What Can We Glean from a Bean: Ricin’s Appeal to Domestic Terrorists

By Stevie Kiesel

Stevie is a part-time PhD student in the GMU Biodefense program, and a full-time transportation security analyst. Her area of study is extreme right wing terrorism and WMD.

In June 2019, FBI leadership testified to the House Oversight and Reform Committee that “individuals adhering to racially motivated violent extremism ideology have been responsible for the most lethal incidents among domestic terrorists in recent years, and the FBI assesses the threat of violence and lethality posed by racially motivated violent extremists will continue.” In September 2019, the Department of Homeland Security published a Strategic Framework for Combating Terrorism and Targeted Violence, which acknowledges that “white supremacist violent extremism…is one of the most potent forces driving domestic terrorism” and “another significant motivating force behind domestic terrorism has been anti-government/anti-authority violent extremism.” A few weeks later, William Braniff, director of START at the University of Maryland, testified to the Senate Homeland Security and Governmental Affairs Committee that “among domestic terrorists, violent far-right terrorists…are responsible for more…pursuits of chemical or biological weapons…than international terrorists.” Just as policymakers have been slow to acknowledge and act upon the threat of domestic CBRN terrorism, timely extant research on the issue is scarce as well. In this article, I focus on ricin as an agent of domestic terror. As government agencies acknowledge the threat domestic terrorism poses, policymakers and law enforcement should take ricin seriously as a potential weapon.

To understand the plausibility of ricin’s use as a weapon, I reviewed a number of journal articles, news articles, and court records from 1978 through 2019 and compiled data on 46 incidents of ricin acquisition and/or use. Of these 46 incidents, 19 could be credibly tied to terrorism, 19 were not related to terrorism, and 8 were unclear. The most common motivation after terrorism was murder (10 instances). Of the 19 terrorist incidents, 58% were committed by extreme right-wing terrorists, a term that here encompasses the following ideologies: neo-Nazi/neo-fascist, white nationalist/supremacist/separatist, religious nationalist, anti-abortion, anti-taxation, anti-government, and sovereign citizen. The remaining incidents were committed by Islamist terrorists (16%), Chechen nationalists (10%), or their exact ideology was unclear (16%). Continue reading “What Can We Glean from a Bean: Ricin’s Appeal to Domestic Terrorists”

Pandora Report: 9.19.2019

This week your dose of biodefense news is arriving a bit early – what a way to kick off the weekend! Flipper fans will be sad to hear that dolphins are a new source for antibiotic resistance.

Russian Virology Research Center Hit By Blast/Fire
In perhaps not the best of places to have a gas-cylinder explosion, the Russian Virology Center, Vektor, is causing a bit of concern around the world. Cue the conversations regarding the destruction of smallpox stockpiles…”Russia’s consumer-safety watchdog Rospotrebnadzor said on September 16 that one worker was sent to hospital for third-degree burns suffered in the incident at the State Research Center of Virology and Biotechnology (Vector) near the Russian city of Novosibirsk. It added that no biohazardous substances were present in the sanitary inspection room at the time of the fire. The city’s mayor, Nikolai Krasnikov, said the laboratory, on the fifth floor of a six-story building in the city of Koltsovo, was undergoing renovation and repair work at the time of the incident. All glass in the building was said to have been broken in the blast. A fire covering about 30 square meters was extinguished after the explosion. In the 1970-1980s, the research center developed biological and bacteriological weapons, as well as means of protection against them.”

Preparedness for a High-Impact Respiratory Pathogen Pandemic
The Johns Hopkins Center for Health Security has just released their report, which “examines the current state of preparedness for pandemics caused by ‘high-impact respiratory pathogens’—that is, pathogens with the potential for wide- spread transmission and high observed mortality. Were a high-impact respiratory pathogen to emerge, either naturally or as the result of accidental or deliberate release, it would likely have significant public health, economic, social, and political consequences. Novel high-impact respiratory pathogens have a combination of qualities that contribute to their potential to initiate a pandemic. The combined possibilities of short incubation periods and asymptomatic spread can result in very small windows for interrupting transmission, making such an outbreak difficult to contain. The potential for high-impact respiratory pathogens to affect many countries at once will likely require international approaches different from those that have typically occurred in geographically limited events, such as the ongoing Ebola crisis in Democratic Republic of the Congo (DRC).”

UK Vaccine Network – Mapping Pathogens of Pandemic Potential
Do you know what the United Kingdom is doing to develop vaccines against pandemic pathogens? “During the 2013–2016 Ebola outbreak in West Africa an expert panel was established on the instructions of the UK Prime Minister to identify priority pathogens for outbreak diseases that had the potential to cause future epidemics. A total of 13 priority pathogens were identified, which led to the prioritisation of spending in emerging diseases vaccine research and development from the UK. This meeting report summarises the process used to develop the UK pathogen priority list, compares it to lists generated by other organisations (World Health Organisation, National Institutes of Allergy and Infectious Diseases) and summarises clinical progress towards the development of vaccines against priority diseases. There is clear technical progress towards the development of vaccines. However, the availability of these vaccines will be dependent on sustained funding for clinical trials and the preparation of clinically acceptable manufactured material during inter-epidemic periods.”

Global Preparedness Monitoring Board
In their very first report, the GPMB “reviewed recommendations from previous high-level panels and commissions following the 2009 H1N1 influenza pandemic and the 2014-2016 Ebola outbreak, along with its own commissioned reports and other data. The result is a snapshot of where the world stands in its ability to prevent and contain a global health threat.” The report includes actions for leaders to take, like commitment and investment from heads of government, building strong systems, and preparing for the worst. For example, they note that “Donors, international financing institutions, global funds and philanthropies must increase funding for the poorest and most vulnerable countries through development assistance for health and greater/earlier access to the United Nations Central Emergency Response Fund to close financing gaps for their national actions plans for health security as a joint responsibility and a global public good. Member states need to agree to an increase in WHO contributions for the financing of preparedness and response activities and must sustainably fund the WHO Contingency Fund for Emergencies, including the establishment of a replenishment scheme using funding from the revised World Bank Pandemic Emergency Financing Facility.”

Blue Ribbon Study Panel Becomes Bipartisan Commission on Biodefense
At their latest event, the Blue Ribbon Study Panel announced it would be “taking on a new name to more accurately reflect its work and the urgency of its mission. Effective immediately, the organization now will be known as the Bipartisan Commission on Biodefense. ‘We do not simply study the problem,’ said Executive Director Dr. Asha M. George. ‘We conduct our activities with a self-imposed mandate and the same sort of urgency that congressional commissions demonstrate. Moving forward, we will be the Bipartisan Commission on Biodefense. Our leadership team and unyielding focus remain unchanged.’ The organization was established in 2014 to comprehensively assess the state of U.S. biodefense, and to issue recommendations to foster change. The Commission will continue to be co-chaired by former Senator Joe Lieberman and former Governor Tom Ridge, the first Secretary of Homeland Security.”

NAS Workshop – Public-Private Partnerships for Global Health at the National, Municipal, and Community Levels
Don’t miss this National Academies event on October 23rd and 24th in Washington, D.C. “The National Academies’ Forum on Public-Private Partnerships for Global Health and Safety is convening a 1.5 day workshop to examine the enabling environments for public-private partnerships (PPP’s) at the national, municipal, and community levels. Panelists will provide case studies that focus on the mechanics of building a partnership in a region, the conditions the private sector needs to establish itself in a region, and how a country becomes PPP-ready to accept private partners. The panelists will include: the private sector actors who established a business in a region; the government representative who worked with the private sector actors to create the conditions for private sector involvement; and the intermediary who helped to facilitate the partnership. Additionally, local business owners who distribute the products from larger businesses, or that develop their own businesses within a region, will be brought in to discuss the conditions they need at the local level to form sustainable business models. Intermediaries that work to facilitate global partnerships will also give a broader view of how partnerships are enabled.”

Efforts to Reduce Nosocomial Ebola Transmission
Today there were 15 new cases of Ebola virus reported in the DRC, bringing the case counts to 3,145. Ongoing violence has been a concern, but the growing number of nosocomial infections is also worrisome. “In the wake of this outbreak, the threat of health care-associated infections has grown and thus far 18% of the outbreak cases are nosocomial. The ability for hospitals and treatment centers to act as amplifiers in the middle of an outbreak is not a novel concept. Unfortunately, this number is deeply concerning and represents critical breakdowns in infection control measures. In addition to the avoidable cases, the high number of nosocomial cases is also a driving factor for many to avoid care within the treatment centers. Consider an already skeptical community, and now include the fact that nearly 1 out of 5 cases occur as a result of exposure within a medical setting. Not only can this fuel fear and apprehension to seek care within the community, but it also can put health care workers in danger. In response to this trend, the WHO is partnering up with agencies like the United Nations Children’s Fund, and the US Centers for Disease Control and Prevention (CDC) to help boost health care response and infection prevention in the 3000 nurses, physicians, and health care workers responding to the outbreak.”

Big Pharma Drops New Drugs Despite Drying Antibiotic Pipeline
Despite the continued warnings of the drying antibiotic pipeline and the growing threat of antimicrobial resistance, the pharmaceutical world has shown little interest in investing in the production of new antimicrobials. These costly efforts are a considerable hurdle for companies as a new class of antibiotics is desperately in need. “According to an in-depth report from German public broadcaster NDR this week, the reason for this lack of preparation for the impending crisis is simple: Antibiotics simply aren’t profitable. Antibiotics are only used for a few days once in a while, and are being prescribed less as doctors become more aware of the dangers of overprescription. Instead, drug companies are focusing on lucrative medications for chronic conditions such as high cholesterol, arthritis, epilepsy and cancer. Johnson & Johnson, Sanofi, Pfizer, AstraZeneca, Novartis, Otsuka and many others have all gutted their antibiotic development teams and moved those budgets elsewhere. This is despite a 2016 pledge signed by over 100 companies, including Johnson & Johnson and Novartis, saying they would help prevent the next epidemic by investing in ways to combat the rise of antibiotic-resistant superbugs.”

Stories You May Have Missed:

  • Rising Cases of EEE in Massachusetts – “Eastern equine encephalitis (EEE) virus—a rare but often fatal mosquito-borne virus—has been found in Massachusetts for the first time since 2013. Since the beginning of August, seven people in the state have tested positive for the virus, and one woman from Bristol County has died from the illness. State officials have additionally found the virus in 400 mosquito samples.”
  • The Future of Duodenoscopes – “Over the years, these scopes have shown a propensity for making the transmission of multidrug-resistant organisms easier than we anticipated. There continues to be a strong infection control and regulatory focus on reprocessing to ensure patient safety. The flexible medical devices are used to help visualize and assess not only the small intestine, but also the pancreas and bile ducts. Since they products are reusable, the complex, error-prone process of reprocessing becomes critical to avoid disease transmission between patients. Unsurprisingly, there has been increased pressure to move to avenues that reduce the risk for patient exposure and promote safety during these procedures. On August 29, 2019, the US Food and Drug Administration (FDA) put forth a recommendation that both duodenoscope manufacturers and health care facilities alike, should move towards those scopes with disposable components, specifically the endcaps.”

