Pandora Report 1.19.2018

Happy Friday and welcome to your favorite source for all things biodefense! We hope you’re able to avoid the onslaught of respiratory viruses that are circulating right now, but on the off chance that you’re battling a bug, here’s some infectious disease new that won’t get you sick.

Fighting Influenza
Whether you’re fighting the flu or watching the mayhem unfold in the news, you can’t escape influenza right now. We’re getting hit hard with flu season in the United States and the CDC has reported that activity is still rising and we’re not out of the woods yet. You can find the latest flu data here, but what is worrying so many is the hit that hospitals are taking across the country. It’s not just that we’re facing an IV bag shortage due to the devastation Hurricane Maria wreaked upon Puerto Rico, but that hospitals are being overrun with an onslaught of ILI (influenza like illness) patients. Wait times are through the roof, staff are stretched thin, patients are being admitted into overflow areas, hospitals are having to divert patients because they’re so full, triage areas have been set up in parking lots and emergency areas, and hospitals are even struggling to ensure they have enough PPE and influenza tests. This year marks the centennial of the 1918/1919 influenza pandemic, and it seems like what’s going on is out of a history book instead of down the street. As an infection preventionist and infectious disease epidemiologist, it is not surprising or unexpected that we’re running into these issues. It’s easy for people to point to the current situation and use it as an example of why we’re not ready for a flu pandemic – and they’re right, but it shouldn’t take what’s going on to see that. These are not new issues. Infection control and hospital preparedness has been struggling for a long time and it doesn’t take a pandemic to prove it. Even after the surge of funding and focus on hospital preparedness post-Ebola, we still struggle with these issues, but throw in budget cuts and an administration that is set to pull funding away from public health…well, the outlook is dismal.

With so much attention on influenza, pandemic preparedness, and how we’re just not ready for the next great flu pandemic, what kind of household interventions can we apply in our own little ecosystems? Researchers looked at a HPAI H5N1 outbreak and estimated the reduction in primary attack rates for household-based interventions. “We show that, for lower transmissibility strains, the combination of household-based quarantine, isolation of cases outside the household, and targeted prophylactic use of anti-virals will be highly effective and likely feasible across a range of plausible transmission scenarios. For example, for a basic reproductive number (the average number of people infected by a typically infectious individual in an otherwise susceptible population) of 1.8, assuming only 50% compliance, this combination could reduce the infection (symptomatic) attack rate from 74% (49%) to 40% (27%), requiring peak quarantine and isolation levels of 6.2% and 0.8% of the population, respectively, and an overall anti-viral stockpile of 3.9 doses per member of the population.” While we all may not access to anti-virals, the use of quarantine and isolation are all effective strategies. From an infection control standpoint, it can be tough to maintain such efforts in a household where one or two people are sick. When in doubt, wash your hands, cover your cough, and clean those high-touch surfaces/objects!

GMU Biodefense MS Open House
Mark your calendars for the February 21st Master’s Open House at GMU’s Arlington campus! If you’ve been thinking about getting a MS in biodefense (who wouldn’t want to take classes on biosurveillance, historical bioweapons programs, and more?!), this is a great chance to talk to faculty and learn about the admissions process. GMU has biodefense MS programs in person and online, so even if you’re not in the DC-area, you can get your biodefense on.

Smallpox, Horsepox, And The Trouble With Poxviruses
It seems only a few months ago that news broke of a Canadian research team’s de novo synthesis of horsepox. Since then, there has been considerable discussion surrounding not only the biosafety and biosecurity behind research involving an orthopoxvirus, but also the implications of normalizing orthopoxvirus synthesis, and again, if the remaining smallpox stockpiles should be destroyed. The latest report from researchers at the University of Alberta points to the potential smallpox vaccine developments that synthetic viruses could bring. “Virologist David Evans and his research associate Ryan Noyce produced an infectious horsepox virus, which they synthetically reconstructed using a published genome sequence and DNA fragments manufactured entirely by chemical methods. The team went on to show that the synthetic horsepox virus could provide vaccine protection in a mouse model of poxvirus infection.” Unfortunately, the implications of synthesizing an orthopoxvirus aren’t so simple. GMU biodefense professor and program director Dr. Gregory Koblentz evaluated the implications of such synthesis for biosecurity and what would be needed to prevent a reemergence of smallpox. “The synthesis of horsepox virus takes the world one step closer to the reemergence of smallpox as a threat to global health security. That threat has been held at bay for the past 40 years by the extreme difficulty of obtaining variola virus and the availability of effective medical countermeasures. The techniques demonstrated by the synthesis of horsepox have the potential to erase both of these barriers. The primary risk posed by this research is that it will open the door to the routine and widespread synthesis of other orthopoxviruses, such as vaccinia, for use in research, public health, and medicine.” Koblentz notes that while there are potentially legitimate uses for synthesizing orthopoxviruses (safer smallpox vaccine development), it also means that such labs have the potential to produce smallpox from synthetic DNA and emphasized that action is needed now to avoid the misuse of synthetic biology by nefarious actors. “Unfortunately, the current legal and technical safeguards against the synthesis of smallpox virus are weak and fragmented. There is no clear international legal or regulatory framework to prevent the synthesis of smallpox virus. The WHO has a policy banning the synthesis of the smallpox and regulating who can produce and possess large fragments of smallpox DNA, but it hasn’t been widely adopted by states. Furthermore, there is no mechanism—at either the national or international level—for detecting or punishing violations of this policy.” GMU biodefense PhD student Saskia Popescu cited the importance of medical providers understanding the dual-use research of concern debate and that ultimately, biosecurity impacts us all. “From the healthcare perspective, it may not seem like something we should worry about, but the direction of gene editing and dual-use research of concern is something that is intrinsically linked to public health. Nefarious outcomes of such experiments, regardless of the origin or intent, will inevitably make their way into an emergency department, urgent care, or worse, the community. Although we may not be seeing the implications today, as medical providers and healthcare workers, we must keep our ears to the ground, listening for these biotech advancements, and then thinking through what they mean for us tomorrow.”

Blue Ribbon SLTT Ability to Respond to Large Scale Biological Events: Challenges and Solutions
If you missed the Wednesday meeting, here’s a recording to catch up on all things biodefense. “State, Local, Tribal, and Territorial Ability to Respond to Large-Scale Biological Events: Challenges and Solutions government officials, federal and academic representatives, and subject matter experts will discuss their perspectives, experiences, challenges, and recommended solutions with regard to SLTT response to large-scale biological events.”

Gene Therapy Hits a Wall With Microbial Resistance
Can gene editing trigger an immune reaction in humans? A new study is suggesting that it may be a risk. “The CRISPR-Cas9 system, which functions as a genetic scissors and tape for editing DNA, is generally derived from either Staphyloccoccus aureus or Streptococcus pyogenes bacteria.” Most of us though, have been exposed to these organisms throughout our lives. “This prior exposure could potentially render the gene editing ineffective, with the body quickly eliminating all the CRISPR–Cas9 proteins. Or worse, it could trigger the kind of immune storm that killed a young gene therapy patient named Jesse Gelsinger in 1999, derailing the field for more than a decade. ‘We share everyone’s excitement about doing Cas9 genome editing, but we want to make sure we have learned from what happened in the gene therapy world and not ignore the possibility that this could become a problem,’ Porteus says. ‘As we’re all thinking about developing Cas9-based therapeutics, we should think carefully about this potential problem’.”

Pediatric Rabies Death
A 6-year-old boy in Florida has died from rabies he contracted after being scratched by an infected bat. The boy’s father reports that he found the sick bat, put it in a bucket, and told him not to touch it however, he did and was scratched. In response, the father had the boy wash his hands thoroughly based off what he read online and opted not to take him to the hospital because the boy didn’t want to get shots. Unfortunately, within a week, the boy became ill and even after attempts at treatment, passed away. Rabies is almost always fatal once symptoms appear, which highlights the importance of seeking care immediately after exposure.

Stories You May Have Missed:

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

Pandora Report 1.12.2018

 The Bright Side of Synthetic Biology and Crispr
GMU biodefense professor Sonia Ben Ouagrham-Gormley and Phd alum Shannon Fye-Marnien are looking at the realities of synthetic biology and fears of bioterrorism. Biological advances have inspired questions regarding the safety and potential for nefarious use, but are such technologies guilty until proven innocent or innocent until proven guilty? “As with previous advances in biology, Crispr is sometimes characterized as a blueprint for bioweapons development or bioterrorism, and it has elicited calls for increased control and regulation of science. But while it is important to examine the potential dangers of emerging technologies, reaching a balanced assessment of risks and benefits requires that technologies’ potential to improve human life be appreciated as well. Synthetic biology and Crispr offer a potentially enormous package of benefits, spanning from medicine to energy to agriculture and beyond. Discussions about the security and safety of synthetic biology and Crispr should not obscure these technologies’ potential to address a wide variety of complex and pressing problems.”

The United States Battles Influenza
Flu season is hitting hard in the United States as 46 states report widespread activity. 80% of cases are of the H3N2 strain, which is associated with severe symptoms and hospitalizations. “The flu is now widespread across the country and the peak of transmission probably occurred during the Christmas-New Year’s holiday week, just as many people were crowded into planes, buses and cars or in large family gatherings, said Dr. Daniel B. Jernigan, director of the influenza division of the Centers for Disease Control and Prevention. ‘H3N2 is a bad virus,’ Dr. Jernigan said. ‘We hate H3N2’.” 26 states (and New York City) are reporting high influenza-like illness (ILI) activity. The CDC has reported that “Influenza-like illness (ILI) went from 4.9% to 5.8%. ‎These indicators are similar to what was seen at the peak of the 2014-2015 season, which was the most severe season in recent years.” This tough influenza season is a helpful reminder that it could always get worse, especially in the context of the 1918/1919 influenza pandemic, which marks its centennial this year. Michael T. Osterholm and Mark Olshaker recently wrote an OpEd regarding the dismal truth – we’re not ready for a flu pandemic. Pointing to not only massive growth in population, but also challenges of supply shortages, and an outdated approach to vaccine research, they highlight the need to find a universal vaccine that can do battle against all influenza A strains with a longer immunity. “But there is no apparent effort to make these vaccines a priority in the current administration. Its national security strategy published last month cites Ebola and SARS as potential bioterrorism and pandemic threats, yet makes no mention of the risk of pandemic influenza nor any aspect of critical vaccine research and development. The next few weeks will highlight how ill prepared we are for even ‘ordinary’ flu. A worldwide influenza pandemic is literally the worst-case scenario in public health — yet far from an unthinkable occurrence. Unless we make changes, the question is not if but when it will come.”

GMU Biodefense Professor – Robert House
We’d like to welcome back professor Dr. Robert House to GMU biodefense, who will be teaching BioD766: Development of Vaccines and Therapeutics. Dr. House holds a PhD in medical parasitology and is a senior VP for government contracts at Ology Bioservices (previously Nanotherapeutics). The world faces a growing threat from microbiological agents in the form of terrorist weapons, pandemics (particularly influenza) and emerging/re-emerging diseases. Characteristics such as high pathogenicity/toxicity and lack of appropriate animal models, as well as lack of a viable commercial market, make it difficult to develop effective medical countermeasures for these agents. In his course, students will explore how the US Government is developing medical countermeasures (MCM) against these threats and will explore the various threat agents, the context of regulatory considerations, and the specifics of how MCMs are developed.

Infectious Disease Mapping Challenge Launched!
Do you love infectious diseases and maps? The goal of the challenge is to promote the use of geospatial mapping to address the objectives of the GHSA. The NextGen Network has partnered with the U.S. Department of State’s Virtual Student Foreign Service program to launch the 2018 challenge. You can find out more information from this engaging and informative webinar or at the page here. The deadline for signing up for the challenge is January 19, 2018. This is a great way to contribute to the GHSA goal of creating a world safe and secure from the threat of infectious diseases.

Biodefense Alum – Stay Connected! 
Are you a GMU Biodefense alum? If so, please make sure to keep your information updated in our Schar Stay Connected site. We have a strong alum community and would love to keep you up to date on future events and give shout outs for the amazing work our biodefense students accomplish.

