Pandora Report 9.15.2017

Global Health and the Future Role of the United States
The latest report from the National Academies of Science Engineering, and Medicine, is now available! “Growing forces for globalization have increased the interconnectedness of the world and our interdependency on other countries, economies, and cultures. Monumental growth in international travel and trade have brought improved access to goods and services for many, but also carry ongoing and ever-present threats of zoonotic spillover and infectious disease outbreaks that threaten all.” The report includes chapters on investing in global health for America and how such investments protect U.S. interests, the effects of globalization, and looking into the future. There are individual chapters on infectious diseases like pandemic influenza and global health security as national security, TB, and how we can enhance productivity and economic growth. “By investing in global health over the next 20 years, there is a chance to save the lives of millions of children and adults. Beyond these health benefits to individuals, global health is directly linked to economic productivity and growth worldwide. According to the Lancet  Commission on Investing in Health, the return on investments in global health can be substantial—as the benefits can exceed the costs by a factor between 9 and 20, for low-income and lower middle-income countries, respectively. Worldwide, investing in core capacities to prevent, detect, and respond to infectious disease outbreaks through the development of multidisciplinary ‘One Health’ systems focused on the interface of human and animal health can result in an estimated savings of $15 billion annually from the prevention of outbreaks alone.” The report emphasizes the importance of continued commitment to global health and that ultimately, aid is truly an investment in global health, which benefits us all. Disease knows no borders and an outbreak anywhere is an outbreak everywhere. Melinda Gates also recently discussed the importance of foreign aid, noting that “If we don’t make these investments in global health, my argument to people is, you’re going to see a lot more things like Ebola in our own country, and we’ll be dealing with them in our own health clinics because borders are porous,”.

GMU Biodefense Graduate Program Information Sessions 
Don’t miss out on the chance to learn about our PhD program on September 21st! You can join the info session at 7pm at the GMU Arlington Campus. The GMU Schar School PhD info session will also include a panel of current PhD students to discuss their experiences and answer questions. This is also a great chance to chat with faculty and learn about admissions. Where else can you study a range of topics that include biosurveillance, select agents, global health security, and policy with such an engaged group of faculty and students?

Tom Frieden Launches New Global Health Initiative
Former CDC director Dr. Tom Frieden is launching a new program to combat not only global cardiovascular disease, but also infectious diseases. The new initiative Resolve to Save Lives, will be located in New York City, and “will prevent heart attacks, strokes, and epidemics with the goal of saving 100 million lives and making the world safer from epidemics.” The initiative has $225 million in backing over the next five years by major funders including the Chan Zuckerberg Initiative, Bloomberg Philanthropies, and the Bill and Melinda Gates Foundations. Frieden hopes to work with major players like the WHO and CDC “to persuade more countries to ban trans fats and lower the salt content in foods and shore up defenses against disease outbreaks”.

Johns Hopkins Center for Health Security ELBI Workshop
The Johns Hopkins Center for Health Security Emerging Leaders in Biosecurity Initiative (ELBI) recently hosted their last event for the 2017 class. The 2017 group capped off their fellowships with a day of engaging lectures and discussions including talks from FBI SSA Ed You, STAT reporter Helen Branswell, MIT’s Peter Carr, and more. The group was able to tour the Ginkgo Bioworks and George Church labs while chatting with Andy Weber, George Church, Patrick Boyle, Tom Knight, and Devin Leake about the future of synbio and biotechnology. Last but not least, the fellows participated in a viral storm exercise, which challenged them through a real-world scenario that required policy, security, public health, and science responses on a global scale. GMU biodefense PhD student Saskia Popescu attended as a member of the class, noting that “one of my favorite parts from this workshop was getting to hear from Tom Inglesby and several analysts from the CHS regarding their research and initiatives they’ve worked on. Learning about projects like Outbreak Observatory, data-driven outbreak response (outbreak science), and healthcare capacities during natural disasters, was fascinating and really opened my eyes to the range of topics the CHS is involved in.”

Biological Engagement Programs: Reducing Threats and Strengthening Global Health Security Through Scientific Collaboration
Don’t miss out on this latest eBook addressing biological engagement programs and the health security perspective. “Biological engagement programs are a set of projects or activities between partner countries that strengthen global health security to achieve mutually beneficial outcomes. Engagement programs are an effective way to work collaboratively towards a common threat reduction goal, usually with a strong focus on strengthening health systems and making the world a safer place. Cooperative programs are built upon trust and sharing of information and resources to increase the capacity and capabilities of partner countries.” You can download the PDF here – make sure not to miss the chapter “Strengthening Biosecurity in Iraq: Development of a National Biorisk Management System”, co-authored by GMU biodefense professor and graduate program director, Dr. Gregory Koblentz.

NAS Symposium on Cooperative Threat Reduction (CTR) for the Next Ten Years and Beyond
The National Academy of Science will be hosting this symposium on September 18-19 at the Keck Center in Washington, D.C. “In 2009 the National Academy of Sciences (NAS) report Global Security Engagement: A New Model for Cooperative Threat Reduction concluded that expanding and updating U.S. Government Cooperative Threat Reduction (CTR) programs in both form and function would enhance U.S. national security and global stability. The NAS Committee on International Security and Arms Control (CISAC) is convening a symposium to examine how CTR has evolved since that time and to consider new approaches for CTR programs and related WMD elimination efforts to increase their ability to enhance U.S. security. The symposium is sponsored by the Project on Advanced Systems and Concepts for Countering Weapons of Mass Destruction (PASCC) in the Naval Postgraduate School and will be open to the public. A ‘meeting in brief’ document will be issued by NAS after the symposium. For detailed information on this event and a draft agenda please visit:  www.nas.edu/cisac.”

Stories You May Have Missed:

  • GAO Report on Medical Devices for Infectious Disease Rapid Diagnosis – The latest GAO report is looking to the capabilities and challenges of technologies that allow for the rapid diagnosis of infectious diseases. Diagnosis of bio-threats is a crucial component to prevention and control, which makes the efficacy of these technologies critical. “Some stakeholders GAO spoke to identified the need for more clinical studies to establish the benefits of these technologies. Implementation challenges included reluctance by medical users to adopt these technologies, due to factors such as (1) lack of familiarity with such technologies, (2) costs and resources to use them, and (3) reluctance to order, and pay for, all of the tests for a given multiplex assay. Further, in some situations, positive test results for rare diseases are more likely to be false positives; thus systematic testing for such diseases may result in wasted resources to address all patients who test positive.”
  • CSIS Event: The New Barbarianism- don’t miss out on this event organized by the CSIS Global Health Policy Center on Monday, September 18th, from 6:30-9pm at the Newseum. “This hour-long film explores the recent surge of violence we’ve witnessed against the health sector across multiple wars, both new and old, and the accompanying shredding of international humanitarian norms”. Make sure to register here.

Pandora Report 9.8.2017

Happy Friday and welcome to your weekly source for all things biodefense. Got plague? Good news – if you have some live chickens hanging around, you can try this medieval treatment.

Defense Against Biological Attacks
Biological threats come in all shapes and sizes – whether it’s an outbreak of Ebola, a biological weapon, a laboratory mishap, or even the potential for biosafety breaches following  a hurricane. Preparedness and response efforts need to be just as diverse. As Texas begins the process of rebuilding and the threat of nuclear weapons has been fresh in everyone’s mind, it is crucial we don’t forget about the importance of health security. Disease knows no borders and it’s easy to diminish the threat of it however, Laura Holgate and Elizabeth Cameron are drawing attention to the need for President Trump to prevent the next biological attack before it happens. “As Congress and the Trump administration mull a new biodefense strategy, we urge them to use this time — the time in between biological crises — to get ahead of the curve before the next major biological event inevitably comes our way.” They point to several different strategies that should to be followed – watch out for emerging threats in unstable regions, fund and renew the Global Health Security Agenda, replenish the budget to maintain global biosecurity, keep laboratory assets for attributing biological attacks, and use biosurveillance to stop outbreaks before they start. We need to take the National Bioforensics Analysis Center off the chopping block, stop slashing the biosecurity budget as programs like the Cooperative Biological Engagement Program are vital, and truly, the GHSA renewal is a no-brainer. These efforts not only defend against current threats, but work to address the next generation of bioweapons and biothreats.  Holgate and Cameron note that “We know that biological threats must remain at the top of the national security agenda, and leaders must recognize that stopping outbreaks at the source requires strong global and domestic capacity to prevent, detect and rapidly respond to naturally occurring outbreaks and biological attacks”

Health Security – Call for Papers
The Health Security journal is currently looking for papers on communication and health security: improving public health communication in response to large-scale health threats. Manuscript deadlines are October 20, 2017. “Effective communication is an essential tool in establishing an appropriate response to any large-scale health threat or disaster, such as a newly emerging infectious disease, terrorism, environmental catastrophe, or accident. Yet, public health communication is occurring in an increasingly complex world with competing messages, new platforms, and limited trust.A special feature in Health Security will be devoted to analysis of the current communication environment and efforts to effectively communicate during outbreaks of infectious diseases and other health threats. The journal seeks papers that address the wide range of policy, practice, and research issues relevant to communication in large-scale health events.” Topics might include exploration of the communication environment during recent infectious disease events or public health disasters, investigation of the role of social media and other emerging or recently emerging communication platforms, etc. Submission information can be found here.

GMU Biodefense MS – Open House on September 14th
Don’t miss out on the Master’s Open House next week for the GMU Biodefense MS program!  From 6:30-8:30pm next Thursday, September 14th, at the GMU Arlington campus, you can speak to faculty, learn about admissions, and why biodefense students have a blast while getting their graduate degrees. This is a great chance to learn about the MS program (for both online or in-person) and chat with faculty about the exciting classes and activities GMU biodefense students get to enjoy.

