Pandora Report 7.21

Beat the heat and cool down with your weekly report on all things biodefense! Have you ever wondered how researchers become bug-chasers? Check out this story on what turned a wildlife biologist into a plague-chaser in the Southwest.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
Thanks to our amazing faculty and attendees for a successful (and fun) summer workshop this week. We heard from Ed You on safeguarding the bio economy, Dave Franz explained the dual-use dilemma in life sciences, Sonia Ben Ouagrham-Gormley discussed barriers to bioweapons, Andy Kilianski explained the ins and outs of biosurveillance, Kendall Hoyt discussed the role of innovation and MCM, Sandy Weiner highlighted the social and cultural disease amplifiers, and so much more! Did I mention that Greg Koblentz brought the house down by discussing why biosecurity is a wicked problem? You can check out the Twitter stream here to see some amazing photos and dialogue during the three-day event. Participants from all over the globe, with backgrounds in everything from infectious diseases to defense and academia, participated in talks that truly ranged from anthrax to Zika, with pit stops on influenza and Ebola. With the 1918/1919 pan-flu centennial anniversary next year, we’re already starting to put together a great workshop for the summer of 2018, so keep on the look-out for more info in the future.

The Future of the GHSA and American Biodefense
Next week in Seoul, a meeting will be held for the Steering Group of the Global Health Security Agenda (GHSA) to discuss what exactly the future entails for the group. While its five-year run will expire in 2019, many are pushing for the GHSA to be extended as it is a highly valuable piece to global health security and IHR compliance. “Recognizing that the GHSA’s work has never been more vital and would be impossible to replace, more than 100 health and health security organizations and companies operating in over 150 countries, including the Nuclear Threat Initiative (NTI), this week banded together to urge GHSA’s extension for at least another five years.” The NTI signed on for several reasons – the world is still not prepared to handle a pandemic of a lethal/easily transmittable disease and frankly, the GHSA provides measurement, accountability, and transparency, which are all desperately needed in global health security efforts. The NTI recently released a statement regarding their support for extending the GHSA beyond 2019, highlighting its irreplaceability and proven ability to help measure and support change in countries working to strengthen their prevention and response to biothreats. Next week’s meeting with be the first since President Trump took office, which makes its outcome that much more important. NTI cites several GHSA successes in efforts to highlight the desperate need we have for it – commitment of more than 75 countries, developing and implementing the first agreed set of global metrics for national health security, mobilizing the private sector to engage in pandemic preparedness and response, etc. Discussions regarding the future of the GHSA comes at a poignant time as the House Appropriations Subcommittee approved FY 2018 State and Foreign Operations (SFOPs) and Health and Human Services (HHS) Appropriations Bills. The approval supports efforts to maintain global health funding. The bill includes funding for the State Department and USAID through the Global Health Program (the bulk of global health assistance) and despite President Trump’s FY2018 request (which would have cut it by $1.8 billion, or 28%), it’s providing $3.8 billion, which is roughly 5% less than FY 2017. Also within the bill – “funding provided to CDC for global health matched the FY 2017 enacted level ($435.1 million) and was $85.1 million (24%) above the President’s FY 2018 request. Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $73.4 million, a slight increase above the FY 2017 enacted levels ($72.5 million); FIC was eliminated in the FY18 Request.” Despite the cuts that are suggested in his proposed FY 2018 request, the Trump administration is reportedly developing the first comprehensive strategy on biosecurity. A top White House homeland security official reportedly said that such efforts are underway and involve retired Admiral Tim Ziemer. “We have not had as a country a comprehensive bio-defense strategy ever,” White House homeland security adviser Thomas Bossert told the annual Aspen Security Forum, in Aspen, Colorado. “It’s high time we had a bio-defense strategy.” While Bossert points to the need for a biodefense strategy, it is crucial to remember that the U.S. has already gone through two biodefense strategies – the 2004 Homeland Security Presidential Directive 10 (Biodefense for the 21st Century) and 2009’s National Strategy for Countering Biological Threats. This news comes on the heals of Trump’s nominee for a key biosecurity position. Guy B. Roberts of Virginia was just nominated to be an Assistant Security, Nuclear, Chemical, and Biological Defense Programs within the DoD. “Mr. Roberts is currently president of GBR Consulting, a national security consulting firm. In that capacity, Mr. Roberts has provided subject matter expertise on arms control, non-proliferation, international legal issues and strategies to combat terrorism to over 30 international and domestic organizations and institutions. In addition, he is a senior associate with the Center for Strategic and International Studies and an adjunct professor teaching courses on homeland security, international terrorism, non-proliferation, and arms control at Mary Washington University and Virginia Commonwealth University. Mr. Roberts previously served as the Deputy Assistant Secretary General for Weapons of Mass Destruction Policy and Director of Nuclear Policy for the North Atlantic Treaty Organization.” You can catch some of his talks via C-SPAN here, and while there’s not a lot on his work in biodefense, you can read this paper within the USAF Institute for National Security Studies, entitled, “Arms Control Without Arms Control: The Failure of the Biological Weapons Convention Protocol and a New Paradigm for Fighting the Threat of Biological Weapons“. His paper notes that despite the 2001 U.S. rejection of the BWC protocol for more stringent compliance mechanisms, there was still substantial focus on biological weapons and potential threats (especially after the 2001 Anthrax attacks). Roberts notes that “The time for ‘better-than-nothing’ proposals is over. A united world, acting in concert across a broad front of areas utilizing the full panoply of financial, diplomatic, economic, and military resources at our disposal, with the firm determination to rid the world of these weapons of terror, is our best hope for success.” In all, with talks next week on the GHSA, presidential hopes of cutting health funding, and a supposed biosecurity plan in the works, the future of health security is seemingly in the air.

The Case of the Reconstituted Horsepox and Other Dual-Use Adventures 
Last week we, like so many others, were engrossed in the news that a Canadian research team had reconstituted horespox with $100,000 worth of supplies and mail-ordered DNA. The news of this unpublished study has raised a lot of red flags for those in the dual-use research community, as well as the debate on the remaining smallpox stockpiles. What’s most concerning about the project, led by virologist David Evans as the University of Alberta, is that it wasn’t stopped earlier on for DURC concerns and risk reviews. Gregory Koblentz, biodefense guru and director of the GMU graduate program, “says the work should never have been done. His worry isn’t so much that terrorists will cook up smallpox anytime soon. ‘My concern is that we have opened up the door to the idea that it is perfectly acceptable to synthesize [such] viruses without any oversight,’ Koblenz says. And if the necessary technology and expertise spread, it will become “that much easier at some point for those capabilities to be turned from peaceful uses to hostile uses’.” This project and the resulting discussions will surely play a pivotal role in the future of DURC and oversight, so we’ll make sure to keep you updated!

North Korea’s Bioweapons Program
GMU Biodefense professor Sonia Ben Ouagrham-Gormley is taking a deep dive into the realities of North Korea’s potential bioweapons program. Working backwards from the 2015 photo tour with Kim Jun-un at a pesticide facility that certainly had dual-use potential and was a seemingly obvious attempt to send a message to the U.S.,  Ouagrham-Gormley highlights the sordid history that is North Korean bioweapons. While South Korea has repeatedly claimed North Korean maintains an active program, there have been inconsistent reports elsewhere and Ouagrham-Gormley hones in on realities about this well-publicized dual-use equipment and facility. She notes critical aspects that would be missing from an active bioweapons program (even if you have all the shiny equipment), like consistent electricity, economic stability, and an effective laboratory/research management. While there are gaps in intelligence regarding the conditions that would truly facilitate an active (and successful) bioweapons program, “analyses of past state and terrorist bioweapons programs indicate that the continuity and stability of scientific and production work must be ensured over a long period of time to allow scientists and technicians to accumulate the knowledge necessary for development of a working bioweapon.” While many suspect that a North Korean bioweapons program was launched in the 1960s and then new infrastructure was built in the 1970s, there are a lot of questions regarding the continuity of such efforts. Were there breaks in between? Changing research teams and inconsistent management/organization all severely impact the efficacy of such secretive work. Perhaps one of Ouagrham-Gormley’s most critical points (and why you should check out her book, Barriers to Bioweapons), is that to truly assess the alleged bioweapons program, one has to understand the state of natural and medical science in North Korea. “Without a solid foundation in natural and medical sciences, a bioweapons program cannot succeed. When Soviet authorities issued a decree to expand the country’s bioweapons program in the early 1970s, they had to face the reality that Soviet science had fallen behind and needed modernization. Years of Stalin’s purges, along with the policy of Lysenkoism—which negated the role of genetics in science—had resulted in the elimination of a whole generation of competent scientists. Decades of economic sanctions, and the desperate state of North Korea’s economy and society, have undoubtedly had an effect on the scientific sector.” With these notions, Ouagrham-Gormley questions if the North Korean bioweapons program is more of a Potemkin village. While there is limited information on the organized scientific research in North Korea or real potential for such a program to exist, more information is needed, which would be a great task for a BWC verification regime.

Center for Biosecurity ELBI Research and Policy Symposium 
This week the Johns Hopkins Center for Health Security held their first research symposium for the Emerging Leaders in Biosecurity Initiative (ELBI). The current ELBI class and several alumni presented on research and projects they’re working on. The topics ranged from dual-use research to risk assessments, biosecurity, and more. During this time they also toured the Johns Hopkins Medical Center’s Biocontainment Unit. Two GMU biodefense students attended – Francisco Cruz (MS alumni and ELBI class of 2016) and Saskia Popescu (PhD student and ELBI class of 2017), who presented on the role of infection prevention in biodefense efforts.

Tackling the Next Epidemic With Big Technology
In an age of globalization and increasing spillover, the threat of naturally occurring outbreaks spreading from one corner of the globe to the other is a real fear. Fortunately, we also live in a time of great technological advances and a wealth of data. A recent article from B.Next highlights the availability of data technologies and how such big data can be woven into the fabric of public health prevention and intervention. Outbreaks and pandemics threaten global security and perhaps one of the biggest hurdles is matching the data needs with the limited supplies on the ground. Data gaps and lags are a massive problem when responding to an outbreak, especially in terms of specialized personnel and resource constraints. There are several technologies though, that could be applied to response efforts – novel data or means of collection, crowdsourcing methods, data cleansing, analytics, and visualization. “Improving response times for activities that have proven to be effective (i.e, non-pharamceutical interventions) need to be prioritized. The full potential of surveillance and advanced analytics for improving outbreak management has not yet been realized and, unfortunately, is not yet adequate to the task. We need a fundamental reconsideration of how to use combinations of data technologies for effective response management. Accomplishing this reconsideration and implementing it effectively will allow for faster, better, stronger responses. Past outbreaks have threatened national security, but they do not need to be as significant a threat in the future. Current and emerging data technologies can help tackle the next epidemic.”

Stories You May Have Missed:

  • USDA Test Finds Atypical BSE In Alabama Cow – A recent announcement from the USDA reported the finding of atypical bovine spongiform encephalopathy (BSE) in an 11-year-old cow in Alabama. This would be the 5th case in the U.S. since 2012 and the cow did in fact have symptoms of the disease, which was picked up by routine surveillance. “The animal never entered the slaughtering process and has not posed a threat to the food supply or to human health. The Alabama Department of Agriculture and Industries (ADAI) said in a press release yesterday that cow died after it was delivered to the livestock market and that routine tissue samples were taken and sent for testing. Tony Frazier, DVM, Alabama’s state veterinarian, said ‘This instance proves to us that our on-going surveillance program is working effectively’.”
  • Three Antibiotics Discovery Projects You Should Know About: With the threat of antimicrobial resistance only growing bigger, BARDA, CARB-X, and big pharma are bringing out the big guns with the Superbugs & Superdrugs USA this November. “Understanding the translational link between animals and humans; navigating the pitfalls of early drug discovery; and evaluating the potential of immunotherapies will be a major focus, as will hearing from a selection of biotech and pharma companies currently undertaking clinical research. This will include case studies from Pfizer, MedImmune, Merck, Visterra and ContraFect. Event highlights will include a keynote presentation by Tim Opperman, Senior Research Scientist from Microbiotix. The talk will discuss advances in the three-prong approach taken by Microbiotix to address the problem of MDR Gram-negative pathogens. It is claimed that all three discovery projects have demonstrated efficacy in murine models of infection.”
  • Stanford Hospital – A Canary In A Coal Mine: Stanford Healthcare is coming under increasing public scrutiny as a battle between members of an affiliated union have highlighted hospital infection rates as evidence for unsafe working conditions and patient safety. GMU biodefense PhD student Saskia Popescu takes a deeper dive into this situation and what it really means for healthcare infections and patient safety. “The healthcare industry is always in a battle against cutting costs, keeping patients safe, and maintaining high patient satisfaction; all while following federal regulations and requirements. Despite the alarmist nature that comes across in the media coverage on the Stanford case, we need to realize that this is only a glimpse through the window that is healthcare infection control and the struggle to follow best practices while working in an increasingly stressful environment. In this case, Stanford Health Care is the canary in the coal mine, alerting us that there’s a problem. They just happened to get the media scrutiny that comes with being pulled into a union debate involving the safety of employees.”

Pandora Report 7.14.2017

Welcome to your weekly dose of all things biodefense! We’ve got a lot of global health security goodies for you this week, so grab a coffee and let’s get our biodefense on!

Canadian Researchers Reconstitute Horsepox With Online DNA Order
Friday was an exciting day in the world of dual-use research of concern (DURC) and biosecurity efforts. News of a Canadian research team and their successful experiment in reconstituting horsepox, brought to light several concerns and gaps within DURC oversight. Led by virologist David Evans, the team was able to synthesize horsepox, a relative of smallpox, which is no longer found in nature. What is really concerning so many about this experiment is that Evans and his team were able to do this with little specialized knowledge, $100,000, and using mail-order DNA fragments. While the study hasn’t been published, it is drawing a lot of attention, not only for the potential that such a process could be applied to smallpox, but also that it failed to trigger more reviews at an institutional level for DURC risks. While the U.S. DURC oversight only applies to federally funded research with fifteen select agents, the Canadian processes cover such research that could disseminate knowledge, regardless of what organism is being used. GMU’s Dr. Gregory Koblentz spoke to Science and discussed DURC oversight, noting, “That should have captured the horsepox synthesis,”. “But as far as I understand, they did not engage in a systematic review of the broader dual-use implications of synthesizing an orthopox virus,” says Koblentz. “I don’t think this experiment should have been done.” Researchers and biosecurity experts around the world are weighing in on this study, especially since its publication is immiment. Tom Inglesby of the Center for Health Security pointed to three serious questions and concerns that this work raises – whether experimental work should be performed for the purpose of demonstrating that a dangerous or destructive  outcome could be created by using biology, how much new detail will be provided in the forthcoming publication regarding the processes for constructing an orthopox virus, and the international biosecurity and biosafety implications regarding the approval process for such experimental work. Perhaps one of the most startling aspects of all the commentary and reports on the horsepox experiment has been Evans own opinion on it all – “Have I increased the risk by showing how to do this? I don’t know,” he says. “Maybe yes. But the reality is that the risk was always there.” Where ever you might stand on the topic of dual-use research, bioethicist Nicholas Evans of the University of Massachusetts (of no relation to David Evans), said it best regarding this debated experiment – “an important milestone, a proof of concept of what can be done with viral synthesis. Aside from the oversight and life science research questions that this experiment brings to light, it also stirs the embers of the fiery debate regarding the destruction of the remaining smallpox stockpiles. The most recent blue ribbon panel review regarding the 2014 NIH variola incident sheds some light on the biosecurity and biosafety challenges of maintaining the stockpiles. You can check out the report of the Blue Ribbon Panel to Review the 2014 Smallpox Virus Incident on the NIH Campus  here. The report goes through the event itself, as well as their findings on the incident, response to the incident, and policy changes. Some of the contributing factors they identified included lack of responsibility for infectious materials in shared space, failure to find all variola samples in the 1980s, lack of complete and regular inventory of potentially hazardous biological materials, lack of policy for abandoned materials, history of NIH lapses following implementation of the Select Agent Regulations, etc.

