread Ebola
I’d be lying if I didn’t consider wiping down my phone with a disinfecting wipe when I first read that headline, but the truth is much more painful and harder to change…which is why Laurie Garrett is pulling back the curtain on the impact valuable minerals have in global health security. “One set of actions, however, can and should be taken immediately by the Trump administration, the U.N. Security Council, the G-20, and international trade offices in countries with significant mobile phone and laptop production and manufacturing facilities. It concerns the vast mineral riches in the soils of North Kivu, sales of which finance weapons purchases for all of the rival forces in the region and constitute a key incentive behind the ongoing violence. Conflict seems to have deepened in North Kivu alongside the spectacular global growth in the mobile phones market, which has made the locally plentiful black stones of columbite-tantalite, or coltan, potentially more valuable than Congo’s gold, diamonds, uranium, and other minerals and gems. (The mineral trade brings as much as $1.4 billion per year.) Coltan is a heat-resistant mix of compounds that conduct high-energy signals inside laptops, electric cars, and cell phones, allowing compressed signals to display videos and games without exploding and batteries to safely store energy. Médecins Sans Frontières and other NGOs doing humanitarian work in the region noted a clear increase in regional violence in 2018, and rape, possibly linked to higher coltan demand. Coltan is labeled a ‘conflict mineral’, which, like ‘blood diamonds,’ is meant to be shunned. Nine years ago, the U.N. Security Council passed Resolution 1952, calling for an end to the trade in conflict minerals and stipulating that ‘all States, particularly those in the region, regularly publish full import and export statistics for natural resources including gold, cassiterite, coltan, wolframite, timber, and charcoal and enhance information sharing and joint action at the regional level to investigate and combat regional criminal networks and armed groups involved in the illegal exploitation of natural resources’.” Of note – the outbreak has now topped 1,290 cases and last week, the WHO decided not to declare it a PHEIC. This outbreak is also increasingly difficult to control, as it was reported that a physician had fallen ill with the disease and had 534 contacts now requiring epidemiological efforts.

The Infectious Disease Physician Well is Running Dry
GMU biodefense doctoral student and infection preventionist Saskia Popescu discusses what the shortage of infectious disease physicians truly means for biodefense efforts. “Right now, there is an Ebola outbreak raging in the Democratic Republic of the Congo (DRC), measles spreading throughout many states due to increased rates of vaccine exemptions, and resistant microorganisms continuing to spread globally. These are just a few of the infectious disease concerns we face, but that doesn’t paint a full picture of the nuanced care these physicians provide—from complex secondary infections to health care-associated infections, there is a desperate need to fix this problem. We rely on infectious disease physicians for managing complex antibiotic regimens with comorbidities. Moreover, they are often the only providers with experience in identifying these vaccine-preventable diseases. In terms of future needs, consider the threats we know vs the ones we haven’t really experienced. Pandemics, novel diseases, newly resistant organisms, nefarious uses of synthetic biology, and even bioterrorism—these are all events or scenarios that we worry about in biodefense, and infectious disease physicians play an absolutely critical role.”

Scientists: We kept pig brains alive 10 hours after death. Bioethicists: “Holy shit”
And the award for best headline this week goes to Vox‘s Brian Resnick regarding this new finding that researchers were able to revive 23 dead pig brains after slaughter. “In a paper that reads a bit like an adaptation of Mary Shelley, researchers at Yale University describe how they were able to partially revive disembodied pigs’ brains several hours after the pigs’ death. First, the researchers took 32 brains from pigs slaughtered for food and waited four hours. Then they hooked them up for six hours to a system called BrainEx, which pumped those brains full of oxygen, nutrients, and protective chemicals. At the end of the 10 hours, the scientists found that the tissue of the pig brains was largely intact, compared to controls. Individual brain cells were up and running, performing their basic duties of taking up oxygen and producing carbon dioxide. To be clear: The neurons in these brains were not communicating, so there was no consciousness. But the cells were alive — and that alone is a very big discovery.” Following this announcement, there was likely an audible sigh from every bioethicist in the world. “’My first reaction was holy shit,’ says Hank Greely, a Stanford law and ethics professor who reviewed the findings and co-authored a commentary on the paper in Nature. ‘The conventional wisdom is brain cells die, irretrievably, after about 10 to 12 minutes without oxygen — and that’s part of the scientific underpinning for the definition of brain death, the definition of death in humans. The idea [that] after four hours with no oxygen, or glucose, or anything else, most of the cells in the pig’s brain would start functioning again? That’s astounding.’ It’s so astounding, he says, that perhaps we should reconsider the definition of death. And we should definitely consider the unexplored ethical implications of partially reviving a dead animal. Because, what if, even for a moment, that pig brain felt something?”

Base Editor Tool Accidentally Mutates RNA While Editing Targeted DNA
Whoops? “When researchers first reported 3 years ago that they had created base editors, a version of the powerful genome-editing tool CRISPR, excitement swirled around their distinct powers to more subtly alter DNA compared with CRISPR itself. But the weaknesses of base editors have become increasingly apparent, and a new study shows they can also accidentally mutate the strands of RNA that help build proteins or perform other key cellular tasks. Researchers say this could complicate developing safe therapies with the technology and hamper other research applications. Human diseases from sickle cell to Tay-Sachs are caused by a single mutation to one of the four DNA bases—adenine, guanine, cytosine, and thymine—and CRISPR has often had difficulty swapping out the bad actors. That’s in part because CRISPR cuts double-stranded DNA at targeted places and then relies on finicky cell repair mechanisms to do the heavy lifting of inserting a corrected DNA sequence for a mutation. Base editors, in contrast, chemically change one DNA base into another with enzymes called deaminases, which doesn’t require a cut or help from the cell.”

Stories You May Have Missed:

  • Family Duo Sold Body Parts Infected With HIV, Hepatitis – “A father and son have been federally charged for allegedly selling body parts on the black market they knew were contaminated with infectious diseases. Donald Greene Sr. was charged with wire fraud in relation to a years-long operation that involved selling diseased cadavers to unwitting researchers, the Associated Press reports. His son, Donald Greene II, was charged with intentionally concealing a crime. The family duo was associated with the Biological Resource Center of Rosemont, Ill., which provided human remains donated to science to medical professionals for a fee.”
  • Salmonella and the Case of the Tainted Tuna– “Late yesterday the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) announced that a line of frozen tuna tainted with Salmonella Newport is associated with illnesses in 13 people in seven states, resulting in two hospitalizations. Jensen Tuna of Houma, Louisiana, voluntarily recalled the frozen ground tuna product associated with the outbreak yesterday. The frozen tuna is individually packaged in clear, 1-pound bags and only sold wholesale in 20-pound boxes.”




Pandora Report 4.12.2019

Biodefense Summit: Implementation of the National Biodefense Strategy                                                                                                                     Don’t miss this April 17th event at the National Academies of Science Building, hosted on behalf of the Federal Government. “Biological threats are among the most serious threats facing the United States. In today’s interconnected world, biological incidents have the potential to cost thousands of American lives, cause significant anxiety, and disrupt travel and trade. The Strategy sets the course for the United States to combat the serious biothreats our country faces, whether they arise from natural outbreaks of disease, accidents involving high consequence pathogens, or the actions of terrorists or state actors. Engagement with non-governmental organizations and the private sector is critical to prevent the spread of disease and respond to the next outbreak before it becomes an epidemic. Preparing for biothreats is a critical aspect of our national security, and the Strategy encompasses five goals for strengthening the biodefense enterprise including: enabling risk awareness to inform decision-making across the biodefense enterprise, ensuring biodefense enterprise capabilities to prevent bioincidents, ensuring biodefense enterprise preparedness to reduce the impacts of bioincidents, rapidly responding to limit the impacts of bioincidents, and facilitating recovery to restore the community, the economy, and the environment after a bioincident.The meeting will also be webcast; information about registering for the webcast is available at Given the importance of the Nation’s biodefense to every American, the public is encouraged to submit written comments on questions on the meeting agenda, on which the U.S. Government would specifically like to solicit comment. Comments should be submitted to or the address above by May 1, 2019.”

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Come spend 3.5 days with some of the top minds in the biodefense field this July at our summer workshop. From vaccine development to biosecurity as a wicked problem, we’ll be having frank conversations regarding the toughest issues in health security. Register before May 1st for an early discount and get another discount if you’re a returning student, GMU alum/current student/professor, or registering with a large group.

