Pandora Report: 4.5.2019

Good news- spring is in full effect and flu transmission is starting to slow. With summer around the corner, have you registered for our workshop on all things biodefense, from anthrax to Zika?

The Plague Years – How the Rise of Right-Wing Nationalism is Jeopardizing the World’s Health
Maryn McKenna is calling out a very real issue – politics, vaccines, and the reality that “As nativist appeals undermine public health systems and cooperation among countries degrades, the potential for catastrophe increases. We are always at risk of a new disease breaking out, or a previously controlled one surging back. What’s different now is that the rejection of scientific expertise and the refusal to support government agencies leave us without defenses that could keep a fast-moving infection at bay. Pathogens pay no respect to politics or to borders. Nationalist rhetoric seeks to persuade us that restricting visas and constructing walls will protect us. They will not. ‘Nationalism, xenophobia, the new right-wing populism in Europe and the United States, are raising our risk,’ said Ronald Klain, who was the White House Ebola response coordinator for President Barack Obama and now teaches at Harvard Law School. ‘There’s a focus not so much on stopping infectious diseases as much as there is on preventing the movement of people to prevent the transmission of diseases. And that’s not possible, because no matter what you do about immigrants, we live in a connected world’.” Moreover, that belief system can be seen in the White House, as President Trump tweeted during the 2014 Ebola outbreak – “Keep them out of here,” he tweeted about American missionaries who fell ill in West Africa. “Stop the Ebola patients from entering the U.S.” and “The U.S. cannot allow Ebola infected people back.” As McKenna notes “This is the perverse legacy of nationalism in power: By stigmatizing immigrants and segregating them, xenophobia can turn the lie of the ‘dirty foreigner’ into truth.
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 Hospital-Associated Conditions Penalties: What They Really Mean
Just how good is your local hospital at preventing infections in patients? GMU biodefense doctoral student and infection preventionist Saskia Popescu is breaking down what these quality metrics really mean and how hospitals are scoring. “In 2014, CMS established another rule tying health care quality of care and reimbursement—the HAC Reduction Program. Although this started with reporting of certain conditions, such as central-line associated bloodstream infections, these pay-for-performance programs were expanded over time. The program links hospital performance in certain categories with reimbursement. That’s right, if a hospital performs poorly, they can be hit where it hurts—the bank. Scores are determined by a hospital’s performance in 2 domains—1 includes indicators like pressure ulcers and in-hospital falls with injury, while the second domain focuses on health care-associated infections that include central-line associated bloodstream infections, catheter-associated urinary tract infections, certain surgical-site infections, methicillin-resistant Staphylococcus aureus bacteremia, and Clostridium difficile (C diff) infections. Considering there are 500,000 cases and 15,000 deaths a year related to C diff in the United States, it’s not surprising that CMS would want to crack down on those cases associated with hospitalization.” “There are just over 5000 US community hospitals that will likely receive CMS reimbursement in FY2019, and 800 (16%) of these institutions experienced financial penalties related to poor performance. That’s a pretty substantial amount, but the painful truth is that this number is likely higher considering there have been concerns for hospitals failing to report HACs and a general lack of CMS data validation.”

Ebola Continues to Hit the DRC
We’ve surpassed 1,000 cases and are now beyond the point where the WHO called a PHEIC in the 2014-2016. On Tuesday, the “World Health Organization (WHO) today reiterated that the outbreak in the Democratic Republic of the Congo (DRC) will be defeated only with local communities at the helm of response efforts. The message came from Ibrahima-Soce Fall, MD, WHO assistant director-general for emergency response, who held a brief teleconference this morning from Butembo. With 72 Ebola cases reported last week and 56 in the previous week, March was a low point for responders, as activity spiked and the outbreak topped the 1,000-case milestone.” On Thursday, it was reported that 7 new cases were identified, including a healthcare worker. “The healthcare worker in Musienene brings the total number of health workers infected during the outbreak to 82 (7.4% of all confirmed or probable cases), and 29 of them have died, the DRC said. In an update released late yesterday, the DRC recorded 8 new confirmed cases, and 7 deaths, including 5 community deaths. Butembo and Katwa each had a community death, and Mandima recorded 3. Community deaths have been a compounding factory of this outbreak, as they enable the virus to spread more easily among family members and funeral attendees.” Based off the latest case counts, three main areas have been the hotspots for the outbreak – Katwa, Vuhovi, and Mandima.

Next Generation Biosecurity Online Course
“An open online course exploring biosecurity and biological threats begins this week on FutureLearn. This course is for professionals working in public and global health, international security, politics and international relations. It may be of particular use to biosafety officers in academia, industry or government, and early-career science scholars in the life sciences.” You can access the course here.

 Why the Scientific Debate Over a UW Bird Flu Study Isn’t Going Away
“A University of Wisconsin-Madison laboratory is set to resume experiments that could build the foundation of an early warning system for flu pandemics. The research is based on altering a deadly type of the influenza virus in a way that could make it more dangerous, though, and critics say its approval lacked transparency and creates unnecessary risks. Yoshihiro Kawaoka is a virologist and professor at the UW School of Veterinary Medicine and the University of Tokyo who has figured prominently in Wisconsin’s long-term central role in flu research. Kawaoka’s work has been the focus of fierce debate among epidemiologists ever since he announced in 2011 that his lab had successfully altered the H5N1 subtype of the influenza A virus to be transmittable through the air among ferrets. These small mammals are a common laboratory stand-in for studying human flu transmission.” “That debate has lingered since 2011 and intensified in early 2019 after the federal government approved funding for Kawaoka to continue his research. Marc Lipsitch is a professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health. He’s a longtime critic of research that modifies flu viruses to be more dangerous in humans. ‘What worries me and my colleagues is the effort to modify viruses that are novel to humans and therefore to which there’s no immunity in the population, and where a laboratory accident wouldn’t just threaten the person who got infected … but potentially could be the spark that leads to a whole pandemic of infectious disease,’ Lipsitch told WisContext.”

New Plant Breeding Tech for Food Safety
Tackling the issue of food safety is up there with a universal flu vaccine – something we all want, but a task requiring a Herculean effort. A new insight to this problem has come forward though and the authors “argue that with careful deployment and scientifically informed regulation, new plant breeding technologies (NPBTs) such as genome editing will be able to contribute substantially to global food security. Previously, conventional plant breeding through cross- and self-pollination strategies played a major role in improving agricultural productivity. Moreover, the adoption of genetically modified (GM) crops by smallholder farmers has led to higher yields, lower pesticide use, poverty reduction, and improved nutrition. Nevertheless, so far only a few developing and emerging economies—such as China, India, Pakistan, Bangladesh, and South Africa—have embraced GM crops. Even though three decades of research show that GM crops are no more risky than conventional crops, many countries in Africa and Asia are hesitant to promote the use of GM crops, largely because of erroneously perceived risks and fears of losing export markets to Europe.”

