Pandora Report: 7.1.2022

Happy July 4th weekend to our US readers! This week, we cover the US release of smallpox vaccines to combat the spread of monkeypox, the first decade with CRISPR, and plenty of great publications and an exciting upcoming TEXGHS event. Also, the Global Partnership just turned 20, making it of legal drinking age in all G7 countries except for the US!

Happy Birthday to the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction!

The G7-led Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (Global Partnership) turned 20 this week! Launched on June 27, 2002, at the Kananaskis G8 summit, the Global Partnership is an international initiative aimed at preventing the proliferation of chemical, biological, radiological, and nuclear weapons and related materials. You can find the partnership’s latest newsletter and subscribe here to wish it a happy birthday.

Monkeypox Not Declared PHEIC, US Expands Vaccine Access

WHO Director-General Dr. Tedros Adhanom Ghebreyesus released a statement on the report on the Meeting of the IHR Emergency Committee regarding the multi-country monkeypox outbreak this week, writing:

I am deeply concerned by the spread of monkeypox, which has now been identified in more than 50 countries, across five WHO regions, with 3000 cases since early May. The Emergency Committee shared serious concerns about the scale and speed of the current outbreak, noted many unknowns, gaps in current data and prepared a consensus report that reflects differing views amongst the Committee. Overall, in the report, they advised me that at this moment the event does not constitute a Public Health Emergency of International Concern, which is the highest level of alert WHO can issue, but recognized that the convening of the committee itself reflects the increasing concern about the international spread of monkeypox. They expressed their availability to be reconvened as appropriate.

The Director-General also expressed concern about current monkeypox outbreaks spreading into children and pregnant women, stating “We are starting to see this with several children already infected.”

Days later, the US announced a new vaccine strategy for monkeypox in the US, with phase one focusing on “rapidly scaling up the delivery of monkeypox vaccines and targeting at-risk groups with vaccination.” According to CIDRAP, this plan will see 296,000 doses of the Jynneos vaccine made available this month, with 56,000 being allocated immediately. In the coming months, 1.6 million additional doses will be made available, according to the Biden administration, being distributed equally among states.

Select Subcommittee On the Coronavirus Crisis Meets

The US Select Subcommittee on the Coronavirus, chaired by Rep. James E. Clyburn, met last week to discuss the Trump administration’s response to COVID-19. This was following the release of the subcommittee’s first report investigating the administration’s political interference with the federal COVID-19 response. Dr. Deborah Birx, former White House Coronavirus Response Coordinator, testified before the committee during a hearing, in which she stated that “dangerous ideas” undermined the administration’s response while also discussing failures in communication, ignoring of guidance, and more. Dr. Birx’s full transcribed interview and emails uncovered over the course of the investigation, including those indicating that senior White House officials believed case identification would damage the president’s reputation, can also be found on the subcommittee’s website.

A Decade of CRISPR

A decade ago this week, Jinek et al. published “A Programmable Dual-RNA–Guided DNA Endonuclease in Adaptive Bacterial Immunity” in Science and, while the paper initially received lackluster attention, it soon opened numerous doors for scientific advancement and won Doudna and Charpentier the 2020 Nobel Prize for chemistry. However, it is not without serious ethical and biodefense questions and concerns that, as The New York Times explained this week, are becoming more important than ever. One of these questions is how this technology can be used to alter human embryos, which became much more pressing when following He Jiankui’s 2018 experiment in which he edited a gene in three embryos to make them HIV-resistant. The embryos were later implanted in three women in Shenzhen and it was announced in 2019 that He and two of his collaborators were found guilty of “illegal medical practices”.

For more on the security risks of CRISPR and He’s experiment, check out Dr. Sonia Ben Ouagrham-Gormley’s award winning article, “From CRISPR Babies to Super Soldiers: Challenges and Security Threats Posed by CRISPR,” in The Nonproliferation Review.

“Examining North Korea’s COVID-19 Data: A Curious Case Study”

Martyn Williams, writing for the Stimson Center’s 38 North, does a deep dive on COVID-19 in North Korea in this piece, helping shine some light on several burning questions, including the almost impossible official death count. He discusses a number of potential reasons for this, including deliberate misinformation, and discusses how it appears even North Koreans themselves are suspicious of these numbers, writing “Just as foreign analysts have questioned the figures and unusually low fatality rate, so it appears are North Koreans. On June 9, state media reported work was underway to “enhance the scientific accuracy, promptness and credibility of medical checkups, tests and treatment,” suggesting internal questioning of the numbers as well.”

Trust and Verify No. 170, Summer 2022 Released

VERTIC’s summer 2022 edition of Trust and Verify was recently released, featuring articles ranging from several discussing issues arising from the Russo-Ukraine war to others like the first meeting of states parties for the TPNW to a prosecution in Germany for a CW-related offense. An article on the role of women in the BWC and its enforcement is also featured.

“Roundtable – The Biological Weapons Convention at 50: Still Seeking Verification AFter 50 Years…”

In this piece featured by the American Political Science Association, Dr. Jean Pascal Zanders discusses historical challenges that prevented establishment of verification tools under the BWTC, taking readers through different periods of the treaty’s history and discussing the power of norms embedded in the treaty.

“One Health: A New Definition for a Sustainable and Healthy Future”

This PLOS Pathogens article features the One Health High-Level Expert Panel discussing how COVID-19 has highlighted the need for a One Health approach to outbreak response. They explain:

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic once more demonstrated the close connection between humans, animals, and the shared environment. Although still under investigation, the closest relatives of this virus exist in animals, and the factors leading to spillover remain to be fully understood. This interconnectedness again highlighted the need for a One Health approach. Although the One Health concept is not new and has been at the forefront of interdisciplinary and multisectoral discussions for years, there is now an increased interest for this approach to be applied and translated into action. Following a proposal made by the French and German Ministers for Foreign Affairs at the November 2020 Paris Peace Forum, 4 global partners, the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), the United Nations Environment Programme (UNEP), and the World Health Organization (WHO), in May 2021 established the interdisciplinary One Health High-Level Expert Panel (OHHLEP) (https://www.who.int/groups/one-health-high-level-expert-panel) to enhance their cross-sectoral collaboration. The creation of OHHLEP represents a recognition at the highest level of the urgency and complexities surrounding One Health and the intent to take this concept forward into policies and concrete actions.

