Pandora Report: 5.15.2020

The Coronavirus Chronicles
We recently introduced our new series,The Coronavirus Chronicles, which is a collection of stories, based on the personal and professional experiences of the faculty, students, and alumni of the Biodefense Graduate Program, about life during the pandemic. From lab safety to parenting and even healthcare work, The Coronavirus Chronicles have detailed the lives of so many of our students and alumni working in COVID-19 response. We hope these stories help the public better understand the challenges posed by COVID-19 and how current and former members of the Biodefense Graduate Program have responded to these challenges and contributed to the pandemic response at the local, national, and international levels. This week, we’re launching a new story by biodefense doctoral alum Jomana Musmar, who shares how she’s responding to COVID-19 with HHS while multitasking as a mother and spouse to an ED physician. Jomana’s experiences provide insight into the challenges we’re facing in terms of pandemic response and lesson we can all take away, noting that “Another important lesson learned is the need for everyone—from households to corporations to governments—to have a Plan B for continuity of operations for every aspect of life. Our reliance on the internet, laptops, and mobile phones has shown how pivotal a role this technology plays in being able to survive.”

COVID-19 Reopening and Recovery: Proposed Plans for the US
GMU biodefense doctoral student and Pandora Report associate editor Rachel-Paige Casey is breaking down the recovery plans to help get the U.S. back from COVID-19. “Throughout April, strategies regarding the reopening of the US economy and its associated public health factors were published by the White House with the Centers for Disease Control and Prevention (CDC), the Center for Health Security at Johns Hopkins University, the Rockefeller Foundation, and the Edmond J Safra Center for Ethics at Harvard University. The four strategies discussed here either outline phases for resuming activity or describe systems to enable and assist safe reopening.” Casey details the four strategies, their phases, and provides a risk assessment in this detailed review of what experts are suggesting for COVID-19 recovery. Read more here.

Schar School Event- Public Policy in the Pandemic Age: How COVID-19 is Reshaping our Government, Economy, and Society
Join the Schar School Faculty, Alumni, Schar Alumni Chapter, and Dean Mark Rozell for an engaging virtual panel on the future of public policy post COVID-19 – COVID-19: How the Pandemic is Reshaping our Government, Economy, and Society. This virtual event will be moderated by Biodefense Graduate Program director Dr. Gregory Koblentz, and will be held from 2-3:30pm EST on Wednesday, May 20, 2020. The COVID-19 pandemic is presenting unprecedented challenges to the United States and the rest of the world. Not since the “Spanish Flu” of 1918 have we experienced a pandemic of this scale and severity. Aside from the steep and growing human toll of the outbreak, virtually every aspect of our personal and professional lives are being affected. The sheer breadth of issues impacted by COVID-19 is overwhelming: public health, medicine, government, the economy, international trade, education, national security, politics, and technology, to name just a few. The effects of the pandemic are also magnified by existing cleavages within our society ranging from hyperpartisanship to racial disparities to socioeconomic inequalities. You can read more about our distinguished panel members and register for the event here.

The Future Bioweapons Threat: Lessons from the COVID-19 Pandemic
Looking for a webinar to discuss lessons learned from COVID-19 and the implications for bioweapons threat analysis? The Council on Strategic Risks (CSR) is thrilled to present its first LIVE webinar on May 28 from 3:00-4:30pm EST, which will examine the future bioweapons threat from the perspective of the COVID-19 pandemic. Panelists include Max Brooks, author of World War Z and Devolution, Nonresident Fellow at The Modern War Institute and Atlantic Council, Honorable Andrew C. “Andy” Weber, Senior Fellow at Council on Strategic Risks, former Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs at the Pentagon, GMU Biodefense alum Dr. Saskia Popescu, Epidemiologist and Senior Infection Preventionist, HonorHealth, and Dr. Alexander Titus, Chief Strategy Officer, Advanced Regenerative Manufacturing Institute and Senior Fellow at Council on Strategic Risks. Register for event here.

 Social Distancing During Pandemics According to the GAO
The US Government Accountability Office (GAO) released a brief report about the science behind social distancing to curb the spread of COVID-19. Based on historical studies, the Centers for Disease Control and Prevention (CDC) asserts that the area of highest risk is within 3 feet of an infected individual, but a buffer radius of 6 feet is recommended. These recommendations are founded on studies in the fields such as fluid mechanics, epidemiology, and microbiology. Other studies found that infectious droplets can travel beyond 6 feet, but the degree of infectivity of particles that travel relatively long distances is uncertain. The distance that an infectious droplet can travel depends on several factors such droplet size, humidity level, and air currents. For instance, the smaller the droplet, the farther it can potentially travel. The goal of social distancing (keeping a personal bubble with a 6-foot radius) is to reduce the rate of transmission; however, it is not a perfect non-medical countermeasure. The speeds and distances of viral particle travel from coughing or sneezing are difficult to determine with absolute precision. Additional challenges beyond the science and calculations are related to the difficulty in application: the psychological impacts of social distancing and isolation are yet to be fully realized. Read the full two-page here.

DHS S&T Launches Indoor Predictive Modeling Tool for Coronavirus Stability
This week, the Science and Technology Directorate (S&T) of the Department of Homeland Security (DHS) released a predictive modeling tool that estimates the natural decay of SARS-CoV-2 based on temperature within the 70-95°F range and relative humidity between 20-60%. The current iteration of the model is for stainless steel or ABS plastic surface types; nitrile (a compound used in disposable gloves) surface type will be available soon. For example, on a stainless steel or ABS plastic surface with a temperature of 77°F/25°C and relative humidity of 33%, the half-life of the virus is 11.52 hours, or 0.48 days. This model was developed to inform response efforts regarding the persistence of the virus on certain surfaces (fomites) and under specific combinations of conditions. Additional enhancements in the pipeline for this model include droplets in the air vs. on a surface, expanded temperature and humidity ranges, different surfaces. The model can be found here.

Pandemic dispatch: An infection-prevention expert on shortages, misinformation, and health worker strain on the coronavirus front line
GMU Biodefense doctoral alum and infection prevention epidemiologist Saskia Popescu discusses her experiences on the frontlines during the COVID-19 pandemic. “For the past four months, I’ve had a front row seat to the coronavirus pandemic. Working in a major hospital system, I’ve seen first-hand the issues that have come to define the crisis: the concerns about supplies, the torrent of misinformation, and the critical problem of health care worker exposure to COVID-19. Infection preventionists such as myself work in hospitals to stop the spread of infections among patients, staff, and visitors alike. Despite our training, the coronavirus has tested hospital programs like mine, forcing us to drastically change our daily practices.” Read more here.

News of the Weird: Pajama Sales in a Pandemic
Though many industries are struggling to survive as sales have plummeted during the response to COVID-19. Pajamas, however, are in high demand as many of us remain at home; pajama sales have soared by 143%since lockdown. Real pants are optional when working from home.   According to CNN Business, eCommerce sales were up almost 50% in April, because in-person retail shopping is currently limited, if not impossible. Other items with growing demand include beer and liquor and creative audio equipment like sound mixers.

News of the Weird: Cocktail-Friendly Face Masks
Artist Ellen Macomber designed an unconventional face mask that sports a small hole fit for a straw that allows the wearer to enjoy cocktails in Covid-19. Macomber is based in the Big Easy, also called New Orleans, a city known for its round-the-clock party life. These bedazzled and flamboyant face masks run $60 a pop. She does admit that the masks are not the “best form of prevention” given its opening right into the mouth.

Biosecurity Is the Lesson We Need to Learn from the Coronavirus Pandemic
Dr. Daniel Gerstein, graduate of the Biodefense PhD program, and Dr. James Giordano wrote in The National Interest about the biosecurity lessons we need to learn from the coronavirus pandemic. Though there is no scientific evidence that the novel coronavirus was human-made, humans do bear some the blame for this pandemic. Humans disrupt and destroy the environment and its habitats, mix species as bush meat in wet markets, and experiment with dangerous pathogens. The COVID-19 pandemic and the human behavior that encouraged it signal the need to develop a new approach to biosafety and biosecurity that “addresses the full range of biological threats that humankind and the global environment will face in the future.” As humans continue to intrude into natural habitats, the risk of zoonotic disease spillover continues to increase. Over the last thirty years, 30 new human pathogens have been found, most of which originated in animals. Gerstein and Giordano encourage the expansion of biosafety and biosecurity to include consideration of the global biological ecosystem. Read the full article here.

WHO Announces the Launch of New Informational Apps
The World Health Organization (WHO) launched two COVID-19 apps for smartphones. One is for healthcare workers and the other is for the general public. For healthcare workers, the WHO Academy app provides information on COVID-19 resources, guidance, training, and virtual workshops. For the general public, the WHO Info app provides access to the latest COVID-19 news and developments. Both apps can be downloaded for free from the Google Play Store and the Apple App Store.

 

Pandora Report: 4.10.2020

National Security in the Age of Pandemics
This week, Dr. Gregory Koblentz, Director of the Biodefense Program, and Dr. Michael Hunzeker, Associate Director of the Center for Security Policy Studies, published a commentary asserting that pandemic preparedness cannot be improved if it becomes another item on the military’s infinite laundry list of missions and threats. The COVID-19 outbreak on the USS Theodore Roosevelt forced the ship’s commander to temporarily scale back operations it so that its crew could isolate themselves and later resume their duties after subduing the infection. Now, the USS Ronald Reagan is reporting positive COVID-19 cases and may have no option but to follow the lead of the Roosevelt. These events are warnings to our national security apparatus that pandemic diseases are clear and present threat to our Nation and her allies and interests. Koblentz and Hunzeker urge the US to recognize this threat and adjust to it with urgency and intensity. For more, Koblentz and Hunzeker’s article is available here.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Are you registered for the summer workshop yet? From July 13-16, 2020, GMU Biodefense will be hosting a three and a half-day workshop on all things global health security. Leaders in the field will be discussing hot topics like COVID-19, pandemic preparedness, vaccine development, medical countermeasures, synthetic biology, and healthcare response to COVID-19. This is also a great networking opportunity as past participants come from a range of government agencies, NGOs, universities, think tanks, and foreign countries. Don’t miss out on the early-bird discount for this immersive workshop – you can register here.

Syria’s Chemical Weapons Attacks
The Organisation for the Prohibition of Chemical Weapons (OPCW) published its First Report by the Investigation and Identification Team, which strongly linked the Syrian government to the March 2017 sarin and chlorine attacks on a rebel town. Specifically, in March 2017, three projectiles – two containing sarin and one containing chlorine – were dropped from aircraft of the Syrian Arab Air Force into Ltamenah in northern Syria. In total, these weapons affected at least 106 individuals. The Washington Post reported on these findings and our own Dr. Gregory Koblentz, Director of the Biodefense Program, stated that strong evidence for attribution is the first concrete step toward punishing such violations of international laws and agreements. The OPCW is not a judicial body with the ability to determine and punish criminal acts, so action must be taken by the Executive Council and the Conference of the States Parties to the Chemical Weapons Convention, the United Nations Secretary-General, and the international community. The full report is available here.

Smartphones and Contact Tracing
Contact tracing is a vital piece to not only public health response, but also helping “reopen” the country (keep reading for more insight into this). Unfortunately, it’s quite time and resource intensive and with widespread transmission and not enough public health resources, this can limit our capabilities. Some countries though, are looking to employe technology into contact tracing – “In Singapore, a country that’s turned to cellphone contact tracing, an app called TraceTogether uses Bluetooth to log when a user’s phone encounters another phone that has the app. If someone tests positive for COVID-19, he or she can easily submit a log of all the other people (and their phones) that he or she came in contact with in the last 21 days.” GMU’s HyunJung Kim has recently discussed this approach in South Korea – noting that “The disclosure of epidemic information is very significant for disease prevention and control, because we experienced the failure of disease control and prevention during the MERS of 2015,” HyunJung Kim, a PhD student in biodefense at George Mason University who has written about Korea’s public health system, says. “Information … makes people more comfortable because they can avoid and detour the areas/hospitals where infected people visited.” On the other hand though, such tech has ethical implications. Kelly Hills, Co-Principal of Rogue Bioethics noted that “We really have to keep our guard up against surveillance technologies that could be abused with very little effort, especially since these technologies are almost always going to be used against our most marginalized communities.” Damien P Williams, PhD candidate in the Department of Science, Technology, and Society at Virginia Tech recently noted that “First and foremost, supposedly anonymized tracking data sits alongside facial recognition as technologies which, in the current formulation of Western society, have no non-oppressive, non-exploitable use. Things developed and deployed in times of heightened fear and concern will very likely become every day violations.” Williams further stated that “Such a tool simply reinforces the trend toward surveillance technologies which are both insidiously abusive and also disproportionately leveraged against already-marginalized communities, as it has been the case with technologies and research in this vein, for literally centuries.” Where do you land on the topic?

Small Groups, Big Weapons: The Nexus of Emerging Tech and WMD Terrorism
A paradigm shift in recent years has seen non-state actors enhance their capabilities to utilize WMDs. A new report from the Combating Terrorism Center at West Point, is shedding light on the changes to capital, infrastructure, and intellectual capacity that are aiding this shift. “The commercialization of emerging technologies is reducing the financial, intellectual, and material barriers required for WMD development and employment. This report surveys three emerging technologies—synthetic biology, additive manufacturing (commonly known as 3D printing), and unmanned aerial systems—and examines the nexus of each with nuclear, biological, and chemical weapons agent proliferation. It examines how non-state actors might use these emerging technologies to overcome traditional barriers against the development and employment of WMD.” You can access the report here.

