The Challenge of Triage for CBRNE and Mass Casualty Incidents

By Deborah W Cohen, Biodefense Graduate Certificate Program

Imagine you have travelled across the country to attend a professional conference. While attending a presentation, the session is suddenly interrupted by news that other attendees are falling ill from a chlorine leak at the conference center’s pool. There are sounds of sirens and chaos outside. The presenter asks everyone to stay calm. They resume their presentation, but about an hour later a handful of individuals in the room begin to fall ill. As you being to wonder if this is connected to the incident outside at the pool, you suddenly become incapacitated and fall off your chair. The last thing you see is first responders wearing hazmat gear entering the room. 

This was the initial stage of the scenario for the Tabletop Capstone Exercise on the last day of the U.S. Army’s Hospital Management (HM) – Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) Incidents training course held in late January 2021. I was assigned to the RED HOSPITAL response team which was comprised of military and civilian members. As the scenario unfolded, we organized a response utilizing the doctrine, tools, and planning concepts of the Hospital Incident Management System (HIMS) taught during the first four days of the course. 

Many kinds of emergency incidents happen in our communities. The scenario to which we responded could have been caused by a “conventional” emergency or a terrorist attack involving a chemical agent and a biological agent. The nature of the attack would be determined through an investigation using evidence collected during and after the response. The disaster response, however, must start immediately and be premised on the National Incident Management System (NIMS) guided by the National Response Framework (NRF). The NRF is the national emergency management doctrine formulated by the Office of the Assistant Secretary of Preparedness and Response (ASPR) in the Department of Health and Human Services. The NIMS provides federal support to state and local incident managers and is designed to be scalable, flexible, and adaptable to all types of incidents. 

This emergency management system was put in place by Homeland Security Presidential Directive 5 in 2003 which sought to “enhance the ability of the United States to manage domestic incidents by establishing a single, comprehensive national incident management system.” The guiding principles of the NIMS are the template for local Incident Command Systems (ICS). By way of background on nomenclature, Incident Management Systems (IMS) are more comprehensive in scope than Incident Command Systems (ICS).  IMS also deal with the longer term direct and indirect effects of an event in a community. ICS can be thought of as aa component of IMS dealing more narrowly with specific urgent actions of getting an incident under control.  However, ICS and IMS are designed to be compatible with each other. The ICS operates on the principle of “unity of effort” which provides the multiple organizations responding to an incident a way to coordinate and focus their efforts efficiently by setting aside overlaps and competition across authorities and jurisdictions.Local hospitals are required to prepare for and respond to disasters using the Hospital Incident Command System (HICS) in compliance with NIMS. One of the ways that HICS improves emergency planning, response and recovery is by clearly designating who is responsible for different roles across the response command organization such as incident command, security, medical technology, personnel, finance, supply, logistics, public information, liaison services, and transport.  Since compliance with NIMS is a condition for any healthcare facility to receive Federal assistance, the adoption of ICS by first responders and HICS by healthcare organizations enables government and non-government entities to respond cooperatively to an incident.

The week of training provided by the HM-CBRNE course covered the properties of each of the CBRNE threats and their respective hospital management protocols. These threat-response relationships were further illustrated by incident scenarios. In these scenarios, triage was, for me, the main component that best characterized the realities of emergencies.  In contrast to the Medical Management of Chemical and Biological Casualties (MCBC) Course that I attended last year, which focused on battlefield triage, this course also included lessons on triage in a  civilian community setting.

We learned about three types of triage systems that hospitals use for trauma casualties that are not specifically designed for CBRNE incidents: (1) field triage conducted at the scene of an incident to match available resources with patients; (2) inter-hospital sorting for the transfer of more seriously injured patients to higher level care facilities; and (3) mass-casualty sorting and prioritizing during a disaster. There is also a reverse triage system to sort hospital patients for discharge. These triage systems support the creation and utilization of surge capacity by hospitals to deal with mass casualty incidents, which resonates today with the challenges posed by the COVID-19 pandemic.  Triage of casualties caused by a CBRNE incident can be complicated by the unique effects of these weapons as well as by pre-existing conditions among patients and the impact of psychological trauma. 

The U.S. Army uses three types of “sorting” systems for triage: medical treatment, decontamination, and evacuation. For medical treatment, there are four categories of triage: Immediate, Delayed, Minimal, and Expectant (IDME). In medical triage, Immediate cases require intervention within a few minutes using the ABCDDs: Airway, Breathing, Circulation, Decontamination, and Drugs. In CBRNE events, immediate intervention can also use the (MARs)2 system:  Mask, attention to issues of Massive hemorrhage, Airway, Antidotes,Respirations, and Rapid removal of contaminants. Delayed cases can tolerate a short postponement of medical attention. Minimal patients are those with minor, stable, or resolving injuries that can tolerate a longer delay in treatment.  Expectant patients will not survive without the use of scarce resources that could otherwise be used for possible survivors.  For a civilian community setting, triage of CBRNE casualties will be handled differently.  Four different triage systems for CBRNE casualties, each with their own advantages and limitations, have been developed: (1) Rapid Assessment of Mentation and Pulse (RAMP); (2) Sort Assess Life-saving Treatments Treatment and/or Transport (SALT); (3) Simple Triage and Rapid Treatment (SMART); and (4) Simple Triage and Rapid Treatment (START).

A second triage system developed by the military is for decontamination and it depends on the type of agent and exposure involved. It is typically conducted concurrent with medical triage. For decontamination, the sorting categories are Immediate, Operational, and Thorough. The Assistant Secretary for Preparedness and Response (ASPR) and its partners have developed a protocol for decontamination triage based on a tool called the Primary Response Incident Scene Management (PRISM).

The third triage system is for evacuation which includes Urgent, Priority, and Routine (UPR) sorting categories.  Triage for evacuation is based on the determinations of medical triage and time factors. Patients who can be matched with available treatment and are most likely to survive and recover will be evacuated. Patients in the Urgent category are those who need treatment within two hours. Priority triage is for those who need treatment within four hours. Routine triage patients can wait for up to 24 hours for treatment. The Routine group of evacuees will also include terminal patients.

Col. (ret.) James M. Madsen, MD, the Army presenter, explained that while all triage methods are based on on-the-scene determinations of urgency, survivability, and resource availability, mass-casualty and CBRNE triage is different from other kinds of triage in several ways. For triage of victims of a CBRNE incident, the speed of operation is even more critical, personal protective equipment (PPE) is always needed due to the risk of contamination, verbal communication is difficult, hands-on exams may not be possible, and first responders are sorting simultaneously for medical treatment, decontamination, and evacuation. CBRNE triage schemes are very challenging as they must quickly account for the clinical implications of the specific CBRNE agent to which the victims have been exposed. For instance, the length of the latent period before symptoms manifest, the risk of secondary contamination, and the existence of specific antidotes varies among different chemical warfare agents. The most important message about triage for mass casualties and CBRNE incidents is that while there are many methods under development, there is no consensus about the best option to employ in every case. It was sobering to learn that current triage methods are not adequate for the complex situations, conditions, and circumstances that characterize the evolving landscape of CBRNE and terrorism events.

Intersection of Mental Health and Hospital Management for CBRNE Incident Response

By Sally Huang, Biodefense PhD Student

In January 2021, I attended the Hospital Management—Chemical, Biological, Radiological, Nuclear, Explosives (HM-CBRNE) course organized by the United States Army Medical Research Institute of Chemical Defense (USAMRICD), the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), and Armed Forces Radiobiology Research Institute (AFRRI). Seeing how the COVID-19 pandemic has overwhelmed hospitals nationwide, I was interested in learning how healthcare workers and first responders respond to CBRNE scenarios. With the Army offering the course virtually to substitute for what would normally be an in-person course, the HM-CBRNE course was a great opportunity for me to gain a first-hand look at hospital management operations and protocols as well as improve my understanding of CBRNE casualty symptoms. The course covered a variety of topics through informative lectures by subject matter experts, interactive seminar discussions, and a tabletop exercise and it provided a very useful complement to my education in the Biodefense Graduate Program at the Schar School of Policy and Government.

Though it was unfortunate that we could not be in the classroom to interact with the seasoned professionals who served as instructors, their vivid descriptions of various facilities and CBRNE equipment helped us learn how to navigate the frenzied scene at a hospital in the wake of a mass casualty incident. The virtual setting also did not inhibit our ability to communicate with the instructors or cooperate with other students. Setting aside reticent mannerisms that would have been apparent in the classroom, the virtual platform instead allowed us to more freely type or vocally express our opinions and questions. After the first day of acquainting ourselves with the platform and with each other, the following four days consisted of constant dialogue in the chat hub. It was particularly heartening to be part of a cohort who openly shared their personal and professional experiences with the rest of the class to create a more dynamic and memorable learning experience.

As hospital management is not regularly part of mainstream academic curriculum, the opportunity to familiarize myself with hospital protocols was a valuable experience. The course introduced me to essential federal disaster response frameworks, such as the National Incident Management System (NIMS), National Response Framework (NRF), and Occupational Safety and Health Administration (OSHA) best practices that help ensure that CBRNE response and recovery operations are carried out safely and effectively. Without knowing that these protocols exist, one may be forgiven for thinking that federal responses to such events are spur-of-the-moment occurrences. Through the HM-CBRNE course, I learned about the six critical areas vital to guiding interagency coordination for an all-hazards response effort: communication strategies, resources and assets, safety and security, staff responsibilities, utility management, and patient support activities. As important as it is to actively respond, learning the fundamentals in hospital logistics, planning, finances, and operations is equally important in order to optimize mass casualty CBRNE response.

I was especially glad to see the incorporation of mental health in the HM-CBRNE course. While healthcare providers may first scan for physical symptoms to indicate what kind of CBRNE agent is involved, it is equally important to recognize the telltale psychological signs that affect mental and behavioral health, increase mass panic, and cause the “worried-well” phenomenon. There is historical evidence of psychological effects from battlefield experience and, although mental health awareness has increased over recent years, we cannot dismiss the occurrence of psychological impacts during CBRNE events. Scorn and stigma remain highly correlated with mental health conditions, which can negatively impact the way that hospitals receive and treat patients. As a result, the HM-CBRNE course effectively highlighted how considerations of psychological symptoms can be integrated into casualty management to pave the way for more holistic, well-informed medical decisions.