Stories You May Have Missed:

  • Opioid Epidemic Increases Some Infectious Disease Rates – “The United States faces a converging public health crisis as the nation’s opioid epidemic fuels growing rates of certain infectious diseases, including HIV/AIDS, hepatitis, heart infections, and skin and soft tissue infections. Infectious disease and substance use disorder professionals must work together to stem the mounting public health threat, according to a new commentary in the Journal of Infectious Diseases. The article was co-authored by officials from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the Institute of Human Virology at the University of Maryland School of Medicine in Baltimore. Since 1999, nearly 400,000 people in the United States have fatally overdosed on opioid-containing drugs, with 47,600 deaths in 2017 alone. Many people with opioid use disorder (OUD), who initially were prescribed oral drugs to treat pain, now inject prescribed or illegal opioids. High-risk injection practices such as needle-sharing are causing a surge in infectious diseases. Additionally, risky sexual behaviors associated with injection drug use have contributed to the spread of sexually transmitted infections.”
  • US Army Develops Fast-acting Spray for CW Decon– “Chemical and biological weapons experts earned the U.S. Army a patent on Tuesday for their groundbreaking work on rapid decontamination. Gregory Peterson, Joseph Myers, George Wagner, Matthew Shue, John Davies, Jr., and Joseph Rossin were listed as the inventors on U.S. Patent 10,245,456, “Process for Decontamination and Detoxification with Zirconium Hydroxide-Based Slurry.” (The patent is linked below). The research team works at the Army’s Chemical Biological Centerin Maryland, and has significantly reduced decontamination time down to less than 30 minutes and the amount of water needed to treat large amounts of equipment coated in deadly toxins.”

 

Pandora Report: 3.15.2019

TGIF or beware the Ides of March? Either way, we’ve got some health security news for you, so grab your Caesar salad and enjoy this weekly dose of all things biodefense.

Summer Workshop – Are You Registered?
We’re offering an early-bird discount for registration prior to May 1st – have you signed up? Threats to global health security continue to evolve due to the changing nature of conflict, advances in science and technology, globalization, and the growing threat posed by emerging infectious diseases and pandemics. Pandemics, Bioterrorism and Global Health Security: From Anthrax to Zika is a three and a half-day workshop, non-credit summer workshop designed to introduce participants to the challenges facing the world at the intersection of national security, public health, and the life sciences. The workshop faculty are internationally recognized experts from the government, private sector, and academia who have been extensively involved with research and policy-making on public health, biodefense, and national security issues. Don’t miss out on an additional discount if you’re a returning attendee, GMU employee/student, or are registering with a large group.

Germline Gene-Editing – Do We Need a Moratorium?
In the wake of He Jiankui’s gene-edited babies, many are calling for a moratorium on germline gene-editing. In fact, the Chinese health ministry released draft guidelines at stopping rogue efforts with unapproved biotech. This topic is so important that Nature published a call for a moratorium by several top ethicists and researchers. “Whether or not a moratorium receives more widespread support, several things need to be done to ensure that germline gene-editing studies, done for the purposes of research only, are on a safe and sensible path. As a starting point, proposals for all ethically vetted and approved basic research studies that use gene-editing tools in human embryos and gametes, including those aimed at assessing efficacy and safety, should be deposited in an open registry. Second, researchers need to develop a system that allows early recognition of any research that risks overstepping predefined boundaries. A useful model to follow could be the WHO guidance for regulating research with a potential biosecurity risk. The system should include a mechanism — perhaps affiliated with the open registry — that allows researchers to flag up potentially dangerous research. Analysing whether He’s work could have been prevented will help. It’s important to hammer out whether, how and to whom scientists and ethicists who became aware of the project could have voiced their concerns — and how they could do so more easily in future. Raising the alarm would require a change of practice for researchers who, for the sake of scientific independence, often do not intervene in the choice of research projects undertaken by their peers.” In the joint statement, the researchers noted that “By ‘global moratorium’, we do not mean a permanent ban. Rather, we call for the establishment of an international framework in which nations, while retaining the right to make their own decisions, voluntarily commit to not approve any use of clinical germline editing unless certain conditions are met.”

Taking A Step Back in Staph
This common skin bug is becoming increasingly resistant to not only intervention efforts, but also antimicrobials. Saskia Popescu, GMU biodefense doctoral student and infection preventionist, discusses the latest CDC report on the concerning state of Staphylococcus aureus infections, including MRSA. “Staph infections can either be methicillin-resistant or methicillin-sensitive (MSSA) but, overall, staph is the leading cause of infections in US hospitals. Infection preventionists have been zeroing in on MRSA for decades in the health care industry, working tirelessly to stop the spread. Unfortunately, according to the CDC, progress in curbing MRSA has slowed, and findings indicate that MSSA rates are also not declining. One theory is that the opioid crisis may be connected, as 9% of all serious staph infections in 2016 occurred in patients who used injection drugs, a statistic that represented an increase from 4% in 2011. Consider this—right now, nearly 1 in 10 staph infections that occur are in people who use intravenous drugs.”

 MERS-CoV Outbreak
Speaking of healthcare-associated infections…Saudi Arabia’s Ministry of Health reported two more cases in an ongoing outbreak in Wadi ad-Dawasir. Unfortunately, most of these cases are linked to healthcare exposures and a handful are related to contact with camels. One particular study assessed camel infections, noting that “The investigators focused on 53 studies published from 2013 to December 2018, of which 33 were from the Middle East, 13 from Africa, and 7 from Spain, Australia, Japan, Bangladesh, and Pakistan. The team reported its findings yesterday in the preprint server bioRxiv. The team said another group unknowingly carried out a similar review, which covered studies published from 2013 to April 2018 and was published Feb 21 in Epidemiology and Infection by a team from Qatar and the Netherlands. The authors of the bioRxiv said their study confirms and updates the findings of the other study.The authors of the new review found that MERS-CoV seroprevalence in camels increases with age, up to 80% to 100% in adult dromedaries, which the team says suggests that the virus is widely endemic in camels on the Arabian Peninsula and in African countries that export dromedaries. However, they note variable patterns within some countries. Also, the experts found a high prevalence of active infection in juvenile animals and at sites where the animals mix, such as livestock markets and slaughterhouses. Other findings from the longitudinal studies they examined include reinfection despite high MERS-CoV antibody titers.”

Improving Global Health Security Through One Health Platforms
Don’t miss out on this March 21st even at the National Press Club, hosted by the USAID -funded Preparedness and Response project. “Over the past four and a half years, the USAID-funded Preparedness & Response project has worked across 16 countries to spread the vision of a multisectoral One Health approach — where human, animal, and environmental health assets join forces — becoming the standard way to prevent, detect, and respond to emerging pandemic threats. As the project approaches the end of its tenure, please join us as we bring together the One Health community of practice to share key learning, demonstrate successful approaches to country ownership, and discuss the future of multisectoral coordination for preparedness and response.”

Biodefense MS and PhD Open Houses
Looking to improve your biodefense knowledge while obtaining a graduate degree? The Schar school Biodefense program is the place for it – from anthrax to Zika, we’ve got you covered. We’ve got two events coming up that you won’t want to miss if you’re looking to invest in your education. On Wednesday, March 20th you can attend a Master’s in Biodefense Webinar (online) at 12pm EST and at 7pm there will be a PhD Open House at the Arlington campus. These are great opportunities to hear about the biodefense programs, meet faculty and students, and learn how you can become a biodefense guru through our in-person and online programs.