New NCT Magazine Edition Issue on Biological Threats

June’s edition of NCT Magazine features “pieces by renowned professionals from the US and Europe that wish to share their views on the likelihood of biological threats as a result of modern synthetic biology tools. As in all disciplines, these members from the academia and first responders are a diverse group and they hold different views on SynBio,” in an effort to enrich discourse on the topic.

“Adding Novichok Nerve Agents to the CWC Annex on Chemicals: a Technical Fix and Its Implications for the Chemical Weapons Prohibition Regime”

Alexander Kelle’s recent work published by UNIDIR “discusses and analyses the use of a novichok nerve agent in the United Kingdom in March 2018. This triggered a political process at the Organisation for the Prohibition of Chemical Weapons (OPCW) that led to the amendment of the CWC schedules. It provides a factual overview of the scientific discussion around the novichok class of chemical agents, and how this has changed since the amendment of the CWC schedules was adopted. Against the background of the cases where nerve agents have been used for political assassination, the report concludes with a discussion of implications of the schedule amendments for compliance with, and implementation of, the chemical weapons prohibition regime.”

This report features our own Dr. Koblentz’s work with Dr. Stefano Costanzi on Novichok agents, “Novichok Agents: Further Amending the Chemical Weapons Convention Schedules and the Australia Group Precursors List after the Navalny Incident”.

“Public Comment on Oligo Synthesis Screening”

The Engineering Biology Research Consortium has published its comments in response to a request by HHS ASPR for comments on the Screening Framework Guidance for Providers and Users of Synthetic Oligonucleotides. EBRC convened a two-day workshop with stakeholders from academia, industry, and government to consider the Guidance, and the discussions that ensued formed the basis for this response.

TEXGHS: Monkeypox and the Western Media’s Portrayal of Infectious Disease

Join TEXGHS for their free monthly lecture series, featuring public health physician & global health thought leader Dr. Ifeanyi Nsofor on July 12 at 12 pm CDT. Global health is colonial in its origin. This colonial nature is reflected in skewed leadership of global health organizations favoring the global north. It is also reflected in the way some western media outlets paint the African continent: as a disease-ridden continent (or country) incapable of helping itself. This bias reporting must stop in the interest of both global north and global south.

Russian WMD Disinformation Resources

We are currently working on creating a searchable collection of resources on Russian WMD disinformation on the Pandora Report site. The page is a work in progress, and currently just lists resources we have highlighted in the past. In the meantime, here are some recent updates and works on the topic:

“Russian Disinformation Finds Fertile Ground in the West”

Ilya Yablokov’s June article in Nature Human Behaviour discusses potential methods for tackling Russian disinformation in the West. 

Recording- The History and Future of Planetary Threats | Biological Risks and Hazards in the World Today- with Special Focus on Russia and Ukraine

A panel of experts, including our own Dr. Gregory Koblentz, discussed evolving biological risks, the health security environment in post-Soviet states, and the biological risks posed by Russia’s invasion of Ukraine- including those associated with Russia’s disinformation campaign at this event in May! Access the event recording here.

“A Perspective on Russian Cyberattacks and Disinformation”

Glenn Gerstell, a senior advisor at the Center for Strategic and International Studies and former general counsel of the National Security Agency, was interviewed at a Wall Street Journal event in San Francisco in front of a live audience. The discussion focused on Russian cyberattacks against Ukraine and Russia’s use of disinformation. Highlights of the discussion are available here.

“Fact Sheet on WMD Threat Reduction Efforts with Ukraine, Russia and Other Former Soviet Union Countries”

The Department of Defense recently released this fact sheet covering the history and accomplishments of US collaboration with the international community to reduce WMD threats in Ukraine, Russia, and other countries who were formerly part of the USSR. It provides a comprehensive yet concise timeline of efforts, including the Nunn-Lugar CTR program, and discusses efforts by Russia and China to undermine these immense accomplishments today to further their agendas.

Schar School Applications Open- Deadline July 15

The Biodefense program is accepting Fall 2022 applications for our MS and graduate certificate program through July 15. Learn more about our admissions process and apply here.

Pandora Report: 6.24.2022

Happy Friday! This week we cover new reporting on Russian disinformation campaigns, including those it backs in Syria and a new Microsoft report discussing Russia’s cyber strategy. We also discuss the WHO’s emergency meeting to discuss declaring monkepox a public health emergency of international concern, the winners of NTI’s next gen biosecurity competition, and a new resource from the One Health Commission.

WHO Considering Declaring Monkeypox a PHEIC, Vaccination and Testing Expands

WHO Director General Dr. Tedros Adhanom Ghebreyesus convened an Emergency Committee under Article 48 of the International Health Regulations in relation to the current outbreak of monkeypox virus yesterday (June 23). The goals of this meeting were to provide opinions to the Director General on whether the event constitutes a public health emergency of international concern (PHEIC) and also on proposed potential Temporary Recommendations. While we have not heard their findings and decision yet, some critics argue that the WHO’s choice to wait and act only after the disease spread in the West “could entrench the grotesque inequities that arose between rich and poor countries during the coronavirus pandemic.” Furthermore, some have cast doubt that a PHEIC declaration would matter much since developed countries seeing outbreaks are moving quickly to contain them.

This comes as the US CDC is reporting they have evidence of local transmission of monkeypox, including through family members sharing things like bedding and towels. The Biden administration announced this week that it is authorizing commercial laboratories to conduct monkeypox tests in an effort to quickly grow testing capacity. The US is currently reporting 172 cases, with 48 of those in California, while the UK’s count continues to climb, currently sitting at 793. Globally as of Wednesday, 42 countries reported cases totaling 3,308, with the UK, Germany, and Spain having the most confirmed cases currently.