Inadequate PPE Distribution & Hospital Experiences Responding to COVID-19: A U.S. Survey 
Just how well are hospitals managing the current pandemic? Not well. A survey by the HHS Office of the Inspector General (OIG) across U.S. hospitals from March 23-27, revealed some sobering insight into the challenges of COVID-19 response. 323 hospitals across 46 states chatted with the OIG on this (at least the hospital administrators did…). At a glance, the findings aren’t surprising – severe shortages of testing supplies, extended waits for results, widespread shortage of PPE, challenges maintaining adequate staffing and hospital capacity to treat patients, shortages of critical supplies and materials, and changing/sometimes inconsistent guidance. “Hospitals reported that changing and sometimes inconsistent guidance from Federal, State, and local authorities posed challenges and confused hospitals and the public. Hospitals reported that it was sometimes difficult to remain current with Centers for Disease Control and Prevention (CDC) guidance and that they received conflicting guidance from different government and medical authorities, including criteria for testing, determining which elective procedures to delay, use of PPE, and getting supplies from the national stockpile. Hospitals also reported concerns that public misinformation has increased hospital workloads (e.g., patients showing up unnecessarily, hospitals needing to do public education) at a critical time.” This is an insightful and telling report about the current challenges hospitals are facing in the U.S., not only in responding to COVID-19, but also preparing for it. Unfortunately, this isn’t the only report regarding inadequate supplies and distribution of PPE and vital medical supplies across the U.S. to various states. A new document has been released from HHS on the insufficient distribution of these critical pieces to healthcare response. “Only 11.7 million N95 respirator masks have been distributed nationwide—less than 1% of the 3.5 billion masks that the Trump Administration estimated would be necessary in the event of a severe pandemic. Only 7,920 ventilators have been distributed from the stockpile, even though a recent survey of 213 mayors—which did not include New York City, Chicago, or Seattle—identified a total estimated need of 139,000 ventilators.” Moreover, the report notes that the Strategic National Stockpile has made its last shipment of PPE for states as it now has 10% left, which will be reserved for federal workers and not distributed to states.

When Can We “Reopen” the U.S.? 
The U.S. has over 427,000 cases and 14,696 deaths related to COVID-19, but many of us have been wondering, when will we be able to go back out to restaurants and congregate in public? The answer though, isn’t so simple and frankly, contingent upon a lot of factors like rapid testing and the ability to do contact tracing. First– “Number one: any given state that’s considering relaxing social distancing should have a demonstrated downward trend in cases over the two weeks prior. And we need to get better at being able to evaluate trend data across the country. Ultimately it would be good to have more data that would allow decision makers to be able to look at neighboring states and make sure they’re congruent with others in the region.” Beyond this and a sustained reduction in cases, we need widespread availability of PPE for healthcare workers. An adequately supplied healthcare infrastructure is critical and we must support healthcare workers as they face an onslaught of cases across the U.S.

Biodefense and Pandemic Policy
With each week, we learn more about ignored messages, red flags, and exercises that shed light on the very real failures in pandemic preparedness/response we are living right now. From the disbanding of the NSC global health security team to the failures in following the 69-page pandemic playbook, there have been several missteps and delays in the administration’s response. “The playbook was designed ‘so there wasn’t piecemeal thinking when trying to fight the next public health battle,’ said one former official who contributed to the playbook, warning that ‘the fog of war’ can lead to gaps in strategies.” Pandemic preparedness is no easy task, but many are looking at previous presidential responses to biological threats as an indicator that what we’re seeing now isn’t ideal. Within the most recent International Affairs journal, there is a reading list regarding global health crises that shed light on behavior norms and response measures during such events. In this collection, you’ll see GMU Biodefense professor and graduate program director Gregory Koblentz’s review of the Obama administration’s strategy for countering biology threats. “This strategy represents a shift in thinking away from the George W. Bush administration’s focus on biodefence, which emphasized preparing for and responding to biological weapon attacks, to the concept of biosecurity, which includes measures to prevent, prepare for and respond to naturally occurring and man-made biological threats.” The current COVID-19 pandemic will be a pivotal moment in biodefense and biosecurity policy, hopefully guiding future efforts and investments into pandemic preparedness.

Student Spotlight: PREDICT-ing the Next Pandemic?
Michael Krug, a second-year student in the Biodefense MS program, November 2019 article highlights the critical need for comprehensive and quick biosurveillance tools to aid in pandemic preparedness. Last week, the decision was made to end USAID’s PREDICT project. PREDICT was established in 2009 to help develop wide-ranging detection capabilities; it was a component of the early-warning system. the project identified 1,200 viruses – including 160 novel coronaviruses – with the potential to induce a pandemic. Beyond identification, the project trained and supported staff across 60 foreign laboratories, such as the Wuhan Institute of Virology. Krug points out that the dissolution of PREDICT is an unfortunate reversal away from the US goal of slowing the emergence (or reemergence) of infectious diseases. This week, the LA Times reported on the termination of PREDICT, corroborating the echoed Krug’s sentiments and shared the announcement that the PREDICT program was just extended through September so that it can assist in the COVID-19 response.

Why Giving Americans Checks Makes Sense
In response to the March 22 column by Steven Pearlstein stating that providing funds to every American would be a bad idea, you can now read a rebuttal here. Included in this list of respondents is GMU Biodefense professor Sonia Ben Ouagrham-Gormley, who noted that “The plan to send money to every American may not be economically sound in normal circumstances, but it is an appropriate response to the economic hardships caused by this pandemic. And it could help curb the spread of the disease. True, many people will maintain their income, but what about the short-term burden people will face because of the pandemic? What about the employee who already lost her job and needs to care for her children? What about elderly people who have no one to rely on and who cannot stock up on food? These people need cash now to face the additional (temporary) economic burden caused by the epidemic. More important, they need it now to heed the Centers for Disease Control and Prevention’s guidelines: Stay home for a long enough period to break the transmission chain of the disease.”

Pandora Report: 2.28.2020

Welcome to your favorite weekly source for all things biodefense! We’ll be doing a shorter, slightly delayed newsletter next week, but rest assured, your source for global health security news will be back in full force on March 13th. Fortunately, we’ve got a registration page for you to reserve a spot (with an early-bird registration discount!) for the 2020 workshop on Pandemics, Bioterrorism, and Global Health Security: From Anthrax to Zika.

Experts Examine COVID-19 and an Unsettling Response by the Chinese Government
Missed the Coronavirus and Its International Ramifications February 21st event at GMU? Here’s a great recap. While the lively discussion was even-tempered, the information imparted about the global health crisis was often staggering. No less than a longtime veteran of international health emergencies—including investigating Japan’s nuclear reactor crisis—is alarmed. “This is an astonishing outbreak,” said senior vice president of the Center for Strategic and International Studies Stephen Morrison, director of the center’s Global Health Policy Center. “What we think we know today could change tomorrow.”

International Security Crisis Reader
This week’s International Security Crisis Reader covers biosecurity and the global Covid-19 pandemic. An article by our own Dr. Gregory Koblentz, Director of the Biodefense Graduate Program at GMU, is a featured piece. Koblentz’s Spring 2010 article, “Biosecurity Reconsidered: Calibrating Biological Threats and Responses,” describes how biosecurity arose as a critical component of the international security agenda, scrutinizes the contending definitions and conceptualizations of biosecurity, and outlines a taxonomy of naturally-occurring and human-made biological threats to international security. Other featured articles cover HIV/AIDS amidst the conflict in Africa, globalization and biosecurity, and intelligence assessments for biosecurity threats. The Crisis Reader can be found here.

SARS-CoV-2/COVID-19 Pandemic Updates
This week has been non-stop in terms of COVID-19 news and cases. From possible community spread in California, and  8,400 people being monitored, to a state of emergency being called in certain counties, there’s been a lot going on. On Thursday evening, the CDC revised the criteria to guide evaluation of patients under investigation for COVID-19 – this now expands to those with symptoms and travel to an affected area (China, Iran, Italy, Japan, and South Korea), as well as those with severe acute respiratory illness requiring hospitalization without a source of exposure. A whistle blower recently came forward and “is seeking federal protection after complaining that more than a dozen workers who received the first Americans evacuated from Wuhan, China, lacked proper training or protective gear for coronavirus infection control.” On Wednesday President Trump gave a press conference on the pandemic, breaking from what senior public health officials have said about the likelihood for additional cases in the United States. Vice President Pence has also been tasked with leading the COVID-19 response in the U.S., however there was concern on Thursday regarding the communication channels that are now being put in place. Shortages and communication gaps within response has been problematic in recent weeks, with comments of disruption being left to air without more guidance. Many are wondering how they can prepare though and experts have worked to dispel fear but also encourage general preparedness measures. GMU biodefense alum Saskia Popescu recently spoke on this, noting that “‘A lot of preparedness is planning ahead of time,”’ Popescu said.’“Practice makes permanent. If I have a plan, that means I don’t have to panic.’ ‘The most important thing right now is to remain calm,’ she said. ‘Remember, we don’t have that many cases in the U.S., and prevention strategies for this coronavirus are not new. We’ve been doing them for years’.” You can also hear her speak on NPR’s On Point with Jeremy Konyndyk regarding preparedness in the United States. Cases have continued to grow outside of China as Italy, South Korea, and Iran all report many infections. As COVID-19 cases spring up more and more outside of China, thoughts of containment have moved to mitigation. There has been increasing attention to the economic impact of the pandemic, and the UBS Chief Investment Office recently noted “While the situation in China appears to be improving, the next two weeks will be important in determining whether the authorities in Europe and elsewhere can quickly contain the outbreak, or whether there is a further rapid spread of the virus.The full impact on economic activity from the COVID-19 epidemic remains in a state of flux.” Moreover, they note that “In a risk case where containment in China takes much longer or the spread abroad significantly worsens, further reductions to growth would have to be made.” Realistically, how does one keep China’s economy running with 750 million in quarantine? Public trust has been hard hit and overstressed public health/healthcare systems aren’t helping. “The good news for Xi and the party at the moment is a decline in reported new cases and deaths nationwide (the vast majority in Hubei). The bad news, however, is that Hubei’s horrors have tarnished the trust many Chinese had in their officials’ ability to safeguard citizens’ lives and livelihoods.” Realistically, this also calls into attention the travel bans that despite continued use, fail to be truly effective. From discouraging transparency to the realistic issues in focusing on symptoms during respiratory virus season, these efforts appear more taxing than helpful. The economic impact of the outbreak will continue to be a topic of conversation though, as President Trump scrambles to downplay the stock market losses this week.

Synthetic Biology Surprise: Synthesis of Vaccinia Virus
Dr. Gregory D Koblentz, the Director of the Biodefense Graduate Program at Schar School of Policy and Government at George Mason University, published an article this week in the Bulletin of the Atomic Scientists about a frightening feat in biotechnology that remains unnoticed amidst the chaos of Covid-19. In January, Tonix Pharmaceuticals discreetly announced that it had successfully synthesized the vaccinia, the virus used for the smallpox vaccine, in a press release about a poster it presented at an American Society for Microbiology conference. Tonix’s “achievement” was sought after despite serious concerns from several biosecurity experts, many of whom raised criticism of the firm’s synthesis of horsepox virus in 2017. Of grave concern is the utility of synthesized vaccinia as the benefits do not outweigh the risks. In fact, synthesis is unnecessary for researching vaccinia as samples are widely available.  Any claims that Tonix’s work was intended to help develop an improved or safer smallpox vaccine are undercut by the recently licensed JYNNEOS vaccine, a 3rd generation smallpox vaccine developed by Bavaria Nordic. The resources and skills needed to synthesize even complicated viruses are becoming more readily available as synthetic biology and the flourishing bioeconomy lower costs and simplify processes. Unfortunately, the lack of regulations and oversight for DNA synthesis, whether in the name of peaceful research or otherwise, is not matching pace with its accessibility to scientists and DIY bio-users. This is yet another example of the possibilities – both beneficial and detrimental – made reality by synthetic biology, and the risks of puny safeguards for its tools and data.

Upcoming Event: The Story of Technology by Daniel Gerstein, PhD
On 4 March 2020, the CSPS Speaker Series is hosting Dr. Daniel Gerstein, a GMU Biodefense PhD alumnus, to discuss his new book, The Story of Technology: How We Got Here and What the Future Holds. The book examines the rapid proliferation and pervasive influence of technology in human societies. Dr. Gerstein is a senior policy researcher at the RAND Corporation, and he has served in the Department of Homeland Security as Under Secretary (Acting) and Deputy Under Secretary in the Science and Technology Directorate. Dr. Gerstein will be joined by Ellen Laipson, Director of the Master’s in International Security program and CSPS, and Dr. Gregory Koblentz, Director of the Biodefense Program. The event will take place at Noon in Room 113 of Van Metre Hall. Drinks and cookies will be provided. Register here.

