Happy National Nurses Day to all our readers in the US and a big thank you to the countless nurses working hard always, but especially during this pandemic! Our main focus this week is on the continued spread of H5N1 influenza in the United States and current challenges and evolving knowledge of the COVID-19 pandemic as BA.2.12.1 accounts for more and more cases. We have also included several new publications, a couple of great new podcast episodes, and announcements, including the launch of CBWNet. Finally, in case you missed it, check out our May 4 special feature on bioweapons in Star Wars on our site.
The Birds, 2022 Edition
Highly Pathogenic Avian Influenza A(H5N1) continues to spread in the United States with 32 states reporting at least one confirmed infected flock as of May 5, 2022. Iowa has the most infected birds currently, with USDA reporting a total of 13,373,901 infections in that state. Minnesota has the most infected flocks currently at 69. 34 states have also reported positive samples in wild bird populations across the country. This has prompted massive poultry culling across the US in an attempt to control outbreaks in commercial and backyard flocks. For example, Rembrandt Enterprises, a large egg producer in Iowa owned by the same person as the Minnesota Timberwolves, has culled 5.3 million hens so far using what some describe as inhumane methods, prompting multiple public protests at Timberwolves games (Rembrandt also laid off most of its staff in the process as well, contributing to the backlash). HPAI spreads rapidly through bird populations and is a particularly painful disease for the birds to suffer through. Many of the H5 and H7 subtype viruses cause severe, systemic disease with near 100% mortality, prompting the culls. Amid skyrocketing grocery prices, eggs and poultry are especially more costly these days, with nearly 9% of all US hens having been culled recently. This is particularly challenging as the world, including the US, has steadily increased its egg consumption over the last decade, with many turning to chicken eggs as a cheaper source of protein compared to meat.
While large commercial flocks are easy targets for rapid infection, illegal cockfighting rings are also pressing dangers. Cockfighting is illegal in all US states and it is penalized as a felony in 42 of them, though enforcement and punishment vary. Oklahoma, a state with at least 20 documented major cockfighting traffickers, is especially at risk as it is a prime location for inter-state shipment of fighting birds who have higher chances of coming into contact with commercial birds along the way. Of the Oklahoma rings, Wayne Pacelle (President of Animal Wellness Action and the Center for a Human Economy) said, ““Cockfighting has unique potential to make the avian influenza outbreak even more deadly and far-reaching. Cockfighters are orchestrating illegal fights in state that cluster people and their animals from multiple states, creating perfect conditions for birds to contract the disease and then to spread it back home when the derbies are done.”
This comes as some in the Oklahoma legislature seek to lessen punishments for cockfighting. State Rep. Justin Humphrey’s measure would also “redefine the definition of “cockfighting.” Only when the birds are fitted with artificial spurs, knives or gaffs would it be considered a cockfight. Language would be removed from the law that currently includes “any training fight in which birds are intended or encouraged to attack or fight with one another” under the definition of “cockfight.” This bill, HB 3283, passed out of committee with a 5-0 vote before failing to be voted on before the legislative deadline, though Humphrey later amended a similar Senate bill that subsequently also passed the House committee. Oklahoma City’s Journal Record wrote, “Tropical conditions overseas, where there is a demand for cockfighting birds, makes it difficult to raise healthy birds in those climates – that’s why they buy quality birds from Oklahoma, Humphrey said. Purchasers might buy several males aged 10 months, raise them to two years and then choose best to use for breeding the next generation.”
Colorado reported a case of H5 influenza in a person who had direct exposure to poultry while culling animals with presumptive H5N1 bird flu late last month. CDC has confirmed the case and insists that the public health risk of H5N1 remains low as this person had direct exposure to infected animals. The patient experienced several days of fatigue (their only symptom) and has since recovered following isolation and treatment with oseltamivir (Tamiflu). CDC has been monitoring exposed humans for symptoms since the outbreaks were first detected in bird populations in late 2021, finding just one case so far in the 2,500 people tracked. The UK notified the WHO of a confirmed human H5 case in South West England in January of this year, bringing the human case total to two so far this round. Over 880 human infections with previous H5N1 viruses have been reported since 2003, though the predominant H5N1 viruses circulating currently in birds globally are different from previous viruses, according to CDC. 10 people who came into contact with the Colorado case or were also exposed at work are under close observation.
