Pandora Report 6.15.2018

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

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

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

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report: 5.18.2018

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report – 5.4.2018

Happy Friday and May the Fourth Be With You!

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

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

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

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

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

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

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

Stories You May Have Missed:

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

Pandora Report 4.13.2018

Welcome to your Friday biodefense fix! Have you registered for the summer workshop on pandemics, bioterrorism, and global health security? Don’t miss the chance to learn from the top minds in the field on everything from anthrax to Zika.

Blue Ribbon Study Panel Meeting – Transnational Biological Threats & Global Security
On April 25th, the Blue Ribbon Study Panel on Biodefense will be hosting a meeting regarding transnational biological threats. From 10am to 3pm, you can attend (or watch live!) this event. “Biological threats to the Nation increase continuously, recognizing no borders. As emerging and reemerging naturally occurring diseases continue to spread throughout the world, terrorists continue to pursue biological weapons to add to their arsenal, and nation states are establishing new and reinvigorating old offensive biological weapons programs. This meeting of the Study Panel, chaired by former Senator Joe Lieberman and Governor Tom Ridge, will provide the Study Panel with a better understanding of: Current transnational biological threats, Homeland defense and security in the global context, Global security efforts to combat these threats, International public health security efforts; and the need to elevate global health security as a national and global priority”.

Chemical Weapons Attack in Syria
This past weekend saw a horrific suspected chemical weapons attack upon the rebel-held Syrian city of Douma. Victims began seeking medical care on Saturday evening with the telling signs of chemical weapons exposure. Rough estimates are that 500 people sought medical care related to the attack and the WHO has demanded “immediate unhindered access to the area to provide care to those affected, to assess the health impacts, and to deliver a comprehensive public health response.” Healthcare workers on the ground have reported patients with symptoms, “which included frothing at the mouth, suffocation, dilated and constricted pupils, corneal burns, central cyanosis – a blue tinge to the skin – and a chlorine-like odour, were consistent with exposure to an organophosphorus compound. Sarin gas is such a chemical”. Sadly, the use of chemical weapons is becoming increasingly common in Syria, as the Assad regime has revealed an appreciation for the abhorrent tactic. “Gregory D. Koblentz, the director of George Mason University’s Biodefense Graduate Program, said the attack appeared to reflect how much the clout of U.S. policy has faded in Syria. ‘Assad is less concerned about Beltway politics, less concerned by who is in the White House. His calculation is based on whether it will help his chances in achieving gains on the ground, or punishing the rebels,’ he said.” “The possibility of western intervention against Assad was heightened on Tuesday after Russia and its western opponents, the US, UK and France, respectively vetoed duelling resolutions at the UN security council over the latest atrocity. The UN high commissioner for human rights said the world must react to the use of chemical weapons or risk dire consequences. ‘After decades when we thought we had successfully outlawed the use of chemical and biological weapons, the world is sitting idly by while their use is becoming normalised in Syria,’ said Zeid Ra’ad al-Hussein. ‘This collective shrug to yet another possible use of one of the most ghastly weapons ever devised by man is incredibly dangerous’.” What is to be done? President Trump’s recent Twitter activity points to planned use of “smart” missiles, but U.S. Defense Secretary Jim Mattis said on Wednesday that the U.S. is still assessing intelligence about the suspected chemical weapons attack. The OPCW (Organisation for the Prohibition of Chemical Weapons) is set to meet on April 16th to discuss the “alleged use of chemical weapons” in Syria. The OPCW team is also currently en-route to Syria for investigation into the suspected attack. “‘I think it looks pretty clear that a chlorine weapon was used’ on the civilians, said Charles Duelfer, former deputy head of the U.N. inspections team in Iraq, in an interview with NPR.”

Who Owns Smallpox?: The Nagoya Protocol and Smallpox Virus Retention
This week the Center for the Study of WMD held a talk on smallpox stockpiles. Spotlight speaker Michelle Rourke discussed her article regarding the convention on biological diversity and the Nagoya Protocol. If you missed the event, GMU biodefense graduate student Morasa Shaker was able to attend and has provided a detailed account of the day. “While the case can be made that endangered species pose an intrinsic value to the world’s genetic diversity, it is has proven less feasible to make the same case for a virus, specifically the variola virus—the causative agent of smallpox. Nevertheless, Michelle Rourke, a Fulbright scholar at Georgetown University’s O’Neill Institute for Domestic and Global Health Law, led an in-depth educational seminar organized by the Center for the Study of Weapons of Mass Destruction to support that very case—the smallpox virus is worthy of our conservation efforts.”

Controlling Dangerous Biological Research
Filippa Lentzos is asking a question we’ve been trying to avoid for a while – how can we control biological research that is inherently dangerous? The desire to advance technologically and in the life sciences pushes researchers and defense programs to invest in biological sciences, like synthetic biology. Just as we make gains in such research, we also worry that adversaries could use the same technologies against us. “Washington, Moscow, and other governments say they are focused only on ‘defensive’ biosecurity activities, but there is a fine line between ‘defensive’ and ‘offensive’ in this realm, and the alarming military focus on synthetic biology may cause people to wonder if there is some way to control the weaponization of biology.” Lentzos calls upon the international community to face the monster head on – let’s discuss how to address biological research that pushes the boundary of defense into offense. “To accomplish any of this, we have to be able to both characterize and evaluate biological research with high misuse potential. This is exceptionally difficult to do, and continues to elude both the international community and national policymakers.” Lentzos points to the horsepox synthesis experiment as a good example of the failures that occurred along the way and that ultimately, risk-benefit analysis is the wrong approach to biosecurity review. “Good security rests not on evaluating risks and benefits, but rather on managing uncertainty, ambiguity, and ignorance—sometimes even situations where we don’t know what we don’t know. Standard risk-benefit calculations are the wrong approach to evaluating biological research with high misuse potential.”

HHS Large-scale Exercise Moving Highly Infectious Patients
How do you transport a highly-infectious patient? The care of Ebola patients in the United States during the 2014/2015 outbreak highlighted the challenges of moving such patients to regional treatment centers. HHS sponsored a large-scale exercise that took place this week, with a hot-wash today. “The exercise focuses on moving seven people acting as patients with Ebola symptoms in different regions of the country. The patients, including one pediatric patient, first present themselves at one of the following healthcare facilities: CHI St. Luke’s Health-The Woodlands Hospital in The Woodlands, Texas; Medical University of South Carolina in Charleston, South Carolina; Norman Regional Hospital in Norman, Oklahoma; St. Alphonsus Regional Medical Center in Boise, Idaho, and St. Luke’s Regional Medical Center in Boise, Idaho.At each facility, healthcare workers will collect and ship samples for diagnostic tests to state laboratories, which in turn will practice running the necessary laboratory tests to diagnose the patients with Ebola. As part of the exercise, each patient will receive a positive diagnosis. Using appropriate isolation techniques and personal protective equipment, health care workers then must take steps to have six of the patients transported by air to designated Regional Ebola Treatment Centers. These patients will be placed into mobile biocontainment units for these flights. The pediatric patient will be placed into protective equipment and transported by ground ambulance.” The drills will also involve several airports, which include LAX, Charleston International, etc.

NASEM Bio, Chem, and Health Security Luncheon: April
Don’t miss the National Academies-hosted lunch today from noon to 1:30PM EDT. “April’s event features features George Korch, Senior Science Advisor to the Assistant Secretary for Preparedness and Response (ASPR) in the Department of Health and Human Services and Dana Perkins, Senior Science Advisor in ASPR’s Office of Policy and Planning. Dr. Korch will discuss recent developments and ASPR strategic priorities in support of the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE). Dr. Perkins will talk about implementation of the recommendations arising from the Federal Experts Security Advisory Panel (FESAP) and current activities for 2018. This event is free and open to the public, but you must register to attend. This event will not be webcast, and a summary will not be provided after the fact, so please register to attend in person if you are interested! A light lunch and beverages will be provided for all attendees.”