Opportunities with the GHSA Next Gen Network
The Global Health Security Agenda’s Next Generation Network just announced its 2020 theme: Inclusive Expansion. Toward that, applications for the Next Gen Mentorship Program are open until 18 March and matches will be announced on 2 April. Apply here for the Mentorship Program. Additionally, leadership positions are available as regional coordinators; apply here. Other opportunities include helping to translate documents into multiple languages. To assist, email your name and language proficiencies to the coordinator at nextgenghsa@gmail.com. For more information on the Global Health Security Agenda click here and for more information on the GHSA Next Generation Network click here.

Covering COVID-19: What do you need to know?
Don’t miss this March 10th event hosted by the Association of Health Care Journalists. The COVID-19 outbreak story is evolving quickly and there are many unknowns about the epidemic, including how contagious the virus is, its mortality rate and whether there is undetected spread occurring outside of China. Providing accurate information to the public is more important than ever in this moment of uncertainty. Hear a panel of infectious disease experts and a journalist explain what is known, what to watch out for, where to find trusted resources and how to combat misinformation and confusion. Speakers include: Maryn McKenna, independent journalist, author; Senior Fellow of the Center for the Study of Human Health at Emory University. Michael Osterholm, Ph.D., M.P.A., director, Center for Infectious Disease Research and Policy. Saskia Popescu, senior infection preventionist at Honor Health, ELBI Fellow, and managing editor of Pandora Report.

Pandora Report: 2.21.2020

Happy Friday Biodefense Gurus! We have a packed edition of the Pandora Report this week, but before we begin – don’t forget to register and reserve your spot for the “Coronavirus & International Security” panel event this evening in Arlington, VA. The CSPS Distinguished Speaker Series event will be at 5pm and you can find more information and register here.

GMU Biodefense Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
We’re excited to announce the summer dates for the workshop: Pandemics, Bioterrorism, and Global Health Security: From Anthrax to Zika. This three and a half-day workshop will be held in Arlington, VA, from July 13-16, 2020. Registration links and speaker information will be provided in the coming weeks. We hope you’ll join us for this immersive and engaging workshop with some of the top minds in the biodefense world, where we’ll discuss everything from synthetic biology to MCM, antibiotic resistance, and the current outbreak of COVID-19.

CW Use in Syria – Atrocities and Accountability 
We’ve got the scoop on a brand new article by GMU Biodefense graduate program director and professor Dr. Gregory Koblentz in Nonproliferation Review regarding Assad regime use of chemical weapons. International efforts to hold the government of President Bashar al-Assad accountable for the use of chemical weapons in the Syrian civil war have entered a new phase. For the first time, the Organization for the Prohibition of Chemical Weapons (OPCW), the international organization responsible for implementing the 1993 Chemical Weapons Convention, has been empowered to identify the perpetrators of chemical attacks in Syria. The Investigation and Identification Team (IIT), which was formed to conduct the OPCW’s new attribution mission, has announced its intention to investigate and identify the perpetrators of nine chemical attacks in Syria, including the April 7, 2018, attack in Douma. This article reviews recent efforts to attribute chemical attacks in Syria, describes what we know about the nine incidents to be investigated, discusses what to expect during the next phase of the attribution process, and offers insights into how the international community can move beyond attribution to accountability. An annex to the article summarizes what is known about the Syrian government officials, military commanders, and chemical-warfare scientists suspected of being responsible for these attacks. As Koblentz notes, “Without attribution, there can be no accountability. Without accountability, the atrocities will continue: if not by the hand of Assad, then by others emboldened by his ability to use outlawed weapons to hold onto power.” You can read the article here, which builds upon his previous research on Syria’s chain of command for the use of chemical weapons and international efforts to hold the regime accountable for these attacks.

Reaping What You Sow: The Case for Better Agroterrorism Preparedness
GMU Biodefense MS student Stevie Kiesel is pulling back the curtain on this all too forgotten aspect of biodefense – agroterrorism. “An attack on the food supply gives the perpetrating group several benefits. First, the psychological and economic effect of targeting food supplies would be substantial. Such an effect could have a powerful pull with a group such as al Qaeda, who has shown interest in biological weapons and in targeting US economic strength. Second, and related, this type of attack would be relatively low cost when compared to the economic effects it could cause. Third, similar to other forms of terrorism, agroterrorism can allow a weaker group to lessen the power imbalance between themselves and the state they are targeting. Fourth, some groups may turn to agroterrorist tactics because these attacks ‘do not harm humans directly and may therefore be more easily justified’.” Read more of Stevie’s highly engaging and relevant article here.

SARS-CoV-2/COVID-19 Outbreak Updates
As of Thursday evening, there have been 76,214 cases and 2,247 deaths related to COVID-19. From the realm of synthetic biology, many are rushing to recreate SARS-CoV-2 from its DNA code. Since it only took a few weeks to get the genetic sequence of the virus, many researchers are hoping to start ordering copies of genes to build it for efforts like diagnostic testing and vaccine development. On another front, one of the biggest topics has been that of cruise ships…One in particular, the MS Westerdam, finally docked and passengers/crew disembarked in Cambodia. Unfortunately, following the release of passengers, one was later found to have the disease, which has prompted concern as people have begun their travels home. The other, the Diamond Princess ship, finally saw its passengers allowed to leave the controversial ship-based quarantine. 621 (20% of the people onboard) of those on the ship tested positive for the virus. “Those passengers who have been declared free of the virus and are leaving the ship for the first time in two weeks face a confusing array of circumstances. Many will be forced to undergo a 14-day quarantine upon their return home — reflecting a lack of trust in the effectiveness of the ship’s quarantine. Others can remain in Japan under their own recognizance but are still barred from returning home for two weeks.” Here is a good timeline of the outbreak onboard and how the ship was initially placed into quarantine on February 4th after 10 people onboard tested positive. Passengers being flown back to the U.S. have been sharing their account of the experience, but as these two cruise ships provide unique examples of outbreak response, it sheds light on the limitations of quarantine and challenges of public health efforts during the COVID-19 outbreak. “Based on what is known so far, Cambodia’s approach is preferable to quarantining people aboard a ship where the virus is spreading, said Saskia V. Popescu, GMU Biodefense alum and senior infection prevention epidemiologist for HonorHealth, a hospital system in Phoenix. But that requires educating passengers about reporting symptoms and self-isolating if necessary, and having public health authorities in home countries closely monitor those who have returned. It includes quickly tracing the contacts of anyone who develops the infection. ‘I think we can say if you’re going to quarantine people, doing it on a cruise ship is not the best place,’ Popescu said.” In the face of these exhaustive efforts to respond to the disease, conspiracy theories have been a frustrating distraction – Chinese labs have noted that these often hurt efforts to curb the virus and scientists around the world have been working to condemn rumors and conspiracy theories regarding the origin of the virus. “A group of 27 prominent public health scientists from outside China is pushing back against a steady stream of stories and even a scientific paper suggesting a laboratory in Wuhan, China, may be the origin of the outbreak of COVID-19.” Senator Tom Cotton continues to push such conspiracy theories. The Federation of American Scientists (FAS) has a new initiative regarding the outbreak, known as the Coronavirus Project. The project focuses on debunking misinformation and providing accurate information from qualified researchers and scientists. “Since late 2019, information about the infectious Coronavirus has been trickling out from sources around the web. But not all information is created equal. Some of this information comes from science and medical professionals, who have years of experience in epidemiology. Some comes from unreliable anonymous internet accounts, bad actors, and hoaxers.” Despite these distractions, a paper in The Lancet recently emphasized the support for scientists, public health professionals, and medical professionals in China combatting the disease. “We have watched as the scientists, public health professionals, and medical professionals of China, in particular, have worked diligently and effectively to rapidly identify the pathogen behind this outbreak, put in place significant measures to reduce its impact, and share their results transparently with the global health community. This effort has been remarkable.” In times like these, the global health security community truly comes together to address common vulnerabilities and enhance strengths.

The Economic Impacts of COVID-19
The ongoing outbreak of coronavirus has already infected over 75,000 people and taken over 2,000 lives. The newly dubbed COVID-19 outbreak originated and remains strongest in China, but the economic effects of the it is already rippling across the globe. As an outbreak disseminates and intensifies, the labor force shrinks (at least temporarily), supply chains fracture, international mobility of persons and products decelerates or ceases altogether, and spending and investment decline. Though the full magnitude of economic effects from the outbreak can only be speculated upon at this point, the downward economic trends have begun. The sectors most impacted and at highest risk, thus far, are technology, oil, apparel, retail, tourism, and automobiles. The losses in production from Chinese manufacturing of key inputs and final products are critical drivers of the losses we are seeing and will continue to see across the globe. These items include iron, steel, aluminum, textiles, cement, chemicals, toys, electronics, and many more. According to the latest Statista Infographics Bulletin, global shipments of various tech products are expected to fall by 4.5 to 16% in this first quarter of the year. China is the world’s primary producer and exporter of textiles, so the fall in Chinese textile production will impact the global apparel and retail markets. Global oil demand is falling for the first time in over a decade as global transit drops from diminished trade and travel. Travel bans are, of course, squelching international tourism and costing travel hot spots to lose revenue. This is compounded as major events that attract troves of visitors are cancelled in response to COVID-19 fears. For instance, projections from the UN’s International Civil Aviation Organization expect Japan to lose $1.3 billion and Thailand to lose $1.2 billion in tourism revenue just in this first quarter. Due to the travel bans and the general disinclination to travel at the moment, US tourism from Chinese visitors will take a compounding hit in addition to the losses from the ongoing trade war with China. Relatedly, global airline revenues are predicted to drop by $4-5 billion in the first quarter of 2020 due to flight cancellations. Automobile makers are closing plants in China as the much-needed inputs such as steel and aluminum are shrinking the availability of parts. As ground zero, China is suffering the most so far. China’s growth rate is expected to drop from 6% to 4.5% in the first quarter of 2020. As the infection sweeps through the Chinese labor force, factories are shutting down or lowering output capacity, slowing the flow of parts and final products from China. Virtually all countries are and will be impacted by the break in the supply chain as a result of reduced output from China. The absence of a single small component may render a final product unachievable.  As supply falters across various sectors and products reliant on Chinese manufacturing, we should anticipate a rise in those prices. On the other hand, China is one of the largest markets for US products, especially Apple electronics and fashion items, so we should anticipate a significant decline in demand from that large consumer base as spending shrinks among the Chinese population. The Severe Acute Respiratory Syndrome (SARS) outbreak in China in 2003 provides a rough analogue on which to base predictions of the economic impacts of COVID-19. Virulence was highest from November 2002 to July 2003, and that nine month period was all the time needed for the disease to infect almost  8,500 people and kill over 800 people globally. Lee and McKibbin estimate the total economic cost of the 2003 SARS epidemic to be around $40 billion. The geographic dissemination of COVID-19 is currently akin to that of 2003 SARS with cases concentrated in China and small clusters popping up in Asia, Australia, Europe, and North America. The COVID-19 mortality rate is much lower at 2% versus 10%; however, the total number of coronavirus cases after just a couple months greatly surpasses the total case count for SARS at over 75,000. Though the loss of life may, thankfully, be much less severe with COVID-19, the adverse economic impacts of this outbreak may greatly surpass that of SARS. In 2020, we are more of a global economy than in 2003 and supply chains for a cornucopia of products are spread across nations and even continents, so a kink in one place catalyzes a domino effect across borders and industries. Unfortunately, there is no end in sight for COVID-19 as we approach March; therefore, the hits to the global economy will continue to spread across sectors and countries, as well as grow in severity. Only time will tell the full scale and spectrum of adverse economic effects instigated by COVID-19.

The 2021 Nuclear Weapons National Security Budget Proposal
The 2021 budget proposal exemplifies the continuing shift in the US nuclear posture toward a renewed nuclear arms race. This month, President Trump sent Congress a proposed Fiscal Year 2021 budget request of $740.5 billion for national security, 95% of which is for the Department of Defense. The clear priority of the proposed budget is the expansion of investment in and capabilities of US nuclear weapons. The proposal requests almost $29 billion, a 16% increase from the previous year, for the modernization of the US nuclear weapons arsenal. In addition to the $29 billion for modernization, the proposal includes other related items that would bring the total nuclear weapons budget to about $50 billion. The bump in nuclear weapons investment comes at the cost of shrinking most other security and defense programs. This should come as no surprise given Trump’s proclivity for nuclear strength as evidence by his late 2016 tweet, “must greatly strengthen and expand its nuclear capability until such time as the world comes to its senses regarding nukes.” Despite recommendations that DOD dedicate more resources on challenges from strategic rivals, namely China and Russia, the proposal outlines cuts to such programs. For example, the Navy is preparing for a significant reduction in funding for new warships. Lawrence J Korb, former Assistant Secretary of Defense for Logistics and Materiel Readiness, recommends that the administration extend the New Strategic Arms Reduction Treaty (START) with the Russians and resume negotiations. This would renew efforts toward reducing nuclear arsenals and enable the allocation of limited resources to programs that make our country and the world safer.