 

Pandora Report: 8.30.2019

Alumna Spotlight: Biodefense Grad Tam Dang, Dallas County Epidemiologist
“Tam Dang started in the biology world, earning her Bachelor’s of Science degree from George Mason University in 2008. But it was her course of study in the Master’s in Biodefense program at the Schar School that put her on her present career path. The degree, she said, ‘introduced me to the public health field, and offered a unique perspective from a biosecurity and bioterrorism standpoint.’ Today, Dang is an epidemiologist for the Dallas County Department of Health and Human Services in Dallas, Texas. She works in the Acute Communicable Disease Epidemiology Division, helping to lead epidemiological investigations for infectious disease outbreaks or potential bioterrorism events. She monitors local, regional, and state data sources related to infectious diseases, and helps develop outbreak and bioterrorism plans to help support public health preparedness. Her work is at the intersection of public health and health security, an important field in the modern era.”

BioWatch Data Stored on Vulnerable Contractor Website for Years
Well that’s a big oops… “For more than a decade, the Department of Homeland Security failed to properly secure sensitive information on the primary BioWatch information portal, which contained bioterrorism surveillance testing information and response plans that would be put in place in the event of an attack. In August 2016, Harry Jackson, who worked for a branch of Homeland Security that deals with information security, was assigned to the BioWatch program. Three months later, he learned about biowatchportal.org and demanded the agency stop using it, arguing that it housed classified information and that the portal’s security measures were inadequate. A security audit completed in January 2017 found ‘critical’ and ‘high risk’ vulnerabilities, including weak encryption that made the website ‘extremely prone’ to online attacks. Internal Homeland Security emails and other documents reviewed by the Los Angeles Times show the security issue set off a bitter clash within the department over whether keeping the information on the dot-org website run by Logistics Management Institute posed a threat to national security.”

Oversight of Lab-Created Potential Pandemic Pathogens and the BWC
Lynn C. Klotz discusses accidental releases and research with pathogens of pandemic potential in relation to the Biological Weapons Convention. “Seeding a pandemic is not a problem for future consideration; the possibility is upon us now. There is an urgent need for international oversight and regulation of this research. The countries that are party to the Biological Weapons Convention  (BWC) may not believe it to be within the BWC mandate to oversee academic research whose goal is public health. But if the parties decide this kind of oversight is within the BWC mandate (under Article XII), guidelines and regulations could be enacted fairly quickly. At the very least, the parties could act as a catalyst, launching discussions toward a new international treaty on oversight and regulation of this dangerous research. In the meantime, since enacting new treaties is an uncertain and long process, the BWC parties should work to pass legislation in their nations.” Klotz breaks down if such a release could result in a pandemic and if those pathogens could be classified as a biological weapon. “For lab-created potentially pandemic pathogens, any quantity, however small, could seed an outbreak or pandemic. In this circumstance, development also implies production and stockpiling, since a single vial of infectious agent and one to a few infected individuals are all that is necessary to launch an attack. From a military tactical point of view, however, lab-created pandemic pathogens would not be good biological weapons; they would boomerang back on the attackers since they are highly transmissible. Nonetheless, a suicidal terrorist group or a desperate country might employ them as a last resort, or threaten to employ them as a means of extortion.” Klotz ultimately notes that there is a need for action from the parties of the BWC – “Hopefully, the states that are party to the BWC will set in motion a process for overseeing relevant new research and technologies. If they decide that lab-created potentially pandemic pathogens are within the BWC mandate under Article XII, they could speed up the enactment of guidelines and regulations.”

Data Collection Gaps Are Damning the Ebola Outbreak
The outbreak in the DRC is continuing to spread as 14 new cases were reported on Wednesday and the South Kivu cluster has grown by 5, bringing the outbreak closer to 3,000. GMU Biodefense PhD alum Saskia Popescu discusses the implications of the data gaps within the current Ebola outbreak in the DRC. “Late last week 2 Ebola virus disease (EVD) cases were confirmed in the South Kivu region of the Democratic Republic of the Congo (DRC), some 400 miles away from where the outbreak first began. The cases were reported in a woman, who had been vaccinated, and her child who had traveled from Beni. The government is currently working to vaccinate and monitor 120 contacts of these 2 individuals. In the face of this expanding outbreak that has surpassed 2700 confirmed cases, there has been much attention on the drug and vaccine trials that are ongoing. Unfortunately, in the fervor of excitement surrounding the promise of treatment, few have paid attention to the quality of data that is made available. Pierre Rollin, MD, a veteran Ebola fighter, recently drew attention to some deeply concerning issues in the outbreak response in an article in The Lancet Infectious Diseases. Rollin underscored that although there was initial confidence in the response to the outbreak, mostly due to therapeutics and experienced personnel, leadership and coordination failures amid a conflict zone and community mistrust all helped the outbreak spiral. One component of Rollin’s review is deeply concerning—the ‘ineffectiveness of the collection, analysis, and diffusion of epidemiological data, the centerpiece of any response, is predictive of the situation worsening.’ Similar to what was felt by many on the ground during the 2014-2016 West African Ebola outbreak, the various databases between agencies, groups, etc., all made situational awareness and response that much more challenging.”

How Does USAMRIID’s Shutdown Impact US Biodefense and Bioterrorism Laboratory Response Network?
“The Laboratory Response Network (LRN) is a collaborative federal effort run by the U.S. Centers for Disease Control and Prevention in cooperation with other federal agency and public health partners. Most state public health laboratories participate as reference laboratories of the LRN. These facilities support hundreds of sentinel laboratories in local communities throughout the U.S. and its territories, providing confirmatory diagnosis and typing of biological threats used in a bioterrorist attack or causing a public health emergency. The U.S. Army Research Institute of Infectious Diseases (USAMRIID) Special Pathogens Laboratory at Fort Detrick is one of only three National Laboratories at the top of the protective umbrella of the LRN structure, along with those operated by the CDC and the Naval Medical Research Center (NMRC), responsible for specialized characterization of organisms, bioforensics, select agent activity, and handling highly infectious biological agents. It begs the question then, what happens when an important component of the nation’s biopreparedness infrastructure fails to meet CDC biosafety requirements and has its Federal Select Agent certification pulledGlobal Biodefense submitted requests to USAMRIID and the CDC on Aug. 6 for information on the status of the Institute in the LRN structure and whether another Biosafety Level-4 laboratory will be designated as an interim substitute National Laboratory.”

Identifying and Responding to Newly Resistant Infections
“In the world of growing antimicrobial resistance, the identification of patients with highly resistant (or newly resistant) infections is critical. Because this is an emerging challenge, national and international surveillance efforts are still being strengthened to tackle all the avenues that contribute to antimicrobial resistance. The frontline identification of these newly resistant infections is critical though and surveillance is not only the first step in identifying and understanding the problem, but it also allows us to properly isolate the patient to avoid further transmission. Bacteria like Klebsiella pneumoniae are increasingly developing resistance to antimicrobials and can easily be spread through health care facilities. Klebsiella bacteria are also showing a relatively new resistance to the carbapenem class of antibiotics. Typically, these bacteria cause infections like pneumonia, bloodstream infections, wound or surgical site infections, and even urinary tract. A recent publication in the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) described experiences surrounding the identification of a Klebsiella pneumoniae isolate that had 3 carbapenem-resistant genes (CR-Kp) and was related to urinary procedures.”

NTI’s Educational Resources
Whether you’re a student or an educator, you’ll love these resources from NTI’s Education Center. “You’ll find teaching tools, such as the new Building Security Through Cooperation report about working with North Korea on denuclearization and Middle East Missile Mania, our new comprehensive interactive map and analysis detailing the history of missile programs in 12 countries across the Middle East. Do you want to know more about what’s making headlines but only have a few minutes to catch up? We have a new U.S.-Russian arms control infographic and a one-page fact sheet on the INF Treaty. You may also want to watch our 3-minute video about the importance of the New START treaty. Those wanting a deeper dive for their advanced classes might want to check out our updated Global Incidents and Trafficking database, which tracks global incidents involving nuclear or other radioactive material, or the North Korea Missile Test Database.”

Stories You May Have Missed:

  • Outbreak of Resistant Salmonella Newport Tied to Soft Cheese-“The Centers for Disease Control and Prevention (CDC) today detailed an unusual 255-case outbreak of Salmonella Newport infections in 32 states tied to both beef and soft cheese and showing resistance to multiple antibiotics. ‘Infections were linked to beef obtained in the United States and soft cheese obtained in Mexico, suggesting that this strain could be present in cattle in both countries,’ the CDC said in an overview emailed to physicians as part of its Clinician Outreach and Communication Activity (COCA) efforts.

Pandora Report: 8.23.2019

Welcome to your favorite source for biodefense nerdom! We hope your week was wonderful and you’re ready for a dose of health security news…

STEM: An Open Source Tool for Disease Modeling
Have you been looking for a good epidemiological modeling software? Lucky for you, there’s STEM (Spatiotemporal Epidemiologic Modeler) and one of GMU’s very own biodefense doctoral alums, Nereyda Sevilla, was part of a team who published on how great this software is. “The Spatiotemporal Epidemiologic Modeler (STEM) is an open source software project supported by the Eclipse Foundation and used by a global community of researchers and public health officials working to track and, when possible, control outbreaks of infectious disease in human and animal populations. STEM is not a model or a tool designed for a specific disease; it is a flexible, modular framework supporting exchange and integration of community models, reusable plug-in components, and denominator data, available to researchers worldwide at www.eclipse.org/stem. A review of multiple projects illustrates its capabilities. STEM has been used to study variations in transmission of seasonal influenza in Israel by strains; evaluate social distancing measures taken to curb the H1N1 epidemic in Mexico City; study measles outbreaks in part of London and inform local policy on immunization; and gain insights into H7N9 avian influenza transmission in China. A multistrain dengue fever model explored the roles of the mosquito vector, cross-strain immunity, and antibody response in the frequency of dengue outbreaks. STEM has also been used to study the impact of variations in climate on malaria incidence. During the Ebola epidemic, a weekly conference call supported the global modeling community; subsequent work modeled the impact of behavioral change and tested disease reintroduction via animal reservoirs. Work in Germany tracked salmonella in pork from farm to fork; and a recent doctoral dissertation used the air travel feature to compare the potential threats posed by weaponizing infectious diseases. Current projects include work in Great Britain to evaluate control strategies for parasitic disease in sheep, and in Germany and Hungary, to validate the model and inform policy decisions for African swine fever. STEM Version 4.0.0, released in early 2019, includes tools used in these projects and updates technical aspects of the framework to ease its use and re-use.”