Ebola Outbreak Updates and An Epidemic of Suspicion 
On Tuesday, two new cases were reported, as well as two new deaths, bringing the case counts to 925, including 584 deaths. Vinh-Kim Nguyen recently wrote in NEJM regarding the violence and turmoil surrounding outbreak response efforts in the DRC. “As a medical team leader for Médecins sans Frontières (MSF), I work halfway between Butembo and Goma, North Kivu’s capital city and a transport hub. In late January, five Ebola cases were identified in Kayna and Kanyabayonga; MSF opened a center in Kayna to isolate patients with suspected cases and test them for Ebola virus disease (EVD). I soon suspected that most patients would turn out to have diseases other than EVD. The standard “isolate and test” model often leads to expectant management for such patients — the tendency is to “cover” patients with antimalarials and broad-spectrum antibiotics, wait for EVD test results, and then discharge patients without Ebola. We instead took a more active approach, treating severe cerebral malaria, typhoid, sepsis, and even cholera. I have witnessed how such active clinical management for all patients, along with MSF’s long-term presence in North Kivu, has contributed to the community’s acceptance of our Ebola unit. Having patients emerge from isolation in improved health is powerful evidence that we aim to make everyone better, not just to stop Ebola’s spread.” Nguyen further discusses the labeling of attacks as “resistance” are fundamentally wrong and how they are actually a bigger issue – persons against prevention activities aimed at them and those orchestrated, armed attacks against symbols of the international response. “The mistrust of authority in the DRC also reflects a growing global mistrust of experts and science. Vaccine refusals are a growing problem worldwide, and they have already resulted in measles epidemics in the United States and France and in outbreaks elsewhere. Mistrust of public health authorities may thus be the new norm, and smoldering epidemics merely a symptom.”

 Ambitious American AIDS Initiatives & Cutting Foreign Aid Programs
In the February State of the Union, President Trump pledged to end the HIV epidemic by 2030. This re-invigoration of HIV efforts was shocking, but exciting. The official pledge of $291 million to help end transmission of HIV within the United States will hopefully bring us closer to that goal through initiatives that increase access to pre-exposure prophylaxis (PrEP). While Congress still needs to approve the 2019 budget, there is a concerning proposal within it. Beyond the cuts to Medicare and Medicaid ($845 billion and $241 billion respectively) which are deeply worrisome, the budget seeks to drop US contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria by one billion. “The US will contribute $3.3bn between 2020 and 2023, a reduction on its previous contribution of $4.3bn. In a statement the global fund said: ‘The United States is the leading supporter of the Global Fund, and we are confident that the U.S. Congress will continue the strong funding that is urgently needed to improve global health security by ending epidemics. Various proposals are being considered and we look forward to final budget decisions taken by Congress in the coming months.’ The fund is looking for at least $14bn for the next year and, as the US donates around a third of the total, its contribution will mark a significant reduction on previous years. Mr Trump also proposes a $12.3bn cut to the State Department and USAID, marking a 23 per cent cut from the previous year. USAID, through the President’s Emergency Programme for Aids Relief, is a key player in the United Nations programme to eliminate HIV around the world.”

WHO Launches New Global Influenza Strategy
Influenza continues to be not only an annual issue, but the lack of preparedness for severe seasons and potentially pandemic strains is also an international issue. The WHO released their Global Influenza Strategy for 2019-2030. “The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals to humans and potentially causing a pandemic is real.   The question is not if we will have another pandemic, but when.  We must be vigilant and prepared – the cost of a major influenza outbreak will far outweigh the price of prevention.” This new strategies “is the most comprehensive and far-reaching that WHO has ever developed for influenza.  It outlines a path to protect populations every year and helps prepare for a pandemic through strengthening routine programmes. It has two overarching goals: 1. Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness. To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security. 2. Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals and treatments, with the goal of making these accessible for all countries.”

How Africa Can Quell the Next Disease Outbreaks
How can African nations enable public health institutions (NPHIs) to help stop emerging and re-emerging infectious diseases from springing up and causing large outbreaks? Beyond waiting for outside intervention and emergency help from the West, John N. Nkengasong, head of the Africa Centre for Disease Control and Prevention, calls “on all 55 member states to establish or strengthen NPHIs. And I urge the private sector in Africa and worldwide, and bodies everywhere, to invest in these efforts. According to the World Bank, Africa needs between US$2 billion and $3.5 billion a year for epidemic preparedness; in 2015, 8 African nations received from various donors about $700 million for this cause.” Furthermore, he notes that “NPHIs should prioritize four broad areas. First, providing basic functions such as disease surveillance and coordinating emergency operations, even in remote areas. Second, creating lab networks that can quickly diagnose, track and pinpoint the origin of emerging infections. Third, developing a workforce to collect, assess, share and act on quality data, including advanced technologies such as genetic sequencing and informatics. Fourth, developing a strong capacity for social scientists to engage with communities and change behaviours. Sociologists and anthropologists were crucial in ending the Ebola outbreak in West Africa by, for example, promoting safe burials — which meant modifying long-standing traditions, such as washing the corpse of a loved one.”

Measles and the Threat of the Anti-vaccination Movement
From measles to polio, the threat of vaccine-preventable diseases is a real one that we’re slowly losing our headway in. “The anti-vaccination movement threatens to undo years of progress made against a range of preventable diseases. Mass immunization campaigns helped slash the number of measles deaths worldwide by 80 percent between 2000 and 2017, but that headway may now be stalling. Today, only 85 percent of the world’s infants receive the first dose of the treatment, and even fewer get the second dose. This is well short of the 95 percent vaccination rate that the WHO says is needed to prevent outbreaks. If the anti-vaccination movement continues to gain momentum, there could be more outbreaks in places such as the United States, where measles has been considered eliminated for nearly two decades. With more cases, there will be greater potential for measles to spread across borders. Until governments turn the tide of the anti-vaccination movement, health workers will face the dual challenge of containing measles in both countries where the disease is still endemic and those where it was thought long gone.”

Infectious Diseases Spike Amid Venezuela’s Political Turmoil
The crisis in Venezuela is leaving millions without clean water, access to hospitals,  safe food, and more. Unfortunately, it is also causing a spike in infectious diseases as public health and healthcare efforts have been all but decimated. “These so-called vector-borne diseases—transmitted by mosquitoes or other organisms—have increased by as much as 400 percent in Venezuela in the last decade, according to a review study published in The Lancet in February. Spiraling economic and political turmoil have worsened the situation, as has the government’s apparent hostility toward researchers who publish epidemiological data—with reports of pro-government paramilitary groups smashing labs and even stealing experimental mice. “’Last year we had more than 600,000 cases [of malaria] reported by the government,’ says study co-author Maria Eugenia Grillet, a tropical disease ecologist at Central University of Venezuela in Caracas. She and her co-authors estimated there were actually around 1.2 million cases, taking into account underreporting and disease relapses, Grillet notes. (Relapses occur when a patient has recovered but still carries the malaria-causing parasite and later suffers a recurrence of symptoms.) She blames the increase on a lack of antimalarial surveillance, treatment and control, partly due to funding cuts. ‘Research in our universities and laboratories is almost completely paralyzed because there are no financing programs that allow us to cover the basic needs to carry out our experiments or fieldwork,’ she says.”