GAO Report – National Biodefense Strategy
The Government Accountability Office (GAO) has released a new report – “National Biodefense Strategy: Additional Efforts Would Enhance Likelihood of Effective Information”. You can access it here, but the report notes that “There are a number of challenges, however, that could limit long-term implementation success. Among other things, there was no documented methodology or guidance for how data are to be analyzed to help the enterprise identify gaps and opportunities to leverage resources, including no guidance on how nonfederal capabilities are to be accounted for in the analysis. Many of the resources that compose national capabilities are not federal, so enterprise-wide assessment efforts should account for nonfederal capabilities.” Moreover, the report points out that agency officials struggled to identify how decisions were made and there generally lacked a clear process or series of roles for joint-decision making, “As a result, questions remain about how this first-year effort to catalogue all existing activities will result in a decision-making approach that involves jointly defining and managing risk at the enterprise level.”

Pandemics and Podcasts
There are a lot of great podcasts in the infectious disease and biodefense world, so we’ll be spotlighting a few from time to time. Our first is the Next Generation GHS episode from last week, in which GMU Biodefense MS alum Jessica Smrekar sat down to discuss COVID-19. You can listen to it here. Jessica noted that “It was great sitting down with Jono and Taylor to hash out this rapidly developing COVD-19 outbreak in light of Jono’s book, The End of Epidemics: The Looming Threat to Humanity and How To Stop It. We discussed at length the weak links in local, national, and international health structures that leave us vulnerable to disease outbreaks and how we can remedy these in the future. Jono’s book outlines 7 specific actions that, if taken, could reduce these gaps and allow us to create a safer world. We explored the problems we face in developing strong, resilient health systems and how these actions work to solve those problems. Though the COVID-19 outbreak really highlights that we are not where we should be to keep our world safe, Jono expressed ‘the NextGen Group and your leadership and the fact we have such a mobilized network worldwide makes me optimistic. I think we’re building a really powerful network, both internationally and at the national level. And it’s that network of capable, informed, engaged people, who really do care about having a safer world, I think that’s what makes me feel optimistic’.”

News of the Weird
Video games and outbreaks – apparently they go hand in hand. Virus games are growing in popularity right now, in the middle of the COVID-19 outbreak, especially that of Plague, Inc. “Plague Inc. and Pandemic may have a certain morbid appeal in the time of the coronavirus. But they have more than that to offer, many experts and players agree. ‘I can certainly understand the hesitation around this — no one wants to trivialize the very real human suffering that this coronavirus has brought with it,’ said Leacock, Pandemic’s creator. ‘But the reality is that playing helps us process the world around us, and people may be turning to these games now for that reason’.”

Outbreak Dashboard 
Qatar has reported a new MERS-CoV case, marking the fourth case since December. The DRC outbreak of Ebola has now reached 3,443 cases with over 330 suspected cases under investigation.

Pandora Report: 2.14.2020

To our amazing readers, we hope you’re having a lovely Friday and a happy Valentine’s Day! Did you know the CDC estimates that every year in the United States, more than 300,000 people cope with Trypanosoma cruzi infections (Chagas disease) due to those pesky kissing bugs.

The Coronavirus and Its International Ramifications
Don’t miss this February 21st event at GMU’s Van Metre Hall in Arlington, VA at 5pm -The CSPS Distinguished Speaker Series Presents: Coronavirus & International Security featuring: Steve Morrison, Ashely Grant, and Ketian Zhang. Join CSPS for a panel discussion on the broad implications of the coronavirus crisis, the role of the international community in global health management, and the implications for China, US-China relations, and East Asian security. The panel will be moderated by Ellen Laipson, CSPS Director. The event is free to the public but please register here to reserve your spot.

2019-nCoV/COVID-19 Outbreak Updates
The outbreak of COVID-19 has been quite the whirlwind so far. Case counts are changing so rapidly, that on Wednesday evening, over 60,000 cases were reported and by Thursday, it was well over 64,000. In quite possibly some of the worst timing, the HHS Budget in Brief was released this week, which revealed proposed funding cuts to CDC’s Public Health Preparedness and Response program by $25 million, as well as ASPR’s Hospital Preparedness Program. The CDC’s Global Health Security efforts might get an extra $50 million, which might not feel like much as their Emerging Zoonotic Infectious Disease programs and funding for the Epidemiology and Laboratory Capacity program are taking a huge hit.  While many were concerned about the rapid spike in cases as China sacked a senior city health official, the rise was due to a change in reporting definition, which was broadened to account for those without lab confirmation but meeting clinical definition. The United States now has 14 confirmed cases. The second case of the novel coronavirus among the U.S. evacuees from Wuhan, China, was also confirmed on Wednesday in the San Diego quarantine site. Earlier this week, the World Health Organization (WHO) announced the naming of the disease – COVID-19. The virus, previously known as 2019-nCoV, will be referred to as SARS-CoV-2 per the International Committee on Taxonomy of Viruses, meaning that SARS-CoV-2 is the virus that causes the COVID-19 illness/disease in humans. The role of healthcare transmission has been increasingly brought up, as roughly 500 healthcare workers were diagnosed by mid-January in Wuhan. The JAMA study recently released found that 41% of the 138 hospitalized cases they studied in Wuhan, were related to healthcare transmission. As the world struggles with personal protective equipment (PPE) supplies, the CDC has provided guidance to hospitals regarding the shortages that impact healthcare worker safety. GMU Biodefense doctoral alum Saskia Popescu recently wrote on the U.S. healthcare system’s readiness during this time – “For hospital officials, preparing for cases of coronavirus infection means not only ensuring they have adequate supplies, but also the right processes put in place for the rapid identification and isolation of potential patients—which can be challenging during a patient surge.” More concerning, the CDC announced that their rollout of the COVID-19 diagnostic tests will be delayed across the U.S. Also, the cruise ship that has been quarantined for what’s felt like weeks now is finally being allowed to dock and its passengers to disembark in Cambodia.

Bipartisan Commission on Biodefense- Next Evolution: Overhauling Key Elements of Biodefense 
The Bipartisan Commission on Biodefense is hosting this March 18, 2020 event “to inform our continuing assessment of biodefense programs with structural challenges that impede the government’s ability to safeguard the Nation. Topics to be discussed at this meeting include the: Select Agent Programs, BioWatch Program, and Hospital Preparedness Program.” RSVP here by March 13. Registration is required and attendance is free. This event will also be webcast (registration for webcast is encouraged). Lunch and refreshments will be provided. WEBCAST WILL GO LIVE just before 10:00 a.m. on March 18.

News of the Weird
Have you ever wondered what an authentic plague mask looked like? Now you can get a glimpse via the German Museum of Medical History as they are showing off a 16th century plague doctor mask here. “The mask had glass openings in the eyes and a curved beak shaped like a bird’s beak with straps that held the beak in front of the doctor’s nose. The mask had two small nose holes and was a type of respirator which contained aromatic items. The beak could hold dried flowers (including roses and carnations), herbs (including mint), spices, camphor, or a vinegar sponge. The purpose of the mask was to keep away bad smells, known as miasma, which were thought to be the principal cause of the disease, before it was disproved by germ theory.”

Center for Health Security Announces New ELBI Fellows
The Johns Hopkins Center for Health Security has announced the new class of fellows for the Emerging Leaders in Biosecurity Initiative (ELBI).  “As the current novel coronavirus epidemic shows, preparing for and responding to biological threats requires talented people from a range of fields working together to take on many complicated challenges,” said Tom Inglesby, MD, director of the Center. “Our 2020 Emerging Leaders fellows are the rising leaders who will be part of preparing for and responding to biological threats in our future, and we are very excited to work with them in the year ahead.”

“The Present and Future Promise of Synthetic Biology” at CSIS
Last week, the Center for Strategic and International Studies (CSIS) launched its Synthetic Biology: The Ongoing Technology Revolution Series with an inaugural forum. The speakers included Dr. Diane DiEuliis, Senior Research Fellow at National Defense University; Dr. Gigi Gronvall, Senior Scholar and Associate Professor at Johns Hopkins Center for Health Security; and Dr. Jason Kelly, Founder of Ginkgo Bioworks. Synthetic biology, SynBio for short, encompasses the concepts, methods, and tools that enable the creation or modification of biological organisms; it traverses the fields of biology, chemistry, engineering, and computer science. Several emerging technologies, such as artificial intelligence and CRISPR, along with emerging technology companies, such as SynLogic and Evolva, were discussed as boons for a variety of sectors. Further, the exponential improvement in computers, especially in programming, bolsters other technologies and efficiencies in the field. SynBio is growing for industrial, military, personal, and amateur uses. The methods by which a variety of products – medicines, tires, makeup, and more – are made is updating to use more efficient and less extractive means thanks to these tools. Some defense specific technologies mentioned were the LALO tactical boot made from Susterra propanediol, BioBricks made from algae, and structural composite materials derived from a polymer resin matrix. Personalized medicine, such as CAR-T cell therapy cancer treatment, caters to the specific and unique set of characteristics of a patient and her/his health needs. There are a number of advantages to SynBio, but the risks cannot be ignored. As these tools and methods become more available and accessible to more people and groups, the risk of dual-use research of concern (DURC) swells. Specifically, we now must recognize that the misuse and abuse of emerging technologies is no longer limited to states and large groups as DIY biology enables virtually any individual capable of creating or modifying an organism. The sticky situation created by DURC is the continued and encouraged advancement of synthetic biology while also discontinuing and discouraging its misuse and abuse. But, how do we quantify the benefits versus the risks of a new or improved technology? And, by whom? These are questions with currently elusive answers; however, the field of SynBio will not slow so that policy can catch up. There exist some barriers and bottlenecks to the safe and appropriate use of the outputs of SynBio. There is often some level of strategic confusion around a new output, especially given that lack of a one-to-one replacement of old for new. This means that a new technology may not comprehensively replace an old one. Relatedly, best practices are yet to arise and a set of international standards and norms remains unclear. Additionally, the bioeconomy remains largely unmeasured, leaderless, and underappreciated in risk assessment and mitigation. The lack of regulatory standards for any new and incomparable product or process can cripple its advancement and adoption, a current problem for SynBio as well as the bioeconomy in general. On the bright side, there are solutions to these barriers and bottlenecks. Investments in early stage R&D for cutting-edge programming, like that for the Human Genome Project, would provide widespread support to new biotechnologies. Of the same vein, we should target investment in particularly promising innovations like advanced materials and distributed manufacturing. Most importantly, expanding the openness in the life sciences as a whole will gain us more in security than we will lose. A recording of the forum can be accessed here.

2019-2020 Flu Season: CDC Preliminary Burden Estimate
While much attention has been to COVID-19, the CDC just released their preliminary estimate for this flu season and it’s no wonder hospitals are feeling overwhelmed. 22-31 million flu illnesses, 10-15 million flu medical visits, between 210,000-370,000 flu hospitalizations, and 12,000-30,000 flu-related deaths. This data provides a good reminder for why vaccination is so important and basic infection control measures -hand hygiene, staying home when you’re sick, cough etiquette, etc.

Rogue Scientists and Deadly Pathogens?
It’s not surprising that the current COVID-19 outbreak is bringing about questions related to synbio and screening gaps that leave potentially damning vulnerabilities. What would happen if you asked a lab to send you the genetic code to the influenza strain that caused the 1918/1919 pandemic? “What if I sent them the instructions for a new disease that I have reason to believe is dangerous? What if I was doing legitimate research, but my lab didn’t adhere to modern safety standards? The answer is that a few DNA synthesis companies will send me what I asked for, with no screening to check whether they’re sending out a pathogen that ought to be carefully controlled. (Synthetic DNA is not a live virus, of course; I’d have to be a talented biologist with specialized knowledge, lots of resources, and access to expensive tools to use it maliciously.)” Screening though, presents its own challenges as DNA is a dual-use technology and tool, and we have existing policies set in place to avoid potentially dangerous events. “So new screening — and new regulations backing the international use of that screening — is needed. The aim of a new screening regime should be to ensure that requests for DNA are checked to determine whether they contain prohibited, dangerous sequences, without adding too much to the expense of screening and without slowing down legitimate researchers, who should be able to access DNA for their projects cheaply and quickly.”

Pandora Report: 1.31.2020

ASM Biothreats
Missed the 2020 ASM Biothreats conference? Next week we’ll have you updated with our coverage across multiple talks, panels, and the highlights of this top conference on all things biological. GMU biodefense graduate students will be providing detailed accounts of these discussions at a pivotal time in international health. “ASM Biothreats is a one-of-a-kind meeting offering professionals in biodefense, biosecurity and biological threats the opportunity to exchange knowledge and ideas that will shape the future of this emerging field. ASM Biothreats offers a unique program that explores the latest developments and emerging technologies in the industry.”