Biopreparedness Needs to Start At the Frontlines of Disease Control
GMU biodefense PhD student and infection preventionist Saskia Popescu evaluates the attention to biopreparedness and how our focus on bioterrorism fails to address the major gaps within disease control in the United States. “The Blue Ribbon Panel report and the CNN article both highlight the bureaucratic challenges with coordination at a national level across many agencies and sectors. The crux of it all is that from a grass-roots level, we’re struggling to better prepare and respond for a host of reasons. Public health funding is always in a chronic state of too little too late and often, we don’t push out resources until we’re already in the throes of a major incident (Ebola, Zika, etc.). Preparing for biothreats, regardless of origin, requires that we strengthen the most basic surveillance and response systems within public health and health care. During the 2014–2015 Ebola outbreak, for example, there was a lot of attention on enhanced precautions. Although this was beneficial and brought attention to several gaps infection control and prevention measures, I found myself reminding staff that we can’t truly prepare and respond to rare events if we can’t get our daily practices down. The shear challenges of ensuring staff practice appropriate hand hygiene and isolation precautions in health care are indicators that we are struggling on the frontlines of disease preparedness.”

Lessons from A 2016 CRE Outbreak in A Kentucky Hospital
Hospital outbreaks are tough. The shear volume of people that go into a single patient’s room is considerable (healthcare workers, visitors, ancillary staff, etc.) and enough to spread germs throughout an entire hospital. Now imagine that the organism is a highly resistant one, such as carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE). A hospital in Kentucky experienced this very thing in 2016 and a recent CDC MMWR revealed just how difficult it can be to conquer an outbreak involving one of the worst resistant organisms you can imagine. “Over the next 4 months, scientists identified an additional 21 CRE isolates from patients at the hospital via screening and clinical cultures. The investigators believe organisms were imported into the facility and then spread among patients.” Epidemiological investigation found that five of the thirteen interviewed patients had received healthcare outside the local area and that three of the patients may have brought CP-CRE into the facility. “The authors of the report say their investigation highlights the potential role of cleaning equipment, which frequently moves between patient rooms, in CP-CRE spread. In addition, they note that although there is a low prevalence of CP-CRE in rural areas, rural hospitals should be aware that patients who’ve also accessed healthcare in areas with higher CP-CRE prevalence—primarily urban areas—can introduce these organisms into their facilities.”

Stories You May Have Missed:

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

Pandora Report 11.24.2017

We hope you had a wonderful tryptophan-induced holiday and are ready for your weekly dose of all things biodefense! Roughly 46 million turkeys were eaten on Thursday, but did you ever wonder if yours was antibiotic-free? (hint: we’re venturing down antimicrobial resistance rabbit hole in this week’s newsletter).

Russia Shuts Down The UN Probe Into Syrian Chemical Weapons
Despite the launch of the 2015 Joint Investigation Mechanism (JIM) by the UN and the Organization for the Prohibition of Chemical Weapons (OPCW), efforts to investigate the use of chemical weapons by President Assad in Syria, have been stalled and challenged by Russia. The latest move by Russia to kill international investigations into such attacks has come in the form of Security Council vetoes. “Russia’s actions have enraged al-Assad’s Western critics, who accuse the Syrian leader of secretly stockpiling chemical weapons in contravention of UN resolutions, and who now want to deliver accountability by other means.” This latest hurdle leaves many to wonder how we got here and if the OPCW can potentially overcome these protests. “As it happens, the OPCW’s top decision-making body, the 192-nation Conference of States Parties, is also scheduled to meet next week. Although that meeting is not directly related to the chemical weapons crisis in Syria, it ‘can’t ignore Syria’s continued non-compliance,’ says Gregory Koblentz, a nonproliferation expert at George Mason University who spoke to IRIN last week.” Not only did the vetoes do damage to inspections, but a draft Russian-Iranian decision that was circulated at the OPCW was recently obtained, in which the objectives were to overturn OPCW inspector procedures and information sharing practices. “(Russia‘s) supreme goal is to compromise the ability of the (OPCW) fact-finding mission to do its job professionally and without political interference,” said Gregory Koblentz, a non-proliferation expert at George Mason University, in the U.S. state of Virginia.“This draft resolution has to be seen as part of a Russian strategy to undermine all international investigations into the use of chemical weapons by the Syrian government,” he said.

Antimicrobial Resistance: An Underrated Biological Threat
GMU Biodefense PhD student Saskia Popescu is hoping to change the narrative for how we look at antimicrobial resistance. AMR isn’t the kind of flashy disease that gets the headlines or surges of funding, and yet it’s been wreaking havoc for decades. Popescu points to the need to address AMR as the global biological catastrophic event that it is rather than a neglected public health issue that is predominantly seen as medical or agricultural. Citing the ominous predictions of the antibiotic abyss, challenges in drug research and development, and why this is such a difficult beast to tackle, Popescu highlights just how devastating AMR is on a global level. “One of the biggest impediments to developing effective treatments is the normalization of AMR. Researchers, infection prevention and control practitioners, and medical professionals have been raising the red flag for decades. Drug-resistant infections, such as methicillin-resistant Staphylococcus aureus(MRSA), used to be rare events in health care but are now considered a common occurrence.” She notes that “AMR poses a national security threat due to its ease of transmission and its potential for a major public health crisis. Unfortunately, the spread of highly resistant diseases has received far less concern and funding than emerging infectious diseases.”

Read-Out on the GHSA Summit in Kampala Event – Save the Date!
We’re excited to announce that on Monday December 4th, GMU will be hosting a seminar on the GHSA Ministerial Meeting from several health security experts who attended. Held at the Arlington campus in Founders Hall from 12-1:30pm, guests will hear from Jamechia Hoyle, Coordinator of the Next Generation Global Health Security Network, Jennifer Nuzzo, Senior Associate at the Johns Hopkins Center for Health Security, and two GMU Biodefense MS students – Anthony Falzarano and Stephen Taylor. More details will be be provided in the coming days, but make sure to save the date as this is a great chance to hear about this critical meeting and the future of the GHSA.

Potential Role of Social Media in Combatting Antimicrobial Resistance
As we continue to see the rise of MCR-1 gene, antimicrobial stewardship and predictions of the future become increasingly important, but just how accurate is this information? GMU Biodefense MS student Janet Marroquin is fact-checking the predictions of the post-antibiotic apocalypse and how the media has portrayed this threat. “In this era of fake news, the credibility of articles circulating on social media can be dubious, particularly when citations are not readily available.  Further investigation of the statistical data used in the video yielded mixed results.” Marroquin points to a NowThis video-based news report and how antimicrobial resistance has been portrayed and introduced to the public through such venues. “Although the dissection of the data used in the NowThis video revealed a few inconsistencies, the attention that 90 seconds can bring to various aspects of AMR to the general public is much. As of November 6, 2017, the video has had 2.1M views and has been shared by 12,333 users on Facebook, retweeted by 175 users on Twitter, and has been featured on news sites. Interestingly, a few days after the release of the NowThis video, NBC News Mach published an online news article addressing the ‘post-antibiotic apocalypse’.”

Ready for a Global Pandemic?
Director of the Center for Health Security Tom Inglesby and Stanford law student Benjamin Haas are evaluating just how likely a pandemic is and how prepared we might be with the current administration. Between the rapid growth of people in densely populated areas and globalization, microbes have a sort of novel freedom that hasn’t been seen before. Biological threats go beyond pandemics to the potential for bioterrorism or even laboratory accidents. So what is the U.S. government doing to prepare? Efforts have ranged from NIH-funded research into pathogens of pandemic potential, the development of Biomedical Advanced Research and Development Authority (BARDA), reinforcing the Strategic National Stockpile (SNS), etc. “Unfortunately, President Donald Trump has not indicated so far that his administration takes this issue seriously. Initially, his 2018 budget proposed slashed funding for such programs by nine percent, or $1.25 billion, from the preceding year, which would be the largest reduction in over a decade.” “Although the civil-servant workforce has continued to make progress in important programs, it remains to be seen whether the administration’s political leadership will push biosecurity efforts forward in a meaningful way. In the months ahead, there are four elements to look for in evaluating just how seriously the Trump administration will pursue these issues: its budget priorities for the new fiscal year, its impending biodefense strategy, its approach to overseeing research on novel and highly dangerous pathogens, and its level of engagement in the Biological Weapons Convention (BWC) process.” Inglesby and Haas highlight the importance of supporting the Global Health Security Agenda (GHSA), approaching complex topics like certain kinds of scientific research, and ensuring funding for vital agencies. “The administration has opportunities to make substantial headway on pandemic risks at the national and international levels. Its budget, biodefense strategy, approach to high-consequence research, and engagement on the BWC are all key. The means exist to diminish the spread of pandemics—through science, intelligence, medical and public health preparedness, diplomacy, and smart governance.”

Bird Flu Moves Throughout Asia
China is experiencing its fifth wave of H7N9 infections since 2016 and of the 1,600 laboratory-confirmed human cases, 40% have died. While most  of the human cases have occurred due to poultry exposure, there is concern that some are related to transmission between people. Responding to the threat of avian influenza has been challenging  – wanting to avoid total alarmism and hysteria, but also ensuring the public health response is adequate and prepared. “In September, the Centers for Disease Control and Prevention summarized some disturbing developments. The H7N9 virus had become lethal to birds, which made it potentially more dangerous to people but also easier to spot. And the virus had split into two lineages — called Yangtze and Pearl, after the river deltas in which each was spreading — complicating efforts to make vaccines. In October, the World Health Organization put out an update citing new cases of H7N9 infection as cold weather set in and noting that poultry farmers were vaccinating flocks against both this virus and other strains.” Avian influenza still circulates in Egypt and Indonesia and H1N1 is now a common strain for seasonal flu, but just how close are we to continued transmission of H7N9 between humans?

Addressing Challenges in Global Health Security: Executive Program
The Geneva Centre for Security Policy will be hosting this event as a Swiss contribution to the GHSA – it’s free of charge for the representatives of GHSA member states! “Leaders are expected to formulate policies for best practices and strategies for dealing with future health contexts and crisis scenarios. This programme provides an opportunity to learn the basics of current health practices, policies, implementation schemes, and approaches for the road ahead. Throughout the programme, participants will examine emerging health challenges and their governance implications, working together to understand and devise ways to mitigate potential health threats.” This event runs January 29th – February 1st, 2018, in Geneva and applications are due November 29th, 2017.

Center for the Study of WMDs – Spotlight Seminar on Japanese Germ Warfare
Don’t miss this December 12th seminar “Hidden Atrocities: Japanese Germ Warfare and American Obstruction of Justice at the Tokyo Trials” from 1230-1400 at NDU’s Lincoln Hall in the Proceres Conference Room (Lincoln Hall 3212). “In the aftermath of World War II, the International Military Tribunal for the Far East, also known as the Tokyo Trials, tried 28 Japanese political and military leaders and more than 5,700 personnel with war crimes. Yet U.S. military intelligence and Washington decision makers prevented the indictment of the government leaders and scientists responsible for Japan’s secret germ warfare program, Unit 731. In an effort to acquire Japan’s biological warfare expertise to gain an advantage over the Soviet Union, the United States covered up the extent of the program, jeopardizing international justice with lasting consequences. Dr. Jeanne Guillemin, Senior Advisor in the MIT Security Studies Program, will discuss her new book, Hidden Atrocities, and its account of both the Japanese program and the subsequent collusion.” RSVP is required. All non-DOD-affiliated visitors will need to fill out the attached JBM-HH Base Access Form, even if you have attended previous Spotlight events. We ask that you send us this form to cswmd-admin@ndu.edu no later than 5 December 2017.  You may also bring the completed form with you. Please allow extra time for the new security procedures.*

Stories You May Have Missed:

  • Raw Milk Brucella Outbreak Across 4 States– The CDC has issued a warning for people “in four states—Connecticut, New Jersey, New York, and Rhode Island—who drank raw milk from Udder Milk may be infected with a rare but serious Brucella abortus RB51 bacterium and should see their doctors for antibiotic treatment.”
  •  New Malaria Parasite Discovered in Bonobos – A new malaria parasite has been found in the African animals, as researchers have confirmed the bonobos are a host. “Now, by sampling more bonobos in geographically diverse settings, scientists writing in Nature Communication show that bonobos harbor a new species of malaria parasite, called Plasmodium lomamiensis. The parasite is a previously unknown Laverania species, which are closely related to P falciparum, one of the parasites that causes human malaria infections.”