Orders for smallpox vaccines have skyrocketed as a result, with the European Health Emergency Preparedness and Response Authority having purchased 110,000 doses for 27 EU countries and the US ordering half a million doses just this month. Bavarian Nordic’s Vice President Rolf Sass Sorensen has said he is confident his company can keep up with global command even though they were caught by surprise with the sudden outbreak. The US stockpile has 36,000 doses of the Jynneos vaccine, more than 100 million of ACAM2000, and Bavarian Nordic holds 1 million US-owned doses. New York City became the first major US city to begin offering smallpox vaccines to people at-risk of contracting monkeypox this week with the city representing about 14% of the national case count.

However, not all are confident in the United States’ ability to handle this or other future health crises. This week, the Commonwealth Fund Commission on a National Public Health System released a report in which experts described the various inadequacies and inequities of the United States’ response to COVID-19. Among other things, the panel recommends the “creation of a new national public health system” to better help address crises. The New York Times explains that “While other countries have centralized public health authorities, public health in the United States is largely managed at the state and local level. The Centers for Disease Control and Prevention, the federal public health agency, does not have the authority to compel states to act — it cannot, for example, investigate outbreaks of infectious disease in a particular state unless it has an invitation from state officials to do so.” Their proposed system would be overseen by an Undersecretary for Public Health in the US Department of Health and Human Services, who would be responsible for coordinating the work of over a dozen federal agencies who have some role in public health.

In related news, the Senate Committee on Health, Education, Labor, and Pensions passed the bipartisan Murray-Burr PREVENT Pandemics Act with a 20-2 vote. The Murray-Burr bill combines numerous prior efforts to, among several other things, “Ensure the CDC’s Accountability and Leadership by Requiring a Senate-confirmed CDC Director and an Agency-wide Strategic Plan.” This is a move some caution will only further harm the CDC, with GOP-backed efforts to make the CDC Director position a senate-confirmed one late last year sparking controversy. The CDC and its current director, Dr. Rochelle Walensky, have caught much flack in recent years, with a recent internal probe at the agency finding serious deficiencies in the organization’s culture and responsiveness to public health threats.

Winners of 2022 Next Generation for Biosecurity Competition Announced

In better news, the Nuclear Threat Initiative and its partners recently announced the winners of their annual biosecurity competition – Nicholas Cropper, Shrestha Rath, and Ryan Teo – and their paper, “Creating a Verification Protocol for the Biological Weapons Convention: A Modular-Incremental Approach.” The second place team’s paper, “Leveraging Advances in Biotechnology to Strengthen Biological Weapons Convention Verification Protocols,” was also announced. Biodefense program alumnus Dr. Yong-Bee Lim and program director Dr. Gregory Koblentz were on the international panel of judges as well.

“Defending Ukraine: Early Lessons from the Cyber War”

Microsoft’s new report discussing Russia’s cyber strategy and how it has played out during the invasion of Ukraine was released this week. It devotes much attention to how effective Russia’s disinformation campaign has been, including the spread of disinformation regarding US-supported biological research facilities in Ukraine. It reads in part, “The Russian invasion relies in part on a cyber strategy that includes at least three distinct and sometimes coordinated efforts—destructive cyberattacks within Ukraine, network penetration and espionage outside Ukraine, and cyber influence operations targeting people around the world. This report provides an update and analysis on each of these areas and the coordination among them. It also offers ideas about how to better counter these threats in this war and beyond, with new opportunities for governments and the private sector to work better together.” It offers five conclusions, including that “…defense against a military invasion now requires for most countries the ability to disburse and distribute digital operations and data assets across borders and into other countries,” and “…the lessons from Ukraine call for a coordinated and comprehensive strategy to strengthen defenses against the full range of cyber destructive, espionage, and influence operations.”

“Deadly Disinformation: How Online Conspiracies About Syria Cause Real-World Harm”

The Syria Campaign, supported by Friedrich-Ebert-Stiftung and using ISD research, recently released this report on a disinformation network coordinated by a Russian campaign targeting the White Helmets and spreading disinformation about the Syrian conflict – including “the denial or distortion of facts about the Syrian regime’s use of chemical weapons and on attacking the findings of the world’s foremost chemical weapons watchdog.” The Guardian explains that “The White Helmets became a target of Russian ire after documenting incidents such as the chemical attack on Khan Sheikhoun in 2017, which killed 92 people, a third of them children. A UN unit later concluded there were “reasonable grounds to believe that Syrian forces dropped a bomb dispersing sarin” on the town in Idlib province.” The report also finds that Russian official government accounts, including those of the Russian embassies to the UK and Syria, played a central role in creating and spreading false content. The report finds that “Of the 47,000 disinformation tweets sent by the core of 28 conspiracy theorists over seven years from 2015 to 2021, 19,000 were original posts, which were retweeted more than 671,000 times.”

What We’re Listening To- Poisons and Pestilence Podcast

The University of Bath’s Dr. Brett Edwards’ podcast, Poisons and Pestilence, recently released a bonus episode episode focused on the Polish resistance movement’s use of CBW during World War II. After a great first season that included “Episode 2: Hittite me Plaguey one more time”, Dr. Edwards announced a second season “looking at poison arrows, toxic smoke, water poisoning and the laws of war from the 13th to the 18th century.” Be sure to give this podcast a listen and follow!

Virtual Stakeholder Engagement Meeting on USG Policies for the Oversight of Life Sciences Dual Use Research of Concern

The purpose of this meeting is to gather feedback from stakeholders about their experiences implementing these policies, the effect of these policies in terms of achieving their stated goals, the overarching definition of DURC, and possible alternative approaches for the oversight and responsible conduct of DURC. This feedback will also be used to inform the discussions of the National Science Advisory Board for Biosecurity (NSABB) in fulfillment their current charge to evaluate and analyze the DURC policies. It will be held on June 29, 2022 at 12 pm ET. Registration is not required to attend. Find the webcast link and more information here.