GMU Biodefense Fall Courses – Are You Registered?
The start of the Fall semester is just around the corner and if you’re a GMU biodefense graduate student, you’ve got a great menu of courses this term. There are still open spots in three courses – Global Health Security Policy taught by Ashley Grant (lead biotechnologist at the MITRE Corporation and previously the Senior Biological Scientist at the Government Accountability Office where she led government-wide technical performance audits focused on biosafety and biosecurity issues), Nonproliferation and Arms Control with Richard Cupitt (Senior Associate and Director of the Partnerships in Proliferation Prevention program at Stimson and prior to joining Stimson, he served as the Special Coordinator for U.N. Security Council resolution 1540 in the Office of Counterproliferation Initiatives at the U.S. State Department from 2012 through 2016.), and Biosurveillance with Andrew Kilianski (GMU professor and CINO for the Joint Program Executive Office for Chemical, Biological, Radiological, and Nuclear Defense JPEO-CBRND). These are just a handful of the classes but since there are a few spots left in each, now is your change to grab a seat!

GMU Biodefense MS and PhD Open Houses
Have you been considering investing in your education and career through a graduate degree in biodefense? Check out one of our Schar School Open Houses to get a feel for what the MS and PhD programs are like – you can chat with faculty, students, and learn more about the coursework and application process. The Master’s Open House will be at 6:30pm on Thursday, September 12th, and the PhD Open House will be at 7pm on Thursday, September 19th – both will be held at our Arlington campus in Van Metre Hall.

Ebola Outbreak – New Cases in Remote Areas 
Late last week two remote regions in the DRC reported cases of Ebola virus disease – North and South Kivu, of which there hadn’t been cases for several incubation periods. Moreover, there were 27 cases reported over 3 days, bringing the outbreak closer to 2,900. “According to Reuters, DRC officials today confirmed a new case of Ebola in the remote, militia-controlled territory of Walikale, which is 95 miles northwest of Goma. Goma recorded four cases of Ebola in the last 6 weeks, and it is unclear if the case in Walikale had any contact with other Ebola patients. Reuters also reported the DRC confirmed a third case in South Kivu region, which reported its first case late last week. South Kivu is more than 430 miles from the outbreak’s epicenter. The first cases in South Kivu were a mother and child who were likely exposed in Beni. For almost a year, the DRC’s Ebola outbreak—the second largest in history—was contained to North Kivu and Ituri provinces along the country’s eastern border.” Unfortunately, there has also been transmission within healthcare facilities where patients are being treated, as infection control is increasingly a challenge. “The World Health Organization (WHO) said today the third case of Ebola identified in South Kivu province was in a patient who contracted the virus at a health center where other Ebola patients had been treated. The details on the nosocomial transmission emerged in the WHO’s latest situation report on the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC). In the past week, two more DRC regions far from outbreak hot spots have reported cases: South Kivu province and Pinga health zone, which is in North Kivu province. The WHO is still investigating how the case-patient in Pinga contracted the virus, but investigations have shown a mother and child in Mwenga, South Kivu, became infected after contact with a patient from Beni, the city most hard hit by the outbreak this summer. The two towns are about 473 miles apart, and South Kivu province shares a border with Rwanda and Burundi.” The Department of Health and Human Services (HHS) is helping via $23 million funding towards Merck’s Ebola vaccine production. The WHO also just released their list of eight lessons being applied to the DRC outbreak in a “Ebola then and now” segment. This list includes things like putting research at the heart of response and supporting survivors.

Syria: Anniversary of the Ghouta Chemical Weapons Attack
The U.S. State Department recently released a statement on the attack that occurred six years ago. “On August 21, 2013, the Assad regime launched a horrific chemical attack with the nerve agent sarin on the Ghouta district in Damascus – killing more than 1,400 Syrians, many of them children. On this solemn anniversary we remember the numerous lives lost to the Assad regime’s use of chemical weapons.  We reiterate our resolve to prevent further use of these deadly weapons and to hold the Assad regime accountable for these heinous crimes. The regime’s barbaric history of using chemical weapons against its own people cannot and will not be forgotten or tolerated. Assad and others in his regime who believe they can continue using chemical weapons with impunity are mistaken.  The United States remains determined to hold the Assad regime accountable for these heinous acts and will continue to pursue all efforts alongside partner countries to ensure that those involved in chemical attacks face serious consequences.  We will continue to leverage all of the tools available to us to prevent any future use. We condemn in the strongest possible terms the use of chemical weapons anywhere, by anyone, under any circumstances.”

Stories You May Have Missed:

  • Packed Dorms Help MERS Transmission – Crowded living spaces and a high stress environment encouraged the transmission of a respiratory virus? Shocker… “New findings from an investigation into a large MERS-CoV cluster in a women’s dormitory revealed that crowded living conditions can lead to higher attack rates and hints that even healthcare workers who don’t directly care for patients can play a role in disease spread. In other developments, Saudi Arabia reported one new MERS-CoV (Middle East respiratory syndrome coronavirus) case.”
  • NIH Study to Offer Genetic Counseling – “A US government study that aims to sequence the genomes of one million volunteers will partner with a genetic-counselling company to help participants understand their results. It will be the largest US government study to provide such a service. The National Institutes of Health (NIH) is leading the project, called All of Us. And on 21 August, the agency announced the award of a US$4.6-million, 5-year grant to Color. The firm, in Burlingame, California, will counsel every study participant with a genetic variant that could have serious health implications — such as BRCA mutations associated with breast cancer — when they receive their results. Color will also develop educational materials for all study participants, and will offer telephone consultations to anyone who wishes to discuss their results with a counsellor.”

 

Pandora Report: 8.16.2019

 Pandemic Bonds – Designed to Fail Ebola 
Is the World Bank’s funding approach to outbreak response hurting the DRC during their fight against Ebola? Olga Jones discusses how the Pandemic Emergency Financing Facility (PEF) works and how it is ultimately helping investors but not health security. “The World Bank has said that the PEF is working as intended by offering the potential of ‘surge’ financing. Tragically, current triggers guarantee that payouts will be too little because they kick in only after outbreaks grow large. What’s more, fanfare around the PEF might have encouraged complacency that actually increased pandemic risk. Following false assurance that the World Bank had a solution, resources and attention could shift elsewhere. Rather than a lack of funds, vigilance and public-health capacity have been the main deficiencies. When governments and the World Bank are prepared to respond to infectious-disease threats, money flows within days. In the 2009 H1N1 influenza outbreak in Mexico, clinics could diagnose and report cases of disease to a central authority that both recognized the threat and reacted rapidly. The Mexican government requested $25.6 million from an existing World Bank-financed project for influenza response and received the funds the next day.” Jones notes that “the best investment of funds and attention is in ensuring adequate and stable financing for core public-health capacities. The PEF has failed. It should end early — and IDA funds should go to poor countries, not investors.”

Maximizing Opportunities for US Bioeconomy Growth and National Security with Biology
“Recently, the Johns Hopkins Center for Health Security and Gingko Bioworks convened key science, technical, academic, and industry experts for a meeting to solicit stakeholder input on specific ways that national policy can strengthen the US bioeconomy. Their recommendations are synthesized in a summary report, released today. Participants considered the benefits to the US if its bioeconomy were to be expanded; examined the current health of the US bioeconomy; discussed existing US government programs, policies, and initiatives related to the bioeconomy; and identified priorities for strengthening the US bioeconomy.”

DRC Ebola Outbreak Updates
Beni and Madnima continue to be hotspots for the disease as they have accounted for 60% of recent cases, not to mention ongoing violence and unrest. “The security situation increased in volatility as a result of a surge in attacks from suspected ADF elements in Beni Health Zone and successive demonstrations,” the WHO said. “A recent attack in Mbau on the Beni/Oicha axis led to the deaths of six civilians, including a prominent civil society leader. EVD operations in the area were temporarily suspended with resumption pending improvement in the security situation.” On a more positive note, two outbreak treatment trials are showing promise. “An independent monitoring board meets periodically to review safety and efficacy data, and at their Aug 9 review recommended that the study be stopped and all future patients be randomized to receive either Regeneron, an antibody cocktail, or mAB 114, an antibody treatment developed from a human survivor of the virus. The other two drugs involved in the original trial were zMapp, which in an earlier trial didn’t show  statistically significant efficacy but performed better than standard care alone, and Remdesivir, an antiviral drug. Earlier in the outbreak, an ethics committee in the DRC approved the four experimental treatments for compassionate use, and patients at all of the country’s Ebola treatment centers have had access to them, along with safety monitoring. However, the formal clinical trial has been under way since November at four treatment centers with the help of the Alliance for International Medical Action (ALIMA), the International Medical Corps (IMC), and Doctors Without Borders (MSF). At a media telebriefing today, Anthony Fauci, MD, director of the National institute of Allergy and Infectious Diseases (NIAID), said Regeneron was the drug that crossed the efficacy threshold, triggering a pause in the study. And he said the group recommended proceeding with mAb 114, because there were only small differences in the data between the two drugs.”

Combatting Legionella and Carbon Footprints
Can we reduce the burden of Legionnaire’s disease while reducing our carbon footprint? GMU Biodefense PhD student and infection preventionist Saskia Popescu discusses a new strategy to preventing this water-based bug. “Typical health care control methods range from routine sampling to temperature control measures, like keeping cold water below 20°C and hot water at a minimum of 60°C. This has been the tried and true approach to Legionella control since there will always be some small level of the bacteria in water and the ultimate goal is to avoid growth that can cause human disease. Investigators in the United Kingdom recently published a study assessing a large health care facility’s approach to reducing Legionella risk through use of copper and silver ionization at hot water temperatures that were deliberately reduced to 43°C within a new water system. The research team collected 1589 water samples between September 2011 and June 2017, looking for not only Legionella bacteria, but also copper and silver ion levels, and total viable counts. To also assess the internal costs and function of this system, investigators collected data on energy consumption and water usage.”

2015 HPAI Outbreaks in the US – Insight Into Airborne Transmission 
“The unprecedented 2015 outbreaks of highly pathogenic avian influenza (HPAI) H5N2 in the U.S. devastated its poultry industry and resulted in over $3 billion economic impacts. Today HPAI continues eroding poultry operations and disrupting animal protein supply chains around the world. Anecdotal evidence in 2015 suggested that in some cases the AI virus was aerially introduced into poultry houses, as abnormal bird mortality started near air inlets of the infected houses. This study modeled air movement trajectories and virus concentrations that were used to assess the probability or risk of airborne transmission for the 77 HPAI cases in Iowa. The results show that majority of the positive cases in Iowa might have received airborne virus, carried by fine particulate matter, from infected farms within the state (i.e., intrastate) and infected farms from the neighboring states (i.e., interstate). The modeled airborne virus concentrations at the Iowa recipient sites never exceeded the minimal infective doses for poultry; however, the continuous exposure might have increased airborne infection risks. In the worst-case scenario (i.e., maximum virus shedding rate, highest emission rate, and longest half-life), 33 Iowa cases had > 10% (three cases > 50%) infection probability, indicating a medium to high risk of airborne transmission for these cases. Probability of airborne HPAI infection could be affected by farm type, flock size, and distance to previously infected farms; and more importantly, it can be markedly reduced by swift depopulation and inlet air filtration.”