Avian influenza (AI) cases have been documented in commercial flocks since at least the 1800s. However, AI became a much more troubling threat at the end of the 20th century when an H5N1 outbreak in Hong Kong resulted in 18 infections and six deaths in the human population and the culling of over 1 million chickens. Outbreaks of H5N1 naturally occur every few years, with the last one in the US occurring in 2014 and 2015. While bird flu viruses typically do not infect humans (and generally only infect those with close contact with infected animals), there is concern that these viruses might mutate and become better able to spread in human populations, potentially causing wide spread disease. There is no indication this has happened yet, but it is important to limit the opportunity for this to happen by containing the outbreak. Read more on precautions, including those for bird feeders, from the Raptor Center at the University of Minnesota.
Our Evolving Understanding of COVID-19 and Its Impacts
27 months into the pandemic, the United States reached 1 million COVID-19 deaths to on Wednesday. While not as high as they once were, the US is averaging about 600 deaths per day in its current 7-day average. Cases are continuing to climb as well across the country, with the BA.2.12.1 subvariant now accounting for 29% of new infections. The WHO also confirmed this week that the world saw 14.9 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021, a grim reminder of how severe this has been.
This comes as the FDA announced this week that it is limiting the EUA on the Johnson & Johnson/Janssen COVID-19 vaccine “to individuals 18 years of age and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate, and to individuals 18 years of age and older who elect to receive the Janssen COVID-19 Vaccine because they would otherwise not receive a COVID-19 vaccine.” The FDA stated this is because of the risk of developing thrombosis with thrombocytopenia syndrome associated with the J&J vaccine. Unlike the mRNA offerings from Pfizer and Moderna, the J&J vaccine uses more traditional viral vector technology, using a disabled adenovirus to deliver COVID-19’s DNA to cells, instructing them to produce the spike proteins. This prompts the body to mount an immune response by creating antigens. While the J&J vaccine was initially thought to be a game changer in terms of its potential to increase patient compliance versus that of the two dose vaccines, it only proved to be 66.3% effective in preventing lab-confirmed COVID-19 infection, despite being highly efficacious in preventing hospitalization and death in those who did fall ill. It also was later found to be less effective against the Delta and Omicron variants that emerged in late 2021. This EUA limitation comes alongside pandemic response challenges. With the prospect of more COVID-19 funding for the administration held up in Congress, it’s unclear if the Biden administration could even afford a broader push for second boosters the FDA has hinted at recently.
The recent Omicron subvariants have, in some ways, fundamentally changed how many think of the pandemic. With the federal mask mandate struck down, many, including Delta Airlines, have celebrated the “return to normal” and COVID-19’s transition “to an ordinary seasonal virus.” Megan Molteni with STAT News notes that COVID-19 has yet to find a seasonal cadence and COVID-19 is still more than capable of causing mass death and disability, as recently witnessed in Hong Kong. Omicron has brought a number of changes still, such as drastic differences in how the virus spreads among people. Whereas up to 80% of infections with the original version were caused by about 10 to 20% of those infected, Omicron is spreading much more in places like households, meaning superspreader events might be less important as key drivers of outbreaks. Given the drastic differences in variants, some scientists think it is worth turning to prior variants that never took off as much as ones like Delta and Omicron to better understand what future variants might bring, according to this new article in the New York Times.
Of course, the costs of this pandemic have not been limited to lives alone. A recent article in Nature examines the long-term health consequences of the COVID-19 pandemic on healthcare workers (HCWs). The results are not all that surprising–more front-line HCWs now show signs of PTSD than they did before the pandemic. In the article, Ouyang et al. seek to “investigate the development of posttraumatic stress disorder (PTSD) in HCWs in a longitudinal manner.” They also aim to further explore how risk perception impacts the evolution of PTSD over a longer period of time using a one-year follow-up study. Their study used HCWs in Guangdong, China (a coastal city bordering Macau and Hong Kong) and concludes, “Our data provide a snapshot of the worsening of HCWs’ PTSD along with the repeated pandemic outbreaks and highlight the important role of risk perception in the development of PTSD symptoms in HCWs over time.”