Cyberbiosecurity – A New Way To Protect The Bioeconomy and Gene Editing for Good
How can we better ensure cybersecurity and biosecurity? Researchers are bringing forth this emerging hybrid field that we should be giving more attention to. Life sciences and biotech are heavily engrained in cyber systems. Consider 3-D printing, personalized genomics, medical labs and surgical robots, etc.  “We propose ‘Cyberbiosecurity’ as an emerging hybridized discipline at the interface of cybersecurity, cyber-physical security and biosecurity. Initially, we define this term as ‘understanding the vulnerabilities to unwanted surveillance, intrusions, and malicious and harmful activities which can occur within or at the interfaces of comingled life and medical sciences, cyber, cyber-physical, supply chain and infrastructure systems, and developing and instituting measures to prevent, protect against, mitigate, investigate and attribute such threats as it pertains to security, competitiveness and resilience’.” Promoting this field and strengthening educational strategies is key to inform people on cyberbiosecurity and ensure a trajectory that can be supported. How do we move cyberbiosecurity forward though? “Academia, industry, government or non-profits (including policy, regulatory and legal experts) need to begin to learn to communicate with and educate each other, harmoniously identify and develop priorities, opportunities and specify ‘next steps.’ A major opportunity exists right now to propose a unified structure and common vernacular. Lastly, while definition and assemblage of Cyberbiosecurity is occurring, national or international strategies should be pursued to harmonize the emerging enterprise and foster measurable value, success and sustainability.” As the talks surrounding cyberbiosecurity grow, it’s hard not to consider some of the technologies we’re discussing and their potential. Bill Gates recently wrote for Foreign Affairs regarding the good that CRISPR could do. “the next decade, gene editing could help humanity overcome some of the biggest and most persistent challenges in global health and development. The technology is making it much easier for scientists to discover better diagnostics, treatments, and other tools to fight diseases that still kill and disable millions of people every year, primarily the poor. It is also accelerating research that could help end extreme poverty by enabling millions of farmers in the developing world to grow crops and raise livestock that are more productive, more nutritious, and hardier. New technologies are often met with skepticism. But if the world is to continue the remarkable progress of the past few decades, it is vital that scientists, subject to safety and ethics guidelines, be encouraged to continue taking advantage of such promising tools as CRISPR.” Gates points to several avenues for good – feeding the world, ending malaria, etc. He also notes though that there are legitimate questions regarding the potential for misuse and risks, and that regulations for genetic engineering are decades old and need revision to remain applicable. Part of the process for truly utilizing CRISPR is also to responsibly assess risks and communicate openly.

3MT Competition 
The George Mason University 3-Minute Thesis competition took place this past weekend and we’d like to congratulate Biodefense PhD student Chris Brown on his participation in this exciting event! He was one of ten finalists who competed to explain their dissertation to a non-specialist audience in 3 minutes. Chris described his dissertation regarding protecting critical workers against emerging infectious diseases – “Many different types of workers, including those who provide essential services the rest of us frequently depend on, are at risk of exposure to emerging infectious diseases that spread through the general population. Although many factors play into these types of workers being exposed on the job, protective gear—equipment like gloves, gowns, goggles, and respirators—is an essential part of infection prevention programs aimed at keeping workers healthy. During recent outbreaks, the public health enterprise has tended toward reinventing guidelines for each new infectious disease we face. That can lead to confusion about what guidelines for worker protection should be followed, as well as delays in implementing protective measures as science works to understand the disease agent and its transmission mechanisms. Pivoting toward a system based on worker exposures associated with various job tasks instead of one built around accurately characterizing transmission routes, my research offers a guideline for protective gear that is applicable to a wide range of diseases and that can be used as soon as outbreaks begin. It serves as an off-the-shelf solution for worker protection until empirical evidence supports using disease-specific infection prevention practices.”

Stories You May Have Missed:

  • In Pictures: Decades of Navy Efforts To Combat Malaria – “Malaria is ranked by the Department of Defense as the number one infectious disease threat to military personnel deployed to areas where malaria is endemic. This includes countries spanning the tropical and subtropical regions of the world, including most of sub-Saharan Africa and larger regions of South Asia, Southeast Asia, Oceania, central Asia, the Middle East, Central and South America and the Caribbean.”

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

Pandora Report 4.6.2018

Are You Prepared For the Next Pandemic?
Attend the GMU biodefense workshop on pandemics, bioterrorism, and global health security from July 18-20 to learn about pandemic preparedness, vaccine production, health security, and more!  From anthrax to Zika, we’re covering all things biodefense. Register before May 1stand you’ll even get an early-bird discount!  

Recounting the Anthrax Attacks
Wanting a new book for your biodefense book club? Look no further than Scott Decker’s account of the Amerithrax attacks in 2001. One of the chief scientific lead investigators, Decker provides a first hand look into the investigative process and innovative forensics that were used. “Decker provides the first inside look at how the investigation was conducted, highlighting dramatic turning points as the case progressed until its final solution. Join FBI agents as they race against terror and the ultimate insider threat—a decorated government scientist releasing powders of deadly anthrax. Walk in the steps of these dedicated officers while they pursue numerous forensic leads before more letters can be sent until finally they confront a psychotic killer.” This is a great account of one of the largest FBI investigations in the past two decades, the science behind it, and what it was like from the inside of Amerithrax.

 Russia Proposes Joint Investigation Into Salisbury Attack
As if it couldn’t get more uncomfortable…tensions are running high after a meeting of the Organization of the Prohibition of Chemical Weapons (OPCW) between London and the Kremlin. “Russia had demanded the emergency gathering of the OPCW’s top body in The Hague, after being blamed by the UK Government for the poisoning of ex-spy Sergei Skripal and his daughter Yulia.” Following this meeting, the UK delegation to the OPCW tweeted “Russia’s proposal for a joint, UK/Russian investigation into the Salisbury incident is perverse. It is a diversionary tactic, and yet more disinformation designed to evade the questions the Russian authorities must answer.” In response, Russian officials are pushing back and stating that their position is “fact-driven” and supported by 14 other nations.

GAO Report on Ebola Recovery & USAID Funds
The 2014/2015 Ebola outbreak was not only devastating, but also severely financially impacting. Response efforts alone cost billions, but what about recovery? USAID (US Agency for International Development) was given the task of supporting recovery efforts in Guinea, Liberia, and Sierra Leone however, their fiscal responsibility is being called into question. A new GAO report found that USAID was provided with $1.6 billion for Ebola recovery, of which $411.6 million was obligated for 131 recovery projects. “As of September 2017, USAID had completed 62 of its 131 planned Ebola recovery projects, had 65 projects that were ongoing, and had 4 planned projects that it had not yet started. Of the 62 completed projects, USAID had completed 39 within original time frames and budgeted costs and extended 23. Of the 65 ongoing projects, USAID expected to implement 46 within original time frames and costs, but had extended 19. USAID extended projects, in part, to complete host-government actions, hire staff, finalize project activities, and continue and expand food assistance.” The GAO report found several discrepancies in the data between USAID and its contractors. “In addition, as of December 2017 USAID has not ensured that the contractor has a complete and accurate inventory, which it said is also useful for informing and improving its ability to respond to future global health emergencies. The GAO said it looked at the contractor’s evaluation plan and found some incomplete or unclear elements, which have since been addressed by USAID and the contractor. The report also recommended that the USAID administrator ensure that a complete and accurate inventory of Ebola recovery project is compiled for ongoing evaluations.”

Enhancing Global Health Security Through Biosecurity and Engagement Programs 
The National Academics of Science, Engineering, and Medicine (NASEM) will be hosting this event April 23rd (12:30-5:30pm) and April 24th (9am-5pm) at the Keck Center of NASEM. “For over two decades, the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program (CBEP) has endeavored to reduce the threat posed by especially dangerous pathogens and related materials and expertise, as well as other emerging infectious disease risks. Through collaboration with other U.S. government agencies and international partners, CBEP identifies and addresses gaps in human and animal public health systems, enhance biosafety and biosecurity standards and procedures, and strengthens the ability of human and animal public health laboratories to detect, diagnose, and report outbreaks of infectious disease. Recently, CBEP collaboration has increased with the U.S. Centers for Disease Control and Prevention (CDC) on the Global Health Security Agenda (GHSA), enabling CBEP to advance its security goals across the GHSA countries. Recognizing that it must coordinate with a host of domestic and international agencies and organizations, CBEP has requested a consensus study to be conducted by the National Academies of Sciences, Engineering, and Medicine (NAESM) to engage key partners of biological and health-security support, and to assist in articulating a vision for a coherent and harmonized set of programs that align with the larger DTRA, DOD, and USG missions. The overall objectives of the NASEM study are to help CBEP and its sister programs to be as effective as possible while ensuring that critical opportunities are not inadvertently missed.”