The Biological Weapons Convention At A Crossroad
As Robert Frost once said, “Two roads diverged in a wood, and I- I took the one less traveled by, and that has made all the difference.” Which direction will the BWC take? Bonnie Jenkins investigates the uncertain future of the BWC, its current challenges, which direction it might take, and the direction it should take. Despite its relevance and capacity to endure decades of challenges, the latest RevCon was considered a monumental disappointment and left many in a state of disagreement. “Some of the major issues that were discussed at previous meetings—but at this point have no platform for discussion at the BWC—include advances in science and technology, disease outbreak preparedness and response, and national BWC implementation. Previously-held mid-year experts’ meetings have also been dropped, so there is now no chance for the exchanges with experts from relevant international organizations, including input from the World Health Organization that has been so useful in the past. These are all steps backward.” Despite a lack of Meeting of States Parties in August, there is hope that the December meeting with work towards developing an inter-sessional work program. On top of these barriers, the BWC has funding challenges, which severely impacts the Implementation Support Unit (ISU). Against these odds, the BWC ISU continues to promote universal membership and treaty implementation. Global initiatives are also beneficial to promotion of health security and prevention of biological weapons. “When global initiatives interconnect like this, it reinforces all of the initiatives. The Global Health Security Agenda, for instance, brings over 55 countries together to strengthen countries’ capacities to prevent, detect, and respond to infectious disease threats, whether natural, deliberate, or accidental.” These efforts seek to strengthen the BWC through global health security, but there is still work to be done. Jenkins suggests three tasks are crucial to maintain BWC relevancy and sustainability: “1) Sufficient and sustained funding by states parties, to include payments now in arrears; 2) Strong leadership and a successful December MSP that reaffirms the importance of the treaty to the international community and that also develops an inter-sessional work program; and 3) A vision for developing the role of the BWC as part of a larger interconnected global security architecture.”

Using Ebola Data to Fight Future Outbreaks
Learning from past outbreaks to avoid future failures is always a tough aspect of public health however, a new strategy is using data to help stop the next outbreak of Ebola. Researchers have developed a new platform to help organize and share Ebola data that was previously scattered and unable to be utilized. This was a significant issue on the ground during the 2014/2015 outbreak, which makes this project all the more important. “The information system is coordinated by the Infectious Diseases Data Observatory (IDDO), an international research network based at the University of Oxford, UK, and is expected to launch by the end of the year. At a meeting to discuss Ebola on 7–9 September in Conakry, Guinea, the team heading the platform will seek input from West African scientists, health officials and advocacy groups.” One of the most vital components to the system is the emphasis of partnership and involvement of African collaborators. Not only will this focus encourage the use of historical data, but will also allow utilization during future outbreaks. Control of the data has also been a challenging hurdle to overcome, as there are many cooks in the kitchen. “Amuasi says that he would have liked the database to be hosted and curated in Africa, rather than in Oxford, because training and paying African researchers to manage the platform would teach them how to use the information and improve their ability to respond to future outbreaks in the region. But he adds that this seems unlikely, because it would raise the cost of the project, and the infrastructure already exists at Oxford. Merson says that a copy of the database will be maintained in West Africa, although its exact location has yet to be determined. She adds that an African committee may be in charge of deciding who gets access to the data. And she says that fellowships are likely to be made available for West African students who want to work on the database.”

The Global Health Security Agenda: Public & Private Partnerships
The Global Health Security Agenda Consortium and EcoHealth Alliance will be hosting this meeting on Thursday, September 14th at 12pm. Held at the ONE UN New York Hotel in NYC, you can catch this event with speakers like Dr. Beth Cameron from the Nuclear Threat Initiative and Admiral Tim Ziemer from the US National Security Council. Make sure to RSVP here.

Launch of International Health Regulations Costing Tool
Georgetown University Center for Global Health Science & Security is launching their new open-access IHR costing tool. “In 2016, the World Health Organization adopted the Joint External Evaluation tool (JEE) to measure country-specific progress in developing the capacities needed to prevent, detect, and respond to public health threats, as mandated under the 2007 International Health Regulations (IHR). However, national governments and development partners have struggled to accurately define the costs of strengthening and maintaining critical health security systems that often depend on multi-sectoral coordination. This poses a serious dilemma for global health security and presents a compelling opportunity to improve the drafting and implementation of practical health security policies.” A joint effort with Talus Analytics, this new tool was developed to help estimate the cost to build capacity under the IHR. You can access the tool here (you may want to use Google Chrome).

IDSA Slams Budget Cuts to AMR
Biodefense budgets aren’t the only ones to be taking a beating… The president’s FY2018 budget released in May would cut the CDC’s Antibiotic Resistance Solutions Initiate (ARSI) by 14%, as well as 23% from the NIH and NIAID, which funds research on AMR. Leaders from Infectious Disease Society of America (IDSA) are rallying to oppose such efforts. “In a letter published yesterday in Annals of Internal Medicine, IDSA treasurer Helen Boucher, MD, past president Barbara Murray, MD, and current president William Powderly, MD, argue that the budget cuts for public health and research proposed by the Trump administration will not only diminish the nation’s surveillance capacity and its efforts to reduce infections and promote appropriate antibiotic use, but also undercut US leadership in global efforts to tackle the AMR threat, which is responsible for more than 700,000 deaths each year globally.” The letter emphasizes that such cut would severely impact AMR efforts, which is highly worrisome and dangerous given the severity of the global AMR threat. You can read the letter here.

An Integrated Approach to Forensic Investigation of Threat Agents
In the wake of a chemical or biological event, threat analysis is a high-stakes operation that has little room for error. Determining the substance, origin, and components all make for a stressful situation that requires effective analytical methods. “Traditional analytical methods are good at confirming the presence or absence of a particular agent or substance. If a sample is believed to contain Bacillus anthracis, standard biological analysis will quickly determine whether or not this is the case. But it will not provide insight into its virulence, origin or how it might have been manipulated. And if the sample turns out to be something other than B. anthracis, it will not tell you what it actually is. An integrated approach to CB forensics provides investigators with richer information. Integrated forensics combines advanced forensic science technologies to provide more comprehensive and timely technical intelligence.” Some of these strategies include advanced genomic analysis like massively parallel sequencing and advanced chemical analysis like gas chromatography and high resolution mass spectrometry. Currently, the extraction methods for biological analysis can render the sample unusable for chemical analysis, which make analysis problematic. A new strategy from Battelle is looking to combat these discrepancies, which involves a new process to “systematically triage samples and integrate biological and chemical forensics, as well as developing and testing new technologies to help investigators more quickly identify and characterize biological agents, including new, emerging and synthetic agents, to glean more forensic information from the samples.”

Stories You May Have Missed:

  • Zika Vaccine Efforts Slow– Sanofi recently announced they are halting work on a candidate Zika vaccine. The vaccine was a joint effort with Walter Reed Army Institute of Research however, budgetary cuts and federal efforts to scale back put the project in jeopardy. “In its Sep 1 statement, Sanofi said BARDA informed the company on Aug 17 that the agency reassessed its Zika-related projects and have decided to focus on a more limited set of goals and deliverable, and that BARDA has decided to “de-scope” its contract with Sanofi for the manufacture and clinical development of an inactivated Zika vaccine. BARDA said it would limit its funding to a case definition and surveillance study, as well as any activities needed to pause work on the vaccine until an epidemic re-emerges. As a result, Sanofi said it doesn’t intend to continue developing or seek a license from WRAIR for the Zika vaccine candidate.”
  • Australia Battles Influenza – As Australia experiences a particularly harsh flu season, many are wondering what this will mean for Europe and North America.”In general, we get in our season what the Southern Hemisphere got in the season immediately preceding us,” Fauci said. An “intelligent guess,” therefore, is that the north will probably have a bad flu season. “With influenza, it is never 100%,” he said. “So when you talk about influenza, almost nothing is absolutely precision,” Fauci said. “In general, one can say we usually see here what they see there in their season.” Schaffner agrees: “There’s not a one-to-one correlation.” Still, hearing about Australia’s high number of flu cases, he said, “I started to tighten my belt.”

Pandora Report 8.25.2017

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

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

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

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

Pandora Report 8.18.2017

ECDC Tool for Prioritizing Biothreats
The European Centre for Disease Prevention and Control has released their tool for the prioritization of infectious disease threats. “This qualitative tool, implemented as an Excel workbook, is based on multi-criteria decision analysis. It ranks infectious disease threats in a transparent, comparable and methodologically reproducible manner. The tool enables the relative ranking of different infectious disease threats. It is intended as a supplement to other methods that also support decision-making in preparedness planning.” Part of the tool involves a scoring of diseases, in which it suggests that a multidisciplinary expert group works to establish reliable information and adequate scoring. The ECDC tool also includes a handbook and manual for users to get the most out of it.

 Long Ignored: The Use of CBW Against Insurgents
GMU Biodefense PhD alum Glenn Cross investigates the use of chemical and biological weapons in counterinsurgency campagins like that of Rhodesia, South Africa, and Syria. Cross notes that history has shown the efficacy of CBW against ill-equipped and often poorly trained insurgents. He points to the debate regarding application of use – some say that these weapons are used when conventional forces are ineffective and often a last resort, while others note that the lack of an international and effective response have given insurgents incentive. “The conclusion from these examples is that regimes in extremis — when the battle is for their very survival — seem to have little compunction about resorting to chemical and biological weapons use. The much-heralded international norms and conventions prohibiting and condemning chemical and biological development and use go out the window when a regime’s survival is at stake. The examples of Rhodesia and Syria show that the international community must be united and demonstrate the requisite political will to enforce norms if the use of chemical and biological weapons is to be prevented.” Cross highlights two case studies, Rhodesia and Syria, pointing to the use of biological weapons by Rhodesian forces as being the only example of a nation using bioweapons since the end of WWII. While the regime was aware of treaty obligations, it had no bearing on their decision to use such weapons. So what are effective constrains on the use of CBW? The case studies reveal that regimes care little about their efficacy, international norms, or international agreements, but it is really deterrence that likely prevents the use of such weapons. The credible threat of military action is the strongest deterrent and realistically, until international norms include uniform enforcement amongst nations, they won’t be as effective. “As we’ve seen in Syria, such consensus is elusive, and the international community has failed to act. As a consequence, the world faces a sad, but inevitable conclusion. The Syrian regime is unlikely to ever face justice for its use of chemical weapons.”