Stories You May Have Missed:

  • New Vaccine Manufacturing Innovation Centre Bolsters Pandemic Preparedness – “The first dedicated Vaccines Manufacturing Innovation Centre (VMIC) is coming to the UK in 2022, addressing gaps in late-stage vaccine manufacturing for clinical trials and emergency preparedness for epidemic and pandemic threats. Led by the the University of Oxford’s Jenner Institute, the new centre has been awarded funding by UK Research and Innovation of £66 million ($86 million USD) through the UK Government’s Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing challenge. ‘This is an exceptional opportunity for the UK to lead in the provision of vaccines against a wide range of outbreak pathogens which threaten to cause major epidemics,’ said Adrian Hill, Jenner Institute Director. ‘The lack of commercial incentive to develop these has now led to this exceptional partnership of major academic and industrial players in the vaccine field, to accelerate a range of vaccines towards large-scale manufacture and stockpile provision for vulnerable populations. In parallel, the Centre will develop innovative manufacturing technologies with UK companies and Universities to support the next generation of life-saving preventive and therapeutic vaccines’.”

Pandora Report: 9.14.2018

Happy Friday fellow biodefense gurus – we’re happy to have you read our weekly report on all things from anthrax to Zika.

George Mason Global Health Security Ambassadors Program
The Schar Biodefense program is excited to announce an opportunity for two current biodefense students (MS or PhD) to attend the  5th Annual Global Health Security Agenda (GHSA) Ministerial Meeting in Bali, Indonesia from November 6-8, 2018. The GHSA Ministerial Meeting provides an unparalleled opportunity to share experiences and engage in meaningful discussions on global health security with senior government officials from the GHSA member states and implementing partners from civil society and the private sector. One of the main goals of this year’s summit is to launch the GHSA 2024 Framework to guide GHSA members and partners in their collective effort to tackle current and future global health security issues. Therefore the theme of this year’s meeting is Advancing Global Partnerships. The two lucky biodefense students will participate in the meeting as members of a delegation representing the Next Generation Global Health Security Network which is led by Dr. Jamechia Hoyle. The Biodefense program is grateful to Dr. Hoyle and Dean of the Schar School, Mark Rozell, for providing this opportunity. If you’re interested in attending, please make sure to reference the email that was sent out on Friday as this opportunity is only available for current GMU Biodefense MS/PhD students. 

South Korean Man Infected With MERS
South Korea’s preparedness against MERS is being tested again as a man hospitalized in Seoul has tested positive for MERS following a trip to Kuwait. “‘As far as found by now, 20 people including flight attendants and medical staff have been in close contact with the patient and they are under isolation at home,’ KCDC director Jeong Eun-kyeong told a press briefing. The patient, who was suffering from diarrhea, headed directly to Samsung Medical Center from the airport, Jeong said. He is now in an isolation ward at Seoul National University Hospital. The KCDC director said all flights from Middle East countries have been put into quarantine. ‘The KCDC and local governments will do our best to prevent spread of the MERS,’ Jeong noted.” The last time South Korea experienced a MERS case, in 2015, a significant outbreak occurred due to poor infection control and hospital practices. A recent update found that the number of contacts was higher, at 21 people, all of whom are being monitored and are currently asymptomatic.

GMU Biodefense Master’s Open House
Next Thursday, September 20th, is your chance to learn about Schar School’s MS in Biodefense. Located in Arlington, this is a great chance to learn about the program requirements, curriculum, and how you can study biodefense online or in person! The session will provide an overview of our master’s degree programs, an introduction to our world-class faculty and research, and highlights of the many ways we position our students for success in the classroom and beyond. Our admissions and student services staff will be on hand to answer your questions.

Medical Countermeasures: Mission, Method, and Management
The latest issue of AJPH focuses on medical countermeasures (MCMs) and future innovations. “Medical countermeasures (MCMs) are critical for minimizing morbidity and mortality in the event of a large-scale public health emergency. MCMs involve a broad spectrum of medical assets, including biological products and personal protective equipment. Whether the emergency results from a chemical, biological, radiological, or natural disaster or from widespread infectious disease and contagions, a well-prepared public health community will readily access and deploy lifesaving MCMs. Ensuring appropriate distribution and dispensing of MCMs can be logistically complex, but coordinated planning between local, state, and federal agencies facilitates an efficient public health response.” The issue includes articles on MCM history, lessons learned by rapid deployment force 3, planning considerations, Taiwan’s annual seasonal flu mass vaccination program, etc.

ABSA International Call for Abstracts
“ABSA International announces the CALL FOR ABSTRACTS for posters for the USDA Agricultural Research Service (ARS) 5th International Biosafety & Biocontainment Symposium to be held February 11-14, 2019, in Baltimore, Maryland. We are anticipating over 200 attendees and over 30 vendors showcasing the latest biosafety and biocontainment products and services. ABSA International is pleased to offer funding support to help selected students and young professionals* (see definition at end of announcement) to attend the symposium. The selection will be made by a panel of judges who will evaluate the submitted abstracts and identify the top submissions. In addition, ABSA International/USDA ARS will present a Student and Young Professional Poster Award* and a Professional Poster Award for the best posters in the categories listed below. The awards will be announced during the reception on Wednesday, February 13th.”

Responding to Airline Outbreaks – A Hidden Safety Net
Helen Branswell lifts back the curtain on the hidden safety net we have regarding ports of entry and infectious diseases. The Emirates flight that was quarantined at NYC last week due to reports of 100 passengers becoming sick mid-flight, raised several questions regarding how we respond to such events. “The fact that a rapid and aggressive response involving a number of agencies and response teams could be pulled together so quickly is thanks to work that has been underway to build this safety net since the early 1990s. That’s when a seminal report from the Institute of Medicine — now called the National Academy of Medicine — issued a clarion call of the threat emerging infectious diseases posed to the U.S. Many such incidents happen over the course of any given year, but in most cases, the CDC does not get immediate word that someone who was on a plane had a disease such as active tuberculosis or measles. In those scenarios, the agency or its partners work to track down passengers who might have been at risk.” While the news of such events much be worrisome, it’s nice to know we have a strong response in place.

Releasing Genetically Modified Mosquitoes 
Africa will see its first release of GMO mosquitoes by researchers sometime this year or next, as the government of Burkina Faso granted permission for the experiment. “The release, which scientists are hoping to execute this month, will be the first time that any genetically engineered animal is released into the wild in Africa. While these particular mosquitoes won’t have any mutations related to malaria transmission, researchers are hoping their release, and the work that led up to it, will help improve the perception of the research and trust in the science among regulators and locals alike. It will also inform future releases. Teams in three African countries—Burkina Faso, Mali, and Uganda—are building the groundwork to eventually let loose “gene drive” mosquitoes, which would contain a mutation that would significantly and quickly reduce the mosquito population. Genetically engineered mosquitoes have already been released in places like Brazil and the Cayman Islands, though animals with gene drives have never been released in the wild.” Success isn’t just based off the scientific outcomes of the project, but also the consent of those living in the areas. 10,000 mosquitoes will be released and are not planned to have a lasting impact on the insect population as they have a “sterile male” mutation meaning that they are unable to procreate.