Summer Workshop – Last Chance to Register!
Our Summer Workshop on Pandemics, Bioterrorism, and Global Health Security starts on Monday, July 17th, which means you still have time to register! Don’t miss out on this wonderful opportunity to discuss everything from Ebola to the concerns surrounding the horsepox dual-use dilemma. This three-day workshop will feature experts across the field of biodefense and will provide participants with a wonderful opportunity for networking and brainstorming!

The Pentagon Weighs the Threat of Synthetic Bioweapons 
While the topic of synbio and DURC is still fresh in our minds, how is the Pentagon considering gene-editing as a potential threat? Sure, we prepare for natural outbreaks and acts of bioterrorism, but how does CRISPR come into the mix? “Pentagon planners are starting to wonder what happens if the next deadly flu bug or hemorrhagic fever doesn’t come from a mosquito-infested jungle or bat-crowded cave. With new gene editing tools like Crispr-Cas9, state enemies could, theoretically, create unique organisms by mixing-and-matching bits of genetic information.” In response to these questions and potential scenarios, deputy assistant secretary of defense for chemical and biological defense, Christian Hassell, is working to get some answers. Hassell and other Pentagon colleages funded a year-long review by the National Academies of Sciences to evaluate the health security threats of synbio. While the review is still going on, a preliminary report is undergoing “classified review” before it can be publicly released. This review will be vital to consider the future of gain-of-function research and other dual-use research of concern in the context of biodefense. “Scientists at the meeting expressed a range of ideas about how the military could best defend against biological threats. Sriram Kosuri runs a synthetic biology lab at UCLA that has developed libraries of DNA sequences that can be developed into new kinds of organisms. While he understands the possibility of a lab-engineered threat, he believes the Pentagon and federal health officials should focus on responding to emerging public health menaces rather than monitoring academic labs that use genetic manipulation tools. ‘There’s a legitimate threat of emerging viruses and we need to be prepared for those things,’ Kosuri said during a break in the meeting. ‘The tiny threat of engineered viruses is miniscule compared to that’.” The challenging part in all of this is that there’s no precedent – this is a new field of threat and risk analysis where historical examples are lacking. Hypothetical situations and response scenarios are the best we can offer, but some of the most valuable tools are the ones we already have, like surveillance or early-stage review processes.

Trump Appoints A Key Bioterrorism Position But Still Leaves Dozens Open
Biological threats aren’t just acts of bioterrorism, but also natural outbreaks or laboratory accidents. If the latest horsepox experiment hasn’t convinced you already, we live in a time of quite unique and diverse biothreats. The spectrum of threats requires an array of agencies and personnel with the skills and resources to prevent and respond to such an event. Unfortunately, we’re currently at a national disadvantage in terms of biodefense. If we look at just one small facet of biothreats (bioterrorism), the U.S. has twenty-six (now twenty-five with the nomination of Kadlec) major and vital roles that are vacant and have not been filled by the Trump administration. While some are awaiting confirmation, there are vacancies without even a nominee like the White House position of Director, Office of Science and Technology Policy. The Department of Health and Human Services is missing a surgeon general and assistant secretary for health (awaiting confirmation), while the U.S. Agency For International Development lacks a nominee for the assistant administrator for global health. There are just a few of the vital positions we rely upon for preventing and responding to acts of bioterrorism. In the wider context of all biological threats, it may not seem like much, but the truth is that these vacancies leave the U.S. in a dangerously vulnerable position. Fortunately, President Trump announced on Monday his plans to nominate Robert P. Kadlec of New York to be the Assistant Secretary of Health and Human Services for Preparedness and Response. “Currently, Dr. Kadlec is the Deputy Staff Director for the Senate Select Committee on Intelligence. Previously, he served as a Special Assistant to the President for Biodefense Policy for President George W. Bush. Dr. Kadlec holds a B.S. from the U.S. Air Force Academy; a M.D. from the Uniformed Services University of the Health Sciences, and a M.A. in National Security Studies, Georgetown University.” He was also the Director for the Biodefense Preparedness on the Homeland Security Council and aided in drafting the Pandemic and All-Hazard Preparedness Act, as well as conducting the biodefense end-to-end assessment (culminating in the National Biodefense Policy for the 21st Century). You can even watch Dr. Kadlec speak on C-SPAN at the Bipartisan Policy Center & Kansas State University forum on biodefense in October of 2016. Dr. Kadlec also directed the Blue Ribbon Study Panel on Biodefense during their efforts to establish guidance during critical biothreats.

Public Health Preparedness and Response National Snapshot 2017
The CDC just released their 2017 snapshot regarding U.S. public health preparedness and response, noting that “this year has shown us, once again, that we can’t predict the next disaster. But it has also shown us clearly how being prepared protects health and saves lives. Emergencies can devastate a single area, as we saw with Hurricane Matthew, or span the globe, like Zika virus. Disasters from 9/11 to Ebola have demonstrated that we absolutely must have people, strategies, and resources in place before an emergency happens.” Within the snapshot, there are four main sections- Prepare, Respond, Connect, and Looking Forward. Within these sections, you can look at Zika, laboratories as the front lines of America’s health, global training programs, delivering results through partnership, etc. I found the section on Health Security: How Is The U.S. Doing, quite interesting. They note that “as part of the Global Health Security Agenda, teams of international experts travel to countries to report on how well public health systems are working to prevent, detect, and respond to outbreaks. This process is known as the Joint External Evaluation.” The CDC and Office of the Assistant Secretary for Preparedness and Response (ASPR) work together to establish evaluators , etc. Thankfully, this position is in the process of being filled so that these efforts can move forward. While this snapshot captures the range of issues that must be covered in public health preparedness, it also draws attention to how vital the roles in each agency are, which makes the vacancies that much more impacting.

Summary of Key Recommendations – Meeting to Solicit Stakeholder Input on Forthcoming 2017 National Biodefense Strategy
The Johns Hopkins Center for Health Security, supported by the Open Philanthropy Project, recently held a meeting to discuss and consider the landscape of biological threats to the United States and what response measures, programs, and policies are in place, etc. Featuring members from across academia, industry, and government, these subject matter experts weighed in on this honest and frank discussion about U.S. biodefense strengths and weaknesses. There were several recommendations and topics that were discussed but some of the highlights include improving biosurveillance capabilities and laboratory network, performing risk assessments and characterizing threats, strengthening emergency response capabilities including decontamination efforts, prevention-related efforts, building global capacities for bio-threat preparedness and response, etc. They noted several components to improving U.S. biodefense – “internationally, laboratory and surveillance systems for early detection of new outbreaks will be most effective when they serve the needs of countries where they are housed. It will not work for the US to create systems to gather and export data that the US needs from countries if those countries do not get the information themselves and find it to be valuable.” In regards to healthcare system response and strengthening the workforce, the group pointed out that “national and international preparedness for biological threats requires a strong workforce, including public health experts and animal and plant disease scientists. To some degree, success at controlling infectious diseases in the US may have inadvertently resulted in workforce attrition in these fields. Federal support for developing the workforce in these fields is important”.

Strategies for Effective Biological Detection Systems: A Workshop
Don’t miss this workshop put on by the National Academies of Sciences on Monday, September 18th – Tuesday, September 19th. “The National Academies of Sciences, Engineering, and Medicine will host a two-day public workshop on strategies for effectively updating biological detection systems. The workshop will explore alternative effective systems that would meet requirements for the Department of Homeland Security’s BioWatch Program as a biological detection system for aerosolized agents. There will be a focus on systems or strategies that could be deployed by 2027, and enable indoor surveillance and dual-use with day-to-day environmental surveillance that would be of value to the public health and medical communities. There will also be a focus on the integration of improvements and new technologies into the existing biological detection architecture.”

MRSA Screening – Healthcare Prevention Methods for Resistant Germs & Swabbing Our Way To A Solution for Antibiotic Resistance
Antibiotic resistance is a growing global issue and one of the hotspots for transmission of resistant germs is in hospitals. Given that MRSA (Methicillin-resistant Staphylococcus aureus) is now a common bacteria in the community and healthcare world, hospitals are working to screen patients to ensure those with MRSA are isolated appropriately and they can stop the spread of infection. GMU biodefense PhD student and infection preventionist Saskia Popescu looks at MRSA screening practices within hospital intensive care units (ICUs) and the cost analysis that can make or break a program. Most hospitals utilize one of two approaches – preemptive universal precautions (isolate all ICU patients until microbiology labs can prove they are negative for MRSA) or targeted isolation (wait until labs come back and then isolate). Each tactic has benefits and weaknesses. Delays in isolation can translate to further spread of MRSA, while longer periods in isolation mean additional costs associated with isolation. A recent study evaluated these very two strategies and the “researchers found that the total cost of preemptive isolation ‘was minimized when a PCR screen was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time.’ For ICUs that used targeted isolation, the researchers found that costs would be lowest when chromogenic agar 24-testing was used and not PCR.” What this study highlights is that there is inherently no best practice and that depending on laboratory capability, hospitals may have to plan their MRSA screening and isolation protocols off their microbiology department and cost centers. While hospitals are working to screen patients as a means of responding to microbial resistance, researchers are working against the clock to find solutions. Dr. Adam Roberts is one such innovative microbiologist in the UK who is using an old-school approach to respond to a new problem. Popescu was able to interview him regarding his Swab and Send program, which utilizes citizen scientists from around the world to collect samples that may help produce new antimicrobials from the environment. Roberts is working to utilize environmental samples that hold microorganisms which produce compounds that can help build new antibiotics. “The initiative also helps create a microbial database. For £30, Dr. Roberts’ team will send anyone a handful of sample tubes, a mailing envelope, and directions for what to swab (for example: a nutritious area bacteria would likely grow, likely something unsanitary). After you send back your swabs, you can check out Swab and Send’s Facebook page and see what microbes grew from the samples.” Check out Dr. Roberts’ comments on trends he’s seeing and how even GMU biodefense students are getting in on the swabbing!

Naval Research Lab Find High Prevalence of Antibiotic Resistance in Kenya
Microbial resistance has a way of popping up in even the most unexpected places and projects. The U.S. Navy Research Laboratory (NRL), U.S. Army Medical Research Directorate-Kenya (USAMRD-K), Kenya Medical Research Institute (KEMRI), and University of Washington, led a joint effort to evaluate intestinal tract bacteria and its resistance in patients across Kenya. The NRL-developed microarray they used is capable of detecting over 200 difference antimicrobial resistant genes. “These results suggest that there is selective pressure for the establishment and maintenance of resistant strains,” said Dr. Chris Taitt, research biologist, NRL Center for Bio/Molecular Science and Engineering. “This is potentially due to agriculture and prophylactic use of antibiotics and further suggests the need for more effective public health policies and infection control measures than those currently implemented.” “Specific to Kenya, widespread use of tetracycline in livestock production, use of trimethoprim/sulfamethoxazole (SXT) and chloramphenicol as first line therapeutics for typhoid, and prophylactic use of SXT in persons exposed to or infected with human immunodeficiency virus (HIV) might have contributed to the high prevalence of resistance.” Surveillance of antimicrobial resistance has been a struggle on an international level however, joint efforts like this are vital to not only establishing global standards and processes, but also highlighting the importance it has for military personnel abroad.

Stories You May Have Missed:

  • Agroterrorism Bill – a new bill was recently introduced by U.S. Rep. David Young (R-IA) and Sen. Pat Roberts (R-KS) regarding the preparedness of the U.S. agriculture, food, and veterinary systems. “The Securing Our Agriculture and Food Act requires the DHS Secretary, through the Assistant Secretary for Health Affairs, to ensure food, agriculture, animal, and human health sectors receive appropriate attention and are also integrated into the DHS’s domestic preparedness policy initiatives. The legislation specifically addresses issues seen after the 2015 avian influenza outbreak, which killed millions of turkeys, backyard flocks, and layer hens. It was the deadliest outbreak of avian influenza in Iowa’s history.”
  • What The G-20 Needs To Do To Fight The Next Ebola– The G-20 summit occurred last week in Hamburg and many were hoping for a renewed passion surrounding biological threats. While much attention was focused on climate change, there is also a call for efforts to prevent the next outbreak that will produce a pandemic. “Ultimately, strong health systems depend on communities, health workers, managers, researchers and other local stakeholders being empowered to respond to the inevitable, future waves of change we all face. At Health Systems Global, our members represent these multiple groups. Strengthening everyday resilience demands that we all — governments, donors, researchers, communities, health professionals — work with the resources that health systems already have — their people and relationships. This must be done as we take wider action to confront inequality at all levels. If we do not do that, then efforts to safeguard disease outbreaks will be meaningless.”

Pandora Report 7.7.2017

WHO Leadership Prioritization
There are six key positions the new WHO director general should prioritize, according to Mukesh Kapila of The Atlantic. The newly elected, first ever African director general has a lot on his plate and his future efforts will surely be evaluated against the mistakes and successes of his predecessors. Dr. Tedros comes into the position with somewhat of a dark cloud following him – during the election an advisor to his opponent made public comments accusing  Tedros of intentionally covering up outbreaks within his home country of Ethiopia. Kapila’s proposed to-do list for Tedros includes six main components. Firstly, promote home-grown national solutions, which focuses on sustainability and developing models that fit them and not a standardized solution for all countries. Secondly, remember that the WHO does not have a monopoly on health wisdom. “Delivering change will require a revisioning of WHO’s long-presumed position as the centre of the global health ecosystem. Today we have many well-resourced international bodies and national institutions with highly-qualified experts. Thus, WHO does not have a monopoly on health wisdom and its norm-setting and convening authority is questioned. It’s high time that the humbleness that has endeared Tedros to many people rubs off on the organisation.” Third, hire diverse talent that helps restore trust throughout member states instead of pulling from just a select few. Fourth, don’t get bogged down in international reform. “Tedros can’t afford to waste his five-year tenure on simply rearranging institutional furniture. All his recent predecessors as director general have huffed and puffed but ultimately failed to reform WHO. An effective and efficient organisation is just a means towards an end. So, Tedros only has to do enough to make WHO fit for the purpose of delivering his vision.” Fifth, look beyond traditional thought leaders – tackle the exhaustive list of issues by thinking outside the box and approach such challenges with a different vantage point. Lastly, accept that the WHO has to live within its means. “WHO is broke with budget gaps in priority areas and excessive reliance on ad hoc voluntary funding. But he should resist setting out with a begging bowl and instead reform the budgetary architecture and agree a new compact for consistent and predictable funding.” WHO headquarters alone are in an expensive location, but overall Tedros must work to truly budget accordingly while re-establishing the WHO as a leader in global health with a reputation that encourages participation and support.