A View from the CT Foxhole: Edward You, FBI Weapons of Mass Destruction Directorate, Biological Countermeasures Unit
As if we need any more reasons to think Edward You is a biosecurity action hero! The Combating Terrorism Center recently sat down with Supervisory Special Agent in the FBI’s WMD Directorate, Biological Countermeasures Unit, and discussed not only his role within the FBI but also their work and coordination with partners. You notes that hisprimary mission is to support outreach and engagement, but probably most importantly it is to backstop the WMD Coordinators who are positioned in the field. They have to cover the whole broad range of modalities—chem, bio, nuke, explosives. They do the initial engagements, the partnerships, the initial response, but they can always call back to headquarters where we leverage all of our expertise as subject matter experts. We can bring in the laboratory division; we can bring in Centers for Disease Control and Prevention (CDC), if necessary, the Department of Homeland Security to support them when they run into an incident out in the field.” He emphasizes the importance of the relationship the FBI has with the private sector, not only in terms of shared interests, but also communicating security problems to help get more buy-in and coordination. When asked about the DIY biohacker, You notes that “We look at these community labs as a big positive force in the economy and engines of innovation. That has helped us overcome the natural tendency for such outfits to be a little bit anti-establishment. By engaging with them, we’re helping them to raise their level of awareness that they could potentially be targeted by malicious actors seeking to subvert their work, steal their technology, or recruit insiders on their staff. By helping them establish a form of ‘neighborhood watch,’ they will be best positioned to identify and report on instances of suspicious activity both internal and external to their community. Who better to identify threats than the community members themselves?” While the partnerships with DIY labs haven’t garnered any leads to potential threats, they help the FBI understand the direction biotech is heading, which allows them to flag areas of concern faster than if they used a top-down approach. You also addresses the 2016 Europol warning of potential ISIS experimentation with bioweapons, commenting that “With ISIS, al-Qa`ida, or any other threat actor for that matter, we are faced with two significant challenges. The first is ideology. What happens if that lone individual that becomes persuaded by their ideology happens to be a microbiologist or a biochemist? The counter WMD mission has always proceeded by identifying the actors expressing the intent to acquire, develop, or use WMDs (e.g., counterproliferation efforts). And historically, significant effort and investments have been made to counter the biological weapon threat ranging from state/non-state actors to individual level biological crimes (e.g., attempted ricin poisonings). But this introduces the second challenge. Unlike the chemical and radiological/nuclear realms where materials of concern are highly regulated and the expertise is almost arcane, biology could be classified as dual use or multi-use. The strength of the field is based on the fact that it is inherently open in nature (e.g., peer-reviewed scientific journals), which has led to significant advances in areas such as healthcare.” Lastly, You points to what he considers the greatest biosecurity threat facing the U.S. – the concerns of non-state actors, but also the role of data in terms of gene editing and other biotech, noting that “we may have have been short-sighted. Most of our legal frameworks have been focused on privacy and not on security.” “Because there’s a lack of understanding about where bio is going, we’re in danger of falling behind, and my biggest concern is that for lack of our foresight and being strategic in this space, I think China is going to become a potential biological superpower.” Did I mention that Edward You is frequently a speaker at our summer workshops?

North Korea’s Chemical Arsenal Complicates U.S. Options 
As concerns over North Korea’s nuclear weapons program grows, the threat of chemical weapons has seemingly been downplayed. Tackling nuclear threats through preemptive strikes could push North Korea to utilize their chemical weapons program and sizable stockpile, which is considered to be one of the largest. “Experts are also disturbed by Kim Jong-un’s brazen public assassination of his half-brother using the nerve agent VX, saying it demonstrates the regime’s willingness to use deadly toxins. ‘I think if people paid more attention to the chemical side, they’d be less inclined to talk about preemption and going first against North Korea,’ said Greg Koblentz, a researcher of weapons of mass destruction at George Mason University.” In the event that chemical weapons are deployed, the South Korean capitol of Seoul would surely take a hit, which is home to 25 million people. While details of North Korea’s biological weapons program have given little insight into what is actually going on, there is considerably more knowledge regarding their chemical weapons initiatives. “The exact composition and size of North Korea’s chemical arsenal is unclear, but it’s believed to include everything from antiquated chlorine gas all the way up to sarin, VX, and other highly lethal nerve agents. These weapons are distributed at facilities across the country, often tucked away in underground bunkers or other sites unknown to U.S. and allied intelligence. The weapons are also deployed along the armistice line, which sits just 35 miles north of Seoul.” While there are limits to their chemical weapons capabilities, they surely provide little comfort to South Korean citizens and those living in Seoul.

 Chatting With the WHO
New WHO Director-General Tedros Adhanom Ghebreyesus spoke with Foreign Affairs’ regarding his plans for the future of the WHO and efforts to combat global disease. Tedros notes that epidemics or pandemics keep him up at night, especially something like the 1918 pandemic and the “serious gaps we have”. He comments that “I think the world should unite and focus on strong health systems to prepare the whole world to prevent epidemics—or if there is an outbreak, to manage it quickly—because viruses don’t respect borders, and they don’t need visas.” In regards to irrational beliefs as a public health threat, Tedros highlights the role of governments (and the WHO in supporting them) to communicate with communities and use media as a tool for teaching. Tedros discussed the WHO’s response to Ebola and when asked about hesitancy governments may experience regarding raising the alarm for an outbreak, he noted that “it’s not an issue between the WHO and the member state in question; it’s about the overall implementation of the International Health Regulations [the rules that govern how states respond to outbreaks]. That involves not only the country in question but other countries, as well. For instance, a country may fear the impact on the economy if it reports a certain disease. And if the other countries, instead of banning travel or other measures, could be supportive and implement the IHR, then the country could be encouraged to report immediately.”

Book Review – Barriers to Bioweapons
As the summer winds down, you may find yourself needing a new book to delve into. GMU biodefense professor Sonia Ben Ougrham-Gormley‘s book, Barriers to Bioweapons, is a great addition to any lover of health security and the realities of biological experiments. This latest book review gives a witty and entertaining overview of her work, noting that “Barriers to Bioweapons argues that actually, we’re not all living on borrowed time – that there are real organizational and expertise challenges to successfully creating bioweapons. She then discusses specific historical programs, and their implications for biosecurity in the future.”

Pandemic Preparedness & A Global Catastrophic Biological Risk By Any Other Name Would Smell As Sweet

GMU biodefense PhD student Saskia Popescu tackles the importance of pandemic preparedness and the latest publication from the Center for Health Security regarding global catastrophic biological risks. “We may think written plans and the occasional table-top exercise are making us more prepared to handle a pandemic, but true preparation goes far beyond that. The ability to prevent, detect, respond, and control outbreaks is a hefty investment that countries are still struggling to make, and as a new report recently revealed, a paltry amount of countries may be ready for a pandemic.” She highlights the latest World Bank report that only six countries have truly taken efforts to evaluate their readiness to handle a pandemic. Like many things, the devil is in the details, and often that is as simple as a real name for a problem. A recent publication from the Johns Hopkins Center for Health Security sought to fix this by establishing a working definition for global catastrophic biological risks (GCBR). “What makes this definition unique, aside from it being the first working definition for GCBRs, is that it highlights several components, such as sustained catastrophic damage, and instead of highlighting a specific number of deaths, it looks to a range of negative outcomes, such as infertility. The challenging task of defining such a globally feared, but poorly understood risk was daunting; however, the Center for Health Security has provided us with a working tool that can now be applied to policy, and future preparedness and response efforts.”

H5 Hits the Philippines and Plague in Arizona
The Philippines is reporting its first highly pathogenic H5 avian influenza outbreak. Hitting a commercial poultry farm in Luzon, the outbreak began in July and killed 36,485 of the 190,000 birds. “A report today in the Manila Times, based on a media briefing with Emmanuel Pinol, the country’s agriculture secretary, said the outbreak was confirmed in the city of San Luis and that six poultry farms were affected. Most of the poultry deaths were in layer chickens. Pinol told reporters that the outbreak may have begun as early as April when deaths were reported in quail housed above ducks. He said ducks are the likely source of the outbreak, since they had contact with migratory birds. The Manila Times report said the outbreak site is 37 miles north of Manila and is close to swamps that are stopovers for migratory birds from the Asian mainland.” Public health officials in Arizona have announced that fleas in two counties have tested positive for plague (Yersinia pestis). While plague is endemic in the southwest, public health officials still work to ensure residents are aware that there is an increased risk. Officials are warning residents to be mindful of the potential for exposure via pets. “Fleas can bite rabbits, prairie dogs and other rodents — and anything that may eat them — and transfer the disease to pets, who in turn can infect humans. Cats who get plague transmit it through their cough. Dogs typically carry the fleas on their fur. Health officials cautioned county residents and visitors to keep their pets leashed and to avoid touching dead animals. Evidence of a large die-off could indicate plague is present, they say.”

Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology
Don’t miss out on these events by the National Academies Committee on Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology:

  • August 21 – the committee’s interim report and proposed framework will be released at 11am EDT here
  • August 22 – a public release webinar and report briefing will be held from 11am-12pm EDT. Committee Chair Michael Imperiale and committee members Patrick Boyle and Andrew Ellington will be reviewing the interim report and the proposed framework. This webinar is free to attend and open to the public, but you must register to attend. You can register at the following link:  https://nasevents.webex.com/nasevents/onstage/g.php?MTID=e39277a767b1f0190db4f7ee491c01271  You will be able to submit questions and comments during this webinar through a text-based feature but will not be able to speak directly with the presenters.
  • August 23-24: The meeting will be held at the National Academies of Sciences, Engineering, and Medicine’s Keck Center at 500 5th Street NW, Washington, DC Room 208. You must register to attend the meeting in person; the Keck Center is a secure building and we will need to have your name on the guard’s list to enter the building. You can register by emailing synbiodefense@nas.edu. If you would like to attend via teleconference, you can access the conference by dialing the following: to listen, please dial 1-(866) 668-0721 and use conference code 380 454 1676.

The committee is also soliciting feedback from the public on the interim report and the associated framework. You can submit questions or comments through September 5, 2017 at the following link:  http://www.surveygizmo.com/s3/3758337/A-Proposed-Framework-For-Identifying-Potential-Biodefense-Vulnerabilities-Posed-By-Synthetic-Biology  Due to the anticipated volume of questions, the committee may not explicitly address every comment received but all comments will be considered and reviewed. PLEASE NOTE: if you submit a question, your question and any associated identifying information you provide will be added to the study’s public access file as per the National Academies’ requirements to comply with FACA.

Stories You May Have Missed:

  • Uganda Ebola-like Illness Demystified- Public health officials in Uganda are sighing with relief as results from the Uganda Virus Research Institute (UVRI) have reported the death of a 20-year-old woman in Luweero was due to carbon monoxide poisoning and not the suspected Ebola virus. “There are currently 3 female cases admitted at Bishop Asili hospital, Luweero. However, results from UVRI indicate that all cases were negative for Ebola, Marburg, Crimean-Congo hemorrhagic fever, Rift Valley fever, and Sosuga viruses. ‘The ministry of health team is working closely with the District Health Team to monitor, review, and manage these cases as well as orienting health workers on management and referral protocols of suspected cases,’ reads the statement.”

Pandora Report 8.11.2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

Pandora Report 7.21

Beat the heat and cool down with your weekly report on all things biodefense! Have you ever wondered how researchers become bug-chasers? Check out this story on what turned a wildlife biologist into a plague-chaser in the Southwest.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
Thanks to our amazing faculty and attendees for a successful (and fun) summer workshop this week. We heard from Ed You on safeguarding the bio economy, Dave Franz explained the dual-use dilemma in life sciences, Sonia Ben Ouagrham-Gormley discussed barriers to bioweapons, Andy Kilianski explained the ins and outs of biosurveillance, Kendall Hoyt discussed the role of innovation and MCM, Sandy Weiner highlighted the social and cultural disease amplifiers, and so much more! Did I mention that Greg Koblentz brought the house down by discussing why biosecurity is a wicked problem? You can check out the Twitter stream here to see some amazing photos and dialogue during the three-day event. Participants from all over the globe, with backgrounds in everything from infectious diseases to defense and academia, participated in talks that truly ranged from anthrax to Zika, with pit stops on influenza and Ebola. With the 1918/1919 pan-flu centennial anniversary next year, we’re already starting to put together a great workshop for the summer of 2018, so keep on the look-out for more info in the future.

The Future of the GHSA and American Biodefense
Next week in Seoul, a meeting will be held for the Steering Group of the Global Health Security Agenda (GHSA) to discuss what exactly the future entails for the group. While its five-year run will expire in 2019, many are pushing for the GHSA to be extended as it is a highly valuable piece to global health security and IHR compliance. “Recognizing that the GHSA’s work has never been more vital and would be impossible to replace, more than 100 health and health security organizations and companies operating in over 150 countries, including the Nuclear Threat Initiative (NTI), this week banded together to urge GHSA’s extension for at least another five years.” The NTI signed on for several reasons – the world is still not prepared to handle a pandemic of a lethal/easily transmittable disease and frankly, the GHSA provides measurement, accountability, and transparency, which are all desperately needed in global health security efforts. The NTI recently released a statement regarding their support for extending the GHSA beyond 2019, highlighting its irreplaceability and proven ability to help measure and support change in countries working to strengthen their prevention and response to biothreats. Next week’s meeting with be the first since President Trump took office, which makes its outcome that much more important. NTI cites several GHSA successes in efforts to highlight the desperate need we have for it – commitment of more than 75 countries, developing and implementing the first agreed set of global metrics for national health security, mobilizing the private sector to engage in pandemic preparedness and response, etc. Discussions regarding the future of the GHSA comes at a poignant time as the House Appropriations Subcommittee approved FY 2018 State and Foreign Operations (SFOPs) and Health and Human Services (HHS) Appropriations Bills. The approval supports efforts to maintain global health funding. The bill includes funding for the State Department and USAID through the Global Health Program (the bulk of global health assistance) and despite President Trump’s FY2018 request (which would have cut it by $1.8 billion, or 28%), it’s providing $3.8 billion, which is roughly 5% less than FY 2017. Also within the bill – “funding provided to CDC for global health matched the FY 2017 enacted level ($435.1 million) and was $85.1 million (24%) above the President’s FY 2018 request. Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $73.4 million, a slight increase above the FY 2017 enacted levels ($72.5 million); FIC was eliminated in the FY18 Request.” Despite the cuts that are suggested in his proposed FY 2018 request, the Trump administration is reportedly developing the first comprehensive strategy on biosecurity. A top White House homeland security official reportedly said that such efforts are underway and involve retired Admiral Tim Ziemer. “We have not had as a country a comprehensive bio-defense strategy ever,” White House homeland security adviser Thomas Bossert told the annual Aspen Security Forum, in Aspen, Colorado. “It’s high time we had a bio-defense strategy.” While Bossert points to the need for a biodefense strategy, it is crucial to remember that the U.S. has already gone through two biodefense strategies – the 2004 Homeland Security Presidential Directive 10 (Biodefense for the 21st Century) and 2009’s National Strategy for Countering Biological Threats. This news comes on the heals of Trump’s nominee for a key biosecurity position. Guy B. Roberts of Virginia was just nominated to be an Assistant Security, Nuclear, Chemical, and Biological Defense Programs within the DoD. “Mr. Roberts is currently president of GBR Consulting, a national security consulting firm. In that capacity, Mr. Roberts has provided subject matter expertise on arms control, non-proliferation, international legal issues and strategies to combat terrorism to over 30 international and domestic organizations and institutions. In addition, he is a senior associate with the Center for Strategic and International Studies and an adjunct professor teaching courses on homeland security, international terrorism, non-proliferation, and arms control at Mary Washington University and Virginia Commonwealth University. Mr. Roberts previously served as the Deputy Assistant Secretary General for Weapons of Mass Destruction Policy and Director of Nuclear Policy for the North Atlantic Treaty Organization.” You can catch some of his talks via C-SPAN here, and while there’s not a lot on his work in biodefense, you can read this paper within the USAF Institute for National Security Studies, entitled, “Arms Control Without Arms Control: The Failure of the Biological Weapons Convention Protocol and a New Paradigm for Fighting the Threat of Biological Weapons“. His paper notes that despite the 2001 U.S. rejection of the BWC protocol for more stringent compliance mechanisms, there was still substantial focus on biological weapons and potential threats (especially after the 2001 Anthrax attacks). Roberts notes that “The time for ‘better-than-nothing’ proposals is over. A united world, acting in concert across a broad front of areas utilizing the full panoply of financial, diplomatic, economic, and military resources at our disposal, with the firm determination to rid the world of these weapons of terror, is our best hope for success.” In all, with talks next week on the GHSA, presidential hopes of cutting health funding, and a supposed biosecurity plan in the works, the future of health security is seemingly in the air.

The Case of the Reconstituted Horsepox and Other Dual-Use Adventures 
Last week we, like so many others, were engrossed in the news that a Canadian research team had reconstituted horespox with $100,000 worth of supplies and mail-ordered DNA. The news of this unpublished study has raised a lot of red flags for those in the dual-use research community, as well as the debate on the remaining smallpox stockpiles. What’s most concerning about the project, led by virologist David Evans as the University of Alberta, is that it wasn’t stopped earlier on for DURC concerns and risk reviews. Gregory Koblentz, biodefense guru and director of the GMU graduate program, “says the work should never have been done. His worry isn’t so much that terrorists will cook up smallpox anytime soon. ‘My concern is that we have opened up the door to the idea that it is perfectly acceptable to synthesize [such] viruses without any oversight,’ Koblenz says. And if the necessary technology and expertise spread, it will become “that much easier at some point for those capabilities to be turned from peaceful uses to hostile uses’.” This project and the resulting discussions will surely play a pivotal role in the future of DURC and oversight, so we’ll make sure to keep you updated!