This importance of mental health is particularly relevant as the COVID-19 lockdown and quarantine dominates our daily lives. From overworked and overstressed healthcare workers, individuals whose feelings of isolation compound preexisting mental health issues, and family members who have to simultaneously juggle professional and personal responsibilities, it is clear that the extent of a person’s limits is being tested like never before. Thus, it is important that we continue efforts to improve mental health awareness and actions beyond a case-by-case approach.

The HM-CBRNE course was an informative and distinct experience that any individual interested in mass casualty and CBRNE management would benefit from. The instructors and staff worked diligently to help make a challenging and complex area seem less scary. This week-long course, filled with high-quality lectures and interactive activities, demonstrated the Army’s deep commitment to providing civilian and military participants with functional hospital management knowledge about how to address CBRNE incidents. This was an amazing and instructive experience that provided me with an inside look at how the United States prepares for and responds to unconventional weapons and incidents.

Commentary – Systematizing the One Health Approach in Preparedness and Response Efforts for Infectious Disease Outbreaks

By Michelle Grundahl, Biodefense MS Student

We can use a One Health approach to improve our next pandemic response to actually strengthen global health security – and we can choose to systemize and globalize right now.  One Health is a collaborative, multisectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. The objective of this workshop – offered by The Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine – was to confront our emerging health threats through systematizing and integrating the One Health approach. Systematizing is defined as arranging an organized system; to make systematic. Living through the current pandemic required us to perform outbreak detection and response to SARS-CoV-2, but prevention and preparedness is actually what we should be doing prior to outbreaks. Topics in this workshop included integrating One Health into existing coordination mechanisms (into national action plans for health security) and integrating animal and human health surveillance systems.  Essentially, this new paradigm in biodefense will create a framework across sectors and bring order among disparate expertise. The adopters of One Health are ready for the challenge.

Should we create a National Pathogen Surveillance and Forecasting Center for biological threats? Pandemic prediction, prevention, and policies are our next step in responding to the current SARS-CoV-2 pandemic. Medical countermeasures are useful during outbreaks but perhaps it would be better to truly mitigate global health threats, and even prevent them. We can achieve global health security through relationship building and lateral leadership. Two themes were repeated during the workshop: (1) future public-private collaboration must happen and (2) strong health systems are needed (globally and locally).

Day one of the workshop focused on the practices of existing programs and how these could improve the current model for global public health responses. The Africa CDC provided their lessons from COVID-19 and they stressed the continued importance of using a holistic approach to health threats. Specifically, the creation of a new framework for the African continent – Framework for One Health Practice in National Public Health Institutes – recognizes that other countries are frequently hampered by siloed health systems. The African Framework explains that the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and Sustainable Development Goals (SDGs) call for a One Health approach in order to comply with the 2005 International Health Regulations (IHR).

Back in the United States, we learned about the activities at Harris County (Texas) Public Health office. They explained their operational approach using One Health practices. An example given was the removal of old tires (mosquito breeding grounds) to combat Zika. Another was their response to Hurricane Harvey when they sheltered people and their pets together. Most recently, Harris County did surveillance of SARS-CoV-2 in pets.

On day two, the sessions tackled the urgency of a One Health approach and how it can be applied immediately. The development of a One Health workforce is one path forward. Dr. Lonnie King suggests that we should value a “T-shaped worker who has a deep understanding and high proficiency in one area with the skills to work collaboratively and respectfully across disciplinary lines for synergistic problem-solving.” In fact, USAID has a workforce project to do just this. An example, Africa One Health University Network (the latest effort in this USAID project) is creating a competent future workforce by developing multi-skilled students, who can work outside of silos. Universities can integrate systems thinking and encourage collaboration across disciplines. Woutrina Smith reminded the audience that social context is important, too; we cannot forget to incorporate the social sciences into traditional science to effectively create solutions using the data that we generate. Transdisciplinary thinking is essential.

Day three looked at the future of One Health with the experience of SARS-CoV-2 in mind. Biosurveillance using shared international data would create the ability to better forecast outbreaks. This will require cooperation through public-private partnerships, along with policy changes. The workshop suggested the goal of building a “broad, threat-agnostic global health system.”  This includes learning from the past to determine future capabilities. Collaboration across disciplines, sectors, and communities can enhance the detection of threats. Surveillance is key here. Realistically, it is unfeasible to collect and monitor all global health data.  Local, national, and international epidemiological surveillance systems are still needed though. They should be designed (and refined) with One Health in mind. The session on “Precision Epidemiology, Human Behavior, and the Future of One Health” (led by Jonathan Quick) discussed machine learning, which can sort through the massive amounts of data that we may begin to collect. Intelligence and national security applications of this surveillance data were not obviously addressed in this three-day event. Future conversations to address this sort of data will need to include scientists and intelligence professionals. Regardless, most agree now that global health security is national security.

Many of the topics of this workshop focused on current and future actions; which were reminiscent of the challenges listed in 2016’s Pandemic Prediction and Forecasting Science and Technology Working Group of the National Science and Technology Council. The major theme for this workshop was that collaboration is a must if we want to improve resilience to global health threats. Other groups (outside of this workshop) are collaborating and systemizing at the state level. On March 1st, New Jersey passed a bill (A-1992/S-347) for the ‘New Jersey One Health Task Force’ to operationalize One Health in the state. Looking forward, will we excel in our reaction to the next pandemic? Will we also create multisectoral preparedness that allows us to forecast, or prevent, the next pandemic?

There were many heavy hitters speaking at this NASEM workshop, including: Peter Daszak from EcoHealth Alliance; Laura Kahn from Princeton University; Casey Barton Behravesh, Director of the One Health Office at the US Centers for Disease Control and Prevention; John Nkengasong from the Africa Centres for Disease Control and Prevention; Jonna Mazet, Professor of Epidemiology and Disease Ecology and Executive Director of the One Health Institute School of Veterinary Medicine at University of California, Davis; Tracey McNamara from Western University of Health Sciences; Peter Rabinowitz from University of Washington; Lonnie King, Dean Emeritus for the College of Veterinary Medicine at The Ohio State University; and Jonathan Quick, Managing Director of the Pandemic Response, Preparedness, and Prevention Health Initiative at The Rockefeller Foundation.

Pandora Report: 3.5.2021

The Pacific Northwest National Laboratory (PNNL) released the National Response Framework Policy Landscape Analysis Tool, the first iteration of a new tool for understanding responsibilities following a disaster or emergency. The norms against the use of chemical weapons have been eroding, adding another challenge for the international community and the new Biden administration. Chris Quillen, a Biodefense PhD student, shares his review of Red Line: The Unraveling of Syria and America’s Race to Destroy the Most Dangerous Arsenal in the World.

The “Red Line” That Wasn’t

Syrian President Bashar al-Assad’s use of chemical weapons (CWs) against his own people is the greatest challenge the Chemical Weapons Convention has ever faced. This breach of the taboo against CW use sparked numerous national and international investigations to determine the details of exactly what happened and who had done it. These investigations, in turn, were severely complicated by numerous factors. Investigators had to deal with (1) the dangers of operating during a complex civil war, (2) multiple belligerents using CWs on the battlefield (both the Syrian government and the Islamic State of Iraq and Syria or ISIS), and (3) the Syrian government’s repeated denials and counter-accusations of any CW use. Syria’s dubious position was backed by Vladimir Putin’s Russia in the public debate and, most importantly, at the United Nations Security Council, which provided Assad significant protection from international sanction. The global opposition to Syria’s use of CWs was widespread, but was led by the United States primarily under Barack Obama and also Donald Trump. The debate about what happened in Syria—and especially about how the world reacted to it—will undoubtedly rage for years to come. Joby Warrick’s Red Line: The Unraveling of Syria and America’s Race to Destroy the Most Dangerous Arsenal in the World is a useful addition to this debate, but the definitive book on the use of chemical weapons in the Syrian civil war remains to be written. Chris Quillen, a Biodefense PhD student, provides a revealing review of the book. Read it here.

How S&T’s Past Bioagent Research Informs Current and Future Pandemic Response

The Department of Homeland Security (DHS) Science and Technology Directorate (S&T), along with many other research and development institutions, was suddenly forced to shift priorities when the COVID-19 pandemic began. Researchers at S&T’s National Biodefense Analysis and Countermeasures Center (NBACC) – the first DHS national laboratory – hit the ground running “to learn as much as possible about the coronavirus so that our nation is better armed to fight, control and defeat the deadly COVID-19 disease.” NBACC researchers were asked: When faced with the challenge of a lifetime, where do you start? NBACC was established in response to the 2001 anthrax attacks to study “bioterrorist threats that endanger our homeland security,” so these scientists went back to the basics as it did 20 years ago. For SARS-CoV-2, the group studied how stable the virus is in the air and how it can be transmitted. According to Dr. Victoria Wahl, Deputy Director of NBACC’s National Biological Threat Characterization Center, “The same unique capabilities NBACC has established for biodefense research can also be applied to a new agent like SARS-CoV-2 to help us understand it better.” S&T’s risk assessment practices “consider the risk posed by a variety of chemical, biological, radiological and nuclear agents that could potentially be used by terrorists to harm the US.” Those practices helped S&T develop a Master Question List (MQL) for Ebola, and that list informed work regarding SARS-CoV-2. In the early days of the pandemic, NBACC used the knowledge garnered from the 2003 SARS-CoV-1 outbreak to help inform its efforts to better understand SARS-CoV-2. Turning toward pandemic preparedness for the future, “NBACC is using lessons learned from all these research experiences to refine and streamline the lab’s planning and workflows, so response to future outbreaks will be swifter from day one.”

Introducing the Launch of the National Response Framework Policy Landscape Analysis Tool (NRF-PLAT)

The Pacific Northwest National Laboratory (PNNL) just released the first iteration of a new tool for understanding responsibilities following a disaster or emergency. The National Response Framework Policy Landscape Analysis Tool, NRF-PLAT, was inspired by input and questions from users of PNNL’s Biodefense Policy Landscape Analysis Tool (B-PLAT). The NRF-PLAT currently captures 474 requirements, recommendations, value statements and training opportunities excerpted verbatim from the main NRF document, fourth edition. Users can view and parse requirements, recommendations, value statements and training opportunities using facets that include Primary Partner, Specific Designee, Additional Partners/Designees, Specific Roles, Community Lifelines, Emergency Support Functions and Section of the NRF. The facets can also be displayed in visual format using icicle and sunburst charts, which allow a user to graphically display, for example, the relative number of requirements, recommendation, value statements and training opportunities assigned to the federal government versus individuals, families and households. NRF-PLAT is publicly available here.  