Skin Bacterium Gets Feisty With Antibiotics
Well, maybe not feisty, but the common skin commensal, Staphylococcus epidermis, has recently become resistant to almost all antibiotics and has spread around the world. “The researchers also found that some of the genetic mutations identified in these lineages confer resistance not only to an antibiotic called rifampicin but also to last-resort antibiotics such as vancomycin. Clinical guidelines often recommend co-administering both rifampicin and vancomycin for the treatment of Staphylococcus infections to prevent the development of drug resistance. But the authors’ findings suggest that the combination may instead fuel resistance in S. epidermidis.”

Stories You May Have Missed:

  • Bionic Bug Podcast with Natasha Bajema – Looking for a new podcast where fiction meets reality? Check out Dr. Natasha Bajema’s podcast on the latest tech news. The most recent episodes (19 & 20) discuss gene drive, mosquitoes, exoskeletons, and artificial intelligence!

Pandora Report 8.17.2018

Happy Friday fellow biodefense nerds! Welcome to your weekly roundup of all things global health security. If you’re finding yourself a food source for mosquitoes and ticks this summer, just a friendly heads up – the associated diseases are on the rise (hint: climate change may be a big reason).

The Lingering Scare of Smallpox
The recent FDA approval of TPOXX to treat smallpox, a disease eradicated since 1980, has many wondering, especially those of us born in a time where the vaccine was not necessary, why so much attention is being raised. It’s an easy thing to forget – the peril of a disease long since eradicated, but the threat of smallpox is very much still a concern in biodefense. Between the concerns of a laboratory biosecurity/biosafety incident at the two remaining stockpile locations or the chance that a frozen corpse (aka corpsicle) who died of smallpox could defrost as the Arctic permafrost melts. Did I mention the risk of a de novo synthesis like the horsepox one in Canada? These are the reasons we haven’t been able to shake the nightmare that is smallpox. “The greatest threat is advances in synthetic biology, which could permit a rogue lab to re-engineer a smallpox virus. In 2016, researchers in Canada announced that they had created horsepox using pieces of DNA ordered from companies. A synthetic smallpox virus could be even more dangerous than the original, because it could be designed to spread more easily or with ways to survive new therapies.” While we eradicated smallpox and proved that such a feat was possible, there is the painful reality that such efforts left an unvaccinated and inherently vulnerable population.

Biological Events, Critical Infrastructure, and the Economy: An Unholy Trinity
Biodefense graduate student Stephen Taylor is reporting on the latest Blue Ribbon Study Panel. “At its recent meeting about resilience, the Blue Ribbon Study Panel on Biodefense explored the potential impacts of a biological event on critical infrastructure in the United States, as well as the best way to approach risk mitigation.  Ann Beauchesne, former Senior Vice President of the National Security and Emergency Preparedness Department at the U.S. Chamber of Commerce, summed up critical infrastructure as ‘the critical services for our society and the backbone our economy.’  Projected increases in global travel, trade, and development all rely on critical infrastructure, magnifying the potential impact of insults to infrastructure systems.  Concurrently, biological threats are also on the rise. As the world warms and urbanizes, natural infectious disease outbreaks manifest in unexpected places.”

Ebola, Healthcare Workers, and the Pandemic Potential in Vulnerable Countries 
Every day brings news of the Ebola virus disease outbreak along the eastern border of the DRC. On Thursday, cases jumped by seven – one of whom is a healthcare worker. The outbreak is up to 73 cases, 46 of which are confirmed and 27 are probable. 43 deaths have been reported. Nearly a thousand people are under surveillance as contacts of cases and healthcare workers are again, experiencing increased risk of transmission. On Tuesday, it was reported- “that health worker Ebola infections could amplify the current outbreak in the Democratic Republic of Congo (DRC), the country’s health ministry today reported five more confirmed cases, including four involving health workers at a health center in Mangina. The other is a patient recently treated at that facility.” The hope is that the new vaccine can help put an end to the outbreak and curb the risk for healthcare workers. The recent outbreak draws attention yet again, to the inherent danger that infectious disease outbreaks pose in vulnerable countries. We’ve seen how fast and unexpectedly such outbreaks can spread beyond international borders (SARS, MERS, Ebola, etc.), which means that these are global health security issues. The 2013-2016 Ebola outbreak taught us a “great deal about how to respond in a fragile state setting. Traditional leaders and faith leaders played an important role in communicating necessary information and behavior change requirements to isolated groups who did not necessarily trust the government or health care workers.” Preventative measures like stronger public health and healthcare infrastructure can make a world of difference. “Preventative investments can mean the difference between life and death for people in those countries and the difference between an outbreak being contained or becoming an epidemic. As we face repeated outbreaks of infectious diseases, including new pathogens, it is essential that U.S. policy-makers continue funding the operations that make containment possible.”

BWC Meeting of Experts
Don’t miss out on the daily reports from Richard Guthrie on the latest MX. You’ll definitely want to check out days six and seven, where national implementation and preparedness were discussed. How would countries respond to a potential act of bioterrorism? Guthrie notes that “Concerns were raised about whether bodies such as the World Health Organization should be engaged with any assessment of the cause of an outbreak if there were indications it was deliberate in case this brought the health body into the security realm with potential negative consequences for other health work. A number of contributions to the discussion noted that health officials would have different roles to officials looking to attribute the cause of an attack and there was a need to ensure that effective ways of operating together were established. An example of the challenges was given in WP.10 from the USA in the section on ‘preservation of evidence’.” The response and preparedness measures for each country can be complex and challenging when considering the global context of the BWC. For example, Saudi Arabia discussed its own preparedness measures for natural events during times when influxes of people were expected (pilgrimages).

 The Economic Burden of Antimicrobial Resistance and the Drive For Intervention
A recent study enumerated the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Their model utilized three components – correlation coefficient between human antibiotic consumption and resulting resistance, economic burden of AMR for five key pathogens, and the consumption data for antibiotic classes driving resistance in these organisms. “The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins.” Ultimately, they found that the cost of AMR per antibiotic frequently exceeded the purchase cost, which should encourage policy and consumption changes.

NASEM Report: Cooperative Threat Reduction Programs for the Next Ten Years and Beyond
The latest report from the National Academies is now available regarding the Cooperative Threat Reduction (CTR) Program. “The Cooperative Threat Reduction (CTR) Program was created by the United States after the dissolution of the Soviet Union to provide financial assistance and technical expertise to secure or eliminate nuclear weapons delivery systems; warheads, chemical weapons materials, biological weapons facilities, and nuclear, biological, and chemical weapons technology and expertise from the vast Soviet military complex. In a 2009 report, Global Security Engagement: A New Model for Cooperative Threat Reduction, the National Academy of Sciences (NAS) recommended adoption of a modified approach to thinking about CTR, including the expansion of CTR to other countries and specific modifications to CTR programs to better address the changing international security environment.” The report has insight from some of the time minds in the field of biological threats – Elizabeth Cameron, David Franz, James Le Duc, etc.