Richard Cupitt Joins GMU Biodefense                                                                We’re excited to announce that Richard Cupitt is joining the GMU Biodefense program as an adjunct professor. Cupitt will be teaching Nonproliferation and Arms Control this fall and “his areas of expertise include WMD nonproliferation, export controls, and foreign policy. Prior to joining Stimson, he served as the Special Coordinator for U.N. Security Council resolution 1540 in the Office of Counterproliferation Initiatives at the U.S. State Department from 2012 through 2016. As such, he led U.S. government efforts to further implementation of the more than two hundred legally binding obligations and recommendations of the resolution, which aims to combat proliferation of WMD and their means of delivery, especially to non-state actors such as terrorists and criminal organizations.”

A Guide to Training and Information Resources on the Culture of Biosafety, Biosecurity, and Responsible Conduct in the Life Sciences
Have you read the latest guide from ASPR? This informative new resource includes not only helpful definitions of biosafety, biosecurity, and responsible conduct, but it also discusses the building blocks of organization culture, courses and education resources (worldwide opportunities as well!), DURC, ethics and codes of conduct, contributing organizations, and more. “If you are interested in finding out more about the culture of biosafety, biosecurity, and responsible conduct, this guide is for you. A U.S. interagency Working Group was established in 2015 to implement the recommendation of the Federal Experts Security Advisory Panel to ‘create and strengthen a culture that emphasizes biosafety, laboratory biosecurity, and responsible conduct in the life sciences… characterized by individual and institutional compliance with biosafety and laboratory biosecurity regulations, guidelines, standards, policies and procedures, and enhanced by effective training in biorisk management’. This group morphed into an International Working Group, a Community of Practice comprised of representatives of governments, academia, industry, professional and international organizations from across the globe. We are using crowdsourcing to develop educational materials and promote learning. From the U.S. perspective, we are guided by the 2018 National Biodefense Strategy which tasked us to ‘support and promote a culture of global biosafety, biosecurity, ethical, and responsible conduct in the life sciences’. Per our 2019-2022 National Health Security Strategy, ‘we must ensure the benefits of scientific research are effectively realized, while the potential for misuse is minimized by…supporting responsible conduct in the life sciences through promoting a culture of responsibility, effective oversight of dual-use research, and engagement with nontraditional and amateur research communities…” Bonus: there is a great biosecurity crossword puzzle on page 81!

Re-Introduction of the Global Health Security Act
“Today, Congressman Gerry Connolly (D-VA), Chairman of the U.S. Delegation to the NATO Parliamentary Assembly, and Congressman Steve Chabot (R-OH) reintroduced the bipartisan Global Health Security Act, which reaffirms the United States’ commitment to promoting global health security. The legislation is cosponsored by Representatives Brian Fitzpatrick (R-PA), Ami Bera (D-CA), Ann Wagner (R-MO) and Rick Larsen (D-WA). Republican and Democratic presidents alike have recognized the critical importance of global health security – from President Obama’s role in launching the Global Health Security Agenda (GHSA) to President Trump’s National Security Strategy and National Biodefense Strategy. The Global Health Security Act codifies U.S. investments in the ability to prepare for and respond to public health threats and reduce or prevent their spread across borders. In particular, this bill bolsters U.S. commitments under the Global Health Security Agenda, which is a multilateral initiative to build countries’ capacity to manage infectious disease threats and elevate heath security as a global priority.” Rep Connolly noted that “Saving lives from the next global pandemic starts with investing in preparedness before it strikes,. As we’ve seen time and time again, diseases do not respect borders, and global health crises have immense security, economic, and humanitarian consequences. Unfortunately, almost 70% of the world’s nations are underprepared to manage or control outbreaks. Our legislation recognizes the critical role of U.S. leadership in international health security, enshrines U.S. global health security policy in statute, and ensures that there is a permanent designated official responsible for coordinating these efforts in a strategic way.”

Why You Should Be Paying Attention to Candida Auris and How There’s Too Much Secrecy Around Outbreaks of Resistant Infections

We love talking germs but the truth is that there are some that tend to be neglected when it comes to important conversations. A recent article by Matt Richtel is calling us out on the lack of attention we’ve given the fungus Candida auris. In his quest to discuss drug-resistant infections, Richtel stumbled upon one that was causing significant infections and requiring considerable medical interventions but no one seemed to want to sit down and have a conversation about it… “From this germ of an observation grew one of the most curious aspects of our series: The rise in resistant bugs is cloaked in widespread and chronic secrecy. As our reporting continued, we discovered it was common for hospitals, doctors and public health agencies to clam up when it came to talking about their troubles with resistant bugs, though they widely acknowledged the existence of the problem and even encouraged our efforts. This disconnect was at its most extreme when the issue turned to the subject of the first article in our series, which was published online on Saturday — Candida auris. C. auris is a drug-resistant fungus that has emerged mysteriously around the world, and it is understood to be a clear and present danger. But Connecticut state officials wouldn’t tell us the name of the hospital where they had had a C. auris patient, let alone connect us with her family. Neither would officials in Texas, where the woman was transferred and died. A spokeswoman for the City of Chicago, where C. auris has become rampant in long-term health care facilities, promised to find a family and then stopped returning my calls without explanation.” Beyond the discussion of this resistant and rising infection, Ritchel started looking into the secrecy that exists in healthcare and why outbreaks of these infections weren’t being reporting. “‘They might not get up and go to another hospital, but patients and their families have the right to know when they are at a hospital where an outbreak is occurring,’ said Lisa McGiffert of the Patient Safety Action Network. ‘That said, if you’re going to have hip replacement surgery, you may choose to go elsewhere.’ Kevin Kavanagh, board chairman of the advocacy group Health Watch USA, contrasted the C.D.C.’s handling of the infections in Tijuana with a 2016 outbreak of a different drug-resistant pathogen, known as carbapenem-resistant Enterobacteriaceae, or CRE, at a rural hospital in Kentucky. It was not until early 2018 that the C.D.C. issued a report on that outbreak — and even then, the agency did not name the hospital where it occurred.” From the viewpoint of this infection preventionist – this is just skimming the surface in terms of hospital secrecy and drug-resistant infections, and there are considerable issues in hospital transparency.

Brexit Threatens Biosecurity                                                                           What are the biosecurity implications of Brexit? How will safeguards for diseases be managed with this new separation? “Biosecurity is likely to be seriously compromised by the United Kingdom’s exit from the European Union. Common rules and safeguards, backed by a common judicial system, have for decades protected human, animal and plant health against biological hazards. Even so, ash dieback still threatens 60 million UK trees, and African swine fever has spread to Europe (see I. Capua and M. Monti Nature 566, 326; 2019). Despite the rush to pass the huge volume of secondary legislation required by the EU Withdrawal Act before the end of this month, it is almost certain that the mechanisms and operational capacities to replicate these protective systems nationally will not be in place (see, for example, Establishing such mechanisms will take time — and, meanwhile, hazards will persist.”

Is it Time to Declare the DRC Ebola Outbreak a PHEIC?                               On Wednesday, 18 new cases were reported in the DRC, which was been the biggest jump in a single day since last August – bringing the total to 1,186 cases and 751 deaths. In the wake of this alarming news, the WHO is re-evaluating if the outbreak should be declared a Public Health Emergency of International Concern (PHEIC). The panel of experts will meet today (Friday). “This will be the second time an emergency committee has been asked to advise WHO Director-General Tedros Adhanom Ghebreyesus on whether this outbreak meets the criteria to be declared a Public Health Emergency of International Concern, known in global health circles as a PHEIC. The committee met in October and though it described the outbreak as very worrying, it recommended against declaring a PHEIC at that time.”