Public Transit Emergency Preparedness Against Ebola and Other Diseases
Globalization and innovative developments in transit allows us to travel around the world within hours rather than days or months. Unfortunately, we’re not the only ones that travel with such new capabilities. Outbreaks like SARS, MERS, and even Ebola have all bubbled outside of their origins thanks to the ability of global travel. What can be done though? “The Transportation Research Board’s Transit Cooperative Research Program (TCRP) Legal Research Digest 50: Public Transit Emergency Preparedness Against Ebola and Other Infectious Diseases considers federal and state laws and available court decisions affecting transit agencies’ responses to infectious disease outbreaks, including potential cohesiveness among transit agencies’ procedures and federal and state guidance”. This finding highlights major topic areas like closures of major traffic generators, quarantine and isolation, employee protocols, etc. Overall, the TCRP digest investigates the legal basis for closures or emergency regulations on transit agencies as a response mechanism to pandemics or outbreaks. One particularly interesting component to the report is section VIII, which discusses infection control and disinfection measures related to transit.

Summer Workshop – Don’t Miss Out!
With just over a week before our Summer Workshop on Pandemics, Bioterrorism, and Global Health Security begins, don’t miss out on the last remaining spots! We’ll have instructors from all over the realm of biodefense discussing a range of topics as diverse as the threats themselves. Biotechnology and medical countermeasures? We’ve got it! Dual-use research and biosecurity? Got it. Don’t worry – we’ve got all the topics covered. You won’t want to miss this three-day workshop filled with wonderful topics and some of the top names in the biodefense field.

How Bill Gates Got Bioweapons Wrong
Following Bill Gates’s comments on bioterrorism, Filippa Lentzos points out that while his intentions were good, his comments about a terrorist wiping out 30 million people with a weaponized disease are wrong, especially as they draw such attention to amateurs as terrorists. Lentzos specifically highlights the tacit knowledge that would be needed for such an act and that frankly, it’s a stretch for terrorists to take advantage of biotech advances. “Available evidence shows that few terrorists have ever even contemplated using biological agents, and the extremely small number of bioterrorism incidents in the historical record shows that biological agents are difficult to use as weapons. The skills required to undertake even the most basic of bioterrorism attacks are more demanding than often assumed. These technical barriers are likely to persist in the near- and medium-term future.” Moreover, Lentzos points out that by making such comments, Gates distracts from those who are more concerning in terms of bioweapons – state-sponsored groups and national militaries. It’s within these groups that the capacity to develop and deploy weapons lies, not within the small DIY garage bioterrorist. “Another factor significantly limiting the use of biological weapons is their lack of perceived military utility. In the near-to-medium term, however, advances in science and technology may enable the development of more capable and more accessible biological weapons. These weapons might allow attacks to be targeted more precisely. Attribution would become more difficult. These technical developments—paired with changes in the social context around biological weapons—may lower barriers to the development and use of biological weapons.” To defend against these degrading barriers, Lentzos urges several things – modernizing the Biological Weapons Convention, use of a collective and convincing response for any breaches in norms against bioweapons or actual use of one, and development of national biodefense capacities. Lentzos leaves the reader with a final plea – within these biodefense programs, ensure biosafety and biosecurity, implement the BWC, declare the program to ensure confidence-building measures are submitted, and regularly review your program to ensure compliance with the BWC. In the end, it’s the state-sponsored or military bioattacks we should worry about rather than drawing attention to the potential for bioterrorists.

Bio: Separating Fact From Fiction
GMU biodefense PhD alum Daniel M. Gerstein evaluates the good, bad, and ugly of DIY biotechnology. Drawing on a range of events and even films, Gerstein first describes what exactly DIY biotechnology is as there is frequently confusion. He highlights the freedom that DIY biologists have in terms of their projects, especially since they aren’t driven by grants or deadlines that companies or universities place on such projects. The promises and perils of DIY bio has been met with an array of critics and supporters – some say that this freedom is how scientific discovery occurs, while others point to the lack of oversight and that people without fundamental understanding of scientific ethics may abuse such technology. “The DIY spirit is embedded in humankind’s quest for discovery and knowledge. As DIY bio continues to evolve, two ‘courses of action’ are available. The first would be to place harsh limitations on such activity, but that would ultimately be counterproductive and likely fail. The second would be to embrace DIY, understand its risks and limitations and work collaboratively with the community to shape activities to ensure the safety of those conducting the experiments and the general population. If and when boundaries are breached, swift and appropriate actions must be taken to remediate the actions and even discipline the offenders. Finally, important outreach will be important to ensure law enforcement and society at large understands DIY bio. The image of DIY bio in the movie Quarantined must be replaced with a more nuanced understanding of the benefits and risks of the use of biotechnology.”

Scientists Utilize Old School Approach Against Resistant Bacteria
In the fight against resistant bacteria, an old strategy may be worth a try – bacteriophages. Using viruses to kill bacteria is an old strategy but it may be effective for our new problem – resistance. While the strategy was first discovered in the early 20th century, isolating and truly utilizing bacteriophages was challenging. Fortunately, now we have technology and advances in medicine on our side. “As a result, scientists are taking a fresh look at what is called phage therapy. ‘They are starting to dust off their old laboratory notes and re-explore the use of bacteriophages as a ‘new’ way to treat serious, life-threatening infections,’ says William Schaffner, medical director of the National Foundation for Infectious Diseases. Increasingly, specialists in infectious diseases believe phage therapy holds promise against bacterial diseases, especially in cases where antibiotics have failed. In 2016, the approach saved a San Diego man who otherwise would have died. Several similar successes have been reported since then.” While phage therapy isn’t yet FDA-licensed for humans, it can be used in life-threatening situations (like the San Diego case), but researchers are working to combat the challenges with getting it approved. Despite its use in other countries as a means of treatment, there is limited phage data within the U.S. There’s a long road ahead for harnessing the power of phage therapy, but it just may be one of the greatest tools in the fight against the resistant germ.

Stories You May have Missed:

  • How the DRC Beat Ebola in 42 Days – After the destruction that the virus left in its wake in 2014/2015, the news that the Democratic Republic of the Congo (DRC) had a case, triggered PTSD for many. With the news of their initial case in May, public health response teams were dispatched and within 42 days, the outbreak was over. So how did the DRC manage such a feat? “This swift resolution was partly a matter of luck. The virus hit the remote and sparsely populated Likati region, which is 1,300 kilometers away from the capital city of Kinshasa, and nestled deep in equatorial rainforest. ‘People weren’t moving around in the way they were during the West African outbreak,’ says Anne Rimoin from the University of California Los Angeles, who has worked in the DRC for 15 years. ‘So it was a very small outbreak in and of itself’.”
  • The Trouble With Ticks– traditionally, we’ve seen ticks as a source for Lyme disease and not much else. Unfortunately, this isn’t the case as a bad tick season is afoot. “Experts say the Northern United States may be in for a bad tick season this summer, raising concerns about Lyme and other scary tick-borne diseases, including the Powassan virus, which causes encephalitis and can leave people with permanent neurological damage. ‘This spring definitely seems worse than others I remember,’ said Dr. Catherine Wiley, chief of general pediatrics at Connecticut Children’s Medical Center. ‘People are coming in from the yard with numerous ticks on them’.”
  • Ebola Exhibit – While we all remember the fear and frustration surrounding the most devastating outbreak of Ebola, a new exhibit is taking viewers through a visual journey of the epidemic. “A new and poignant special exhibit at the Centers for Disease Control and Prevention, in the agency’s David J. Sencer CDC Museum. Sencer, who died in 2011, happens to have been the CDC’s director in 1976, when the first known outbreak of Ebola occurred in Yambuku, Zaire — now the Democratic Republic of Congo.”

Pandora Report 6.30.2017

Happy Friday to all our amazing readers – we hope you have a lovey holiday weekend! Don’t miss the July 1st deadline for an early registration discount to the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security.

Preventing Pandemics and the Necessity of Funding Prevention
Next January will mark the centenary of the 1918-1919 pandemic influenza, but what have we really learned since then? The looming threat of antimicrobial resistance is slowly surrounding us, as is the increasing biothreat of zoonotic disease. Globalization, encroachment into animal habitats, and recent models that predict a 60-day global spread for a virulent strain of airborne flu virus, all paint a rather gloomy reality for the future of health security. So what are we doing? Not enough. That’s usually the answer in public health- a field of which you can comfortably say society likes to contribute the bare minimum. A highly pathogenic influenza virus that could engulf the globe in a pandemic isn’t the storyline for a horror movie, but rather something that even UN panels note is “not an unlikely scenario”. “Pathogens are not only terrifying, they’re expensive. The 2003 SARS epidemic cost $30 billion in only four months. A flu pandemic of a severity that occurs every few decades could contract the global economy by 5 percent — some $4 trillion”. Here’s where the economics of preventative public health come into play – vaccines are expensive to make and there’s little incentive when we’re not in the eye of a disease storm. Moreover, global health security is challenging. Politics makes disease response and preparedness a sensitive topic, especially during an outbreak. The key lesson to remember though, is that an outbreak anywhere is really an outbreak everywhere. So what preparedness tactics can we start utilizing? “The project is called CEPI — the Center for Epidemic Preparedness Innovations. After the world’s failure to control Ebola quickly in 2014 and 2015 cost 11,000 lives and at least $6 billion, three global experts proposed a vaccine development organization with $2 billion in start-up funding. Harvard, the National Academy of Medicine and the United Nations all created commissions that proposed ways to avoid another catastrophe. Among other steps, all endorsed vaccine development.” CEPI aims, in the next five years, to develop vaccine candidates for Lassa fever, Nipah, and MERS. “Creating vaccines is not the same as guaranteeing that people who need them can get them. CEPI will require its awardees to sell vaccines to the poorest and lower-middle-income countries (more likely, to donors who will buy vaccine for them) at the lowest possible price.” Perhaps one of the most poignant comments from this article was that the threat to this goal is not scientific, but rather political, highlighted by short attention spans. The World Bank has initiated it’s “pandemic bond” to aid in outbreak response should there be a public health crisis like that of Ebola in 2014. “The catastrophe bond, which will pay out depending on the size of the outbreak, its growth rate and the number of countries affected, is the first of its kind for epidemics. It should mean money is disbursed much faster than during West Africa’s Ebola crisis.” The Pandemic Emergency Fund (PEF) will offer coverage to those countries eligible for financing from the IDA (International Development Agency), which is dedicated to helping the poorest countries. Head of derivatives and structured finance at the World Bank’s capital markets department, Michael Bennett, noted that “if a trigger event occurs, instead of repaying the bond in full, some or all of the principal is transferred to the PEF trust fund. So essentially the investors are acting like insurance companies. The objective of offering the risk in both forms is that the bonds and swaps appeal to different types of investors, and therefore … we are creating the broadest possible investor pool for this risk,”. The PEF would provide more than $500 million in coverage over the next five years. Efforts to provide financial support to outbreaks before they reach pandemic potential are vital. It is estimated that had the PEF been available during the 2014 Ebola outbreak, $100 million could have been mobilized as early as July 2014, which may have prevented the outbreak spreading so rapidly and costing $2.8 billion. “The annual global cost of moderately severe to severe pandemics is estimated at roughly $570 billion, or 0.7 percent of global income, the World Bank said.”

Ebola Burial Teams 
The 2014/2015 Ebola outbreak in West Africa was not only the worst in history, but taught us a great many lessons about outbreak control. One of the most extraordinary lessons learned was just how valuable burial teams could be. Funerals became a significant source for disease exposure and transmission, especially for loved ones of the deceased, as washing and handling the body was customary. In effort to combat this high-risk activity, public health responders established burial teams comprised of paid volunteers, who would collect the bodies from homes and aid in their burial. The teams would don PPE and work with families to ensure they avoided exposure. Dignified burial through these teams helped ease much of the concern for families regarding the treatment of their loved one. A recent study published in the PLOS Neglected Tropical Disease Journal evaluated the impact of these burial teams using modeling and data from 45 unsafe community burials and 310 people who were identified as having contact with the infected bodies. Researchers found that those who cared for the Ebola patient just before their death were at greatest risk, meaning that caring for an infected loved one at home was far riskier than bringing them to a healthcare facility. The study estimates that the safe and dignified burials performed by Red Cross volunteers (the burial teams) prevented between 1,411 and 10,452 cases of Ebola. “Hundreds of paid volunteers took on the grim task of collecting bodies from people’s homes in full personal protective gear, while also having to manage the grieving families and communities. They were ordinary West Africans, such as teachers and college students. Many carried out the relentless and dangerous work for months. Some were stigmatised in their communities, because people became scared they might bring the virus home with them. In reality, they were helping to stem world’s worst ever Ebola outbreak.” In the end, the Red Cross burial teams managed over 47,000 burials, carried out more than 50% of all burials during the outbreak, and consisted of 1,500 volunteers.

Instructor Spotlight – Workshop on Pandemics, Bioterrorism, & Global Health Security
We’re nearing the last few weeks before our workshop and your opportunity to get the early registration discount, so don’t miss out! This week we’re happy to show off not only the director of this workshop, but also of our GMU biodefense graduate program – Dr. Gregory Koblentz. If there was a biodefense Jeopardy, Dr. Koblentz would not only be the reigning champion, but would also have Alex Trebek doubled over in laughter. Gregory Koblentz, PhD, MPP, is an Associate Professor in the Schar School of Policy and Government and Director of the Biodefense Graduate Program at George Mason University. During 2012-2013, he was a Stanton Nuclear Security Fellow at the Council on Foreign Relations. Dr. Koblentz is also a member of the Scientist Working Group on Chemical and Biological Weapons at the Center for Arms Control and Non-Proliferation in Washington. He previously worked at Georgetown University, the Executive Session for Domestic Preparedness at Harvard University, and the Carnegie Endowment for International Peace. He is the author of Strategic Stability in the Second Nuclear Age (Council on Foreign Relations, 2014), Living Weapons: Biological Warfare and International Security (Cornell University Press, 2009) and co-author of Tracking Nuclear Proliferation (Carnegie Endowment for International Peace, 1998). He serves on the editorial boards of Nonproliferation Review, World Medical and Health Policy, and Global Health Governance. His teaching and research interests focus on international security, weapons of mass destruction, terrorism, and homeland security. He received his PhD from the Massachusetts Institute of Technology, his Master in Public Policy from the John F. Kennedy School of Government, and his BA from Brown University. For more information, see https://schar.gmu.edu/about/faculty-directory/gregory-koblentz. Don’t miss your chance to not only learn from Dr. Koblentz, but also chat with him and other experts in the field at our workshop July 17-19th!