Stores You May Have Missed:

  • Key Global Health Positions and Officials in the USG – Have you ever wondered who is in charge for global health programs throughout the government? Look no further than this comprehensive list by the Kaiser Family Foundation.
  • CEPI Collaborative for Lassa Fever Vaccine“In a deal worth up to $36 million to advance the development of a vaccine against Lassa fever, the Coalition for Epidemic Preparedness Innovations (CEPI) today announced a new partnership with Profectus BioSciences and Emergent BioSolutions.”

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

Pandora Report 6.22.2018

 US Military Asks – What Would A SynBio Weapon Look Like?
A new study ordered by the DoD seeks to evaluate the potential for synthetic biology to be a biodefense threat. The report, Biodefense in the Age of Synthetic Biology, was issued by the National Academies of Sciences, and provides an actual ranking of national security threats that genetic engineering technology, like CRISPR, pose. “’Synthetic biology does expand the risk. That is not a good-news story,’ says Gigi Gronvall, a public health researcher at Johns Hopkins and one of the report’s 13 authors. ‘This report provides a framework to systematically evaluate the threat of misuse’.” The report includes a framework for assessing synbio capabilities as well as concerns related to the production of chemicals or biochemicals, bioweapons that alter the human host, pathogens, etc. The report also includes a section on related developments that impact the ability to effect an attack using a synthetic biology-enabled weapon, where the authors note several mitigation challenges posed by synbio. Some of the challenges to deterrence and prevention include accessibility of biotechnology, pointing to DIY biohackers, the iGEM competition, and traditional pathways like academic laboratories. Regarding the challenges in recognizing and attributing an attack, they note that “synthetic biology could also confound the ability to identify the causative agent in a biological attack. Despite the breadth and depth of available repository resources, there would not always be a reference specimen to use as comparator, particularly if the agent is markedly different from natural pathogens or toxins.” “According to the report, the US must now also track ‘enabling developments’ including methods, widely pursued by industry, to synthesize DNA strands and develop so-called chassis’ organisms designed to accept genetic payloads.” Consider the recent de novo synthesis of the horsepox virus by researchers in Canada that has opened up Pandora’s box regarding synbio and biosecurity. GMU Biodefense professor and graduate program director Gregory Koblentz noted that “Synthetic biology has provided the tools necessary to recreate the smallpox virus,” and “Safeguards against the misuse of those tools are weak and fragmented.”  “The US government should pay close attention to this rapidly progressing field, just as it did to advances in chemistry and physics during the Cold War era,” says Michael Imperiale, a microbiologist at the University of Michigan. The recent tabletop hosted by the Center for Health Security (Clade-X) even presented some real-world scenarios and gaps for dealing with a bioterrorism event that involved an engineered organism.

Gene Drives and Frank Discussions With CRISPR Scientists
Speaking of gene editing…GMU Biodefense professor Sonia Ben Ouagrham-Gormley recently sat down with Vox to discuss the good and bad side of gene drives in the context of genetically modified mosquitos and their place in the fight against malaria. Malaria kills hundreds of thousands a year and despite eradication efforts, it’s still a monumental task for public health. “We have eliminated malaria from the rich world; it used to be endemic to France just as it is to Mali today. And now, with CRISPR gene drives, we have the potential to wipe it out globally and save millions of lives. Gene drives allow humans to change the genetic makeup of a species by changing the DNA of a few individuals that then spread the modification throughout an entire population. In the case of malaria, the idea is to change the three species of mosquito most responsible for its transmission — Anopheles gambiae, Anopheles coluzzii, and Anopheles arabiensis — so that all their offspring would be male, effectively leading to the species’ extinction.” The debate though is that if gene drive was used poorly, it could cause irreversible changes in the ecosystem. Many worry about the potential for weaponization of gene drives or nefarious actors using it, but several biosecurity experts have pointed to the limitations of gene drive when it comes to making diseases more potent. “The biosecurity experts I talked to are deeply skeptical of those nightmare scenarios. Sonia Ben Ouagrham-Gormley, a professor in the biodefense program at George Mason University, says she doubts gene drives will be militarily effective in targeting rival countries’ harvests. ‘Animals and plants that are raised for food are generally monitored, and a gene drive can be easily detected in the genome of the animal,’ she explained. ‘Because of that regular monitoring, I don’t think gene drives would be a good tool for affecting a country via agriculture.’ Biosecurity experts like Ben Ouagrham-Gormley and Filippa Lentzos have concerns that are more social. “What happens if one of the few thousand fruit fly biologists around the world decides to act unilaterally and throws international talks on the matter into chaos? What if a grad student creates a gene drive that can’t reliably hurt people but can reliably terrify them?” If she wasn’t busy enough, Sonia Ben Ouagrham-Gormley recently returned from a research trip to China where she met with several CRISPR scientists and toured their laboratories. She discussed CRISPR developments in China and gave a talk at the University of the Chinese Academy of Sciences in Beijing (UCAS) on the technological, regulatory and technical challenges of CRISPR.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
We’re less than a month away from the workshop on all things health security, are you registered? Since we’re on the topic of biotechnology and biosecurity, our workshop is a great chance to hear from Supervisory Special Agent Edward You of the FBI’s WMD Directorate, Biological Countermeasures Unit. “Mr. You is responsible for creating programs and activities to coordinate and improve FBI and interagency efforts to identify, assess, and respond to biological threats or incidents. These efforts include expanding FBI outreach to the Life Sciences community to address biosecurity. Before being promoted to the Weapons of Mass Destruction Directorate, Mr. You was a member of the FBI Los Angeles Field Office Joint Terrorism Task Force and served on the FBI Hazardous Evidence Response Team.” Don’t miss Mr. You’s talk on the bioeconomy and biosecurity threats during this three-day workshop on all things biodefense!

WHO Releases New International Classification of Disease (ICD11)
The World Health Organization (WHO) released the latest ICD-11, which includes 55,000 codes for specific injuries, diseases, and causes of death. “The ICD is also used by health insurers whose reimbursements depend on ICD coding; national health programme managers; data collection specialists; and others who track progress in global health and determine the allocation of health resources. The new ICD-11 also reflects progress in medicine and advances in scientific understanding. For example, the codes relating to antimicrobial resistance are more closely in line with the Global Antimicrobial Resistance Surveillance System (GLASS). ICD-11 is also able to better capture data regarding safety in healthcare, which means that unnecessary events that may harm health – such as unsafe workflows in hospitals – can be identified and reduced.”