North Korea’s Bioweapons Program
GMU Biodefense professor Sonia Ben Ouagrham-Gormley is taking a deep dive into the realities of North Korea’s potential bioweapons program. Working backwards from the 2015 photo tour with Kim Jun-un at a pesticide facility that certainly had dual-use potential and was a seemingly obvious attempt to send a message to the U.S.,  Ouagrham-Gormley highlights the sordid history that is North Korean bioweapons. While South Korea has repeatedly claimed North Korean maintains an active program, there have been inconsistent reports elsewhere and Ouagrham-Gormley hones in on realities about this well-publicized dual-use equipment and facility. She notes critical aspects that would be missing from an active bioweapons program (even if you have all the shiny equipment), like consistent electricity, economic stability, and an effective laboratory/research management. While there are gaps in intelligence regarding the conditions that would truly facilitate an active (and successful) bioweapons program, “analyses of past state and terrorist bioweapons programs indicate that the continuity and stability of scientific and production work must be ensured over a long period of time to allow scientists and technicians to accumulate the knowledge necessary for development of a working bioweapon.” While many suspect that a North Korean bioweapons program was launched in the 1960s and then new infrastructure was built in the 1970s, there are a lot of questions regarding the continuity of such efforts. Were there breaks in between? Changing research teams and inconsistent management/organization all severely impact the efficacy of such secretive work. Perhaps one of Ouagrham-Gormley’s most critical points (and why you should check out her book, Barriers to Bioweapons), is that to truly assess the alleged bioweapons program, one has to understand the state of natural and medical science in North Korea. “Without a solid foundation in natural and medical sciences, a bioweapons program cannot succeed. When Soviet authorities issued a decree to expand the country’s bioweapons program in the early 1970s, they had to face the reality that Soviet science had fallen behind and needed modernization. Years of Stalin’s purges, along with the policy of Lysenkoism—which negated the role of genetics in science—had resulted in the elimination of a whole generation of competent scientists. Decades of economic sanctions, and the desperate state of North Korea’s economy and society, have undoubtedly had an effect on the scientific sector.” With these notions, Ouagrham-Gormley questions if the North Korean bioweapons program is more of a Potemkin village. While there is limited information on the organized scientific research in North Korea or real potential for such a program to exist, more information is needed, which would be a great task for a BWC verification regime.

Center for Biosecurity ELBI Research and Policy Symposium 
This week the Johns Hopkins Center for Health Security held their first research symposium for the Emerging Leaders in Biosecurity Initiative (ELBI). The current ELBI class and several alumni presented on research and projects they’re working on. The topics ranged from dual-use research to risk assessments, biosecurity, and more. During this time they also toured the Johns Hopkins Medical Center’s Biocontainment Unit. Two GMU biodefense students attended – Francisco Cruz (MS alumni and ELBI class of 2016) and Saskia Popescu (PhD student and ELBI class of 2017), who presented on the role of infection prevention in biodefense efforts.

Tackling the Next Epidemic With Big Technology
In an age of globalization and increasing spillover, the threat of naturally occurring outbreaks spreading from one corner of the globe to the other is a real fear. Fortunately, we also live in a time of great technological advances and a wealth of data. A recent article from B.Next highlights the availability of data technologies and how such big data can be woven into the fabric of public health prevention and intervention. Outbreaks and pandemics threaten global security and perhaps one of the biggest hurdles is matching the data needs with the limited supplies on the ground. Data gaps and lags are a massive problem when responding to an outbreak, especially in terms of specialized personnel and resource constraints. There are several technologies though, that could be applied to response efforts – novel data or means of collection, crowdsourcing methods, data cleansing, analytics, and visualization. “Improving response times for activities that have proven to be effective (i.e, non-pharamceutical interventions) need to be prioritized. The full potential of surveillance and advanced analytics for improving outbreak management has not yet been realized and, unfortunately, is not yet adequate to the task. We need a fundamental reconsideration of how to use combinations of data technologies for effective response management. Accomplishing this reconsideration and implementing it effectively will allow for faster, better, stronger responses. Past outbreaks have threatened national security, but they do not need to be as significant a threat in the future. Current and emerging data technologies can help tackle the next epidemic.”

Stories You May Have Missed:

  • USDA Test Finds Atypical BSE In Alabama Cow – A recent announcement from the USDA reported the finding of atypical bovine spongiform encephalopathy (BSE) in an 11-year-old cow in Alabama. This would be the 5th case in the U.S. since 2012 and the cow did in fact have symptoms of the disease, which was picked up by routine surveillance. “The animal never entered the slaughtering process and has not posed a threat to the food supply or to human health. The Alabama Department of Agriculture and Industries (ADAI) said in a press release yesterday that cow died after it was delivered to the livestock market and that routine tissue samples were taken and sent for testing. Tony Frazier, DVM, Alabama’s state veterinarian, said ‘This instance proves to us that our on-going surveillance program is working effectively’.”
  • Three Antibiotics Discovery Projects You Should Know About: With the threat of antimicrobial resistance only growing bigger, BARDA, CARB-X, and big pharma are bringing out the big guns with the Superbugs & Superdrugs USA this November. “Understanding the translational link between animals and humans; navigating the pitfalls of early drug discovery; and evaluating the potential of immunotherapies will be a major focus, as will hearing from a selection of biotech and pharma companies currently undertaking clinical research. This will include case studies from Pfizer, MedImmune, Merck, Visterra and ContraFect. Event highlights will include a keynote presentation by Tim Opperman, Senior Research Scientist from Microbiotix. The talk will discuss advances in the three-prong approach taken by Microbiotix to address the problem of MDR Gram-negative pathogens. It is claimed that all three discovery projects have demonstrated efficacy in murine models of infection.”
  • Stanford Hospital – A Canary In A Coal Mine: Stanford Healthcare is coming under increasing public scrutiny as a battle between members of an affiliated union have highlighted hospital infection rates as evidence for unsafe working conditions and patient safety. GMU biodefense PhD student Saskia Popescu takes a deeper dive into this situation and what it really means for healthcare infections and patient safety. “The healthcare industry is always in a battle against cutting costs, keeping patients safe, and maintaining high patient satisfaction; all while following federal regulations and requirements. Despite the alarmist nature that comes across in the media coverage on the Stanford case, we need to realize that this is only a glimpse through the window that is healthcare infection control and the struggle to follow best practices while working in an increasingly stressful environment. In this case, Stanford Health Care is the canary in the coal mine, alerting us that there’s a problem. They just happened to get the media scrutiny that comes with being pulled into a union debate involving the safety of employees.”

Pandora Report 6.30.2017

Happy Friday to all our amazing readers – we hope you have a lovey holiday weekend! Don’t miss the July 1st deadline for an early registration discount to the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security.

Preventing Pandemics and the Necessity of Funding Prevention
Next January will mark the centenary of the 1918-1919 pandemic influenza, but what have we really learned since then? The looming threat of antimicrobial resistance is slowly surrounding us, as is the increasing biothreat of zoonotic disease. Globalization, encroachment into animal habitats, and recent models that predict a 60-day global spread for a virulent strain of airborne flu virus, all paint a rather gloomy reality for the future of health security. So what are we doing? Not enough. That’s usually the answer in public health- a field of which you can comfortably say society likes to contribute the bare minimum. A highly pathogenic influenza virus that could engulf the globe in a pandemic isn’t the storyline for a horror movie, but rather something that even UN panels note is “not an unlikely scenario”. “Pathogens are not only terrifying, they’re expensive. The 2003 SARS epidemic cost $30 billion in only four months. A flu pandemic of a severity that occurs every few decades could contract the global economy by 5 percent — some $4 trillion”. Here’s where the economics of preventative public health come into play – vaccines are expensive to make and there’s little incentive when we’re not in the eye of a disease storm. Moreover, global health security is challenging. Politics makes disease response and preparedness a sensitive topic, especially during an outbreak. The key lesson to remember though, is that an outbreak anywhere is really an outbreak everywhere. So what preparedness tactics can we start utilizing? “The project is called CEPI — the Center for Epidemic Preparedness Innovations. After the world’s failure to control Ebola quickly in 2014 and 2015 cost 11,000 lives and at least $6 billion, three global experts proposed a vaccine development organization with $2 billion in start-up funding. Harvard, the National Academy of Medicine and the United Nations all created commissions that proposed ways to avoid another catastrophe. Among other steps, all endorsed vaccine development.” CEPI aims, in the next five years, to develop vaccine candidates for Lassa fever, Nipah, and MERS. “Creating vaccines is not the same as guaranteeing that people who need them can get them. CEPI will require its awardees to sell vaccines to the poorest and lower-middle-income countries (more likely, to donors who will buy vaccine for them) at the lowest possible price.” Perhaps one of the most poignant comments from this article was that the threat to this goal is not scientific, but rather political, highlighted by short attention spans. The World Bank has initiated it’s “pandemic bond” to aid in outbreak response should there be a public health crisis like that of Ebola in 2014. “The catastrophe bond, which will pay out depending on the size of the outbreak, its growth rate and the number of countries affected, is the first of its kind for epidemics. It should mean money is disbursed much faster than during West Africa’s Ebola crisis.” The Pandemic Emergency Fund (PEF) will offer coverage to those countries eligible for financing from the IDA (International Development Agency), which is dedicated to helping the poorest countries. Head of derivatives and structured finance at the World Bank’s capital markets department, Michael Bennett, noted that “if a trigger event occurs, instead of repaying the bond in full, some or all of the principal is transferred to the PEF trust fund. So essentially the investors are acting like insurance companies. The objective of offering the risk in both forms is that the bonds and swaps appeal to different types of investors, and therefore … we are creating the broadest possible investor pool for this risk,”. The PEF would provide more than $500 million in coverage over the next five years. Efforts to provide financial support to outbreaks before they reach pandemic potential are vital. It is estimated that had the PEF been available during the 2014 Ebola outbreak, $100 million could have been mobilized as early as July 2014, which may have prevented the outbreak spreading so rapidly and costing $2.8 billion. “The annual global cost of moderately severe to severe pandemics is estimated at roughly $570 billion, or 0.7 percent of global income, the World Bank said.”