Dr. Matthew Meselson Wins 2019 Future of Life Award for Efforts Against Bioweapons           Dr. Meselson has been fighting the good fight since the 1960s and we’re glad to see him as the recipient of the Future of Life award, recognizing his role in biodefense. “In 1963, he was an academic working on arms control issues, and it was then that he learned the US was working on developing anthrax. ‘I asked why would we do that? [My boss] said it would be a biological weapon a lot cheaper than nuclear weapons,’ Meselson recalls. ‘I don’t think it hit me immediately. But by the time I got back to the office, it dawned on me that we don’t want a weapon of mass destruction that is cheap. We don’t want to save money to the point where anybody could have a cheap weapon of mass destruction’.” Meselson has been discussing the need to disarm biological weapons since he first found they were being developed and hasn’t stopped since. “Daniel Feakes, chief of the Biological Weapons Convention Implementation Support Unit, said in a statement, ‘Through his work in the US and internationally, Matt Meselson was one of the key forefathers of the 1972 Biological Weapons Convention. The treaty bans biological weapons and today has 182 member states. He has continued to be a guardian of the BWC ever since’.” You can watch this great video on Dr. Meselson and his work here                                   

A Scary Shortage of Infectious Disease Physicians                                        In a time of increasing antimicrobial resistance, emerging infectious diseases, and concern surrounding synthetic biology, the ability to diagnose and treat infectious diseases is pivotal. Unfortunately, those specialized physicians we rely on are becoming scarce. “Infectious diseases is one of just two medicine subspecialties that routinely do not fill all of their training spots every year in the National Resident Matching Program (the other is nephrology). Between 2009 and 2017, the number of programs filling all of their adult-infectious-disease training positions dropped by more than 40 percent.” You might wonder why this is occurring if infectious disease physicians are so critical…”The problem is that infectious-disease specialists care for some of the most complicated patients in the health care system, yet they are among the lowest paid. It is one of the only specialties in medicine that sometimes pays worse than being a general practitioner. At many medical centers, a board-certified internist accepts a pay cut of 30 percent to 40 percent to become an infectious-disease specialist.” The issue lies in both the way insurance reimbursement occurs for these providers, but also that they don’t really perform procedures, which are big sources of revenue for hospitals (i.e. incentive to have them) and there’s not much to bill. “The Infectious Diseases Society of America and other professional organizations have devised aggressive recruitment and advocacy strategies, but there is far more work to be done. It begins with the recognition that infectious-disease doctors are overworked and underpaid. Our insurance system needs a better way to measure the value of diagnoses and treatments so that we can fairly reimburse doctors in cognitive specialties. We must hurry. Superbugs are coming for us. We need experts who know how to treat them.”

Weapons of Mass Distraction: Foreign State-Sponsored Disinformation in the Digital Age                                                                      The US Department of State’s Global Engagement Center has aided in this new report. “If there is one word that has come to define the technology giants and their impact on the world, it is“disruption.” The major technology and social media companies have disrupted industries ranging from media to advertising to retail. However, it is not just the traditional sectors that these technologies have upended. They have also disrupted another, more insidious trade – disinformation and propaganda. The proliferation of social media platforms has democratized the dissemination and consumption of information, thereby eroding traditional media hierarchies and undercutting claims of authority. The environment, therefore, is ripe for exploitation by bad actors. Today, states and individuals can easily spread disinformation at lightning speed and with potentially serious impact. The problem of disinformation is therefore not one that can be solved through any single solution, whether psychological or technological. An effective response to this challenge requires understanding the converging factors of technology, media, and human behaviors. The following interdisciplinary review attempts to shed light on these converging factors, and the challenges and opportunities moving forward.”

Twist Bioscience Adopts Battelle’s ThreatSEQ DNA Screening Web Service for Advanced Biosecurity                                                                       “Twist Bioscience Corporation (NASDAQ: TWST), a company enabling customers to succeed through its offering of high-quality synthetic DNA using its silicon platform, today announced that it is the first to implement Battelle’s ThreatSEQ web service DNA screening platform for the detection and characterization of sequences of concern in genomic data, supplementing its internal biosecurity efforts. ‘We have spent decades working with and characterizing biothreats to support global biodefense efforts, which has resulted in the curation of a high-quality Sequence of Concern database and the development of a robust algorithm for screening DNA at production scale rapidly,’ said Matt Vaughan, President of Battelle’s Contract Research business. ‘Twist Bioscience continues its leadership in the field of biosecurity as the first to integrate the ThreatSEQ web service into its gene-length DNA screening pipeline. We look forward to expanding this service to all companies who desire standardized and sustainable screening capabilities’.”

Stories You May Have Missed:

  • World Pork Expo Cancelled As A Precaution Against African Swine Fever– “The National Pork Producers Council’s (NPPC) board of directors has announced its decision to cancel World Pork Expo 2019 out of an abundance of caution as African swine fever (ASF) continues to spread in China and other parts of Asia. The World Pork Expo, held each June at the Iowa State Fairgrounds in Des Moines, hosts approximately 20,000 visitors over three days, including individuals and exhibitors from ASF-positive regions. ASF affects only pigs and presents no human health or food safety risks. There is currently no vaccine to treat the swine disease. ‘While an evaluation by veterinarians and other third-party experts concluded negligible risk associated with holding the event, we have decided to exercise extreme caution,’ said David Herring, NPPC president and a producer from Lillington, N.C. ‘The health of the U.S. swine herd is paramount; the livelihoods of our producers depend on it. Prevention is our only defense against ASF, and NPPC will continue to do all it can to prevent its spread to the United States’.”
  • More Pediatric Antibiotics Prescribed with Telemedicine – “A study published in Pediatrics revealed that children with acute respiratory infections who are treated through direct-to-consumer telemedicine visits are significantly more likely to receive antibiotics. These children, according to the researchers, are also less likely to receive guideline-based antimicrobial treatment. Kristin N. Ray, MD, MS, assistant professor of pediatrics at the University of Pittsburgh School of Medicine, told Infectious Diseases in Children that the findings show that antimicrobial stewardship should be a priority for telemedicine programs that treat acute pediatric illnesses.”

Pandora Report: 4.5.2019

Good news- spring is in full effect and flu transmission is starting to slow. With summer around the corner, have you registered for our workshop on all things biodefense, from anthrax to Zika?

The Plague Years – How the Rise of Right-Wing Nationalism is Jeopardizing the World’s Health
Maryn McKenna is calling out a very real issue – politics, vaccines, and the reality that “As nativist appeals undermine public health systems and cooperation among countries degrades, the potential for catastrophe increases. We are always at risk of a new disease breaking out, or a previously controlled one surging back. What’s different now is that the rejection of scientific expertise and the refusal to support government agencies leave us without defenses that could keep a fast-moving infection at bay. Pathogens pay no respect to politics or to borders. Nationalist rhetoric seeks to persuade us that restricting visas and constructing walls will protect us. They will not. ‘Nationalism, xenophobia, the new right-wing populism in Europe and the United States, are raising our risk,’ said Ronald Klain, who was the White House Ebola response coordinator for President Barack Obama and now teaches at Harvard Law School. ‘There’s a focus not so much on stopping infectious diseases as much as there is on preventing the movement of people to prevent the transmission of diseases. And that’s not possible, because no matter what you do about immigrants, we live in a connected world’.” Moreover, that belief system can be seen in the White House, as President Trump tweeted during the 2014 Ebola outbreak – “Keep them out of here,” he tweeted about American missionaries who fell ill in West Africa. “Stop the Ebola patients from entering the U.S.” and “The U.S. cannot allow Ebola infected people back.” As McKenna notes “This is the perverse legacy of nationalism in power: By stigmatizing immigrants and segregating them, xenophobia can turn the lie of the ‘dirty foreigner’ into truth.

 Hospital-Associated Conditions Penalties: What They Really Mean
Just how good is your local hospital at preventing infections in patients? GMU biodefense doctoral student and infection preventionist Saskia Popescu is breaking down what these quality metrics really mean and how hospitals are scoring. “In 2014, CMS established another rule tying health care quality of care and reimbursement—the HAC Reduction Program. Although this started with reporting of certain conditions, such as central-line associated bloodstream infections, these pay-for-performance programs were expanded over time. The program links hospital performance in certain categories with reimbursement. That’s right, if a hospital performs poorly, they can be hit where it hurts—the bank. Scores are determined by a hospital’s performance in 2 domains—1 includes indicators like pressure ulcers and in-hospital falls with injury, while the second domain focuses on health care-associated infections that include central-line associated bloodstream infections, catheter-associated urinary tract infections, certain surgical-site infections, methicillin-resistant Staphylococcus aureus bacteremia, and Clostridium difficile (C diff) infections. Considering there are 500,000 cases and 15,000 deaths a year related to C diff in the United States, it’s not surprising that CMS would want to crack down on those cases associated with hospitalization.” “There are just over 5000 US community hospitals that will likely receive CMS reimbursement in FY2019, and 800 (16%) of these institutions experienced financial penalties related to poor performance. That’s a pretty substantial amount, but the painful truth is that this number is likely higher considering there have been concerns for hospitals failing to report HACs and a general lack of CMS data validation.”