Recording- The History and Future of Planetary Threats | Biological Risks and Hazards in the World Today- with Special Focus on Russia and Ukraine

A panel of experts, including our own Dr. Gregory Koblentz, discussed evolving biological risks, the health security environment in post-Soviet states, and the biological risks posed by Russia’s invasion of Ukraine- including those associated with Russia’s disinformation campaign at this event in May! Access the event recording here.

One Health Commission Launches One Health Tools and Toolkits Compilation Page

“Many governmental agencies, NGOs, academic institutions, and other organizations have created a diverse array of One Health (OH) tools and toolkits to help OH practitioners and lifelong learners integrate health operations & monitoring across societal sectors and geographic boundaries. They aid in health systems management, disease surveillance, research, learning, and much more.

Since 2019, the One Health Commission has been compiling these toolkits to characterize the increasing operationalization of OH worldwide. The webpage listing of these resources is now available to the world: https://tinyurl.com/OHC-OH-Toolkits

Russian WMD Disinformation Resources

We are currently working on creating a searchable collection of resources on Russian WMD disinformation on the Pandora Report site. The page is a work in progress, and currently just lists resources we have highlighted in the past. In the meantime, here are some recent updates and works on the topic:

“A Perspective on Russian Cyberattacks and Disinformation”

Glenn Gerstell, a senior advisor at the Center for Strategic and International Studies and former general counsel of the National Security Agency, was interviewed at a Wall Street Journal event in San Francisco in front of a live audience. The discussion focused on Russian cyberattacks against Ukraine and Russia’s use of disinformation. Highlights of the discussion are available here.

“Fact Sheet on WMD Threat Reduction Efforts with Ukraine, Russia and Other Former Soviet Union Countries”

The Department of Defense recently released this fact sheet covering the history and accomplishments of US collaboration with the international community to reduce WMD threats in Ukraine, Russia, and other countries who were formerly part of the USSR. It provides a comprehensive yet concise timeline of efforts, including the Nunn-Lugar CTR program, and discusses efforts by Russia and China to undermine these immense accomplishments today to further their agendas.

Schar School Applications Open- Deadline July 15

The Biodefense program is accepting Fall 2022 applications for our MS and graduate certificate program through July 15. Learn more about our admissions process and apply here.

Pandora Report: 6.17.2022

Monkeypox, plague, and COVID-19-Oh my! We have another mixed bag this week, covering the WHO’s formation of an external committee to help determine if monkeypox is a PHEIC, new research that helps determine the Black Death’s origin, INTERPOL’s collaboration with the WOAH, and the US Government’s new MOU on public health emergency testing capacity. As always, we round out the week with new publications, upcoming events, and announcements. Finally, we wish everyone a meaningful Juneteenth holiday weekend, as the US observes its newest federal holiday this Sunday.

No More Monkeying Around- WHO to Convene Emergency Committee on Monkeypox Spread

This Tuesday, the WHO announced it will convene a meeting next week of external experts to help the organization determine if the current spread of monkeypox is a public health emergency of international concern (PHEIC). As of June 16, 37 countries where the disease is not endemic are reporting outbreaks, with confirmed cases breaking 2,100 globally. These are mostly in Europe, with the UK reporting 524 confirmed cases, followed by Spain at 313, Germany at 305, Portugal at 241, and France at 183. Canada is reporting 159 cases and the US currently sits at 99.

This casts a dark shade over ongoing Pride celebrations for some, as many caution that the virus’s spread primarily in men who have sex with men echoes the spread of HIV/AIDS in the 1980s. Montreal announced this week that the city would expand its monkeypox vaccination campaign to all men who have sex with men, calling the city the “epicentre of the North American monkeypox outbreak.” As the diseases spreads in New York City, officials are cautioning the public to “Be aware, but don’t panic.” Sharon Otterman wrote in The New York Times that, “Grindr, the social networking app, sent a pop-up message about the risk of monkeypox to millions of European and American users. A sex party organizer in New York asked invitees to check themselves for lesions before showing up. And the organizers of the city’s main Pride celebrations posted a monkeypox notice Sunday on their Instagram account.”

The WHO’s monkeypox page is available here and is routinely updated with new guidance, press releases, and fact sheets. The US CDC’s global case tracker is available here and the US map and case count is available here.

The Black Death’s Origin Solved?

New research published in Nature this week identifies the origin of the infamous Black Death that killed an estimated 30-60% of all Europeans in the mid-14th century. Spyrou et al.’s article, “The Source of the Black Death in Fourteenth-Century Central Eurasia,” uses DNA data from seven people exhumed at two cemeteries located near Lake Issyk-Kul in modern Kyrgyzstan to shine light on this enduring debate. Ian Sample explains how the team came to focus on this location in The Guardian, writing “The international team came together to work on the puzzle when Dr Philip Slavin, a historian at the University of Stirling, discovered evidence for a sudden surge in deaths in the late 1330s at two cemeteries near Lake Issyk-Kul in the north of modern-day Kyrgyzstan. Among 467 tombstones dated between 1248 and 1345, Slavin traced a huge increase in deaths, with 118 stones dated 1338 or 1339. Inscriptions on some of the tombstones mentioned the cause of death as “mawtānā”, the Syriac language term for “pestilence”.”

Researchers at Germany’s University of Tübingen extracted DNA from these individuals’ teeth, finding that three of them contained Y. pestis. The bacteria’s genome was determined to be a “…direct ancestor of the strain that caused the Black Death in Europe eight years later and, as a result, was probably the cause of death for more than half the population on the continent in the next decade or so.” This determination also helps settle historians’ debate over whether the Black Death spread into Europe via Eurasian trade routes or Mongol military actions in the early 13th century, as Gina Kolata explains in The New York Times.

