The Pandora Report

Happy Friday! Ready for some global health security news? Down the rabbit hole we go….the FDA has just approved ANTHIM injection, a new treatment for inhalation anthrax in adults and children. Researchers are considering the possibility that the highly virulent E. coli O104:H4 strain that hit Germany in 2011 may have been an intentional act. “The sudden and unexplainable emerging of a fast increasing number of cases and deaths from bloody diarrhea and HUS might have been caused naturally, accidentally, or intentionally,” a Serbian-German research team writes in the European Journal of Public Health Advance Access for April 15.

The Finances of A Pandemic
From SARS to Ebola and now Zika, the growing threat of emerging infectious diseases doesn’t seem to be slowing down. Has this become our new normal? Will we learn from these outbreaks and start putting the resources and support into prevention? “Ebola has infected almost 30,000 people, killed more than 11,000 and cost more than $2 billion in lost output in the three hardest-hit countries. SARS infected 8,000 and killed 800; because it hit richer places, it cost more than $40 billion. Predicting these losses is hard, but a recent report on global health risks puts the expected economic losses from potential pandemics at around $60 billion a year.” So how do we defend against these international security threats? America’s National Academy of Medicine recently made the suggestion that $4.5 billion a year solely dedicated to pandemic preparedness and defense could halt this impending reality. Even more interesting? This estimate accounts to roughly 3% of what “rich countries spend on development aid”, while the world spends about $2 trillion annually on defense.

U.S. Biothreat Defense Inadequate
American response to Ebola and now Zika reveals a startling trend of slow response, inadequate supplies, and poor cooperation and coordination between agencies. Director of National Intelligence, James Clapper states that “Gaps in disease surveillance and reporting, limited health care resources, and other factors contributed to the outpacing of the international community’s response in West Africa,”. The National Biosurveillance Integration Center (NBIC) is one such agency that was developed in 2007 in attempts to “be a hub of information and coordination for federal agencies tracking disease and biological threats”, however it has been frustrated by poor relationships and sharing from other agencies like the CDC. In essence, agencies that are developed for global health security, like NBIC, suffer from poor cooperation that then trickles into their reputation and capabilities in the eyes of their federal partners. “Congress has put forth a potential legislative fix. The CBRNE Defense Act of 2015 would create a new office within DHS, the Chemical, Biological, Radiological, Nuclear, and Explosives Office, which would place both NBIC and BioWatch under integrated new management.” Just as we reported from the Blue Ribbon Study Panel, federal biodefense efforts and resources need to be better organized and developed.

Rare Blood Infection Outbreak
Elizabethkingiam is currently causing dozens of cases in Wisconsin and now a Michigan resident is suffering from the bloodstream infection. The bacteria that causes the infection, Elizabethkingia meningoseptica, is commonly found in soil but has also caused infections in hospitals. Typical infections have resulted in bacteremia and neonatal meningitis related to the gram-negative bacillus, although it is naturally found in soil, fresh water, and salt water. Most of the 54 cases in Wisconsin have been in patients 65 years and older, of which 17 have died. Public health officials are working to identify the source of the outbreak and the links between the Michigan case and those in Wisconsin. The concerning aspects of this rising outbreak is also the difficulty in treating the organism and prevalence of multi-drug resistant organisms in seniors.

Complex Engineering by Violent Non-State Actors
Check out this special issue on complex engineering by violent non-state actors (VSNAs). “Why and how different VNSAs remain low-level and localized or undertake and achieve complex engineering tasks in pursuit of their objectives are at the heart of understanding the threat environment faced by states.” The authors address several terrorist groups like Aum Shinrikyo (the chapter was actually co-authored by GMU Biodefense Alum Benjamin Ash!), Hamas (also co-authored by GMU Biodefense Alum Alena James!), the Provisional Irish Republican Army (PIRA), etc.  “The approach of this collection moves beyond weapons and embraces facilitating or logistical aspects that support the operations and objectives of the various actors”. This special edition, with an introduction by Jez Littlewood, reviews these organizations and their resources and strategies. The authors also consider the attitudes of leadership regarding innovation in detail to assess the role of complex engineering by VSNAs. Through this close look into the VSNA use of complex engineering, further research and preparedness can occur to understand the threats posed by these actors.

All Roads Lead to Zika 
Now that Spring has officially begun, the impending summer rains are right around the corner, and with those – mosquitoes. Many worry about the potential for local transmission in countries where imported cases have already been identified. The US isn’t immune to these concerns as the CDC reports 273 travel-related cases. Dr. Nabel mirrors the sentiments of Sanofi’s global R&D head, Dr. Elias Zherouni, who emphasizes the need for changes in global public health outbreak response. He notes that “we just run from one crisis to another. It’s not an optimal way to respond. Not when the stakes are so high and when so many people can either lose their lives or have their whole lives changed because of one five-day infection. That’s no way to protect the world’s population. We have to step back and we have to say, ‘Is there a more systematic way to gather the intelligence that we have about these viruses, recognize where they stand in terms of the threat level, and then develop a systematic program where, when the next Ebola outbreak occurs, it’s not that we haven’t done anything since the last outbreak, that we’ve actually moved things forward?’ That’s all possible. It’s just that we have not had the collective will to do it.” Panama has also announced their first case of microcephaly linked to Zika virus outside of Brazil. Chris Mooney from The Washington Post discusses why Zika virus, among other diseases, could disproportionally impact America’s poorer populations.  He notes that scientists have found that more mosquitoes are found in lower-income neighborhoods due to persistent trash and abandoned buildings, which creates a ripe environment for standing water and thus mosquito breeding. Researchers found that when compared to wealthier neighborhoods in New Jersey, “poverty was positively correlated with number of [Asian tiger mosquitoes] captured and accounted for over half the variation”. Many are saying that the “U.S. is botching the Zika fight” due to the problems within the FDA and the Agriculture Department regarding turf. “A genetically tweaked mosquito could stop the illness, but regulators won’t test it. Why would that be?” The combination of worrying reasons, like “budgetary concerns and antagonism to genetic engineering among some senior USDA officials”, leave many feeling that instead of getting ahead of the outbreak, “the U.S. is falling behind, solely because of bureaucratic muddle.” On the other hand, on Friday, the WHO rallied for pilot projects on two projects that would involve genetically modified mosquitoes to help stop the spread of Zika virus. In the meantime, the FDA gave emergency approval for a 3-in-1 test for Zika, Chikungunya, and Dengue.