Ebola Continues to Hit the DRC
We’ve surpassed 1,000 cases and are now beyond the point where the WHO called a PHEIC in the 2014-2016. On Tuesday, the “World Health Organization (WHO) today reiterated that the outbreak in the Democratic Republic of the Congo (DRC) will be defeated only with local communities at the helm of response efforts. The message came from Ibrahima-Soce Fall, MD, WHO assistant director-general for emergency response, who held a brief teleconference this morning from Butembo. With 72 Ebola cases reported last week and 56 in the previous week, March was a low point for responders, as activity spiked and the outbreak topped the 1,000-case milestone.” On Thursday, it was reported that 7 new cases were identified, including a healthcare worker. “The healthcare worker in Musienene brings the total number of health workers infected during the outbreak to 82 (7.4% of all confirmed or probable cases), and 29 of them have died, the DRC said. In an update released late yesterday, the DRC recorded 8 new confirmed cases, and 7 deaths, including 5 community deaths. Butembo and Katwa each had a community death, and Mandima recorded 3. Community deaths have been a compounding factory of this outbreak, as they enable the virus to spread more easily among family members and funeral attendees.” Based off the latest case counts, three main areas have been the hotspots for the outbreak – Katwa, Vuhovi, and Mandima.

Next Generation Biosecurity Online Course
“An open online course exploring biosecurity and biological threats begins this week on FutureLearn. This course is for professionals working in public and global health, international security, politics and international relations. It may be of particular use to biosafety officers in academia, industry or government, and early-career science scholars in the life sciences.” You can access the course here.

 Why the Scientific Debate Over a UW Bird Flu Study Isn’t Going Away
“A University of Wisconsin-Madison laboratory is set to resume experiments that could build the foundation of an early warning system for flu pandemics. The research is based on altering a deadly type of the influenza virus in a way that could make it more dangerous, though, and critics say its approval lacked transparency and creates unnecessary risks. Yoshihiro Kawaoka is a virologist and professor at the UW School of Veterinary Medicine and the University of Tokyo who has figured prominently in Wisconsin’s long-term central role in flu research. Kawaoka’s work has been the focus of fierce debate among epidemiologists ever since he announced in 2011 that his lab had successfully altered the H5N1 subtype of the influenza A virus to be transmittable through the air among ferrets. These small mammals are a common laboratory stand-in for studying human flu transmission.” “That debate has lingered since 2011 and intensified in early 2019 after the federal government approved funding for Kawaoka to continue his research. Marc Lipsitch is a professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health. He’s a longtime critic of research that modifies flu viruses to be more dangerous in humans. ‘What worries me and my colleagues is the effort to modify viruses that are novel to humans and therefore to which there’s no immunity in the population, and where a laboratory accident wouldn’t just threaten the person who got infected … but potentially could be the spark that leads to a whole pandemic of infectious disease,’ Lipsitch told WisContext.”

New Plant Breeding Tech for Food Safety
Tackling the issue of food safety is up there with a universal flu vaccine – something we all want, but a task requiring a Herculean effort. A new insight to this problem has come forward though and the authors “argue that with careful deployment and scientifically informed regulation, new plant breeding technologies (NPBTs) such as genome editing will be able to contribute substantially to global food security. Previously, conventional plant breeding through cross- and self-pollination strategies played a major role in improving agricultural productivity. Moreover, the adoption of genetically modified (GM) crops by smallholder farmers has led to higher yields, lower pesticide use, poverty reduction, and improved nutrition. Nevertheless, so far only a few developing and emerging economies—such as China, India, Pakistan, Bangladesh, and South Africa—have embraced GM crops. Even though three decades of research show that GM crops are no more risky than conventional crops, many countries in Africa and Asia are hesitant to promote the use of GM crops, largely because of erroneously perceived risks and fears of losing export markets to Europe.”

Stories You May Have Missed:

  • Opioid Epidemic Increases Some Infectious Disease Rates – “The United States faces a converging public health crisis as the nation’s opioid epidemic fuels growing rates of certain infectious diseases, including HIV/AIDS, hepatitis, heart infections, and skin and soft tissue infections. Infectious disease and substance use disorder professionals must work together to stem the mounting public health threat, according to a new commentary in the Journal of Infectious Diseases. The article was co-authored by officials from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the Institute of Human Virology at the University of Maryland School of Medicine in Baltimore. Since 1999, nearly 400,000 people in the United States have fatally overdosed on opioid-containing drugs, with 47,600 deaths in 2017 alone. Many people with opioid use disorder (OUD), who initially were prescribed oral drugs to treat pain, now inject prescribed or illegal opioids. High-risk injection practices such as needle-sharing are causing a surge in infectious diseases. Additionally, risky sexual behaviors associated with injection drug use have contributed to the spread of sexually transmitted infections.”
  • US Army Develops Fast-acting Spray for CW Decon– “Chemical and biological weapons experts earned the U.S. Army a patent on Tuesday for their groundbreaking work on rapid decontamination. Gregory Peterson, Joseph Myers, George Wagner, Matthew Shue, John Davies, Jr., and Joseph Rossin were listed as the inventors on U.S. Patent 10,245,456, “Process for Decontamination and Detoxification with Zirconium Hydroxide-Based Slurry.” (The patent is linked below). The research team works at the Army’s Chemical Biological Centerin Maryland, and has significantly reduced decontamination time down to less than 30 minutes and the amount of water needed to treat large amounts of equipment coated in deadly toxins.”


Pandora Report: 3.29.2019

GMU Biodefense Student Accepts CGSR Position At Livermore National Lab
We’re excited to announce that biodefense MS student Anthony Falzarano is now working with in the Center for Global Strategy Research at Lawrence Livermore National Lab. The Center for Global Security Research works on emerging national security challenges – particularly CBRN – and serves as a bridge between the fields of science, technology, and national security policy. CGSR also does substantial work with concepts of United States deterrence and strategic stability internationally. Falzarano noted that “I found the job thanks to a referral from Dr. Koblentz, and I’m super excited to apply all of the knowledge and concepts that I have been learning in all of my classes to real world US security policy work.”

 Beth Cameron Joins the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Just another reason you’ll want to attend our summer workshop in July – NTI’s Beth Cameron has just joined as a speaker on all things global health security! Dr. Cameron is currently Vice President of Global Biology Policy and Programs at NTI and previously served as the senior director for global health security and biodefense on the White House National Security Council (NSC) staff, where she was instrumental in developing and launching the Global Health Security Agenda and addressed homeland and national security threats surrounding biosecurity and biosafety, biodefense, emerging infectious disease threats, biological select agents and toxins, dual‐use research, and bioterrorism. We are thrilled to have Dr. Cameron join our team of instructors and hope to see you in July!

The True Dollar Cost of the Anti-Vaccine Movement
Vaccines are pretty awesome and I, for one, am grateful to have grown up in a time when there wasn’t a debate about their usage or government conspiracies surrounding them. Unfortunately, we’re in a different situation today and there are some very real consequences of the anti-vaccine movement. Aside from the hundreds of cases of vaccine-preventable diseases, associated deaths, long-term health consequences, and strain such illnesses takes up on the healthcare and public health system…they’re really, really expensive. Maryn McKenna is breaking down the real implications of this anti-vaxxer movement – from the $800,000 price tag on one child’s tetanus treatment to the public health response price tag of $1.6 million in Washington state. “The numbers can grow much bigger still. Researchers at the CDC estimated that handling 107 cases of measles that occurred in 2011 cost state and local health departments between $2.7 million and $5.3 million. In 2014, 42 people came down with the disease after passing through Disneyland at the same time as a never-identified person with measles—and subsequently infected 90 additional people in California, 14 more in other states, and a further 159 people in Canada. The cost of controlling the outbreak, just in California, totaled almost $4 million. And in 2017, a five-month outbreak of measles in Minnesota infected 79 people and cost the state $2.3 million. The funding to support that work isn’t being conjured out of the air. It’s coming from the budgets of public agencies, which have already been facing years of cuts and have no secret stashes of discretionary money to spend.” McKenna notes that “But we can quantify the medical and public health response. It is the bottom lines on hospital bills, for medical care that would not otherwise have been necessary. (In the tetanus case, the hospital has declined to say whether the parents or their insurance will pay, or whether the hospital will eat the cost as charity care.) It’s lab work that was never budgeted for, hotel charges and gas for investigators sent out on the road, overtime hours for state police rushing emergency doses of immunotherapy across the state. Those costs are being paid by state governments, and by federal agencies such as the CDC that give states grants and loan them personnel. State and federal budgets are public money—which means those necessary bills for unnecessary outbreaks are being paid by all of us. The toll of illness may be confined to individuals, but the cost of responding to outbreaks related to vaccine refusal is a bill that we are all being compelled to pay.”