Ebola Virus Disease Outbreak Updates
The DRC has reported 5 more suspected cases in the Iboko health zone, which brings the total to 60 cases, included 28 deaths (38 confirmed, 14 probable, and 8 suspected) as of June 19th. The case fatality rate for this outbreak is at 47% and “‘The number of contacts requiring follow-up is progressively decreasing, with a total 1,417 completing the mandatory 21-day follow-up period,’ the WHO said. As of Jun 17, a total of 289 contacts were still being monitored.” WHO Director General Tedros Adhanom Ghebreyesus recently tweeted “Just over a month into the response in , further spread has largely been contained. In spite of progress, there should be no room for laxity and complacency until it’s finally over. This is a collaborative effort led by

 MERS Trends in Saudi Arabia – Hospitals and Households
Since January of this year, the WHO has reported 75 laboratory confirmed MERS-CoV cases and 23 deaths in Saudi Arabia. 21 of these cases were involved in four clusters (2 household and 2 healthcare) – “Cluster 1: From 2 through 4 February, a private hospital in Hafer Albatin Region reported a cluster of three (3) health care workers in addition to the suspected index case (four [4] cases in total). Cluster 2: From 25 February through 7 March, a hospital in Riyadh reported six (6) cases, including the suspected index. No health care workers were infected. Cluster 3: From 8 through 24 March, a household cluster of 3 cases (index case and 2 secondary cases) was reported in Jeddah. No health care workers were infected. Cluster 4: From 23 through 31 May, a household cluster was reported from Najran region with eight cases including the suspected index case. This cluster is still under investigation at the time of writing. As of 31 May, no health care workers have been infected and the source of infection is believed to be camels at the initial patient’s home.” The total number of MERS cases since 2012 is now 2,220. These clusters underscore the role of hospitals as amplifiers for MERS transmission during outbreaks and the importance of infection prevention efforts.

Infection Prevention Gaps Found Across Critical Access Hospitals
GMU Biodefense doctoral student Saskia Popescu addresses infection prevention failures and gaps within the United States and specifically in critical access hospitals. “These findings are not novel as staffing issues are problematic across the country in all types of hospital systems. The importance of having IPs within health care and ensuring they have access to training and the ability to focus on infection control activities—not just reporting tied to CMS reimbursement—is critical. IPs need time for activities such as education, rounding, antibiotic stewardship, and more. This study supports the notion that not only should hospitals be ensuring proper staffing and support for infection prevention programs, but that significant gaps exist across CAHs. In the areas where CAHs are the only health care patients may access, it is vital that infection prevention processes be supported and followed”

How Ready Is the United States For The Next Anthrax Attack?
This week the CDC reviewed their recommendations for mass vaccination in the event of an anthrax attack. “The way that people think about [nuclear weapons] is on a much, much grander scale than biological weapons, and I think that’s a misperception,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “If you use a contagious infectious disease, you really could create havoc on a different scale.” The Amerithrax attack was in 2001 and since then we’ve seen SARS, MERS, and Ebola as potential infectious disease threats that reveal a rather large spectrum of avenues for microbial events. “But there’s still a long way to go in terms of preparedness, Redlener said, adding that no city is fully prepared. Questions remain about what dosage of the vaccine to use for children, the safety of the vaccine for the general public, delivery and distribution of the vaccine and medications. ‘I think a vaccination program would be a nightmare. Who would administer it? Who would pay for it? Who would manufacture it? The cost of complications that may occur. I don’t think it would be practical,’ Redlener said.”

Stories You May Have Missed:

  • Gene-edited Farm Animals – “The team edited the animals’ DNA to make them resist the deadly respiratory disease known as PRRS – a move that could prevent billions of pounds in losses each year. However, consumers have traditionally been reluctant to eat genetically altered animals and crops. This poses a significant barrier to farmers owning gene-edited pigs. And because genome, or gene, editing (GE) is relatively new, the absence of regulation currently prevents their sale anyway.”
  • FDA Releases New Food Defense Guidance – “Today the US Food and Drug Administration (FDA) released the first of three installments of draft guidance on the intentional adulteration (IA) rule, part of the Food Safety and Modernization Act (FSMA). The rule is meant to guide the food industry on reducing the risk of exposing food facilities to IA, such as acts of terrorism. Unlike other FSMA rules that address specific foods or hazards, IA will require preventive measures for reducing vulnerabilities at all domestic and foreign companies that are required to register with the FDA as food facilities.”

Pandora Report: 5.18.2018

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report – 5.4.2018

Happy Friday and May the Fourth Be With You!

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

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

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

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

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

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

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

Stories You May Have Missed:

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

Pandora Report: 4.20.2018

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security: From Anthrax to Zika
The early-bird registration discount deadline is fast approaching, so make sure you’re signed up for the workshop on all things health security from July 18-20! Whether it’s the 2001 anthrax letter attacks, SARS and avian influenza, Ebola in West Africa, or dual-use research of concern, we’ll be covering it all in this three-day workshop. Where else can you mingle with some of the top minds in the field, engage with other passionate health security professionals, and learn about the latest issues in biodefense?

80,000 Hours Interview With Dr. Tom Inglesby – Careers & Policies That Can Prevent Global Catastrophic Biological Risks
If you’re not listening to the 80,000 Hours podcast, make sure to add it to your list. This is a wonderful podcast on making the right career choices and lucky us, they’re covering global health security jobs. In October, NTI’s Dr. Beth Cameron spoke about fighting pandemics and the challenge of preparing an entire country. Cameron spoke about the current state of American health security, what we’ve learned, new technologies, and more. This week, they spoke with Dr. Tom Inglesby from the Johns Hopkins Center for Health Security on how passionate health security gurus can pursue a career in the field, the top jobs, worrisome scientific breakthroughs, etc. You’ll even catch Dr. Inglesby discuss PhD programs and advisors in the field, in which he names GMU’s very own Dr. Gregory Koblentz! During his talk, Inglesby notes that “I don’t think it’s a good approach to think about it [catastrophic biological risk] as zero sum with other epidemic problems and here’s why: I think in many cases it’s gonna be similar communities that are thinking about these problems. I don’t think it’s likely, even if we really decided to get very serious as a world, I don’t think it’s likely that there will be a community solely dedicated. I don’t want to say never, because it could happen, but I don’t think it’s likely that there will be a robust enduring community of professionals that would only, solely be dedicated to global catastrophic risk, biological risks alone.”

An Afternoon with ASPR – Dr. Robert Korch and Dr. Dana Perkins
GMU Biodefense MS student Anthony Falzarano is reporting on his time at the National Academies monthly series on biological, chemical, and health security issues. “This luncheon – consisting of an open forum session with a two-member panel and a moderator – featured Dr. George W. Korch and Dr. Dana Perkins, both from the Department of Health and Human Services office of the Assistant Secretary for Preparedness and Response (ASPR). Drawing from their current roles with ASPR as well as their illustrious careers and vast experiences, two presenters made for a compelling afternoon discussing health security issues and the work being done by ASPR to prepare for and address them.” Make sure to read his report-out on this luncheon to learn Dr. Korch’s favorite priorities for ASPR!