Can CRISPR Tackle Zika?
GMU Biodefense PhD student Saskia Popescu is looking at CRISPR and its application as a vector-borne disease prevention tool. “Whether it be the latest announcement that CRISPR reversed Huntington’s Disease in mice or that it could provide rapid diagnostic improvements, the technology is being considered a breakthrough for many diseases and conditions, including vector-borne diseases.” Drawing on a recent TED Talk by famed molecular biologist, Dr. Nina Federoff, she highlights the potential for GMO mosquitoes to be used as a biological control tool. Federoff points to the public perception issues that come with GMO products, which was seen in Key Haven, Florida when GMO mosquitoes were to be trialed as a means to prevent dengue and Zika cases. “Concluding her talk with a plea to the audience, Dr Federoff emphasized the need to dig past misinformation and hype to truly look at the science of this work and the substantial benefits that can come from biological control efforts and the science of genetic modification.”

The Case of the Missing Sarin
Dugway Proving Ground is under the spotlight again for mishandling of dangerous substances. The same Army lab was responsible for mishandling Anthrax in 2015, during which they sent 575 shipments of live samples across the U.S. Unfortunately, the latest reports are looking to Dugway as the source for potentially losing a small amount of sarin. The inspector general for the DoD released a report highlighting the findings that a contractor used by the facility was not maintaining inventory properly. “Dugway stored its sarin in a two-container system. The sarin was stored in a primary container, which is then stored inside a secondary container. But officials only checked the secondary containers when doing inventory, and did not check inside the primary container, so they did not know if all the sarin was still in the containers, the inspector general found. ‘Therefore, custodians cannot identify and account for leaks, evaporation, or theft that may have occurred,’ the inspector general found. ‘Furthermore, Dugway officials did not immediately notify the chemical materials accountability officer of a 1.5-milliliter shortage of … sarin identified during an April 19, 2016, inventory nor did they properly document the results of that inventory,’.” The report found that the contractor and Dugway used varying methods for container sealing but that the amount missing is relatively small. Fortunately, sarin evaporates and degrades very quickly. Overall the report highlights the operations and procedures for handling the chemical agent put workers at an increased risk and encouraged the Army to evaluate and improve practices immediately.

The Moral Question of Bioengineering
The financial and technical hurdles for biotechnology and gene-editing have been decreasing over the years and Stanford is taking a unique approach to their budding bioengineers – asking moral questions. During their final exams for the university’s Intro to Bioengineering course, the students are asked several questions – at what point will the cost of printing DNA to create human life equal the cost of teaching a student at Stanford?  If you and your partner are planning to have kids, would you start saving for college tuition, or for printing the genome of your offspring? These questions represent much of the debate and concern regarding gene editing – the rapid decrease in cost and the morality of just how far the technology can and will take researchers. Many note that just because we can, doesn’t mean we should. Stanford professor Drew Endy emphasizes the decrease in costs, which was initially prohibitive when the technology was developing. Regarding the last question, “about 60 percent say that printing a genome is wrong, and flies against what it means to be a parent. They prize the special nature of education and would opt to save for the tuition. But around 40 percent of the class will say that the value of education may change in the future, and if genetic technology becomes mature, and allows them to secure advantages for them and their lineage, they might as well do that. There is clearly no right answer to the second question, and students are graded on their reasoning rather than their conclusion. But when both questions are considered together, they suggest, Endy says, that ‘in the order of a human generation, we’ll have to face possibilities that are much stranger than what we’re prepared for’.”

Stories You May Have Missed:

  • John Oliver Takes on Anti-Vaxxers – If you’re a fan of the HBO host, make sure to check out his recent episode of  “Last Week Tonight” in which he points out just how dangerous the anti-vaccine movement really is. “Some have even developed an ‘alternative vaccine schedule’ in which the inoculations can be delivered less frequently and over a longer period of time. ‘That sounds like a decent compromise because it’s the middle-ground position, right?”’Oliver said on ‘Last Week Tonight’ on Sunday. ‘The problem is, it’s the middle ground between sense and nonsense. It’s like saying, ’It would be crazy to eat that entire bar of soap, so I’ll just eat half of it’.”
  • Yemen’s Growing Cholera Outbreak– Yemen is currently experiencing the worst international outbreak of cholera, with 200,000 suspected cases and an average of 5,000 new cases reported daily. The WHO and UNICEF have gotten involved as there have already been 1,300 deaths in the past two months. “By calling the outbreak the “world’s worst” UNICEF and WHO hope to speed international aid efforts to the war-torn country. “This deadly cholera outbreak is the direct consequence of two years of heavy conflict,” said a press statement from UNICEF. ‘Collapsing health, water and sanitation systems have cut off 14.5 million people from regular access to clean water and sanitation, increasing the ability of the disease to spread.’ In addition to a lack of public health infrastructure, UNICEF estimated that 30,000 dedicated local health workers who play the largest role in ending this outbreak have not been paid their salaries for nearly 10 months.”

 

Pandora Report 6.16.2017

Temperatures may be soaring but we’ve got all your biodefense news, including a frosty story on frozen diseases coming to life!

Big Data Takes on Epidemics
The potential applications for big data are vast and we’re just now starting to get a taste for how it can be utilized during an outbreak. Rapid access to data sets and available personnel to handle modeling is a challenge during emergent situations however, many are pointing out just how the data science revolution can be used to fight diseases. Metabiota Senior Director of Data Science Nita Madhav has put together a list of the five ways big data analytics are changing the fight against epidemics. First, better genetic data through genome sequencing that can help speed up genetic analysis during an outbreak. Second, cell phone mobility data. This is particularly interesting as it was used during the Ebola outbreak in 2014, which allowed experts to tract contacts of cases as a means of prevention. Cell phone mobility data also provides information on movement during outbreaks. Third, social media data, which can be used to predict peaks and perform sentiment analysis (think vaccination skepticism), but also as a means of pushing public health messaging. Fourth, mapping high risk areas. “Machine learning techniques can now yield global, high-resolution maps pinpointing where epidemics are likely to emerge and take hold. These techniques make use of remotely-sensed and other geographic data about environmental, human and animal factors to estimate how many people live in the riskiest places. For example, this type of analysis helped map likely locations for Zika virus to thrive and even identified areas where the virus would later establish itself, including southern Florida.” Last but not least, large-scale simulations, which allow epidemiologists to take all the data we currently have and generate tons of simulations to reveal gaps in response mechanisms. “These simulations help fill in gaps in observed data using synthetic outbreaks and deliver novel insights into possible outcomes of outbreaks, including expected numbers of illnesses, hospitalizations, deaths, employee absences and monetary losses. Ultimately, these insights can help inform the world about epidemic risks and the best ways to mitigate them.”

Chemical Weapons & ISIS
New analysis from Conflict Monitor by IHS Market is drawing attention to a significant reduction in chemical weapons used by ISIS in Syria in 2017 as well as a concentration of the chemical attacks in Iraq. The report highlights that 71 allegations of ISIS CW attacks have occurred since 2014 (41 in Iraq and 30 in Syria) however, the only alleged use in Syria in 2017 was on January 8th at Talla al-Maqri. “The operation to isolate and recapture the Iraqi city of Mosul coincides with a massive reduction in Islamic State chemical weapons use in Syria”, said Columb Strack, senior Middle East analyst at IHS Markit. “This suggests that the group has not established any further CW production sites outside Mosul, although it is likely that some specialists were evacuated to Syria and retain the expertise.” In response to ISIS use of chemical weapons, the U.S. Department of the Treasury’s Office of Foreign Assets Control (OFAC) is taking action against ISIS leader, Attallah Salman ‘Abd Kafi al-Jaburi (al-Jaburi), who was involved in several attacks ranging from vehicle-borne improvised explosive devices (VBIEDs) to the development of chemical weapons. OFAC is also taking action against Marwan Ibrahim Hussayn Tah al-Azaw, an Iraqi ISIS leader. “As a result of today’s action, all property and interests in property of these individuals subject to U.S. jurisdiction are blocked, and U.S. persons are generally prohibited from engaging in transactions with them.” OFAC Director John E. Smith noted that “today’s actions mark the first designations targeting individuals involved in ISIS’ chemical weapons development,” and that “the Department of the Treasury condemns in the strongest possible terms the use of chemical weapons by any actor, and will leverage all available tools to target those complicit in their development, proliferation, or use.”

Pandemics, Bioterrorism, & Global Health Security Workshop Instructor Spotlight
This week we’re excited to share that Sanford Weiner will be our instructor spotlight! Sanford is a Research Associate in the Center for International Studies at the Massachusetts Institute of Technology, and a Visiting Fellow at Imperial College, University of London. For several decades he has done international comparative policy studies of public health agencies, and research on national security policies and environmental policies. He has published on policymaking at the Centers for Disease Control, the phase-out of CFCs, toxic substance control, and innovation in the Air Force. He is currently studying responses to pandemic flu in Europe and the United States, and the politics of alternative energy projects. He directs a Professional Education summer course at MIT on “Technology, Innovation and Organizations.” He has also taught in professional education courses for the Royal Society Technology Fellows (London), the National University of Singapore, UC San Diego, and in Stockholm. Before MIT he was on the research staffs of the School of Public Policy at UC Berkeley, the Health Policy Center at Brandeis, and the Harvard School of Public Health. Sanford looks to the need for organizational innovation and adaptation to address new threats, the politics of public health emergencies, and the importance of risk assessment and making evidence-based public health decisions. If you’re looking to talk about taking lessons from pandemic flu and applying them to polio, Zika, bioterrorism, and even Ebola, you won’t want to miss his lecture during our workshop!

The Awakening of Frozen Permafrost Diseases
Climate change has an undeniably impact on infectious diseases. Whether it be the vectors that spread them, movement of animals that act as hosts, or an increasing encroachment of humans into animal habitats, we simply can’t deny that the two are wholly interconnected. Unfortunately now we get to add zombie diseases to the list. Well, maybe not a zombie virus, but a bacteria or virus that has been trapped in the icy permafrost for thousands of years and is now waking up. “Climate change is melting permafrost soils that have been frozen for thousands of years, and as the soils melt they are releasing ancient viruses and bacteria that, having lain dormant, are springing back to life.” Last year we saw anthrax cases in the Arctic Circle due to exposure from infected reindeer carcasses that were exposed due to the melting of the frozen soil and snow. “As the Earth warms, more permafrost will melt. Under normal circumstances, superficial permafrost layers about 50cm deep melt every summer. But now global warming is gradually exposing older permafrost layers. Frozen permafrost soil is the perfect place for bacteria to remain alive for very long periods of time, perhaps as long as a million years. That means melting ice could potentially open a Pandora’s box of diseases.” Nothing like a good permafrost to keep the bacteria happily frozen and alive! What is so worrying about the melting permafrost is a range of threats – buried bodies of people who died from smallpox, unknown viruses or bacteria that we’ve never seen before, or even a resistant organism that changes the course of antibiotics forever.

Angry Birds – The Flu Version
While this isn’t the title of the latest game, the projectile you should be worried about is actually avian influenza droplets. China is currently battling against HPAI H7N9  outbreaks in poultry across three provinces. “Chinese health officials detailed four outbreaks in two OIE reports. Two occurred in different locations in Inner Mongolia province in the north, one at a large layer farm that began on May 21, killing 35,526 of 406,756 susceptible poultry. The remaining birds were culled to curb the spread of the virus.The other outbreak began Jun 5 at a poultry farm in Inner Mongolia’s Jiuyuan district, which led to the loss of 55,023 birds, including 2,056 that died from the disease.” These outbreaks spark fear for a number of reasons – the mass culling of birds is always economically devastating, the risk to human life, and really, the potential for sustained human-to-human transmission due to a few genetic tweaks that could result in a pandemic. That’s right, just three mutations should switch H7N9 into a lethal human-killing virus that has pandemic potential. H7N9 is one of the more concerning avian influenza strains because it’s already been known to do damage in terms of human cases (of the 1,500 cases, 40% died). “‘As scientists we’re interested in how the virus works,’ says Jim Paulson, a biologist at The Scripps Research Institute. ‘We’re trying to just understand the virus so that we can be prepared.’ That’s why he and his colleagues recently tinkered with a piece of the H7N9 flu — a protein that lets the virus latch onto cells. It’s thought to be important for determining which species the virus can infect. ‘So it’s not the whole virus,’ says Paulson. ‘It’s just a piece — just a fragment — that we can then study for its properties’. What they studied is how different changes affected the virus’ ability to bind to receptors found on the surface of human cells.” Paulson’s group found that just three tiny mutations made it able to sustain human transmission. This brings about the dual-use research of concern (DURC) and gain-of-function (GoF) research dilemma though – while we’re using it for good, couldn’t a person with bad intentions come along and turn it into a weapon? Or a lab error that results in an outbreak? While some argue for the need of GoF research, others agree with the 2014 White House moratorium that halted federal funding for such work. Ron Fouchier of Erasmus Medical Center in the Netherlands notes that, “‘The rest of the world is moving forward with this type of experiment already,’ says Fouchier, whose genetic experiments with a different bird flu virus sparked a public outcry in 2011. And so the U. S. can either join or not join. It’s up to them, but the work will continue,’.” Topics like avian influenza, pandemics, and dual-use/GoF research are all issues we’ll be discussing in the workshop this July, so don’t miss out!

Boston University’s BioLab Nears Approval
This hotly debated BSL-4 lab has been a source of contention between researchers and surrounding neighbors for over a decade. Boston University received a $200 million federal grant nearly 15 years ago to build the regional lab as a new source for work with deadly pathogens however, neighborhood activists have been halting work since the beginning. Despite the ongoing debate, the lab is just one vote away from approval. “Supporters say it will speed the development of new vaccines and cures.  But after 15 year of fighting, the neighborhood that’s home to the lab is making a final push to keep the diseases away from the busy urban hub.”

The Scary Reality Behind WHO’S Updated Essential Medicine List
GMU Biodefense PhD student, Saskia Popescu, is taking a deeper dive into the recent announcement by the WHO regarding their reformatting of the EML list. The antibiotics sections haven’t seen an overhaul like this for 40 years, so what’s really afoot? Last week we discussed the changes- the categorization of antibiotics into three groups (ACCESS, WATCH, and RESERVE). Each list has a series of antibiotics and recommendations (i.e. for RESERVE, these are antibiotics which should be treated as the last resort of accessible antibiotics and should be used in “tailored” situations when other medications have failed. RESERVE antimicrobials should be targeted in national and international stewardship programs). While the updates make sense, they reveal a much deeper concern for developing countries and the growing threat of microbial resistance. “This extensive change to the EML highlights the dire situation that we are progressing towards in terms of microbial resistance. The EML provides the most basic medicine needed for patient care and its focus on antibiotic stewards highlights the stark reality even in the most dire of environments.”

Stacking Countermeasures for Layered Defense 
DTRA’s Joint Science and Technology Office’s (JSTO) Toxicant Penetration and Scavenging (TPS) research program is working to better defend us against chemical and biological weapons. “One such weaponized threat is the use of organophosphonates in an attack. These nerve agents inhibit acetylcholinesterase (AChE), an essential enzyme responsible for neurological function. Irreversible inhibition of AChE may lead to muscular paralysis, convulsions, bronchial constriction and death by asphyxiation. One of the projects in the TPS uses engineered DNA-enzyme nanostructures to create multi-enzyme pathway biocatalysts. These new biocatalysts are designed to process the destruction of chemical agents and their degradation compounds.”