Synthetic Biology Could Bring a Pox on Us All
It wasn’t so long ago that a NIH scientist stumbled across smallpox vials in a cold-storage room and it definitely wasn’t during a time of increased concern for synthetic biology. From CRISPR babies to garage DIY biohacking kits, it seems like the last few years have been inundated with synbio conversations. Throw in the horsepox synthesis experiment in 2017 and you’ve got quite a heated conversation about the potential for synthetic biology to bring back some pretty horrible diseases we’d like to forget. “The trio published their findings in the scientific journal PLOS One in January 2018—and the blowback was swift and brutal. Critics accused Evans and Noyce of opening a Pandora’s box that could send humanity back to the dark ages of disease. The Washington Post’s editorial board wrote that ‘the study could give terrorists or rogue states a recipe to reconstitute the smallpox virus.’ Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, denounced the research on National Public Radio: ‘Anything that lowers the bar for creating smallpox in the world is a dangerous path.’ Gregory Koblentz, director of the biodefense program at George Mason University, warned in the journal Health Security that the synthesis of horsepox ‘takes the world one step closer to the reemergence of smallpox as a threat to global health security’.” The fallout of this research brought forth more concerns regarding smallpox defense, if we should destroy the samples, and the safety of synthetic biology. Sure, DARPA has launched Safe Genes and Ginkgo Bioworks is helping to improve screening tools, but “even these automated checks can’t prevent determined buyers from obtaining samples through less scrupulous vendors on the black market. As with computer viruses, new strains appear from the ether before society is aware they exist. The same is true for trying to keep ahead of potentially lethal synthetic DNA.”

Resistant Genes Found in Wastewater
Wastewater treatment plants in seven European countries have shown to carry antibiotic resistant genes. Researchers “found that the amount of resistance genes was higher in the wastewater from countries with higher antibiotic use and aligned with the levels of antibiotic resistance found in clinical isolates in the countries. The results are consistent with the north-to-south pattern that’s been observed in studies of antibiotic resistance and consumption in Europe. The genes that were detected conferred resistance to several classes of antibiotics, including genes that confer multidrug resistance and are of high concern in clinical settings. The study also identified mobile genetic elements that enable bacteria to share and spread resistance.”

Can Cockroaches in Hospital Environments Harbor MRSA?
“Cockroaches. The mere use of the word elicits shudders and retches, even more so when you consider how these critters are often associated with disease and a lack of cleanliness. These insects have an affinity for human excrement and trash, which leads many of us to hit the panic button when we see them. They’re gross when found in a home, but imagine if you stumbled across a cockroach within a hospital…Not only is it a huge patient and staff dissatisfier to see one of these insects scuttling across the floor during medical treatment, but it presents a major issue for hospital administration, which can’t easily exterminate an entire hospital with insect spray. And unfortunately, the concern over cockroaches in hospitals goes beyond just the “ick” factor; the bugs can also put patient safety at risk from an infection control perspective. Urban pests are a big enough concern that the World Health Organization (WHO) put together a report regarding the public health significance of pests in 2008. Guess which pest landed first in the table of contents? That’s right—the cockroach. Following the laboratory work, the team found that the prevalence of MRSA varied a bit between the 2 kinds of cockroaches that were captured. These 2 different kinds are the most common in domestic, industrial, and residential areas. The Periplanets americana cockroaches had a MRSA prevalence of 52.77%, while the Blattella germanica cockroaches had a prevalence of 43.33%.”

Hospital Utilizes Drones to Transport Samples
Imagine flying blood samples and other laboratory specimens across a hospital campus. Sure, you could transport them in a car or by foot…or you could fly them via drone. That’s exactly what is happening in North Carolina. “With the approval of the Federal Aviation Administration and North Carolina’s department of transportation, UPS and Matternet will conduct routine daily flights that transport medical samples. Previously, WakeMed relied on courier cars, which were subject to road delays. The drone-led deliveries entail a medical professional first loading the drone with a medical sample or specimen, such as a blood sample. From there, the drone will fly along a predetermined route to a fixed landing pad at WakeMed’s main hospital and central pathology lab.” Imagine the biohazard spill if the drone went down….

Russian Disinformation and Measles
As GMU Biodefense graduate program director Gregory Kolbentz noted, “Russia has a long history of using disinfo to compromise global health for their own political reasons: from smallpox eradication in India in 1970s to AIDS in Africa in the 1980s to measles today. No health issue is too important for the Kremlin to hijack for its own purposes.”  In the face of a 20-year high in measles cases across Europe, Russia is reportedly playing a large role in disinformation. “According to the recent study Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate, the same bots and trolls linked to Russia’s Internet Research Agency which spread discord in the 2016 US elections are the same ones feeding disinformation and contributing to the current measles crisis in Europe.  This same study attributes 93% of the vaccine narrative on Twitter originating or being amplified by Russian trolls and/or bots.”

Artificial Intelligence in Global Health
Check out this April 1st event hosted by the Bill & Melinda Gates Foundation, the Rockefeller Foundation, and the U.S. Agency for International Development’s (USAID’s) Center for Innovation and Innovation (CII). “The Aspen Global Innovators Group invite you to join us Monday, April 1st at the Aspen Institute in Washington DC for the launch of a new report and a panel conversation with experts from the public and private sector on the opportunities and challenges of exploring and applying artificial intelligence in global health. With the findings of the new report, AI in Global Health: Defining a Collective Path Forward, as background and context, the panel will discuss some of the most promising use cases of AI in healthcare, the opportunities and challenges to scaling AI in global health, and how the global health community can best accelerate the development and scale of AI in global health.”

Stories You May Have Missed:

  • Late Flu Push Means a Longer Season – “The US flu season is already a long one, with illness activity still widespread in 44 states and expected to continue for several more weeks, the Centers for Disease Control and Prevention (CDC) said in its latest weekly update. Though the level of clinic visits for flu peaked in February, the latest markers show little change from the previous week, with H3N2 viruses causing an increasing number of infections. Though 2009 H1N1 has been predominant for most of the season, H3N2 has caused more illnesses for 3 weeks in a row now.”

Pandora Report: 3.22.2019

Non-Medical Obstacles Impacting Public Health Responses
GMU Biodefense doctoral alum Jennifer Osetek is discussing non-medical challenges of public health preparedness and responses. “Clearly, for most populations, receiving medical therapies and supplies saves lives; however, medications unable to reach their intended targets prove worthless. ‘Vaccines that remain in the vial are 0% effective’ (Orenstein, Seib, Graham-Rowe, & Berkley, 2014). Outside obstacles stand between patients and the administration of critical health care resources (CHCRs) including medical countermeasures (MCMs), equipment, and supplies. These obstacles can, therefore, result in severe consequences. From a public health perspective, resources that do not reach those affected during an outbreak can mean the difference between a contained disease cluster or the disease spreading and threatening national or even global health security. This is especially relevant as ‘the problem of infectious disease is no longer only one of prevention, but also—and perhaps even more—one of preparedness’ (Lakoff 2008). Obstacles preventing sick people from accessing available resources is not a hypothetical concern any longer. Instead, it is one continually being played out both domestically and internationally in routine and emergency response situations. These obstacles are rooted in various causes and require more specific identification and analysis to prevent inadequate public health responses. Barriers to the delivery of care cost hundreds of thousands of lives simply because they are not defined or incorporated into public health planning and execution operations.”

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Come spend 3.5 days with some of the top minds in the biodefense field this July at our summer workshop. From vaccine development to biosecurity as a wicked problem, we’ll be having frank conversations regarding the toughest issues in health security. Register before May 1st for an early discount and get another discount if you’re a returning student, GMU alum/current student/professor, or registering with a large group.