Serbia Suspects African Swine Fever – Implications for Imports 
One Health in a nutshell – the economic implications of zoonotic diseases like African swine fever (ASF). “Serbia has reported four suspected outbreaks of African swine fever among backyard pigs, the Paris-based World Organisation for Animal Health (OIE) said on Monday, prompting neighbouring countries to ban imports of the animals. Three of the cases were detected in the Belgrade area and one in the district of Podunavski, the OIE said, citing a report from Serbia’s Agriculture Ministry. The suspected cases of the disease killed seven pigs while another 114 were slaughtered, the report showed. Bosnia, Montenegro and North Macedonia banned imports of pigs, wild boar and related products from Serbia to prevent the spread of the outbreak, the countries’ veterinary authorities said.”

A New Drug to Tackle Extensively Drug-Resistant TB
XDR-TB is a disease that causes significant health issues on a global scale and the effort to try and treat can be costly. A “new drug, pretomanid, has been approved by the US Food and Drug Administration (FDA) for use in a treatment for XDR-TB. Amazingly, it’s the first time that a treatment for XDR-TB infections has been recognized for actually working—no other treatment has demonstrated any consistent effectiveness. Up until now, people with XDR-TB had to suffer through up to two years or more of toxic treatment that worked only one third of the time. Today’s news means that treatment time is drastically reduced—to six months—while the effectiveness of treatment is significantly improved. We welcome this approval as it shows the real-world impact of US government investment in finding new cures and vaccines for the world’s deadliest diseases. The developer of pretomanid, the nonprofit organization TB Alliance, could not have succeeded in advancing this breakthrough without support from the American people, through the US Agency for International Development (USAID) and National Institutes of Health (NIH).”

Stories You May Have Missed:

  • Mega Malaria Vaccine Test Postponed in Kenya – “Kenya has postponed a large-scale pilot test for a malaria vaccine that could reduce the burden of the disease. The World Health Organisation (WHO) chose Malawi, Ghana and Kenya to vaccinate 360,000 children per year; and while the two nations began the rollout in April, Kenya is yet to start. The introduction in Kenya, planned for this Thursday, was postponed by the Ministry of Health. ‘I regret to inform you that the stakeholders breakfast meeting planned for this Tuesday, August 13, and the launch planned for Thursday, August 15, have been postponed to a later date to be communicated to you shortly. This is due to the upcoming Health Summit scheduled on August 14 and 15,’ head of the National Vaccines and Immunisation Programme, Dr Collins Tabu, said.”

Pandora Report: 8.9.2019

From Legionella to the BWC, we’re the spot for all things biodefense. Did you know that China recently approved an ethics advisory group after the CRISPR-babies scandal? Welcome to your weekly dose of global health security news!

Launch of the 2019 Next Generation Biosecurity Competition
Are you a global health security and biosecurity student or professional? “NTI | bio is partnering with the Next Generation Global Health Security (GHS) Network to advance the biosecurity and biosafety-related targets of the Global Health Security Agenda (GHSA). Together, we are launching the third annual joint competition to foster a biosecurity professional track within the Next Generation GHS Network. The 2019 competition will spur next generation experts in health security to discuss catalytic actions that can be taken to reduce biological risks associated with advances in technology and promote biosecurity norms. For the 2019 Next Generation for Biosecurity Competition, we will publish creative and innovative papers that promote regional, multi-sectoral, and global collaboration.  Each team can include up to three people and should: 1) explore concrete collaborative actions that can be taken to build national, regional, and global norms for preventing deliberate and/or accidental biological events; and 2) promote cross-sectoral and cross-regional partnerships to advance biosecurity and biosafety. Papers should directly address the biosecurity targets included within the World Health Organization Joint External Evaluation and the GHSA Action Package on Biosecurity and Biosafety (APP3).” If you’re a GMU biodefense student or alum – you’re in luck as we’ve got a Next Generation Global Health Security Network chapter (membership is a requirement for the competition).

CSIS- Federal Funding for Biosafety Research is Critically Needed
The Center for Strategic & International Studies (CSIS) has just released their report on why we desperately need to provide funding for biosafety research in the face of new biotech and emerging infectious disease threats. “Currently, we lack the evidence basis to take new, needed measures to prevent accidents in biological laboratories, which, as mankind continues to expand its capabilities to manipulate life (including the viruses and bacteria that cause disease), leaves us more vulnerable to the accidental initiation of disease outbreaks with potentially dangerous consequences locally, regionally, and beyond. New biotechnologies are enabling scientists to design or modify life in ways not previously possible. These biotechnologies enable professional and amateur researchers to use simple life forms (e.g., bacteria and yeast) to create simple sensors and produce industrial chemicals, materials, and pharmaceuticals cheaply and from commonplace reagents. The manipulation of pathogens (the microbes that cause disease) fosters a better understanding of how these agents evolve and interact with the body, enabling the development of next generation cures. Despite the significant U.S. and global investment in biotechnology, concern has been voiced by scientists, policy experts, and members of the community  that scientists may be ill-equipped to handle novel, manipulated microbes safely, potentially resulting in accidental infection of themselves or their local communities, accidental release into the environment, or even the initiation of a global pandemic.”

Biological Weapons Convention Meeting of Experts – Updates and Deciding on Emergency Assistance in Cases of Bioweapons Use
If you’ve been missing the MXs, Richard Guthrie has you covered with his daily accounts of these meetings and events. Thursday was the closing day of MX4 and focused on the financial situation. “The Chair of the 2019 Meeting of States Parties (MSP), Ambassador Yann Hwang (France), held informal consultations with delegates from states parties to discuss the financial situation for the BWC which remains difficult. Non- payments of agreed assessments by a number of states parties continue to cause problems. While some of these eventually appear as late payments, the ongoing deficit is sufficiently large to put the MSP at risk. As the financial accounting period is the calendar year, the MSP at the end of the year is always going to be the most vulnerable activity if there is a financial shortfall. In 2018, some economies were made on the MSP by having one informal day of activities without interpretation, putting a number of delegates at a disadvantage. The government of France has a clearly stated position on multilingualism within multilateralism and so the MSP Chair would be extremely reluctant to implement a similar route to financial savings. The Working Capital Fund established by the 2018 MSP is specifically designed not to subsidise non-payment, but to smooth out cash flow during the year. Depleting the fund — which is not even close to its target value – in its first year to cover the costs of the MSP would render it useless for purposes of supporting core activities such as the ISU. There are also financial implications of decisions that will need to be taken in relation to the Ninth Review Conference to be held in 2021.” Dr. Jean Pascal Zanders was also in attendance and has reported out on discussions surrounding Article VII – “Being one of the more obscure provisions in the BTWC, Article VII only attracted state party attention over the past ten years or so. In follow-up to the decision of the 7th Review Conference (2011), parties to the convention looked for the first time more closely at the provision during the August 2014 Meeting of Experts (MX). As it happened, the gathering coincided with the expanding Ebola crisis in West Africa. The epidemic gave urgency to the concrete implementation of Article VII. The daily images of victims and fully protected medical staff broadcast around the world left lasting impressions of how a biological attack from another state or terrorist entity might affect societies anywhere. Operationalising Article VII has proven more complex than anticipated. The provision comprises several clauses that fit ill together upon closer inspection and hence obscure its originally intended goals. In addition, it contains no instructions about how a state party should trigger it or the global community respond after its invocation.”

CSIS Commission on Strengthening America’s Health Security Meeting
“On June 26, 2019, the CSIS Commission on Strengthening America’s Health Security convened for the third time since its launch in April 2018. The Commission’s core aim is to chart a dynamic and concrete vision for the future of U.S. leadership in global health security—at home and abroad.” “On June 26, Commission members—a diverse group of high-level opinion leaders who bridge security and health and the public and private sectors, including six members of Congress—met to discuss a proposed U.S. doctrine for global health security. Commission members deliberated and reached a broad consensus endorsing a doctrine of continuous prevention, protection, and resilience, which would protect the American people from the most pressing global health security threats we face today. The measures outlined in the paper are affordable, proven, and draw support from across the political spectrum. The time to act is now.” Participants called for Congress and the administration to take action across seven areas, including ensuring full and sustained, multi-year funding for the GHSA, ensuring ample and quick-disbursing finances, establishing a global health crises response corps, etc.

Combatting AMR Through Payment Shifts
In the battle against the resistant bug, sometimes you have to change tactics and bring in the big guns – like the Centers for Medicare and Medicaid Services (CMS). Developing antimicrobials has been a particular challenge, despite efforts to push and pull research and development. BARDA Director Rick A. Bright recently discussed this problem, but now a new CMS rule could help guide change. “Without payment reform, the antimicrobials marketplace will not survive. CMS Administrator Seema Verma understands this reality and the necessity for a strong marketplace for both public health and national security purposes. On Friday, August 2, CMS issued its fiscal year (FY) 2020 Hospital Inpatient Prospective Payment System (IPPS) Final Rule. Among other changes to the way CMS pays for Medicare services, CMS recognized the need for greater payment of newer, potentially safer and more effective antimicrobial drugs. The new rule will (1) change the severity level designation for multiple ICD-10 codes for antimicrobial drug resistance from ‘non-CC’ to ‘CC’ (which stands for complications or comorbidities) to increase payments to hospitals due to the added clinical complexity of treating patients with drug-resistant infections, (2) create an alternative pathway for the new technology add-on payment (NTAP) for qualified infectious disease products (QIDPs), under which these drugs would not have to meet the substantial clinical improvement criterion, and (3) increase the NTAP for QIDPs from 50 percent to 75 percent. This final rule lessens economic incentives to utilize older antimicrobial drugs such as colistin, and shift medical practice to employ more appropriate, newer generation antimicrobials. Payment more closely aligned with the value of these lifesaving medicines will shift the current market realities of these drugs for companies, investors, and patients. No single action will solve the antimicrobial resistance problem; however CMS’ efforts undoubtedly can improve the marketplace and re-catalyze innovation in basic science discovery, and research and development efforts. We appreciate and congratulate Administrator Verma for taking such bold leadership in this fight. ”

Ebola in the DRC
The latest WHO dashboard is showing that the outbreak has reached 2,787 cases. Seven cases were reported from the DRC ministry of health earlier this week and there is growing concern about the impact the outbreak is having on children in the area. “Last December UNICEF sounded the alarm about the high number of children infected in the outbreak, noting that one of every third people confirmed infected in the DRC’s outbreak was a child, unusual for Ebola epidemics. The agency noted that 1 in 10 children were under age 5 and that kids were more likely to die from the disease than adults. Save the Children said in its statement yesterday that around 737 children have been infected with Ebola in the DRC’s outbreak. And based on the latest numbers, the impact on kids has increased. In the first 6 months of the outbreak, which was declared on Aug 1, 2018, just under 100 deaths in children had been reported. However, in the 6 months that followed, over four times as many have died. Heather Kerr, Save the Children’s country director in the DRC, said, ‘This is another grim milestone in a crisis that is devastating children in its path, especially the youngest. Some 40% of children who have contracted the disease are under the age of five, and many of them have died.’ She also said the outbreak has had a wider impact on children because of the high overall fatality rate from the virus, with thousands losing at least one of their parents or separated from their families.”