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

Potential Role of Social Media in Combatting Antimicrobial Resistance

By Janet Marroquin

Experts from around the world have been sounding the alarm on the rise of antimicrobial resistance (AMR) for years, declaring that with the current trend, previously preventable diseases will claim up to 10 million deaths annually by 2050.  As governments and international agencies take heed and create formal strategies to combat AMR, audiences outside of biology and medicine are starting to join in the conversation.  NowThis, a popular video-based news outlet on social media, released a 90-second video dedicated to a “post-antibiotic apocalypse” on October 17th. In addition to introducing the rising trend of antimicrobial resistance, the video touches on stewardship, international efforts (or lack thereof) against AMR, and “phone apps that…could be a game changer.”  The video is formatted as more of a fact-listing slideshow than a traditional news article and the data presented provides the viewer with a fair snapshot of the current AMR threat.

In this era of fake news, the credibility of articles circulating on social media can be dubious, particularly when citations are not readily available. Further investigation of the statistical data used in the video yielded mixed results. The widely circulated figure of 10 million deaths from previously preventable diseases per year by 2050 stemmed from the Review of Antimicrobial Resistance, a 2014 report published by a team of AMR experts at the request of then UK Prime Minister David Cameron. Since the publication of this report, this figure has been used by other experts, policy-makers, and news media to shed light on the extent of the current AMR threat. Such a strong prediction however, is bound to be met by skepticism. A PLOS article called into question the ability of scientists to realistically forecast the global impact of AMR in the decades to come. According to the article, the 10 millions annual deaths figure is erroneously used without the stated caveats and contextual informationwould reinforce its credibility. De Kraker, Stewardson, and Harbarth explain that the projections leading to the figure were based on four hypothetical scenarios that do not take into account disparities in public health across countries with varying degrees of economic status and urban development and that would likely affect the international impact of AMR in 2050. The authors conclude with the acknowledgement that current forecasting methods are still limited and calls for further research to develop improved models to estimate the anticipated global morbidity and mortality burden if AMR is left unchecked.

The video also stated that 85% of countries have started action plans to combat AMR, but only 5% have financed these plans. This data is most likely taken from a May 2017 WHO estimate that about 2/3 of member countries, in which 85% of world’s population resides, had completed or were in the process of developing their national action plans against AMR, a request set forth by the WHO Global Action Plan issued in 2015. It may be important to note the percentage of countries combating AMR rather than the proportion of the global population that they inhabit as many of the remaining countries without action plans have fragile infrastructures that cannot support AMR efforts, thus illustrating the need for the international community to join forces in a globalized effort to fight antibiotic resistance.

Although the dissection of the data used in the NowThis video revealed a few inconsistencies, the attention that a 90-second video can bring to various aspects of AMR to the general public is significant.  As of November 6, 2017, the video has had 2.1M views and has been shared by 12,333 users on Facebook, retweeted by 175 users on Twitter, and has been featured on news sites. Interestingly, a few days after the release of the NowThis video, NBC News MACH published an online news article addressing the “post-antibiotic apocalypse.” The article described the development of alternatives to antibiotics such as bacteriocins, bacteriophages, pathogen genotyping, and addressing the need to combat AMR through novel drug development in light of the current antibiotic drought precipitating antibiotic resistance. In another instance of social media being used to in the fight against AMR, antimicrobial stewardship programs have used Facebook and Twitter to increase awareness of AMR amongst internal medicine residents.  In case anyone else is interested in joining the Facebook and Twitter AMR campaigns, the CDC has even provided sample posts and messages to help spread the word. The power of social media is just beginning to be harnessed to raise awareness and promote healthy habits and antibiotic stewardship on a personal level.

Janet Marroquin is a first-year graduate student in the GMU Biodefense MS program.  Janet graduated from the George Washington University with a Bachelor of Arts in Speech and Hearing Sciences with a premedical concentration.  Her research interests include antimicrobial resistance, drug innovation program analysis, and infectious diseases.  Janet hopes to use her medical interests to focus on emerging infectious disease preparedness in global health security.

Pandora Report 9.29.2017

 Homeland Security Struggles to Fund ChemBio Defense & The Invisible Threat Looming budget cuts within DHS are doing little to qualm concern that state and local infrastructure is simply unprepared to handle a biological or chemical attack. “In terms of bsecurity, ‘we are much better prepared than we were’ post-9/11, said Tom Inglesby, director of the Center for Health Security at the Johns Hopkins School of Public Health in Baltimore, Maryland. ‘But we are not where we need to be, and the progress is, in some cases, somewhat fragile’.” Internationally, the use of chemical weapons in Syria and growing tensions with North Korea are continual reminders that preparedness is vital. “The department’s science and technology directorate took a 28 percent budget cut when the omnibus bill for fiscal year 2017 was signed in May, and the chemical biological defense division is ‘taking a cut much more significant than that’ in fiscal year 2018, said John Fischer, division director. The directorate in May released a budget overview for congressional justification, which stated over $58 million would be put toward chemical, biological and explosive defense research and development for 2017, assuming a continuing resolution would remain in effect for the rest of the fiscal year. Less than $53 million was requested for 2018, according to the document. DHS did not respond to requests for an interview.” 2018 will be a year of harsh budget reductions for biosurveillance and chemical detection programs, as border security will be headlining in terms of priority. The surge of biodefense funding that was seen post-Amerithrax has certainly waned, but there is also concern for complacency and a tendency to go from fire to fire instead of working to establish robust and effective prevention and response mechanisms. Overall, this fiscal tightening will surely have an impact on prevention, identification, and response strategies for biological and chemical threats, leaving many people holding their breath that the blowback won’t be severe.

 Now more than ever, it is important we change the narrative of lackluster efforts to defend against biological threats. Budgetary slashing, lowering of barriers, and an era of increasing globalization and rapid international travel – these are all the things that should remind us that biological threats are not a figment of science fiction. “What was unthinkable back in the day is now quite common and easy,” Inglesby said. “Genetic engineering is now possible with kits from boxes at younger and younger ages with less and less training.” The dual-use nature of biological research not only has the capacity to lower the barriers to bioweapon development, but can also muddy the waters when determining if research is  offensive or defense. “That’s not the only challenge facing those sounding the alarm about biothreats. Government scientists worry that there aren’t enough biologists working on this problem. “We have relatively few biologists working in national security,” Matheny told FP. “This is one area where we’re just starting to catch up to the fact.” While the future of NBACC is still not set, such uncertainty has rippling effects when it comes to staffing. While we consider biological threats a multi-faceted enemy – natural, intentional, or accidental, it is now biodefense efforts that are facing attacks at multiple fronts. The recent de novo synthesis of smallpox has brought many of these concerns to fruition. Whether it be through the advancement of life sciences that poses dual-use risk, severe budgetary cuts, or a shifting focus onto border walls, we cannot afford to allow this threat to be invisible much longer.

 GMU Schar School MS Open House – October 19th
Have you ever wanted to study what you love to further your career? GMU’s MS in Biodefense is just that chance and we’ve got an open house coming up so you can get all the information on it. On Thursday, October 19th at 6:30pm at our Arlington campus, we’ll be hosting an information session about our in-person and online biodefense MS program. From anthrax to Zika, GMU is the place for all things biodefense!

Navigating Our Way Out of the Jungle: Modernizing Meat Inspection
It’s been over 111 years since the famous Meat Inspection Act of 1906 and we’re still struggling to keep food safety efforts at a pace that can beat risks from farm to table. “What triggered such a shift after decades of poor industry practice? The year prior, in 1905, a book by Upton Sinclair was published in a series, which would then be published in entirety in early 1906. The Jungle brought forth the unsavory and grotesque underbelly of the American meat system. Although this may not have been the focus of his book, readers took away from it that their trusted source for meat was corrupt and lacked safety mechanisms. Within the year, the Federal Meat Inspection Act was established.” Pew Charitable Trusts is working to help evaluate and strengthen the meat and poultry industry and to help reduce the impact that contamination has within the U.S. population (2 million are sickened annually due to contamination). “A June 2017 report from Pew and Cargill, an American privately held global corporation based in Minnetonka, Minnesota, highlighted some of these concerns and established an open dialogue to develop recommendations. They addressed the need to establish a risk-based oversight system, which would incorporate data from across the food-safety system. The guidance also included better risk communication, a modernized approach to slaughter inspection that would include current technology and pathogen-specific appropriate levels of protection, among other components.” Food safety and security is truly the soft underbelly of American and it’s vital that we modernize such efforts.

BBC Pandemic
If you’re one of our readers in the UK, make sure to take advantage of this new outbreak tool through the BBC. The BBC Pandemic app can be downloaded onto your phone and may just help us understand how future outbreaks spread. “Through the app, BBC Pandemic will be conducting two experiments: the National Outbreak, which is open to anyone in the UK from 27th September 2017; and the Haslemere Outbreak, a closed local study that is only open to people in the town of Haslemere, Surrey, and runs for 72 hours starting on Thursday 19th October 2017. In the National Outbreak, the app will track your approximate movement at regular intervals over a 24 hour period. (Don’t worry, it won’t know exactly where, or who you are.) It will also ask some questions about your journeys and the people you spent time with during those 24 hours. All data collected will be grouped to ensure your anonymity, and a research team from the University of Cambridge and the London School of Hygiene and Tropical Medicine will use it to predict how a flu pandemic might spread across the country – and determine what can be done to stop it.” If you’re still not sold on it, here’s another reason why apps like this can truly help future pandemic response – data modeling. Despite our best efforts, epidemiological models are only as good as the data we have available. Simulation efforts help response efforts coordinate resources and plan accordingly however, if our modeling isn’t a decent representation of the population due to limited data, it won’t be that effective. Getting information from a broad range of people helps strengthen such efforts.

Recommendations for Incentivizing the Development of Therapeutics, Diagnostics, and Vaccines to Combat Antibiotic-Resistance 
The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) has been working since 2015 to curb the threat of resistant germs. The group has found that current economic efforts are insufficient and through three working groups on incentives (for vaccines, diagnostics, and therapeutics), they have released a new report. Identifying 46 critical issues that are preventing the development of new/improved products and providing 64 recommendations to address them, this new report is a robust 42 pages worth the read. For example, regarding human health and incentives for vaccine use, the group found that “federal and nonfederal stakeholders lack a common understanding about the current and potential economic value and societal impact of vaccines that can reduce AMR.” Their recommendation for this issue: “Analyses on the cost and societal impacts associated with new vaccine development and administration in the AMR arena developed via a multi-agency process that involves at least CDC, the Centers for Medicare and Medicaid Services (CMS), and the Treasury Department, in partnership with industry and public health stakeholders.” Within each section, you can find issues and recommendations categorized by economic, R&D, regulatory, and behavioral. The United Nations Foundation and the Wellcome Trust has also released a new report regarding the global efforts that have been sustained to fight AMR. “The report, published a year to the day that the United Nations (UN) General Assembly agreed to address the root causes of AMR and take action to tackle the problem, shows that many nations are following up on their pledge to encourage more responsible use of antimicrobials in human medicine and agriculture. Out of 151 countries recently surveyed, 85% say they are developing or have developed national action plans on AMR and 52% have a fully developed plan that addresses the One Health spectrum of human, animal, and environmental sectors.”

 Chemical & Biological Attacks: Underground Transport Restoration Project
After four years, this DHS-sponsored project is finally wrapping up their work studying the methods for chem-bio agent dispersion in subways. “Sandia National Laboratories’ engineer Bob Knowlton has worked on this challenge for a dozen years. His team has developed scientific sampling methods to determine the extent and nature of the contamination. Sampling also is essential to confirm the decontamination was effective and the site is safe to re-enter. Sandia researchers and their collaborators at other national laboratories and local, state and federal agencies have looked at everything from how to clean subway stations and grimy tunnels to where a surrogate for anthrax would go when released inside the New York City subway system and the best way to decontaminate a subway car.” Check out their findings on this project and from the 2016 large-scale testing they did in a mock subway system.