Criminal Inquiries Loom Over al-Assad’s Use of Chemical Arms in Syria

Investigations into Bashar al-Assad’s use of chemical weapons in Syria may soon be underway in France and Germany, and could lead to prosecutions of al-Assad and his associates. Syrian President al-Assad and his accomplices should be held accountable for “some of the worst atrocities committed in the decade-old Syria conflict.” Judges in a special war crimes unit of France’s Palais de Justice received a complaint about the chemical weapons attacks in Syria, which were filed by three international human rights groups. This complaint requests a criminal investigation into al-Assad, his brother, and the senior advisers and military officials that formed the chain of command. Lawyers have stated that the judges will likely accept the complaint. The request for a criminal investigation is based, in part, on a two-year study of the Syrian chemical weapons program, and this study surpasses the work of other international inquires. The study used a variety of sources with links to or knowledge of the program: defectors, former insiders, employees, and engineers. Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, reviewed the study and said, “it brings to light new information from defectors and insiders.” Dr. Koblentz called it the “most comprehensive and detailed account of the Syrian weapons program available perhaps outside the intelligence services. It maps out new details on the chain of command and shows how large and complex this program was. And it can name names.”

Chemical Weapons Norms

Over the past four years since now-President Joe Biden was in the White House, chemical weapons (CWs) attacks have continued within and beyond the borders of Syria, and new state perpetrators have emerged. Indeed, the norms against the use of chemical weapons established by the Chemical Weapons Convention (CWC) have been unashamedly violated by state and nonstate actors. Such perpetrators include North Korea, Russia, and, of course, the al-Assad regime of Syria. Any actor that uses chemical weapons must be held accountable in order to reinforce the norms and validate the notion that violations of the CWC will be punished; “consequences can deter other actors from engaging in chemical weapons programs and attacks.” The Trump administration was inconsistent and variable in its responses to chemical weapons uses. Trump mobilized a military response to CW use in Syria, but arranged to meet with North Korea’s leader Kim Jong-un – after Kim’s half-brother Kim Jong-nam was assassinated using VX nerve agent. The erosion of the global norm against chemical weapons use requires international action and cooperation to counter the degradation and restore compliance. Reinforcement of the norm against CW use will require bolstering the existing mechanisms of the CWC, while simultaneously supporting the ability of the international community to respond to the use of CWs by any actor and to hold perpetrators accountable. Additionally, states should “clarify and codify the rights and privileges a state risks losing for violating the CWC, establish a precedent for challenge inspections, and expand the mandate for the attributive Investigation and Identification Team.” Given the lack of unity within the United Nations Security Council, the Organisation for the Prohibition of Chemical Weapons (OPCW) plays a vital role in pursuing actions to reinforce the norm against chemical weapons use. As a reminder, the 96th Session of the Executive Council of the OPCW will take place on 9-12 March.

Event – Chemical Weapons Arms Control at a Crossroads: Russia, Syria, and the Future of the Chemical Weapons Convention

The Biodefense Graduate Program is hosting a live webinar on 23 March about Russia, Syria, and the future of the Chemical Weapons Convention (CWC). The repeated use of chemical weapons by Syria and Russia threatens to undermine international efforts to eliminate these weapons. How will states parties to the Chemical Weapons Convention, which bans the development and use of chemical weapons, respond to these violations of the treaty at their annual meeting in April? The panelists will discuss the challenges posed by the current Russian and Syrian chemical weapons programs, the status of international efforts to strengthen accountability for use of chemical weapons, and the implications for global chemical weapons arms control.

Dr. John R Walker is a Senior Associate Fellow at the European Leadership Network and a Senior Associate Fellow at the Royal United Services Institute. Una Jakob is a research associate at the Peace Research Institute Frankfurt (PRIF) in Germany who specializes in arms control, disarmament, and non-proliferation. Hanna Notte is a Senior Non-Resident Scholar with the James Martin Center for Nonproliferation Studies (CNS), focusing on arms control and security issues involving Russia and the Middle East. This event is moderated by Gregory D Koblentz, Director of the Biodefense Graduate Program. Register here.

Third Vaccine Gets Emergency Use Authorization

The Food and Drug Administration (FDA) granted emergency use authorization on 27 February to Johnson & Johnson’s single dose COVID-19 vaccine. This is the third vaccine designed to fight SARS-CoV-2 that has received authorization in the US. It should simplify the logistics of the vaccination campaign, because it is a single dose inoculation and it can be stored for up to three months in a refrigerator. The other two vaccines, which are based on a different technological platform, require two shots and must be stored at extremely low temperatures. The Johnson & Johnson vaccine is an adenovirus vector vaccine, a 30-year-old technology based on genetically engineered common cold viruses. The multinational corporation will provide the vaccine on a non-profit basis for emergency pandemic use, and intends to produce 100 million doses in the first half of 2021.

The Last Thing Health Workers Should Have to Worry About

Even as they were making countless sacrifices during the pandemic, healthcare workers were targeted in nearly 1,200 attacks and threats of violence last year, according to a new report by Insecurity Insight and the UC Berkeley Human Rights Center. According to the research, 824 of these attacks were related to conflicts—hospitals bombed in Yemen, doctors abducted in Nigeria, robbery and ransom in the Democratic Republic of the Congo. In a disturbing twist, 412 of these attacks were directly related to the pandemic, including: threats, beatings, and assaults with stones or hot liquids. Pandemic-triggered violence was especially pronounced in India and Mexico, but it is a “truly global crisis,” affecting 79 countries, said Insecurity Insight’s Christina Wille, who led development of a new interactive map. Additionally, there have been violent reactions to mask mandates and arson attacks on COVID-19 testing facilities. The failures of year one of the COVID-19 pandemic need to be replaced with immediate action to safeguard health workers, said Leonard Rubenstein, chair of the Safeguarding Health in Conflict Coalition. Rubenstein highlights recommendations in a research brief accompanying the interactive map: counter disinformation; end repression against healthcare workers who speak up; increase protection for healthcare workers; and hold perpetrators of violence and threats accountable.

CID Agent Sought Puffer Fish Toxin Before Poisoning His Wife, Charges Allege

A special agent with the Army’s Criminal Investigation Command (CID) is “suspected of poisoning his wife two years ago and allegedly tried to acquire a toxin derived from puffer fish.” This week, Staff Sergeant Lesly J. Lindor was formally charged with the 3 September 2018 murder of Rachelle Lindor, his wife. The couple lived near Fort Hood in Harker Heights, Texas. According to records acquired by Army Times, in the months leading up to his wife’s death, Lindor “attempted to acquire tetrodotoxin for use as a weapon.” Tetrodotoxin is a potent neurotoxin found in puffer fish, globefish, and toadfish. In addition to the murder, Lindor is charged with attempting to violate the Federal Biological Weapons statute.

Book Review – The “Red Line” That Wasn’t

By Chris Quillen, Biodefense PhD Student

Syrian President Bashar al-Assad’s use of chemical weapons (CW) against his own people is the greatest challenge the Chemical Weapons Convention has ever faced. This breach of the taboo against CW use sparked numerous national and international investigations to determine the details of exactly what happened and who had done it. These investigations, in turn, were severely complicated by numerous factors. Investigators had to deal with (1) the dangers of operating during a complex civil war, (2) multiple belligerents using CWs on the battlefield (both the Syrian government and the Islamic State of Iraq and Syria or ISIS), and (3) the Syrian government’s repeated denials and counter-accusations of any CW use. Syria’s dubious position was backed by Vladimir Putin’s Russia in the public debate and, most importantly, at the United Nations Security Council, which provided Assad significant protection from international sanction. The global opposition to Syria’s use of CWs was widespread, but was led by the United States primarily under Barack Obama and also Donald Trump. The debate about what happened in Syria—and especially about how the world reacted to it—will undoubtedly rage for years to come. Joby Warrick’s Red Line: The Unraveling of Syria and America’s Race to Destroy the Most Dangerous Arsenal in the World is a useful addition to this debate, but the definitive book on the use of chemical weapons in the Syrian civil war remains to be written. 

A Washington Post reporter since 1996, Warrick offers a compelling, character-driven narrative with interesting new insights and impressive detail on key aspects of the story. His focus on individual actors, however, offers both strengths and weaknesses. Warrick should be commended for telling the compelling stories of (1) everyday Syrians risking their lives to get the evidence of Assad’s CW use to the world, (2) international inspectors from the United Nations (UN) and the Organisation for the Prohibition of Chemical Weapons (OPCW) overcoming amazing odds to gather the proof, and (3) American bureaucrats courageously and creatively destroying the part of Syria’s CW turned over by the Assad government. These individual stories are invaluable and offer useful guidance for similar efforts to document and destroy CW in the future. However, the focus on the individual often obscures the broader strategic context and limits the perspective of the book. At its best, this approach presents unique historical insights, but, at its worst, it runs the risk of allowing each individual perspective to overwhelm the big picture. As the saying goes, “Every person is the hero of their own story.” While many true heroes can be found in the pages of Warrick’s book, the temptation to put one’s own spin on history is evident and ultimately detracts from the larger message.

Warrick covers numerous sides to the story through his characters, but focuses primarily on the US angle, the most accessible to him. The life-threatening challenges inside of Syria are largely viewed through the eyes of refugees who later escaped the war in their homeland. ISIS’s efforts to develop and use sulfur mustard and the coalition efforts to destroy it are told through a largely unrepentant ISIS detainee who worked in the sulfur program.. The political battles at the UN are recounted from various diplomats and bureaucrats. 

The bulk of the book, however, addresses the US response to Syria’s use of chemical weapons. The title of the book makes this focus clear, but also reveals the two competing narratives of the story. The main title “Red Line” is taken from President Obama’s August 2012 statement in which he implied the US military would take action if Syria used chemical weapons: “We have been very clear to the Assad regime that a red line for us is we start seeing a whole bunch of chemical weapons moving around or being utilized. That would change my calculus.” The fact that no such military action followed Syria’s repeated confirmed use of CWs remains one of the more controversial aspects of the Obama administration’s record. Eric Sterner has argued the lack of a response destroyed America’s credibility on the issue such that later explicit threats to use force after Assad continued to use CWs were ineffective. For his part, Obama acknowledges that his credibility was on the line after his previous statements, but defends his decision not to act as being in “America’s interest.” Warrick largely defends Obama’s decision citing the lack of Congressional and public support for US military action, but these justifications seem to come too late. The fact is Obama issued a red line and failed to follow through. As a result, the taboo against CW use was severely weakened. 