SWP Comment- Why the Containment of Infectious Diseases Alone Is Not Enough
You can now access this commentary by Daniel Gulati and Maike Voss here, which discusses the current DRC Ebola outbreak and that in “crisis situations like these, the interdependencies between health and security are highly complex. Which population groups and which diseases are perceived as suspected health risks, and why, is a normative question for donor countries. It has political consequences above all for affected developing countries. Where health and security are common goals, it is not enough to contain infectious diseases in developing countries. Instead, resilient, well-functioning, and accessible health systems must be established. This fosters the implementation of the human right to health, creates trust in state structures, and takes into account the security interests of other states. In the United Nations (UN) Security Council, the German government could advocate for policies based on the narrative ‘stability through health’.” 

Stories You May Have Missed:

  • MERS and Healthcare Transmission– “Since its last update in June 2018, 219 cases were reported in four countries: Saudi Arabia (204), Oman (13), South Korea (1), and the United Kingdom (1). However, of the 97 secondary cases reported to the WHO, 52 were linked to transmission in hospitals, including 23 infections in healthcare workers. Since the virus was first detected in humans in 2012, 2,449 cases have been reported through Jun 30, 84% of them in Saudi Arabia. The virus is known to spread more easily in healthcare settings, and research is under way to better understand the factors that drive transmission. The WHO said awareness of the disease is still low, and the nonspecific early symptoms can make it difficult to identify cases. Gaps in infection prevention and control measures also contribute to disease spread. ‘Much more emphasis on improving standard IPC [infection prevention and control] practices in all health care facilities is required,’ the WHO said.”
  • Managing Measles: A Guide to Preventing Transmission in Health Care Setting– “Perhaps one of the most challenging aspects of this outbreak from a health care perspective is preparation. Although some may not consider this to be a concern, between 2001-2014, 6% of US measles cases (that were not imported) were transmitted within a health care setting. Sadly, I experienced this firsthand during a 2015 exposure at the health care facility I worked at, in which a health care worker was exposed to the virus while treating a patient and subsequently became infected. As a result of the health care worker’s infection, 380 individuals were exposed and the response efforts were extensive and significantly disruptive to the daily infection prevention duties. Due to the fact that hospitals can easily act as amplifiers for airborne diseases like measles, the CDC has provided interim infection prevention and control recommendations for measles in health care settings. At its core, this guidance focuses on health aspects of both the employee and the patient. For health workers, it is critical to ensure presumptive evidence of immunity to measles and manage exposed/ill health care workers properly. On the patient side, rapid identification and isolation of known or suspected cases and proper isolation maintenance is critical. “

Pandora Report: 8.2.2019

Greetings fellow biodefense friends! We hope your summer is winding down nicely and you’re ready for your weekly dose of all things health security. You might want to avoid pig ear dog treats as there’s currently an outbreak of multi-drug resistant Salmonella infections.

 Bioweapons Convention – Meeting of Experts
The BWC Meeting of Experts (MX) is currently under way and you can get detailed, daily reports via Richard Guthrie’s BioWeapons Prevention Project, which has been covering the BWC since 2006. Guthrie notes “The first Meeting of Experts (MX1) in the 2019 series opened on Monday morning with Ambassador Victor Dolidze (Georgia) in the Chair. Owing to refurbishment work in the Palais des Nations, MX1 opened in Room XX [renowned for its elaborately decorated ceiling] instead of the usual location for BWC meetings two floors below. One advantage of using Room XX is that the proceedings can be webcast via <<http://webtv.un.org/>&gt; After brief opening formalities, six sub-topics were covered during Monday, the full titles of which can be found in the agenda for MX1. There was a full day of activities which means that this report can only be a selective snapshot of proceedings. The background information document produced by the Implementation Support Unit (ISU) for the MX1 held in 2018 contains much information relevant to the discussions this year.” You can also find the Joint NGO Statements that were given here. “In her reflections on last year’s MX1, the Chair, Ambassador Almojuela of the Philippines, suggested several concrete proposals for further consideration at today’s meeting. These included: An action plan for Article X implementation; Guidelines on Article X reports; The creation of a BWC Cooperation and Assistance Officer position within the ISU; and An open-ended working group to monitor, coordinate and review activities of cooperation and assistance. These are all proposals that the NGO community strongly endorses, and which were also set out in our Position Paper last year. Ambassador Almojuela also proposed to further collaboration with INTERPOL, OIE and WHO; we would also wish to draw attention to the importance of further collaboration with non-governmental entities. We would also urge States Parties to facilitate regional S&T dialogues that are focused on regional BWC-related interests and problems, and that draw in regional and international expertise to share information and stimulate collaboration and cooperation.”

DRC Ebola Outbreak 
The outbreak has now hit the one year mark and it continues to worsen – with 41 new cases reported since the end of last week. “According to the World Health Organization’s (WHO’s) online Ebola dashboard, the outbreak total now stands at 2,671 cases. The dashboard also recorded a total of 1,782 deaths, an increase in 20 fatalities over the weekend. So far the DRC president’s office, which last week shifted outbreak response activities to its technical group, has not issued any detailed daily updates following the resignation of the country’s health minister.” A day later, the second case of Ebola was identified in the city of Goma. “Reports from DRC journalists and international media outlets said the case was announced at a media briefing where the head of a presidential expert committee, Jean Jacques Muyembe Tamfum, PhD, shared details about the development. The country’s president put the committee in charge of outbreak management on Jul 20, prompting the DRC’s health minister to resign. The infected man, a father of 10 children, is from Mongbwalu, about 43 miles from Bunia, the capital of Ituri province, according to a Tweet from DRC journalist Cedric Ebondo Mulumb. Goma and Bunia are about 347 miles apart, with road travel taking about 13 hours.” The WHO has recently noted how “relentless” this outbreak has been since it began one year ago.

 GMU Biodefense MS and PhD Open Houses
Have you been considering adding to your education and career through a graduate degree in biodefense? Check out one of our Schar School Open Houses to get a feel for what the MS and PhD programs are like – you can chat with faculty, students, and learn more about the coursework and application process. The Master’s Open House will be at 6:30pm on Thursday, September 12th, and the PhD Open House will be at 7pm on Thursday, September 19th – both will be held at our Arlington campus in Van Metre Hall.

MERS-CoV: Novel Zoonotic Disease Outbreak a Hard Lesson for Healthcare
“Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in 2012 and since then, sporadic but continued outbreaks have been occurring within the Arabian Peninsula. There have been 2,428 cases of the coronavirus since 2012, and 838 associated deaths. Reported across 27 countries, this has been a disease that seems to have found a stronghold and established itself as endemic. MERS-CoV challenges response in that while we have diagnostic testing now, there truly is not treatment outside of supportive measures. Spread through the respiratory secretions of infected individuals, there has also been transmission via close contact (i.e. caring or living with an infected person), and ongoing investigation into the role of camels in zoonotic transmission. The disease does circulate in dromedary camels in Africa, the Middle East, and southern Asia, but cases have tended to be related to healthcare exposures and household contacts, with some camel-to-human transmission occurring. Hospitals are encouraged to ensure adherence to Standard, Contact, and Airborne isolation precautions, meaning that the patient should be placed in a negative pressure isolation room and healthcare workers should wear a gown, gloves, eye protection, and N95 respirator. Given the need for these isolation precautions, it’s not surprising that exposures often come from delays in isolation and crowded emergency rooms.”

WHO Statement on Governance and Oversight of Human Genome Editing
The World Health Organization has released the statement from this expert advisory committee held in March of this year. “At this meeting the Committee in an interim recommendation to the WHO Director-general stated that ‘it would be irresponsible at this time for anyone to proceed with clinical applications of human germline genome editing.’ WHO supports this interim recommendation and advises regulatory or ethics authorities to refrain from issuing approvals concerning requests for clinical applications for work that involves human germline genome editing. ‘Human germline genome editing poses unique and unprecedented ethical and technical challenges,’ said WHO Director-General Dr Tedros Adhanom Ghebreyesus. ‘I have accepted the interim recommendations of WHO’s Expert Advisory Committee that regulatory authorities in all countries should not allow any further work in this area until its implications have been properly considered.’ WHO’s Expert Advisory Committee continues its consideration of this matter, and will, at its forthcoming meeting in Geneva on 26-28 August 2019. evaluate, inter alia, effective governance instruments to deter and prevent irresponsible and unacceptable uses of genome edited embryos to initiate human pregnancies.”

Breaking Down Resistant Rumors and C diff Disinfectants
GMU biodefense doctoral student and infection preventionist Saskia Popescu discusses how poor communication regarding resistant organisms can cause confusion and misleading headlines. A recent study noted resistance of Clostridioides difficile to disinfectants however, “The investigators sought to treat the gowns with disinfectant to test its efficacy and whether it would help with the bioburden. The research team found that after being treated with the 1000 ppm chlorine-based disinfectant for 10 minutes, the gowns still were able to pick up and hold the C diff spores. This concern over resistance sent shockwaves and many news outlets picked up on this as an indicator of what’s on the horizon. But an issue with the study was the disinfectant that was used. First and foremost, as an infection preventionist and the first to stand on my soapbox to shout about the perils of antimicrobial resistance, I know that the efficacy of our disinfectants will eventually fail. The issue with this study is that much of the media coverage speaks broadly of a chlorine-based disinfectant and goes into little detail about what exactly what used. For my infection prevention peers, you know that not all disinfectants are alike and, well, some just weren’t designed for combatting hardier bugs like C diff. This is the playbook we live by in health care.”

 Rinderpest, Smallpox, and the Imperative of Destruction
To destroy or not to destroy…that is indeed the question. “In June, The Pirbright Institute (UK) announced that it had destroyed its final archived stocks of rinderpest, the devastating viral disease of cattle that was declared eradicated in 2011. Rinderpest is only the second infection to be eradicated from the wild. The decision raises the question once again of what to do with the remaining stocks of the first eradicated virus—smallpox. The Pirbright Institute did not hold the final stocks of rinderpest in existence; samples are also known to be stored in a handful of facilities in China, Ethiopia, France, Japan, and the USA. Still, The Pirbright Institute is the World Reference Laboratory for rinderpest, previously storing more than 3000 viral samples. That it has taken the decision to destroy them represents a bold commitment to permanently ridding the world of the disease and should encourage others to do the same. France plans to destroy its remaining stocks, and discussions continue at other facilities.” The debate surrounding the survival and destruction of smallpox stocks has been ongoing for decades – some argue the risk of accidental or intentional release is too great, while others argue that destruction would remove the potential for research…however the Pirbright Institute’s practice countered this with their “sequence and destroy” policy, which is encouraging others to push for this policy regarding smallpox. “Smallpox stocks have been earmarked for destruction since eradication of the disease in 1980. Yet, successive meetings of the World Health Assembly have postponed making a final recommendation while the threat of re-emergence from elsewhere remains. At its last meeting in September, 2018, the Advisory Committee on Variola Virus Research told WHO that live virus is still needed for the development of new antivirals, with split opinion on whether it is needed for diagnostics. Huge strides have been made in these areas in recent years. New more advanced and safer vaccines have been developed; new diagnostic tests are in development; and the first specific antiviral for smallpox—tecovirimat—was approvedby the US Food and Drug Administration in June last year, after some innovative regulatory manoeuvres. The deliberations over smallpox stocks happen regularly, but the decisions are ad-hoc. For rinderpest, destruction seems only a matter of time. Smallpox stocks will also likely be destroyed once diagnostics are finalised and a second antiviral, with a different mode of action in case of resistance, is approved (many are in development).”