Little Island of Horrors – Vozrozhdeniya 
During height of the Soviet offensive bioweapons program, an ideal island, like Vozrozhdeniya, was the perfect place to test cutting-edge biological weapons. Present day, the island is a sad reminder of one of the largest state-sponsored bioweapons programs. “The island’s secrets have endured, partly because it isn’t the kind of place where you can just turn up. Since Vozrozhdeniya was abandoned in the 1990s, there have only been a handful of expeditions. Nick Middleton, a journalist and geographer from Oxford University, filmed a documentary there back in 2005. ‘I was aware of what went on, so we got hold of a guy who used to work for the British military and he came to give the crew a briefing about the sorts of things we might find,’ he says. ‘He scared the pants off me, to be honest’. Aerial photographs taken by the CIA in 1962 revealed that while other islands had piers and fish-packing huts, this one had a rifle range, barracks and parade ground. But that wasn’t even the half of it. There were also research buildings, animal pens and an open-air testing site. The island had been turned into a military base of the most dangerous kind: it was a bioweapons testing facility.” An isolated secret, this island was the testing ground for some of the worst pathogens. It was also chosen as a holding place for “the largest anthrax stockpile in human history” and while the cache’s location was never disclosed, the pits were visible from space, which meant that the U.S. pledge $6 million towards a clean-up project. Sadly, this isn’t a resolution as the open-air testing done on the island has surely left residual microbial burden, not to mention the burial pits of infected animals. Make sure to read about Dave Butler’s journey to this island and how even now, it still instills fear.

Stories You May Have Missed:

  • China to Open BSL-4– The first certified BSL-4 lab in China will be opening this year. The research institute, located in Wuhan, represents a partnership with the Chinese Academy of Sciences and the Wuhan government. “The lab is part of a 10-year-plan by the Ministry of Science and Technology that proposes to build five to seven BSL-4 laboratories by 2025 as well as one BSL-3 lab in every province. It was built with technology and equipment imported from France, and some of its future research staff have visited France for BSL-4 training. Although construction was finished in 2015, the lab has since undergone multiple assessments, Yuan Zhiming, director of the Wuhan branch of CAS, told the Science and Technology Daily. ‘The lab will become a public platform for Chinese scientists to conduct research into dangerous viruses,’ Yuan said.”
  • Signature Science-led Team awarded $2.9M contract to develop advanced genomic computational technologies in support of IARPA’s Functional Genomic and Computational Assessment of Threats Program – “The Intelligence Advanced Research Projects Activity (IARPA) awarded Signature Science, LLC a $2.9M contract for the development of new computational tools to screen DNA sequences to detect biological threats that may manifest from synthetic microbial manipulation. The challenge is to overcome the speed and precision limitations of contemporary synthetic DNA screening practices to rapidly detect and isolate a prospective threat within a segment of DNA. The research team will re-tool bio-threat detection methods, and focus detection efforts on functional genetic elements to increase analytic speed and precision, thereby dramatically improving predictive capacity to isolate the toxic gene that constitutes the threat.”
  • Medieval Plague Gives Insight Into Human Pollution History – “A recent study indicates that much less lead occurs naturally in the air than we thought—in fact, there should be almost none. Scientists measured lead trapped in an ice core from the Swiss-Italian Alps. They found that lead levels dropped dramatically only once in the past 2,000 years, during a time that coincided with the Black Death pandemic. This means that in Europe, lead levels in the air have been elevated for thousands of years. Most people think about air pollution as a problem that began with the Industrial Revolution, but we’ve been spoiling the quality of our air for a very long time. It has harmed our health throughout history, from Medieval Europe to the Roman Empire to Ancient Egypt and Peru, and continues to do so today.”

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

Pandora Report 8.25.2017

Happy Friday and welcome to your weekly dose of all things biodefense. Have you ever wanted to take a tour of Dugway Proving Ground? Here’s your chance at a virtual tour through some amazing photography.

GMU Biodefense Graduate Programs & Information Sessions
Classes are just starting up and if you’ve ever wanted to take classes on synthetic biology and biosecurity, global health security policy, nonproliferation and arms control, biosurveillance, or emerging infectious diseases, we’ve got just the program for you! GMU offers both Masters and PhD programs in biodefense and has several informational sessions coming soon. Our program provides the perfect intersection of policy and science with courses taught by a range experts. If your time is limited or distance is a problem, we also offer an online MS program, which means you can study biodefense from anywhere!

Revisiting NIH Biosafety Guidelines
It’s been forty years since NIH established the Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules to assess the risks of genome editing. Now more than ever, with the speed of biotech development, it is relevant to take a moment and look back at the significance of such guidelines. “Responsibilities include setting up Institutional Biosafety Committees (IBCs) to assess risks and potential hazards through standards for containment and laboratory practices. Noncompliance on any project, whatever the funding source, can result in loss of all such NIH funding. In his address to the workshop.” Since its inception, there have been several advances in the field, like DIY gene editing and CRISPR, which may require changes to the existing guidelines. “And conventional risk management practices that focus on listed pathogens may underestimate risks of new, unlisted organisms. The informality of voluntary guidelines has enabled prompt responses by funders and researchers to emerging evidence on benefits and risks of technologies. But what has worked with those receiving NIH funding with IBCs may not work with the wider range of actors who now have access to these technologies.” How can the NIH meet these challenges with a forty-year-old set of rules? A few things might help it maintain relevancy- participation in international forums, facilitating researchers/publishers/insurers to set common benchmarks on researcher conduct, engage more with institutional biosafety officials, and working to ensure there are more IBCs. Overall, there is a need to modernize the guidelines to better meet and serve the expanding plain of the life sciences.

Revisiting Compliance in the Biological Weapons Convention                                                                       Have you noticed a trend this week? Revisiting is the name of the game and that’s just what the latest occasional paper from the Middlebury Institute of International Studies at Monterey is doing. The latest RevCon was a dud and the future of the BWC and its relevance is being tested. James Revill is looking at compliance and an incremental approach within the BWC. Revill notes that “compliance with the BWC is more than a simple binary choice to sign a commitment not to develop or produce biological weapons. It requires the adherence to all the obligations, both negative and positive, undertaken by BWC states parties in signing and ratifying the convention. In the BWC context, this is complicated by the ambiguity surrounding certain obligations, changes in science and security, and the limited resource capacity of some states to fulfill their obligations. Under such circumstances, without episodically revisiting compliance, there remains the risk that BWC will become ever more fragmented, outmoded and poorly implemented.” He emphasizes that despite many pushing for multilaterally negotiated, legally binding verification protocols, this is an unlikely outcome. An incremental approach to revisiting compliance, Revill suggests, could incorporate several activities – review relevant science and technology, enhance the collection and analysis of compliance indicators, develop the consultative mechanism, building the provision of assistance in the event of a violation of the BWC, explore voluntary visits, enhance the United Nations Secretary-General’s Mechanism, and remedy the institutional deficient. Overall, he points to the wavering nature of norms against bioweapons and that “without revisiting compliance and tending the convention, there is a risk that the regime will be left to fester and fragment, in time potentially diminishing the norms against biological weapons.”

Meeting on the Attribution of Biological Crime, Terrorism, and Warfare
The Blue Ribbon Study Panel on Biodefense will be hosting this October 3rd meeting in Washington D.C. “Effective prosecution and decisions regarding U.S. response depend on accurate attribution of biological attacks. Despite ongoing biological crimes and suspected development of biological weapons for the purpose of attacking the Nation, the United States has yet to establish this capability fully. The Study Panel will host a special focus meeting entitled Biological Attribution: Challenges and Solutions. This meeting of the Study Panel, chaired by former Homeland Security Advisor Ken Wainstein and former Senate Majority Leader Tom Daschle, will provide federal government, industry, and academic representatives with the opportunity to discuss their perspectives, experiences, challenges, and recommended solutions with regard to biological attribution.” Stay tuned for more details!

SynBio Salmagundi: Proposed Framework for Identifying Potential Biodefense Vulnerabilities Posed by Synthetic Biology – Report, SB7.0 & Options for Synthetic DNA Screening 
It’s a good day to get your synbio nerdom on with this potpourri of news! If you missed the webinar on Tuesday, you can now access the latest NAS interim report regarding the biodefense implications of synthetic biology. “Synthetic biology and related biotechnologies hold great promise for addressing challenges in human health, agriculture, and other realms. At the same time, synthetic biology raises concerns about possible malicious uses that might threaten human health or national security. This interim report is the first phase of a study by the National Academies of Sciences Engineering and Medicine to assess potential vulnerabilities. The report proposes a strategic framework that can be used to identify and prioritize potential areas of concern.” Within the report you can find definitions and study scope regarding synthetic biology in the context of biodefense, factors to assess capability for malicious use, technologies and applications to assess, and framework approach (parameters to consider, use and limitations, etc.). Check out this latest article regarding the screening processes of for synthetic DNA ordering. Sure, there are current screening processes (providers affiliated with the International Gene Synthesis Consortium voluntarily screen double-stranded DNA synthesis orders over 200bp to check for regulated pathogens and additional customer screening), but truly, the processes isn’t that easy…or cheap. Researchers, like Gigi Kwik Gronvall, pointed out actions that could help “preserve the effectiveness of DNA order screening as a security tool and develop additional mechanisms to increase the safety and security of DNA synthesis technologies.” Highlighting the DHHS screening guidance as quickly becoming obsolete, they emphasized options like including direct financial support to companies for screening, especially as we look to the future costs and responsibilities of the U.S. government. “The screening of dsDNA orders is not a panacea for biosecurity concerns: it is possible for nefarious actors to work around the screening. However, we believe that screening dsDNA orders still raises barriers to the development of biological weapons and may offer some protection against biosafety concerns.” The future of synthetic DNA ordering will surely be debated as experiments, like the recent horsepox reconstitution, bring to light new gaps. One such focus onto the realm of biosecurity and synthetic biology comes from Dr. Eric van der Helm, who participated at the latest SB7.0 synthetic biology conference. Van der Helm attended as part of the SB7.0 biosecurity fellowship and has highlighted some of the biorisks we worry about. He also points to the latest horsepox experiment which brought about so much attention to the biosecurity implications of reconstituting an extinct virus. “Synthetic biology has only been recently recognized as a mature subject in the context of biological risk assessment — and the core focus has been infectious diseases. The main idea, to build resilience and a readiness to respond, was reiterated by several speakers at the SB7.0 conference.  In the case of biosecurity, we’re already dependent on biology [with respect to food, health etc.] but we still have an opportunity to develop biosecurity strategies before synthetic biology is ubiquitous.  There is still an opportunity to act now and put norms and practices in place because the community is still relatively small.” Van der Helm emphasizes the need to have these conversations regarding biosecurity measures and synbio, like those at SB7.0, more frequently and openly.

North Korea’s Bioweapon Program: What do we actually know?
If you haven’t gotten enough on discussions regarding North Korea’s bioweapons program, check out GMU biodefense professor Sonia Ben Ouagrham-Gormley‘s latest interview in which she discusses what we know and what we might be missing. What a perfect way to enjoy the morning commute or a lunch break!

Post-Ebola Recovery – An Upside to an Epidemic
A recent mudslide in Sierra Leone is revealing a positive outcome from the 2014/2015 Ebola outbreak – sustained disaster response. Shortly after the mudslide, emergency response crews were already working alongside volunteers to help rescue victims. Sidi Tunis chatted with Buzzfeed, noting that “During Ebola we had a lot of community engagement, so they knew how to be first responders. They knew how to do search and rescues, they knew how to convey corpses safely to the morgue.” Many of the young men digging through rubble were already experienced, having helped with Ebola burial teams and the ambulance system was better equipped and supported as a result of the outbreak. “There was a lesson learnt from Ebola that instead of creating parallel system of NGOs, let’s take leadership from the start,” she said. “So this time it’s been led by the government from the onset, and having them take that ownership is more of a sustainable system.” “Still, NGOs playing a critical role are in a better position than they might typically have been. Three days after the mudslide, unclaimed bodies piling up in Freetown’s main mortuary posed another health risk. There were so many that they began to decompose in the tropical heat, prompting the government to order mass burials over the following two days. Workers from UNICEF were among those who helped scrub out the morgue during a massive clean-up operation that followed. ‘That needed a lot of infection prevention equipment – gloves, boots, aprons,’ James said. ‘UNICEF had emergency stock ready to go from Ebola’.”

Meeting of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria
Don’t miss out on this September 13th and 14th meeting in which the “Advisory Council will provide advice, information, and recommendations to the Secretary regarding programs and policies intended to preserve the effectiveness of antibiotics by optimizing their use; advance research to develop improved methods for combating antibiotic resistance and conducting antibiotic stewardship; strengthen surveillance of antibiotic-resistant bacterial infections; prevent the transmission of antibiotic-resistant bacterial infections; advance the development of rapid point-of-care and agricultural diagnostics; further research Start Printed Page 38913on new treatments for bacterial infections; develop alternatives to antibiotics for agricultural purposes; maximize the dissemination of up-to-date information on the appropriate and proper use of antibiotics to the general public and human and animal healthcare providers; and improve international coordination of efforts to combat antibiotic resistance.” The meeting will be held at the DHHS Hubert Humphrey Building or you can attend online here.