The second part of Warrick’s story is captured in the subtitle “America’s Race to Destroy the Most Dangerous Arsenal in the World.” While legitimate debate can be had about whether Syria’s chemical weapons constituted “the most dangerous arsenal in the world,” the successful effort to destroy the bulk of Assad’s chemical weapons is undoubtedly a victory to be celebrated and Warrick should be commended for his work in capturing this account. Warrick’s inside stories about the development of the hydrolysis systems that were used to break down Syria’s CWs and the subsequent destruction that took place at sea onboard the Cape Ray are fascinating tales that need to be told.         

In the final analysis, the juxtaposition of the failure of Obama to enforce his own “red line” and the success of the effort to destroy most of Syria’s CW carried out by his administration is striking. The credibility of US government statements, however, is not the real issue here. The failure of the taboo against CW use—and the failure of the international community to enforce that taboo in any meaningful way—is the real story and the real tragedy. The fact is Bashar al-Assad used chemical weapons extensively against his own people, but he remains in power in Damascus, weakened but unapologetic. Assad claims to have given up his entire chemical arsenal, but he still retains (and still uses) his chemical weapons to this day, fewer in number but every bit as deadly. For a world that claimed to learn its lesson after Saddam Hussein’s extensive use of chemical weapons in the 1980s, these failures are egregious and heartbreaking. So much for that “red line.”

Pandora Report: 2.26.2021

The global norm against chemical weapons use is eroding and coordinated international action is needed to restore it. Scientists are racing to determine if the COVID-19 vaccines prevent people from contracting SARS-CoV-2 and spreading the virus. Three biodefense graduate students share their summaries and takeaways from the 6th International Biosafety and Biocontainment Symposium.

6th International Biosafety & Biocontainment Symposium: Emerging Biorisk Challenges in Agriculture

The US Department of Agriculture (USDA) provides leadership on food, agriculture, natural resources, rural development, nutrition, and related issues based on public policy, the best available science, and effective management. Agricultural Research Service (ARS) is the chief scientific in-house research agency of the USDA. The USDA ARS hosted the 6th International Biosafety and Biocontainment Symposium, held virtually in light of the COVID-19 pandemic, on February 2- 4, 2021. This symposium brought together experts in academia, research, government, and industry to discuss the emerging biorisk challenges in agriculture. This year, three students from the Biodefense Graduate Program attended the conference: Rachel-Paige Casey, Michelle Grundahl, and Stevie Kiesel. Their summaries and takeaways are available here.

Dual-Use Biology: Building Trust and Managing Perceptions of Intent

Dr. Filippa Lentzos, a mixed methods social scientist researching biological threats at King’s College London, considers how the international community can use the Biological and Toxin Weapons Convention framework to strengthen compliance monitoring of rapidly increasing dual-use capacities around the globe. Lentzos’ analysis in The Nonproliferation Review comes at a time of heightened concern about potential future biological-weapons threats. It presents three conceptual layers within the treaty regime which states can draw from to inform their compliance judgments: one legally binding, one politically binding, and one wholly voluntary. The article outlines how these were established and how they have been used so far, and argues for an incremental, inclusive, practical, and forward-looking approach to evolving these structures to better manage perceptions of the intent behind dual-use capacities, and to further trust between states. Read the article here.

Reinforcing the Global Norm Against Chemical Weapons Use

The global norm against the creation and deployment of chemical weapons has eroded, and continues to erode. Coordinated international action is needed to reinforce the norm against chemical weapons use, which will require “strengthening existing mechanisms in the Chemical Weapons Convention (CWC) while shoring up the international community’s ability to respond to the use of chemical weapons by any state or non-state actor and to hold them accountable.” Given the lack of unity among the United Nations Security Council, “it is vitally important that the Organisation for the Prohibition of Chemical Weapons (OPCW) and coalitions of like-minded states pursue actions to reinforce the norm against chemical weapons use.” Julia Masterson from the Arms Control Association recommends that states-parties “clarify and codify the rights and privileges a state risks losing for violating the CWC, establish a precedent for challenge inspections, and expand the mandate for the attributive Investigation and Identification Team.” Beyond clarifying and codifying, expanding the International Partnership Against Impunity for the Use of Chemical Weapons, establishing a clearinghouse for details about perpetrators of chemical weapons, and pursuing the prosecution of users as war criminals could help reinforce the norm.

Event – Chemical Weapons Arms Control at a Crossroads: Russia, Syria, and the Future of the Chemical Weapons Convention

The Biodefense Graduate Program is hosting a live webinar on 23 March about Russia, Syria, and the future of the Chemical Weapons Convention (CWC). The repeated use of chemical weapons by Syria and Russia threatens to undermine international efforts to eliminate these weapons. How will states parties to the Chemical Weapons Convention, which bans the development and use of chemical weapons, respond to these violations of the treaty at their annual meeting in April? The panelists will discuss the challenges posed by the current Russian and Syrian chemical weapons programs, the status of international efforts to strengthen accountability for use of chemical weapons, and the implications for global chemical weapons arms control.

Dr. John R Walker is a Senior Associate Fellow at the European Leadership Network and a Senior Associate Fellow at the Royal United Services Institute. Una Jakob is a research associate at the Peace Research Institute Frankfurt (PRIF) in Germany who specializes in arms control, disarmament, and non-proliferation. Hanna Notte is a Senior Non-Resident Scholar with the James Martin Center for Nonproliferation Studies (CNS), focusing on arms control and security issues involving Russia and the Middle East. This event is moderated by Gregory D Koblentz, Director of the Biodefense Graduate Program. Register here.

Feds Now Say Right-Wing Extremists Responsible for Majority of Deadly Terrorist Attacks Last Year

For the first time, the US government is acknowledging that right-wing extremists were responsible for most of the fatal domestic terrorist attacks that occurred last year. This acknowledgement is based on an internal report circulated by the Department of Homeland Security (DHS) last week. The report was drafted by the Joint Regional Intelligence Center, a fusion center funded by DHS, and shared with police and law enforcement agencies nationwide through an intelligence-sharing system established after the 9/11 attacks. The Center reviewed last year’s domestic terrorist incidents and found that “right-wing [domestic violent extremists] were responsible for the majority of fatal attacks in the Homeland in 2020.” Indeed, in October 2020, the Center for Strategic and International Studies (CSIS) released an analysis of domestic terrorist activity in the US for just the first eight months of 2020, finding that “white supremacists and other right-wing extremists conducted two-thirds of the terrorist plots and attacks in the nation during that period.”

A GDP for Nature: How Measuring the Health of the Natural World Might Prevent the Next Pandemic

SARS-CoV-2 has undeniably revealed that the world is vulnerable to infectious diseases. This is not a new revelation, but one that has long been ignored. The factors that drive zoonoses to jump to humans from animals – the wildlife trade, intensive agriculture, deforestation, urbanization – are well-known. As these factors persist, infectious disease events (epidemics and pandemics) will continue to arise. Zoonoses account for about 60% of all known human infectious disease agents, as a result of direct or indirect interaction between humans and animals. The health and well-being of a country depend on meeting the dietary needs of the population. Dr. Laura Kahn, a physician and research scholar with the Princeton School of Public and International Affairs at Princeton University, emphasizes that “to ensure that our food systems do not raise the risks of another pandemic, countries should prioritize the replenishment and protection of their natural resources and biodiverse ecosystems.” Dr. Kahn recommends formulating a One Health calculus akin to gross domestic product (GDP) – the total value of services and goods produced in one year for a nation as a measure of economic prosperity. This calculation could “measure the status of a nation’s natural resources, the purity of its environments, the biodiversity of its ecosystems, the sustainability of its agriculture, the health of its flora and fauna, the resiliency of its food security, and the life expectancies of its peoples.”

The Quest to Rid Facebook of Vaccine Misinformation

A number of creative conspiracy theories about the COVID-19 vaccines have spread across social media platforms like wildfire: it causes blindness or infertility; it contains a microchip or fetal tissue; and Bill Gates is using it to get even wealthier. An analysis of more than 14 million social-media posts mentioning vaccines or vaccination during a three-month period last year discovered the emergence of two vaccine narratives: (1) emphasis on safety concerns and (2) focus on mistrust of the individuals and institutions involved in vaccine development. Facebook (along with Instagram, its subsidiary)  “drives vaccine discourse on social media” by allowing conspiracy-related content, but it has recently taken some actions to quell the spread of vaccine misinformation on the platform. Nearly one year ago, Facebook stated that it was collaborating with several fact-checking organizations to “detect false claims, hide some groups and pages from Facebook’s search function, and add warning labels with more context.” At the end of 2020, the platform banned certain COVID-19 vaccine-related content, including claims that the vaccine contains fetal tissue or carries the Antichrist’s “mark of the beast.” Now, Facebook is consulting with leading health organizations to expand its efforts to remove false claims on Facebook and Instagram about COVID-19, vaccines for the disease, and vaccines in general. Unfortunately, some experts question if these actions are sufficient to stop misinformation from invading the platform and spreading across its users. A partnership between Critica, Weill Cornell Medicine, and the Annenberg Public Policy Center of the University of Pennsylvania launched a pilot program that is “deploying infodemiologists to respond directly when misinformation about vaccines is posted by Facebook users commenting on news articles.” Infodemiologists are “health experts who fight false information in a similar way to how epidemiologists with the CDC’s Epidemic Intelligence Service fight epidemics.” These experts work on the virtual frontlines to detect any outbreak of misinformation or disinformation that threatens public health.

Coronapod: Our Future with an Ever-Present Coronavirus

What’s the endgame for the COVID-19 pandemic? Is a world without SARS-CoV-2 possible, or is the virus here to stay? The latest episode of Coronapod, a podcast from Nature that provides a weekly pandemic report, discusses what it means if the novel coronavirus becomes endemic. A recent Nature survey asked over 100 immunologists, infectious-disease researchers, and virologists working on the coronavirus whether it could be eradicated. The survey found that 90% of respondents expect SARS-CoV-2 to become endemic – remain in circulation in parts of the world for many years – but it could pose less danger over time. Listen to the Coronapod here.