“Under a magnification of 500X, this photomicrograph of a Giemsa-stained lung tissue sample, harvested from a Pecos, New Mexico patient with secondary plague pneumonia, revealed the histopathologic findings that resulted from this illness. Note the presence of numerous, Yersinia pestis bacteria, which exhibited characteristic pleomorphism. In this view, the exudate was scant, though it did harbor the most abundant quantity of plague organisms.” Source: CDC Public Health Image Library, Dr. H.E. Stark

World Organisation for Animal Health Partnering with INTERPOL to Prevent Biocrimes

The World Organisation for Animal Health (WOAH) and INTERPOL (the International Criminal Police Organization) are partnering together to collaborate on building global preparedness and countering biocrimes and bioterrorism. This approach will see improved understanding between veterinary services and law enforcement, which is critical given the world’s current challenges. For example, INTERPOL’s website identifies several crimes as being linked to animal disease and able to harm human populations, including sales of falsified products, animal cruelty and abuse, agroterrorism, food fraud, non compliance, illicit wildlife use, smuggling, and poaching. To learn more about this collaboration, check out this interview with Fanny Ewann, Specialized Officer in INTERPOL’s Bioterrorism Prevention Unit, discussing what constitutes and biothreat, the agroterrorism risk today, and how INTERPOL, WOAH, and the Food and Agriculture Organization of the United Nations are working together to help improve collaboration between veterinary and law enforcement organizations. If you would like a re-fresher and brief history of the differences between biocrime, bioterrorism, and biowarfare, check out Oliverira et al.’s work discussing it here.

New MOU for Diagnostic Surge Testing Capacity for Public Health Emergencies Released

The US FDA, CDC, and several other stakeholders signed and released a memorandum of understanding earlier this month on enhancing lab testing capacity outside of CDC and public health laboratories before and during public health emergencies. After the US failed to build-up testing capacity rapidly in the early days of the pandemic, it became clear that many changes in regulatory policies are needed in order for this to not happen next time. The MOU reads in part:

The capability and capacity of PHLs was utilized during several outbreaks, including Anthrax 2001, the response to the Middle East Respiratory Syndrome, and Ebola outbreaks. However, public health laboratory systems are not currently designed to handle and execute diagnostic testing at a large scale and scope beyond the initial critical phases of public health emergencies. Furthermore, in the early phase of an emergency response, FDA-authorized tests and testing platforms may be inherently limited and may not be optimized for high throughput. The need to supplement public health laboratory diagnostic testing capacity has been demonstrated in previous virus outbreaks. At the advent of the H1N1 influenza virus outbreak, hospital- based clinical laboratories responded rapidly and effectively and the need for a coordinated and streamlined response from both public health and clinical diagnostic laboratories became apparent. The Zika virus outbreak resulted in the engagement of large independent laboratories with nationwide facilities. At the same time, hospital-based laboratories served the diagnostic needs of their patient populations. Most recently, the extensive demands for diagnostic testing during the coronavirus disease (COVID-19) pandemic quickly extended beyond public health laboratories and independent laboratories to other Clinical Laboratory Improvement Amendments (CLIA) certified testing facility types.

The Biden administration is also expected to release a revised National Biodefense Strategy as early as this month, signaling that some major pitfalls may start to be addressed in the United States’ biodefense game plan.

Summary of Expert Insights for the US Department of Defense Biodefense Posture Review Meeting

The Johns Hopkins Center for Health Security recently released this report discussing expert input on the Department of Defense’s first Biodefense Posture Review, including that of our own Dr. Gregory Koblentz. The Center writes that, “During the meeting, a variety of participants discussed two recurring recommendations:

  1. The DoD, and the nation, would benefit from organizational realignment so that one person or office is responsible for biodefense policy across the DoD. This would help the Department to plan, build resources, and engage experts. Current efforts that shift responsibilities depending upon the nature of the health security crisis—for example if it is deliberate or natural, outside the contiguous US (OCONUS) or domestic—inhibit coherent planning.
  2. Disinformation is a threat in all aspects of the biodefense posture, ranging from operational restrictions to reputational impacts on the United States. The DoD should routinely consider how its statements and actions can both enable and counter disinformation and take steps to minimize impact. Also, DoD should consider using its communications abilities to dissuade other nations from developing biological weapons.”

“Public Health Preparedness: Medical Countermeasure Development for Certain Serious or Life-Threatening Conditions”

The US Government Accountability Office released this new report this week discussing MCM development and the Food and Drug Administration’s Animal Rule, implemented in 2002 to guide animal efficacy studies when human clinical trials are not ethical or feasible. GAO writes, “We found that FDA has provided guidance to support development of medical countermeasures under the rule, such as by clarifying the types of data needed to demonstrate product efficacy. FDA has approved 16 medical countermeasures under this rule.”

“Back to the Future for Verification in the Biological Disarmament Regime?”

The UN Institute for Disarmament Research recently released this report from Revill, Borrie, and Lennane. They write, “Twenty years after the termination of the Biological and Toxin Weapons Convention (BWC) Ad Hoc Group negotiations, the notion of adopting a BWC verification protocol is now almost an article of faith among some States Parties to the Convention. Yet it is clear that in 2001, the work of the Ad Hoc Group was a long way from agreement around a robust regime capable of ensuring confidence in compliance with the BWC’s prohibitions. Moreover, if there are some elements of continuity in the biosecurity sphere since then, much has also changed – geopolitically, technologically and economically. These changes generate challenges as well as opportunities to strengthen the BWC, which remains a central multilaterally-agreed component of a much wider set of measures that have emerged over the last two decades to prevent the hostile use of biology and manage the challenge of dual use biology around the globe. This report looks at these changes and identifies areas to move forward.”

“Lack of Access to Medicine is a Major Driver of Drug Resistance. How Can Pharma Take Action?”

The Antimicrobial Resistance Research Programme recently released this new report on antimicrobial resistance’s global rise. They write, “Antimicrobial resistance (AMR) is rising faster than expected. Worldwide, more than one million people die of AMR each year, most of them in low- and middle-income countries (LMICs). Resistant infections can rapidly spread without appropriate access to essential antibiotics and antifungals. Yet, the issue of responsibly providing access for people living in resource-poor settings has been largely overlooked. Pharmaceutical companies are only using a limited number of the opportunities that exist to expand access in poorer nations, resulting in significant gaps. This study sets out how companies and their partners are using a combination of access strategies to cut through the complexity and address access at a local level.”