 ProMed April Fool’s
If you’re a subscriber to the International Society for Infectious Disease’s ProMed email alerts, you may have come across this little gem on Monday. Little did people realize, the source from the Scotland Sunday Herald was a satirical article. Regarding Anthrax Island in the UK and a possible purchase- “A group of Russian oligarchs is bidding to buy Gruinard Island off the north west coast of Scotland.” “One British source said: ‘If Gruinard had an active volcano under which they could build a lair, replete with shark tank, lasers and dozens of goons in uniform, then this move would make sense. As Gruinard is basically a contaminated hell-hole where we once bombed sheep to death with bio-weapons in the hope of doing the same to Germans, then I cannot for the life of me understand what these oligarchs would want with the place.’ A Kremlin source said: ‘Why should a group of shadowy billionaires not buy up your land of Scotch and haggis? To raise questions about this is typical of lick-spittle imperialist lackeys who see conspiracies by Russia at every turn.’ When asked how anyone could survive on an island contaminated with anthrax, the source initially said that Russia ‘had years of experience with this type of thing’, before adding: ‘You cannot report that. We didn’t say that’.” ProMed issued an alert the following day, after it was notified by readers that the Scottish Herald article was in fact, an annual April Fool’s joke. Who says we don’t have fun in biodefense?

CARB-X Specific Diagnostics Award
A novel partnership may help the battle against antimicrobial resistance. A new $1.7 million award to Specific Diagnostics will help support the company’s antibiotic susceptibility testing (AST), which would significantly help early screening and rapid diagnostics, as well as lowering costs. “CARB-X funding will support the development and testing of Specific’s product, which is designed to quickly detect the emitted volatile molecules that are the first sign of bacterial growth in the blood and to determine which antibiotic is most suited to kill the bacteria. Rapid diagnostics provide quick answers to doctors and can take the guesswork out of treatment decisions in the first critical few hours and days of illness, reducing the chance of life-threatening sepsis and other urgent complications of blood infections. Currently, it can take days of laboratory testing to diagnose a lethal bacterial infection in the bloodstream. Faster diagnosis will enable medical staff to treat the patient quickly with appropriate antibiotics.”

NextGen Happy Hour
Looking to meet other people who are passionate about global health security? Next Generation Global Health Security Network is hosting a happy hour at Penn Commons (700 6th St NW, Washington, DC 20001) on April 26th at 5pm. This is a great opportunity to meet other NextGen members, the 2018 Next Generation Global Health Security Proteges, and other health security colleagues. Please confirm your attendance by April 20th by emailing nextgenghsa@gmail.com.

CDC Makes Gains in AMR Struggle
The CDC is reporting containment of new multidrug-resistant organisms in their latest MMWR. Utilizing data from the National Healthcare Safety Network (NHSN) regarding infections, researchers calculated changes in annual proportion of specific organisms that were highly resistant (CRE and ESBL). “The percentage of ESBL phenotype Enterobacteriaceae decreased by 2% per year (risk ratio [RR] = 0.98, p<0.001); by comparison, the CRE percentage decreased by 15% per year (RR = 0.85, p<0.01). From January to September 2017, carbapenemase testing was performed for 4,442 CRE and 1,334 CRPA isolates; 32% and 1.9%, respectively, were carbapenemase producers. In response, 1,489 screening tests were performed to identify asymptomatic carriers; 171 (11%) were positive.” The new strategy the CDC is relying on (and unveiled in 2017) involves rapid detection, on-site infection control assessments, screening of exposed contacts to identify asymptomatic colonization, coordination of the response among facilities, and continuing these interventions until transmission has been controlled. “The proportion of Enterobacteriaceae infections that were CRE remained lower and decreased more over time than the proportion that were ESBL phenotype. This difference might be explained by the more directed control efforts implemented to slow transmission of CRE than those applied for ESBL-producing strains. Increased detection and aggressive early response to emerging antibiotic resistance threats have the potential to slow further spread.”

Prepare For Pandemics – Reauthorize the Preparedness Act
The CDC’s elite team of disease detectives, the Epidemic Intelligence Service (EIS), is one of our greatest tools against microbial threats, so why do we keep cutting funding? The EIS program was initially established in the 1950s, when biological weapons programs were at trending and smallpox was not yet eradicated. EIS officers are deployed to public health events, and that doesn’t just mean infectious diseases, but can include natural disasters as well. “Over the last decade, however, cuts in funding for hospital and public health programs have diminished resources and capacities to identify and contain infectious disease outbreaks. Rising costs of graduate medical education, combined with disparities between public sector and private salaries for physicians have resulted in fewer physicians applying to the EIS fellowship program. While CDC once had the authority to offer student loan repayment to EIS fellows (as the National Health Service Corps and the National Institutes of Health and do for clinicians in underserved areas and scientists), CDC’s authority expired in 2002.” This can be challenging though as EIS fellows serve two years and repayment requires three years of service. In response to these budgetary cuts, Congress could, within the reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA), “reinstate CDC’s loan repayment authority and conform the commitment to CDC employment to the term of current fellowship programs.” This would encourage and better support the development of more EIS officers, as they are vital to global health security, but also a critical component to public health after their service is completed.

Stories You May Have Missed:

  • One Health Day 2018 Promotional Launch– November 3rd is the official day we celebrate global One Health Day, and three global partners are launching promotional activities to make sure we get the word out. “Anyone, from academia to government to corporate to private individuals can plan and implement a One Health Day Event which can be organized any time of the year and does not have to fall right on 3 November (unless participating in the student events competition). The global One Health Day Events webpage and map provides an impressive account of registered One Health Day events. Online registration is free of charge and yields special benefits: promotion on the One Health Day website, free use of the One Health Day logo and other materials and –anew benefit in 2018 – the chance for a surprise visit by a renowned One Health leader at selected One Health Day events.”
  • Department of Health and Human Services FY2019 Budget Request – “This report provides information about the FY2019 budget request for the Department of Health and Human Services (HHS). The report begins by reviewing the department’s mission and structure. Next, the report offers a brief explanation of the conventions used for the FY2018 estimates and FY2019 request levels in the budget documents released by the HHS and the Office of Management and Budget (OMB). The report also discusses the concept of the HHS budget as a whole, in comparison to how funding is provided to HHS through the annual appropriations process. The report concludes with a breakdown of the HHS request by agency, along with additional HHS resources that provide further information on the request. A table of CRS key policy staff is included at the end of the report.”

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

Pandora Report 3.30.2018

Happy Friday! On March 26th, we celebrated the anniversary of the BWC entering into force in 1975! While it was initially ratified by 22 countries, the BWC now has 180 States Parties.

Antimicrobial Resistance – The Troublesome Truth
AMR isn’t that flashy and it doesn’t require the kind of PPE or laboratories that might lend itself to eye-catching photographs. AMR may not be the kind of biological threat that people think of when they consider pandemics, but one thing it undeniable is… is a growing threat of international proportion. A recent Proceedings of the National Academies of Sciences shed some light on a pretty horrific truth – in over 76 countries, antibiotic use has risen by 65% in the last 16 years and it’s fueled by economic growth. “In this study, we analyzed the trends and drivers of antibiotic consumption from 2000 to 2015 in 76 countries and projected total global antibiotic consumption through 2030. Between 2000 and 2015, antibiotic consumption, expressed in defined daily doses (DDD), increased 65% (21.1–34.8 billion DDDs), and the antibiotic consumption rate increased 39% (11.3–15.7 DDDs per 1,000 inhabitants per day). The increase was driven by low- and middle-income countries (LMICs), where rising consumption was correlated with gross domestic product per capita (GDPPC) growth (P = 0.004).” High-income countries had modest antibiotic consumption increases, but there was no correlation with GDPPC. “Global antibiotic use rose by 65% from 2000 through 2015, while the antibiotic consumption rate increased by 39%.” The positive association of growing antimicrobial consumption and GDP is a scary notion. Researchers suggest that this relationship may be due to increasing capabilities to afford such medications. Not only does AMR have a substantial cost in terms of morbidity and mortality, but it also carries a hefty financial burden. A new study found that AMR has a price tag of $2 billion a year in the United States and costs an additional $1,400 for each infection in terms of medical treatment. These expenditures are due to increasing costs of inpatient treatments that are necessary when they have failed to respond to initial antibiotic treatment(s). Imagine how much the care for the UK’s first case of high-level resistant gonorrhea costs.  Fighting these infections is increasing challenging though, as AMR crosses several industries (agriculture, medicine, etc.) but from just the medical standpoint, it poses unique obstacles. Prescribing habits are always the first be addressed, as a new study even found that a significant proportion of antibiotics given to children are unnecessary. “Nearly a third of hospitalized children are receiving antibiotics to prevent bacterial infections rather than to treat them, and in many cases are receiving broad-spectrum antibiotics or combinations of antibiotics. The authors of the study say this high rate of prophylactic prescribing in pediatric patients and frequent use of broad-spectrum agents suggests a clear overuse of antibiotics in this population and underscores the need for pediatric-specific antibiotic stewardship programs.” Prescribing practices are one issue, but Maryn McKenna recently drew attention to the role patients have in driving physicians to overprescribe for fear of bad online reviews. “Some health care workers and researchers are beginning to talk about an uncomfortable explanation: Doctors feel pressured by what patients may say about them afterward. The fear of bad patient-satisfaction scores, or negative reviews on online sites, may be creating a ‘Yelp effect’ that drives doctors to provide care that patients don’t actually need.” Just these handful of examples underscore the complexity of the clash against antimicrobial resistance. To fight the battle of the resistant bug, we need all hands on deck. A new release from APIC and SHEA called out the importance of infection prevention and control programs in antibiotic stewardship efforts. “According to the paper, when AS programs are implemented alongside IPC programs, they are more effective than AS measures alone, verifying that a well-functioning IPC program is fundamental to the success of an AS strategy. ’It is important that all clinicians depend on evidence-based IPC interventions to reduce demand for antimicrobial agents by preventing infections from occurring in the first place, and making every effort to prevent transmission when they do’.” This is a single piece of the puzzle when it comes to reducing AMR and we all play a vital role. Just another reason why antimicrobial resistance is an underrated biological threat.