Pandemic Readiness (Hint: We’re Not There Yet)
Despite funding for the Hospital Preparedness Program (HPP) and an increase in funding to the Public Health Emergency Preparedness Program (PHEP), many are pointing out that these programs are chronically underfunded to begin with. “This House bill also does little to create a realistic public health emergency response fund, a standing pot of money to meet the immediate needs of a public health crisis. We saw how long it took to get emergency funds to respond to Zika, Ebola and Hurricane Sandy, with each event taking longer and longer to help these communities respond to devastating disasters.” You can also check out this latest meeting with Judy Woodruff and Liberian-born Dr. Raj Panjabi at Spotlight Health. Dr. Panjabi discusses the seriousness of infectious disease threats and the challenges of pandemic prevention.

Forecasting Outbreaks One Image at a Time
Tracking infectious diseases is a tough job and requires a lot of boots on the ground (shout out to gumshoe epidemiologists who go door to door doing contact tracing). Researchers at Los Alamos National Laboratory have been using computer modeling for a while to track disease movement, but a new partnership with Descartes Labs, is bringing high-resolution satellite imagery into the arsenal. “By mapping where high-moisture areas intersect with those social media signals and clinical surveillance data, we can help identify areas at risk for disease emergence and subsequently predict its potential path. Descartes Labs collects data daily from public and commercial imagery providers, aggregating the images into a single database. Our team at Los Alamos will use the Descartes Labs Platform to correlate satellite imagery with multiyear clinical surveillance data from approximately 5,500 Brazilian municipalities for mosquito-borne diseases such as dengue, chikungunya, and Zika in order to better understand how they spread.” This new imagery will allow Los Alamos Lab researchers to focus on specific neighborhoods and other small geographical areas. By using retrospective analysis via historical data, they’ll make sure the mathematical models are accurate and ensure that future models are truly capable of prediction.

Stories You May Have Missed:

  • Munich Re Signs Strategic Agreement With Metabiota to Enhance Insurability Against Epidemic Losses – The risk analytics firm Metabiota has announced a strategic agreement with Munich Re, one of the world’s leading reinsurers, to better establish insurability “by protecting companies and local economies from the financial loss related to epidemics. This really is the next frontier for the insurance industry – given the high risk of infectious disease outbreaks, it is imperative that we find new ways to manage and finance these risks for our customers.” Metabiota’s newest platform is a modeling method for estimating epidemic preparedness and risk, as well as the cost and severity of outbreaks by using historical data and disease scenarios and analytics.
  • Ebola Survivors Plagued With Long-term Disabilities – Imagine becoming infected with one of the most deadly viruses on the planet. Now, imagine by some stroke of luck and medical marvel, you’re able to survive. After the long, miserable road that is Ebola infection, survivors have been finding themselves with chronic conditions and high rates of disabilities. A new study found that Ebola survivors have seven times the disability rate compared to their close contacts. “In the first study, researchers followed 27 Ebola survivors in Sierra Leone for 1 year after diagnosis and found they were seven times more likely than their close contacts to report a disability. Almost 80% of the survivors (77.8%) reported a disability 1 year post-infection, compared with 11.1% of their close contacts. Disabilities included major limitations in vision, mobility, and cognition. ‘This study has demonstrated that a year following acute disease, survivors of the recent EVD outbreak have higher odds of persisting disability in mobility, vision, and cognition,’ the authors concluded. ‘Mental health issues such as anxiety and depression persist in EVD survivors and must not be neglected’.”
  • Minnesota Measles Woes & Anti-vaxxers– The benefits of vaccines have been under fire from anti-vaccine activists, despite the overwhelming good they’ve done for the world. While Minnesota continues to battle their worst outbreak of measles in decades, the antivaxxers are becoming energized in their efforts. “In Facebook group discussions, local activists have asked about holding ‘measles parties’ to expose unvaccinated children to others infected with the virus so they can contract the disease and acquire immunity.” The initial cases of this outbreak were in the Somali American community, which are believed to be the result of anti-vaccine activists speaking to community members and instilling fears and concerns. “Despite the anti-vaccine drumbeat, Minnesota’s Somali American community has begun to push back, according to some health-care providers. As part of an unprecedented collaboration clinicians and public health officials launched this summer, ­Somali American imams are urging families to protect their children by getting the measles-mumps-rubella (MMR) vaccine.”

Pandora Report 8.11.2017

Norovirus may be plaguing athletes in London for the World Championships, but we’re making sure to deliver the latest biodefense news to you (germ free)! Check out these WHO courses for managing public health emergencies.

CDC Invests $200 Million For Infectious Disease Preparedness
Last week the CDC announced that it awarded more than $200 million to help prevent, detect, respond to, and control biothreats posed by emerging and re-emerging infectious diseases. The funds will go through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) cooperative agreement and reach all fifty state health departments and several local health agencies in large metropolitan areas. The CDC announcement noted that the “CDC and states work together to improve local surveillance, laboratory diagnostic capabilities, and outbreak response. The CDC has awarded more than $200 million through the Epidemiology and ELC cooperative agreement to help states, cities, counties, and territories prevent, detect, respond to, and control the growing threats posed by emerging and re-emerging infectious diseases. State programs are the foundation of the U.S. public health system and are integral to the nation’s efforts to combat infectious disease threats. CDC and states work together to improve local surveillance, laboratory diagnostic capabilities, and outbreak response.” This also includes $77 million to help state health departments combat antibiotic resistance in their areas. The 2017 funding enhances current Antibiotic Resistance Laboratory Network (AR Lab Network) activities by increasing testing nationwide for Candida fungal threats, strengthening national TB surveillance and infrastructure, and enhancing detection of drug-resistant gonorrhea. This surge of funds, mixed with a new strategy that combines market entry rewards with population-based payments from insurers, could help bring us ahead in the battle against the resistant bug. “The proposal, dubbed the Priority Antimicrobial Value and Entry (PAVE) award, would use limited public funds to cover the majority of revenue for the first 1 to 2 years a new antibiotic is on the market, but that revenue would be phased out over 5 years and replaced by revenue from population-based contracts with health insurers. The purpose of the PAVE award, the authors said in their recent Journal of the American Medical Association paper, is to guarantee a return-on-investment for antibiotic developers by ‘de-linking’ the revenue of new antibiotics from the volume used and to promote stewardship of those drugs, so that thy remain effective and available.”

A Short History of Biological Warfare: From Pre-History to 21st Century
Don’t miss out on the latest bioweapon gem from W. Seth Carus – a history on biological warfare! “It covers what we know about the practice of BW and briefly describes the programs that developed BW weapons based on the best available research. To the extent possible, it primarily draws on the work of historians who used primary sources, relying where possible on studies specifically focused on BW. By broadening our knowledge of BW, such studies have enabled us to write about the topic with more accuracy and detail than could have been done even a few years ago.” Carus breaks BW history into three sections – prehistory to 1900, 1900-1945, and then 1945-modern day. He focuses on the agents covered by the BWC and looks at the history of state-sponsored programs, the role of scientific advances in understanding microorganisms, use of BW in warfare, and more.

What It Means To Militarize Biotechnology
Biotechnology is a fickle beast and a frequently debated topic. While many focus on the security implications of gene-editing and other biotechnologies in the hands of nefarious actors, there has been an increasing militarization of the field. Military research and investment in biotechnology can be a bag of mixed outcomes and there has been little discussion regarding the growing military interest in it. “One such issue is the risk that military investment in biotechnology will adversely affect research priorities. Another is the possibility that military investment into defensive or public health projects by one state might be misinterpreted by other states as having offensive potential. In the same vein, the scarcity of publicly available information about military research into biotechnology might fuel public distrust of valuable and well-intended work. It is clear, for example, that research into preventing, identifying, and treating infectious diseases by various militaries around the world will continue to provide broader spin-off benefits—but publics in some states might be unsure why military rather than public health institutions lead such work.” Progress in fields like synthetic biology has brought forth almost a renaissance of research and also engagement in security discussions. Brett Edwards highlights the role of the Amerithrax attacks in bringing biology into the forefront of American terrorism worries. He notes that the synbio community has been heavily engaged in the debate of misuse and its implications for innovation and regulation. Working in the synbio field inherently carries with it a forced sensitization to these issues. Edwards emphasizes that the future should include international dialogue with researchers regarding biotechnology militarization. “This sort of dialogue might allow shared principles regarding state investment in biotechnology to be identified and articulated—principles that would both guide research priorities and establish hard limits about what is permissible. Such discussions could draw upon relevant principles in international human rights, humanitarian, and arms control law—including, but not limited to, treaties specifically dealing with biological, chemical, and environmental warfare.”

Air Travel or Bug Travel?
We’ve all been on that flight with one (or more) people who are visibly and audibly ill…and there’s nothing like that ominous feeling of “I’m definitely getting sick after this flight.” A new study investigated disease transmission on airplanes and found that things like plane size and boarding method can have some pretty profound implications for disease transmission. Sure, jamming ourselves into a metal box where it’s cold and we’re in close quarters should already be a redflag for disease transmission, but there are many more variables that impact airborne disease spread. Researchers started first with how Ebola might be transmitted on a plane. “Unfortunately for current fliers, the commonly used three-section boarding technique, where passengers board by first class, middle zone and back section, is actually the worst strategy for reducing the number of infected. The reason this works so poorly is that it forces passengers to stand together in the aisle while they all wait to get to their seats, which means more time for a tightly packed group to be exposed to the contagious passenger”. They found that changing the boarding method to a two-section, random method is much more protective. Also, the speed at which we all race off the airplane once we’re landed appears to have little impact. “For plane size, you might think the bigger the plane, the smaller your odds, right? Not quite. In fact, the study found that planes with less than 150 seats are better at reducing new infections; there are fewer susceptible people present overall, fewer people within a given person’s contact radius and less time spent moving through the plane to reach assigned seats. ‘Using smaller airplanes during an outbreak, instead of completely banning flights to a specific destination, can drastically reduce the probability of introduction of infection,’ Mubayi said.” The investigative team found that if airlines stuck to their existing boarding strategies during an ebola outbreak, there would be a 67% chance of infection rates reaching 20 air-travel-related cases per month. Regardless of plane size, if airlines modified their boarding strategies, the change for infection drops to 40%. Such work gives us great insight into strategies to help slow the rate of transmission during outbreaks through the powerful vector that is international air travel.

Computer Security and DNA Sequencing
A recent article on the implications of DNA sequencing and big data highlights investigations into the “robustness of such tools if (or when) adversarial attacks manifest”. Researchers noted that DNA synthesis can provide attackers with arbitrary remote code execution and highlight the need to look at the feasibility of such attacks. Performing their own attacks on a modified down-stream sequencing utility, they found data leakage and used such lessons to evaluate security hygiene of the more common DNA processing programs. Such work is especially prudent given that biohackers recently encoded malware in a DNA strand. University of Washington researchers revealed at the USENIX Security conference this week that it’s actually possible to encode malware into DNA strands, “so that when a gene sequencer analyzes it the resulting data becomes a program that corrupts gene-sequencing software and takes control of the underlying computer. While that attack is far from practical for any real spy or criminal, it’s one the researchers argue could become more likely over time, as DNA sequencing becomes more commonplace, powerful, and performed by third-party services on sensitive computer systems.” The researchers are calling it the “the first ‘DNA-based exploit of a computer system‘.” This new finding sounds like something out of a science fiction film, but points to the unexpected threats within DNA sequencing and data processing. Thankfully, the process was pretty unreliable and the researchers had to take some significant shortcuts, which means attacks like this may be not be in the immediate future. Nonetheless, it brings forth the need to consider the security implications of information stored within DNA.

Next Generation Global Health Security Network & the Nuclear Threat Initiative Webinar 
Don’t miss out on this webinar today, at 2pm EST regarding the Next Generation for Biosecurity in GHSA Competition! This webinar will provide an overview of eligibility and submission requirements for the NTI-sponsored biosecurity competition to develop regional and global partnerships among next generation professionals. Participants will also have an opportunity ask questions about the competition. Click here to add the event to your calendar.