Biosecurity Risks Associated with Vaccine Platform Technologies

A new article in Vaccine, co-authored by Biodefense Graduate Program Director Dr. Gregory Koblentz, discusses the biosecurity risks surrounding vaccine platform technologies. Vaccine platforms have been critical for accelerating the timeline of COVID-19 vaccine development. Faster vaccine timelines demand further development of these technologies. Currently investigated platform approaches include virally vectored and RNA-based vaccines, as well as DNA vaccines and recombinant protein expression system platforms, each featuring different advantages and challenges. Viral vector-based and DNA vaccines in particular have received a large share of research funding to date. Platform vaccine technologies may feature dual-use potential through informing or enabling pathogen engineering, which may raise the risk for the occurrence of deliberate, anthropogenic biological events. Research on virally vectored vaccines exhibits relatively high dual-use potential for two reasons. First, development of virally vectored vaccines may generate insights of particular dual-use concern such as techniques for circumventing pre-existing anti-vector immunity. Second, while the amount of work on viral vectors for gene therapy exceeds that for vaccine research, work on virally vectored vaccines may increase the number of individuals capable of engineering viruses of particular concern, such as ones closely related to smallpox. Other platform vaccine approaches, such as RNA vaccines, feature relatively little dual-use potential. The biosecurity risk associated with platform advancement may be minimized by focusing preferentially on circumventing anti-vector immunity with non-genetic rather than genetic modifications, using vectors that are not based on viruses pathogenic to humans, or preferential investment into promising RNA-based vaccine approaches. To reduce the risk of anthropogenic pandemics, structures for the governance of biotechnology and life science research with dual-use potential need to be reworked. Scientists outside of the pathogen research community, for instance those who work on viral vectors or oncolytic viruses, need to become more aware of the dual-use risks associated with their research. Both public and private research-funding bodies need to prioritize the evaluation and reduction of biosecurity risks. Read the article here.

Can COVID Vaccines Stop Transmission? Scientists Race to Find Answers

Even as many countries are administering COVID-19 vaccines, studies are ongoing to assess whether inoculations prevent people from contracting SARS-CoV-2 and spreading the virus. If widely distributed, vaccines that prevent transmission could help to control the novel coronavirus. Preliminary studies suggest that some vaccines likely help block transmission of SARS-CoV-2; however, confirming that effect and determining its strength remains a tricky task. The trickiness is due to the other factors that may explain the decrease in infections in a given area, such as lockdowns or behavior changes. To be frank, it is possible that the vaccines will not prevent or significantly lower the chances of SARS-CoV-2 infection, but they may render individuals less infectious, which will reduce transmission. Measuring viral load – roughly defined as the amount of virus in a person – is a respectable proxy for infectiousness, and it is being studied by researchers in Israel. Scientists are also tracking the close contacts of vaccinated individuals to find out whether those contacts gain any indirect protection against infection.

Executive Summary – The 6th Global Health Security Agenda Ministerial Meeting

The 6th Global Health Security Agenda (GHSA) Ministerial Meeting was held in November of 2020. The main objectives of the meeting were to “exchange experiences on disease prevention and control among various sectors and countries, update the progress of action packages implementations, enhance the engagement of multisectoral cooperation, identify gaps in implementation and fill them with through concrete action as well as jointly address means and ways forward to improve the GHSA mechanism and collaboration on the global health concern issue.” The meeting highlighted several issues but also several recommendations. The COVID-19 pandemic revealed that the world remains ill-prepared to counter pandemic threats, despite several red flags with previous outbreaks. The negative impacts of the pandemic reverberated beyond public health – severe supply shocks, heightened food prices, widespread layoffs, and compromised education. The official report of the meeting emphasizes that security is a global issue that requires global coordination and collaboration across countries, sectors, and organizations. Another major takeaway is that the economy and health are integrated and interdependent. Also, there is a vital need for “mass compliance” with basic public health preventive measures in order to minimize the transmission of SARS-CoV-2.  New policies should be tailored to support health care systems and improve the socioeconomic situation to aid the recovery of the economy. Also, “health is not a cost, but an investment.” Read the final report here.

In case you missed it, Maddie Roty, a Biodefense MS student, attended a Meeting event, “Incorporating One Health into Global Security: Educating the Public and Governments,” which addressed how to educate students about One Health and how to implement One Health initiatives in US government agencies. Read Roty’s takeaways here.

Three Biodefense Grads Set to Lead Global Health Organization

Three 2019 graduates from the Master’s in Biodefense program have been elected to top leadership positions in the Next Generation Global Health Security Network, an international organization of nearly 1,000 early- to mid-stage professionals and students who work on the full spectrum of issues related to global health, ranging from combating antibiotic resistance to preventing the next pandemic. Next Generation Global Health Security Network—NextGen, for short—is an affiliate of the Global Health Security Agenda, a collaboration founded in 2014 by representatives from 44 countries (now 69) and organizations, including the World Health Organization. The new officers are Kate Madison Kerr, who will coordinate the global network; Anthony Falzarano, who will manage the organization’s finances; and Jessica Smrekar, the newly appointed coordinator for the United States. “It is an incredible feat that three Schar School graduates are assuming leadership of an organization this large, and I’m incredibly proud of it,” said Kerr. “[NextGen] truly was my first introduction to anything on a global scale and it allowed me to begin interacting with and learning from global partners,” Smrekar said of her NextGen experience. “As a mentee in the 2018 mentorship program, I was able to create a research project that was accepted to the inaugural Global Health Security Conference in Sydney, Australia, in 2019.”

African Swine Fever: Biosecurity Coordination and Early Detection to Mitigate the Risk

By Stevie Kiesel, Biodefense PhD Student

The 6th International Biosafety and Biocontainment Symposium, presented by the US Department of Agriculture’s Agricultural Research Service (USDA ARS), brought together experts from government, academia, and industry to discuss emerging biorisk challenges in agriculture. Speakers highlighted how the convergence of food, agricultural, and natural resource challenges require coordination and intensification of food safety, nutrition, and food security efforts to mitigate risks.

I attended this virtual conference along with my GMU Biodefense Program colleagues Ms. Rachel-Paige Casey and Ms. Michelle Grundahl. You can find their discussions of other symposium sessions here. This report provides an overview and commentary on Session I, which dealt with the biosecurity risks associated with African Swine Fever virus (ASFV). Speakers for this session were as follows:

  • Dr. Douglas Gladue, US Department of Agriculture, “African Swine Fever”
  • Dr. Vittorio Guberti, Institute for Environmental Protection and Research, “Feral Pig Population”
  • Dr. David Pyburn, National Pork Board, “Prevention and Preparation for ASF”
  • Dr. Jishu Shi, Kansas State University, “International Perspectives: Past, Present, and Future”
  • Dr. Jack Shere, US Department of Agriculture, “ASF: The US Perspective”
  • Dr. Cassie Jones, Kansas State University, “Biorisks on the Farm: Practices to Prevent Pathogen Transmission to and from Animals”
  • Lindsay Gabbert, Plum Island Animal Disease Center, “Disinfection/Decontamination for Various Surfaces Effective Against ASFV”

In the midst of the COVID-19 pandemic, much attention is on zoonotic diseases—infectious diseases caused by a pathogen that has jumped directly from an animal to a human. While zoonotic diseases clearly represent a significant risk, other diseases that do not directly infect humans can still have a substantial impact. For example, though the ASFV is not transmitted from pigs to humans, the virus’s spread has inflicted serious economic pain in multiple outbreaks. However, these consequences can be largely mitigated through prevention and early detection efforts. This report summarizes the speakers’ key takeaways and suggests areas for future research and policy development.  

ASF is a highly contagious, highly lethal disease that is rapidly transmitted among wild boar, warthogs, and domestic pigs. Though the virus cannot be transmitted to humans and does not pose a food safety issue, ASF outbreaks have the potential for devastating economic consequences. For example, as Dr. Shi points out, China lost tens of millions of pigs in the first few months of their most recent outbreak, and the social and economic impact was severe. Dr. Pyburn estimates that an ASF outbreak in the US that took 10 years to control could cause $50 billion dollars in losses and 140,000 job losses. Even in a rosier scenario where the US controlled the outbreak after 2 years, projected losses are $15 billion.

ASF is endemic in Africa, particularly in sub-Saharan Africa. Its natural hosts there are warthogs and bushpigs, with soft ticks acting as a vector. In the 1950s, outbreaks began occurring in Europe, and later in the Caribbean, likely via contaminated pork products. European countries combatted ASF with a policy of slaughtering infected animals and modernizing farming facilities, and by the 1990s Europe was declared free of ASF. However, in 2007, ASF was identified in the country of Georgia, presumably attributed to the importation of contaminated pork. This outbreak spread quickly to neighboring countries among their wild boar populations, to such an extent that ASF was declared endemic in the Russian Federation. Despite enacting slaughter policies and other measures, ASF has not been eradicated from eastern Europe. Another key event is the 2018 introduction of ASF in China. This outbreak spread rapidly across Asia, with significant economic impacts. For example, China saw a 50% reduction in its swine herd in 2019. ASF has also spread to other European countries, such as Belgium, Poland, and German, in recent years. The World Organization for Animal Health (OIE) found that as of December 2020, there are ongoing ASF outbreaks in 24 countries: 8 in Europe, 12 in Asia, and 4 in Africa.

There are several key challenges in eradicating ASF. Both wild and domestic porcine animals can spread the virus. The main challenge in addressing an outbreak among wild boar is their uncontrollable movement and the need to quickly remove infected carcasses to stem the spread. In winter temperatures, a carcass can maintain the virus for months or years. Therefore, even though ASF initially spreads in a wave with a high fatality rate (~60%), the infected carcasses as a source of infection can cause ASF cases to persist locally for years. European countries have pursued three different strategies to manage infected wild boar populations: depopulation (90% of the total wild boar population hunted), soft hunting (60% of the post-reproductive population hunted), and fencing of infected populations coupled with a hunting ban. Depopulation was the least successful, while soft hunting led to a slow but still steady spread of disease. However, banning wild boar hunting and erecting a double fence around identified infected populations has been successful in eradicating the virus in the Czech Republic and Belgium, though further research is needed to understand the conditions under which this strategy is and is not effective.

For domestic pigs, the main challenges to ASF eradication are an underreporting of symptomatic animals, the inability of smaller farms to implement adequate biosecurity measures, the contamination of feed, and illegal domestic pig movement. Dr. Jones argues that an often-overlooked weakness in the US is the feed supply chain as a potential pathogen transmission route, involving the ingredient facility, the feed mill, and individual farms. Obviously, contamination at the ingredient facility or feed mill can be spread to many farms, but more attention should be paid to delivery drivers transporting feed from the mill to farms and moving from farm to farm without adequate hygiene measures in between trips. A culture of biosecurity, as well as clear and appropriate information reporting measures, is key to mitigating the many points of entry for infectious diseases to spread rapidly on and from individual farms.