Update: 2019-nCoV
If you have turned on any news channel or navigated to news website, you most certainly encountered a number of discussions about the ongoing coronavirus outbreak originating in Wuhan, China. The WHO was alerted on New Years Eve of this novel pathogen causing pneumonia-like illness and chaos increasingly ensued over the continuing weeks. This mysterious pathogen was identified as a coronavirus (think SARS and MERS) and is currently dubbed “2019-nCoV.” As the disease spreads globally, the WHO is launching a Global 2019-nCoV Clinical Data Platform for Member States to contribute anonymized clinical data that can inform the public health clinical response. On 30 January, the Emergency Committee on the 2019-nCoV under the International Health Regulations (IHR 2005) reconvened to determine if the outbreak constitutes a Public Health Emergency of International Concern (PHEIC), and, if so, what recommendations and actions should be made to manage it. Thursday evening, the Committee announced declaration of a PHEIC for the 2019-nCov outbreak. As of 28 January, there are confirmed cases in China, Nepal, the Republic of Korea, Japan, Sri Lanka, Viet Nam, Thailand, Cambodia, Malaysia, Singapore, United Arab Emirates, Australia, France, Germany, Finland, Canada, and the United States. Within the United States, there are 5 confirmed cases in Washington, California, Arizona, and Illinois as well as an additional 92 suspected cases awaiting diagnostic results. Currently, there are 165 persons located in the US under investigation for 2019-nCoV infection. On Thursday, public health officials reported that the husband of the case identified in Chicago, had tested positive for the disease. This marks a second-generation of cases, or transmission, within the U.S. There are also reports of people running to buy face masks in the U.S., leaving concern for shortages. Experts have been quick though to note that these are not needed as transmission is not widespread within the United States and that hand hygiene is most effective this time of year. GMU Biodefense doctoral alum Saskia Popescu recently spoke to CNN on this, noting that “Wearing a surgical mask helps you prevent sharing your germs if you’re sick,” Saskia Popescu, a hospital epidemiologist and infection prevention expert, told CNN. “Surgical masks do not seal around the face, so while they offer some protection, it’s the N95 mask that offers the most protection.” The CDC released an updated travel warning to its most severe yet – Warning Level 3 – urging travelers to avoid all nonessential travel to China. According to the WHO, the latest figures (30 January) for the outbreak are:

  • 7,818 confirmed cases worldwide
  • 7,736 confirmed cases in China
  • 170 deaths worldwide
  • Global Risk Assessment: High

Experts from the University of Hong Kong estimate the true total number of cases in Wuhan to be about 44,000, and they predict this figure could double by the start of February. The city is already under an unprecedented quarantine and hospitals are overrun as the epidemic intensifies. GMU biodefense graduate program director Dr. Gregory Koblentz recently spoke about the importance of promoting education, not travel bans as coronavirus concerns spread. “Widespread travel bans are ineffective and even counterproductive,” said Koblentz, a professor at George Mason University’s Schar School of Policy and Government and an expert on biodefense and biosecurity. “The idea that you can quarantine the entire population of large cities is just not feasible.” If people want to travel, they will find a way to travel, but they will be secretive about it, said Koblentz. “Then when they do get sick, they will avoid seeking medical attention because they don’t want to get in trouble,” said Koblentz. “A travel ban basically means that people will avoid getting help and notifying public health authorities, and the spread of the virus will continue, undetected.” Instead, Koblentz recommended that health officials work to get the public on their side by communicating with them about the symptoms and when to seek medical care.

Speculation abounds about the zoonotic origin of the virus, but the prevailing theory (at the moment) points toward bats as the culprit. The source location of the outbreak is the Huanan seafood market in Wuhan, which did not sell bat meat, so speculation continues. It is possible that another animal provided the channel to human infection. Previous conjecture that snakes are the origin is under criticism as it remains unclear if coronaviruses can infect snakes. Additionally, experts reject the fringe theory that the outbreak is a consequence of accidental release of biological weapons research samples housed in the Wuhan Institute of Virology. Richard Ebright, a professor of chemical biology at Rutgers University, stated the virus’s genome and properties do not indicate that it is the product of engineering. Stay tuned to the Pandora Report for updates on the progression of the 2019-nCov outbreak.

Of Quarantine and robots: How China and the U.S. Are Working to Combat Coronavirus
GMU Biodefense PhD alum Saskia Popescu recently wrote on the efforts by both the Chinese and the U.S. in responding to and preventing transmission of the 2019-nCoV. From quarantine to travel screenings, Popescu discusses the pros and cons, but also breaks down the opportunities within U.S. response. “The first case of the coronavirus in the United States received wide news coverage, and rightly so. But the Providence Regional Medical Center in Everett, Wash., used some extreme techniques to treat the patient, a man in his 30s who’d travelled to Wuhan. He was taken from an urgent care to the hospital in a negative-pressure transportation device called an ISOPOD that’s more often associated with Ebola care and put into an isolation room, where the hospital used a robot to treat him to reduce health care worker exposure. At this point, though, these extra precautions aren’t required. The Centers for Disease Control and Prevention notes that health care workers caring for patients with coronavirus should protect themselves with a gown, gloves, eye protection, and an N95 mask, which can filter out most airborne particles. If the Everett hospital wanted to use its robot and ISPOD to test its capabilities and protocols, it should have communicated this more clearly–to keep from confusing other health care providers about the advice of federal officials.”

ABSA International – Risk Group Database App
The Association for Biosafety and Biosecurity (ABSA) just released their new International Risk Group Database app, which allows users to work offline and access the ABSA database via their mobile device. The ABSA International Risk Group Database consists of international risk group classifications for bacteria, viruses, fungi, and parasites. In many countries, including the United States, infectious agents are categorized in risk groups based on their relative risk. Depending on the country and/or organization, this classification system might take the following factors into consideration: pathogenicity of the organism; mode of transmission and host range; availability of effective preventive measures (e.g., vaccines); availability of effective treatment (e.g., antibiotics); and other factors.

Doomsday Clock
The Bulletin of the Atomic Scientists released their 2020 Doomsday Clock statement and revealed that the clock is now closer than ever at 100 seconds to midnight. The Doomsday Clock is “universally recognized indicator of the world’s vulnerability to catastrophe from nuclear weapons, climate change, and disruptive technologies in other domains.” This year’s statement highlights two coexisting existential threats to humanity: nuclear war and climate change. Adding insult to injury, these threats are exacerbated by cyber-enabled information warfare, which continues to advance in efficiency and capability. The last year saw the dissolution or undermining of several key arms control treaties aimed at quelling the risk of nuclear war – the Joint Comprehensive Plan of Action (JCPOA) and Intermediate-Range Nuclear Forces (INF) Treaty, for example. Iran, the DPRK, and Russia remain major dangerous players in the nuclear game. On a more positive note, awareness of the adverse effects of climate change swelled over 2019; however, governmental action to counter climate change left much to be desired. The Bulletin implores leaders and citizens to take thoughtful and actionable steps to lessen these threats:

  • US and Russian leaders can return to the negotiating table to reach an agreement on nuclear arms and other arsenals
  • The nations of the world should publicly rededicate themselves to the temperature goal of the Paris climate agreement (limiting warming below 2 degrees Celsius higher than the preindustrial level)
  • US citizens should demand climate action from their government
  • The United States and other signatories of the JCPOA cooperate to curb nuclear proliferation in the Middle East
  • The international community should commence multilateral discussions to create norms of domestic and international behavior that discourage and punish the misuse of science

Alumni Spotlight – NextGen GHSA
A new piece published on the Next Generation Global Health Security Network was co-authored by Anthony Falzarano, Stephen Taylor, Kate Kerr and Jessica Smrekar, graduates of GMU’s MS in Biodefense program (Taylor Winkenfeld is also an author). This Op-Ed, “We Preach Prevention, WHO Practices Response,” chastises the sluggish response of the WHO to the ongoing 2019-nCov outbreak originating in Wuhan, China. China’s President Xi Jinping instituted a mass quarantine of 50 million people, yet the WHO has yet to declare this outbreak a Public Health Emergency of International Concern (PHEIC), which helps mobilize funding and political will toward outbreak response efforts. In fact, the committee that makes such a declaration met on 30 January, weeks after the start of the outbreak. The WHO possesses a history of delayed action, such as with the current Ebola outbreak in the Democratic Republic of Congo. The authors suggest that the delay in PHEIC declaration for the 2019-nCov outbreak is founded in fear of political and economic impacts, especially given the “reach of the Chinese global engine.” This outbreak is yet another example and, hopefully, lesson waiting and watching cannot be the default response to tragic events, especially ones that harm public health, regardless of the political, economic, and social issues that complicate decision-making and action.

The Ethics of Acquiring Disruptive Military Technologies
Technological innovation – especially in human enhancement, artificial intelligence, and cyber tools – continues at an accelerating rate and yield a significant effect on combat by reducing risk to soldiers and civilians, but also broadening the spectrum of actors capable of chasing policy goals through military methods. An article by C. Anthony Pfaff published in the Texas National Security Review expands the discussion about emerging and advancing technologies to include the ethics of disruptive military technologies. Disruptive technologies in a military context are defined as “technologies or sets of technologies applied to a relevant problem in a manner that radically alters the symmetry of military power between competitors, which then immediately outdates the policies, doctrines and organization of all actors.” These technologies necessitate changes in soldier training and identity as well as the relationship between society and soldiers. A technology is considered disruptive based on its attributes’ interactions with a specific community of users in a specific environment. The author outlines a framework to evaluate the moral effect, necessity, and proportionality of technologies to determine if and how they should be developed and deployed. This framework includes consideration for moral autonomy, justice, well-being, transfer of technology, and, of course, the civilian-military relationship. The author recommends eight measures and policies to maintain ethical conditions for developing disruptive technologies ranging from managing the transfer of technologies to greater society to accounting for soldier well-being.  Pfaff’s full article detailing his analysis, framework, and recommendations is available here.

Considering Pediatrics During CBW Preparedness and Response
Often during measures to prepare for a chemical or biological weapons attack, it can be easy to forget about the unique care that children and neonates require. A new article in Physicians New Digest discussed this very critical nuance to CBW preparedness, highlighting the CW attacks in Syria by the Assad regime against civilians, included children, underscoring the need for pediatricians. Often, medical countermeasures require very specific dosages or are contraindicated in children, which poses a very unique challenge for responders. “In chemical attacks, for example, children may be disproportionately affected because they would take in more contaminated air, food and fluids relative to their body weight than adults, said co-author Carl Baum, MD, FACMT, FAAP, a former AAP Council on Environmental Health executive committee member who now serves on the Council on Disaster Preparedness and Recovery executive committee. ‘Children also spend more time closer to the ground, where toxic substances can settle. And they have a relatively larger body-surface area, which makes chemicals that touch the skin more dangerous for them,’ Dr. Baum said.” Children might also have high respiratory rates or present differently, which puts them at an increased risk for both inhalation of a CB agent, but also delays in medical care or diagnostics. The authors highlighted the importance of including pediatricians in preparedness efforts to ensure children have triage and treatment protocols in the event of a CBW attack.

News of the Weird
Sure, the novel coronavirus is in the news a lot right now, but where does beer come into the picture? Unfortunately the whole “corona” portion of the name has been throwing people off. “In the United States, Google Trends calculated that 57% of the people that searched one of those terms searched for “beer virus,’ and the remaining 43% searched for ‘corona beer virus.’ States like Hawaii, New Mexico and Kansas are searching ‘beer virus’ more, whereas states like South Carolina, Colorado and Arizona are searching ‘corona beer virus’ more”

Pandora Report: 1.17.2020

Happy Friday! We’re glad to start the weekend with a healthy dose of all things biodefense. Before we get too far down the nCoV-2019 rabbit hole…Senator Dianne Feinstein recently wrote a letter to DHHS regarding steps the department is taking to protect the U.S. against pandemics.

ASM Biothreats 
It’s almost that time of year and if you can’t make the January 28-30 ASM Biothreats conference, don’t worry – we’ll have great coverage. GMU Schar School Biodefense is sending graduate students to the conference to report out on these three days of all things biothreats. Check out previous years of our coverage here, where we provide detailed overviews of the talks and events. “ASM Biothreats is a one-of-a-kind meeting offering professionals in biodefense, biosecurity and biological threats the opportunity to exchange knowledge and ideas that will shape the future of this emerging field. ASM Biothreats offers a unique program that explores the latest developments and emerging technologies in the industry.”

AI Weapons
The end of 2019 and the start of 2020 sees an uptick in discussion regarding artificial intelligence-driven weapons. Three of the world’s biggest plays – the United States, Russia, and China – are all strongly indicating that artificial intelligence (AI), considered a transformative technology, will be dominant in their respective national security strategies. Recent headlines on the topic include terms like “killer robots” and “Terminator-style war.” Indubitably, we are in an era of rapid and momentous technological advancement and discovery; however, the true application of these technologies is fairly narrow and now necessarily nefarious. Larry Lewis, a senior advisor for the State Department in the Obama administration and a member of the US delegation in the UN deliberations on lethal autonomous weapons systems, recently published an article in the Bulletin of the Atomic Scientists about the utility of AI in reducing the collateral damage of war. Lewis spent the last decade working to reduce the civilian casualties in war, and he found that such casualties were largely the result of inaccurate indicators regarding civilian presence or the misclassification of civilians as combatants. Though military applications of AI include autonomous weapons, this technology can also be employed to optimize automated processing to detection and as a decision aid to helping personnel interpret complex or vast sets of data. Though discussion tends toward the risks of AI technology, especially its military applications, Lewis endorses adding a new facet to the discussion that focuses on the benefits of AI technology in minimizing civilian casualties in warfare.

nCOV-2019 and the Wuhan Outbreak
The past few weeks have been busy with the news of this novel coronavirus cluster in Wuhan, China. Following the identification of it as a novel strain and the temporary name of nCoV-2019, public health authorities have been working to better understand the epidemiological aspects of the virus and how we can prevent further transmission. News of a case in Thailand, following travel to the affected region in China, quickly spread as it meant that cases were no longer contained in China. Interestingly, the Chinese woman whose infection was detected after her arrival in Thailand, had no exposure to the market that is considered to be the epicenter of the outbreak. “A new statement from the World Health Organization (WHO) today had several new details, including that the woman had not visited the Wuhan seafood market, which also sold live animals such as chickens, bats, and marmots, where most patients are thought to have been exposed. However, she reported regularly visiting a local fresh market before her symptoms began on Jan 5. That illness onset is later than that of the others infected in the outbreak, which ranged from Dec 8 to Jan 2, according to a Jan 12 update from the WHO. The incubation period for nCoV-2019 isn’t known, and authorities closed the seafood market on Jan 1.” 182 contacts are being monitored related to this case and eight febrile travelers at the Suvarnabhumi Airport have been isolated and tested (all were negative). Japan also confirmed their first case in a 30-year-old man who tested positive following a visit to Wuhan. On Thursday, officials released more information regarding a second family cluster in Wuhan (likely exposed via the same source), as well as findings from environmental testing at the market in Wuhan.