“Risky ‘Gain-of-Function’ Studies Need Stricter Guidance, Say US Researchers”
This new news piece from Nature details experts’ calls for the US government to improve its guidance on experiments that might make pathogens more deadly or transmissible. It covers the April 27 listening session offered by the National Science Advisory Board for Biosecurity (NSABB), to which Biodefense Graduate Program Director Dr. Gregory Koblentz provided a statement. The Nature article explains that, “Many at the listening session pushed for stricter oversight of risky-pathogen research, however. Some suggested that the HHS advisory-panel approach be extended to other US entities. Gregory Koblentz, a biosecurity-policy specialist at George Mason University in Arlington, Virginia, pointed out that pharmaceutical firms, philanthropic institutions and federal agencies, including the Department of Energy, the Department of Agriculture and the Department of Defense, also conduct research on potentially risky pathogens. They should adhere to the same guidelines, he said.”
While the debate about gain-of-function (GoF) testing has been strong over the last decade, it has gained renewed attention amid the COVID-19 pandemic and debates about the origin of SARS-CoV-2. In 2014, the US government announced a funding moratorium on GoF experiments that was lifted in 2017 after HHS implemented an extra review layer for such experiments. While most virologists think SARS-CoV-2 spilled-over to humans directly from animals, this has remained a political debate in the US centering on the Wuhan Institute of Virology. Regardless of COVID-19’s origin, concerns over these kinds of experiments and challenges in biosecurity standards should still be reviewed and addressed now before it is too late. Watch the NSABB listening session recording here and read the Under the NIH Poliscope blog post about it here.
“Building a Sustainable Biopreparedness Industrial Base”
The MITRE Corporation recently released this report discussing the state of the American biopharma industry and what objectives the US government should pursue within it. MITRE identifies several shortfalls across USG capabilities, the mRNA industry, and the mRNA supply chain and ecosystem. The report argues that “To counter strategic competition in this industry, the United States needs a focused approach to drive action and accountability on sustaining needed capacity and capabilities. However, a history of inconsistent priorities and funding constitutes a significant barrier to creating a strong partnership between government and industry in this sector.” The report outlines a number of courses of action the US government can take to help improve this capacity and help protect the US population from future biological threats.
“Strengthening Biological Security After COVID-19: Using Cartoons for Engaging Life Science Stakeholders with the Biological and Toxin Weapons Convention”
Novossiolova et al.’s new article in the Journal of Biosafety and Biosecurity reports on the development of an awareness-raising resource which uses the cartoon format to facilitate consideration of biological and chemical security issues. This resource takes the form of a cartoon series comprising five two-page thematic cartoons. The cartoon series was published by the London Metropolitan University, UK and is freely available online in 13 languages. Indicative facilitation notes aim to support the use of the cartoon series for outreach and training.
“Critical Federal Capabilities Needed to Evaluate Real-World Safety, Effectiveness, and Equitable Distribution and Use of Medical Countermeasures During a Public Health Emergency“
From the National Academies:
The COVID-19 pandemic has highlighted the importance of having access to real-world data and evidence to monitor and assess medical countermeasure (MCM) use and performance so policy makers can make more effective and rapid public health decisions, protect population health, and save lives. During public health emergencies, the use of MCMs, such as therapeutics, vaccines, and diagnostics, can be made available to the public under a range of regulatory access mechanisms.
This Rapid Expert Consultation was produced by individual members of the Standing Committee for CDC Center for Preparedness and Response. Its aim is to review and propose modifications to an initial draft list of critical federal capabilities presented by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration that are needed to evaluate real-world safety, effectiveness, equitable distribution, access, and use of MCMs during a public health emergency. This effort draws from expert input, published literature, and lessons learned from previous public health emergencies, as well as the ongoing COVID-19 pandemic.