As the saying goes, “You can’t fatten the pig on market day.” To prevent a large-scale, economically devastating outbreak of African Swine Fever (ASF), stakeholders must coordinate on robust biosecurity, disease surveillance, and containment measures. Preparation is key; responding to an outbreak after it happens will lead to catastrophe. The symposium speakers had many promising ideas for future research to address current gaps. While the USDA has developed experimental live attenuated ASFV vaccines, more research is needed on protective immune mechanisms; subunit vaccines could also be explored. More development of computational models to understand the spread of ASFV, particularly in wild boars, would be a helpful tool in tracking and eradicating the virus. Focused study of eradication methods and their implications on economies and the environment would point to tailored strategies for an outbreak of a wild or domestic origin. Speakers also discussed ongoing projects to address ASFV, such as an educational initiative with Customs and Border Protection to increase biosecurity awareness as it related to passengers entering the US from foreign ports. The National Pork Board is also developing a tool called AgView, a data dashboard that provides real-time ASFV updates and pig movement data to state health officials, increasing collaboration and information sharing. The combination of industry, government, and academic stakeholders at this symposium reflected the broad portfolio of efforts currently underway to address ASFV.

Applying Biosafety Research to Lower Biorisk in the Laboratory: Building a Culture of Safety

By Michelle Grundahl, Biodefense MS Student

The 6th International Biosafety and Biocontainment Symposium, presented by the US Department of Agriculture’s Agricultural Research Service (USDA ARS), brought together experts from government, academia, and industry to discuss emerging biorisk challenges in agriculture. Speakers highlighted how the convergence of food, agricultural, and natural resource challenges require coordination and intensification of food safety, nutrition, and food security efforts to mitigate risks.

I attended this virtual conference along with my GMU Biodefense Program colleagues Ms. Stevie Kiesel and Ms. Rachel-Paige Casey. You can find their discussions of other symposium sessions here. This report provides an overview and commentary on Session II – Applied Biosafety Research: An International Effort.

Session II: “Applied Biosafety Research: An international Effort”

Applied biorisk research is the “systematic, scientific investigation into and study of materials, tools, and practices to provide for the safe handling and containment of infectious microorganisms and hazardous biological substances.” This is a bit more specific than the biorisk management practices that one might be familiar with; this type of research informs the procedures that laboratories should implement. Applied biorisk research is important because it provides assurances to researchers, and the public, that sound practices are in place. This is of domestic and international importance in universities, government laboratories, industry and diagnostic labs (all who might work with unknown risks). This focused research is relevant even to non-traditional labs, such as DIY community science spaces and in global settings that may have low resources.

Overview of 2019 US Workshop: What is Applied Biosafety Research, Who’s Doing It and How Might We Do It Better?

Applied Biosafety Research is not a new field of research. A presentation by Joseph Kozlovac, an Agency Biological Safety Engineer for the Agricultural Research Service (ARS) of the USDA, remined us that there were programs for this in the 1960s. These past programs resulted in guidance such as those published by the National Institutes of Health (NIH) in 1976. Mr. Kozlovac states that currently there are no great efforts researching the topics of facility design, personal protective equipment, bioengineering controls, and more. In October 2007, the House Committee on Energy and Commerce held a congressional hearing: “Germs, Viruses and Secrets” and determined that a task force would consider the ongoing proliferation of biolabs in the United States. Their Trans-Federal Task Force on Optimizing Biosafety and Biocontainment Oversight aimed to ensure oversight of labs involved in handling toxins and infectious agents. A 2009 report suggested the research agenda for this. The Federal Experts Security Advisory Panel provided recommendations in 2014 for biosafety and biosecurity to be improved (there had been a few incidents). The panel specifically suggested a program of applied biosafety research, one that used evidence-based information. Eventually, the 2018 National Biodefense Strategy made these directives clear, emphasized that mitigating lab risks was imperative, and asserted that conducting applied research would provide evidence.

The outcome of a September 2019 “Federal Stakeholders Applied Biosafety Research Workshop” identified five categories with gaps in need of research. One of those gaps in need of further research is the evidence based “hierarchy of controls,” which represents eliminating risks as a top effector. Substituting risks, or engineering to control the risk, is more effective than altering how workers perform, or use protective equipment. Managing the risk of preventing pathogen exposure (and infection) also requires data on the agent, including evidence of the known exposures, morbidity rates, characterization and validation of the pathogens. Potential mitigation strategies require prior information of work-related incidents (such as needle sticks and equipment failures). Identifying the errors that cause incidents in the lab is just a starting point. Another factor to explore are the actual methods used to evaluate hazard mitigation. These efforts aim to identify the appropriate risk assessment methods that should be used. The most interesting research category identified by the Federal Stakeholders Applied Biosafety Research Workshop: where intangible human factors insert into laboratory science. Creating a safety minded culture is not done via protocol. Studying the sociology of laboratory biorisk management makes attempts to tease apart issues such as non-compliance, attitudes, training, and communication.

Dr. Danielle Lohman, Foreign Affairs Officer for US Department of State, provided a review of the stakeholders. There are numerous implementations where applied biorisk research protects workers, agriculture, and the environment. The people who can benefit are funders (government, private), researchers (federal, university and private lab workers), disseminators of knowledge (institutions, journals and organizations), and the end-users (regulators, biosafety professionals).  An excellent example of coordination and collaboration of these applied research activities, Dr. Lohman explained, is the example of COVID-19. We saw rapid international scientific effort to quickly understand an unknown pathogen. The promotion of scientifically sound action is a collaborative effort. The US Department of State is promoting this idea, too. In October 2020, they hosted an invitation only G7 Expert’s meeting on Strengthening Laboratory Biorisk Management to improve the research process internationally.

Applied biorisk research is a critical discipline that can benefit from more professional attention. While some might equate safe laboratory practices with mundane tasks and added duties, others see this field as immensely important in creating standards with great impact. In fact, the Biorisk management standards and their role in BTWC implementation working paper (from the most recent Meetings of Experts of the Biological Weapons Convention) clearly shows the need for greater applied biorisk research.

Department of Defense (DOD) Biological Select Agents and Toxins (BSAT) Scientific Gaps in Biorisk Research Program (SGBRP)

Dr. Cristine Lawson, Deputy Director for Biosecurity for the Department of Defense (DOD) Biological Select Agents and Toxins (BSAT) Biorisk program Office (BBPO) and manager of the DOD BSAT Scientific Gaps in Biorisk Research Program (SGBRP), provided an enlightening overview of the program. Apparently, the DOD is very active in BSAT applied biorisk research.  They are contributing to the knowledge base of biorisk practices as applied to Biological Select Agents and Toxins. Some people might recall May 2015 when we learned that the DOD shipped residual live spores of Bacillus anthracis(Anthrax) to 88 sites and that 194 labs received these spores. DOD took this very seriously and they executed comprehensive reviews of their procedures, protocols and accountability. Among the findings revealed was that there was insufficient information to inform and develop  B. anthracis inactivation protocols. The 2016 Government Accountability Office report High Containment Laboratories: Improved Oversight of Dangerous Pathogens Needed to Mitigate Risk2018 report expands upon this. As a result, the DOD has changed its guidelines, created centralized oversight for its BSAT-registered laboratories, and updated its procedures (for more than just their Anthrax research).

The DOD’s creation of the Scientific Gaps in Biorisk Research Program (SGBRP) is intended to fund research in the pursuit of increased scientific knowledge for BSAT procedures. Their review panel assesses the risk of procedures at DOD facilities, and assesses the available scientific evidence that can be used for mitigation. As part of a proactive approach, proposals are solicited. Some proposal categories examples include viability, inactivation, decontamination, environmental sampling, monitoring, and other similar biorisk topics. These proposals are ranked, selected, and then granted funding. One issue in this initiative, Dr. Lawson explained, is the challenge of funding. Funding, of course, is always a concern, but the program focuses on ensuring that senior DOD leadership is aware of the importance of applied biorisk research in order to maintain funding for closing knowledge gaps. It would be ideal for DOD to remain as the lead agency in the efforts to close the gaps of scientific knowledge for BSAT protocols. There is room for improvement here, as noted in the Inspector General’s 2020 report, but most would agree that the DOD has had great success with their BSAT program. Another area Dr. Lawson believes the biorisk community should engage on is encouraging scientists and biorisk experts to engage on policy development. When the federal registrar asks for input, the program encourages feedback from its experts and scientists, and that should be encouraged throughout the entire regulated community. 

Biosafety and Chemical Safety Research

Do you wear your safety goggles every single time you step foot into your laboratory so that you can avoid an accident? Two safety researchers, Dr. Dana Ménard, Assistant Professor of Psychopathology at the University of Windsor, and Dr. John Trant, Assistant Professor of Bioorganic and Medicinal Chemistry at the University of Windsor, described their research, “A review and critique of academic lab safety research,” regarding academic chemical laboratory safety. It involves more than just posting safety protocols at eye wash stations. Enhancement of research laboratory safety requires collaboration from the entire laboratory community. The true number of laboratory accidents is largely unknown. The data on incidents and deaths in laboratories are sparse, in Canada and in the US. Safety practices and policies tend toward industry in regard to regulations. Academic institutions do not have the same regulatory framework as industry laboratories. A UCLA study (sample size of 2400) reported that 30% of the researchers surveyed had been involved in a laboratory accident. A 2017 study showed that 32% of 261 students had a lab accident. The presenters of this session asserted that the numbers could be higher, as they expect that under-reporting happens frequently. One major concern with surveys like these is that respondents tend answer questions in a way they think is socially acceptable. Social desirability is an issue: we know and report what we should do but we might actually act differently.

Many injuries are likely unreported, for a variety of reasons. Dr. Ménard noted that lab accidents in academia are handled quite different than in industry. Industry workers seem not to keep quiet about accidents and they are usually obligated to report accidents at work. Conversely, academic investigators tend to have low consequences after major incidents in their labs, and student researchers have little-to-no recourse. Dr. Ménard summarized a Canadian study of 104 participants that showed 56.7% were involved in at least one laboratory accident; and around half of those involved (or should have received) medical attention. Around 30% did not report the accident at all. Some of the reasons given for not reporting accidents include “not too serious” and “shame.”    