NBACC Funding Restored
The National Biodefense Analysis and Countermeasures Center (NBACC) is no longer in immediate jeopardy as the federal omnibus spending bill that was released on Wednesday evening provided full funding for the Fort Detrick laboratory. “The bill fully restores funding for federal laboratories the Trump administration proposed to close, including continued operational costs of $44.3 million for the National Biodefense Analysis and Countermeasures Center (NBACC). The Fort Detrick facility includes two high-level laboratories that handle federal select agents and toxins, including the Ebola virus, ricin and avian influenza.” Within NBACC, there is the National Bioforensic Analysis Center, which aids in the processing of evidence surrounding biological events, and the National Biological Threat Characterization Center, which seeks to study the complexities of biological threats.

 Summer Workshop – Are You Registered Yet?
From July 18-20, you can attend a workshop on all things health security – from pandemic flu to DIY genome editing, and all the outbreaks in between. Are you prepared to respond to the next pandemic? Attend our workshop and you’ll not only learn about how the U.S. has worked to better prepare, but also what future threats may look like. From anthrax to Zika, we’re covering all things biodefense. Register before May 1st and you’ll even get an early-bird discount!  

ABSA 61st Annual Biological Safety Conference Call for Papers                          You are now able to submit proposals for ABSA’s 61st Annual Biological Safety Conference. The conference will take place October 12-17, 2018 in Charleston, South Carolina. We anticipate having 650 attendees and 80 commercial exhibits. The pre-conference courses will take place Friday, October 12 to Sunday, October 14. The conference presentations will take place Monday, October 15 to Wednesday, October 17. The Call for Papers submission deadline is March 30, 2018 at 12 (Noon) pm CDT. 2018 Call for Papers Submission Site

GMU Biodefense Student Awarded ASIS National Capital Chapter Scholarship
We’re proud to announce that GMU Biodefense MS student Mariam Awad has been selected to receive the American Society for Industrial Security (ASIS) Chapter scholarship! Mariam will receive the award at the Chapter’s Annual Scholarship Night on April 11th. ASIS is the world’s largest membership organization for security management professionals. Congrats to Mariam for all her hard work and showing off the dedication GMU biodefense study have to the field!

Global Health Security 2019 Conference 
The first international conference on global health security will be taking place from June 18-20 in Sydney, Australia. “The conference will: Bring together stakeholders working in global health security to measure progress, determine gaps, and identify new opportunities to enhance national, regional and global health security; Provide a venue for government officials and International Organizations to share policy developments, hear from the research community, and create a space for side meetings that advance the health security agenda; Establish and solidify a health security ‘community of practice’ and guiding principles; Through an open call for abstracts, highlight work from partners around the world, bringing cutting edge, evidence-based research to the community; Provide an opportunity for students to showcase their research; Consider creating a professional association for global health security; and Develop and endorse a ‘Sydney Statement’ on global health security.” They also have a call for abstracts on April 27th “We are at a critical juncture in the field of global health security and it is appropriate to organize the community around a set of common principles, goals, and objectives. Like the London Declaration for Neglected Tropical Diseases or the Oslo Ministerial Declaration on global health, this Conference aims to bring together the global health security community to agree on a set of principles to guide the field and set priorities. The Conference themes will address the following topics.”

First Responder Safety
Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response (ASPR) highlighted the importance of protecting Americans from threats like biological weapons. “It is imperative for first responders to keep themselves safe, so that in turn, they can provide care to those who are injured or ill,”. “For example, first responders should become familiar with the ASPR’s Primary Response Incident Scene Management (PRISM) series, which Kadlec said has been developed to provide evidence-based guidance on mass casualty disrobe and decontamination during a chemical incident. The PRISM guidance is based on scientific evidence gathered under a research program sponsored by the Biomedical Advanced Research and Development Authority (BARDA), which is overseen by ASPR. What many first responders may not realize is that studies during the BARDA research showed that disrobing and wiping skin with a dry cloth removes 99 percent of decontamination, Kadlec said.”

ASM Washington DC Branch & GMU Student Chapter Meeting
Join DC area microbiologists (professionals and students) for an exciting evening of microbiology, networking, and refreshments! Submit an abstract for an oral or poster presentation by March 30th! This even will be held at the GMU Fairfax campus (Exploratory Hall, Room 3301), on April 5th from 6:30-9pm.

Stories You May Have Missed:

  • Clade X Exercise – The Johns Hopkins Center for Health Security will be hosting a tabletop exercise in Washington, D.C. in May. “The goal of this exercise (‘Clade X’) is to illustrate high-level strategic decisions and policies that the United States and the world will need to pursue in order to diminish the consequences of a severe pandemic. It will address a pressing current concern, present plausible solutions, and be experientially engaging. Clade X is designed for national decision-makers in the thematic biosecurity tradition of the Center’s two previous exercises, Dark Winter (2001) and Atlantic Storm (2005). The day-long exercise will simulate a series of Cabinet meetings among prominent players who previously occupied similar leadership positions in past Presidential administrations. Players will be presented with a scenario that highlights unresolved real-world policy issues that could be solved with sufficient political will and attention now and into the future.”
  • Rubber Ducky: Bacterial Deathtrap– Sure, this might be a little dramatic, but if you saw the inside of these beloved bath toys, you’d be pretty grossed out. “Swiss and American researchers counted the microbes swimming inside the toys and say the murky liquid released when ducks were squeezed contained ‘potentially pathogenic bacteria’ in four out of the five toys studied. The bacteria found included Legionella and Pseudomonas aeruginosa, a bacterium that is ‘often implicated in hospital-acquired infections’.”

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

Pandora Report 3.23.2018

TGIF and Pandora Report day! Tomorrow is World TB Day, in which we celebrate the progress made to eradicate TB, but also recognize the work that still needs to be done. Did you know that 53 million lives were saved through effective TB diagnosis and treatment from 2000-2016? In 2016 alone, there were nearly 500,000 cases of multidrug-resistant TB around the world and it takes $2.3 billion a year to fill the resources needed for existing TB interventions. If you happen to be traveling by air anytime soon, make sure to read these tips from public health experts.

How Prepared Are You For the Next Pandemic? Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
Three days filled with global health security and all things biodefense from anthrax to Zika – what more could you want in a workshop? Learn from the top minds in the field when it comes to pandemic preparedness, vaccine development, biosecurity, etc. Between the centennial of the 1918 influenza pandemic, the recent horsepox synthesis, and the lift on the gain-of-function research moratorium, these three days will be packed with exciting topics and discussions. From July 18-20th, come get your biodefense on with us in Arlington, VA – registration prior to May 1st also gets an early bird discount!

Shining A Spotlight On Soviet Nerve Agents
A nerve agent attack in the UK has made the poison, Novichok, a household name, but also pointed a very large spotlight on Russia’s scientists and defense labs. “Few experts in the rarefied area of chemical weapons defense are willing—or able—to shed further light on them. Information about the Novichok nerve agents is classified, says one U.S. military scientist who, like other U.S. government scientists, declined to speak with Science.” Whatever the plan, this failed attempt for the quick deaths of Skripal and his daughter have left many questions about delivery of the agent and how this heavily guarded secret nerve agent found its way onto UK soil. An article from The Trench discusses the use of these nerve agents, formal accusations from the UK, and compliance of the Chemical Weapons Convention (CWC). “The OPCW experts travel to the UK under Article VIII, 38(e), which qualifies their activity as a ‘Technical Assistance Visit’ to help with the evaluation of an unscheduled chemical (the Novichock agent) is not listed in any of the three schedules in the Annex on Chemicals).  They will likely visit the sites of investigation and collect their own samples (if for no other reason than to validate any laboratory samples they may receive), take all materials and documents related to the forensic investigation back to the Netherlands where the sample will be divided up and sent to two or more designated OPCW laboratories.” On Wednesday, Russian diplomatic and military officials reportedly accused the UK of hiding evidence in the investigation of the attack. “Speaking to a lecture hall of diplomats, Vladimir Yermakov, deputy head of the ministry’s department for non-proliferation, suggested that the UK was ‘hiding facts’ about the case that may later ‘disappear’.” British diplomat Emma Nottingham noted that “Russia has offered us so far no explanation of how this agent came to be used in the United Kingdom and no explanation as to why Russia has an undeclared chemical weapons programme in contravention of international law,”.