Ebola Burial Teams 
The 2014/2015 Ebola outbreak in West Africa was not only the worst in history, but taught us a great many lessons about outbreak control. One of the most extraordinary lessons learned was just how valuable burial teams could be. Funerals became a significant source for disease exposure and transmission, especially for loved ones of the deceased, as washing and handling the body was customary. In effort to combat this high-risk activity, public health responders established burial teams comprised of paid volunteers, who would collect the bodies from homes and aid in their burial. The teams would don PPE and work with families to ensure they avoided exposure. Dignified burial through these teams helped ease much of the concern for families regarding the treatment of their loved one. A recent study published in the PLOS Neglected Tropical Disease Journal evaluated the impact of these burial teams using modeling and data from 45 unsafe community burials and 310 people who were identified as having contact with the infected bodies. Researchers found that those who cared for the Ebola patient just before their death were at greatest risk, meaning that caring for an infected loved one at home was far riskier than bringing them to a healthcare facility. The study estimates that the safe and dignified burials performed by Red Cross volunteers (the burial teams) prevented between 1,411 and 10,452 cases of Ebola. “Hundreds of paid volunteers took on the grim task of collecting bodies from people’s homes in full personal protective gear, while also having to manage the grieving families and communities. They were ordinary West Africans, such as teachers and college students. Many carried out the relentless and dangerous work for months. Some were stigmatised in their communities, because people became scared they might bring the virus home with them. In reality, they were helping to stem world’s worst ever Ebola outbreak.” In the end, the Red Cross burial teams managed over 47,000 burials, carried out more than 50% of all burials during the outbreak, and consisted of 1,500 volunteers.

Instructor Spotlight – Workshop on Pandemics, Bioterrorism, & Global Health Security
We’re nearing the last few weeks before our workshop and your opportunity to get the early registration discount, so don’t miss out! This week we’re happy to show off not only the director of this workshop, but also of our GMU biodefense graduate program – Dr. Gregory Koblentz. If there was a biodefense Jeopardy, Dr. Koblentz would not only be the reigning champion, but would also have Alex Trebek doubled over in laughter. Gregory Koblentz, PhD, MPP, is an Associate Professor in the Schar School of Policy and Government and Director of the Biodefense Graduate Program at George Mason University. During 2012-2013, he was a Stanton Nuclear Security Fellow at the Council on Foreign Relations. Dr. Koblentz is also a member of the Scientist Working Group on Chemical and Biological Weapons at the Center for Arms Control and Non-Proliferation in Washington. He previously worked at Georgetown University, the Executive Session for Domestic Preparedness at Harvard University, and the Carnegie Endowment for International Peace. He is the author of Strategic Stability in the Second Nuclear Age (Council on Foreign Relations, 2014), Living Weapons: Biological Warfare and International Security (Cornell University Press, 2009) and co-author of Tracking Nuclear Proliferation (Carnegie Endowment for International Peace, 1998). He serves on the editorial boards of Nonproliferation Review, World Medical and Health Policy, and Global Health Governance. His teaching and research interests focus on international security, weapons of mass destruction, terrorism, and homeland security. He received his PhD from the Massachusetts Institute of Technology, his Master in Public Policy from the John F. Kennedy School of Government, and his BA from Brown University. For more information, see https://schar.gmu.edu/about/faculty-directory/gregory-koblentz. Don’t miss your chance to not only learn from Dr. Koblentz, but also chat with him and other experts in the field at our workshop July 17-19th!

Can CRISPR Tackle Zika?
GMU Biodefense PhD student Saskia Popescu is looking at CRISPR and its application as a vector-borne disease prevention tool. “Whether it be the latest announcement that CRISPR reversed Huntington’s Disease in mice or that it could provide rapid diagnostic improvements, the technology is being considered a breakthrough for many diseases and conditions, including vector-borne diseases.” Drawing on a recent TED Talk by famed molecular biologist, Dr. Nina Federoff, she highlights the potential for GMO mosquitoes to be used as a biological control tool. Federoff points to the public perception issues that come with GMO products, which was seen in Key Haven, Florida when GMO mosquitoes were to be trialed as a means to prevent dengue and Zika cases. “Concluding her talk with a plea to the audience, Dr Federoff emphasized the need to dig past misinformation and hype to truly look at the science of this work and the substantial benefits that can come from biological control efforts and the science of genetic modification.”

The Case of the Missing Sarin
Dugway Proving Ground is under the spotlight again for mishandling of dangerous substances. The same Army lab was responsible for mishandling Anthrax in 2015, during which they sent 575 shipments of live samples across the U.S. Unfortunately, the latest reports are looking to Dugway as the source for potentially losing a small amount of sarin. The inspector general for the DoD released a report highlighting the findings that a contractor used by the facility was not maintaining inventory properly. “Dugway stored its sarin in a two-container system. The sarin was stored in a primary container, which is then stored inside a secondary container. But officials only checked the secondary containers when doing inventory, and did not check inside the primary container, so they did not know if all the sarin was still in the containers, the inspector general found. ‘Therefore, custodians cannot identify and account for leaks, evaporation, or theft that may have occurred,’ the inspector general found. ‘Furthermore, Dugway officials did not immediately notify the chemical materials accountability officer of a 1.5-milliliter shortage of … sarin identified during an April 19, 2016, inventory nor did they properly document the results of that inventory,’.” The report found that the contractor and Dugway used varying methods for container sealing but that the amount missing is relatively small. Fortunately, sarin evaporates and degrades very quickly. Overall the report highlights the operations and procedures for handling the chemical agent put workers at an increased risk and encouraged the Army to evaluate and improve practices immediately.

The Moral Question of Bioengineering
The financial and technical hurdles for biotechnology and gene-editing have been decreasing over the years and Stanford is taking a unique approach to their budding bioengineers – asking moral questions. During their final exams for the university’s Intro to Bioengineering course, the students are asked several questions – at what point will the cost of printing DNA to create human life equal the cost of teaching a student at Stanford?  If you and your partner are planning to have kids, would you start saving for college tuition, or for printing the genome of your offspring? These questions represent much of the debate and concern regarding gene editing – the rapid decrease in cost and the morality of just how far the technology can and will take researchers. Many note that just because we can, doesn’t mean we should. Stanford professor Drew Endy emphasizes the decrease in costs, which was initially prohibitive when the technology was developing. Regarding the last question, “about 60 percent say that printing a genome is wrong, and flies against what it means to be a parent. They prize the special nature of education and would opt to save for the tuition. But around 40 percent of the class will say that the value of education may change in the future, and if genetic technology becomes mature, and allows them to secure advantages for them and their lineage, they might as well do that. There is clearly no right answer to the second question, and students are graded on their reasoning rather than their conclusion. But when both questions are considered together, they suggest, Endy says, that ‘in the order of a human generation, we’ll have to face possibilities that are much stranger than what we’re prepared for’.”

Stories You May Have Missed:

  • John Oliver Takes on Anti-Vaxxers – If you’re a fan of the HBO host, make sure to check out his recent episode of  “Last Week Tonight” in which he points out just how dangerous the anti-vaccine movement really is. “Some have even developed an ‘alternative vaccine schedule’ in which the inoculations can be delivered less frequently and over a longer period of time. ‘That sounds like a decent compromise because it’s the middle-ground position, right?”’Oliver said on ‘Last Week Tonight’ on Sunday. ‘The problem is, it’s the middle ground between sense and nonsense. It’s like saying, ’It would be crazy to eat that entire bar of soap, so I’ll just eat half of it’.”
  • Yemen’s Growing Cholera Outbreak– Yemen is currently experiencing the worst international outbreak of cholera, with 200,000 suspected cases and an average of 5,000 new cases reported daily. The WHO and UNICEF have gotten involved as there have already been 1,300 deaths in the past two months. “By calling the outbreak the “world’s worst” UNICEF and WHO hope to speed international aid efforts to the war-torn country. “This deadly cholera outbreak is the direct consequence of two years of heavy conflict,” said a press statement from UNICEF. ‘Collapsing health, water and sanitation systems have cut off 14.5 million people from regular access to clean water and sanitation, increasing the ability of the disease to spread.’ In addition to a lack of public health infrastructure, UNICEF estimated that 30,000 dedicated local health workers who play the largest role in ending this outbreak have not been paid their salaries for nearly 10 months.”

 

Pandora Report 6.23.2017

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

 

Pandora Report 6.16.2017

Temperatures may be soaring but we’ve got all your biodefense news, including a frosty story on frozen diseases coming to life!

Big Data Takes on Epidemics
The potential applications for big data are vast and we’re just now starting to get a taste for how it can be utilized during an outbreak. Rapid access to data sets and available personnel to handle modeling is a challenge during emergent situations however, many are pointing out just how the data science revolution can be used to fight diseases. Metabiota Senior Director of Data Science Nita Madhav has put together a list of the five ways big data analytics are changing the fight against epidemics. First, better genetic data through genome sequencing that can help speed up genetic analysis during an outbreak. Second, cell phone mobility data. This is particularly interesting as it was used during the Ebola outbreak in 2014, which allowed experts to tract contacts of cases as a means of prevention. Cell phone mobility data also provides information on movement during outbreaks. Third, social media data, which can be used to predict peaks and perform sentiment analysis (think vaccination skepticism), but also as a means of pushing public health messaging. Fourth, mapping high risk areas. “Machine learning techniques can now yield global, high-resolution maps pinpointing where epidemics are likely to emerge and take hold. These techniques make use of remotely-sensed and other geographic data about environmental, human and animal factors to estimate how many people live in the riskiest places. For example, this type of analysis helped map likely locations for Zika virus to thrive and even identified areas where the virus would later establish itself, including southern Florida.” Last but not least, large-scale simulations, which allow epidemiologists to take all the data we currently have and generate tons of simulations to reveal gaps in response mechanisms. “These simulations help fill in gaps in observed data using synthetic outbreaks and deliver novel insights into possible outcomes of outbreaks, including expected numbers of illnesses, hospitalizations, deaths, employee absences and monetary losses. Ultimately, these insights can help inform the world about epidemic risks and the best ways to mitigate them.”