Antibiotic Tolerance Can Affect Combo Treatments, Study Finds
A team of scientists in Israel found evidence that antibiotic resistance in microbes may render combination therapies ineffective, a long-held fear that may now be reality. Combination drug therapy is a commonly used clinical method for treating infections caused by resistant microbes and to prevent the progression of resistance. This team monitored the evolution of Staphylococcus aureus strains in patients undergoing combination treatment and exposed the swift emergence of tolerance mutations trailed by the emergence of resistance. Tolerance mutation in antibiotics is a general term “used to describe the ability, whether inherited or not, of microorganisms to survive transient exposure to high concentrations of an antibiotic without a change in the MIC, which is often achieved by slowing down an essential bacterial process,” whereas antibiotic resistance is “the inherited ability of microorganisms to grow at high concentrations of an antibiotic, irrespective of the duration of treatment, and is quantified by the minimum inhibitory concentration (MIC).” After the discovery of tolerance to combination treatments in the S. aureus case, the scientists were able to expand the finding by measuring bacterial growth in Escherichia coli after drug combinations from four different antibiotic classes. Isolates with tolerance to norfloxacin and ampicillin promoted resistance in some of the combinations for treating E. coli. Therefore, the authors conclude that “rescue of resistance mutations by tolerance is a general phenomenon that may have crucial implications for the evolution of resistance in patients treated with combinations of antimicrobials.” A short article summarizing the study can be found here and the original publication can be found here.

WHO- Urgent Health Challenges for the Next Decade
The World Health Organization has released their list for the new decade – which was “developed with input from our experts around the world, reflects a deep concern that leaders are failing to invest enough resources in core health priorities and systems.” The list does not place challenges by priority, as they are all urgent and includes elevating health in the climate debate, delivering health in conflict and crisis, making healthcare fairer, expanding access to medicines, stopping infectious diseases, and more. Within each challenge, the WHO discusses what it is and what they are doing to help correct it.

Outbreak Dashboard 
While much attention has been to the novel coronavirus outbreak, more Ebola cases have been identified in the DRC. The latest situation report from The Who reports 8 new cases, including 3 in Beni.

Pandora Report: 1.3.2020

Welcome to 2020! We’re excited to start the new year with a short newsletter to keep you up to date on all things biodefense.

 Alcatraz of Viruses
The Island of Riems in the Baltic Sea, once inhabited by the Nazis for biological weapon research, is now a heavily restricted site for German scientists to develop vaccines against viruses. The island hosts the Friedrich Loeffler Institute, Germany’s National Institute for Animal Health, which is a hub for the study of pathogens like rabies, African swine fever, and Ebola, and maintains the primary objective of preparing for future infectious disease outbreaks. The deputy head of the Friedrich Loeffler Institute, Franz Conraths, dubbed the island to be the “Alcatraz of Viruses.” Given its nickname-sake, the island is subject to stringent security protocols in order to safely contain all pathogenic samples and protect researchers and visitors. Since 2008, the German government has invested over $300 million in the Institute for infrastructural upgrades; there are now 89 laboratories and 163 stables for the research animals within the facility. Animal welfare is an important pillar for the Institute, hence their efforts to minimize animal research and minimizing the suffering of any tested animal. That said, the potential for their vaccine research to save millions of human and animal lives, protect the livelihoods of farmers, and alleviate global hunger, according to the head of the diagnostics department, outweighs the desire to eliminate animal testing.

NAS Workshop Proceedings: Improving International Resilience and Response to Chemical, Biological, Radiological, and Nuclear Events
In October 2017, the National Academies of Sciences, Engineering, and Medicine (NAS) coordinated an international, science-based workshop in Tokyo regarding resilience to Chemical, Biological, Radiological, and Nuclear (CBRN) events. The CBRN resilience workshop, in collaboration with Niigata University and the Japan National Research Institute for Earth Sciences and Disaster Resilience (NIED), aimed to “increase understanding of the communication, interoperability, and coordination issues that arise among various international stakeholders who are responsible for responding to CBRN event.” Partakers included experts and representatives from the government/public sector, private sector and industry, international organizations, academia, and NGOs. The event included a simulation as well as various plenaries covering topics such as lessons from past CBRN events and strengthening collaborative capacity. The workshop included a Resilience Exercise that used an explosion created by the collision of a large Liquid Natural Gas Tanker into a chemical depot on the shore near the Tokyo Motor Show as its base scenario. The explosion was compounded when the adjacent industrial complex ignited and debris oil was launched into Tokyo Bay. The flames and smoke of the chemical fire travelled inland toward Tokyo, home to about 14 million people, and smoke is further spreading toward the Tokyo Big Sight complex. Additional simulation components include the challenges of responding to a cascading CBRN event and the difficulty stimulating multi-party discussion for rapid response and international cooperation. Examples of some of the issues recognized during the workshop include delayed information sharing, incongruent definitions and terminologies across organizations, and the lack of defined roles and responsibilities for response.

Antimicrobial Resistance – A New Plan For A New Year?
Since the CDC announced their latest report and findings that each year 2.8 million Americans are infected with a drug-resistant organism, 35,000 of whom later die, we can safely say we’ve got a big problem. Antimicrobial resistance (AMR) isn’t new though and the problem has been boiling up for decades however it seems that we’re starting to truly take it seriously. From rivers to traveling patients, it’s hard to escape resistant microbes. New efforts to invigorate surveillance/reporting, as well as stewardship initiatives and even addressing the drying pipeline of antibiotics, are all tactics that have been employed. In fact, this latest piece is the one that is perhaps the most damning – big pharma has all but fled the antibiotic R&D field and those start-ups courageous enough to try, are increasingly falling upon financial ruin. “Antibiotic start-ups like Achaogen and Aradigm have gone belly up in recent months, pharmaceutical behemoths like Novartis and Allergan have abandoned the sector and many of the remaining American antibiotic companies are teetering toward insolvency.” Sadly, this is only adding to the issue as it paints a grim image for those considering any investment in antibiotic R&D. Many are calling for government intervention to help address the push-pull dynamics of antibiotic development – noting that “If this doesn’t get fixed in the next six to 12 months, the last of the Mohicans will go broke and investors won’t return to the market for another decade or two,” said Chen Yu, a health care venture capitalist who has invested in the field. Another component though is the heavy push on stewardship and prescribing practices, which often makes hospitals and providers weary against using new antimicrobials. Adding to this sentiment, Dr. Rick Bright, BARDA Director and Deputy Assistant Secretary for Preparedness and Response, wrote on the need for better diagnostics for resistant infections. Dr. Bright shares his own experiences with a simple-turned-complex infection that required several antibiotics. From delays in diagnostics/treatment, to being on six antibiotics, this is a great personal account of what it’s like to have a resistant infection and the inherent limits of existing diagnostics. “The gardening incident gave me personal insight into the many challenges that confront medical professionals and every patient fighting a resistant infection. I am more committed than ever to overcoming this challenge, to identifying solutions, and to partnering with private sector to get ahead of antimicrobial resistant infections and protect our nation’s health security. I hope more potential industry partners will look closely at the problem and join me by partnering through programs like CARB-X, BARDA DRIVe and other BARDA-supported initiatives.”

Senate Passes Bipartisan One Health Awareness Month Resolution
On December 20th, the Senate unanimously passed a bipartisan resolution to promote January as “National One Health Awareness Month”. Since more than 74% of emerging infectious diseases are zoonotic, the awareness to One Health and the role we all play is critical in addressing current and future biological threats.The One Health Commission is working to promote this new resolution, including a guide to help raise awareness for this critical initiative. You can read the full resolution here.  Happy National One Health Awareness Month!

Outbreak Dashboard
Flu activity continues to rise in the United States, as the CDC reported 4.6 million flu illnesses, 39,000 hospitalizations, and 2,100 deaths in this season. The Ebola outbreak in the DRC has also been growing, as 4 new cases were recently reported in Kalunguta, which is frustrating as the area had previously gone 63 days without a new case.

Pandora Report: 12.6.2019

Are We Making Progress on the Antibiotic Resistance Front?
Antibiotic resistance is a problem that crosses sectors, industries, species, and frankly, requires a widespread effort to make a dent in the problem. Whether it be stewardship among medical providers, surveillance and rapid isolation, or use within agriculture, this is a global issue that we’re just not doing that well in. While the latest CDC report shows that annual deaths due to drug-resistant infections is decreasing since their last analysis, the number of infections occurring is still quite high. In 2013 it was reported that 2.6 million infections occur annually and in this latest report, they found that each year there are 2.8 million antibiotic-resistant infections resulting in 35,000 deaths. Moreover, the 2019 report shows 5 new urgent threats and 2 new threats, which emphasizes the role of stewardship initiatives and One Health. “But there is plenty to worry about. Though hospitals are making headway, the agency found some of the greatest increases in infections are acquired outside hospitals. Also, the threat of antibiotic resistance is remarkably fluid; new threats arise even as old ones are mitigated. For example, the CDC has raised the alert level to ‘urgent” for Candida auris, a multi-drug-resistant yeast that can cause invasive infection and death’.” At a global level, the World Health Organization (WHO) has worked to guide national action plans, which countries can employ and modify to their specified needs. Hint: we’ll be doing a spotlight on resistant fungal infections within this newsletter so make sure to keep reading.

The Mystery and the Truth Surrounding the Explosion at Vektor
Since the explosion in September, there’s been  growing conversation around what really happened at Vektor, but also the immediate media coverage that was often over-hyped and opportunistic. Dr. Filippa Lentzos has broken down the facts and ultimately, the implications of those rapid reports. Citing inspections from the WHO-led team, she notes that previously, the site had met international biosecurity and biosafety standards as a smallpox repository. While Vektor’s history includes being an offensive weapons site during the era prior to the Biological Weapons Convention (BCW) and some time after, it has been transformed to a site for research and biodefense. Truly, the biggest issue, Lentzos notes, is the biosafety issues that frequent such research. “Jens Kuhn, a German virologist who was part of a Pentagon-sponsored program that sent young scientists to work in former bioweapons labs, was the first Western scientist through the door at VECTOR in July 2001. Getting in was anything but easy, but once inside he found that contrary to fears he had heard expressed in the West, the high-containment units operated both safely and securely. ‘The Russians don’t want to kill themselves any more than Western scientists,’ Kuhn is quoted as saying in a Nature news story.” While the facility has been upgraded and repaired in recent decades, the Russian government declares biodefense activities and confidence-building measures through the BWC regularly. Sure, they’re doing research with deadly disease like Ebola and Marburg, not to mention storing smallpox, but it’s important to remember that not only is Russia following the International Health Regulations (IHR), which would require them to report risky public health events, but they also did communicate the explosion (although, mostly through the media) and that it happened in the decontamination room – an incident that did not warrant such IHR reporting. As Lentzos underscores, some of the reactions to the event were overblown but this is a prime example of why transparency during such events is critical to avoid misinformation and opportunistic reporting.