Pandemic Preparedness
“Are we prepared for the next pandemic?” Such a question pulls at the string of a much larger web that tends to leave many feeling unsettled. The scary truth is that we’re not ready. We know there will be a pandemic – history, science, and society, all tell us this. Encroachment on nature, increasing globalization and populations, and struggles against more frequent threats like seasonal flu and even antimicrobial resistance, all reveal a severe vulnerability to infectious diseases. Lessons from HIV, Ebola, and Zika, are just the latest and on the centennial of the 1918/1919 influenza pandemic, many hope that we learned from such events and can help prevent future ones. Predictions trickle across many sectors – loss of healthcare worker lives, financial and economic struggle, etc. “Such a pandemic could cause a global stock market crash that obliterates the livelihoods and savings of millions of survivors. ‘A severe and prolonged global pandemic could … hit global GDP by as much as 5-10% in the first year,’ noted the authors of the Bank of America/Merrill Lynch 2015 Global Pandemics Primer report. Oxford Economics has suggested that the cost of a global pandemic, including spillover across industry sectors, could be as great as $3.5tn – an impact far greater than the magnitude of the great financial crisis of 2008.” With funding for the GHSA in peril, the question of preparedness becomes even more relevant…and pessimistic. The tricky thing about infectious disease threats is that we’re not sure where the next one will come from. We have hints and sometimes we’ll get a whiff of which way the wind is blowing before the storm hits, but ultimately, there is so much we can’t predict. Given these challenges, prevention efforts, like those of the GHSA, should be seen as even more critical. Infectious disease prevention strategies are always a good return on an investment. It’s also the unexpected that impacts disease control and surveillance efforts. Local news is one that doesn’t often come to mind when considering epidemiology and infectious disease forecasting. “Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories. ‘We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,’ said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.”

GMU Biodefense MS Open House & PhD Information Session
Looking to earn a Masters or PhD in a field that’s at the nexus of foreign policy and public health? GMU Biodefense is just the place for that. We’re hosting two information sessions for our biodefense graduate degrees – the MS Open House is next Wednesday at 6:30pm (Arlington Campus) and the next PhD Information Session is on Wednesday, April 18th at 7pm, in Arlington, VA. These are great opportunities to hear from faculty and students in each biodefense program about not only the application process, but also the classes and what it’s like to study what you love!

CDC Selects New Director
Dr. Robert R. Redfield was just announced as the new director for the CDC. Redfield will take over for interim director Dr. Ann Schuchat, who many were hoping would take post. The new director has a background in HIV and is said to be a dedicated researcher and physician. Unfortunately, Redfield also comes with a rather novel history for CDC directors – he has never worked for a public health department. “Critics also point to a resume marred with controversy. In the 1990s, Redfield was accused of falsifying data about an experimental HIV vaccine he worked on. He was eventually cleared of those charges, but the data had to be corrected.” On Tuesday, Sen. Patty Murray (Wash.) raised concerns regarding his appointment, noting that, “This pattern of ethically and morally questionable behavior leads me to seriously question whether Dr. Redfield is qualified to be the federal government’s chief advocate and spokesman for public health.”

Brazil Calls for Country-Wide Yellow Fever Vaccination
Brazil has been battling a yellow fever outbreak since 2017 and vaccine shortages have only fueled the challenges of outbreak response. “Brazil announced yesterday that all citizens should be vaccinated against yellow fever. The country is currently experiencing a spike in cases in what has shaped up to become the largest yellow fever outbreak to hit the country since the 1940s.The Associated Press (AP) reported that Ricardo Barros, Brazil’s health minister, said all 27 of Brazil’s states will be targeted in a vaccination campaign that will aim to reach 78 million people by 2019. Before the announcement, the vaccine was recommended in all but four Brazilian states.”

Importance of GHSA
GMU Biodefense PhD student Saskia Popescu wants clinicians to understand the importance of the GHSA and why US investment is critical. “Like many components of public health and infectious disease, the importance of prevention is often forgotten until an outbreak occurs. Hospital preparedness and infection prevention were not necessarily ‘big ticket’ items in the United States until we had Ebola in Dallas, Texas, but it only takes 1 laboratory incident to remind us of the importance of biosecurity and biosafety.”

Food Defense Conference
The Food Protection and Defense Institute will be hosting this conference on May 22 & 24th in Minneapolis, MN. “As the food system is becoming ever more global, companies need to be prepared to protect not only their products but also their reputation. The Food Protection and Defense Institute will be hosting a 2-day Food Defense Certification Training Course on May 21 & 22, 2018 that will teach food industry professionals how to navigate basic food defense principles, recognize vulnerabilities, and create a tailored food defense plans.”

Stories You May Have Missed:

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

Pandora Report 2.23.2018

Happy Friday fellow biodefense friends! Curious about human migrant history? Ancient DNA is giving us some insight into our ancestors movements and habits. FluMist also just got the green light for use next flu season.

 Crossing the Rubicon: Horsepox Synthesis
Julius Caesar is said to have stated “alea iacta est” (the die is cast) as he led his army across the Rubicon river, triggering a point of no return in Roman history. In many ways, the horsepox synthesis is considered a new Rubicon for synthetic biology and the life sciences. While the lead researcher of the project and the private company backing it cite desires to advance progress in the pursuit of a new smallpox vaccine and identifying gaps (“Our hope is that this work will promote new and informed public health discussions relating to synthetic biology, stimulate new evaluation of [horsepox]-based vaccines, and advance the capacity to rapidly produce next-generation vaccines and poxvirus-based therapeutics.“), many are asking if they put profits ahead of public safety. The research team claimed they chose to synthesize the virus because they could obtain it no other way, but a recent article by NPR is challenging this. “There was another possibility, NPR has learned. Evans could have done research on a specimen of horsepox collected from the wild, but he didn’t pursue that alternative. He says using the natural virus might have prevented the pharmaceutical company he is working with from commercializing horsepox as a new vaccine for smallpox. But the head of the company told NPR that he had not been aware that this stored sample of horsepox was potentially available — and would not have wanted to synthesize the virus from scratch if he had known.” So now that we’ve ventured across the river, it seems that we may be learning more about dual-use research in general. Gregory Lewis notes that “Beyond the immediate issue of whether the horsepox work should have been performed (or published), the horsepox synthesis story highlights a more general challenge facing dual-use research in biotechnology: the unilateralist’s curse.” Lewis describes the unilateralist’s curse – “imagine that 100 scientists are individually deciding whether it would be a good idea to synthesize horsepox. All of them act impartially and in good faith: They would only conduct this work if they really thought it was on balance good for humankind. Each of them independently weighs up the risks and benefits of synthesizing horsepox, decides whether it is wise to do so, and acts accordingly. The situation arises from the fact that, if synthesis of horsepox is not to occur, all 100 scientists must independently decide not to pursue it; while if any of the scientists judges the benefits to outweigh the risks, he or she acts unilaterally to synthesize horsepox. Thus there is an ‘action bias’: Horsepox synthesis is more likely to occur when scientists act independently than when they agree to a decision as a group.” Has the quest for the “first strike” in scientific discovery outweighed the risks of dual-use research? The horsepox synthesis has cast a bright light upon the challenges of DURC oversight and the gaps we are struggling to even acknowledge. 

Examining Challenges & Possible Strategies to Strengthen U.S. Health Security
The National Academies of Science have released the latest proceedings of a workshop regarding the progress that has been made in the last 15 years towards improving health security, but also the gaps that exist. “On March 8–9, 2017, the National Academies of Sciences, Engineering, and Medicine’s Forum on Medical and Public Health Preparedness for Disasters and Emergencies hosted a two-day public workshop to acknowledge these persistent issues; to evaluate past, and perhaps inadequate, approaches to addressing them; and to discuss intentional and innovative new solutions. This publication summarizes the presentations and discussions from the workshop.” The report includes proposed priorities and challenges, underlying issues in health security, and potential strategies for strengthening American health security. Such strategies include developing a shared agenda, promoting a culture of learning and sharing, building the evidence base for policy and operations, etc. “Levy called for a paradigm shift toward conceptualizing health care, public health, the business community, and other sectors as parts of a whole that need to be integrated to provide a better environment for the community at large and better care for the community on a day-to-day basis.” Optimizing the exchange of information was also discussed, as was ensuring the interoperability of data across multiple systems. Participants also examined the financial components of health security and making the business case for investment.