“Summit on Strengthening the Nation’s Early Warning System for Health Threats: A Meeting Summary”
The White House released this meeting summary covering its April 19 Summit supporting the launch of the CDC’s Center for Forecasting and Outbreak Analytics (CFA). The summit included panels on Next-Generation Public Health Data and Analytics, Enabling Local Governments, Strengthening the System for Patients, and closing remarks from Dr. Sandi Ford, Special Assistant to the President for Public Health & Science, Domestic Policy Council.
“The Role of Public Health Emergency Management in Biodefense: A COVID-19 Case Study”
Incoming Biodefense PhD Student Ryan Houser recently published a new article in Disaster Medicine and Public Health Preparedness. Houser uses the COVID-19 pandemic to “explore the biodefense and public health preparedness landscape for tends in federal support and capacity building.” He identifies a number of consistent failures and concludes that, “To counter the increasing biothreats, the United States must invest in revamping the biodefense infrastructure to mimic and support public health emergency preparedness initiatives which will increase our resilience to various biothreats.”
Student Features
Biodefense MS Student Theresa Hoang‘s research paper, “The Hidden Pandemic: COVID-19’s Impact on Antimicrobial Resistance”, was recently posted on the Pandora Report. Hoang uses a number of case studies to discuss how AMR has grown as a threat over the course of the pandemic and what might be done to help combat this mounting public health crisis, including improvements in antibiotic stewardship programs.
Biodefense PhD Student Danyale C. Kellogg recently discussed the threat Chinese failed outbreak responses pose to global health security on the Schar School’s Center for Security Policy Studies (CSPS) website. Kellogg, a current CSPS Fellow, covers prior failures of the Chinese Communist Party in the COVID-19 outbreak response in addition to its efforts to cover up the spread of HIV/AIDS in Henan Province in the 1990s and SARS in the early 2000s. She discusses the challenges of preparing for future pandemics in light of a rising China that is more interested in usurping the international order than promoting global health security.
This Podcast Will Kill You Episode 95, Tetanus: An Inhumane Calamity!
The Erins go beyond the risks of rusty nails and Tdap booster requirements to discuss the biology, clinical presentation, and historical and modern challenges posed by this disease. They provide an especially interesting discussion of how neonatal tetanus in the American South impacted the field of epidemiology on top of all the other great content packed into this episode.
Franklin Institute’s So Curious! Podcast: What is Biohacking? From Bodybuilding to Bacterial Shoes
Episode 9 of So Curious! continues this season’s theme of Human 2.0 by discussing innovations in hacking the human body. Covering everything from cyborgs and laws and ethics, this episode features Ricky Solorzano (CEO of Allevi) and Scott Shunk (a physique athlete who provides an interesting perspective on this topic). Give it a listen!
The 2021 Global Health Security Index: A Tool for Decision-Makers in Latin America
The Nuclear Threat Initiative (NTI) and the Initiative for Global Security (IGS) are offering this Zoom event on May 11 at 3:30 pm EST. The GHS Index is a comprehensive assessment and benchmarking of health security and related capabilities across 195 countries. Since the launch of the first edition of the GHS Index in October 2019, much has changed as a result of the COVID-19 pandemic. The second edition of the GHS Index considers lessons learned from this experience and expands upon the measures of national level health security. National leaders across the globe bear a collective responsibility for developing and maintaining robust global capability to counter infectious disease threats. Political will is needed to protect people from the consequences of epidemics, to take action to save lives, and to build a safer and more secure world. Register here.
The Danger of Disinformation: Understanding Russia’s Propaganda Campaign Against Ukrainian Biological Facilities
Join NTI for a conversation with Dr. Gregory Koblentz, one of the world’s foremost biodefense scholars working at the nexus of health, science, and security, to discuss the ongoing Russian disinformation campaign against biological research facilities in Ukraine.
As part of an effort to justify its invasion of Ukraine, Russia has sought to sow doubt and confusion around the purpose of public health and research labs in the country, spreading disinformation that these facilities are conducting covert, offensive bioweapon development operations. This tactic is a longstanding favorite of the Russian government, going back decades. Koblentz will explore the true aims of Russia’s disinformation campaign in Ukraine and what the international community should do to counter it. This seminar will be held on May 17 at 11 am EST. Register here.