One gap in our knowledge of this area is the lack of understanding on what training is received by people who work in research labs. Dr. Trant discussed revealed one example where 70% of lab workers received training but only 25% received it before they had started experiments. Even though studies describe interventions, there is often little baseline data for these laboratory interventions, per Dr. Ménard. Some training and intervention efforts that labs can use are self-study programs, quizzes, handouts, black lights and games/scavenger hunts as part of training efforts. Training is necessary but perhaps some of our colleagues complain about losing “academic freedom”, or that there are too many rules and too much regulatory compliance. For some principal investigators (and their competing priorities), safety actions can be seen as a “hassle”. Dr. Trant warns that the lax attitude toward safety is currently normalized in academia and that good leadership is necessary.

Understanding Human Reliability in the Laboratory: Implications for Biosafety

In high consequence laboratory environments, we depend on data to support critical decisions that inform policy. Dr. Rocco Casagrande, Managing Director at Gryphon Scientific, presented his risk assessment for the National Bio and Ago Defense Facility (NBAF). This laboratory is the US’s only large animal BSL-4 facility (and will contain agents such as Foot and Mouth disease). Doing this type of research in the middle of the United States is a new endeavor. The Gryphon Scientific group has also performed a risk-benefit analysis of researching modified agents with pandemic potential (such as influenza and coronavirus). Developing standards at facilities is critical; even more critical is the prior decision making before standards are created. So, why should human behavior be a major part of this research? Containment and facility design is the usual focus, but what people are actually doing in the lab is just as important. A lab can be perfectly built, but we still depend on humans for operation.

Data are needed for this as existing data are lacking. Fatigue, motor skills, and protocol violations play a part in the points of failure in laboratory safety. Dr. Casagrande looked at other industries to inform this data gap. He examined the mistakes that pilots make, and he examined seemingly insignificant events (like dropping vials) to see how much material could escape. As the Gryphon team considered how laboratory accidents happen, they found that the workers themselves are frequently who initiate accidents. The actions of workers can mitigate or exacerbate an incident. Knowing how mistakes happen can help mitigate outcomes like lab acquired infections. These types of mistakes may inform the types of mitigation needed for high consequence laboratories.

The Open Philanthropy Project provided a grant for biosafety research in order to improve high-level decision making for critical science policies. A culture of biosafety is the goal. Since the data do not exist, Casagrande’s team is filling the gap on human reliability.  The goal is to have researchers ready to do this type of research, build a community, publish data, and build a culture of biosafety. These data can be generated by inserting dummy pathogens into the workflow of a lab. How challenging will it be to find data on large animal laboratory workers in high containment laboratories? We can only compare Plum Island (since NBAF is not yet open). Testing ‘real’ work versus an experimental environment might also be useful for low- and middle-income countries who frequently have constrained resources. They are identifying innovative practices. Some labs already have unique practices that might be useful to others, and an upcoming workshop plans to find the barriers for implementation of best practices.

This talk did not broach the subject of human reliability in an expected way. I hoped to hear about identifying potentially malicious actors, discussing dual-use research, and learning about the other risks of opening a BSL facility with many new workers. These topics will be useful to explore; it was not clear if this was already included in Gryphon Scientific’s work.  Brand new laboratories provide a unique opportunity for starting new practices, collecting data on worker training, and conducting applied safety research. This opportunity should not be wasted as NBAF becomes operational.

Challenges and Innovations in Personal Protective Equipment (PPE) Decontamination During the COVID-19 Pandemic

Dr. Antony Schwartz, the Director of the Occupational and Environmental Safety Office at Duke University, presented his experience with ensuring a recycled supply of personal protective equipment (PPE) at his institution this past year. Their innovative approach at their biosafety level 3 (BSL-3) lab used vaporized hydrogen peroxide (VHP) to decontaminate face masks and powered air-purifying respirators (PAPRs). They validated this method for multiple types of N95 masks. Other methods are possible, too, but some of them are not recommended since fit and filtration degrade after multiple decontamination cycles. Dr. Schwartz suggested that other interested researchers should review this website showing the various methods that have been considered.  Future innovations might result in sustainable PPE. Under development are textiles with filtering materials, reusable N95s, removable filters with a valve that filters in both directions. These decontamination procedures and sustainable innovations may have many applications in healthcare, emergency response, high containment research, law enforcement, and military activities. An important takeaway from this presentation was that gear can now be used more than once. In my opinion, this could have huge implications for training activities. Single use items can be a challenge to incorporate into training regimens. Reusable protective gear could support more frequent and realistic training activities for health care workers and first responders.

Lessons Learned

How do we manage biorisk? We learned what the current research has uncovered in this field, and its application to high containment laboratories as well as academic spaces. Through applied research for biosafety, we can develop robust procedures, we can decrease accidents, and we can even consider sustainable personnel protective equipment. The efforts of these professionals can make laboratory workers safer; and they will build better practices, training, equipment and data. The studies and procedures shared during this conference encourage all professionals, and students, to use (and generate) reliable biosafety data as they continue to build a culture of laboratory safety. A missing topic from this conference was the consideration of biosecurity and dual-use risks, or the potential need for oversight of the growing number of high containment laboratories around the world.

Biosafety Challenges in COVID-19 (So Far)

By Rachel-Paige Casey, Biodefense PhD Student

The 6th International Biosafety and Biocontainment Symposium, presented by the US Department of Agriculture’s Agricultural Research Service (USDA ARS), brought together experts from government, academia, and industry to discuss emerging biorisk challenges in agriculture. Speakers highlighted how the convergence of food, agricultural, and natural resource challenges require coordination and intensification of food safety, nutrition, and food security efforts to mitigate risks.

I attended this virtual conference along with my GMU Biodefense Program colleagues Ms. Stevie Kiesel and Ms. Michelle Grundahl. You can find their discussions of other symposium sessions here. This report provides an overview and commentary on Session III – Emerging Issues, which covered several of the challenges facing the agriculture sector that arose as a result of the COVID-19 pandemic.

Feeding the Nation During a Pandemic – Insights on Challenges and Triumphs from the Food Industry

Dr. Karleigh Bacon from The Kraft Heinz Company provided a summary of the observed trends in the food industry since the start of the pandemic. Overall, retail sales are up as consumers have increased the number of items in their carts and they are stocking up with each grocery run in order to make fewer trips to the store. At the grocery store, consumers are returning to the “center aisles” with packages foods, baking supplies, paper goods, and cleaning products. Indeed, sales of comfort foods are soaring and baking has become an increasingly popular hobby. On the other hand, food service sales are down for restaurants, hotel services, and schools. Online sales have surged to double or triple their pre-pandemic levels. The food industry’s response to COVID-19 aimed to maintain the stability of the food supply chain by focusing on communications management, operations management, and supply chain management. The response from the food industry, much like the health sector, had to be quick and agile, which requires clear communication. The Operational Risk Management team was assembled to conduct daily calls with the manufacturing sector to communicate new policies and operational statuses. Additionally, new lines of communication were established with the Food and Drug Administration and the USDA FSIS for response management. Turning to employee health and safety as a critical component of operations management, personal protective equipment (PPE) became required and health screenings became an automated step before entry into production facilities. Production lines were altered to maintain social distance between workers, moving from a spread of six to twelve feet. Cleaning and sanitizing schedules were ramped up to improve employee health and safety in the workplace. The compliance to health and safety protocols was critically important to maintaining production with healthy employees. To meet surges in demand in the first several months of the pandemic, production facilities ramped up to churn out as much food as possible. The surge in retail food demand fell and foodservice sales enjoyed a small increase during Summer 2020 when pandemic restrictions were relaxed. Thankfully, there is no evidence that SARS-CoV-2 is transmitted through food items. The most significant impact on food supply chains was the concurrent immediate decrease in foodservice production and increase in retail production. Unsurprisingly, factories and plants suffered from PPE and sanitizing solutions shortages, but also from shortages in meat products and packaging components.

Legal Issues—Lessons Learned on COVID-19 Response

R. Brooks Moore, Deputy General Counsel for The Texas A&M University System, discusses legal, compliance, and policy issues that arose as this public education system transitioned to a remote environment and plans to return to in-person learning and work. Prior to the pandemic, the status quo was that instruction, research, and most other forms of work were conducted primarily in-person. Transitioning to remote learning and work created external legal and compliance issues: overlapping and conflicting lines of authority in a prolonged emergency like a pandemic; details and conditions of directives and funding; waivers of statutory and regulatory requirements, and implementing requirements and documenting compliance. With federal, state, and local authorities all vying for authority in an emergency, the system struggled to determine what actions to take. This also caused confusion with lines of funding, which may require compliance with a specific entity. In a state of disaster, the governor has the power to waive laws and regulations temporarily, so the university had to learn how to operate under these new conditions. Documenting compliance was considered a top priority to maintain compliance with the moving targets of requirements as the pandemic changed over time. Of course, the university also faces internal legal and compliance issues: internal decision-making and communications authority; closure decisions; implementation of remote education and work; employment, student, and vendor concerns; and transparency. Perhaps the biggest struggle was determining who has the decision-making authority within the system to choose how to respond to the pandemic. Similarly, it was critical to determine who has the authority to speak for the university in regard to the pandemic and the system’s response decisions. Education transitioned to an online format, but other activities or facilities were unable to go remote, so decisions had to be made on what to leave open and what to close. A common thread through many of these external and internal legal and compliance issues was the confusion around what entities or personnel had authority to make decisions for the response and communicate those decisions across the system.

Biosafety Community Outreach During COVID-19

David Gillum from Arizona State University (ASU) gave an overview of biosafety community outreach during COVID-19. How do we adapt and how will we thrive? In every challenge, there is an opportunity to learn, grow, and improve. The COVID-19 pandemic put biosafety front and center of society in 2020. Biosafety was a hot topic in mass media, research, and industry. According to Gillum, disasters provide kinetic energy and foment change, and inspires many to be agents of change for the better of all. Arizona State University experienced changing priorities with the novel coronavirus: managing inventories, reviewing SARS-Co-V research, navigating travel restrictions, adjusting research levels, testing, and vaccinating. “Pivot” is now the word du jour and “building the plane as we fly it” is the favored catchphrase for ASU. Over the last several years, Gillum has helped coordinate a variety of biosecurity outreach on several topics – academic espionage, chemical security, cybersecurity, economic espionage, insider threats, and personnel reliability – with the FBI, the Arizona Biosafety Alliance, and the community. He asserts that the public should be at the table with a voice in the biosafety and biosecurity discussion. Biosafety professions should be the sources of relevant and accurate information for the public.