Stories You May Have Missed:

  • MERS and Infection Control – There are endless opportunities when working in infection prevention & control to say, “I told you so” and the ongoing hospital MERS outbreaks only fuels that fire. “The World Health Organization (WHO) today provided new details on three MERS-CoV clusters in Saudi Arabia involving 32 out of the 35 cases reported between Jun 1 and Jun 10. The clusters are in three different hospitals in Riyadh. Cluster 2 is related to cluster 1, as the first case-patient in a second hospital initially visited the emergency room of the hospital implicated in cluster 1. According to the WHO, he was asymptomatic following the visit in hospital 1, and he continued to receive kidney dialysis sessions in the second hospital. The cluster involves the index case plus five healthcare workers and household contacts.The third cluster is not related to clusters 1 or 2. To date four cases are associated with this hospital; the index case involves a patient who had camel contact. Three healthcare workers have also been diagnosed.”

Pandora Report 6.9.2017

Hunting For Ebola and The Outbreak In The DRC
The hunt for Ebola’s hiding place has eluded scientists since its identification in 1976. Believing that bats are a natural reservoir, many are tracking them throughout the DRC. While we’ve picked apart the virus in BSL-4 labs for decades and continue to learn about its genomics, we’re tragically unable to truly understand the virus in its natural habitat. “But the virus’s natural history is a mystery, says virologist Vincent Munster, sitting outside his tent in the darkening jungle. ‘We know everything about its replication cycle but fricking nothing about where it comes from and how it causes outbreaks’. Earlier in his career, at the Erasmus Medical Center in Rotterdam, the Netherlands, Munster took part in the controversial ‘gain of function’ experiments that engineered the lethal H5N1 bird flu virus to spread more readily among mammals-including, presumably, people. These days, however, Munster talks less about viral genes and proteins than about virus ecology: the web of interactions that allows a zoonotic virus to travel between species. Logging, hunting, and other human encroachment on pristine environments all play a role, bringing people into contact with the microbes that lurk there.” Researchers, like Munster, are sampling animals (especially bats) to try and find a pattern that would explain why they’re most likely to carry the virus and if that might fluctuate. Trying to find the virus in bats is equally challenging despite knowing that they carry it. Interestingly, the virus is wholly dangerous to primates and many consider it the biggest threat to gorillas apart from poaching. During their work, the researchers were alerted to a chimpanzee carcass and throughout their response, they note just how careful they must be when handling it. “It was covered in maggots, Munster says-‘just a huge, pulsating mess.’ Ebola may be scarce in living animals, but carcasses like that one practically explode with virus. ‘We’ve done those studies,’ Munster says. ‘Every cell, every orifice of that carcass is loaded with Ebola.’ To minimize the risk to researchers, Munster helped develop a protocol for collecting samples from dead animals: swabbing the outside instead of using sharp instruments to collect blood or tissue.” While their work continues, so does the latest outbreak of Ebola in the DRC. The most recent WHO situation reports noted a new suspected case and 15 contacts for monitoring. Currently, there are 5 confirmed cases, 3 probable, and 1 suspected. Four patients have died and four have survived, translating to a 50% case-fatality rate. You can also read the latest WHO new report on response efforts in the DRC here.

Pandemics, Bioterrorism, & Global Health Security Workshop Instructor Spotlight
Our instructor spotlight this week will shine on FBI Supervisory Special Agent Edward You. Mr. You is like the action hero of the biological countermeasures world (ok, that might be a tad of an exaggeration, but wait until you read about all the amazing things he does with the FBI!). Mr. You is responsible for creating programs and activities to coordinate and improve FBI and interagency efforts to identify, assess, and respond to biological threats or incidents. These efforts include expanding FBI outreach to the Life Sciences community to address biosecurity. Before being promoted to the Weapons of Mass Destruction Directorate, Mr. You was a member of the FBI Los Angeles Field Office Joint Terrorism Task Force and served on the FBI Hazardous Evidence Response Team. Mr. You has also been directly involved in policy-making efforts with a focus on biosecurity. He is an active Working Group member of the National Security Council Interagency Policy Committee on Countering Biological Threats and an Ex Officio member of the NIH National Science Advisory Board for Biosecurity. He also serves on two committees for the National Academies of Sciences, the Institute of Medicine’s Forum on Microbial Threats and the Committee on Science, Technology, and Law’s Forum on Synthetic Biology. Prior to joining the FBI, Mr. You worked for six years in graduate research focusing on retrovirology and human gene therapy at the University of Southern California, Keck School of Medicine. He subsequently worked for three years at the biotechnology firm AMGEN Inc. in cancer research. Special Agent You works to keep the communication channels open between the synthetic biology community and law enforcement to help identify threats and strengthen relations with the biohacker community. Don’t miss the opportunity to learn from Mr. You and pick his brain during our summer workshop in July!

South Africa’s History of Chemical & Biological Weapons
GMU biodefense alum Glenn Cross is taking a deep dive into the Rhodesian use of chemical and biological weapons from 1975-1980. His recent book, Dirty War, investigates the prevalence of such weapons during the Rhodesian War. During periods of manpower and material shortage, the army would use such unconventional techniques that included planting contaminated food and beverages, medicine, and other goods into guerrilla supplies. “Some of these supplies were provided to guerrilla groups inside Rhodesia; some were transported to guerrilla camps in Mozambique. In all, deaths attributed to CBW agents often exceeded the monthly guerrilla body count claimed by conventional Rhodesian military units – demonstrating the utility of CBW agents in a counterinsurgency campaign against an elusive enemy.” Cross’s investigation is particularly valuable in that knowledge has been spotty and few insiders have been willing to talk. “All (insiders willing to talk) share a consistent story about Rhodesia’s development and use of chemical and biological agents during the Bush War; they even chillingly admit that chemical and biological agents were used in experiments on captured insurgents.”

Tracking Microbes and Inspiring Antibiotic Development
The June 6th WHO statement on the Essential Medicines List (EML) is sending ripples throughout the public health community in regards to antimicrobial resistance. The changes to the EML include the creation of three new categories for antibiotics – ACCESS, WATCH, and RESERVE. These categories include recommendations regarding use and aims to shift prescribing to a more accurate practice. “Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections. The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of ‘last resort’ antibiotics that are needed when all others fail.” The revision to this list highlights a growing need for antibiotic innovation. BARDA director, Joseph Larsen, hopes to change this and speed up the pace of antibiotic development in the face of growing microbial resistance. Current antibiotic development can take years, cost millions of dollars, and often only generates a profit after 23 years. Larsen notes that there hasn’t been a new class of drugs for treating gram-negative bacilli for over fifty years and that the volume of candidate antibiotics in phase 3/4 trials is barely 10% of those in oncology trials. BARDA is hoping to facilitate innovation through their CARB-X program, “which is one of the world’s largest public-private partnerships focused on developing new antibacterial products. When they started this program, BARDA expected 50 grant applications, but received 368 applications within the first 2 cycles. The goal is to deliver at least 2 antibacterial products to clinical development within 5 years. BARDA is planning on investing $250 million over the next five years to CARB-X.” Antibiotic innovation will become increasingly important as resistance grows, which highlights the importance of tracing microbial movement. GMU biodefense PhD student, Saskia Popescu, is looking at a recent study on hospital bacterial tracing and what that means for infection prevention efforts. Researchers sampled patient rooms prior to a new medical center opening and continued sampling for nearly a year, finding that microbial communities had some interesting trends. While hospital disinfection failures are frequently a source for transmission, it was found that the microbial community shifts after the patient has been in a room for 24 hours. Moreover, researchers found that a majority of admitted patients were on antibiotics and that those with longer stays tended to show an evolutionary shift to resistance. “Overall, this new study highlights the movement of microbes within healthcare and how we can start improving our tactics to help reduce the risk of healthcare-associated infections and blossoming bacterial resistance.” Worst case scenario, we could just always stop shaking hands

Bioterrorism Budget Cuts & DoD Chemical & Biological Defense Annual Report
GMU biodefense PhD alum Daniel M. Gerstein is focusing on just how vulnerable the proposed budget would make the U.S. in the event of a bioterrorism attack. The budgetary cut to NBACC at Ft. Detrick would mean that laboratory and science response to bioterrorism would be significantly gutted without a replacement plan. “The NBACC’s scientists also are capable of conducting experiments to determine what level of concern is warranted if a potential threat is identifiedThe NBACC also has bioforensics analysis capabilities. This provides the ability to understand how and potentially where a pathogen was prepared, its virulence and physical characteristics and even what medical countermeasures and decontamination techniques might be the most effective.” This is especially vital as even the decontamination of a site can be challenging and expensive. The 2001 Amerithrax attacks highlighted these gaps – between responsibility, practices, protocols, and cost, the decontamination of the office buildings and postal handling facilities cost roughly $320 million and pointed out some pretty significant gaps within U.S. bioterrorism response. Gerstein implores policymakers to take a second look at this proposed budgetary cut and decide if leaving the US without these critical capabilities is truly a wise decision. “They should assess whether NBACC’s capabilities, as an insurance policy, is a price worth paying when weighed against the potential cost in human terms of even a limited bioterror attack.”

The 2017 DoD Chemical and Biological Defense 2017 Annual Report to Congress has just been released, which includes specific comments on response to ISIS and synthetic biology activities. Within the report you can find sections on advanced diagnostics, advanced medical countermeasures (check out the section on the cocktail of three monoclonal antibodies developed to fight Ebola), advances in non-traditional chemical agent defense, and more! One of my favorite sections was actually on information systems – “The Global Biosurveillance Portal (G-BSP) program achieved IOC. This capability will provide a web-based, cloud-hosted enterprise environment that will facilitate collaboration, communication, and information sharing in support of the detection, management, and mitigation of man-made and naturally occurring biological events. G-BSP also facilitates the fusion of multiple unclassified information sources for greater situational awareness and decision support.” A recent study published in The Lancet, highlights the importance of diagnostic preparedness. Citing the 2014/2015 Ebola outbreak as a prime example, researchers note that while the diagnostic response eventually worked, it was slow and expensive, which severely impacted outbreak response. “If a focused mechanism had existed with the technical and financial resources to drive its development ahead of the outbreak, point-of-care Ebola tests supporting a less costly and more mobile response could have been available early on in the diagnosis process. A new partnering model could drive rapid development of tests and surveillance strategies for novel pathogens that emerge in future outbreaks. We look at lessons learned from the Ebola outbreak and propose specific solutions to improve the speed of new assay development and ensure their effective deployment.”

Committee on Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology
Don’t miss this July 6th workshop held at the National Academies of Sciences, Engineering, and Medicine’s Keck Center at 500 5th Street NW, Washington DC.  Attendees will hear from several experts and discuss four main topics: human modulation, public health and military preparedness, efficacy of design, and emerging technologies to overcome existing technical barriers. The meeting won’t be webcast or made available virtually, so you’ll want to attend in person.

China’s Battle Against An H7N9 Outbreak
While the outbreak may be slowing, eight new cases were reported this past week. What worries many though are the recent studies published that point to the highly pathogenic variant that was infecting poultry. Currently in its fifth wave of H7N9 activity, Chinese cases are showing a shift to impact more middle-aged adults in rural areas. “In the second report, a team from China described the clinical course and genetic findings in a 56-year-old Guangdong province man who died from a highly pathogenic H7N9 virus that showed a marker for resistance to neuraminidase inhibitors (NIs), the antiviral drugs commonly used to treat influenza.” You can read the press release from the Government of the Hong Kong Special Administrative Region here.

Stories You May Have Missed:

Pandora Report 5.26.2017

Summer is in full swing and that means the mosquitoes are out in force. Before you make those pesky bugs your biggest enemy, don’t forget about the threat of antibiotic resistance and the current MCR-1 Klebsiella outbreak in China!

Congrats GMU Biodefense Graduates 
Last week we saw several MS and PhD students graduate from GMU’s biodefense program and we couldn’t be more excited to show off their hard work! Earning their MS in biodefense, we’d like to celebrate Kathryn Ake, Rebecca Earnhardt, Nicholas Guerin, Andrew Joyce, Ryan Lockhart, Patrick Lucey, Alison Mann, Jonathon Marioneaux, Scott McAlister, Greg Mercer, Katheryn Payton, Dana Saft, Colleen Tangney, and Anupama Varma. Earning their PhD in biodefense, we’re celebrating Keith W. Ludwick (Dissertation title: The Legend of the Lone Wolf: Categorizing Singular and Small Group Terrorism), Nereyda Sevilla (Germs on a Plane: The Transmission and Risks of Airplane-Borne Diseases), and Craig Wiener (Penetrate, Exploit, Disrupt, Destroy: The Rise of Computer Network Operations as a Major Military Innovation). Congrats to our biodefense graduates – we can’t wait to see what wonderful things you’ll accomplish in global health security!

U.S. Investment in Global Health Security  – The Good and The Bad
Whether it be an intentional, accidental, or natural biological event, infectious diseases can devastate local economies and populations. “Catastrophic” is a term commonly used for such events. Disease knows no borders or boundaries, which means that our global health security is only as strong as the weakest link. To aid in the stability of global health security, the State Department funds projects around the world to help improve biosafety and biosecurity. The philosophy is that if we can train local trainers to establish expertise and biorisk programs, it would lay the foundation for biosecurity/biosafety for the future. “The State Department carefully evaluates and selects the most impactful projects for each region, pairing local needs with appropriate subject matter expertise. One source of such expertise is Sandia National Laboratories (SNL), which has received State Department funding to implement numerous health security projects. Just this April, Lora Grainger, working at the Labs’ International Biological and Chemical Threat Reduction (IBCTR), travelled to Algeria to train Algerian trainers on a project funded by the State Department. Participants included scientists working in Algeria’s national network of laboratories managed by the Ministry of Agriculture, the Institut National de Médecine Véterinaire (INMV).” This partnership is just one of many and involves education that is tailored to the skills and needs of those being trained. Global health security is bigger than any one country and it’s vital to not only strengthen our own practices, but also facilitate its development in countries that might not have all the resources needed. Speaking of U.S. health security efforts, don’t forget to catch the Operation Whitecoat documentary on the June 1st.                                                                                                                                                              

While these are great efforts the U.S. is putting forward, there is also an internal struggle to maintain public health during a hiring freeze. The freeze was imposed by President Trump’s executive order in late January, which covers currently open positions, blocks transfers, and prevents new positions from being created. It was recently reporting that nearly 700 positions within the CDC are vacant due to the ongoing hiring freeze. “Like HHS, the State Department and the Environmental Protection Agency have maintained the freeze as a way of reducing their workforces and reshaping organizational structures after a directive last month from the Office of Management and Budget that said all federal agencies must submit a plan by June 30 to shrink their civilian workforces. HHS, State and EPA also face significant cuts in the Trump administration’s budget proposal for the fiscal year starting Oct. 1. The administration, which unveiled a ‘skinny budget‘ for fiscal 2018 in March, is scheduled to release its full budget next week. A senior CDC official said unfilled positions include dozens of budget analysts and public health policy analysts, scientists and advisers who provide key administrative support.” A new CDC document notes that at least 125 job categories have been blocked from being filled, which includes positions in the Office of Public Health Preparedness and Response.