Synopsis of the Crimson Contagion 2019 Functional Exercise After-Action Review
This week, the National Biodefense Science Board convened a meeting focusing on the after-action review of the Crimson Contagion 2019 Functional Exercise, a national level exercise series conducted to detect gaps in mechanisms, capabilities, plans, policies, and procedures in the event of a pandemic influenza.  Current strategies include the Biological Incident Annex to the Response and Recovery Federal Interagency Operational Plans (2018), Pandemic Influenza Plan (2017 Update), Pandemic Crisis Action Plan Version 2.0, and CDC’s Pandemic Influenza Appendix to the Biological Incident Annex of the CDC All-Hazard Plan (December 2017). These plans, updated over the last few years, were tested by the functional exercise with emphasis on the examination of strategic priorities set by the NSC. Specifically, examined priorities include operational coordination and communications, stabilization and restoration of critical lifelines, national security emergencies, public health emergencies, and continuity. The Crimson Contagion 2019 Functional Exercise included participation of almost 300 entities – 19 federal departments and agencies, 12 states, 15 tribal nations and pueblos, 74 local health departments and coalition regions, 87 hospitals, 40 private sector organizations, and 35 active operations centers. The scenario was a large-scale outbreak of H7N9 avian influenza, originating in China but swiftly spreading to the contiguous US with the first case detected in Chicago, Illinois. Continuous human-to-human transmission of the H7N9 virus encourages its spread across the country and, unfortunately, the stockpiles of H7N9 vaccines are not a match for the outbreak’s strain; however, those vaccines are serviceable as a priming dose. Also, the strain of virus is susceptible to Relenza and Tamiflu antiviral medications. The exercise was intended to deal with a virus outbreak that starts overseas and migrates to the US with scant allocated resources for outbreak response and management, thereby forcing the Department of Health and Human Services (HHS) to include other agencies in the response. To do so, the exercise began 47 days after the identification of the first US case of H7N9 in Chicago, otherwise known as STARTEX conditions. Then, the HHS declared the outbreak as a Public Health Emergency (PHE), the World Health Organization (WHO) declared a pandemic, and the President of the United States declared a National Emergency under the National Emergencies Act. As was the case in the 1918 Great Influenza, transmissibility is high and cases are severe. At STARTEX, there are 2.1 million illnesses and 100 million forecasted illnesses as well as over half a million forecasted deaths. As the pandemic progresses along the epidemiological curve, the overarching foci of the federal-level response adjusts across four phases:

  1. Operational coordination with public messaging and risk communication
  2. Situational awareness, information sharing, and reporting
  3. Financing
  4. Continuity of operations

The outcome of the Crimson Contagion is that vaccine development is the silver bullet to such an outbreak, but there are complications beyond its formulation. Namely, the minimization of outbreak impact prior to vaccine development and dispersal, strategy for efficient dissemination of the vaccine across the country, allocation of personal protective equipment (PPE), and high expense of vaccine development and PPE acquisitions. The exercise concluded that HHS requires about $10 billion in additional funding immediately following the identification of a novel strain of pandemic influenza. The low inventory levels of PPE and other countermeasures are a result of insufficient domestic manufacturing in the US and a lack of raw materials maintained within US borders.  Additionally, the exercise revealed six key findings:

  1. Existing statutory authorities, policies, and funding of HHS are insufficient for a federal response to an influenza pandemic
  2. Current planning fails to outline the organizational structure of the federal government response when HHS is the designated lead agency; planning also varies across local, state, territorial, tribal, and federal entities
  3. There is a lack of clarity in operational coordination regarding the roles and responsibility of agencies as well as in the coordination of information, guidance, and actions of federal agencies, state agencies, and the health sector
  4. Situation assessment is inefficient and incomplete due to the lack of clear guidance on the information required and confusion in the distribution of recommended protocols and products
  5. The medical countermeasures supply chain and production capacity are currently insufficient to meet the needs of the country in the event of pandemic influenza
  6. There is clear dissemination of public health and responder information from the CDC, but confusion about school closures remains

A final report with greater detail of the after-action review of the Crimson Contagion 2019 Functional Exercise is forthcoming. Stay tuned.

Biosecurity Insight
The latest Biosecurity Insight is out, which is a great source for information from the Centre for Biosecurity and Biopreparedness (CBB) established by the Danish Parliament. In this new volume, you can read about the control of CRISPR, fake news and biological weapons (“Pathogens are impossible to see and their effects difficult to understand. This makes the fear of them a dangerous device to be exploited through fake news. In a world where more than half of the population is online, social media can become a device to spread panic and mistrust, and hamper responses to natural disease outbreaks.”), and how the internet enables bioterrorism. You can read more here.

The Nuclear Balancing Act – Energy and Security
On November 14th, the GMU Schar School of Policy and Government hosted a panel conversation on the intersection of nuclear energy and security. “Students and faculty members from the Schar School of Policy and Government, as well as representatives from government agencies and nongovernmental organizations, joined Brent Park, Deputy Administrator for Defense Nuclear Nonproliferation at the U.S. Department of Energy’s National Nuclear Security Administration, and Mikhail Chudakov, Deputy Director General for Nuclear Energy at the International Atomic Energy Agency (IAEA)” to have frank conversations about the future state of nuclear energy and how to address “energy poverty”. Moderated by GMU biodefense professor and graduate program director Dr. Gregory Koblentz, the group discussed the marriage between these two nuclear components and that we ultimately need to continue having these conversations. As Dr. Koblentz noted, “Given the growing demand for carbon-free energy and the dynamic geopolitical situation, it was very informative to hear about how the IAEA and the United States work together to promote safe and secure nuclear energy.”

Biological Weapons Convention Meeting of States Parties (MSP)
This week the MSP began, bringing together states parties engaged in the prohibition of biological weapons. You can read Richard Guthrie’s daily summaries of the meetings here or even watch the livestream on UN Web TV. Hot topics will likely include funding and the current financial state, national implementation, verification, etc. The United Nations Institute for Disarmament Research (UNIDIR) has provided a 30-page overview of compliance and enforcement in the BWC, which you can access here. Written by Filippa Lentzos “this paper takes stock of the mechanisms that are currently available for attempting to determine and ensure compliance with the Biological Weapons Convention (BWC). It presents three conceptual layers of BWC compliance: one legally binding, one politically binding, and one wholly voluntary. The paper also describes a fourth, elusive layer—the verification layer—which remains one of the fundamental challenges of biological disarmament and non-proliferation.” On day 5 of the MSP, Guthrie noted that during the science and technology meeting of experts  “there was broad agreement of a need for some form of review arrangement, but with very little detail in the discussion. In the past, for example, some delegations have favoured a small committee of experts while others have favoured some form of arrangement that would allow all states parties to contribute to it. The lack of expressions of support for specific models may be a positive sign as many delegates would seem to prefer achieving consensus on some form of review mechanism rather than pressing for their ideal.”

Missing Links – Understanding Sex- and Gender-Related Impacts of Chemical and Biological Weapons
A new report released via UNIDIR is also addressing the interest that “has grown in gender as a useful analytical perspective to examine the impact of particular means and methods of warfare. Multilateral debates on chemical and biological weapons, however, have not systematically considered the relevance of sex- and age-disaggregated data on the effects of these weapons, nor knowledge of gender dynamics, in the implementation of the Biological and Chemical Weapons Conventions (BWC and CWC, respectively).” Written by Renata Hessmann Dalaqua, James Revill, Alastair Hay, and Nancy D. Connell, this is an extremely detailed and thorough look into the sex and gender dynamics that we often fail to address when it comes to CBW. The report is broken down into several sections – like sex and gender specific effects of chemical and biological weapons, which delves into the social roles and exposure as women are often the primary caregivers, as well as the social stigma and discrimination associated with exposure. Perhaps one of the most interesting sections was on health-seeking behaviors, noting that in some areas, the potential for stigma often impacts if medical care is sought. “Evidence from South Asia, Africa, and Vietnam suggests that the potential for stigmatization affects women’s help-seeking more than men”. Overall, this report was extremely informative and helpful in understanding those roadblocks for not only accurate reporting, but also building the most effective response in the event of an attack.

Using Genome Sequencing to Combat Healthcare Outbreaks 
GMU Biodefense doctoral alum Saskia Popescu discusses how genome sequencing can change response to outbreaks in healthcare settings. Infection prevention epidemiologists work hard to identify spikes in usual case counts or rapidly respond to single cases of unusual organisms. Unfortunately, identifying a source or transmission mechanism isn’t always that easy and we often don’t find the proverbial “smoking gun”.  However, a study assessed the use of genome sequencing in real-time as a tool to help give hospital epidemiologists and infection control an advantage against microorganisms. Investigators across several universities discussed how they employed the rapid and cost-efficient tool during an outbreak of Acinetobacter baumannii at the Queen Elizabeth Hospital Birmingham in 2011. The source of the outbreak was found to be a military patient from Afghanistan who was being treated for a blast injury. This specific case is unique in that the outbreak lasted an incredibly long time—80 weeks, which is the longest ever studied for Acinetobacter baumannii. 

Antimicrobial Resistant Fungal Infections
Fungi are eukaryotic organisms like molds, yeasts, and mushrooms that can be pathogenic in humans. Antifungal medications treat dangerous fungal infections, but antifungal resistant microbes are on the rise, just like antibiotic resistant bacteria. For example, antifungal resistance is increasingly common in severe Candida (a yeast) infections, which often causes nosocomial bloodstream infections. The Centers for Disease Control and Prevention (CDC) released a report on antibiotic resistance threats in the US, which includes a warning about drug-resistant fungi as a serious public health issue. According to the report, 18 microorganisms cause three million antibiotic resistant infections and 35,000 deaths each year. This is the first CDC report to include antibiotic-resistant fungi to include Candida auris along with other resistant Candida species and azole-resistant Aspergillus fumigatus, a mold. Resistance is inherent to certain fungi but can also develop through the misuse and overuse of antifungal and antibiotic drugs in human medicine and agriculture. As with antimicrobial resistance at large, the ubiquitous use of stronger and stronger antimicrobial medications is contributing to the spread of resistance while struggling to combat ongoing infections. The CDC is taking several steps and actions to prevent and reduce resistance:

  • Tracking trends in antifungal resistance through the Emerging Infections Program (EIP)
  • Supporting a network of regional public health laboratories through the Antibiotic Resistance Laboratory Network (ARLN) to perform antifungal susceptibility testing for Candida
  • Using genetic sequencing and developing new laboratory tests to identify and study specific mutations associated with antifungal resistance in Candida
  • Summarizing antifungal prescribing patterns across different healthcare facilities to promote appropriate use of antifungals

The CDC’s warning also includes suggestions about what can be done to curb the threat of antifungal resistance:

  • Healthcare facility executives and infection control staff can:
    • Assess antifungal use as part of their antibiotic stewardship programs
    • Ensure adherence to guidelines for hand hygiene, prevention of catheter-associated infections, and environmental infection control
  • Doctors and other hospital staff can:
    • Prescribe antifungal medications appropriately
    • Test for antifungal resistance for patients with invasive disease who are not improving with first-line antifungal medications
    • Stay aware of resistance patterns, including antifungal resistance, in your facility and community
    • Document the dose, duration, and indication for every antifungal prescription
    • Participate in and lead efforts within your hospital to improve antifungal prescribing practices
    • Follow hand hygiene and other infection prevention and control guidelines with every patient

Outbreak Dashboard
More attacks have plagued Ebola outbreak response efforts in the DRC, as case counts reach 3,313. Flu activity is also continuing to grow, as B/Victoria viruses are the most common and the CDC reported 8% of respiratory specimens tested by clinical labs were positive for influenza. The CDC is continuing to advise people not to consume romaine lettuce from the Salinas, CA, growing region due to an E. coli O157:H7 outbreak.

News of the Weird
A controversial fence, African swine fever, and Danish critics. In the realm of ASF outbreak response, some are calling the latest efforts in Denmark a waste of money. “On Monday, Denmark completed the fence along the border with Germany to protect its nearly 5,000 pig farms that export 28 million pigs annually, according to the Danish Agriculture and Food Council in a DW.com article. The 1.5-meter tall and half-meter deep fence runs from the Wadden Sea in the west to the Flensburg Fjord in the east. The fence construction cost Denmark around $12 million.” From potentially disrupting migration and an impact on the ecosystem, critics are saying the real threat is the importation of contaminated swine.

Stories You May Have Missed:

Pandora Report: 11.22.2019

Happy Antibiotic Awareness Week! Are you being a good steward of antimicrobials during this respiratory virus season?

When A Lab Explosion Ruins Your Day – Stories of Vector 
A few months back, an explosion at the Russian laboratory complex known as the State Research Centre of Virology and Biotechnology (Vector), raised a red flag regarding the stockpiling of smallpox and realistically, biosafety/biosecurity. Not surprisingly, stories about where the explosion occurred, what was kept in that area, and all manner of horror movie-esque plots began to swirl. Gwyn Winfield though, has broken down the rumors, the realities, and the challenges of understanding what exactly happened when well, there’s not a lot of trust in Russian explanations. Gwyn takes care to highlight how fast speculation occurred though, and that while it may not have been easy to get answers right away, the theatrics of lab-to-bioweapon speculation does little good. Noting that the blast occurred on the 5th floor of building one – “The floor had been under repair since July, and since there was no research in progress there, and the area was not secure, there were no pathogens on that floor to be released.” As Winfield notes, the lack of information makes things challenging and while experts might make guesses, “the individuals that need to take the most lessons from this are exercise planners, globally but especially in Russia”. You can read the full article here.

The Microbiome and AMR
Microbiota bear effects on a variety of chronic diseases such as gastrointestinal, autoimmune, respiratory, neurological, and cardiovascular conditions; however, the microbiome also plays a role with infectious diseases. The growing body of research on the importance of the microbiome to human health links natural flora and the immune system, which are in a largely symbiotic relationship. More specifically, a healthy microbiome aids in the induction, training, and function of the immune system and, in return, the immune system maintains a happy balance between natural flora and the host human. Unfortunately, that relationship is under great threat as the persistent overuse of antibiotics destroys not only the invasive bacteria but also the healthy bacteria that help maintain immune function. Antimicrobial resistance (AMR) is ability of microbes – bacteria, viruses, fungi – to circumvent the mediating effects of antibiotic, antiviral, and antifungal therapeutics. The overuse of antibiotics enables strong, resistant bacteria to survive in the host, so your gut ultimately populates with mostly resistant bacteria, even bacteria resistant to multiple drugs. Disruptions to the microbiome by antibiotic use adds to the spread and strength of antimicrobial resistance in harmful microbes. Our overreliance on the prescription of antibiotics to alleviate bacterial infections, even minor ones that the immune system may be able to overcome, and a lack of medication compliance resulting in misuse are chipping away at the clinical efficacy of these drugs. This is of considerable concern as microbes become cleverer and less susceptible to multiple medications, resulting in infections that are less and less treatable. According to the CDC, there are over 2.8 million antibiotic-resistant infections in the US each year and more than 35,000 people die from those infections. The critical task at hand is to develop alternative therapeutics that can treat infections while, at least, not contributing to further microbial resistance. As a mediator for colonization resistance and a symbiote of the immune system, the microbiome possesses potential as a therapeutic gateway to subvert resistance.