Lessons Learned So Far

The COVID-19 pandemic revealed a number of policy gaps related to biosecurity, especially outside the laboratory. The food industry, higher education, and community outreach came upon unexpected hurdles as a result of the novel coronavirus. Communication and clarity are the common elements needed across many of the challenges created by COVID-19. Knowing what entities – federal, state, and local – have the authority on each topic or issue is critical to a strong response and clear communication of response activities. Clarity on the protocols and chain of command in an emergency is necessary to maximize efficiency and effectiveness of the response. Clear communication also helps ensure compliance with procedures or mandates across the workforce, student body, or community. Though learning how to function in COVID-19 has been a bumpy ride, the trials that came with the pandemic have also provided opportunities to better prepare for the next biological event so that we can adapt and thrive under any conditions.

Pandora Report: 2.19.2021

Joseph Rodgers, a Biodefense PhD student, dissects nuclear modernization challenges that the Biden administration will face. The WHO shares mixed messages about the origin of the COVID-19 pandemic. North Korea tried to steal coronavirus vaccine information from Pfizer. Many of the superspreaders behind COVID-19 conspiracy theories are exposed.

Nuclear Modernization Under Competing Pressures

Joseph Rodgers, a Biodefense PhD student, and Rebecca Hersman published an analysis, Nuclear Modernization under Competing Pressures, that dissects the decisions and challenges the Biden administration must address regarding the modernization of critical elements of the US nuclear weapons enterprise. According to the authors, the “Ground Based Strategic Deterrent (GBSD) and its corresponding W87-1 warhead is one modernization program that will face rigorous scrutiny in the early stages of the Biden administration.” The high-profile and pricey strategic delivery systems get the limelight in the modernization debate; however, the “effective modernization of the US nuclear stockpile itself” is a critically underappreciated challenge. There are a couple important steps that the Biden administration can take to enable successful US nuclear modernization: (1) ensure that modernization timelines are feasible and costs are realistic, and (2) engage Congress and international partners in discussions of nuclear modernization. Read the article here.

WHO: COVID-19 Didn’t Leak From a Lab. Also WHO: Maybe It Did

Dr. Filippa Lentzos, a mixed methods social scientist researching biological threats at King’s College London, discusses the conflicting statements made by the World Health Organization (WHO) regarding the theories about how SARS-CoV-2 came to be. The joint WHO-China investigation into the origins of the COVID-19 pandemic announced that their efforts ruled out the possibility that the novel virus escaped from a laboratory and that it most likely jumped species before infecting humans. A few days later, WHO Director-General Tedros Adhanom Ghebreyesus stated that no hypotheses have been ruled out. Lentzos points out the missing pieces of the puzzle in the joint team’s conclusion as well as the inaccuracies in their logic. For instance, the findings assume that all research is published and publicly available, but much of it is not. Indeed, the virus database of the Wuhan Institute of Virology was taken offline at the start of 2020 for “security reasons.” Also, Peter Ben Embarek, co-leader of the mission, commented that laboratory accidents are “extremely rare events.” On the contrary, such accidents are not rare, but accidents that cause documented outbreaks are rare. Lentzos points out that the “publicly-available genetic and epidemiological evidence collected so far about SARS-CoV-2 and the outbreak does not exclude the possibility of a lab leak.” Read Lentzos’ analysis here.

We Need a Global Outbreak Investigation Team—Now

The much-anticipated findings of the team investigating the origins of the COVID-19 pandemic proved anticlimactic. In fact, they have also added another layer of confusion given the conflicting statement from the WHO’s director-general that all origin hypotheses remain viable. The team ruled out the possibility of the novel virus stemming from a laboratory leak. The conflicting announcements out of WHO have left many worrying about the many constraints the international body must operate under. For instance, the WHO can “only enter member countries and engage in research there on those countries’ terms, and it has no real powers of enforcement.” Perhaps, something new is needed. Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, suggests an international body, similar to the Organisation for the Prohibition of Chemical Weapons (OPCW), that could “require biosafety level 4 (BSL-4) labs to report on the activities that go on inside them.” The Biological Weapons Convention, the international treaty that bans the development of bioweapons, already has a legal structure and could, theoretically, create the enforcement authority for such an agency. Alternatively, Koblentz also suggests, the “UN Security Council could establish such a body, the same way it created commissions to inspect Iraq for possible weapons of mass destruction.” Of course, either of these entities would take time to establish and would be based on voluntary participation from states. Dr. Filippa Lentzos, a biosecurity expert at King’s College London, proposed the World Health Assembly as another option for “mandating investigations that can get boots on the ground the moment reports of an outbreak with pandemic potential emerge.” The proliferation of BSL laboratories in response to COVID-19 “should be reason enough for rethinking the status quo.” More labs mean more gain-of-function research, in which pathogens are modified to study how they might become more dangerous, and would require more lab oversight to ensure safety.

North Korea Tried to Steal Pfizer Coronavirus Vaccine Information, South Says

South Korea’s National Intelligence Service reported that North Korea attempted to hack into the servers of Pfizer, a US drugmaker, to steal COVID-19 vaccine and treatment information. This report belies dictator Kim Jong Un’s “professed view that his isolated dictatorship is untouched by the pandemic.” It is not clear when the cyberattack on Pfizer occurred or if it was successful. This is just the latest cyberattack carried out by North Korea in its “alleged ongoing campaign to obtain sensitive information through nefarious means and its growing cyber capabilities.” In November, Microsoft revealed that North Korean and Russian hackers tried to steal data from pharmaceutical companies and vaccine researchers; efforts were mostly unsuccessful. Last year, South Korea announced it had thwarted a hacking attempt by North Korea that targeted companies developing coronavirus vaccines.

Weaponized: How Rumors About COVID-19’s Origins Led to a Narrative Arms Race

A joint research project with the Digital Forensic Research Lab (DFRLab) and the Associated Press examined the information environments of China, the United States, Russia, and Iran during the first six months of the COVID-19 pandemic and the inaccuracies that gained traction in those states. The report emphasizes how “varying, unverified, and outright false narratives that the virus was a bioweapon or the result of a lab accident spread globally on social media and beyond, and the geopolitical consequences of those narratives.” As the country that suffered the initial outbreak, China was “central to narratives that [the novel coronavirus] was a bioweapon either developed by or, conversely, targeting the country.” Government officials in the US – including then-President Donald Trump – took a different approach, implying that the virus originated in and escaped a laboratory of the Wuhan Institute of Virology (WIV), and going one step further by postulating that its release from WIV could have been intentional. Some of the preliminary narratives arose in Russia, which were aimed at furthering its own geopolitical agenda and its anti-US sentiments. Given its fraught political situation, Iran’s messaging targeted its domestic audiences and aimed to renew the “Iranian public’s fidelity to the regime.” Read the full report here.

The Superspreaders Behind Top COVID-19 Conspiracy Theories

The rapid spread of COVID-19 conspiracy theories can be partially attributed to states – China, Iran, Russia, and even the US – touting ideas tailored to their own agendas. But certain individuals have also gained traction with the public: college professors lacking evidence or virology training are plugged as experts and anonymous social media personalities masquerading as high-level intelligence officials. The joint nine-month investigation conducted by the Associated Press and the Atlantic Council’s Digital Forensic Research Lab (DRFLab) also aimed to “identify the people and organizations behind some of the most viral misinformation about the origins of the coronavirus.” The explosive claims based on weak evidence were shared with the world by COVID-19 conspiracy theory superspreaders. For example, Francis Boyle, a Harvard-trained law professor at the University of Illinois, asserts that SARS-CoV-2 is a genetically engineered bioweapon that escaped from a high-containment laboratory in the Wuhan Institute of Virology. Boyle’s evidence is circumstantial: the existence of a BSL-4 laboratory in WIV, the previous virus escape events from other laboratories, and his belief that “governments around the world are engaged in a secret arms race over biological weapons.” Igor Nikulin, who calls himself a biologist and former weapons inspector in Iraq for the United Nations (UN), claims that the virus was engineered by the US and deployed as an attack in China. Nikulin provides no evidence to support his accusation, nor can his supposed employment history with the UN be verified.

Dr. Saskia Popescu: Hospitals’ First Line of COVID Defense

Dr. Saskia Popescu, an assistant professor in the Biodefense Graduate Program as well as an alumna, is a go-to consultant for hospitals and the World Health Organization, helping to control infections and prepare for new outbreaks. Popescu also helps educate policymakers and the public using her expertise on the novel coronavirus and the approaches to containing it. She also serves as an infection prevention consultant for larger businesses and the City of Phoenix, Arizona, in their efforts to incorporate COVID-19 safety into the workplace. Popescu has “built COVID-19 response and preparedness programs for hospitals from scratch, and is constantly looking at case counts and analyzing data locally and internationally to ensure she’s providing the most informed recommendations possible.” She explained, “It’s extremely hard to build a robust response and preparedness program and be able to keep it agile, respond to changes in the science and data, and do it in a way that is pragmatic.” Popescu said. George Mason News featured Dr. Popescu on Twitter. Watch the video here.

The CRISPR Revolution and Its Potential Impact on Global Health Security

Kyle E. Watters, Jesse Kirkpatrick, Megan J. Palmer, and Gregory D. Koblentz, Director of the Biodefense Graduate Program, published an article in Pathogens and Global Health about the potential impact of the CRISPR revolution on global health security. Global health security is constantly under threat from infectious diseases. Despite advances in biotechnology that have improved diagnosis and treatment of such diseases, delays in detecting outbreaks and the lack of countermeasures for some biological agents continue to pose severe challenges to global health security. In this review, the authors describe some of the challenges facing global health security and how genome editing technologies can help overcome them. They provide specific examples of how the genome-editing tool CRISPR is being used to develop new tools to characterize pathogenic agents, diagnose infectious disease, and develop vaccines and therapeutics to mitigate the effects of an outbreak. The article also discusses some of the challenges associated with genome-editing technologies and the efforts that scientists are undertaking to mitigate them. Overall, CRISPR and genome-editing technologies are poised to have a significant positive influence on global health security over the years to come. Read the article here.  

This new article connects with the two-year multidisciplinary study, Editing Biosecurity, conducted at George Mason University to explore critical biosecurity issues related to CRISPR and related genome editing technologies. The overarching goal of the study was to present policy options and recommendations to key stakeholders, and identify broader trends in the life sciences that may alter the security landscape. Outputs of the Editing Biosecurity project can be found here.