HHS’ BARDA Funds Its First Marburg Vaccine
In pursuit of making progress against those viruses causing hemorrhagic fevers, HHS has partnered with Public Health Vaccines to help develop a Marburg virus vaccine. “The Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response, awarded an initial 2-year, $10 million contract to Public Health Vaccines, LLC to begin development of a vaccine to protect against Marburg infection. ‘This vaccine candidate is the first BARDA has funded against the Marburg virus, and it is an important step toward meeting an urgent public health and biodefense need,’ said BARDA Director Rick Bright, Ph.D. ‘We will leverage our experience in establishing public-private partnerships that bring results that are critical to saving lives and protecting Americans – and possibly people across the globe – from health security threats.’ The Public Health Agency of Canada initially developed the vaccine and licensed it to Public Health Vaccines, LLC. This approach is similar to the one Merck & Co. used to develop its Ebola vaccine. Under the agreement with BARDA, Public Health Vaccines will conduct preclinical development to demonstrate the proof of concept that the vaccine can protect against Marburg virus. If that initial development succeeds, BARDA has the option to provide additional funding for a total of up to $72 million to advance the Marburg virus vaccine through a Phase 2 clinical trial, and begin development of a vaccine candidate against the Sudan ebolavirus, a closely related virus, as well.”

Ebola Outbreak Updates
The outbreak in the DRC has been gaining speed in recent days at eight new cases were reported on Tuesday. “The illnesses lift the overall outbreak total to 968 cases, which includes 903 confirmed and 65 probable infections. Health officials are still investigating 234 suspected cases. Three more people died from Ebola, including two in community settings—one in Katwa and one in Mandima. The other fatality occurred at Butembo’s Ebola treatment center. The developments increase the overall number of deaths to 606. In its weekly diseases and health emergencies update, the WHO’s African regional office said though Katwa health zone is still the main epicenter, responsible for 44% of cases over the past 3 weeks, seven health zones have reported new confirmed cases over the past 3 days and remain a concern. Besides Katwa they include Masereka, Vuhovi, Butembo, Kyondo, Mandima, and Kayina.” Overall, there have been 44 cases reported in the last 5 days, which is deeply concerning and brought an end to the downward trend we were seeing. 

WHO Panel Calls for Registry of Human Gene Editing Research
Two days into a panel meeting of gene editing experts and the WHO is calling for a registry to facilitate transparency in human genome editing research. The panel was created as a result of CRISPR baby experiment and is in the process of setting up the registry to help guide work while ensuring safety. “The WHO panel’s statement said any human gene editing work should be done for research only, should not be done in human clinical trials, and should be conducted transparently. ‘It is irresponsible at this time for anyone to proceed with clinical applications of human germline genome editing.’ The WHO’s director-general, Tedros Adhanom Ghebreyesus, welcomed the panel’s initial plans. ‘Gene editing holds incredible promise for health, but it also poses some risks, both ethically and medically,’ he said in a statement. The committee said it aims over the next two years to produce ‘a comprehensive governance framework’ for national, local and international authorities to ensure human genome editing science progresses within agreed ethical boundaries.”

Lab Failures – How Dangerous Pathogens Are Escape Artists
Any research with dangerous pathogens brings with it an inherent risk, whether it be biosafety or biosecurity related. Unfortunately there are a lot of opportunities for failure during such work and recent efforts have looked to incidents to try and identify trends. “It looks like there are many different points of failure — machinery that’s part of the containment process malfunctions; regulations aren’t sufficient or aren’t followed. Human error means live viruses are handled instead of dead ones. Sometimes, these errors could be deadly. ‘If an enhanced novel strain of flu escaped from a laboratory and then went on to cause a pandemic, then causing millions of deaths is a serious risk,’ Marc Lipsitch, a professor of epidemiology at Harvard, told me.” Breaches can occur as a result of carelessness or just pure human error. “The blizzard of dangerous errors over only a few months in 2014, and the additional errors uncovered by subsequent investigations, inspired the US government to change its practices. The government called on all labs that handle secure substances to immediately improve their inventory policies and review their procedures, and to provide written documentation that they’d done so. It launched government-wide reviews to better understand how to safely regulate pandemic pathogens. The FDA began providing better training and conducting periodic audits to make sure that the safety procedures that were ignored in this case are being followed.”

 A Modern Take on the Broad St. Pump Outbreak
GMU Biodefense doctoral student and infectious disease epidemiologist Saskia Popescu is taking a look into an outbreak linked back to contaminated wells and how this reminds us all of the cholera outbreak in 19th century London. “A city, an outbreak, and a contaminated well. Surely this sounds like some kind of modern version of the John Snow cholera outbreak and the Broad St. pump. But unfortunately, it’s this week’s US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report with a much more recent example of how bad sanitation and contaminated water can affect a city. In 2017, a city in Nebraska experienced an outbreak of Campylobacter jejuni that drove home the realities of One Health, the theory that the health of humans, animals, and the environment are all connected. It all began on a March day in 2017, when the Southwest Nebraska Public Health Department got a call regarding a spike in campylobacteriosis cases—5. The condition, campylobacteriosis –infection due to Campylobacter jejuni, is reportable, indicating labs and hospitals are required to report them to the health department. Typically, a single case of Campylobacter was reported in this particular city every 3 years, making the infection quite rare. ”

How A Measles Quarantine Can Lead to Eviction
Vaccine-preventable diseases have been a topic of conversation lately with a surge of measles cases and presence of the anti-vaxxer movement. One particular aspect of public health and managing outbreaks of vaccine-preventable diseases though, is quarantine. A recent article discusses the need for paid medical/sick leave and how those quarantined during outbreaks have faced financial hardships. “The health department persuaded the restaurants where the families worked to not fire them, but the families nevertheless faced steep consequences from avoiding work, according to Archer and Edsall. One family missed so many paychecks that they were evicted. Several people had their phones shut off after unpaid bills racked up. Ultimately, the health department had a collection among its own employees to raise money to donate to the quarantined families. Much of this could have been avoided if the United States had a mandatory-paid-sick-leave policy, Archer and Edsall argue. The Family and Medical Leave Act of 1993 protects the jobs of some workers for up to 12 weeks for medical reasons, but it does not guarantee pay, and it doesn’t cover more than 40 percent of all American workers. Ten states and 33 cities have their own sick-leave policies, but still, 28 percent of American workers lack access to any kind of sick leave. The United States and South Korea are the only countries in the Organization for Economic Cooperation and Development that do not mandate paid sick leave.”

‘TIS the Way to Transport Highly Contagious Patients by Air
“U.S. Air Force personnel conducted training on the Transportation Isolation System (TIS), an enclosure the Defense Department can use to safely transport patients with highly contagious diseases, aboard a C-17 Globemaster III last week in South Carolina. First implemented after the Ebola virus outbreak in 2014, the TIS was engineered to ensure service members get the proper treatment in the event they get infected with any disease during relief missions to affected areas while protecting the aircrew and support personnel. TIS training takes place roughly three times a year and lasts for four days. The training goes from initial donning and doffing protocols for personal protective equipment to actual patient transport and care. This can include treating simulated patients at the “infection scene” all the way to securing them within the TIS unit and even taking part in a simulated in-flight transport.”

Antibiotics, Orchards, and A Citrus Scourge That Instigated Public Health Fear
I’m just going to say it – if I want to know what’s really going on in the world of antimicrobial resistance, I’m looking to Maryn McKenna. Call her our canary in the AMR coal mine. Yet again, she’s giving insight into a concerning avenue for antimicrobial resistance and over usage in the citrus world – this time combatting citrus greening. “The US Environmental Protection Agency (EPA) is in the process of allowing growers to use streptomycin and oxytetracycline as routine treatments, spraying trees several times per year, beginning with the ‘first flush’ of leaves this spring. Growers in the state could end up using as much as 440,000 kilograms of the drugs. Although the compounds, which are both used in human medicine, have been sprayed on other crops in the past and applied in limited amounts to citrus groves, the scale of this application has researchers and public-health advocates alarmed. ‘They are doing a huge experiment with limited monitoring,’ says Steven Roach, a senior analyst in Iowa City at Keep Antibiotics Working, a coalition of research and advocacy groups that has formally objected to the plan with the EPA.” That’s right, as mounting pressure has been focused on reducing antibiotic usage in agriculture, these farmers are planning to use more. Even more frustrating is the lack of evidence for both efficacy of use but also the implications of long-term use. As McKenna notes, “Academic researchers disagree on how much ecological harm or antibiotic resistance will result.” She further points out that “The EPA has specified certain rules to reduce the risk of resistance emerging. Spraying is limited to a few times per year; farm workers must wear full protective clothing; and groves cannot be fertilized with uncomposted manure. It has also set a deadline of seven years for re-evaluating the programme, half the time that it would normally impose for an agricultural chemical.”