Chemical Weapons Attack on Douma – Update
Last Saturday, 105 missiles were fired against three Syrian chemical weapons facilities in a joint effort by the U.S., UK, and France. While this is unlikely to have completely removed Assad’s chemical weapons capabilities, many are wondering how effective the airstrike truly is. “‘This is now part of their standard combat doctrine’,” said Gregory Koblentz, a chemical weapons expert at the Schar School of Policy and Government at George Mason University. The attack April 7 that triggered the U.S.-led retaliatory strikes forced the surrender of a rebel group holed up in a suburb of Damascus. ‘It changed the course of battle on the ground,’ Koblentz said.” Social media is also increasingly playing a large role in the U.S. and Russian dialogue of the attacks. “The heavy reliance of President Donald Trump’s administration on publicly available information marks a shift from his predecessor’s, which insisted on obtaining physical evidence of chemical weapons use with an established chain of custody before considering the use of force. It also highlights the difficulties Western intelligence agencies have faced in obtaining such evidence — blood, hair, or soil samples — from the Damascus suburb of Douma in the days following the April 7 chemical weapons attack that left nearly 50 dead and hundreds wounded.” The Director-General of the OPCW (Organization for the Prohibition of Chemical Weapons) recently provided an update on the fact-finding mission (FFM) in Douma, which you can find here. Challenges were found in OPCW actually getting into the site. “The United Nations Department of Safety and Security (UNDSS) has made the necessary arrangements with the Syrian authorities to escort the team to a certain point and then for the escort to be taken over by the Russian Military Police. However, the UNDSS preferred to first conduct a reconnaissance visit to the sites, which took place yesterday. FFM team members did not participate in this visit.On arrival at Site 1, a large crowd gathered and the advice provided by the UNDSS was that the reconnaissance team should withdraw. At Site 2, the team came under small arms fire and an explosive was detonated. The reconnaissance team returned to Damascus.” “The delay in the inspectors’ arrival, 10 days after the attack, will raise fresh concerns over the relevance of the OPCW investigation and possible evidence-tampering. The efforts to investigate the attack, which has been blamed on Bashar al-Assad’s government and sparked a joint operation by the US, Britain and France to bomb chemical weapons facilities near Damascus, has been repeatedly delayed despite Syria’s claim to have established full control over Douma and the surrounding region.” Koblentz notes that “Douma has been completely surrounded by the Syrian government and has been subject to intensive bombardment as part of the regime offensive since February,. The problem is that the territory is now occupied by the Syrian government and the crime scene is no longer secure. It doesn’t lend itself to a credible investigation. It’s like the criminals came back to the scene of the crime and they can do whatever they want with the evidence before the cops show up.”

CRISPR, Avengers, & Super Soldiers, Oh My! 
As we get closer to the release of Marvel’s Avengers: Infinity War, discussions about super soldiers and genome editing are growing like a mean, green, fighting machine. A frequent topic of conversation during the December 2017 Meeting of States Parties (at least among the ELBI attendees!), Matt Shearer posed the question – is Captain America a biological weapon? What about the other Avengers though – like Hawkeye, who is one of the few “normal” humans in the group? “Hawkeye’s accuracy with a bow and arrow is heavily dependent on his eyesight, which is clearly more advanced than the average human’s. As far as we know, his genome has not been intentionally altered, leading us to believe that Hawkeye has inherited his extraordinary eyesight from his parents. This theory is strengthened by the fact in the Marvel comic books, Barney Barton, Clint’s brother, is also an accomplished archer thanks to his enhanced vision. Perhaps Hawkeye’s advanced eyesight is the result of thousands of years of genetic evolution in the form of adaptation, genetic drift, or mutation of his ancestor’s DNA.” Writers at Synthego decided to look at which genes would need CRISPR modification to improve vision – like targeting specific opsin genes OPN1SW, OPN1MW, etc.

Survey – Most Americans Favor More Funding to Support Biosecurity Capabilities
A new survey by Alliance for Biosecurity has found that public confidence in US preparedness to address biosecurity has dropped. “Nationally, 73% of the 1,612 Americans surveyed say they would have a favorable reaction ‘if Congress decided to increase the budget this year for developing preventive measures for biological and chemical threats.’ How elected officials act on biosecurity issues is important enough to affect voters at the ballot box, according to the survey. A majority of Americans – 52% –  say they are more likely to support their elected representative if that representative is ‘actively engaged in promoting and supporting biosecurity.’ Similarly, 52% say they would become less likely to re-elect a representative who voted AGAINST providing additional funding to the Strategic National Stockpile (SNS) and Biomedical Advanced Research and Development Authority (BARDA). Only 20% say voting against the additional funding would make them more likely to re-elect that representative.” The survey found that only 31% of Americans are confident in our national preparedness, which is a drop from the 50% found in a March 2016 survey.

Curious 2018
Are you planning on being in Germany July 16-18? Don’t miss out on the Curious2018 Future Insight conference in Darmstadt. “The Curious2018 Future Insight conference is a world-renowned event around the future of science & technology and its application to build a better world for humanity. The best minds in science, technology, and entrepreneurship will come together to make great things happen and join forces to realize the dreams of a better tomorrow.” Topics will include healthy lives, materials & solutions, life reimagined (synthetic biology!), vibrant digital, and bright future.

Foodborne Illness Outbreaks – Romaine Lettuce and Eggs
Cobb salads may be taking a beating this week as two main ingredients are setting food epidemiologists into overtime with E.coli and Salmonella outbreaks. Three days ago, it was announced that the source of a 16-state E. coli O157:H7 outbreak, had been identified as a romaine lettuce farm in Yuma, AZ. The CDC recently announced that 53 people have been sickened and the common ingredient amongst them was chopped romaine lettuce, which was traced back to the Yuma region. If that wasn’t bad enough, over 206 million eggs have been recalled across 9 states due to a Salmonella outbreak linked back to eggs from a farm in Hyde County, N.C., and distributed by an Indiana company. “The FDA said the voluntary recall is the result of 22 illnesses reported in East Coast states, which led to extensive interviews and an inspection of the Hyde County farm. The outbreak involves the Salmonella Braenderup subtype. Federal and state officials have been investigating the outbreak since early March.”

Stories You May Have Missed:

  • Holding Russia Accountable in Salisbury– During this week, the UN Security Council and the Executive Council of the Organization for the Prohibition of Chemical Weapons (OPCW) met to discuss the most recent OPCW findings. Per the U.S. State Department – “The OPCW’s independent report, released last week, confirms the UK lab analysis regarding the identity of the chemical used in Salisbury. We applaud the OPCW’s expeditious support and technical efforts to uncover the facts. We fully support the UK and the need for today’s special meetings of the OPCW Executive Council and the UN Security Council to discuss the chemical weapons attack in Salisbury and the OPCW’s detailed independent analysis.”
  • Apartment Mice: Harborers of Disease? “In a study today in mBio, the researchers report that a genetic analysis of droppings collected from house mice in New York City detected several types of bacteria capable of causing gastrointestinal disease, including Shigella, Salmonella, Escherichia coli, and Clostridium difficile. They also found genes that confer resistance to fluoroquinolones, beta-lactam antibiotics, and methicillin. Overall, more than a third of mice carried at least one potentially pathogenic bacterium, and nearly a quarter carried at least one antibiotic resistance gene.”

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

Pandora Report 4.6.2018

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

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

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report 3.30.2018

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

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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