Stories You May Have Missed:

  • Surge in Drug-Resistant HIV Across Africa, Asia, and the Americas – “Surveys by the World Health Organization (WHO) reveal that, in the past 4 years, 12 countries in Africa, Asia and the Americas have surpassed acceptable levels of drug resistance against two drugs that constitute the backbone of HIV treatment: efavirenz and nevirapine. People living with HIV are routinely treated with a cocktail of drugs, known as antiretroviral therapy, but the virus can mutate into a resistant form. The WHO conducted surveys from 2014 to 2018 in randomly selected clinics in 18 countries, and examined the levels of resistance in people who had started HIV treatment during that period. More than 10% of adults with the virus have developed resistance to these drugs in 12 nations (see ‘Resistance rises’). Above this threshold, it’s not considered safe to prescribe the same HIV medicines to the rest of the population, because resistance could increase. Researchers published the findings this month in WHO report.”

Pandora Report 7.19.2019

Ebola Outbreak Updates- From PHEIC Declaration to Vaccines 
On Wednesday, the WHO declared the outbreak a PHEIC (Public Health Emergency of International Concern). “‘It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,’ said Dr. Tedros. ‘Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders — coming from not just WHO but also government, partners and communities — to shoulder more of the burden.’ The declaration followed a meeting of the International Health Regulations Emergency Committee for EVD in the DRC. The Committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.” A new case of Ebola has been identified in the city of Goma, which represents what the WHO is calling “a game-changer” since the city is a major transportation hub. On July 11th, it was announced that “the Democratic Republic of the Congo (DRC) ministry of health and government officials have agreed that Merck’s rVSV-ZEBOV is the only vaccine that will be used during the current, ever-growing Ebola outbreak in North Kivu and Ituri provinces. ‘Due to the lack of sufficient scientific evidence on the efficacy and safety of other vaccines as well as the risk of confusion among the population, it was decided that no clinical vaccine trials will be allowed throughout the country,’ the ministry said in its daily update yesterday. As of yesterday, a total of 158,830 people have been vaccinated with rVSV-ZEBOV, which clinical data suggest has as high as a 97.5% effectiveness rate against the virus.”

Trump Administration Gutting WMD Detection Programs
Despite 2017 pledges to secure, eliminate, and prevent the spread of WMD and related materials, a new investigation has found that such efforts through the Department of Homeland Security, have been drastically impacted. “Among the programs gutted since 2017, however, was an elite Homeland Security ‘red team,’ whose specialists conducted dozens of drills and assessments around the country each year to help federal, state and local officials detect such potential threats as an improvised nuclear device concealed in a suitcase, or a cargo ship carrying a radiation-spewing ‘dirty bomb.’ Another Homeland Security unit, the Operations Support Directorate, had helped lead up to 20 WMD-related training exercises each year with state and local authorities. The directorate participated in less than 10 such exercises last year and even fewer so far this year, according to internal Homeland Security documents.” The Homeland Security’s National Technical Nuclear Forensics Center has also seen a hit as their leadership is out and staffing has dropped from 14 to 3. “A separate Homeland Security component, the International Cooperation Division, which worked closely with foreign counterparts and the United Nations nuclear watchdog agency to track and stop the smuggling of dangerous nuclear materials overseas, has been disbanded.” “Homeland Security also has halted work to update a formal ‘strategic, integrated’ assessment of chemical, biological and nuclear-related risks.” The investigation also notes that more than 100 scientists and policy experts who specialize in radiological and nuclear threats, have either been reassigned or pushed into jobs that are wholly unrelated to their works. ‘The changes have undermined the U.S. government’s multi-agency commitment since 2006 to build and maintain a ‘global nuclear detection architecture,’ according to the present and former officials.”

 Weaponized Ticks, Lyme Disease, and the Smith Amendment
Remember that time a conspiracy-theory book triggered an investigation into whether the DoD ever weaponized ticks? Well here we are…. Earlier this week the US House of Representatives voted on the Smith Amendment on Bioweaponization of Ticks – and it passed. A lot of this stems from stories of Plum Island and the whispers that Lyme disease actually originated from the testing site and ticks were either intentionally or accidentally released into the surrounding areas…triggering the disease a few decades ago. Since the release of a book on the “secret history of Lyme disease and biological weapons”, there’s been a renewed interest in the bedtime story of the disease’s sinister origin story. Unfortunately, the proposed investigation really doesn’t hit the nail on the head. For one, it’s been widely known for years that ticks, among other vectors, were a part of the bioweapons and biodefense research. Two, the “smoking gun” within the book that’s been used to reinvigorate interest, claims an interview with Dr. Willy Durgdorfer (the researcher who identified Lyme disease) gave confirmation of the true origin of the disease….alas, this was reported post-mortem, when he was not able to confirm or deny such statements. Third, Lyme disease actually has some pretty old origins. Last, but not least, this new amendment doesn’t even touch on Lyme disease…but rather focuses on if the DoD did experiments with insects and vectors as disease delivery systems…which we already know to be true. Ultimately, this does a disservice to not only the people with Lyme disease, but also encourages conspiracy theories.

Using “Outbreak Science” to Strengthen Usage of Models in Epidemics
If you’ve been on the frontlines of an outbreak, you’ve likely heard of disease modeling…but sometimes it can be hard to actually apply this technology to drive change. A new article has created “outbreak science” as an inter-disciplinary field to apply epidemic modeling in a way that can really help. “Nevertheless, the integration of those analyses into the decision-making cycle for the Ebola 2014–2016 epidemic was not seamless, a pattern repeated across many recent outbreaks, including Zika. Reasons for this vary. Modeling and outbreak data analysis efforts typically occur in silos with limited communication of methods and data between model developers and end users. Modeling “cross talk” across stakeholders within and between countries is also typically limited, often occurring within a landscape of legal and ethical uncertainty. Specifically, the ethics of performing research using surveillance and health data, limited knowledge of what types of questions models can help inform, data sharing restrictions, and the incentive in academia to quickly publish modeling results in peer-reviewed journals contribute to a complex collaborative environment with different and sometimes conflicting stakeholder goals and priorities. To remedy these challenges, we propose the establishment of ‘outbreak science’ as an inter-disciplinary field to improve the implementation of models and critical data analyses in epidemic response. This new track of outbreak science describes the functional use of models, clinical knowledge, laboratory results, data science, statistics, and other advanced analytical methods to specifically support public health decision making between and during outbreak threats. Outbreak scientists work with decision makers to turn outbreak data into actionable information for decisions about how to anticipate the course of an outbreak, allocate scarce resources, and prioritize and implement public health interventions. Here, we make three specific recommendations to get the most out of modeling efforts during outbreaks and epidemics.” From establishing functional model capacity and fostering relationships before things happen to investing in functional model capabilities, this guide could be a game-changer for outbreak response.

Building a Case of (non?)compliance Concern
Looking for a new book? Check out this review of Biosecurity in Putin’s Russia – “In the early 1990s, the world was rocked when defectors from the Soviet Union revealed the existence of a massive civilian and military biological-weapons program that had employed more than 65,000 people from 1928 to 1992, directly contravening the 1972 Biological and Toxin Weapons Convention (BWC). In 2012, Raymond Zilinskas, a leading biological- weapons expert, coauthored with Milton Leitenberg a comprehensive account of the program, The Soviet Biological Weapons Program: A History, a reference source so thorough that it ran to nearly a thousand pages. Last year, Zilinskas, in collaboration with Philippe Mauger, produced Biosecurity in Putin’s Russia, a sequel of sorts in which the cautionary note that Zilinskas and Leitenberg sounded earlier—that Russia’s relationship with biological weapons remained complicated, and that the current status of its old programs could not be verified—proved to have been foreshadowing.”

Modeling the Complexities of the Gut for Biodefense Application
“The Nutritional Immunology and Molecular Medicine Laboratory (NIMML), with research funding assistance from the Defense Threat Reduction Agency (DTRA), has developed a high-resolution model of the gut immune system to help solve emerging and re-emerging infectious diseases and biodefense challenges. The advanced model predicts new emerging behaviors and responses to biological threats. The gut ecosystem includes trillions of interactions between host epithelial and immune cells, molecules (cytokines, chemokines and metabolites) and microbes is a massively and dynamically interacting network, like a multidimensional jigsaw puzzle with pieces that are constantly changing shape. These interactions with cooperativity and feedback lead to nonlinear dynamics and unforeseen emergent behaviors across spatiotemporal scales. The NIMML agent-based modeling (ABM) of the gut uses an array of HPC-driven advanced computational technologies such as the ENteric Immunity SImulator (ENISI) – multiscale modeling (MSM). These models and tools simulate cell phenotype changes, signaling pathways, immune responses, lesion formation, cytokine, chemokine and metabolite diffusions, and cell movements at the gut mucosa.”

Radiation Injury Treatment Network Meeting 
Are you attending this event later this month? If so, check out GMU Biodefense doctoral student Mary Sproull discussing Radiation Biodosimetry – A Mass Screening Tool for Radiological/Nuclear Events.

MERS-CoV Clusters
New WHO insight into 14 cases has identified 2 clusters that involved 4 of the infected people. “Of the 14 patients, 3 had been exposed to camels, a known risk factor for contracting the virus. Ten were men and four were women, and patient ages ranged from 22 to 80. Eleven had underlying health conditions, which is a risk factor for MERS. Ten were from Riyadh region, with other cases reported from Jeddah, Medina, Najran, and Al Qassim. One of the clusters involved two people living in the same household in Al Kharj in Riyadh region, a 22-year-old woman who had diabetes and epilepsy and a 44-year-old woman who had no underlying health conditions. The other cluster consisted of a 65-year-old male patient and a 23-year-old female healthcare worker in Riyadh. Five of the people died from their infections.”

CDC Announces E Coli Outbreak Linked to Ground Bison
Put down your bison burger and take a slow step back….”The US Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) have announced that they are collaborating with the Canadian Food Inspection Agency to investigate a multistate outbreak of E coli O103 and E coli O121 infections. Early epidemiologic and traceback information point to ground bison products as the likely source of the outbreak. As of July 12, 2019, there have been 21 individuals infected with E coli in this outbreak. In total, 6 individuals have been infected with the O103 strain, 13 cases of the O121 strain have been confirmed, and 2 individuals have been found to be infected with both strains.”