Assessing the Need for and Uses of Sequences of Interest Database
You can now find the report on the proceedings from this two-day workshop here. “Over the past decade, the biotechnology economy has experienced remarkable growth, resulting in the rapid expansion of biological knowledge and application. Such advances have lowered the technical and financial barrier to entry for bioexperimentation outside the traditional environments of academia and industry. Together these developments provide exciting new opportunities for scientific growth. However, they create openings for actors with malicious intent to harness readily available tools and techniques to create biological threats or bioweapons. In this report, we present the results of a workshop designed to convene key experts from diverse stakeholder groups to understand how a genetic database of “sequences of interest” (SOIs) can best support stakeholders—government agencies, academic researchers, and commercial groups—to improve the utility, safety, and security of biotechnology research endeavors. The sessions consisted of a mix of presentations, panel discussions, and small and large group discussions. This report should be viewed as an exploratory first step in discussing a very complex topic with broad and often conflicting stakeholder interests.”

Attacks on Medicine Machine Learning: Cyberbiosecurity
“With public and academic attention increasingly focused on the new role of machine learning in the health information economy, an unusual and no-longer-esoteric category of vulnerabilities in machine-learning systems could prove important. These vulnerabilities allow a small, carefully designed change in how inputs are presented to a system to completely alter its output, causing it to confidently arrive at manifestly wrong conclusions. These advanced techniques to subvert otherwise-reliable machine-learning systems—so-called adversarial attacks—have, to date, been of interest primarily to computer science researchers (1). However, the landscape of often-competing interests within health care, and billions of dollars at stake in systems’ outputs, implies considerable problems. We outline motivations that various players in the health care system may have to use adversarial attacks and begin a discussion of what to do about them. Far from discouraging continued innovation with medical machine learning, we call for active engagement of medical, technical, legal, and ethical experts in pursuit of efficient, broadly available, and effective health care that machine learning will enable.”

Stories You May Have Missed:

  • H3N2 Cases Keep Flu Activity High – “Though flu activity decreased slightly last week, a wave of H3N2 virus activity has led to severe illnesses across the country and four more children have died from the disease, according to this week’s FluView report from the Centers for Disease Control and Prevention (CDC). This is the second week in a row the CDC recorded more H3N2 cases that H1N1, the virus subtype that dominated the first part of the 2018-19 flu season. ‘H3N2 viruses are typically associated with more severe illness in older adults, and flu vaccine may protect less well against H3N2 illness in older adults, making prompt treatment with flu antivirals in this age group especially important during the current period of H3N2 predominance,’ the CDC said today in a summary of the report.”
  • Changing the Game in Pediatric Diagnosis of Serious Bacterial Infections – “Figuring out why that 2-month-old with a fever is crying often includes spinal taps, which are painful and risky, alongside rapid antibiotic treatment to avoid meningitis. Bacterial meningitis can be deadly, especially in infants; the US Centers for Disease Control and Prevention (CDC) reports that between 2003 and 2007, there were 4100 cases of bacterial meningitis reported in pediatric patients in the United States, as well as 500 deaths. Given these rates and the risk of life-threatening infections, it’s not unusual that pediatricians would want to perform a spinal tap or administer antibiotics until further diagnostics can be performed. Fortunately, a new protocol has been developed that could not only make a diagnosis of bacterial infections in infants easier but would remove the need for spinal taps and unnecessary antibiotic treatments. Investigators from the Pediatric Emergency Care Applied Research Network (PECARN) created a new protocol from a study of more than 1800 infants seen across 26 emergency departments in the United States.”

Pandora Report: 3.15.2019

TGIF or beware the Ides of March? Either way, we’ve got some health security news for you, so grab your Caesar salad and enjoy this weekly dose of all things biodefense.

Summer Workshop – Are You Registered?
We’re offering an early-bird discount for registration prior to May 1st – have you signed up? 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 workshop, 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. Don’t miss out on an additional discount if you’re a returning attendee, GMU employee/student, or are registering with a large group.

Germline Gene-Editing – Do We Need a Moratorium?
In the wake of He Jiankui’s gene-edited babies, many are calling for a moratorium on germline gene-editing. In fact, the Chinese health ministry released draft guidelines at stopping rogue efforts with unapproved biotech. This topic is so important that Nature published a call for a moratorium by several top ethicists and researchers. “Whether or not a moratorium receives more widespread support, several things need to be done to ensure that germline gene-editing studies, done for the purposes of research only, are on a safe and sensible path. As a starting point, proposals for all ethically vetted and approved basic research studies that use gene-editing tools in human embryos and gametes, including those aimed at assessing efficacy and safety, should be deposited in an open registry. Second, researchers need to develop a system that allows early recognition of any research that risks overstepping predefined boundaries. A useful model to follow could be the WHO guidance for regulating research with a potential biosecurity risk. The system should include a mechanism — perhaps affiliated with the open registry — that allows researchers to flag up potentially dangerous research. Analysing whether He’s work could have been prevented will help. It’s important to hammer out whether, how and to whom scientists and ethicists who became aware of the project could have voiced their concerns — and how they could do so more easily in future. Raising the alarm would require a change of practice for researchers who, for the sake of scientific independence, often do not intervene in the choice of research projects undertaken by their peers.” In the joint statement, the researchers noted that “By ‘global moratorium’, we do not mean a permanent ban. Rather, we call for the establishment of an international framework in which nations, while retaining the right to make their own decisions, voluntarily commit to not approve any use of clinical germline editing unless certain conditions are met.”

Taking A Step Back in Staph
This common skin bug is becoming increasingly resistant to not only intervention efforts, but also antimicrobials. Saskia Popescu, GMU biodefense doctoral student and infection preventionist, discusses the latest CDC report on the concerning state of Staphylococcus aureus infections, including MRSA. “Staph infections can either be methicillin-resistant or methicillin-sensitive (MSSA) but, overall, staph is the leading cause of infections in US hospitals. Infection preventionists have been zeroing in on MRSA for decades in the health care industry, working tirelessly to stop the spread. Unfortunately, according to the CDC, progress in curbing MRSA has slowed, and findings indicate that MSSA rates are also not declining. One theory is that the opioid crisis may be connected, as 9% of all serious staph infections in 2016 occurred in patients who used injection drugs, a statistic that represented an increase from 4% in 2011. Consider this—right now, nearly 1 in 10 staph infections that occur are in people who use intravenous drugs.”

 MERS-CoV Outbreak
Speaking of healthcare-associated infections…Saudi Arabia’s Ministry of Health reported two more cases in an ongoing outbreak in Wadi ad-Dawasir. Unfortunately, most of these cases are linked to healthcare exposures and a handful are related to contact with camels. One particular study assessed camel infections, noting that “The investigators focused on 53 studies published from 2013 to December 2018, of which 33 were from the Middle East, 13 from Africa, and 7 from Spain, Australia, Japan, Bangladesh, and Pakistan. The team reported its findings yesterday in the preprint server bioRxiv. The team said another group unknowingly carried out a similar review, which covered studies published from 2013 to April 2018 and was published Feb 21 in Epidemiology and Infection by a team from Qatar and the Netherlands. The authors of the bioRxiv said their study confirms and updates the findings of the other study.The authors of the new review found that MERS-CoV seroprevalence in camels increases with age, up to 80% to 100% in adult dromedaries, which the team says suggests that the virus is widely endemic in camels on the Arabian Peninsula and in African countries that export dromedaries. However, they note variable patterns within some countries. Also, the experts found a high prevalence of active infection in juvenile animals and at sites where the animals mix, such as livestock markets and slaughterhouses. Other findings from the longitudinal studies they examined include reinfection despite high MERS-CoV antibody titers.”

Improving Global Health Security Through One Health Platforms
Don’t miss out on this March 21st even at the National Press Club, hosted by the USAID -funded Preparedness and Response project. “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.”

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. On Wednesday, March 20th you can attend a Master’s in Biodefense Webinar (online) at 12pm EST and at 7pm there will be a PhD Open House 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.