Bio-Labs of the Future – The Promises & Perils of the Fourth Industrial Revolution
The Wilson Center’s Science and Technology Innovation Program takes a deep-dive into the bio-labs of the future . The rise of the biotech revolution and advances in gene-editing DNA synthesis, AI, etc. are all helping laboratories grow in connectivity and intelligence. “While this may be a boon for the development of novel vaccines and therapeutics by parties that have traditionally not had access to the necessary tools, it also opens the risk of nefarious use to engineer or edit biological agents or toxins. While there have been attempts at governance to limit the avenues by which a bad actor may gain access to the pathogens or tools to create biological weapons, the ever-increasing pace of innovation has left gaps that may be exploited.” Many are calling this time a Fourth Industrial Revolution, and with technologies like portable genomics sequencers, there is a need to examine the vulnerabilities, which includes things like growing accessibility. The Wilson Center paper highlights the need to evaluate threat, potential for exploitation of gaps, and provides policy recommendations.

Combating Biological Terrorism Roundtable Discussion
Don’t miss out on this event put on by the Inter-University Center for Terrorism Studies on Thursday, August 24th, noon-2pm at the Potomac Institute for Policy Studies (901 N Stuart Street, Suit 200, Arlington, VA 22203). Roundtable speakers include Professors Rita Colwell, S. Gerald Sandler, Rashid Chotani, and Normal Kahn. “Biological security concerns are a permanent fixture of history, ranging from Mother Nature’s infectious diseases to man-made threats. Recent epidemics, such as Ebola and Zika, and the potential dangers of biological terrorism urgently need to be addressed through international partnerships to reduce the gravest health risks at home and abroad. Experts with governmental, inter-governmental, and non-governmental experience will provide an assessment of future challenges and offer recommendations for an international comprehensive biosecurity strategies.” RSVP is required (please email icts@potomacinstitute.org).

The Future of the GHSA Matters for US Clinicians
GMU Biodefense PhD student Saskia Popescu discusses the importance of the GHSA and why it should matter to U.S. clinicians. “Fundamentally, the GHSA is a crucial component to ensuring a solid and reliable global foundation exists for responding to, detecting, and preventing public health crises. Whether you are a physician in an urgent care, a nurse in a major hospital, a public health epidemiologist, or working in national policy, the importance of the GHSA and its work is apparent and a future without it will only serve to weaken US and global health security.”

CBRN Insurance Approaches
GMU biodefense MS alum Zamawang F Almemar is looking at a new actuarial approach to a CBRN insurance policy. A WMD attack against a major city would have devastating consequences but countries often struggle with the realities of costly prevention efforts. It’s important to truly analyze the threats of national security and develop countermeasure infrastructure accordingly. Drawing parallels to homeowners insurance, “investing national resources to prevent and recover from the effects of a nuclear attack is an appropriate choice for national policymakers, but what level of protection is warranted to guard against non-state actor developed and employed chemical or biological weapons, or against a radioactive attack.” The authors looked to factors that may help determine how much should be spent on WMD “insurance” and a method for evaluation. While calculating some factors, like societal fears, are challenging, there are things to consider, like economic cost of property cost damage and recovery costs, economic and societal costs of injuries, deaths, disruption, and changes to society, etc. “Factors affecting the cost of implementing a protection action include the difficulty of taking the action, the equipment needed, and the extent of the measure being taken”. Regarding policy recommendations, the authors focus on the imminent threat from terrorist organisations, noting that “it is now of utmost importance for the new administration to prioritize cWMD efforts within the national defense strategy and to ensure there is a balance in appropriations investing in these cWMD efforts.”

A Shadow Network of Science Experts
At first glance, this sounds like an elusive club of James Bond-esque scientists. In reality, the truth gives a startling look into the White House. In effort to combat several science gaps within the new administration, there are reports that an unofficial network of Obama loyalists is working to continue the Obama science agenda. “Participants have provided counsel to Democratic lawmakers and their staffs on Capitol Hill, and they have held group-wide strategy sessions much in the same fashion as they did when they worked out of a fourth-floor wing in the Eisenhower Executive Office Building, adjacent to the White House.” “In interviews, members of the new Obama group — which numbers in the dozens — said they have remained more engaged than they expected to before Trump’s victory in November. Beyond fielding policy questions from congressional offices, they have consulted with scientific societies, and advised organizers of the March for Science, among other activists — a few have even made those organizations their new professional homes. They have also assisted in analyzing the impact of White House budget proposals — which have outlined deep cuts to federal research agencies — and the impact of policies including Trump’s decision to withdraw the United States from the Paris climate accords.”

Using Vaccines to Fight Antimicrobial Resistance
While we’re working to find new antimicrobials, reducing antibiotic use, and stopping the spread of AMR, there may be another strategy – vaccines. Many are pointing to the prevention of disease via vaccines as a means of countering infections in the first place, which are frequently misdiagnosed and treated with unnecessary antibiotics. Consider pneumococcal conjugate or influenza vaccines. “A study published in the Lancet led by Ramanan Laxminarayan of the Center for Disease Dynamics, Economics, and Policy found that if every child under 5 years old in the 75 countries studied received pneumococcal conjugate vaccines, the resulting reduction of pneumonia would avert 11.4 million days of antibiotic use each year.” Vaccines can be an effective tool in reducing illness and these infections often lead to not only the missuse of antibiotics, but also hospitalizations that often result in exposure to resistant organisms. We know the benefits of vaccines against specific viral infections however, perhaps it’s time we start adding them to the arsenal against antibiotic resistance? Overcoming AMR will not be a result of a singular effort, but rather a mosaic of combined practices and changes as diverse as the reasons resistance occurred in the first place.

A Silent Anthrax Outbreak Within The Chimpanzee Population
Researchers in the Tai forest within the Ivory Coast are working to find out why chimpanzees are dying from anthrax. The anthrax strain, a new form of Bacillus cereus, known as Bcbva, has been responsible for 38% of local wildlife deaths in the forest. Anthrax in the rainforest environment is unique and this outbreak is challenging the ways we traditionally think about such infections. “In the savannah, anthrax almost always infects hoofed grazing mammals, which ingest soil laced with bacterial spores. Although it can spill over into humans, until 2001, there was no record of it afflicting wild primates. Now, we know that the Taï strain hits chimpanzees, as well as other unusual hosts like mongooses and porcupines. It even affects monkeys that spend all their time in the treetops, far away from contaminated soil. ‘We don’t know how they get infected,’ says researcher Fabian Leendertz. ‘How do the spores make it up in the trees?’” Fortunately, Bcbva isn’t active in other parts of Africa. Chimpanzees, like many great apes in this region are already fighting off disease like Ebola, so this new surge of an unsual disease is worrying researchers.

Stories You May Have Missed:

  • Hot Topics In Biodefense –  What would you consider the hottest topics? GMU’s Biodefense program has students just as diverse as the topics we face in global health security, which makes the classroom discussions pretty fantastic. One of our PhD students recently sat down and wrote about the biggest issues we face in biodefense and why this field is so crucial – check it out here.
  • Graphic Design – A New Public Health Tool?– A new exhibit at London’s Welcome Collection is drawing attention to the role of graphic design during outbreaks and epidemics. The designs range from ambulances, hospital interiors, posters, cigarette packaging, and street art. “Rebecca Wright, who has co-organised the show with graphic designer Lucienne Roberts, says that exhibits in a section about contagion are especially dramatic. An Italian ‘plague notice’ from 1681 ‘uses bold typography to give authority in time of panic,’ she says, adding that it is a beautiful object. Graphic design responding to the early spread of HIV/Aids is included, such the historic and controversial, ‘Don’t Die of Ignorance’ campaign launched by the British government in 1986. ‘It was the first time every household in the UK received a health leaflet, Wright says.”
  • China & the U.S. Battle for Biotech – Check out this latest article on FBI Supervisory Special Agent, biosecurity guru, and GMU summer workshop instructor, Ed You on the U.S.-China dispute over genetic data and its implications for biotechnology. FYI – You’ll need access to the Financial Times.

Pandora Report 7.28.2017

Happy Friday! As we close out the month of July, Texas has reported its first local case of Zika in 2017. If you’re not convinced about the threat of antimicrobial resistance, check out this video on the ability for bacteria to resist even new antibiotics.

The Reality of Trump’s R&D Cuts 
There’s been a steady stream of reports regarding the hits to global health spending that the new administration is making. The proposed 2018 “A New Foundation for American Greatness” budget hits financing of global health security, which is already poorly funded. While Bill Gates met with president Trump several times in efforts to persuade him of the importance of investing in global health and the R&D that goes into it, it seems that the continued assaults to funding aren’t going anywhere. A recent report by the Global Health Technologies Coalition and the Policy Cures Research of Australia took a different approach to swaying the president – money and fear. “The report explains that between 2007 and 2015 an investment of $14 billion (£10.7bn) in global health R&D resulted in a $33 billion injection back into the economy and the creation of 200,000 jobs. Spending since 2000 resulted in 42 successful products, including 11 for malaria and ten for TB. Want to ‘Make America Safe Again?’ Start by investing in R&D.” Just like the Nuclear Threat Initiative highlighted last week in their focus on the GHSA and importance of investment in global health, this report drives home the economics of global health security. We know that an outbreak anywhere is an outbreak everywhere, but for many, it can be difficult to see that when we’re not experiencing a major outbreak on American soil. Despite the impact of Ebola cases in the U.S. in 2014, the rise of antimicrobial resistance, and growing concerns regarding dual-use research and biosafety, there is a consistent struggle to truly get support for not only global public health, but also the R&D that supports biodefense efforts. The report notes that “Between 2007 and 2015, the US government invested nearly US$14 billion dollars in R&D for global health. In comparison, in 2015 alone, the US government spent $1.05 trillion on Medicare and health, $609 billion on the military, and $102 billion on education. Despite relatively limited investment, US government support was essential in helping advance 42 new technologies approved since 2000 – including 11 new products for malaria, 10 for tuberculosis (TB), and 1 for HIV/AIDS.” The U.S. is not an island – we rely on global cooperation and R&D alliances to help fight off current and future microbial threats. Global health security means that we must invest in efforts at home and abroad and to decimate an already limited budget for such efforts would have worldwide ramifications. FYI – the DoD released their guidance on global health engagement  (hint: global health cooperation and engagement is important).

Worry About Water Bugs, Not Sharks
While everyone is up in arms about Michael Phelps not really racing a great white shark, some are saying, “hey…there’s actually a lot of microscopic water germs that are way scarier!” “You’re 75 times more likely to be killed by lightning than by a shark. On average, one person dies of a shark attack every other year in the United States.” The real danger rests in our love of water activities during the summer, whether it be a public pool, water park, private pool, or lake. FYI, I’ve seen one too many presentations on outbreaks associated with splash pads…they are diarrheal disease hotspots.  Here are some of the bugs you should actually be worried about in water – crypto, pseudomonas, shigella, legionella, norovirus, cyanobacteria, and the brain-eating amoeba Naegleria fowleri. How can we dodge these party-crashers? Avoid swallowing the water…don’t go swimming if you’ve had diarrhea recently, check those chlorine and pH levels, and make sure to rinse off from time to time.

Emergent Biosolutions Goes On A Spending Spree
While the future of global health R&D is a little bleak, Emergent Biosolutions is sprinkling some funding around to expand its drug portfolio. “Five days after the company agreed to pay $97.5 million to acquire the smallpox vaccine assets of pharmaceutical giant Sanofi it handed another $96 million to GlaxoSmithKline, one of biggest healthcare providers in the world, to acquire raxibacumab, an antibody that treats a form of anthrax that can be inhaled. Both deals are part of a broader expansion plan that Emergent’s executives hope will turn it into a $1 billion-a-year company by 2020.” These investments are more in the direction of defense against high-consequence biothreats, and their Chief Executive, Daniel Abdun-Nabi, is pointing to not just nefarious biological events, but also those related to climate change. Abdun-Nabi notes that “There’s a real worry starting to grow across the globe about the re-emergence of pathogens that we might not have seen for a number of years,”.