Ebola in the DRC – Updates
While we’re honoring researchers and workers for their efforts during the 2014/2015 West Africa outbreak, Ebola continues to rage through the DRC. You can find daily situation reports here from the WHO, as the numbers of reported cases are constantly changing. The WHO is reportedly optimistic that it can contain the outbreak and many are curious to see how the new director general will handle such challenges. The latest situation report from the WHO is pointing to six more cases of Ebola, bringing the total suspected cases to 43. 365 people are currently under monitoring in the DRC. Researchers have also made substantial progress towards understanding how Ebola disables the immune system so effectively. In response to this latest outbreak, the WHO is requesting funding to ensure adequate response to the DRC outbreak.

Pandemics, BT, & Global Health Security Workshop – Instructor Spotlight
We’re excited to announce that Kendall Hoyt is our instructor spotlight this week! Dr. Hoyt is an Assistant Professor at the Geisel School of Medicine at Dartmouth where she studies U.S. biodefense policy and biomedical R&D strategy. She is also a lecturer at the Thayer School of Engineering at Dartmouth College where she teaches a course on technology and biosecurity. She is the author of Long Shot: Vaccines for National Defense, Harvard University Press, 2012. She serves on the National Academy of Sciences Committee on the Department of Defense’s Programs to Counter Biological Threats and on the advisory board of the Vaccine and Immunotherapy Center at Massachusetts General Hospital. Kendall Hoyt received her Ph.D. in the History and Social Study of Science and Technology at the Massachusetts Institute of Technology in 2002 and was a Fellow in the International Security Program at the Belfer Center for Science and International Affairs at the Harvard Kennedy School of Government from 2002-2004. Prior to obtaining her degree, she worked in the International Security and International Affairs division of the White House Office of Science and Technology Policy, the Washington DC office of McKinsey and Company, and the Center for the Management of Innovation and Technology at the National University of Singapore. Did I mention that she’s also done work on Ebola and has written extensively about medical countermeasures for the disease? Dr. Hoyt is not only an expert on biosecurity and the impact of technology, but will take students through the journey of medical countermeasures and security.

The Finish Line in Ending Pandemics and The Future of the WHO
The recent election of a new WHO director-general highlights the current global shift in priorities, and yet the reality is that we’re still fighting an uphill battle against infectious disease and the threat of a pandemic. Recent decades have shown that outbreaks have been increasingly common, taking advantage of globalization, growing populations, and spillover. Avian influenza has been knocking at the door for a while…while bursts of Ebola and SARS have shaken global health security to its core. MERS has also triggered such events in hospitals, leaving no environment safe from emerging infectious diseases. The list of worrying viral diseases has also grown and taught us a rather painful truth – pandora’s box is already open and every time we think we’ve closed it…we realize the seal just isn’t that tight. “Dynamic, rapidly evolving viral threats emerge with increasing frequency, exploiting new pathways in endless pursuit of their biologic imperative. These viruses are the paradigm of adaptive learning. Pushing and probing at our defenses, they shift to new hosts, opportunistically hijack transmission routes, and acquire capacities to evade immune detection. They are subject to no rules of engagement, and their viral intelligence is anything but artificial”. Our new strategy is now to strengthen our detection efforts and to build up response processes. Many have highlighted that what we’ve seen is just a small percentage of what’s out there, but that doesn’t mean we have to keep our heads buried in the sand forever. The future of international disease response will change with the appointment of the new WHO director-general, especially for poor countries dependent upon resources. On Tuesday, it was announced that Ethiopia’s Dr. Tedros Adhanom Ghebreyesus was voted director-general. Dr. Ghebreyesus is the first ever African director-general and brings to the position a long history of health stewardship as a former health minister in Ethiopia. Not only is this election particularly significant as the future of the WHO will be heavily weighed against its failures in recent years, but recent accusations against the newly elected director-general have created further doubts as to the stability of the organization.

Double-edged Sword Research
A new report from the Swiss Academies of Art & Sciences is drawing attention to the need for continued conversation and engagement about the potential for misuse in life sciences. As a result of the workshop, a report was developed highlighting “six issues that should be considered when designing, conducting, and communicating research projects. Each issue is illustrated with examples from actual research projects.” In fact, CRISPR inventor, Jennifer Doudna, is drawing attention to the promises and perils of the gene-editing technology. She points to the worries of creating designer embryos while contrasting the promises of reducing mosquito-transmitted diseases. In fact, recent work has shown some promise in using CRISPR to fight HIV. “Part of the problem is HIV’s ability to squirrel itself away inside a cell’s DNA – including the DNA of the immune cells that are supposed to be killing it. The same ability, though, could be HIV’s undoing. ast week, a group of biologists published research detailing how they hid an anti-HIV CRISPR system inside another type of virus capable of sneaking past a host’s immune system. What’s more, the virus replicated and snipped HIV from infected cells along the way.” While this work has only been done in mice and rats, the concept is promising. Overall, these advances bring about exciting future possibilities, but it’s important to remember that there are dangers too – whether it be tampering with human evolution, contaminated CRISPR kits, nefarious actors using them for terrorism, etc. The complexities of CRISPR and genetic engineering are only growing, which makes the 2018 arrival of the peer-reviewed publication, The CRISPR Journal, even more relevant.

Stories You May Have Missed:

  • Model Systems and the Need For Curiosity-Driven Science– GMU Biodefense PhD student, Saskia Popescu, is looking at the importance of model systems and picking the brain of a top researcher in the field, Dr. Julie Pfeiffer. “Poliovirus is great to use to create model systems because not only does it grow easily, but it is also relatively safe due to vaccination for lab workers, not to mention that we have a pretty solid understanding of the virus based off a century of working with it. ‘We know a lot about poliovirus and we have great tools in our toolbox. If you’re going to tackle a tough problem, it helps to have a great toolbox. For other fields, the ideal toolbox may be fruit flies, worms, or yeast. Collectively, these model systems have illuminated biology and have led to major advancements in human health.’ stated Dr. Pfeiffer in her recent PLOS Pathogens article on the importance of model systems.” “Firstly, I asked if she thought there were other eradicated or ‘almost’ eradicated diseases that could make decent models. She replied, ‘No. We use poliovirus as a model system because of its great tractability, safety, and ease of use (not because it’s nearly eradicated). [Other eradicated diseases such as] smallpox and rinderpest would not be good model systems because they have been completely eradicated from circulation, making biosafety and tractability major issues. [That being said,] if the poliovirus eradication campaign is successful, the idea is to stop vaccination. If this happens, poliovirus will likely become a BSL3/4 agent and I will no longer work with it’.”
  • Is Your Daycare Prepared For a Pandemic?– Daycare centers may not be your first thought when it comes to pandemic preparedness, however a recent survey found that fewer than one in ten U.S. centers have taken steps to prepare for a pandemic flu event. “Researchers surveyed directors of licensed childcare centers in 2008 and again in 2016, to assess flu prevention measures before and after the 2009 pandemic outbreak of a new strain of H1N1 influenza. Among other things, they looked at flu prevention activities like daily health checks for kids, infection control training for staff, communicating with parents about illness and immunization requirements for children and staff.” Children are great sources for disease transmission and when guardians are needed at work, childcare capacity will be extremely important if a pandemic flu occurs.

 

Pandora Report 5.19.2017

Your weekly dose of all things biodefense is here to fill you in on Ebola in the DRC, antibiotic resistance, the role of the U.S. in global health response, and more!

Ebola Rears Its Ugly Head in the DRC
Sadly, Ebola has returned as cases are sprouting up in the Democratic Republic of the Congo (DRC). On Friday, May 12th, the WHO confirmed an outbreak of the Zaire strain involving nineteen cases and three deaths. “WHO and partners are completing the epidemiological investigation to better understand the extent of the current outbreak and who are potentially at risk of Ebola,” WHO spokesperson Tarik Jasarevic told CIDRAP News. “If pertinent, ring vaccination, as used in the phase 3 study in Guinea, would be the recommended delivery strategy.” These new cases will truly be a test to see if response efforts have changed since the 2014/2015 outbreak in West Africa. Between the WHO response and the potential for real-world testing of the new Ebola vaccine, many are hoping this will be the game-changer. The Global Outbreak Alert and Response Network (GOARN) has been activated and per the WHO website, “the need and feasibility of potential Ebola ring vaccination is being discussed.” Reuters reported that “the GAVI global vaccine alliance said on Friday some 300,000 emergency doses of an Ebola vaccine developed by Merck could be available in case of a large-scale outbreak and that it stood ready to support the Congo government’s efforts to bring the epidemic under control.Under an agreement between GAVI and Merck, the developer of an Ebola vaccine known as rVSV-ZEBOV, it said up to 300,000 doses of the shot would be available in case of an outbreak.” MSF (Medicins sans Frontieres) announced, shortly after the WHO confirmation of cases, that they would be sending a team of 14 people to Likati to launch “an emergency intervention” and that a team of 10 people from the Ministry of Health would also be joining. MSF noted that “the team will be made up of doctors, nurses, logisticians, water and sanitation experts, health promoters and an epidemiologist. Along with organisations already present in the area, the MSF emergency team will conduct an assessment of the situation and may construct an Ebola treatment centre and help care for those suspected or confirmed to be affected by the virus. Fifteen tonnes of medical and logistical supplies will be sent by cargo plane from Kinshasa to allow the team to immediately begin their intervention in Likati.” You can read more about the outbreak timeline here and check out this latest article on how the WHO is preparing to use the experimental vaccine.

Summer Workshop Instructor Spotlight: Andrew Kilianski
As we get closer to the July 17th start date for the Summer Workshop on Pandemics, Bioterrorism, and Global Health security, we’d like to show off some of the wonderful instructors. Dr. Kilianski is currently a GMU professor and biological scientists at the Depart of Defense. His work focuses on combating current and future threats from weapons of mass destruction in addition to teaching classes on biosurveillance and virology in the GMU Biodefense graduate program. Dr. Kilianski was previously a National Research Council fellow with the US Army at Edgewood Chemical Biological Center. During his tenure at ECBC, his research focused on biosurveillance and the identification and characterization of novel agents that threaten today’s warfighter. Dr. Kilianski’s research interests also included emerging viral pathogens and public health and biodefense policy, and he was selected as an Emerging Leaders in Biosecurity Initiative Fellow for 2015.  His research has been published in peer-reviewed journals such as PLoS Pathogens, Journal of Virology, and Emerging Infectious Diseases while also publishing multiple commentary and op-ed articles.  He received his Ph.D. in Microbiology and Immunology from Loyola University Chicago where his dissertation research involved uncoupling virus-host interactions important for coronavirus pathogenesis and developing antiviral compounds against emerging coronaviruses (SARS-CoV and MERS-CoV). During the workshop, Dr. Kilianski will be lecturing on biosurveillance and its role as an integral component of any biodefense strategy and how U.S. policy has mandated that such efforts be accelerated. He notes that “this construct, and how the US and international entities engage in biosurveillance will be covered, as well as how recent Ebola and Zika virus outbreaks have tested the system. Emerging technologies and their role in biosurveillance will also be reviewed. Finally, paths toward integrated biosurveillance for the US and international communities will presented for group discussion discussion.” Dr. Kilianski is a wonderful instructor and his lectures are both engaging and thought-provoking. Don’t miss out on the early-bird registration discount (10%) being offered until June 1st!

GMU Biodefense PhD Student’s Research Could Change Disease Response, Especially When Air Travel Is Involved
Have you ever wondered about the role of air travel during outbreaks? Nereyda Sevilla will be graduating this month with her PhD in biodefense after looking into this very issue. “She believes she has a way to change how authorities and the public respond to disease outbreaks perceived to be transmitted by air travel. If she’s right, it could potentially save billions of dollars in misdirected federal and state money and give millions of air passengers more precise information about infections.” A civilian aerospace physiologist for the Medical Research and Acquisitions Division in the Office of the Air Force Surgeon General, and all around biodefense fan, Nereyda focused her research on the role of air travel and the spread of disease. Utilizing outbreaks like SARS, H1N1, and Ebola, she looked at air travel as a potential incubator for disease transmission. “Sevilla pointed out that despite the numerous aircraft involved, no one became infected with Ebola on an airplane. And yet authorities spent billions on entry and exit screenings, which heightened fear among the general population. Sevilla used an open-source model to study what would happen during a possible future outbreak of pneumonic plague, an infectious lung disease that continues to rear its deadly head around the world. The model could be a game-changing tool, said her professor.” Nereyda says that she’s “found the airplane is not what’s going to get you infected with disease. You’re more likely to get sick from waiting in the boarding area next to some one with a cold.” You can also read this article she wrote regarding the open-source model. Nereyda is a great example of the diverse and passionate students within the GMU biodefense program and we’re excited to show off her amazing research and congratulate her on graduating!

Global Health and the Future Role of the United States
The National Academies of Science just released their report on global health and the role of the U.S. as a leader through efforts like PEPFAR (U.S. President’s Emergency Plan for AIDS Relief), etc. The U.S. has taken a major role in strengthening global health security, whether it be through efforts like the Global Fund to Fight AIDS, TB, and Malaria, or through collaborative international efforts to help strengthen national health systems like the Global Health Security Agenda. “However, resources are not unlimited, and the case for continued commitment must be made. Against the backdrop of the influential legacy of the United States on the global health stage, the new administration is now faced with the choice of whether or not to ensure that gains in global health—won with billions of U.S. dollars, years of dedication, and strong programs—are sustained and poised for further growth.” The report also notes that “approximately 284,000 deaths were attributed to the 2009 H1N1 influenza outbreak, for example, and 2 million excess deaths are projected for a future moderate influenza pandemic. In only a few short months in 2003, the outbreak of severe acute respiratory syndrome (SARS) cost the world $40–$54 billion, while in 2014, the United States alone committed $5.4 billion in response to the Ebola outbreak, $119 million of which was spent on domestic screening and follow-up of airline passengers.” Following a rigorous review, the committee established 14 recommendations that would aid in the delivery of a strong global health strategy and help the U.S. maintain its role as a leader in global health security. The 14 recommendations/actions are: improve international emergency response coordination, combat antimicrobial resistance, build public health capacity in low- and middle-income countries, envision the next generation of the President’s Emergency Plan for AIDS Relief, confront the threat of tuberculosis, sustain progress towards malaria elimination, improve survival in women and children, ensure healthy and productive lives for women and children, promote cardiovascular health and prevent cancer, accelerate the development of medical products, improve digital health infrastructure, transition investments toward global public goods, optimize resources through smart financing, and commit to continued global health leadership.

Would You Survive the Oregon Trail?
If you ever played the video game, you know the chances of making it through this covered-wagon adventure without snakebites, dysentery, or some other misery, were quite low. “The game, one of the earliest educational computer games to reach wide distribution, simulated a 1848 covered-wagon trip from Missouri through the wild frontier of the western US.” Diseases were common to those of us who ventured across the Oregon Trail, but now you can take a quiz to see just how much you really know about those historic bugs.