Syria and the Future of the Chemical Weapons Taboo 

Brett Edwards and Mattia Cacciatori tackle the responses that the international security community has taken regarding the use of chemical weapons in Syria and the resulting reinforcement of “a long standing prohibition norm.” The authors discuss the characteristics of chemical weapons taboo and and the significance that the international community gives to these weapons. “This alone does not support the claim episode has strengthened the global norm against chemical weapons. In this piece we have highlighted how this is not immediately apparent due to the fact that problem cases tend to be externalized from dominant institutional discourses, often justified in terms of the need to protect the sanctity of the chemical weapon norm, as well as those institution’s which embody the norm – especially the OPCW.” Overall, the more problematic cases, like those of incapacitating chemical agents, will grow to alter the existing foundation of chemical weapons norms if left ignored or unchecked.

New Ebola Flare Up
The west African Ebola outbreak is like a campfire that wasn’t put out properly – everyone thinks the flames are extinguished, but those hidden embers lurking in the ash end up causing a spark that leads to a massive forest fire. A fifth person has died from the recent flare in Guinea. The most recent death occurred in a man 200k from the initial four cases. Prior to this death, a young girl died from the village of Korokpara following her hospitalization in an Ebola treatment facility in Nzerekore. It’s still not clear how this specific surge began, but many worry about the lingering traces of the virus in the eyes, CNS, and bodily fluids. In response to the fifth death, Liberia has partially shut its borders. Emergency meetings are now underway and the WHO is sending specialist teams in to try and stop the outbreak before it grows beyond the 11,300 mortality count. On a positive note, Sierra Leone has gone two incubations periods (42 days) without a case, which means they’re Ebola-free since their last flare up.

GMU SPGIA Gettysburg Trip
GMU students interested in learning more about the battle of Gettysburg- the Center for Security Policy Studies (CSPS) will be hosting an informational session on April 6th from 4:30-6pm in Merten Hall 1203 regarding the April 9th trip! GMU students and staff will walk the battlefield, discussing the factors that caused the battle to unfold as it did. They will also link the battle into larger discussions about the causes of war and grand strategy.  The cost for the trip will be $35.  Bus transportation will be provided, and will pick up participants from both the Fairfax and Arlington campuses.

Stories You May Have Missed:

• U.N. Sued Over Haiti Cholera Outbreak– starting in October of 2014, Haiti was hit with an intense wave of cholera that is believed to have started with U.N. peacekeepers. “Poor sanitation at a U.N. camp for peacekeepers allowed cholera-contaminated sewage to enter a tributary of Haiti’s largest river, the Artibonite. Within days, hundreds of people downstream, like Jean-Clair Desir and his mother, were falling ill. The disease subsequently spread to the entire country.” The case is currently being reviewed in US courts and the lawsuit was brought forth by the Institute for Justice in Democracy, asking that the U.N. “end cholera by installing a national water and sanitation system; pay reparations to cholera victims and their families; and publicly apologize for bringing cholera to Haiti.”
• Exploiting the Challenges to Bioweapons Development – Janne E. Nolan discusses GMU Biodefense Professor, Dr. Sonia Ben Ouagrham-Gormley’s book, Barriers to Bioweapons, in regards to the misleading and often exaggerated notion of easy WMD development. Nolan discusses that understanding both the internal and external factors that impact BW program success would allow the international community to “devise better ways to realistically stem BW proliferation”. He notes that “Ben Ouagrham-Gormley’ s book is a fascinating study of the phenomenology of scientific knowledge, providing a compelling analysis of how knowledge is acquired, developed, transmitted, and, at the same time, diluted or lost as a result of organizational, social, economic, political, and ultimately very human factors that vary widely within countries and over time.” You can also access it here: Nolan final
• Five Outbreaks That Stump Epidemiologists– As much as I’d love to say that all outbreaks are investigated and solved, the truth is that epidemiologists are often left with the nagging of an unresolved case. Outbreaks are squirrelly at best, often challenging even the best teams with confounders and biases. Here are some that have stumped public health teams over the years.
• Lassa Fever Outbreak– Three people are suspected of having the viral infection after coming into contact with an infected American. The initial case was a medical director of a missionary hospital in Togo, who died last month. While there are conflicting reports of disease confirmation, several sources are saying the three contacts of this initial case have been diagnosed and are under observation. The outbreak in Nigeria and Benin has continued to grow, resulting in CDC travel warnings. In Nigeria there have been 254 cases and Benin has seen 71.

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