Infection Control vs. MERS
Not surprisingly, infection control failures are a big source for MERS-CoV transmission. Despite ongoing outbreaks and training on PPE and isolation precautions, there’s a pretty significant trend in healthcare – poor infection control practices. A recent WHO report revealed the findings of a risk assessment regarding 199 MERS cases in four countries. Since December, 1/3 of MERS cases have been linked to healthcare facilities and while initial signs and symptoms are non-specific, they found that simply improving standard precautions (also known as universal precautions) could make a difference. Using basic infection control practices, like putting a mask on a patient with a cough, or utilizing isolation precautions when caring for a febrile patient, are all easy and critical components to preventing the spread of disease. “How MERS-CoV spreads in hospitals still isn’t clear and is the topic of scientific studies. The WHO, however, said observations suggests transmission occurs before infection prevention and control steps are applied and patients are isolated. The agency added that hospital outbreak investigations suggest that aerosolizing procedures done in crowded emergency department or medical wards without adequate control measures may have led to human-to-human spread and environmental contamination.” This is an interesting finding for several reasons. Firstly, infection control steps should be applied the second a patient walks into a healthcare facility. During measles outbreaks (and influenza season), many hospitals put kiosks in the hospital entrance that contain alcohol-based hand sanitizer and masks, with signs highlighting the importance of such practices and to wear one if you have a cough. Secondly, utilize your triage staff. Either isolate or ask patients to wear masks during their triage process to prevent the spread of infection. We often wait until patients are in rooms to use PPE but the truth is that it can start a lot earlier. Also, emphasizing hand hygiene from the beginning can be monumentally helpful for everyone involved in patient care. Yes, healthcare workers are a significant part of the transmission chain, but visitors and the patients themselves play a big role. Overall, this study draws attention to infection control failures however, these aren’t new for those of us working in healthcare, and MERS is just a good example of how we can improve them. Preemptively isolating a patient won’t hurt, but delayed isolation can kill.

First Human Embryos Edited in U.S. 
Researchers in Oregon are now the first team to attempt creating a genetically modified human embryo in the U.S. “The effort, led by Shoukhrat Mitalipov of Oregon Health and Science University, involved changing the DNA of a large number of one-cell embryos with the gene-editing technique CRISPR, according to people familiar with the scientific results.” Such work has not been previously done in the U.S. and Mitalipov’s team has shown it can be successful. While the embryos weren’t allowed to develop past a few days and there were never intentions of implantation, the altering of DNA codes within human embryos is a significant leap for biotechnologies like CRISPR. While many highlight concerns with the future of such work and the risk of “designer babies”, the NAS report in February has been seen as a green light to test germline modification. “The advisory committee drew a red line at genetic enhancements—like higher intelligence. ‘Genome editing to enhance traits or abilities beyond ordinary health raises concerns about whether the benefits can outweigh the risks, and about fairness if available only to some people,’ said Alta Charo, co-chair of the NAS’s study committee and professor of law and bioethics at the University of Wisconsin–Madison. In the U.S., any effort to turn an edited IVF embryo into a baby has been blocked by Congress, which added language to the Department of Health and Human Services funding bill forbidding it from approving clinical trials of the concept.”

MSF Lessons Learned During the DRC’s Recent Ebola Outbreak
There have been dozens of analyses since Ebola burned through West Africa in 2014/2015 however, a latest report from Médecins Sans Frontières/Doctors Without Borders (MSF) is providing insight regarding the 2017 outbreak in the Democratic Republic of Congo. The small outbreak (which seems odd to say about a disease like Ebola, but that was until 2014) resulted in the deaths of four people in a remote part of the DRC. When news first sprung up that cases were identified, the world waited with bated breath as the memories of the the last horrible outbreak were all too fresh. Fortunately, rapid field team and resource deployments aided in the quick response that halted the disease in its tracks. MSF was a part of such efforts and since the outbreak was declared over, they have identified five major lessons. Firstly, train frontline health workers. This one is music to my ears, especially in terms of the poor infection control practices among healthcare workers that made them 21-32 times more likely to acquire the diseases. “Healthcare workers play a crucial role not only for the health of the people they serve directly, but also for general epidemiological surveillance for outbreaks like Ebola, but also for more common deadly infectious diseases such as measles and cholera. A health system cannot rely on just one person to play the crucial role of on-the-ground surveillance. What is needed are proper surveillance systems in resource-poor countries, which were clearly lacking in West Africa at the beginning of the epidemic.” Secondly, a forgotten disease finally taken seriously – this is all too true in that many did not know of Ebola until it sent shockwaves through West Africa. Now, the disease is top of the agenda and rapid mobilization is triggered. Third, back to basics, which means that while we can focus on vaccines and new drugs, we can’t forget the basic pillars of outbreak control, like surveillance, isolating and treating the sick, looking for new cases, contact tracing, burying the dead safely, and engaging and mobilizing the local community. Fourth, location matters. The recent outbreak occurred in a very remote and forested area, which impacts movement of contacts, as well as acquisition of supplies. “As in all previous outbreaks before West Africa isolation played a key factor for the containment of the virus.” Lastly, medical interventions are not the magic bullet. “MSF was willing and actively preparing to use the Ebola treatments that are still in development. However the outbreak was over before the process to allow the use of experimental products was complete, so none could be used this time. This outbreak however acted as a booster to speed up the process of preparing medical protocols so that new drugs, still in the experimental phase, can be used in a way that is as safe and ethical as possible.” In the end, the rapid control and early response measures, coupled with the limited size of the outbreak, helped prevent its spread before the vaccine could even really make a difference.

Global Catastrophic Biological Risks Definition – Center for Health Security
The Johns Hopkins Center for Health Security released their working definition for global catastrophic biological risks (GCBR) in efforts to draw attention to this special category of global threats and focus future efforts to combat them. The definition is: “Those events in which biological agents—whether naturally emerging or reemerging, deliberately created and released, or laboratory engineered and escaped—could lead to sudden, extraordinary, widespread disaster beyond the collective capability of national and international governments and the private sector to control. If unchecked, GCBRs would lead to great suffering, loss of life, and sustained damage to national governments, international relationships, economies, societal stability, or global security.” You can read the article and ten commentary pieces written by a variety of leading scientists and public health experts here.

How Infectious Diseases Shape Culture
When we think of infectious diseases, we tend to imagine morbidity and mortality. While this is accurate, there’s a lot more that these microbes impact, like language, culture, etc. We know that during the European bubonic plague in the 14th century, urbanization and economic development were slowed, but those skilled laborers who survived were highly valued. Consider even the food we eat, which has several cultural dynamics within it. We avoid raw meat, raw milk, and even stopped eating raw cookie dough or cake batter (ok, let’s be honest, we still lick the bowl, right?). “Many words and expressions commonly used in English have origins linked to an infectious disease. One such common phrase, used for a person who may not have symptoms of an infectious disease but can transmit it, is to call them a Typhoid Mary. In 1906 Mary Mallon, a cook, was the first healthy person identified in the USA as a carrier of the typhoid bacilli that causes typhoid fever, a serious disease for the Western world in the 19th century (but which globally exists and has often existed in poor communities).” Consider even the term, “feeling lousy”, which originated in conjunction to those with lice who became anemic and experienced general malaise. “In the late 1880s Tunisia experienced severe infectious disease epidemics of cholera and typhoid, and famines, which so badly depleted its economy that it was unable to pay off its debts. This made it vulnerable to French occupation and then colonisation.” There’s been a substantial body of literature that looks to the security implications of disease and how it may leave countries open to political and military disputes (check out Andrew Price-Smith’s Contagions and Chaos). The recent outbreak of Ebola has even changed the way American healthcare handles preparedness. Long thought a rare disease that we would never see, hospitals around the country now have Ebola Response plans and work to train front-line staff in case an outbreak occurs again.

Reports of Pediatric Deaths Following UN Sanctions Is Untrue 
A recently article in BMJ Global Health is highlighting the fictitious statements made by Saddam Hussein’s government during the UN sanctions in 1990. “The United Nations Security Council imposed the sanctions in 1990 following Iraq’s invasion of Kuwait. The sanctions remained in place after the Iraqi army was expelled, on the grounds that Iraq’s weapons of mass destruction would need to be destroyed before they could be lifted. The sanctions greatly restricted Iraq’s ability to export oil and therefore to import supplies of food and medicines, prompting international concerns that the country’s children were being particularly hard hit.” Following these sanctions, a 1999 national survey was conducted by UNICEF and the Iraqi government, which reportedly found that “children in the centre and south of the country were dying at over twice the rate of 10 years earlier”. These results were used by several outlets for either support or refusal to invade Iraq. The researchers in BMJ Global Health have found that the results were “a deception” and studies done since 2003 have found no evidence of such high rates. The researchers concluded that “The rigging of the 1999 Unicef survey was an especially masterful fraud. That it was a deception is beyond doubt, although it is still not generally known.”

Stories You May Gave Missed:

  • CARB-X Awards $17.6M To Fight Global Antimicrobial Resistance – the private initiative, CARB-X, was established with the purpose of facilitating global efforts to combat antimicrobial resistance. This week they announced $17.6 million will fund research efforts by scientists in India, Ireland, France, Switzerland, the U.S., and the U.K. “The seven supported projects include five potential antibiotics targeting Gram-negative bacteria, a new treatment for drug-resistant gonorrhea, a new drug molecule that targets resistance in cystic fibrosis infections, and Phase I development of an oral, broad-spectrum antibiotic. The latest round of awards is part of a $455 million commitment by the U.S. Government and the Wellcome Trust over five years. The first 11 projects to receive funding were confirmed in March, and additional funding announcements are expected later this year.”
  • Biodefense World Summit – If you missed this event in June, check out some of these highlights that include talks on pathogen detection, food safety, and the importance of biodefense in the U.S.!
  • Papaya-linked Salmonella Outbreak – Just went you thought it was safe to go back to the summer fruit salad…. Sadly, salmonella is a current risk for papaya-lovers across the U.S. as an outbreak of Salmonella Kiambu has sickened 47 people across 12 states. “Most of the cases were reported in five eastern states: New York (13), New Jersey (12), Virginia (6), Maryland (5), and Pennsylvania (4).  Seven states across a wide swath of the country, however, have each reported 1 case: Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Texas, and Utah. So far, 12 people have been hospitalized. The death involved a person from New York City. Illness onsets began May 17, with the most recent on Jun 28.Patient ages range from less than 1 year to 95 years, with a median age of 27. About two-thirds are female, and, of 31 patients with available information, 18 (58%) are Hispanic. The epidemiologic and lab investigations both point to tainted papayas as the source of the outbreak. Interviews with 25 sick patients found that 11 (44%) had eaten papayas, a significantly higher proportion of papaya consumption than in healthy Hispanic people (16%) interviewed around the same time.”

Pandora Report 6.23.2017

TGIF! Before we begin our weekly dose of all things biodefense, have you ever wondered the traits that predict animal or host spillover?

What Does A Post-Polio World Look Like?
Decades of battling diseases in eradication efforts has been a struggle throughout public health history, but what happens when you finally reach the finish line? Donors around the world have worked to eliminate polio and in the final stretch and last ditch efforts, many are asking what will happen when polio is eradicated and the donors are gone? The truth is that many polio eradication programs (which include vaccination and surveillance campaigns) actually form the foundation of public health for many countries and rural areas. These programs have been the backbone of establishing some semblance of public health for areas that many not receive it otherwise. “If and when polio is gone, however, much of the transition may fall to national governments. International funding stands to shrink dramatically. About 27 percent of WHO’s $587 million in spending in 2016 went to polio eradication efforts. The African region would also be particularly hard hit. Forty-four percent of WHO spending there went to polio efforts, and about 90 percent of all immunization staff and infrastructure on the continent are funded through the WHO’s Global Polio Eradication Initiative.” We haven’t really considered what it means to eradicate a disease like polio and how the withdrawing of funds and personnel might impact countries. Moreover, many of the polio eradication programs are closely tied to other vaccination programs (measles, tetanus, pertussis, etc.) and if funds are lost because polio is eradicated, these other vaccination programs could take a hit. Aside from vaccination initiatives, if stable public health programs are not established prior to eradicating polio, there is also a risk for loss of disease surveillance. Current polio eradication programs highlight the role of surveillance, which is also used to facilitate laboratory development, all of which could impact pandemic preparedness and global health security. It is vital that efforts to eradicate polio are also met with work from political leadership to ensure a transition occurs that maintains public health efforts. “The transition as polio is eradicated will be complex, and needs to be carefully managed, country specific and country led. Polio surveillance systems can provide an important foundation, and are tremendous assets to health care systems, said Irene Koek, the deputy assistant administrator of global health at the United States Agency for International Development. Civil society organizations will have a role to play in advocating to keep local governments and ministries on target, said John Lange, the United Nations Foundation‘s senior fellow for global health diplomacy.”