Stories You May Have Missed:

  • Polio in Pakistan – “The Global Polio Eradication Initiative (GPEI) today reported nine new cases of wild poliovirus type 1 (WPV1), and, for the first time in more than a year, China has confirmed a case of vaccine-derived poliovirus. In addition, Angola has a new circulating vaccine-derived poliovirus type 2 (cVDPV2) case. The Pakistan patients reported symptom onset on dates ranging from May 28 to Jun 20. The total number of WPV1 cases recorded in Pakistan this year is now 41; last year, the country recorded 12 cases over the entire year. Five of the nine cases originated in Bannu province, where health workers have been targeted by anti-vaccine extremists.”
  • Food Defense and Intentional Adulteration Rule Training – “The Food Protection and Defense Institute is hosting a Food Defense and Intentional Adulteration Rule training on August 20-21 in Minneapolis, MN. This two-day course provides the convenience and interaction of a single, in person class to more comprehensively learn the breadth and interconnections of IA Rule requirements including how to: Prepare a Food Defense Plan Conduct vulnerability assessments including the full FSPCA Intentional Adulteration, Conducting Vulnerability Assessment Course (IAVA) Identify and explain mitigation strategies, Conduct reanalysis”

Pandora Report: 7.12.2019

 Summer Workshop Welcomes New Instructor
We’re excited to announce that Nancy Connell will be joining us for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security next week. Dr. Connell “is a Senior Scholar at the Johns Hopkins Center for Health Security and a visiting Professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health. She is a microbial geneticist by training. Dr. Connell’s work at the Center is focused on advances in life sciences and technology and their application to a number of developments in the areas of biosecurity, biosafety and biodefense.  Her research projects analyze novel biotechnologies that might impact the development of Global Catastrophic Biological Risks (GCBR) in ecosystems, and the development of surge capacity for medical countermeasure manufacturing and other response mechanisms in the event of a global pandemic or other global catastrophic event.  Dr. Connell is a member of the Board on Life Sciences and is a National Associate of the National Academies of Sciences, and she completed a six-month sabbatical as Visiting Scholar at the Board on Life Sciences.  Dr. Connell is a member of the US-CDC’s Biological Agent Containment Working Group in the Office of Public Health Preparedness and Response and was recently appointed the serve on the National Science Advisory Board for Biosecurity. Before joining the Center, Dr. Connell was Professor and Director of Research in the Division of Infectious Disease in the Department of Medicine at Rutgers New Jersey Medical School and the Rutgers Biomedical Health Sciences.  Dr. Connell’s major research focus was antibacterial drug discovery in respiratory pathogens such as M. tuberculosis and B. anthracis. Dr. Connell chaired the Institutional Biosafety Committee of Rutgers University and directed NJMS’s biosafety level three containment laboratory beginning in 1997. Her recent work focused on the use of predatory bacteria as novel therapeutics for treatment of Gram negative bacterial infections, including MDR strains and select agents. Dr. Connell was continuously funded by the NIH, the Department of Defense and DARPA, industry, and/or other sources from 1992 to 2018.  She received a PhD in microbial genetics from Harvard University.” If you’re not able to make the workshop next week, keep an eye on the @PandoraReport twitter for updates.

Is the U.S. Ready for A Tech War?
GMU Biodefense doctoral alum Daniel Gerstein discusses technological priorities and how the US invests in technological advances related to national security. “Today, important technology development changes are underway that could dramatically affect world order. The continued shift in global research and development spending highlights how far U.S. dominance has eroded. In 1960, when considering federal, industry and academia, the United States accounted for 69 percent of the global R&D. By 2016, the United States accounted for only 28 percent of the global R&D. With such a shift, it is no wonder that U.S. technology leadership and superiority can no longer be assured.” Gerstein notes that “the Trump administration should develop technology priorities, and technologies considered vital to U.S. economic and national security should receive investments to stimulate advances and promote U.S. leadership. The administration’s recent call to have greater industry investment in basic research, in lieu of government funding, seems shortsighted and should be reconsidered given the emerging tech war. A reevaluation of programs such as export controls, programs for approving foreign investment transactions, and intellectual property protections would also be useful to both protect and promote U.S. technology.”

Ebola Outbreak – Cases Surge with Violence – and How the CDC Made a Synthetic Ebola Virus to Test Treatments
Recently, the WHO Director General, Dr. Tedros, warned that instability in the DRC is fueling the Ebola outbreak. “In an interview with The Guardian, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said the political climate in the Democratic Republic of the Congo (DRC) is preventing an end to the current Ebola outbreak. ‘The root cause of the problem is lack of peace, the lack of a political solution. The incidence of Ebola, malaria and cholera is the symptom,’ Tedros told the British newspaper. ‘I know we can finish this Ebola outbreak…But at the same time it can come back because all the [political and security] conditions remain the same.’ The DRC outbreak expanded by 10 cases today, to 2,428 cases, according to the WHO’s online Ebola dashboard. Tedros’s comments come 1 day after the UK’s International Development Secretary, Rory Stewart, returned from a trip to the DRC and called on G7 world leaders to increase funding for outbreak response. ‘There is a real danger, that if we lose control of this outbreak, it could spread beyond DRC’s borders to the wider region and the wider world. Diseases like Ebola have no respect for borders and are a threat to us all,’ Stewart said in a Department for International Development (DID) news release.” Ebola has been challenging response efforts since 2013 and the CDC has been working to combat testing and treatment roadblocks through a unique strategy – a synthetic Ebola virus. Helen Branswell recently discussed how the CDC created a synthetic version of the Ebola virus to help guide diagnostic tests and experimental treatments…and it ended up working. “The research, conducted in the agency’s most secure laboratories — BSL4 — showed that even though the tests and two of the treatments being used in the field were developed based on earlier variation of Ebola viruses, they continue to be effective against the virus causing the current outbreak, the second largest on record. The results, reported Tuesday in the journal Lancet Infectious Diseases, are encouraging, but also raise questions about why outside research groups have not received direct access to viral specimens from the DRC and instead had to create a synthetic version. The paper noted that there have been no Ebola samples available to the scientific community from the past four outbreaks in the DRC. Those outbreaks occurred in 2014, 2017, and 2018.”

Mason Hosts Department of Homeland Security Centers of Excellence 2019 Summit 
“George Mason University will host Homeland Security Challenges: Evolving Threats and Dynamic Solutions, a Department of Homeland Security Centers of Excellence Summit, July 31-Aug. 1 at its Arlington Campus. The summit is an opportunity to gather some of the nation’s best academic, public, and private sector leaders to discuss strategies for advancing the DHS mission. Sponsored through the DHS Science and Technology Directorate Office of University Programs, the Department of Homeland Security Centers of Excellence network is a consortium of universities conducting groundbreaking research to address homeland security challenges by developing multidisciplinary, customer-driven, homeland security science and technology solutions and helping train the next generation of homeland security experts. The summit provides a platform for creating connections, fostering collaborations and inspiring new ideas to address homeland security challenges. It also provides an opportunity to highlight student research and innovative problem solving.”

ASPR Updates- the SNS and Biodefense Strategy Summit 
The Office of the Assistant Secretary for Preparedness and Response (ASPR) just released several good resources for the biodefense community. First, they’re celebrating the 20th anniversary of the Strategic National Stockpile (SNS) and you can find some great information on it here. “When state, local, tribal, and territorial responders request federal assistance to support their response efforts, the stockpile ensures that the right medicines and supplies get to those who need them most during an emergency. Organized for scalable response to a variety of public health threats, this repository contains enough supplies to respond to multiple large-scale emergencies simultaneously.” Next, ASPR provided the transcripts from the Biodefense Summit that occurred in April. “The Biodefense Summit, was held on April 17, 2019 in Washington, D.C.  The Summit aimed to engage the biodefense stakeholder community to inform national biodefense enterprise efforts to counter biological threats, reduce risk, prevent, prepare for, respond to, and recover from biological incidents. The Summit informed stakeholders of the implementation of the National Biodefense Strategy. “

Arizona Battles Hepatitis A
Arizona is working to contain an outbreak of hepatitis A and GMU biodefense doctoral student Saskia Popescu discusses how they’re incorporating healthcare providers into these efforts. “Despite making great strides in reducing the burden of HAV, Arizona is experiencing a growing outbreak that began in late 2018. Currently, there have been 424 cases and 3 deaths documented since November 2018, with a 79% hospitalization rate. The outbreak has spread to 7 counties within Arizona, including the largest—Maricopa. A total of 48% of Arizona’s HAV cases have occurred in those individuals who are homeless and report drug use, 25% of cases have been in those reporting using drugs (ie, no reported homelessness), and 22% of cases are in individuals with no identified risk factors. Public health investigators found that 28% of the cases have been in patients who are currently or were recently incarcerated. Five percent of the HAV cases in this ongoing Arizona outbreak have been reported in patients who report homelessness, but no drug use.  More recently, an employee at a restaurant in Maricopa County tested positive for HAV and may have exposed people visiting the restaurant over a 9-day period from late May to June. Public health officials are encouraging those patrons to get vaccinated against HAV to reduce the risk of transmission.”

Worldwide Reduction in MERS-CoV Cases Since 2016
In the latest CDC Morbidity and Mortality Weekly Report, they note the overall decline in MERS-CoV cases and mortality since 2016. “From 2012 through May 31, 2019, Middle East respiratory syndrome coronavirus (MERS-CoV) has infected 2,442 persons and killed 842 worldwide. MERS-CoV is currently circulating in dromedary camels in Africa, the Middle East, and southern Asia; however, most cases of human infection have been reported in the Arabian Peninsula. Large hospital outbreaks in 2014 and 2015 motivated affected countries to substantially invest in prevention and control activities. To estimate the potential number of MERS cases and deaths that might have been averted since 2016 had the risk levels of 2014–2015 continued, we analyzed case-based data on laboratory-confirmed human cases of MERS-CoV infections reported to the World Health Organization. We categorized cases as either secondary (human-to-human transmission) or community-acquired (presumed camel-to-human transmission). In addition, we used case-based data on date of onset (for symptomatic infections) or report (for asymptomatic infections), outcome (died/recovered), and dates and sizes of reported clusters of human-to-human–transmission cases”.

Self-destructing Mosquitoes and Sterilized Rodents: the Promise of Gene Drives
What might the consequences of this novel biotech be? In the face of potential eradication of disease and alteration of an entire animal population’s genome, researchers have very real concerns. “As soon as researchers began to make gene drives regularly in labs, animals developed resistance against them — accumulating mutations that prevented the drives from spreading. In tests of two drives inserted into fruit flies, for example, genetic variants conferring resistance formed frequently. Most commonly, mutations alter a sequence that CRISPR is set to recognize, preventing the gene from being edited. In experiments with caged mosquitoes, Crisanti and Target Malaria researcher Tony Nolan watched a gene drive gradually decrease in frequency over multiple generations owing to resistant mutations at the target gene. The results rocked the field. Would resistance render gene drives impotent? Not necessarily — if researchers select the right target. Some genes are highly conserved, meaning that any change is likely to kill their owners. Picking these genes as a drive target means fewer mutations and less resistance. In September 2018, Crisanti and his team crashed a population of caged Anopheles gambiae mosquitoes with 100% efficiency by making a drive that disrupts a fertility gene called doublesex. With the drive in place, female mosquitoes cannot bite and do not lay eggs; within 8–12 generations, the caged populations produced no eggs at all. And because it is crucial for procreation, doublesex is resistant to mutations, including those that would confer resistance to a drive construct.” “Before Kevin Esvelt ever built a single CRISPR-based gene drive, he’d wake up in cold sweats thinking about the ramifications. ‘I realized, oh hey, this isn’t just going to be about malaria, this is potentially going to be something any individual who can make a transgenic fruit fly could build to edit all the fruit flies.’”