Chemical Weapons & ISIS
New analysis from Conflict Monitor by IHS Market is drawing attention to a significant reduction in chemical weapons used by ISIS in Syria in 2017 as well as a concentration of the chemical attacks in Iraq. The report highlights that 71 allegations of ISIS CW attacks have occurred since 2014 (41 in Iraq and 30 in Syria) however, the only alleged use in Syria in 2017 was on January 8th at Talla al-Maqri. “The operation to isolate and recapture the Iraqi city of Mosul coincides with a massive reduction in Islamic State chemical weapons use in Syria”, said Columb Strack, senior Middle East analyst at IHS Markit. “This suggests that the group has not established any further CW production sites outside Mosul, although it is likely that some specialists were evacuated to Syria and retain the expertise.” In response to ISIS use of chemical weapons, the U.S. Department of the Treasury’s Office of Foreign Assets Control (OFAC) is taking action against ISIS leader, Attallah Salman ‘Abd Kafi al-Jaburi (al-Jaburi), who was involved in several attacks ranging from vehicle-borne improvised explosive devices (VBIEDs) to the development of chemical weapons. OFAC is also taking action against Marwan Ibrahim Hussayn Tah al-Azaw, an Iraqi ISIS leader. “As a result of today’s action, all property and interests in property of these individuals subject to U.S. jurisdiction are blocked, and U.S. persons are generally prohibited from engaging in transactions with them.” OFAC Director John E. Smith noted that “today’s actions mark the first designations targeting individuals involved in ISIS’ chemical weapons development,” and that “the Department of the Treasury condemns in the strongest possible terms the use of chemical weapons by any actor, and will leverage all available tools to target those complicit in their development, proliferation, or use.”

Pandemics, Bioterrorism, & Global Health Security Workshop Instructor Spotlight
This week we’re excited to share that Sanford Weiner will be our instructor spotlight! Sanford is a Research Associate in the Center for International Studies at the Massachusetts Institute of Technology, and a Visiting Fellow at Imperial College, University of London. For several decades he has done international comparative policy studies of public health agencies, and research on national security policies and environmental policies. He has published on policymaking at the Centers for Disease Control, the phase-out of CFCs, toxic substance control, and innovation in the Air Force. He is currently studying responses to pandemic flu in Europe and the United States, and the politics of alternative energy projects. He directs a Professional Education summer course at MIT on “Technology, Innovation and Organizations.” He has also taught in professional education courses for the Royal Society Technology Fellows (London), the National University of Singapore, UC San Diego, and in Stockholm. Before MIT he was on the research staffs of the School of Public Policy at UC Berkeley, the Health Policy Center at Brandeis, and the Harvard School of Public Health. Sanford looks to the need for organizational innovation and adaptation to address new threats, the politics of public health emergencies, and the importance of risk assessment and making evidence-based public health decisions. If you’re looking to talk about taking lessons from pandemic flu and applying them to polio, Zika, bioterrorism, and even Ebola, you won’t want to miss his lecture during our workshop!

The Awakening of Frozen Permafrost Diseases
Climate change has an undeniably impact on infectious diseases. Whether it be the vectors that spread them, movement of animals that act as hosts, or an increasing encroachment of humans into animal habitats, we simply can’t deny that the two are wholly interconnected. Unfortunately now we get to add zombie diseases to the list. Well, maybe not a zombie virus, but a bacteria or virus that has been trapped in the icy permafrost for thousands of years and is now waking up. “Climate change is melting permafrost soils that have been frozen for thousands of years, and as the soils melt they are releasing ancient viruses and bacteria that, having lain dormant, are springing back to life.” Last year we saw anthrax cases in the Arctic Circle due to exposure from infected reindeer carcasses that were exposed due to the melting of the frozen soil and snow. “As the Earth warms, more permafrost will melt. Under normal circumstances, superficial permafrost layers about 50cm deep melt every summer. But now global warming is gradually exposing older permafrost layers. Frozen permafrost soil is the perfect place for bacteria to remain alive for very long periods of time, perhaps as long as a million years. That means melting ice could potentially open a Pandora’s box of diseases.” Nothing like a good permafrost to keep the bacteria happily frozen and alive! What is so worrying about the melting permafrost is a range of threats – buried bodies of people who died from smallpox, unknown viruses or bacteria that we’ve never seen before, or even a resistant organism that changes the course of antibiotics forever.

Angry Birds – The Flu Version
While this isn’t the title of the latest game, the projectile you should be worried about is actually avian influenza droplets. China is currently battling against HPAI H7N9  outbreaks in poultry across three provinces. “Chinese health officials detailed four outbreaks in two OIE reports. Two occurred in different locations in Inner Mongolia province in the north, one at a large layer farm that began on May 21, killing 35,526 of 406,756 susceptible poultry. The remaining birds were culled to curb the spread of the virus.The other outbreak began Jun 5 at a poultry farm in Inner Mongolia’s Jiuyuan district, which led to the loss of 55,023 birds, including 2,056 that died from the disease.” These outbreaks spark fear for a number of reasons – the mass culling of birds is always economically devastating, the risk to human life, and really, the potential for sustained human-to-human transmission due to a few genetic tweaks that could result in a pandemic. That’s right, just three mutations should switch H7N9 into a lethal human-killing virus that has pandemic potential. H7N9 is one of the more concerning avian influenza strains because it’s already been known to do damage in terms of human cases (of the 1,500 cases, 40% died). “‘As scientists we’re interested in how the virus works,’ says Jim Paulson, a biologist at The Scripps Research Institute. ‘We’re trying to just understand the virus so that we can be prepared.’ That’s why he and his colleagues recently tinkered with a piece of the H7N9 flu — a protein that lets the virus latch onto cells. It’s thought to be important for determining which species the virus can infect. ‘So it’s not the whole virus,’ says Paulson. ‘It’s just a piece — just a fragment — that we can then study for its properties’. What they studied is how different changes affected the virus’ ability to bind to receptors found on the surface of human cells.” Paulson’s group found that just three tiny mutations made it able to sustain human transmission. This brings about the dual-use research of concern (DURC) and gain-of-function (GoF) research dilemma though – while we’re using it for good, couldn’t a person with bad intentions come along and turn it into a weapon? Or a lab error that results in an outbreak? While some argue for the need of GoF research, others agree with the 2014 White House moratorium that halted federal funding for such work. Ron Fouchier of Erasmus Medical Center in the Netherlands notes that, “‘The rest of the world is moving forward with this type of experiment already,’ says Fouchier, whose genetic experiments with a different bird flu virus sparked a public outcry in 2011. And so the U. S. can either join or not join. It’s up to them, but the work will continue,’.” Topics like avian influenza, pandemics, and dual-use/GoF research are all issues we’ll be discussing in the workshop this July, so don’t miss out!

Boston University’s BioLab Nears Approval
This hotly debated BSL-4 lab has been a source of contention between researchers and surrounding neighbors for over a decade. Boston University received a $200 million federal grant nearly 15 years ago to build the regional lab as a new source for work with deadly pathogens however, neighborhood activists have been halting work since the beginning. Despite the ongoing debate, the lab is just one vote away from approval. “Supporters say it will speed the development of new vaccines and cures.  But after 15 year of fighting, the neighborhood that’s home to the lab is making a final push to keep the diseases away from the busy urban hub.”

The Scary Reality Behind WHO’S Updated Essential Medicine List
GMU Biodefense PhD student, Saskia Popescu, is taking a deeper dive into the recent announcement by the WHO regarding their reformatting of the EML list. The antibiotics sections haven’t seen an overhaul like this for 40 years, so what’s really afoot? Last week we discussed the changes- the categorization of antibiotics into three groups (ACCESS, WATCH, and RESERVE). Each list has a series of antibiotics and recommendations (i.e. for RESERVE, these are antibiotics which should be treated as the last resort of accessible antibiotics and should be used in “tailored” situations when other medications have failed. RESERVE antimicrobials should be targeted in national and international stewardship programs). While the updates make sense, they reveal a much deeper concern for developing countries and the growing threat of microbial resistance. “This extensive change to the EML highlights the dire situation that we are progressing towards in terms of microbial resistance. The EML provides the most basic medicine needed for patient care and its focus on antibiotic stewards highlights the stark reality even in the most dire of environments.”

Stacking Countermeasures for Layered Defense 
DTRA’s Joint Science and Technology Office’s (JSTO) Toxicant Penetration and Scavenging (TPS) research program is working to better defend us against chemical and biological weapons. “One such weaponized threat is the use of organophosphonates in an attack. These nerve agents inhibit acetylcholinesterase (AChE), an essential enzyme responsible for neurological function. Irreversible inhibition of AChE may lead to muscular paralysis, convulsions, bronchial constriction and death by asphyxiation. One of the projects in the TPS uses engineered DNA-enzyme nanostructures to create multi-enzyme pathway biocatalysts. These new biocatalysts are designed to process the destruction of chemical agents and their degradation compounds.”

Stories You May Have Missed:

  • MERS and Infection Control – There are endless opportunities when working in infection prevention & control to say, “I told you so” and the ongoing hospital MERS outbreaks only fuels that fire. “The World Health Organization (WHO) today provided new details on three MERS-CoV clusters in Saudi Arabia involving 32 out of the 35 cases reported between Jun 1 and Jun 10. The clusters are in three different hospitals in Riyadh. Cluster 2 is related to cluster 1, as the first case-patient in a second hospital initially visited the emergency room of the hospital implicated in cluster 1. According to the WHO, he was asymptomatic following the visit in hospital 1, and he continued to receive kidney dialysis sessions in the second hospital. The cluster involves the index case plus five healthcare workers and household contacts.The third cluster is not related to clusters 1 or 2. To date four cases are associated with this hospital; the index case involves a patient who had camel contact. Three healthcare workers have also been diagnosed.”