“The Pig as an Amplifying Host for New and Emerging Zoonotic Viruses”

McLean and Graham’s new article in One Health discusses how the growth of pig demand and changes in pig husbandry practices have led to an environment that is conducive to increased emergence and spread of infectious diseases from swine populations. They write, “These include a number of zoonotic viruses including influenza, Japanese encephalitis, Nipah and coronaviruses. Pigs are known to independently facilitate the creation of novel reassortant influenza A virus strains, capable of causing pandemics. Moreover, pigs play a role in the amplification of Japanese encephalitis virus, transmitted by mosquito vectors found in areas inhabited by over half the world’s human population. Furthermore, pigs acted as an amplifying host in the first and still most severe outbreak of Nipah virus in Malaysia, that necessitated the culling over 1 million pigs. Finally, novel porcine coronaviruses are being discovered in high pig-density countries which have pandemic potential. In this review, we discuss the role that pigs play as intermediate/amplifying hosts for zoonotic viruses with pandemic potential and consider how multivalent vaccination of pigs could in turn safeguard human health.”

Book Talk- Biocrisis: Defining Biological Threats in US Policy

Al Mauroni, current Director of the US Air Force Center for Strategic Deterrence Studies, will be giving a book talk at the Center for Nonproliferation Studies in DC on June 21 at 10 am EST. How should the US government address biological threats today? In Biocrisis: Defining Biological Threats in US Policy, Al Mauroni provides a timely analysis of US policy on the intersection of national security and public health. He explores disease prevention, bioterrorism response, military biodefense, biosurety, and agricultural biosecurity and food safety, and proposes a new approach to countering biological threats. Learn more about the event and register here.

Reframing Vaccine Diplomacy amid Strategic Competition: Lessons from COVID-19

The Wilson Center is offering this panel event on June 23 at 10 am ET via webcast. Learn more and RSVP here. Addressing continuity and change in different actors’ global health policies over time, this panel will try to explore new strategies for vaccine diplomacy while sharing the perspective of less represented voices in health diplomacy. What lessons can be learned from the competitive nature of COVID-19 vaccine diplomacy to better understand the power and struggle of competition in the global health domain? What hidden layers of great power competition, diplomacy, philanthropy, and regional and national dynamics were revealed? How should new multilateral and bilateral phenomena of vaccine cooperation inform the global health policy making and international relations?

Schar School Applications Open- Deadline July 15

The Biodefense program is accepting Fall 2022 applications for our MS and graduate certificate program through July 15. Learn more about our admissions process and apply here.

Disarmament and Non-Proliferation of WMD 2022 Training Programme

The OPCW and Asser Institute are offering this training program September 19-23 in The Hague. The preliminary program is available here and includes information and discussion sessions on core WMD topics and contemporary policy issues offered by world-renowned experts in the field. There will also be networking opportunities. Registration is open and there are scholarships available. Scholarship applications are due by July 4, 2022.

Russian WMD Disinformation Resources

We are currently working on creating a searchable collection of resources on Russian WMD disinformation on the Pandora Report site. The page is a work in progress, and currently just lists resources we have highlighted in the past. In the meantime, here are some recent updates and works on the topic:

“The Pentagon Didn’t ‘Admit’ That There are 46 US-Funded Biolabs in Ukraine”

PolitiFact recently posted this debunking referencing the factsheet we added last week after internet users ran wild (again) with its discussion of CTR-supported facilities.

“Fact Sheet on WMD Threat Reduction Efforts with Ukraine, Russia and Other Former Soviet Union Countries”

The Department of Defense recently released this fact sheet covering the history and accomplishments of US collaboration with the international community to reduce WMD threats in Ukraine, Russia, and other countries who were formerly part of the USSR. It provides a comprehensive yet concise timeline of efforts, including the Nunn-Lugar CTR program, and discusses efforts by Russia and China to undermine these immense accomplishments today to further their agendas.

Pandora Report: 6.10.2022

This week we cover updates on monkeypox, including the CDC’s Level 2 travel alert, and the conviction of Harry Johannes Knoesen, a South African extremist who was interested in using BW to infect and kill Black people to “reclaim South Africa for white people.” A number of new publications are included, including recent work from a Biodefense PhD Program alumnus and FEMA’s updated guidance for nuclear detonation response. Events and announcements are included at the end, including an upcoming book talk from Al Mauroni and a professional development opportunity offered by the OPCW.

Monkeypox Updates

Monkeypox continues to spread in non-endemic countries, with Oahu, HI announcing a third probable case yesterday as the US total sits at 44 cases. As of June 7, 29 countries reported a total of 1,088 cases, with the UK reporting a whopping 321 cases nationwide. The CDC also raised the travel alert to Level 2 for monkeypox, recommending “enhanced precautions” while traveling, but walking back prior advice to begin masking in response to this specific concern. CIDRAP writes, “The enhanced precautions include avoiding contact with sick people, including genital contact, avoiding contact with dead or live animals, and avoiding contact with contaminated materials, such as bedding.” Cases are still mostly in men who have sex with men, prompting many to express concern that the failures and horrors of the mismanagement of the HIV/AIDS crisis will be repeated. There are also concerns that the strategy the US has in place for testing is creating a bottleneck and is wasting precious time in getting the outbreak managed before it becomes more serious. Information on global and country case counts can be found here on the CDC website.