Biodosimetry Biomarkers and Serum Proteomic Signatures – GMU Biodefense Alum Tackles It All 
GMU Biodefense doctoral student Mary Sproull is our resident guru on radiation – she’s a biologist in the Radiation Oncology Branch of the National Cancer Institute at NIH. Here are just two more reasons why Sproull is the go-to person for things like biodosimetry: she has two new publications that you’ll want to check out. The first, Comparisons of Proteomic Biodosimetry Biomarkets Across Five Different Murine Strains (try saying that five times fast) “seeks to compare the expression levels of five previously established proteomic biodosimetry biomarkers of radiation exposure, i.e., Flt3 ligand (FL), matrix metalloproteinase 9 (MMP9), serum amyloid A (SAA), pentraxin 3 (PTX3) and fibrinogen (FGB), across multiple murine strains and to test a multivariate dose prediction model based on a single C57BL6 strain against other murine strains.” Make sure to read this study as it discusses why these strain specific differences exist between expression levels. In the second article A Serum Proteomic Signature Predicting Survival in Patients with Glioblastoma, Sproull and the research team discuss this common brain tumor and how developing adequate biomarkers can help drive stronger patient outcomes. “Analysis of potentially relevant gene targets using The Cancer Genome Atlas database was done using the Glioblastoma Bio Discovery Portal (GBM-BioDP). A ten-biomarker subgroup of clinically relevant molecules was selected using a functional grouping analysis of the 40 plex genes with two genes selected from each group on the basis of degree of variance, lack of co-linearity with other biomarkers and clinical interest. A Multivariate Cox proportional hazard approach was used to analyze the relationship between overall survival (OS), gene expression, and resection status as covariates.”

Gene Editing
Advancements in biotechnology pose potentials and perils as such technology becomes easier to access and use by a wide array of bio-users, not just formally trained scientists at professional laboratories. Gene editing, the alteration of an organism’s DNA, is one such biotechnology. A number of research and government entities are working diligently to maximize the potential benefits of gene editing while simultaneously minimizing its perils. Two such entities are the National Academies of Sciences, Engineering, and Medicine and the Defense Advanced Research Projects Agency (DARPA). The former is concerned with perils of synthetic biology while the latter is trying to unlock its potential. The National Academies of Sciences, Engineering, and Medicine just released Strategies for Identifying and Addressing Vulnerabilities Posed by Synthetic Biology: Proceedings of a Workshop in Brief, which summarizes the key discussions in an October 2018 meeting of experts and policymakers following a report for the DOD, Biodefense in the Age of Synthetic Biology. The meeting’s purpose was to assemble federal personnel and the committee for the DOD report to consider the implications for actions DOD might take to quell potential misuse of synthetic biology capabilities. The committee evaluated 12 capabilities associated with (1) the synthesis and modification of pathogens; (2) production of chemicals, biochemicals, and toxins; and (3) modulation of human physiology. Each of the three capability areas were assigned relative levels of concern in terms of the usability of a technology, its usability as a weapon, its requirements of actors, and the potential for its mitigation. Additional workshop discussions included the potential of delivery mechanisms to serve as a barrier to the misuse of synthetic biology to produce weapons, the possibility to use synthetic biology to modify human physiology in new ways, and opportunities in computational biology to alleviate fears about synthetic biology capabilities through the prevention, detection, and attribution of its misuse. DARPA’s latest biotechnology project is the “Detect It with Gene Editing Technologies” program, more lovingly called DIGET. The primary objective of DIGET is “to provide comprehensive, specific, and trusted information about health threats to medical decision-makers within minutes, even in far-flung regions of the globe, to prevent the spread of disease, enable timely deployment of countermeasures, and improve the standard of care after diagnosis.” The DIGET dream deliverables are two devices: (1) a handheld and disposable point-of-need tool that simultaneously screens 10 or more pathogens or host biomarkers and (2) a multiplexed detection platform that simultaneously screens at least 1,000 clinical and environmental samples. DIGET seeks to incorporate gene editors and detectors biosurveillance as well as swift point-of-need diagnostics for endemic, emerging, and engineered pathogens. DARPA is hosting a Proposer’s Day meeting about the DIGET program on 11 December 2019.

Biological Threats to U.S. National Security – Subcommittee on Emerging Threats and Capabilities 
On Wednesday, Dr. Thomas V. Inglesby, Dr. Tara J. O’Toole, and Dr. Julie Gerberding gave testimony to this subcommittee within the U.S. Senate Committee on Armed Services. During the testimony, Dr. Inglesby “noted the growing threat of biological events that can emerge from nature, deliberate attack, or accidental release and reviewed current US government efforts in this arena. He presented recommendations to improve the government’s response to and preparedness for a major biological event.” You can read his full testimony here.

Revisiting the Biological Weapons Convention Protocol
Lynn Klotz recently wrote on the gaps within the BWC in relation to compliance monitoring. Despite efforts to change this in the past, those pushing for a protocol to randomly select site visits as means to do quality checks, have been disappointed over the years as administrations cite that such additions would not truly verify or provide greater security. As Klotz underscores – this sentiment fundamentally misses the goal of the protocol…which is transparency. “But recent events serve to underscore that a protocol to the convention to address the treaty’s shortcomings is an idea that should be revisited. Unfounded Russian allegations about biological weapons development in former Soviet countries are threatening the effectiveness of the convention. This concern along with strong arguments for the high importance of transparency in international treaties calls for revisiting the protocol, which had provisions for both transparency and for dealing with allegations like Russia’s.” Citing the 2019 meeting in which Russia alleged that several former Soviet states had active bioweapons programs, distrust soon grew and disruption rippled throughout the BWC. Klotz emphasizes that this exact situation is a prime reason why a protocol should be revisited – to help build confidence through increasing transparency. Not a free-for-all, but rather through managed-access rules, such as random visits by inspection teams would help verify the absence of bioweapons. Klotz takes care to discuss why protocol efforts were abandoned in 2001 and the role of transparency in multilateral arms control regimes, which you can read more about here.

Health Security Career Panel (Left to Right): Ashley Grant, Stuart Evenhaugen, Syra Madad, Sapana Vora, Halley Smith, Justin Hurt, and Malaya Fletcher.

GMU Hosts Health Security Career Panel 
Last week, adjunct professor Ashley Grant, a lead biotechnologist at the MITRE Corporation, held a career panel at the Schar School of Policy and Government at George Mason University as part of her course on Global Health Security Policy. To highlight the different paths that graduate students in the Biodefense program can take in the health security field, Professor Grant convened a diverse panel of health security practitioners to discuss their jobs and the skills they have needed to succeed. The panel included professionals from a variety of different backgrounds ranging from local health providers to Federal employees. Students in the Schar School’s Biodefense Graduate Program were able to ask the panelists about the challenges of moving from a technical career path into science policy and opportunities for internships. The panel included Stuart Evenhaugen of the Assistant Secretary for Preparedness and Response (ASPR)’s Strategy Division in the Department of Health and Human Services (HHS); Syra Madad, the Senior Director of System-Wide Special Pathogens Program at NYC Health + Hospitals; Halley Smith, a program lead with the U.S. Department of State Cooperative Threat Reduction Program, on detail from Sandia National Laboratories Global Chemical and Biological Security Program; Sapana Vora, the Deputy Team Chief for the U.S. Department of State’s Biosecurity Engagement Program (BEP) and Iraq Program in the Office of Cooperative Threat Reduction (CTR); and Malaya Fletcher, a Lead Scientist at Booz Allen Hamilton in Washington, DC.  The panel also included LTC Justin Hurt a CBRN/WMD Organizational Integration Officer in the Army G-3/5/7 Office who is currently enrolled in the Biodefense PhD program. As biodefense graduate student Michael Krug noted, “The panel was immensely valuable in providing detailed insights and experiences into each of the panelist’s unique career paths. Emphasizing the demand for multi-disciplined approaches, as well as active communication to answer the many health security questions facing the world.”

A Little Bit of Plague and A Whole Lot of Panic  
Plague – a word that still sparks fear after hundreds of years. Two cases were recently reported in China’s Inner Mongolia and of course, it involved a hunter and butchering/eating a wild animal. Diagnosed on November 5th, there were two additional cases reported in Beijing but from the Inner Mongolia area. “In both cases, the two patients from Inner Mongolia were quarantined at a facility in the capital after being diagnosed with pneumonic plague, health authorities said at the time. The Inner Mongolia health commission said it found no evidence so far to link the most recent case to the earlier two cases in Beijing.” As many have pointed out, the fear around this news has been more damaging to response efforts. Pneumonic plague is not as highly contagious as many news outlets have let on – only requiring Droplet + Standard isolation precautions and plague is easily treatable with antibiotics or prophylaxis.

Should We Be Celebrating CRISPR’s Anniversary?
It’s not many times an expert and innovator writes an article entitled “CRISPR’s unwanted anniversary” about a tech they were instrumental in developing. Dr. Jennifer Doudna recently wrote on those moments that can make or break a disruptive technology and in the case of CRISPR, it was last year, when Hong Kong-based scientist He Jiankui started the CRISPR baby drama. This was a pivotal moment in not only biotech, but also genome editing and its future. As Doudna notes, it’s comforting that scientists around the world reacted with conversations about the need for safeguards and transparency as CRISPR technology grows. In the face of this anniversary though, what has been done? Are there consequences for going against widely accepted norms? Doudna leaves us with the notion that “The ‘CRISPR babies’ saga should motivate active discussion and debate about human germline editing. With a new such study under consideration in Russia, appropriate regulation is urgently needed. Consequences for defying established restrictions should include, at a minimum, loss of funding and publication privileges. Ensuring responsible use of genome editing will enable CRISPR technology to improve the well-being of millions of people and fulfill its revolutionary potential.”

Outbreak Dashboard
In keeping up with the latest outbreaks, here are some quick updates on a handful of the infectious disease events that are going on  – The outbreak of Ebola virus disease in the DRC may be slowing as there were no new cases reported on November 19th but over 400 suspected cases were still being assessed (total case count is 3,296). With the recent approval of the Ebola vaccine by the European Medicines Agency (EMA), the distribution of the vaccine will increase and could impact the outbreak as well. Nigeria is facing a Yellow Fever outbreak, which it has struggled against since 2017. In the past 4 weeks, 839 new cases have been reported. Flu activity is increasing in the United States and the predominant strains are B/Victoria, A(H3N2) and A(H1N1)pdm09. 2.3% of healthcare provider visits in outpatient settings were for influenza-like illnesses. There is also a new E. coli outbreak linked to pre-packaged chicken Caesar salads impacting 17+ people across 8 states.

Hot Spots and Inadequate Monitoring for Bioterrorism – An American Story
Law professor Ana Santos Rutschman of Saint Louis University recently wrote on the usual and unusual biological suspects and how organisms like Salmonella can easily be overlooked as cases of bioterrorism (case in point the 1984 Oregon attack). Rutschman delves into preparedness efforts, like BioWatch, and how “there is a profound lack of coordination between federal agencies and local communities. When asked about what happens after notifications of a possible bioterrorism attack, Dr. Asha George, executive director of the Bipartisan Commission on Biodefense, answered: “They go off but nobody knows what to do.

Stories You May Have Missed:

  • Ongoing Outbreaks Trigger Laws to Limit Vaccine Exemptions – in the middle of measles outbreaks and pertussis cases occurring frequently, there is a desperate need for reducing vaccine exemptions that protect the anti-vaccine instead of the public’s health. “In 2018, the same research group published a study showing that, despite rising numbers of proposed antivaccine laws, pro-vaccine bills were more likely to become law. For the current study, the team looked at how health data might affect laws. The new findings come following a surge of measles activity in the United States this year, mostly fueled by a few large outbreaks that nearly cost the nation the measles elimination status that it achieved in 2000.”
  • Acinetobacter Baumannii Risk Factors– “After assessing 290 isolates, they found that 169 were endemic (96 of REP-1) and the most common site for isolation was the respiratory tract. In total, 109 patients (37%) had only Acinetobacter baumannii isolated, while some had up to 5 other organisms also identified. In those colonized, 69 were REP-1, and 64 with REP-2-5, the research team found that for those patients with REP-1, there was a 70% increase in carriage per increase in Schmid score (statistically significant), and a 50% increase in REP-2-5. Interestingly, prior colonization, longer lengths of stay, and immunosuppression did now have a statistically significant relationship with Acinetobacter baumannii colonization. “