Instructor Spotlight – Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
We’re getting closer to the July 17th start date for our workshop (and the July 1st early registration discount expiration!) and this week we’re excited to show off one of our very own GMU Biodefense professors, Dr. Sonia Ben Ouagrham-Gormley. An economics and defense expert, biodefense guru, and world traveler, Dr. Ouagrham-Gormley is the kind of professor whose class you spend the entire time on the edge of your seat. Sonia Ben Ouagrham-Gormley, PhD, is an Associate Professor in the Schar School of Policy and Government at George Mason University. She holds affiliations with GMU’s Biodefense Program, Center for Global Studies, and the Department of History and Art History’s Master of Arts in Interdisciplinary Studies (MAIS) program. Prior to joining the faculty at George Mason in 2008, Professor Ben Ouagrham-Gormley was a Senior Research Associate with the Monterey Institute of International Studies’ James Martin Center for Nonproliferation Studies (CNS). While at CNS, she spent two years at the CNS Almaty office in Kazakhstan, where she served as Director of Research. She also was the founding Editor-in-Chief of the International Export Control Observer, a monthly publication focusing on proliferation developments and export controls around the globe. From 2004 to 2008, she was an adjunct professor at Johns Hopkins’ School of Advanced International Studies in Washington, D.C. She is the author of Barriers to Bioweapons: The Challenges of Expertise and Organization for Weapons Development (Cornell University Press, 2014). She received her PhD in Development Economics from the Ecoles des Hautes Etudes en Sciences Sociales (EHESS) in Paris; a graduate degree in Strategy and Defense Policy from the Ecoles des Hautes Etudes Internationales in Paris; a master’s degree in Applied Foreign Languages (triple major in economics, law, and foreign languages —Russian, and English) from the University of Paris X-Nanterre, and a dual undergraduate degree in Applied Foreign Languages and English Literature from the University of Paris X-Nanterre. She is fluent in French, English, Russian, and spoken Arabic, and possesses beginner competence in Kazakh. For more information, visit https://schar.gmu.edu/about/faculty-directory/sonia-ben-ouagrham-gormley

President’s Budget Would Leave U.S. Vulnerable to Global Health Security Threats and Why We Need An Emergency Fund For Future Outbreaks
Cuts to public health, health research, and international aid have some pretty far-reaching implications and faculty from the Johns Hopkins Center for Health Security are pointing to the inherent vulnerability that would come from Trump’s proposed budget. Health security incorporates several programs and the reality is that an epidemic anywhere means an epidemic everywhere – simply put, the outbreaks that could pose a threat to the U.S. commonly begin abroad. “The proposed budget would cut $76 million from CDC’s Global Health programs, including cuts to Global Disease Detection and other programs that train and prepare countries to diagnose and respond to emerging diseases, and to the Global Immunization Program. It would reduce by $65 million CDC’s Emerging and Zoonotic Infectious Diseases programs, which aim to prevent and control outbreaks of diseases such as Zika. It cuts by $136 million the CDC Preparedness and Response Capability budget, which includes the funding for CDC’s Emergency Operations Center and the deployment of its people abroad to emergencies such as the Ebola epidemic in West Africa.” The CDC, among other agencies with biodefense positions, has a significant volume of vacancies that haven’t been filled.  More over, the authors point to the gap within the president’s budget regarding the future work of the GHSA, which is a vital multi-lateral effort to strengthen global health security. The budget has many worried because together, these cuts paint a bleak future for health security efforts – impacting surveillance, preparedness, and response efforts across the board. Global health security is simply not an investment we can afford to ignore. Did I mention that co-author Jennifer Nuzzo is also an adjunct professor at GMU’s biodefense program? Even if you’re not worried about the impact of the budget on health security, Ebola and Zika revealed just how necessary an emergency fund for outbreaks really is. “Creating a similar ‘rainy day’ fund—and providing the Centers for Disease Control and Prevention with permission to use it in advance—could save lives and money, both at home and overseas. The idea behind an emergency fund is not to displace efforts to combat infectious disease but to ramp them up to meet a crushing temporary need. During an outbreak the CDC can call on many doctors and nurses to work without pay, but the costs of transportation, medical supplies and protective equipment still have to be covered.” While the president’s 2018 budget includes such a fund, it fails to give a specific dollar figure and is already cutting into public health funding, which may be counterintuitive. “Lawmakers need to follow through by approving one or both of the proposed measures for the president to sign to ensure that the money will be there when the next public health emergency strikes.”

North Korea & A Sea of Sarin
The threat of nuclear-armed ballistic missiles from North Korea is a growing concern and while many focus on their nuclear and ballistic missile ambition, Reid Kirby is examining North Korean chemical weapons. Looking at the Terminal High Altitude Area Defense (THAAD) missile system and South Korean capital of Seoul, which houses more than 10 million people, many worry about North Korea’s ongoing vague threats. “Proponents of preemptive military action against North Korea’s nuclear program, along the lines of Israel’s 1981 Operation Opera against Iraq’s nuclear program, typically ignore North Korea’s history of asymmetrical responses. But North Korea’s capacity to inflict mass chemical casualties on the Seoul area in a ‘sea of sarin’ attack rivals its capacity for nuclear destruction.” In 2010, it was estimated that North Korea possessed 2,500-5,000 tons of chemical weapons (mostly sarin and VX) and maintains roughly eight manufacturing facilities, which could ramp up production to 12,000 tons. Kirby addresses estimates of rounds per minute and calculations of how much sarin Seoul might receive in such an attack, noting that “a heuristic approach to estimating the total quantity of sarin required to inflict 25 percent casualties on a city such as Seoul under the specified conditions simplifies the problem into a box model of 600 square kilometers, with casualty rates integrated by area to find the necessary quantity. Using this approach, a ‘sea of sarin’ attack on Seoul would require about 400 kilograms of sarin per square kilometer”. He highlights the consequences of a 240-ton sarin attack on Seoul, noting that it would kill around 6.5% (higher lethal dosage) or potentially 25% of the population (if lower lethal dosage assumed). “If publicly stated intelligence estimates are to be believed, North Korea’s chemical arsenal represents a credible and present threat. How North Korea could apply this threat as a deterrent is speculative. But the destructive potential of the threat should give reasonable cause to hesitate regarding preemptive military options against North Korea’s nuclear weapons ambitions.”

Pandemic Flu Plan – A New Approach
The US Department of Health and Human Services (DHHS) just released their updates to pandemic flu plans. “The original plan was geared toward a more severe scenario and set a goal of delivering pandemic vaccine within 6 months of a pandemic declaration. The new document incorporates lessons learned from the 2009 H1N1 pandemic, which resulted in a less severe event. It also spells out the goal of having the first vaccine doses ready within 3 months of pandemic strain emergence, along with approved broad-spectrum antivirals.” Within the plan there are now seven domains of focus, which include objectives, goals, and key steps. The domains are: surveillance, epidemiology, and lab activities, community mitigation measures, medical countermeasures, healthcare system preparedness and response, communications and public outreach, scientific infrastructure and preparedness, domestic and international response policy, incident response, and global partnerships. You can read the plan here, in which HHS notes that they are exploring several innovative approaches to pandemic flu preparedness like re-conceptualizing respiratory protection, accelerating vaccine and antiviral development, building on emerging technologies for innovative diagnostic and diagnostic testing, etc. “Taken together, the updated domains reflect an end-to-end systems approach to improving the way preparedness and response are integrated across sectors and disciplines, while remaining flexible for the conditions surrounding a specific pandemic. This more-nuanced and contemporary approach recognizes the interdependence of domain areas, which should lead to a better understanding of how the system functions as a whole.” The updated HHS pandemic plan emphasizes that while the nature of influenza and pandemics may change, the importance of planning and strengthening critical infrastructure will always be necessary.

DoD Tick-Borne Disease Research Program
There’s been increasing attention to the threat of tick-borne diseases and the DoD is ramping up research efforts. Their Tick-Borne Disease Research Program (TBDRP) looks to help increase not only treatment efforts, but also diagnostic capacity. Created in 2016, the TBDRP works to fill the gaps within tick-borne disease research through programs like the Idea Award which encourages and supports investigators in the early stages of their career. The New Investigator aspect of this award aims at those postdoctoral fellows working to develop independent research and in the early stages of faculty appointments. “There are currently at least 16 known tick-borne illnesses, with emerging diseases being discovered all the time. In the United States, the yearly cases of Lyme disease and other tick-borne diseases, including spotted fever rickettsiosis, anaplasmosis, and ehrlichiosis, have been increasing steadily for years, currently totaling tens of thousands of people diagnosed annually, with more likely undiagnosed. Globally, the US Military prioritizes tick-borne Crimean-Congo hemorrhagic fever as an operational threat abroad. The FY17 TBDRP intends to support conceptually innovative, high-risk/potentially high-reward research in the early stages of development that could lead to critical discoveries or major advancements that will accelerate progress in improving outcomes for individuals affected by Lyme disease and/or other tick-borne illnesses.”

Health Sector Resilience Checklist for High- Consequence Infectious Diseases
Johns Hopkins Center for Health Security and the CDC jointed together to take the lessons learned from Ebola and build a checklist to strengthen the U.S. in the event of such high-consequence outbreaks. This checklist focused on high-consequence infectious diseases (HCIDs), which are novel, moderate to highly contagious, moderate to highly lethal, not easily controllable by MCM or non-pharmaceutical intervention, and cause exception public concern (think Ebola, MERS, H5N1, etc.). “The principal aim of this project was to develop evidence-based recommendations to enable communities to build health sector resilience to events involving HCIDs based on the domestic response to confirmed cases of EVD in the United States.” Aside from the checklist, their findings highlight issues with governance and coordination, communication, public health issues, health-care specific issues, EMS, and laboratories.  The general checklist itself includes sections on preparedness, leadership, creative flexibility, command structure, public trust, managing uncertainty, and crisis and emergency risk communication. There are also checklists for public health, healthcare, EMS, and elected officials, which includes things like a collaborative relationship with partners at other healthcare facilities and awareness of resources related to public health law expertise.

Stories You May Have Missed:

  • Anthrax: DoD Develops Biological Select Agents & Toxins Surrogate Solution – “The Defense Biological Product Assurance Office (DBPAO), a component of the Joint Program Executive Office for Chemical and Biological Defense, has announced the development of a Biological Select Agents and Toxins (BSAT) surrogate solution that will mitigate the risks associated with shipment and use of Bacillus anthracis. In addition to risk mitigation for Department of Defense (DoD) stakeholders and the community at large, this product demonstrates DBPAO’s commitment to providing quality reagents to the DoD and to the biodefense community. To accomplish this task, the DBPAO developed a Bacillus anthracis surrogate strain named Recombinant Bacillus anthracis with Assay Targets (rBaSwAT) using a recombinant DNA approach to create a BSL-2-level genetically modified organism that will allow continuation of operations with reduced risk. The strain is built in a novel, non-virulent Bacillus anthracis background and carries a comprehensive complement of anthrax specific molecular and immunological markers.”
  • Bioviolence- Matt Watson from Johns Hopkins Center for Health Security, is taking us through the history of bioviolence aka using infectious diseases for violent purposes. While not everyone truly sees the immediate threat of biological agents, Watson highlights the newer threats like synbio and biotechnologis that have growing potential for misuse. He also takes care to highlight the history of bioweapons to truly show the range of their application. “Of all the scourges of mankind, plagues and warfare are almost certainly the most dreaded and dangerous. Several times throughout history—and more frequently than most people are aware of—there have been attempts by individuals, organizations, and nation-states to harness the former in service of the latter.” If you want a brief overview of historical biological weapons and to truly understand the future of biothreats, don’t miss out on this great op-ed.
  • New York City Legionnares’ Cluster – Health officials are scrambling to investigate the source of a NYC Legionnaires’ cluster in Manhattan. “In a Jun 16 statement, the New York City Department of Health and Mental Hygiene (DOHMH) said seven illnesses have been confirmed over the past 11 days. Four people are recovering in the hospital, two have been discharged, and one person in his or her 90s with underlying health conditions has died. Authorities are sampling and testing all cooling tower systems within a half-kilometer radius of the affected area of Lennox Hill. The health department is urging New Yorkers who have respiratory symptoms such as fever, cough, and chills to promptly seek medical care. In a typical year, about 200 to 400 Legionnaires’ cases are reported in New York City.” Legionnaires’ can be deadly for immunocompromised patients and is often a result of water treatment issues or poor disinfecting processes with spas, hot tubs, humidifiers, condensers, etc.

 

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.