Pandora Report 6.9.2017

Hunting For Ebola and The Outbreak In The DRC
The hunt for Ebola’s hiding place has eluded scientists since its identification in 1976. Believing that bats are a natural reservoir, many are tracking them throughout the DRC. While we’ve picked apart the virus in BSL-4 labs for decades and continue to learn about its genomics, we’re tragically unable to truly understand the virus in its natural habitat. “But the virus’s natural history is a mystery, says virologist Vincent Munster, sitting outside his tent in the darkening jungle. ‘We know everything about its replication cycle but fricking nothing about where it comes from and how it causes outbreaks’. Earlier in his career, at the Erasmus Medical Center in Rotterdam, the Netherlands, Munster took part in the controversial ‘gain of function’ experiments that engineered the lethal H5N1 bird flu virus to spread more readily among mammals-including, presumably, people. These days, however, Munster talks less about viral genes and proteins than about virus ecology: the web of interactions that allows a zoonotic virus to travel between species. Logging, hunting, and other human encroachment on pristine environments all play a role, bringing people into contact with the microbes that lurk there.” Researchers, like Munster, are sampling animals (especially bats) to try and find a pattern that would explain why they’re most likely to carry the virus and if that might fluctuate. Trying to find the virus in bats is equally challenging despite knowing that they carry it. Interestingly, the virus is wholly dangerous to primates and many consider it the biggest threat to gorillas apart from poaching. During their work, the researchers were alerted to a chimpanzee carcass and throughout their response, they note just how careful they must be when handling it. “It was covered in maggots, Munster says-‘just a huge, pulsating mess.’ Ebola may be scarce in living animals, but carcasses like that one practically explode with virus. ‘We’ve done those studies,’ Munster says. ‘Every cell, every orifice of that carcass is loaded with Ebola.’ To minimize the risk to researchers, Munster helped develop a protocol for collecting samples from dead animals: swabbing the outside instead of using sharp instruments to collect blood or tissue.” While their work continues, so does the latest outbreak of Ebola in the DRC. The most recent WHO situation reports noted a new suspected case and 15 contacts for monitoring. Currently, there are 5 confirmed cases, 3 probable, and 1 suspected. Four patients have died and four have survived, translating to a 50% case-fatality rate. You can also read the latest WHO new report on response efforts in the DRC here.

Pandemics, Bioterrorism, & Global Health Security Workshop Instructor Spotlight
Our instructor spotlight this week will shine on FBI Supervisory Special Agent Edward You. Mr. You is like the action hero of the biological countermeasures world (ok, that might be a tad of an exaggeration, but wait until you read about all the amazing things he does with the FBI!). 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. Mr. You has also been directly involved in policy-making efforts with a focus on biosecurity. He is an active Working Group member of the National Security Council Interagency Policy Committee on Countering Biological Threats and an Ex Officio member of the NIH National Science Advisory Board for Biosecurity. He also serves on two committees for the National Academies of Sciences, the Institute of Medicine’s Forum on Microbial Threats and the Committee on Science, Technology, and Law’s Forum on Synthetic Biology. Prior to joining the FBI, Mr. You worked for six years in graduate research focusing on retrovirology and human gene therapy at the University of Southern California, Keck School of Medicine. He subsequently worked for three years at the biotechnology firm AMGEN Inc. in cancer research. Special Agent You works to keep the communication channels open between the synthetic biology community and law enforcement to help identify threats and strengthen relations with the biohacker community. Don’t miss the opportunity to learn from Mr. You and pick his brain during our summer workshop in July!

South Africa’s History of Chemical & Biological Weapons
GMU biodefense alum Glenn Cross is taking a deep dive into the Rhodesian use of chemical and biological weapons from 1975-1980. His recent book, Dirty War, investigates the prevalence of such weapons during the Rhodesian War. During periods of manpower and material shortage, the army would use such unconventional techniques that included planting contaminated food and beverages, medicine, and other goods into guerrilla supplies. “Some of these supplies were provided to guerrilla groups inside Rhodesia; some were transported to guerrilla camps in Mozambique. In all, deaths attributed to CBW agents often exceeded the monthly guerrilla body count claimed by conventional Rhodesian military units – demonstrating the utility of CBW agents in a counterinsurgency campaign against an elusive enemy.” Cross’s investigation is particularly valuable in that knowledge has been spotty and few insiders have been willing to talk. “All (insiders willing to talk) share a consistent story about Rhodesia’s development and use of chemical and biological agents during the Bush War; they even chillingly admit that chemical and biological agents were used in experiments on captured insurgents.”

Tracking Microbes and Inspiring Antibiotic Development
The June 6th WHO statement on the Essential Medicines List (EML) is sending ripples throughout the public health community in regards to antimicrobial resistance. The changes to the EML include the creation of three new categories for antibiotics – ACCESS, WATCH, and RESERVE. These categories include recommendations regarding use and aims to shift prescribing to a more accurate practice. “Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections. The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of ‘last resort’ antibiotics that are needed when all others fail.” The revision to this list highlights a growing need for antibiotic innovation. BARDA director, Joseph Larsen, hopes to change this and speed up the pace of antibiotic development in the face of growing microbial resistance. Current antibiotic development can take years, cost millions of dollars, and often only generates a profit after 23 years. Larsen notes that there hasn’t been a new class of drugs for treating gram-negative bacilli for over fifty years and that the volume of candidate antibiotics in phase 3/4 trials is barely 10% of those in oncology trials. BARDA is hoping to facilitate innovation through their CARB-X program, “which is one of the world’s largest public-private partnerships focused on developing new antibacterial products. When they started this program, BARDA expected 50 grant applications, but received 368 applications within the first 2 cycles. The goal is to deliver at least 2 antibacterial products to clinical development within 5 years. BARDA is planning on investing $250 million over the next five years to CARB-X.” Antibiotic innovation will become increasingly important as resistance grows, which highlights the importance of tracing microbial movement. GMU biodefense PhD student, Saskia Popescu, is looking at a recent study on hospital bacterial tracing and what that means for infection prevention efforts. Researchers sampled patient rooms prior to a new medical center opening and continued sampling for nearly a year, finding that microbial communities had some interesting trends. While hospital disinfection failures are frequently a source for transmission, it was found that the microbial community shifts after the patient has been in a room for 24 hours. Moreover, researchers found that a majority of admitted patients were on antibiotics and that those with longer stays tended to show an evolutionary shift to resistance. “Overall, this new study highlights the movement of microbes within healthcare and how we can start improving our tactics to help reduce the risk of healthcare-associated infections and blossoming bacterial resistance.” Worst case scenario, we could just always stop shaking hands

Bioterrorism Budget Cuts & DoD Chemical & Biological Defense Annual Report
GMU biodefense PhD alum Daniel M. Gerstein is focusing on just how vulnerable the proposed budget would make the U.S. in the event of a bioterrorism attack. The budgetary cut to NBACC at Ft. Detrick would mean that laboratory and science response to bioterrorism would be significantly gutted without a replacement plan. “The NBACC’s scientists also are capable of conducting experiments to determine what level of concern is warranted if a potential threat is identifiedThe NBACC also has bioforensics analysis capabilities. This provides the ability to understand how and potentially where a pathogen was prepared, its virulence and physical characteristics and even what medical countermeasures and decontamination techniques might be the most effective.” This is especially vital as even the decontamination of a site can be challenging and expensive. The 2001 Amerithrax attacks highlighted these gaps – between responsibility, practices, protocols, and cost, the decontamination of the office buildings and postal handling facilities cost roughly $320 million and pointed out some pretty significant gaps within U.S. bioterrorism response. Gerstein implores policymakers to take a second look at this proposed budgetary cut and decide if leaving the US without these critical capabilities is truly a wise decision. “They should assess whether NBACC’s capabilities, as an insurance policy, is a price worth paying when weighed against the potential cost in human terms of even a limited bioterror attack.”

The 2017 DoD Chemical and Biological Defense 2017 Annual Report to Congress has just been released, which includes specific comments on response to ISIS and synthetic biology activities. Within the report you can find sections on advanced diagnostics, advanced medical countermeasures (check out the section on the cocktail of three monoclonal antibodies developed to fight Ebola), advances in non-traditional chemical agent defense, and more! One of my favorite sections was actually on information systems – “The Global Biosurveillance Portal (G-BSP) program achieved IOC. This capability will provide a web-based, cloud-hosted enterprise environment that will facilitate collaboration, communication, and information sharing in support of the detection, management, and mitigation of man-made and naturally occurring biological events. G-BSP also facilitates the fusion of multiple unclassified information sources for greater situational awareness and decision support.” A recent study published in The Lancet, highlights the importance of diagnostic preparedness. Citing the 2014/2015 Ebola outbreak as a prime example, researchers note that while the diagnostic response eventually worked, it was slow and expensive, which severely impacted outbreak response. “If a focused mechanism had existed with the technical and financial resources to drive its development ahead of the outbreak, point-of-care Ebola tests supporting a less costly and more mobile response could have been available early on in the diagnosis process. A new partnering model could drive rapid development of tests and surveillance strategies for novel pathogens that emerge in future outbreaks. We look at lessons learned from the Ebola outbreak and propose specific solutions to improve the speed of new assay development and ensure their effective deployment.”

Committee on Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology
Don’t miss this July 6th workshop held at the National Academies of Sciences, Engineering, and Medicine’s Keck Center at 500 5th Street NW, Washington DC.  Attendees will hear from several experts and discuss four main topics: human modulation, public health and military preparedness, efficacy of design, and emerging technologies to overcome existing technical barriers. The meeting won’t be webcast or made available virtually, so you’ll want to attend in person.

China’s Battle Against An H7N9 Outbreak
While the outbreak may be slowing, eight new cases were reported this past week. What worries many though are the recent studies published that point to the highly pathogenic variant that was infecting poultry. Currently in its fifth wave of H7N9 activity, Chinese cases are showing a shift to impact more middle-aged adults in rural areas. “In the second report, a team from China described the clinical course and genetic findings in a 56-year-old Guangdong province man who died from a highly pathogenic H7N9 virus that showed a marker for resistance to neuraminidase inhibitors (NIs), the antiviral drugs commonly used to treat influenza.” You can read the press release from the Government of the Hong Kong Special Administrative Region here.

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