Map depicting locations in the US with confirmed MPX cases. One individual in Florida tested positive while in the UK, which is what the asterisk denotes. Source: CDC

Leader of National Christian Resistance Movement Found Guilty of High Treason, Incitement to Carry Out Violent Attacks, and Recruiting People to Commit Attacks

Harry Johannes Knoesen was convicted by a South African court this week for his plot to overthrow the government and kill thousands of Black people in the country using a biological weapon. Knoesen, a pastor, and his group were interested in using a bioweapon to specifically infect and kill Black people. They entertained the idea of using water reservoirs that supply Black communities to do so, according to the prosecution. ABC News writes, “The plot by the pastor’s group was foiled in 2019 by South Africa’s police and intelligence services, who have since dismantled the organization’s cells across various parts of the country and arrested some of its leaders.” Knoesen was also found guilty of unlawful possession of firearms, and the state highlighted what it described as his religious belief that he was ordained to “reclaim South Africa for white people.” “To further this end, he planned to attack government institutions and more specifically police and military institutions,” Monica Nyuswa, a spokeswoman for the National Prosecuting Authority, told The Associated Press. Knoesen is set to return to court today (June 10) to begin sentencing.

This certainly was not the first plot of this nature in the country. ABC writes, “In 2013, 20 members of the right-wing white supremacy group known as the Boeremag were sentenced to prison for plotting to kill South Africa’s first Black president Nelson Mandela, overthrow the government and kill thousands of Black people.” However, it is noteworthy as an example of a non-state group expressing interest in BW to achieve its objectives.

“The Long, Cloudy History of Moscow’s BW Program”

Biodefense PhD Program alumnus, Dr. Glenn Cross, recently published this review article in The Nonproliferation Review. In it, he covers three of Anthony Rimmington’s books, Stalin’s Secret Weapon: The Origins of Soviet Biological Warfare (2018), The Soviet Union’s Invisible Weapons of Mass Destruction: Biopreparat’s Covert Biological Warfare Programme (2021), and The Soviet Union’s Agricultural Biowarfare Programme: Ploughshares to Swords (2021). Cross notes that the Soviet and, later, Russian BW programs were very much understudied by scholars until the early 1990s when two prominent Biopreparat researchers defected from the USSR. He also notes that, until Rimmington’s recent publications, the most recent scholarly works on this topic were from 2012, 2016, and 2018, highlighting the importance of fresh perspectives on this topic. While Cross notes many of Rimmington’s contributions to this area of study, he also calls attention to a few contradictions across the books and a pervasive challenge of unanswered questions in them. Most importantly, Cross notes that these books do not do much to answer the questions of what the purpose of the Soviet BW program was, which he explains is an increasingly relevant question today. He also points out that Cross relies heavily on secondary sources in Stalin’s Secret Weapon, though he does argue that he makes better use of Fedorov than other scholars have previously. Finally, despite these issues, Cross says Rimmington’s work does offer some value, particularly in their descriptions of Soviet BW facilities and in their identification of Soviet BW program leadership.

“Preliminary Report for the Scientific Advisory Group for the Origins of Novel Pathogens”

The WHO released the first preliminary report from the Scientific advisory group for the origins of novel pathogens (SAGO) this week. This report is part of SAGO’s ongoing work and includes background information on the group and its goals, preliminary recommendations for ensuring a global framework to study high-threat zoonotic pathogens and better understand SARS-CoV-2, and discussion of the group’s next steps. Their proposed future meeting topics include everything from “Further analysis of findings from studies pertaining to the Huanan market in Wuhan China and follow up on any identified leads,” to “Discussions about the studies needed to study the re-emergence of other high threat pathogens, e.g., monkeypox virus, MERS-CoV, arboviruses, Ebola virus.”

“Planning Guidance for Response to a Nuclear Detonation”

FEMA’s third edition of this guidance was released last month, having been developed by a federal interagency committee led by the FEMA CBRN Office with representatives from across the Departments of Homeland Security, Energy, Health and Human Service, and Defense plus the Environmental Protection Agency. This edition has been “…updated and expanded to provide guidance for a wider range of nuclear detonations, including larger detonations and air bursts. It also incorporates new research, best practices, and response resources. Additionally, this edition includes a new chapter on the Integrated Public Alert & Warning System (IPAWS), which enables state, local, tribal, and territorial (SLTT) officials to send warnings and key messages during the response.” It includes guidance ranging from providing acute medical care to population monitoring to communications and public preparedness.

“Diagnostic Accuracy of Non-Invasive Detection of SARS-CoV-2 Infection by Canine Olfaction”

Grandjean et al.’s new article in PLOS One discusses use of non-invasive detection of SARS-CoV-2 infection by canine olfaction as a possible alternative to nasopharyngeal RT-PCR. Their study compared detection using canine olfaction with NPS RT-PCR as the reference standard in addition to saliva RT-PCR and nasopharyngeal antigen testing in 335 ambulatory adults. Their findings indicate that overall sensitivity of canine detection was 97% with 91% specificity (94% in asymptomatic individuals) and that canine detection’s sensitivity was higher than that of nasopharyngeal antigen testing.

“The Lanzhou Brucella Leak: the Largest Laboratory Accident in the History of Infectious Diseases?”

Dr. Georgios Pappas’ new article in Clinical Infectious Diseases discusses the aerosolization and spread of Brucella in the summer of 2019 at a biopharmaceutical plant in Lanzhou, China. This accident resulted in more than 10,000 human cases of the disease by November 2020. Pappas writes, “The leak, possibly the largest laboratory accident in the history of infectious diseases, underlines the particular characteristics of Brucella that have made the pathogen a historical entity in biodefense research and a major cause of laboratory-associated infections. It further underlines the need for enhanced vigilance and strict regulatory interventions in similar facilities.”

“Dr. Delirium & the Edgewood Experiments”

Discovery+ released its newest documentary, “Dr. Delirium & the Edgewood Experiments” this week, covering the Army’s experiments during the Cold War to find CW agents that could incapacitate enemy troops without killing them. These experiments, conducted from 1955 to 1975, were done on over 7,000 US soldiers using over 250 agents at the Edgewood Arsenal in Maryland. The documentary relies heavily on interviews with veterans who participated in the experiments, in addition to a long-form interview with Dr. James Ketchum, who ran the psychochemical warfare program at Edgewood. The film does cover theories that Nazi scientists granted asylum through Operation Paperclip were involved with the Edgewood program, though it never actually makes the connection between these two. It also discusses the CIA’s interest in this and other programs. It has received generally positive reviews as well. Read more about the Edgewood Experiments here.