Stories You May Have Missed:

  • UK Works to Test New Payment Model for Antibiotics – “In an effort to stimulate the development of new antibiotics, Britain’s National Health Service (NHS) yesterday announced the launch of a trial for a new pilot program that will pay drug companies for antibiotics using a subscription-style model. Under the program, NHS will pay pharmaceutical companies up front for access to effective antibiotics, rather than reimbursing them based on the quantity of antibiotics sold. The idea behind the program is to delink profit from the volume sold, pay for antibiotics based on their public health value, and encourage the development of new antibiotics.”

Pandora Report: 6.28.2019

Summer Workshop – Early Registration Discount Ends Soon
Just a few more days to get your early registration discount and we’ve only got a few spots left – make sure to grab yours! We’re excited to have top professionals and researchers in the health security field speak to the biological threats we’re facing- from securing the bioeconomy to vaccine development and pandemic preparedness, you’ll want to be there for the 3.5 days of all things pandemics, bioterrorism, and global health security.

Re-thinking Biological Arms Control for the 21st Century
Dr. Filippa Lentzos discusses the challenges of biological arms control in the face of synthetic biology and technological advances. “Innovations in biotechnology are expanding the toolbox to modify genes and organisms at a stagger- ing pace, making it easier to produce increasingly dangerous pathogens. Disease-causing organisms can now be modified to increase their virulence, expand their host range, increase their transmissibility, or enhance their resistance to therapeutic interventions. Scientific advances are also making it theoretically possible to create entirely novel biological weapons, by synthetically creating known or extinct pathogens or entirely new pathogens. Scientists could potentially enlarge the target of bioweapons from the immune system to the nervous system, genome, or microbiome, or they could weaponize ‘gene drives’ that would rapidly and cheaply spread harmful genes through animal and plant populations.” Lentos notes that “The political backdrop to these technical advances in biotechnologies and other emerging technologies is also important. There is increased worldwide militarization, with global military spending at an all-time high since the fall of the Berlin Wall. Unrestrained military procurement and modernization is creating distrust and ex- acerbating tensions. In the biological field, the proliferation of increasingly sophisticated biodefense capacities, within and among states, can lead to nations doubting one another’s intentions.”

GAO – Biodefense: The Nation Faces Long-Standing Challenges Related to Defending Against Biological Threats
The GAO testified before a House committee on their efforts to identify and strengthen U.S. biodefense and here are their overall findings in a report. Despite President Trump signing off on the Pandemic and All-Hazards Preparedness and Advancing Innovations Act (PAHPA) on Monday, there is still a lot of work to be done. “Catastrophic biological events have the potential to cause loss of life, and sustained damage to the economy, societal stability, and global security. The biodefense enterprise is the whole combination of systems at every level of government and the private sector that contribute to protecting the nation and its citizens from potentially catastrophic effects of a biological event. Since 2009, GAO has identified cross-cutting issues in federal leadership, coordination, and collaboration that arise from working across the complex interagency, intergovernmental, and intersectoral biodefense enterprise. In 2011, GAO reported that there was no broad, integrated national strategy that encompassed all stakeholders with biodefense responsibilities and called for the development of a national biodefense strategy. In September 2018, the White House released a National Biodefense Strategy. This statement discusses GAO reports issued from December 2009 through March 2019 on various biological threats and biodefense efforts, and selected updates to BioWatch recommendations made in 2015. To conduct prior work, GAO reviewed biodefense reports, relevant presidential directives, laws, regulations, policies, strategic plans; surveyed states; and interviewed federal, state, and industry officials, among others.” GAO identified several challenges in the ability for the U.S. to defend against biological threats: “Assessing enterprise-wide threats. In October 2017, GAO found there was no existing mechanism across the federal government that could leverage threat awareness information to direct resources and set budgetary priorities across all agencies for biodefense. GAO said at the time that the pending biodefense strategy may address this. Situational awareness and data integration. GAO reported in 2009 and 2015 that the Department of Homeland Security’s (DHS) National Biosurveillance Integration Center (NBIC)—created to integrate data across the federal government to enhance detection and situational awareness of biological events—has suffered from longstanding challenges related to its clarity of purpose and collaboration with other agencies. DHS implemented GAO’s 2009 recommendation to develop a strategy, but in 2015 GAO found NBIC continued to face challenges, such as limited partner participation in the center’s activities. Biodetection technologies. DHS has faced challenges in clearly justifying the need for and establishing the capabilities of the BioWatch program—a system designed to detect an aerosolized biological terrorist attack. In October 2015, GAO recommended that DHS not pursue upgrades until it takes steps to establish BioWatch’s technical capabilites. While DHS agreed and described a series of tests to establish capabilities, it continued to pursue upgrades. Biological laboratory safety and security. Since 2008, GAO has identified challenges and areas for improvement related to the safety, security, and oversight of high-containment laboratories, which, among other things, conduct research on hazardous pathogens—such as the Ebola virus. GAO recommended that agencies take actions to avoid safety and security lapses at laboratories, such as better assessing risks, coordinating inspections, and reporting inspection results. Many recommendations have been addressed, but others remain open, such as finalizing guidance on documenting the shipment of dangerous biological material.”

ABSA 1st International Biosecurity Symposium Call for Papers
“You are now able to submit papers for ABSA’s 1st International Biosecurity Symposium. The symposium will take place May 12-15, 2020 in Minneapolis, Minnesota. We anticipate having attendees from all over the world and approximately 20 commercial exhibits. The professional development courses will take place Tuesday, May 12, 2020. The symposium presentations (platform/poster) will take place Wednesday, May 13 to Friday, May 15, 2020. The Call for Platform/Posters Abstract submission deadline is July 31, 2019 at 5pm Central.”

Blue Ribbon Panel – U.S. Is Not Prepared for Biological Incidents – Testimony
June 26th- “Dr. Asha George, Executive Director of the Blue Ribbon Study Panel on Biodefense, served as an expert witness this afternoon before the House Oversight and Reform Subcommittee on National Security. Chaired by Rep. Stephen Lynch (MA), the Subcommittee is evaluating the readiness of the U.S. government and healthcare system, including hospital and emergency professionals, to respond to naturally occurring pandemics and biological attacks that could be perpetrated by state and non-state actors. The Subcommittee also is investigating the growing threat of antimicrobial-resistance, as well as the implications of this challenge for U.S. national security. ‘Our Panel has assessed and continues to assess the state of our country’s biodefense. We scrutinize the status of prevention, deterrence, preparedness, detection, response, attribution, recovery, and mitigation – the spectrum of activities necessary for biodefense,’ said Dr. George. ‘As expected, we found both strengths and weaknesses, including serious gaps that four years after the release of our Panel’s Blueprint for Biodefense in 2015 continue to make the nation vulnerable. In short, the nation is not prepared for biological outbreaks, bioterrorist attacks, biological warfare, or accidental releases with catastrophic consequences’.” This is especially relevant as many are wondering what Congress is doing to respond to health security threats.

Ebola Outbreak – Updates
As of Wednesday, the outbreak has reached 2,277 cases and security threats are increasingly making response efforts challenging. “In its weekly situation report on the outbreak, the WHO said Ebola activity continues with steady and sustained intensity, with security incidents returning to Beni—one of the outbreak’s former major hot spots—and armed group movements in Musienene and Manguredjipa impeding access to a health area next to Mabalako’s hardest-hit area. Another concern it aired is a tense security situation in neighboring Ituri province cities Bunia and Komanda in the wake of attacks in early June. Over the past few weeks, indicators show hints of easing transmission intensity in the two biggest recent epicenters, Katwa and Butembo. However, the optimism is offset by new cases in previously affected areas, including Komanda, Lubero, and Rwampara. For example, over the past week, Komanda reported its first case after going 11 days without one.”

A Dose of Inner Strength to Survive and Recover from Potentially Lethal Health Threats
“Breakthroughs in the science of programmable gene expression inspired DARPA to establish the PReemptive Expression of Protective Alleles and Response Elements (PREPARE) program with the goal of delivering powerful new defenses against public health and national security threats. DARPA has now selected five teams to develop a range of new medical interventions that temporarily and reversibly modulate the expression of protective genes to guard against acute threats from influenza and ionizing radiation, which could be encountered naturally, occupationally, or through a national security event. The program builds from the understanding that the human body has innate defenses against many types of health threats, but that the body does not always activate these defenses quickly or robustly enough to block the worst damage. To augment existing physiological responses, PREPARE technologies would provide a programmable capability to up- or down-regulate gene expression on demand, providing timely, scalable defenses that are proportional to anticipated threats. Service members and first responders could administer these interventions prior to threat exposure or therapeutically after exposure to mitigate the risk of harm or death.”

Global Community Bio Summit 3.0
From October 11-13, you can attend this community biotechnology initiative at MIT Media Lab. “The Community Biotechnology Initiative at the MIT Media Lab is organizing the third annual Global Summit on Community Biotechnology this October 11 to 13, 2019! Our goal is to provide a space for the global community of DIY biologists / community biologists / biohackers / biomakers and members of independent and community laboratories to convene, plan, build fellowship, and continue the evolution of our movement. You can learn more about last year’s Summit, including our program, here. While all are welcome, space is limited, so we are prioritizing active practitioners in the community with an emphasis on diversity across geographic, cultural, ethnic, gender, and creative backgrounds. We will add accepted participants to the directory on a rolling basis with the goal of accepting everyone interested in joining.”

Stories You May Have Missed:

  • Tackling Dirty Sinks – Did you ever think your hospital sink could be a disease reservoir? “Earlier this year, there were studies that identified sink proximity to toilets as a risk factor for contamination. Bugs like Klebsiella pneumoniae carbapenemase-producing organisms tend to be prolific in moist environments and are often pervasive in intensive care unit sinks and drains. Researchers found that sinks near toilets were 4-times more likely to host the organisms than those further from toilets. More and more, infection prevention is having to look at hospital faucets and sinks for their role in hosting microbial growth. This was also a topic of interest at last week’s annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC 2019). Investigators with the University of Michigan Health System discussed how they worked to identify vulnerabilities and potential sink designs that might contribute to bioburden and biofilm in hospital faucets. Assessing 8 different designs across 4 intensive care units, the research team ultimately found that those sinks with a more shallow depth tended to allow higher rates of contamination (ie, splash of dirty water) onto equipment, surfaces, and patient care areas. In some instances, the splash of contaminated water could be found up to 4 feet from the sink.”