Lessons from COVID-19 for the Public Health Emergency Enterprise: What Happened to the Plans? – A Workshop
The National Academies of Sciences, Engineering, and Medicine Forum on Medical and Public Health Preparedness for Disasters and Emergencies is hosting a workshop exploring the nation’s Public Health Emergency (PHE) preparedness enterprise, through the lens of COVID-19 in the US. The workshop will be hosted on May 17 and 18, and will explore key components, success stories, and failure points throughout the entire PHE preparedness and response enterprise. Participants will also identify opportunities for more effective catastrophic disaster, pandemic, and other large scale PHEs planning at the federal, state, local, tribal, and territorial levels. Speakers include Dr. Deborah Birx (former Coronavirus Response Coordinator at the Office of the Vice President) and Dr. Gigi Gronvall (Senior Scholar at Johns Hopkins Center for Health Security). Register here.
Chemical and Biological Weapons Net Launched
The CBWNet research project received funding from the German Federal Ministry of Education and Research, lasting April 2022 through March 2026. The project will be carried out by the Berlin office of the Institute for Peace Research and Security Policy at the University of Hamburg (IFSH), the Chair for Public Law and International Law at the University of Gießen, the Peace Research Institute Frankfurt (PRIF) and the Carl Friedrich Weizsäcker-Centre for Science and Peace Research (ZNF) at the University of Hamburg. The joint project aims to “identify options to comprehensively strengthen the norms against chemical and biological weapons (CBW).” The project includes an analysis of the normative order of these regimes and investigation of the potential consequences of certain technological developments in light of changing security dynamics. The project’s site explains, “Wherever research results point to challenges for or a weakening of CBW norms, the project partners will develop options and proposals to uphold or strengthen these norms and to enhance their resilience.”
Russian WMD Disinformation Resources
The mountain of debunkings and academic commentary on the Russian disinformation campaign targeting DTRA’s Biological Threat Reduction Program-supported labs in Ukraine continues to grow. While a more comprehensive list and tool on the Pandora Report’s website is currently under construction, here are a couple of recent works on the matter:
“People’s Republic of China Efforts to Amplify the Kremlin’s Voice on Ukraine”
The US State Department released this Disarming Disinformation piece outlining how China and its state outlets seek to influence public opinion on Russia’s war in Ukraine. It discusses the PRC’s toolbox of methods to do this and offers a detailed timeline of these attempts along with more sources on the subject.
“Ukraine’s Battlefield Is Haunted by Putin’s Chemical Weapons Legacy”
William J. Broad’s new piece in the New York Times begins with the 2017 televised destruction of what President Vladimir Putin claimed was the last of Russia’s CW stockpile before diving into current concerns about his potential to use these weapons in Ukraine. Broad discusses differences between how the Kremlin treats nuclear and conventional war versus chemical war as well as past Russian uses of CW, including during the hostage crisis in a Moscow theater in 2002.
“Are Russia’s Claims of Ukrainian Biological Weapons a Propaganda Ploy?“
Deutsche Welle released this English language backgrounder on Russian disinformation focusing on BW. It includes a portion about accusations targeting modern Germany specifically, including the Bundeswehr Institute of Microbiology’s collaboration with Kharkiv’s Institute of Experimental and Clinical Veterinary Medicine.
EUvsDisinfo Now Available in Mandarin Chinese
The European External Action Service’s EUvsDisinfo is now offering articles published in Chinese to target Chinese-speaking audience with factual information about the war in Ukraine. This is in response to previous alignment of pro-Kremlin and Chinese state outlets using disinformation tactics on subjects like biological weapons and the origins of COVID-19. One report released in March (““生物武器被全面禁止，但是进行生物研究并不违法””/””Bioweapons Are Totally Banned, But It’s Not Illegal to Conduct Biological Research””) discusses the mission of the Nunn Lugar Program and the legal, important public health work it conducts in host countries.
The Pandora Report 
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