 Biohacker’s Remorse
Last year saw contaminated CRISPR DIY kits hit Europe, but it did little to calm the biohacking stunts of Odin CEO Josiah Zayner. In a recent article, Zayner pointed to the moment another biotech CEO dropped trouser and injected himself with an untested herpes treatment mid-conference, as a wakeup call. “’Honestly, I kind of blame myself,’ Zayner told me recently. He’s been in a soul-searching mood; he recently had a kid and the backlash to the CRISPR stunt in October had been getting to him. ‘There’s no doubt in my mind that somebody is going to end up hurt eventually,’ he said.” Zayner says his past actions were efforts to provoke people in the industry who are involved in regulation and ethics in regards to roadblocks for CRISPR and DIY kits, noting that it’s a moral and ethical dilemma. Unfortunately, his sentiments aren’t doing much for those who feel his actions were attention-seeking stunts and he has yet to prove his concern for the DIY CRISPR risks. In case anyone was wondering if Zayner is still up to his old tricks, he also provided his latest video (Gut Hack) in which he attempts to give himself a fecal transplant. While this sounds gross (and it is), what’s more concerning is that an unlicensed and untrained individual is attempting to perform a very specific task that requires a stringent infection control guidelines and procedures. For those of us who have spent years working to perfect policies and practices so this medical procedure can be used to treat patients suffering from Clostridium difficile, this is not something to be taken lightly and isn’t exactly a good indicator that Zayner has learned from his mishaps. 

When Poor Infection Control Results In A Lawsuit
Who is responsible when hospitals decide to neglect infection prevention and control? A critical component to patient safety during medical care, infection control failures can result in the spread of infection – like the transmission of Ebola to healthcare workers. A recent court decision may be setting precedent for infection control responsibility during outbreaks. A Seoul court recently ordered the South Korean government to pay compensation to a patient who acquired MERS-CoV after the government failed to implement infection control. The patient “became infected while being admitted at a hospital in Daejeon where patient 16 was staying. Patient 16 moved there not knowing that had been infected by a different person, identified as patient 1 who infected 28 others, at Pyeongtaek St. Mary’s Hospital in Gyeonggi Province. Patient 1, who had been admitted to St. Mary’s more than two weeks after returning from a trip to Bahrain, a Middle Eastern country, May 4, reported suspected symptoms of MERS with health authorities the morning of May 18. However, the Korea Centers for Disease and Prevention (KCDC) dismissed it, saying the country had no reports of a MERS outbreak.” The court notes that if quarantine would have been implemented appropriately, it could have stopped the spread.

Budgeting for Medical Countermeasures
The Bipartisan Policy Center’s latest report highlights not only the growing concern for infectious disease threats, but also the role of medical countermeasures. Pointing to Project Bioshield and the procurement of 27 medical countermeasures, the white paper “will summarize the progress to date in procuring medical countermeasures and prior congressional funding mechanisms for Project BioShield. It will also discuss ways to optimize funding for medical countermeasures so that the existing public-private partnership can continue to thrive: namely, by restoring the program’s original multi-year funding structure.”

Can Nanoparticles Help Us Battle Antimicrobial Resistance?
As news emerges of an extensively drug-resistant (XDR) typhoid strain in Pakistan, it’s hard to imagine winning the battle of the resistant bug. Can nanoparticles tackle AMR? A research team led by Andrea O’Connor at the University of Melbourne is taking on antimicrobial resistance through nanoparticles and collaboration with a nearby hospital. “Together, the team found that selenium (a mineral that humans require in their diets to boost immunity and aid metabolism) in the form of nanoparticles can stop the growth of bacteria such as ‘Golden Staph’ (Staphylococcus aureus). Their findings are published in the Journal of Colloid and Interface Science. They think the nanoparticles do this by disrupting the membrane around the bacteria. ‘One of the ways that these nanoparticles can attack bacteria is by disrupting that membrane so they make the bacteria leaky, and then things can pass in and out of the bacteria in a way they normally wouldn’t’.” The team hopes that selenium nanoparticles have potential applications for when antibiotic efficiency dwindles, especially in terms of chronic wounds. Their nanoparticles have been tested against nine different kinds of bacteria and have found success against all of them.

 Tales From A Virus Hunter
With CDC and global health security funding in a dire situation, the days of virus hunters trekking through jungles and providing boots-on-the-ground support for outbreaks may be in jeopardy. Dr C.J. Peters is one of the old school virus hunters who tackled Rift Valley Fever and Bolivian hemorrhagic fever in their early days. “Peters was a virus hunter. That often meant spending time in the field, mostly in Latin America but also in Africa, where the work was interesting and the bosses far away. ‘If you’re in the shadow of the flagpole from headquarters, you’re in trouble,’ he explained. ‘Because there will be somebody poking into everything you’re doing.’ Virus hunting today is not what it used to be. There is still adventure to be had, with bold scientists seeking to uncover the mysteries of the unseen world and ultimately benefit human health. But things have also changed.”

Stories You May Have Missed:

  • Flu Vaccine Act– Last week several US senators released their proposal to invest $1 billion in research for a universal flu vaccine over the next five years. “From a total investment of $1 billion, the proposed law would direct $200 million each year over fiscal years 2019 through 2023 to universal flu vaccine research at the National Institutes of Health (NIH), according to a press release from Markey’s office. For comparison, he said the NIH’s National Institute for Allergy and Infectious Diseases (NIAID) spent about $64 million in fiscal year 2017 on universal flu vaccine research.”

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

Pandora Report 2.2.2018

The world of health security has been busy this week as news of CDC leadership changes and ongoing flu troubles have caused ripples. A new mouse study is also hinting that West Nile virus may cause Zika-like birth defects. Check out Maryn McKenna’s latest article on changing the market for flu shots and the desperate need for innovation.

 CDC’s Plans to Scale Back Global Health Security Activity 
A recent article brought attention to CDC plans that would reduce efforts to prevent and respond to outbreaks on a global scale through the global health security agenda (GHSA). “In an email to U.S. and overseas leaders in its global health center, the CDC said it anticipates that if its funding situation remains the same, it will have to narrow activities to 10 ‘priority countries’ starting in October 2019. The email was reviewed by The Wall Street Journal.” The 10 countries include Vietnam, India, Nigeria, etc. “Reductions now would halt critical work midstream and result in a loss of newly trained local experts, said Tom Frieden, the former CDC director who led the effort until a year ago and is now president and chief executive of Resolve to Save Lives, an initiative working on strengthening epidemic preparedness.” In response to this alarming plan, the Global Health Security Agenda Consortium, Global Health Council, Next Generation Global Health Security Network, and Global Health Technologies Coalition, have drafted a letter to newly appointed HHS Secretary Alex Azar, regarding the serious implications of such actions. Sent to HHS, CDC, OMB, State and NSC leadership, they underline the funding ramifications of scaling back on CDC’s efforts regarding the GHSA. “US investments in global health security and deployed CDC personnel are making America safer today. For example, US investments in surveillance capacity in Cameroon have decreased the disease outbreak response time from 8 weeks to just 24 hours.” The letter highlights the recent Ebola and Marburg outbreaks as prime examples of work within the GHSA, but also what occurs when global efforts are not available or lacking. “As the United States and the world begin to reap the benefits of our investments in better disease preparedness, now is not the time to step back. The ongoing danger that biological threats pose to American health, economic, and national security interests demands dedicated and steady funding for global health security. Congress and the Administration must invest in our deployed global biodefense capability.” Nothing short of serendipitous, the National Academies have also released their report from a workshop on Exploring Partnership Governance in Global Health. “In global health, collaboration frequently occurs through public–private partnerships (PPPs), with public and private parties sharing risks, responsibilities, and decision-making processes with the objective of collectively and more effectively addressing a common goal. PPPs include government and industry as well as partners from a range of other sectors. The workshop examined what role governance assumes in global health PPPs through presentations and discussion on transparency and accountability, operational challenges, legal considerations, barriers and strategies for engagement, examples of governance structures and lessons learned, and measurement. This publication briefly summarizes the presentations and discussions from the workshop”