GAO Report: U.S. Needs To Do More To Prevent Possible Bird Flu Pandemic
A recent Government Accountability Office report is pointing out just how vulnerable the U.S. would be if faced with an avian influenza pandemic. The GAO report focused on three areas – how outbreaks of avian influenza have affected human and animal health, and the U.S. economy, the extent to which the USDA has taken actions to address lessons learned from outbreaks in 2014 and 2016, and the ongoing challenges federal agencies face in their efforts to reduce the potential harm of such an outbreak. The report comes at a crucial time as China is currently battling an outbreak of the deadly H7N9 strain. Within the report there are several findings: “Unless the agency is responding to an emergency, the Agriculture Department doesn’t have the authority to require poultry producers to take preventive biosecurity measures to keep avian influenza from spreading from farm to farm.” The report notes that the USDA has found lessons learned from its responses to previous events however, they have not established plans for evaluating if these corrective actions actually resolved the issues. The topics within the lessons learned include biosecurity, communication, continuity of business, diagnostics, etc. Simply put, while they identified problems and took corrective actions, there has been virtually no evaluation as to their efficacy. Another issue raised within the GAO report focuses on vaccination and the challenges of egg-based vaccine manufacturing. DHHS stockpiles vaccines supplied by four companies, however only one has a U.S.-based manufacturing facility for egg-based vaccines. “We identified two other issues that federal agencies face associated with mitigating the potential harmful effects of avian influenza. First, outbreaks of the disease threaten the poultry that produce the eggs used in the production of human pandemic influenza vaccine. Second, funding for a voluntary surveillance program that gathers data on influenza A viruses in swine that could pose a threat to human health will be exhausted in fiscal year 2017”. Overall, the USDA must focus more on evaluation and working towards preparedness to combat the growing threat.

Getting Our Hands on Older Antibiotics & The Broken Chain of Hospital Reporting
A recent article in Clinical Microbiology and Infection looked at the recommendations and availability regarding older antibiotics. Researchers found that these antibiotics are not universally available or marketed, which means that physicians have to use other, less optimal, antibiotics that are broad-spectrum. “For example, in the treatment of sore throat, amoxicillin is used instead of penicillin. Fluoroquinolones are used instead of nitrofurantoin, fosfomycin or pivmecillinam for the treatment of cystitis, and co-amoxiclav or cephalosporins for the treatment of skin and soft tissue infections instead of appropriate oral formulations of antistaphylococcal penicillins. Additionally, some old antibiotics such as temocillin or i.v. fosfomycin are valuable alternatives for the treatment of some resistant bacteria. The limited access to these old antibiotics is a threat to antibiotic stewardship.” “In 2011, the ESCMID Study Group for Antimicrobial stewardshiP (ESGAP) showed that 22 out of 33 old but potentially useful antibiotics were marketed in fewer than 20 of the 38 included countries in Europe, USA, Canada, and Australia; economic motives were the major reason for not marketing these antibiotics. ESGAP and the international network ReAct (Action on Antibiotic Resistance) updated this survey in 2015. The situation was worse than in 2011, with even fewer antibiotics available in the included countries.” As if the battle of the resistant bug wasn’t bad enough, it seems that hospitals and their federal oversight systems are failing. Hospital reporting and CMS (Centers for Medicare and Medicaid) validation of such data was recently found to be not only poor, but often inaccurate. GMU biodefense PhD student, Saskia Popescu, looks at the process for which hospitals report healthcare-associated infections and drug resistant organisms for reimbursement through CMS and just how broken the CMS data validation process actually is. “During their annual data evaluation, CMS is supposed to randomly select 400 participating hospitals and request samples of medical records to evaluate the clinical-process-of-care measures and HAI measures. Additionally, they are encouraged to look at a targeted sample of 200 additional hospitals based off a certain threshold, which would be if they failed validation the year before or submitted data after the CMS deadline. CMS has several selection criteria for this ‘targeted’ sample, which includes ‘threshold-based criteria’—hospitals that fail to report half of their HAI’s, late reporting, a new hospital, etc.—or, ‘analysis-based criteria’—abnormal or conflicting data patterns and a rapid change in data patterns. Unfortunately, the report shows that CMS failed to use these measures when they did this targeted sample review in 2016 (which looked at data from 2013/2014). During this review, CMS only selected 49 hospitals and none of these hospitals were chosen from this analysis-based criteria (ie, they were not looking for those with aberrant data patterns or suspicious changes in reporting).”

Stories You May Have Missed:

  • Operation Whitecoat Documentary– Don’t miss out on the June 1st release of the post-WWII documentary on Operation Whitecoat (1954-1973). “During the Cold War, more than 2,300 non-combatant conscientious objectors from the Seventh-day Adventist church volunteered to serve their country by participating in U. S. Army medical experiments focused on developing defensive medical countermeasures against the Soviet Union’s bio-warfare capabilities. These volunteers were exposed to experimental vaccines and infectious pathogens.Operation Whitecoat tells the story of these patriots–their commitment to both their religious principles and desire to serve in America’s defense, their courage to participate in these tests, and their contributions that went far beyond Army biodefense.”
  • How Plagues Help Scientists Puzzle Out the Past –I imagine bioarchaeologists as a mix between Indiana Jones and one of the researchers from Contagion – learning about the past to prevent future pandemics. Plagues and pandemics carry with them a lot of information – how society at the time handled it, health and wellness, medical care, etc. “The tragedy of mass causalities exposes lives that would, statistically, rarely be unearthed, including the adolescents and adults who form the bulk of a living population, so rarely represented in a cemetery. Calamities such as plague that knock everyone into the grave with one indiscriminate sweep are one of the few chances bioarchaeologists have to overcome something known as the Osteological Paradox, a term coined by researcher James Wood and colleagues to cover the very awkward point that, in studying past lives, the evidence bioarchaeologists actually have to go on are past deaths. “

 

 

Pandora Report 5.12.2017

TGIF and welcome to your favorite weekly dose of all things biodefense! Check out this film from PBS Digital Studios Brain Craft exploring the technical and ethical questions about CRISPR and genetic engineering.

The Growing Threat of Pandemics: Enhancing Domestic and International Biosecurity
The Bush School of Government and Public Service at Texas A&M University just released their new white paper on biosecurity measures. The paper highlights the increased threat of pandemics due to globalization and ease of transportation. In their review they found nine priority areas that will help address the current biodefense problem. Their priority areas/action items are leadership, international response, the anti-vaccine movement, animal and human health, uniform health screening, public health and healthcare infrastructure, effective outbreak response, cultural competency, and academic collaborations. The white paper notes that “there should be uniform health screenings for individuals seeking permanent or extended temporary residence in the United States. Currently, there are discrepancies between the vaccination requirements for immigrants and the vaccination requirements for refugees.” The inclusion of the anti-vaccination movement was particularly interesting as few reports truly capture this in regards to biodefense efforts. “The increasing influence of the anti-vaccine movement in the United States is another growing threat. Leaders of the movement spread misinformation to parents with questions or anxiety over the safety of vaccines. Many within the anti-vaccine movement incorrectly believe that vaccines cause autism and the number of individuals seeking nonmedical exemptions to the vaccination requirements of schools is on the rise.”

Pandemic Summer Workshop Sneak Peek 
We’re getting closer to the July 17-19 workshop on pandemics, bioterrorism, and global health security, which means that starting next week, we’ll be highlighting some of the amazing faculty teaching the courses. Make sure to look for our spotlight on Dr. Andy Kilianski in next week’s Pandora Report as we’ll be looking at his work on biosurveillance and its role within U.S. biodefense efforts! Make sure to take advantage of the early registration discount before June 1st!

2017 Infectious Disease Mapping Challenge
Don’t miss this wonderful chance to show off your infectious disease mapping skills! The Next Generation Global Health Security Network and DigitalGlobe Foundation are “seeking undergraduate and graduate students, in a team or individually, to generate up to three maps (one map is perfectly acceptable) that illustrate a research question related to any of the categories detailed below. Maps can be analytic (examining relationships between multiple domains, phenomena, or data sources) or descriptive (depicting a single phenomenon or data source). While analytic projects are ideal, descriptive projects will be accepted as long as students/teams describe why their map depicts a notable phenomenon. Similarly, while international maps are preferred, domestic maps will be accepted if the student/team can provide justification as to why a map focusing on the U.S. is necessary (e.g., U.S. data sets on a given topic are the most comprehensive).”

Scientists Take On HIV By Using CRISPR
Researchers have just made headway in the battle against HIV/AIDS by using the genome editing technology, CRISPR-Cas9. Current treatment for HIV involves anti-retrovirals, which are pretty harsh on the body and come with several nasty side effects. In their fight against HIV, the research team used the CRISPR technology like a pair of scissors to get rid of the HIV-1 DNA in the body of mice. “If you cut out the DNA, you stop the virus from being able to make copies of itself. The team is the first to show HIV can be completely annihilated from the body using CRISPR. And with impressive effect. After just one treatment, scientists were able to show the technique had successfully removed all traces of the infection within mouse organs and tissue.”

Public Interest Report – Chemical Weapons
Don’t miss the latest publication from the Federation of American Scientists, which includes several articles on chemical weapons. The Public Interest Report (PIR) is a great source for articles on human rights, counterterrorism, and more. The most recent edition includes articles on the threat of toxic chemicals, investigations regarding the chemical attacks in Syria, the value of scientific analysis of chemical weapons attacks, and more. The president of the Federation of American Scientists, Charles D. Ferguson, also wrote a special message regarding the value of scientific analysis, specifically in regards to chemical weapons attacks. He highlights several articles regarding chemical weapons attacks over the years, one of which includes an analysis of symptoms and potential agents used. This specific work includes analysis from GMU professor, Keith Ward, and highlights the use of chemical weapons in Darfur and Sudan and the limitations of NGO documentation of chemical warfare agents. The article points to the specific symptoms following chemical weapons attacks and notes that “NGOs find themselves at considerable disadvantage compared to national governments when faced with evaluating evidence of alleged attacks using chemical weapons.”

Could Saving Animals Prevent the Next Pandemic?
70% of emerging infectious diseases are zoonotic, meaning that some type of a spillover event had to occur. Ebola, HIV/AIDS, H1N1, and avian influenza are all examples of spillover that has resulted in human morbidity and mortality. The USAID PREDICT program is working to combat this growing threat of zoonotic diseases. PREDICT works to establish a global surveillance system for infectious diseases that can spillover into humans. PREDICT is a collaborative effort between the University of California at Davis’s One Health Institute and the School of Veterinary Medicine, as well as the Wildlife Conservation Society, Metabiota, EcoHealth Alliance, and the Smithsonian Institute’s Global Health Program. “In its first five years, PREDICT trained 2,500 government and medical personnel in 20 countries on things like the identification of zoonotic diseases and implementing effective reporting systems. They collected samples from 56,340 wild animals, using innovative techniques like leaving chew ropes for monkeys then collecting saliva afterwards. They also detected 815 novel viruses—more than all the viruses previously recognized in mammals by the International Committee on Taxonomy of Viruses.” One of the tools PREDICT uses for surveillance is to monitor animal health and diseases that are circulating in them. “When you disrupt an ecosystem by removing a species through culling, you have a less healthy ecosystem and higher risk of disease,” says Megan Vodzak, a research specialist for Smithsonian’s Global Health Program. “Sometimes you increase the level of the virus within the population because you eliminate some but not all of the animals, and they’re still circulating it.” This brings about a humbling notion – conservation and human health might go hand in hand. Some researchers note that by protecting wildlife, we can help prevent spillover events and outbreaks. This concept however, is a bit more complex and has many on the fence regarding the actual role of conservation in human diseases. Some work has found that increases in biodiversity have no impact on human health, emphasizing the murky water of those trying to sell conservation as a tool for fighting pandemics. “When researchers do embark on conservation projects, she cautions that they should also consider other possible outcomes besides the protective benefit humans get from healthy wildlife and ecosystems. ‘We have to recognize that conservation could provide benefits for public health and it could endanger public health,’.”

The Battle of the Resistant Bug
We often think of an infectious disease threat emerging from some hidden jungle or quiet spillover event. While these are are true scenarios, I offer one more – the moment a bacteria becomes resistant to antimicrobials. Whether it be related to over-use in farming or over prescribing in healthcare, this is often a forgotten battleground. We’ve become accustomed to the ease and availability of antibiotics, which has translated to increased and improper use. Antibiotic resistant has frequently been overshadowed by the flashier of infectious disease threats however, this is to our detriment. Antimicrobial resistance (AMR) has proven time and time again to not only be a devious adversary, but one that gets little attention. Research and development into new antibiotics has lagged in recent years, which has only compounded the issue. One of the issues is also the lack of coordinated international surveillance and response strategies. Interestingly, Russian scientists recently developed an interactive world map, which shows human gut microbiota and their potential for resistance. The ResistoMap (pretty outstanding name, right?) makes it easier to track national resistance trends and potentially create an international response plan. “Using the ResistoMap, it is possible to estimate the global variation of the resistance to different groups of antibiotics and explore the associations between specific drugs and clinical factors or other metadata. For instance, the Danish gut metagenomes tend to demonstrate the lowest resistome among the European groups, whereas the French samples have the highest levels, particularly of the fluoroquinolones, a group of broad-spectrum anti-bacterial drugs.” While the rise of an emerging infectious disease should not be ignored, it is important that we remember the slower burn of antimicrobial resistance. Even Alexander Fleming saw the future involving a world without effective antibiotics, as he noted just following his acceptance of the 1945 Nobel Prize, “The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism.”

Regional Action Needed to Prevent Syrian Chemical Weapons Attacks
GMU biodefense PhD alum, Daniel M. Gerstein, is focusing on the role regional actors could play with respect to Syria, especially in terms of dissuading the use of chemical weapons. Despite the horrific attack in early April, global response has been surprisingly tepid and Russian support is ongoing, but Gerstein also highlights the “deafening silence” on the issue by countries within the region. Pressure could be applied from surrounding countries to indicate a strong message that the use of such weapons will not be tolerated. “Borders with Syria could be sealed to prevent any of the re­maining stocks from leaving the country. This would likely require a mix of military, law enforcement and border police to ensure that any illicit crossings are immediate­ly halted. In the event that chemi­cal weapons do breach the Syrian border, response forces should be prepared to stop suspect ship­ments, conduct searches of cargo and have appropriate protection to avoid becoming casualties them­selves.” Gerstein also notes that regional leaders could direct efforts towards Assad specifically, making it clear that Syria’s future will not include him, by calling for the International Criminal Court to indict him for war crimes.”Over the past 15 years, the norms against the use of chemical weap­ons have continued to be threat­ened, with increasing state and non-state actor use. Most of these attacks have occurred in the Middle East. This trend cannot be allowed to continue.”