Ebola Outbreak Updates and An Epidemic of Suspicion 
On Tuesday, two new cases were reported, as well as two new deaths, bringing the case counts to 925, including 584 deaths. Vinh-Kim Nguyen recently wrote in NEJM regarding the violence and turmoil surrounding outbreak response efforts in the DRC. “As a medical team leader for Médecins sans Frontières (MSF), I work halfway between Butembo and Goma, North Kivu’s capital city and a transport hub. In late January, five Ebola cases were identified in Kayna and Kanyabayonga; MSF opened a center in Kayna to isolate patients with suspected cases and test them for Ebola virus disease (EVD). I soon suspected that most patients would turn out to have diseases other than EVD. The standard “isolate and test” model often leads to expectant management for such patients — the tendency is to “cover” patients with antimalarials and broad-spectrum antibiotics, wait for EVD test results, and then discharge patients without Ebola. We instead took a more active approach, treating severe cerebral malaria, typhoid, sepsis, and even cholera. I have witnessed how such active clinical management for all patients, along with MSF’s long-term presence in North Kivu, has contributed to the community’s acceptance of our Ebola unit. Having patients emerge from isolation in improved health is powerful evidence that we aim to make everyone better, not just to stop Ebola’s spread.” Nguyen further discusses the labeling of attacks as “resistance” are fundamentally wrong and how they are actually a bigger issue – persons against prevention activities aimed at them and those orchestrated, armed attacks against symbols of the international response. “The mistrust of authority in the DRC also reflects a growing global mistrust of experts and science. Vaccine refusals are a growing problem worldwide, and they have already resulted in measles epidemics in the United States and France and in outbreaks elsewhere. Mistrust of public health authorities may thus be the new norm, and smoldering epidemics merely a symptom.”

 Ambitious American AIDS Initiatives & Cutting Foreign Aid Programs
In the February State of the Union, President Trump pledged to end the HIV epidemic by 2030. This re-invigoration of HIV efforts was shocking, but exciting. The official pledge of $291 million to help end transmission of HIV within the United States will hopefully bring us closer to that goal through initiatives that increase access to pre-exposure prophylaxis (PrEP). While Congress still needs to approve the 2019 budget, there is a concerning proposal within it. Beyond the cuts to Medicare and Medicaid ($845 billion and $241 billion respectively) which are deeply worrisome, the budget seeks to drop US contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria by one billion. “The US will contribute $3.3bn between 2020 and 2023, a reduction on its previous contribution of $4.3bn. In a statement the global fund said: ‘The United States is the leading supporter of the Global Fund, and we are confident that the U.S. Congress will continue the strong funding that is urgently needed to improve global health security by ending epidemics. Various proposals are being considered and we look forward to final budget decisions taken by Congress in the coming months.’ The fund is looking for at least $14bn for the next year and, as the US donates around a third of the total, its contribution will mark a significant reduction on previous years. Mr Trump also proposes a $12.3bn cut to the State Department and USAID, marking a 23 per cent cut from the previous year. USAID, through the President’s Emergency Programme for Aids Relief, is a key player in the United Nations programme to eliminate HIV around the world.”

WHO Launches New Global Influenza Strategy
Influenza continues to be not only an annual issue, but the lack of preparedness for severe seasons and potentially pandemic strains is also an international issue. The WHO released their Global Influenza Strategy for 2019-2030. “The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals to humans and potentially causing a pandemic is real.   The question is not if we will have another pandemic, but when.  We must be vigilant and prepared – the cost of a major influenza outbreak will far outweigh the price of prevention.” This new strategies “is the most comprehensive and far-reaching that WHO has ever developed for influenza.  It outlines a path to protect populations every year and helps prepare for a pandemic through strengthening routine programmes. It has two overarching goals: 1. Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness. To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security. 2. Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals and treatments, with the goal of making these accessible for all countries.”

How Africa Can Quell the Next Disease Outbreaks
How can African nations enable public health institutions (NPHIs) to help stop emerging and re-emerging infectious diseases from springing up and causing large outbreaks? Beyond waiting for outside intervention and emergency help from the West, John N. Nkengasong, head of the Africa Centre for Disease Control and Prevention, calls “on all 55 member states to establish or strengthen NPHIs. And I urge the private sector in Africa and worldwide, and bodies everywhere, to invest in these efforts. According to the World Bank, Africa needs between US$2 billion and $3.5 billion a year for epidemic preparedness; in 2015, 8 African nations received from various donors about $700 million for this cause.” Furthermore, he notes that “NPHIs should prioritize four broad areas. First, providing basic functions such as disease surveillance and coordinating emergency operations, even in remote areas. Second, creating lab networks that can quickly diagnose, track and pinpoint the origin of emerging infections. Third, developing a workforce to collect, assess, share and act on quality data, including advanced technologies such as genetic sequencing and informatics. Fourth, developing a strong capacity for social scientists to engage with communities and change behaviours. Sociologists and anthropologists were crucial in ending the Ebola outbreak in West Africa by, for example, promoting safe burials — which meant modifying long-standing traditions, such as washing the corpse of a loved one.”

Measles and the Threat of the Anti-vaccination Movement
From measles to polio, the threat of vaccine-preventable diseases is a real one that we’re slowly losing our headway in. “The anti-vaccination movement threatens to undo years of progress made against a range of preventable diseases. Mass immunization campaigns helped slash the number of measles deaths worldwide by 80 percent between 2000 and 2017, but that headway may now be stalling. Today, only 85 percent of the world’s infants receive the first dose of the treatment, and even fewer get the second dose. This is well short of the 95 percent vaccination rate that the WHO says is needed to prevent outbreaks. If the anti-vaccination movement continues to gain momentum, there could be more outbreaks in places such as the United States, where measles has been considered eliminated for nearly two decades. With more cases, there will be greater potential for measles to spread across borders. Until governments turn the tide of the anti-vaccination movement, health workers will face the dual challenge of containing measles in both countries where the disease is still endemic and those where it was thought long gone.”

Infectious Diseases Spike Amid Venezuela’s Political Turmoil
The crisis in Venezuela is leaving millions without clean water, access to hospitals,  safe food, and more. Unfortunately, it is also causing a spike in infectious diseases as public health and healthcare efforts have been all but decimated. “These so-called vector-borne diseases—transmitted by mosquitoes or other organisms—have increased by as much as 400 percent in Venezuela in the last decade, according to a review study published in The Lancet in February. Spiraling economic and political turmoil have worsened the situation, as has the government’s apparent hostility toward researchers who publish epidemiological data—with reports of pro-government paramilitary groups smashing labs and even stealing experimental mice. “’Last year we had more than 600,000 cases [of malaria] reported by the government,’ says study co-author Maria Eugenia Grillet, a tropical disease ecologist at Central University of Venezuela in Caracas. She and her co-authors estimated there were actually around 1.2 million cases, taking into account underreporting and disease relapses, Grillet notes. (Relapses occur when a patient has recovered but still carries the malaria-causing parasite and later suffers a recurrence of symptoms.) She blames the increase on a lack of antimalarial surveillance, treatment and control, partly due to funding cuts. ‘Research in our universities and laboratories is almost completely paralyzed because there are no financing programs that allow us to cover the basic needs to carry out our experiments or fieldwork,’ she says.”

Stories You May Have Missed:

  • New Vaccine Manufacturing Innovation Centre Bolsters Pandemic Preparedness – “The first dedicated Vaccines Manufacturing Innovation Centre (VMIC) is coming to the UK in 2022, addressing gaps in late-stage vaccine manufacturing for clinical trials and emergency preparedness for epidemic and pandemic threats. Led by the the University of Oxford’s Jenner Institute, the new centre has been awarded funding by UK Research and Innovation of £66 million ($86 million USD) through the UK Government’s Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing challenge. ‘This is an exceptional opportunity for the UK to lead in the provision of vaccines against a wide range of outbreak pathogens which threaten to cause major epidemics,’ said Adrian Hill, Jenner Institute Director. ‘The lack of commercial incentive to develop these has now led to this exceptional partnership of major academic and industrial players in the vaccine field, to accelerate a range of vaccines towards large-scale manufacture and stockpile provision for vulnerable populations. In parallel, the Centre will develop innovative manufacturing technologies with UK companies and Universities to support the next generation of life-saving preventive and therapeutic vaccines’.”

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.”

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