Antimicrobial Resistance Surveillance Efforts and Needs
While the outcome is not surprising, this first release of the WHO’s surveillance data on AMR isn’t pretty. Surveillance data is revealing high levels of antibiotic resistance are in fact, found worldwide. “WHO’s new Global Antimicrobial Surveillance System (GLASS) reveals widespread occurrence of antibiotic resistance among 500 000 people with suspected bacterial infections across 22 countries. The most commonly reported resistant bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae, followed by Salmonella spp. The system does not include data on resistance of Mycobacterium tuberculosis, which causes tuberculosis (TB), as WHO has been tracking it since 1994 and providing annual updates in the Global tuberculosis report.” The GLASS program includes 52 countries (25 high-income, 20 middle-income, and 7 low-income countries) and was launched in 2015 as a way to better track and understand the complexities of AMR. Wellcome Trust has also just announced a new strategy to combat AMR on an international scale. SEDRIC (Surveillance and Epidemiology of Drug-Resistant Infections Consortium) will work to strengthen country capacity for AMR surveillance and detection. “We need to better understand where patients acquire bacteria that cause infections – are they acquiring bacteria from other patients, from healthcare settings, water or food or the general environment? Drug-resistant infections are, like us, international travellers. We need to track which borders they cross, and how quickly. Without detailed and up-to-date information we cannot effectively intervene.” SEDRIC will work to fix surveillance gaps across countries by focusing on improving global coordination, identifying critical gaps and barriers, and helping countries to adopt sustainable best practice and strategies. These surveillance efforts and strategies are desperately needed to understand the AMR problem at a global level, especially as it was reported that India’s farmed chickens are dosed with colistin (the antibiotic of last resort). 

CDC Director Steps Down
Dr. Brenda Fitzgerald has stepped down from her role as director of the CDC due to conflicts of interest. “Politico reported on Tuesday that Fitzgerald, a physician and former commissioner of the Georgia Department of Public Health, bought shares in a tobacco company a month into her leadership of CDC, an agency charged with safeguarding public health, including reducing rates of smoking. She took over leadership at CDC in July. After advising the HHS secretary of the status of her financial interests and the way in which it limited her ability to do her job, Azar accepted her resignation, HHS said in a statement.” Dr. Fitzgerald began her role in July and is the second of top health positions appointed by the Trump Administration to resign. Dr. Anne Schuchat is now the Acting Director for the CDC. 

GMU Master’s Open House – February 21st
We’re just a few weeks out from the GMU Schar School MS Open House on February 21st and you won’t want to miss this opportunity to talk to faculty about our biodefense graduate degrees. Whether you’re looking to attend in person or online, this is a great opportunity to discuss the application process, curriculum, and how students are supported in their academic and career goals.

 Hawaii’s False Missile Alert and The Woeful State of US Preparedness
For 38 minutes, residents of Hawaii were alerted that a ballistic missile was approaching the island. A deep-dive of this mishap has found that the “emergency worker who sent a false public safety alert on Jan. 13 warning of an imminent  ballistic missile attack on Hawaii believed that a ballistic missile was truly bound for the state after mishearing a recorded message as part of an unscheduled drill,”. A mix-up in communication between shift supervisors regarding when the drill would run led to a trickle-down of confusion as the day-shift workers were notified of a missile threat (as part of the drill). “Following standard procedures, the night-shift supervisor posing as Pacific Command played a recorded message to the emergency workers warning them of the fake threat. The message included the phrase ‘Exercise, exercise, exercise.’ But the message inaccurately included the phrase ‘This is not a drill.’ The worker who then sent the emergency alert failed to hear the ‘exercise’ portion of the message and acted upon the ‘This is not a drill’ part of the message that should not have been included, according to the report.” Furthermore, the computer systems in place that should’ve been a stop-gap did not detect the difference between test alerts and actual alerts. This event is a prime example of the traditional failure in emergency preparedness exercises (and real events) – communication. Such an event, while frustrating, should be utilized as a teaching tool to truly fix the communication gaps. Sometimes it’s the “did that seriously just happen?” events that teach us the most about the fissures in our preparedness.

Flu Wreaking Havoc on Hospitals, Infection Control Practices Struggling
GMU Biodefense PhD student and infection preventionist Saskia Popescu is looking at the current flu situation from the perspective of infection control and healthcare response. “Hospitals are being hit hard by a rapid influx of individuals who are requiring isolation, treatment, and manpower during a time where health care institutions are already suffering from an intravenous (IV) bag shortage. I’ve seen some hospitals go on diversion because they are so inundated with patients that they are unable to accept any more. Hospitals are experiencing shortages of influenza testing kits, conference rooms and outside tents are being set up as triage/waiting areas, personal protective equipment (PPE) stores are being strained. Furthermore, infection prevention and control practices are being stressed against the influx of patients and staff calling in sick. All the while, clinicians are trying to maintain proper isolation precautions. To add insult to injury, a recent study on the transmissibility of aerosols and the role they play in spreading influenza has uncovered some disheartening results.”

Tests Link Syrian Government Stockpile to Largest Sarin Attack
Laboratories performing analysis for the Organisation for the Prohibition of Chemical Weapons (OCPW) have confirmed linkage between the Syrian government’s chemical weapons stockpile and the largest sarin attack of the civil war. “The tests found ‘markers’ in samples taken at Ghouta and at the sites of two other nerve agent attacks, in the towns of Khan Sheikhoun in Idlib governorate on April 4, 2017 and Khan al-Assal, Aleppo, in March 2013, two people involved in the process said. ‘We compared Khan Sheikhoun, Khan al-Assal, Ghouta,’ said one source who asked not to be named because of the sensitivity of the findings. ‘There were signatures in all three of them that matched’.” The test results further reinforce the widespread belief that the Assad regime has not destroyed their chemical weapons supply (and continues to use them), which would violate not only the Chemical Weapons Convention, but also several UNSC resolutions. Russia continues to maintain that the Syrian government has not carried out such attacks and that the OCPW inquiries aren’t reliable, but inspectors continue to find evidence of chemical weapons in Syria. “Independent experts, however, said the findings are the strongest scientific evidence to date that the Syrian government was behind Ghouta, the deadliest chemical weapons attack since the Halabja massacres of 1988 during the Iran-Iraq war.” “A match of samples from the 2013 Ghouta attacks to tests of chemicals in the Syrian stockpile is the equivalent of DNA evidence: definitive proof,” said Amy Smithson, a U.S. nonproliferation expert. “The hexamine finding ‘is a particularly significant match,’ Smithson said, because it is a chemical identified as a unique hallmark of the Syrian military’s process to make sarin. ‘This match adds to the mountain of physical evidence that points conclusively, without a shadow of doubt, to the Syrian government,’ she said.” Furthermore, experts are dispelling the notion that the attacks could have been carried out by rebels, noting that it would be impossible for them to achieve such a coordinated, large-scale attack.

Stories You May Have Missed:

  • South Korea Works to Eradicate Avian Flu Before Olympics – “With the PyeongChang Winter Olympics set to begin on Feb. 9, the South Korean Ministry of Agriculture, Food and Rural Affairs announced Monday that it had confirmed the presence of a highly pathogenic strain of the H5N6 avian influenza virus at two chicken farms south of Seoul, Korea JoongAng Daily reportsThe two farms both are approximately 80 miles to the west of PyeongChang. The government has culled 190,000 chickens at the farm in Hwaseong and another 144,000 at the farm in Pyeongtaek. It also has ordered that 430,000 chickens on farms in a 500-meter radius of the Pyeongtaek farm be slaughtered and has destroyed nearly 500,000 eggs at the Hwaseong farm as a precautionary measure. The government also will inspect and disinfect other farms in the area.”
  • Yellow Fever in Brazil – Cases of yellow fever have jumped in Brazil, based upon data from the Ministry of Health data. “In 1 week, the number of recorded deaths from yellow fever rose from 20 to 53, reported cases rose from 470 to 601, while confirmed cases jumped from 35 to 130, O Globo reported yesterday. All deaths have occurred in Minas Gerais, Sao Paulo, and Rio de Janeiro states. Ministry of Health data lag behind data from state officials, Brazilian media reported. The state health data for Minas Gerais notes 24 deaths (1 more than the federal government count), and Rio de Janeiro recorded 8 deaths (also 1 more than the federal total for that state.)  All reports indicate that Sao Paulo has 21 deaths.”

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

Pandora Report 1.26.2018

In this week’s Pandora Report we’re taking a trip down the horsepox synthesis rabbit hole, looking at influenza transmission, and so much more. But first..the Bulletin of the Atomic Scientists just announced that the Doomsday Clock has been moved and is now two minutes to midnight. You can also read the full testimony from Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, during the US Senate Committee hearing on the reauthorization of the Pandemic and All-Hazards Preparedness Act. The Senate has also just confirmed Alex Azar as the new head of Health and Human Services.