The Chemical Attack in Syria – Sorting Truth from Propaganda
Rod Barton takes us through the April chemical weapons attack in Syria and argues against those who claim it was a “false flag” operation, staged by rebels to draw the U.S. into further intervention efforts. The most notable proponents of this argument have been former MIT professor Theodore Postol and Sydney University professor, Tim Anderson. In efforts to help break the cycle of a false narrative, the U.S. has released intelligence reports however, those who support the “false flag” narrative continue to point to misinformation and confusion about the April 4th attack as evidence. Barton argues against the “false flag” narrative by highlighting several points as evidence for the attack – victims seeking medical care following a Syrian air strike with classic symptoms of nerve agent poisoning, analysis samples that confirmed sarin, and the air raid crater found in the road north of the town, which tested positive for sarin and hexamine. Postol, on the other hand, while continuing to claim that the U.S. intelligence reports fail to prove definitively that the attack was done by the Assad regime, does not argue that it was sarin that killed the people in Khan Sheikhoun. “His case is largely based on the nature of distortion of the metal fragment in the crater – he claims this proves that it was not dropped from an aircraft, as stated by US intelligence. His theory is that a sarin-filled tube, possibly a 122mm artillery rocket body, was placed on the road by individuals on the ground and overlaid with a small explosive charge to disperse the agent.” Barton argues against Postol’s comments for several reasons – Postol fails to explain the origin of the sarin in the tubes, how the rebel groups managed to coordinate the detonation of their device with that of a Syrian government air raid, and that Postol fails to account for the evidence of a second chemical round that detonated around 300m from the road crater. Barton notes that “Postol was an eminent scientist and his views cannot simply be ignored. However, on this occasion the evidence to support his argument is not there – he has got it wrong. His writings on this subject have nevertheless been useful in that they have forced analysts to question the evidence closely to determine their degree of certainty in their assessments. But while the particulars are difficult to ascertain, there is still sufficient evidence to state beyond reasonable doubt that the Syrian military is responsible for the attack. In other words, the jury should convict – sadly, in today’s world, the reality may be different.”

Stories You May Have Missed:

  • 3-D Structures vs. Infectious Diseases– Northwestern University Feinberg School of Medicine is leading a team of international researchers to determine the 3-D atomic structure of more than 1,000 proteins to help develop treatments and vaccines against infectious diseases. “Almost 50 percent of the structures that we have deposited in the Protein Data Bank are proteins that were requested by scientific investigators from around the world,” said Wayne Anderson, PhD, professor of Biochemistry and Molecular Genetics at Feinberg, and director of the project. “The NIH has also requested us to work on proteins for potential drug targets or vaccine candidates for many diseases, such as the Ebola virus, the Zika virus and antibiotic-resistant bacteria. We have determined several key structures from these priority organisms and published the results in high-impact journals such as Nature and Cell.”
  • The Million Dollar Minnesota Measles Outbreak – the growing measles outbreak in Minnesota is projected to cost the state $1 million and is quickly growing. “When it began last month, public health officials knew this outbreak could be large and ongoing, because many Somali-Americans have been refusing the measles, mumps, and rubella (MMR) vaccine for years over unfounded rumors that the childhood immunization, whose first dose is routinely given to babies at 12 to 15 months, causes autism.” Sadly, the vaccination declinations in the Somali-Americans in Minnesota are considered to have been a result of targeting from anti-vaccine groups.

Pandora Report 5.5.2017

Welcome to your weekly dose of all things biodefense. We hope you’ll celebrate World Hand Hygiene Day today by practicing awesome hand hygiene to help stop the spread of germs! Will Bill Gates save us from the next Ebola?

Summer Workshop Discount Extended
We’re excited to announce that the early registration deadline has been extended to June 1st for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security! This is a great opportunity to experience a 3-day workshop led by some of the top biodefense people in the field, not to mention networking opportunities with fellow global health security gurus. Don’t miss out on this July 17-19th workshop in which you’ll learn about bioterrorism, synthetic biology, dual-use research of concern, and how experts are working to stop the next pandemic.

Three Insights from the World Bank’s Tim Evans on Global Health
“While in the previous year the U.S. was the biggest single source of development aid finance for health at $12.8 billion — 34 percent of the global total — its future position is less clear. Specifics on U.S. commitments to global health were lacking in U.S. President Donald Trump’s ‘skinny budget‘ released in March. The latest budget document released this week, meanwhile, shows proposed cuts to USAID’s global health funds.” At a recent event hosted by the Kaiser Family Foundation and the Center for Strategic and International Studies, Tim Evans, senior director of health, nutrition, and population at the World Bank Group, pointed to three important lessons. Firstly, we must catalyze domestic resource mobilization. Domestic spending impacts a country’s capacities and universal healthcare development. “Evans said the global health community needs to rethink the way it views and packages development assistance, from largely being linked to service provision to one that can strengthen countries’ domestic resource mobilization.” Second, he notes that it is crucial to build a demand for health. Policy shifts and economic strain increasingly threaten global health security efforts. He notes that there is a “very strong need to think about building demand and not to pretend that because you’re doing health and saving lives that everybody thinks that’s a great idea,”. “Actively cultivate that community, because you know if you don’t, then it doesn’t take much of a counter force — and we’ve seen this in the areas of vaccines and immunizations — to erode that base of support.” Lastly, the growing threat of disease requires that we expand beyond the “public sector-only mindset”. It’s critical to consider and utilize the private sector for public health efforts. He mentioned that “the public sector has massively important functions. But we have to look in a granular way, various ways, in which the private sector is active, will be active, and work with that in ways that are going to address burden of disease in cost effective manners,”.

Has The Deep State Hoodwinked Trump?
GMU Professor Charles P. Blair and biodefense MS student Rebecca Earnhardt are pointing to Trump’s recent military action in Syria and what really happened behind closed doors. “Though many of the administration’s more centrist supporters cheered the US missile strike on the Syrian air base, characterizing it as a bold move necessitated by the weakness of Barack Obama, other Trump supporters argued that the president had been tricked into a grand mistake. Was Trump the victim of a ruse by the ‘deep state’—a monolithic alignment of federal power centers so intent on maintaining command that it was willing to derail the new administration by encouraging it to pursue unwise military action? Or was the president misled by an even more ominous version of the deep state: one that subverts legitimate civilian leadership in a bid to recouple the United States to ‘regime change’ and similar globalist policies of militant ‘humanitarian’ interventionism?” Blair and Earnhardt look at this history of “deep state”, the rise of the “new world order”, and the growth of fringe beliefs in conspiracy and the notion of a hidden organization (think The X-Files, Men in Black, and the Matrix). “This elevated circulation of cross-pollinated conspiratorialism, now manifest in the increasingly normalized views of the fringe far right, has been facilitated not just by television and movies, as discussed above, but also by Internet platforms.” While not all associate the deep state with some totalitarian global group (which reminds me of James Bond‘s Spectre and Mission Impossible‘s Syndicate), the increasing belief in “sanitized conspiracies” has highlighted some changes how we form beliefs and what that translates to. Earnhardt and Blair also note that that while such beliefs have increased while faith in government, science, and the press have declined.

Why Are We More at Risk Than Ever for a Global Pandemic? 
GMU Biodefense PhD student, Saskia Popescu, looks at the seven reasons we’re more at risk than ever for a global pandemic. While concurring with a recent list following CNN’s pandemic documentary, she highlights two gaps within it – attitude towards infectious diseases and the role of healthcare infrastructure. “The current attitude towards infectious diseases puts us more at risk. Ebola brought the realities of borderless outbreaks to the forefront, especially with availability of faster information. Industrialized countries view diseases—emerging infectious diseases, in particular—differently than developing countries. In the United States, we relish our vaccine availability enough that we refuse it and often see emerging diseases as third world problems. Ebola showed us two things; the unfounded and irrational fear that occurred in the United States, and the lack of preparedness or acknowledgement that a disease in West Africa could venture across the pond.” She highlights the damaging implications of viewing emerging infectious diseases as “third world country problems” and what cultural shift is needed for this to change. The second missing component to the list is healthcare infrastructure and infection control efforts. “Physicians and nurses alike are desperately needed in developing countries; however, it is important to include another role that is often forgotten: infection control and prevention. Although there are fewer doctors and nurses in outbreak regions, there is also something to be said about the grossly underfunded and underutilized role of infection control as a preparedness and response tool. Whether it is in the United States or in a developing country, infection prevention and control programs are vital for both patient and employee safety, frequently understaffed, and economically strained.” Highlighting the nosocomial cases in Dallas, TX, she notes that infection control is bigger than just hospital-acquired infections and trickles down to antimicrobial resistance, communicable disease reporting, and patient isolation. “Overall, the way we look at emerging infectious diseases, our role in preventing and responding to them, and how we utilize (or fail to utilize) healthcare have created a substantial vulnerability for future public health threats. We have more than enough proof to show how vulnerable we all are to infectious diseases and how vital hospital infection control is to not only internal infections, but also preventing the spread from the community. Now is the time to truly utilize a holistic approach—including infection control programs, public education and cultural awareness, and more—to prevent the next pandemic.”

U.S. Biodefense Failures
Despite the bipartisan nature of biothreat preparedness, the U.S. struggles to to support such efforts. A recent Blue Ribbon Study Panel on Biodefense meeting highlighted yet again, the lack of leadership for U.S. biodefense efforts -whether that be an agency or person. “For at least two decades, infectious disease experts have been urging the U.S. government to do more to keep the country prepared for outbreaks of diseases such as a new strain of flu, Ebola and severe acute respiratory syndrome, or SARS. They’ve also noted that other countries have prepared biological weapons such as smallpox and anthrax and have used chemical weapons — such as Syria’s use of sarin gas against its own citizens.” Despite the constant supply of warnings from experts regarding the eventuality of a new flu pandemic, the 2014 Ebola outbreak, and concerns over dual-use research and gene editing, we just can’t seem to get it together. We know what the threat of infectious diseases, whether it be natural, intentional, or accidental, is real and will only increase as populations grow and globalizations strengthens. “The United States needs to be ready ahead of time, with stockpiles of drugs, vaccines and equipment, plans for deploying them and someone with the authority to make fast decisions, Cole and other experts said. The 2017 budget agreement worked out early Monday by Congress would provide just $57 million specifically to prepare for a new pandemic of influenza.” The truth is that U.S. response tends to be more reactive than proactive. We’ve gotten lucky so far in that the diseases weren’t highly transmissible with high fatality rates, but the truth is that our luck won’t hold forever.

Contaminated CRISPR Kits
This is quite an interesting twist in the concerns over DIY-gene editing…. While many worry about the outcomes of biohackers and garage genome editors, a recent finding of contaminated CRISPR kits sold by the company, The Odin, has added a new worrisome layer. The kits are normally sold online for $150 for those interested in doing gene engineering at home however, this recent finding by the European Centre for Disease Prevention and Control (ECDC) has resulted in a halting of all CRISPR kits imported into Germany. The kits were meant to contain harmless laboratory strains of E. coli HME63, however multiple kits were found to be contamined with several pathogens, including some that are antibiotic resistant. Klebsiella pneumoniae, Enterobacter, and Enterococcus faecalis were the microbial culprits found in the contaminated kits. The ECDC has stated that there is a low risk for users “because the manipulation of the kit does not involve percutaneous injury-prone manipulations. However, infection resulting from the contamination of broken skin or mucous membranes may occur, even though the kit recommends and provides disposable gloves. Furthermore, the kit includes lyophilised materials that need to be reconstituted, which may lead to contamination of the mucosae of the eyes, mouth and nose. Finally, the risk of infection may be increased for immunocompromised or immunosuppressed persons.” You can find the ECDC statement here, which notes that LGL, the Bavarian Health and Food Safety Authority, issued the press release in late March. There is also concern related to the potential release of drug-resistant organisms into the environment, of which the ECDC noted, “the potential contribution of the contaminated kit to the increasing burden of antimicrobial resistance in the EU/EEA is marginal, and the associated public health risk is considered very low”. They also encouraged users of the kits to appropriately dispose of their used materials to avoid releasing any drug-resistant bacteria into the environment.

Eastern Europe Antibiotic Usage Report
A new WHO report is providing information regarding antibiotic consumption and usage in 11 non-EU countries and Kosovo from 2011-2014. “The most commonly used class of antimicrobials was beta-lactams, whose share of the total ranged from 35.4% in Belarus to 65.6% in Azerbaijan, the report says. Cephalosporins accounted for between 6.1% (Azerbaijan) and 30.3% (Turkey) of total consumption, while the share for quinolones ranged from less than 0.1% in Uzbekistan to 17% in the Republic of Moldova. The report notes that cephalosporins and quinolones are broad-spectrum antibiotics and are considered second-line drugs in many prescribing guidelines. The two groups combined accounted for 10% (Azerbaijan) to 38% (Moldova) of total consumption.”

Workshop on Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology
Don’t miss this May 25th event at the National Academy of Sciences Building! This meeting will be open to the public, and will run from 8:30am until 4:30pm. The committee will hear from speakers who will discuss the current state of the science in DNA synthesis, assembly, and engineering; pathogen engineering and zoonosis; and ease of use as it relates to synthetic biology. There will be question and answer periods following each panel discussion, and members of the public will be invited to ask questions of the panelists, so we invite you to attend in person, if you are able. You can also check out the draft agenda here. It will be interesting to see if the workshop will discuss CRISPR kits and the potential for contamination.

Stories You May have Missed:

  • NIH Sets Research Cap on Funding for Scientists–  On Tuesday it was announced that for the first time, the NIH will restrict the amount of funding any individual scientists can hold at a given time via a point system. It is “part of an ongoing effort to make obtaining grants easier for early- and mid-career scientists, who face much tougher odds than their more-experienced colleagues. According to the agency, just 10% of grant recipients win 40% of the agency’s research money. Advocacy organizations and groups that advise the NIH director have been urging the agency to address this inequality for more than a decade. They are also concerned that increasing competition for grant money drives researchers to spend more time on paperwork and personnel issues associated with grants, and less time in the lab.”
  • Yellow Fever Vaccine Levels Are Dangerously Low – The CDC recently announced that the supply of yellow fever vaccine will be depleted by this summer. France is said to be able to cover the U.S. populations in need of the vaccine by the time the U.S. supply runs out, however the ongoing manufacturing problems continue to strain response efforts. “A number of vaccine doses were lost while Sanofi was transitioning vaccine production from an old site to new construction, slated to open in 2018.The United States uses 500,000 doses of yellow fever vaccine each year, distributed to travelers and military personnel who will be visiting yellow fever–endemic regions. Just 1 dose of the vaccine confers lifelong immunity, with recipients showing 80% immunity to yellow fever virus 10 days after inoculation and 99% immunity within 30 days. According to unpublished data from Sanofi, approximately 60% of these doses are distributed among about 4,000 civilian clinical sites.”
  • Attacking Antibiotic Resistance With Behavioral Approaches
    A recent Dutch study looked at antimicrobial stewardship strategies and found that by letting providers determine the root-cause of inappropriate antibiotic prescribing, they were more effective in responding to the problem. “The aim of the study was to test the effectiveness of a stewardship approach in which prescribers were asked to determine the root causes of inappropriate antimicrobial prescribing in their department, then develop one or more interventions to improve prescribing based on those root causes. The theory behind this strategy is that if you respect prescriber autonomy and allow prescribers to create their own program to improve prescribing, they will value this approach more and show more commitment to it.  Overall, there were 21,306 clinical admissions during the baseline period and 15,394 clinical admissions during the intervention period, with the appropriateness surveys including 1,121 patients and 882 patients, respectively. In the baseline period, 64.1% of antimicrobial prescriptions were considered appropriate, compared with 77.4% in the intervention period, an increase of 20.7% that equaled 4,927 improved days of therapy.”