The Perilous Road of Horsepox Synthesis 
Unless you were in a state of flu-induced delirium, last Friday was a rather big day in with world of dual-use research of concern (DURC) news. The controversial publication of Dr. Evans’ synthesis of horsepox has brought about a flurry of discussion and debate regarding the implications of not only such research, but also the publication of it. Kai Kupferschmidt provided an overview of the history of this paper and what its publication means, so if you’re needing a refresher, I’d start there. As many within the biodefense and biosecurity industry read the paper, it sparked a renewed concern for how such research has exhumed a gap within DURC oversight and publication review. GMU’s biodefense guru and graduate program director Gregory Koblentz expanded upon his thoughts regarding these oversight failures. Pointing to not only the utter disaster that a smallpox re-emergence would be, he also evaluates the PLOS editorial statement and review of DURC work. “Given the serious potential risks that this research could be used to recreate variola virus, the blanket assertion by the PLOS Dual-Use Research Committee that the benefits of this research outweighs the risks is woefully insufficient. The committee dramatically understates the risks and overestimates the benefits this research presents. The U.S. government has outlined a number of factors to consider and questions to ask about dual-use research when weighing the risks and benefits of conducting and publishing such research. Although this research did not fall under current U.S. regulations on dual-use research of concern, the authors and publisher were well aware of the risks that I and others had raised and they had an ethical responsibility to carefully consider those risks before publishing the article.” NTI’s Dr. Elizabeth Cameron, VP of Global Biological Policy and Programs, weighed in on the publication and how it underlines the need for dialogue at a global level to reduce biological risks. Cameron notes that these hurdles aren’t getting smaller and the incremental approach just isn’t getting us where we need to be. “Moving forward, it’s clear that the capability to create and modify biological agents is outpacing governmental oversight and public debate. Now more than ever, scientific stakeholders, private sector actors, and biotechnology leaders should develop and take specific actions to mitigate risk and accelerate biosecurity innovation.” Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, has also put forth commentary on the horsepox synthesis, pointing to the lack of clear-cut benefits and and that ultimately, it created a new risk. Inglesby notes that “The most important locus of control should be whether specific research is approved and funded in the first place. When scientists are considering the pursuit of research that has the potential to increase highly consequential national population-level risks, national authorities and leading technical experts on those issues should be part of the approval process. When there are highly consequential international population-level implications, international public health leaders should also be involved. When researchers put forth claims about potential benefits of this work to justify extraordinary risks, those claims ought not be accepted without discussion; those claims should instead be examined by disinterested experts with the expertise to validate or refute them.” GMU biodefense PhD student and infection preventionist Saskia Popescu also discussed the importance of this publication and why medical providers and researchers should be paying attention to the DURC debate.

ASM Biothreats
The American Society for Microbiology will be hosting their annual conference on biological threats from February 12-14 in Baltimore, MD. If you’re not able to attend, we’ve got you covered with in-depth reporting and analysis by some of GMU’s finest biodefense graduate students. Following the conference, we’ll be providing this report-out as we did with the 2017 conference, so make sure to check back for the scoop on all things ASM Biothreats.

Chemical Weapons – No Impunity
The International Partnership Against the Impunity for the Use of Chemical Weapons has just been launched! “Ringing together around 30 countries and international organizations, its purpose is to supplement the international mechanisms to combat the proliferation of chemical weapons. This intergovernmental initiative deals exclusively with the issue of impunity for the perpetrators of chemical attacks worldwide, and is a forum for cooperation in which the participating States have made several commitments that include gathering, compiling, and retaining all available information on those who use chemical weapons, etc.” Efforts like this are increasingly needed as the use of chemical weapons in Syria has been met with little adverse outcome for those at fault. GMU’s Dr. Gregory Koblentz highlighted Syria’s CW killchain, noting that “Bringing these criminals to justice, however, will be a long, slow, and difficult process. Many individuals who comprise Syria’s chemical weapons kill chain were listed in a U.N. Security Council resolution that was vetoed by Russia and China on Feb. 28.” Koblentz also points out that “So far, the only concrete steps to hold these individuals accountable for their actions are financial sanctions and travel bans imposed by the U.S. and European governments. Although the sanctions themselves are largely symbolic, by identifying these individuals and specifying their role in the chemical attacks, the United States and its European allies are laying the groundwork for future prosecutions once Assad is no longer in power.”

Germ Transmission While Flying
Dr. Nereyda Sevilla, George Mason Biodefense PhD 2017 alum, presented the results of her dissertation at the Transportation Research Board (TRB) 97th Annual Meeting held January 7–11, 2018, at the Walter E. Washington Convention Center, Washington, D.C. The information-packed program attracted more than 13,000 transportation professionals from around the world. Nereyda’s poster entitled “Germs on a Plane:  The Transmission and Risks of Airplane-Borne Diseases” was part of the Young Professional’s Research in Aviation Session.  Her research explored the role of air travel in the spread of infectious diseases, specifically Severe Acute Respiratory Syndrome (SARS), H1N1, Ebola, and pneumonic plague. She concluded that modeling showed that the spread of Ebola and pneumonic plague is minimal and should not be a major air travel concern if an individual becomes infected. On the other hand, H1N1 and SARS have higher infectious rates and air travel will facilitate disease spread across the country.

Schar School Career Fair
Schar School students and employers looking for talented graduate students – on Wednesday, February 14th from 2-5pm, GMU’s Schar School will be hosting a Career Fair at the Arlington campus. “The Schar School of Policy and Government at George Mason University, in conjunction with the School for Conflict Analysis and Resolution, will host our annual career and internship fair that attracts more than one hundred employers from federal, business, and non-profit organizations who are eager to meet our outstanding students.” For our readership – this is also a great place to recruit biodefense students who are passionate about health security!

Nonproliferation Review Call For Papers
Calling all writers of the nuclear, chemical, and biological weapons persuasion – the Nonproliferation Review is accepting manuscripts for publication in 2018! “All submitted manuscripts that are accepted for publication in Volume 25 are eligible to win the Doreen and Jim McElvany prize of $5,000, a $3,000 runner’s-up prize, or a $1,000 honorable mention prize. The deadline to submit is July 6, 2018; however, due to the limited number of pages that we can publish in a single volume, eligible articles will be accepted for publication on a rolling basis. It is therefore in authors’ interest to submit early to ensure consideration for the prize. Submissions must contribute new ideas and insights to the nonproliferation field. The Review’s editors welcome submissions on any topic related to weapons proliferation, including but not limited to chemical, biological, radiological, nuclear, and conventional weapons. Example topics include: activities and developments in international nonproliferation regimes; social, political, and economic dynamics of specific countries and regions with regard to weapons development and/or proliferation; new information on policies or weapons programs of specific countries; the spread of knowledge, materials, or technologies with potential destructive applications; the proliferation of new technologies impinging on international security; measures, either existing or proposed, to control proliferation; the causes of proliferation or nonproliferation; the consequences of proliferation, including its influence on strategic stability and its economic or environmental effects; and the relevant activities of non-state actors, such as nongovernmental organizations or terrorists.”

 Influenza Aerosols
A new study has found that influenza aerosol-spread is more common than previously thought, especially in relation to coughing and sneezing. “To measure transmission, each participant sat in a chamber for 30 minutes with his or her face in a large metal cone, part of a ‘Gesundheit machine’ that captures and measures influenza virus in exhaled breath. Patients were also asked to cough, sneeze, and say the alphabet three times. Altogether, researchers collected 218 nasopharyngeal samples and 218 breathing sample sessions. When the team analyzed the samples, they found that a significant number of patients routinely shed infectious virus—not just RNA particles—into particles small enough for airborne transmission. They were surprised to find that 11 (48%) of the 23 fine aerosol samples acquired when patients weren’t coughing had detectable viral RNA, and of those 8 contained infectious virus, suggesting that coughing isn’t a prerequisite for generating fine aerosol droplets.” The latest news points to not only the importance of staying home when sick, but also the ease of transmission of influenza viruses. While many thought transmission was limited to droplets (i.e. heavier particles that were sneezed/coughed out about three feet), this latest analysis may change the dynamics of isolation.

Stories You May Have Missed:

  • Addressing AMR in Lower-Income Countries – Fighting antimicrobial resistance (AMR) is a global challenge, but we need to ensure that our strategies account for a range of countries and the unique barriers they face. “Although traditional efforts to reduce the spread of antibiotic resistance in these countries have focused on antibiotic use in individuals, LMICs must also address the increasing roles of animal and environmental exposures in this public health crisis, write Maya Nadimpalli, PhD, University of Versailles Saint-Quentin-en-Yvelines, France, and colleagues. ‘In particular, current strategies do not prioritize the impacts of increased antibiotic use for terrestrial food-animal and aquaculture production, inadequate food safety, and widespread environmental pollution,’ the authors stress.”

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