The Impossible State Podcast- COVID-19 in North Korea

In this episode of CSIS Korea Chair’s podcast, The Impossible State, Andrew Schwartz and Dr. Victor Cha are joined by Dr. J. Stephen Morrison to discuss the Covid-19 outbreak in North Korea, the impact of the pandemic on the unvaccinated country, and the road ahead amidst ongoing health and food crises worsened by an extreme lockdown.

Book Talk- Biocrisis: Defining Biological Threats in US Policy

Al Mauroni, current Director of the US Air Force Center for Strategic Deterrence Studies, will be giving a book talk at the Center for Nonproliferation Studies in DC on June 21 at 10 am EST. How should the US government address biological threats today? In Biocrisis: Defining Biological Threats in US Policy, Al Mauroni provides a timely analysis of US policy on the intersection of national security and public health. He explores disease prevention, bioterrorism response, military biodefense, biosurety, and agricultural biosecurity and food safety, and proposes a new approach to countering biological threats. Learn more about the event and register here.

Disarmament and Non-Proliferation of WMD 2022 Training Programme

The OPCW and Asser Institute are offering this training program September 19-23 in The Hague. The preliminary program is available here and includes information and discussion sessions on core WMD topics and contemporary policy issues offered by world-renowned experts in the field. There will also be networking opportunities. Registration is open and there are scholarships available. Scholarship applications are due by July 4, 2022.

New Global Health Security Agenda Consortium Website

GHSA’s new website is live at https://ghsacngs.org/. The consortium is “a voluntary and open collective of nongovernmental entities who are dedicated to promote values of collaboration, excellence, innovation, and commitment in implementing the Global Health Security Agenda and promoting the adherence of the International Health Regulations (IHRs) and the World Organization for Animal Health (OIE) Performance of Veterinary Services (PVS) Pathways, the Alliance for Country Assessments for Global Health Security and IHR Implementation, and the Biological Weapons Convention and United Nations Security Council Resolution 1540.” The new site features member profiles, plenty of resources, and a dedicated events page!

Russian WMD Disinformation Resources

We are currently working on creating a searchable collection of resources on Russian WMD disinformation on the Pandora Report site. The page is a work in progress, and currently just lists resources we have highlighted in the past. In the meantime, here are some recent updates and works on the topic:

“Fact Sheet on WMD Threat Reduction Efforts with Ukraine, Russia and Other Former Soviet Union Countries”

The Department of Defense recently released this fact sheet covering the history and accomplishments of US collaboration with the international community to reduce WMD threats in Ukraine, Russia, and other countries who were formerly part of the USSR. It provides a comprehensive yet concise timeline of efforts, including the Nunn-Lugar CTR program, and discusses efforts by Russia and China to undermine these immense accomplishments today to further their agendas.

Pandora Report: 6.3.2022

Happy Friday! This week we discuss some of the current concerns about the continued spread of monkeypox in non-endemic countries, the end of Aum Shinrikyo’s status as a foreign terrorist organization in the US, Shanghai’s lockdown, and the Office International des Epizooties’ rebranding. New reports from WHO, CRS, RAND, and more are listed as well as several upcoming events, including a multi-day conference focused on biodefense support to the warfighter and a webinar on COVID-19 in the DPRK with the Korea Economic Institute.

Monkeypox On the Move

Monkeypox continues to spread in non-endemic countries, attracting global media attention. However, monkeypox has been known for the last several decades and cases have been climbing in parts of West and Central Africa for years now. Monkeypox is endemic in 10 countries in Africa, with the DRC having seen 1,284 cases this year alone so far. As of May 26, the UK had the highest caseload in a non-endemic country at 106, hinting at the idea that this attention might be in part spurred by the fact that that the disease is spreading in Europe and North America.

Monkeypox spread in May 2022. Source: https://www.statista.com/chart/27537/countries-with-monkeypox-cases/

Recent works highlight the need to listen to those scientists in Africa who have experience with this virus as well as hopes we can learn from failures with COVID-19 and HIV. Many are concerned that the US and other Western countries will repeat their earlier COVID-19 and HIV outbreak response mistakes in disease surveillance and public communication while others worry experts with experience with this virus will be forgotten. Furthermore, as cases are mostly in men who have sex with men, there are valid concerns about how stigmas may play into global response to monkeypox. The CDC’s Dr. Demetre Daskalakis, Director of the Division of HIV/AIDS Prevention, said in a video, “I urge everyone to approach this outbreak without stigma and without discrimination.”

These developments have also renewed some conversations on the closely related, though much more deadly, smallpox and its remaining samples, including renewed calls to destroy the samples. While smallpox was declared eradicated in 1980, the US and Russia both maintain samples in secure facilities, and research with these samples requires approval from the WHO. There are also concerns and suspicions that there are other, unofficial samples elsewhere in Russia and in other countries used for BW research, complicating the entire matter.

Aum Shinrikyo Will No Longer Be Recognized As a Foreign Terrorist Organization

This week, the Department of State announced the revocation of five Foreign Terrorist Organization (FTO) designations under the Immigration and Nationality Act, including those of Basque Fatherland and Liberty, Aum Shinrikyo, Mujahidin Shura Council in the Environs of Jerusalem, Kahane Chai, and Gama’a al-Islamiyya. Aum Shinrikyo is infamous for the 1995 Tokyo subway attacks during which the group used sarin gas to kill over a dozen people and injure many more. Prior to the sarin attacks, the group attempted to use biological weapons, in what the Nuclear Threat Initiative has described as the “most extensive non-state biological weapons program unearthed to date.” This included a failed 1993 attack wherein the group attempted to release anthrax spores from atop a Tokyo office building, among other failures. Secretary of State Antony Blinken told lawmakers that the removal of the designation was the product of the administrative review that is required by law to occur every five years. NHK also reported that, “The department announced the revocation on Friday, saying the group is “no longer engaged in terrorism or terrorist activity” and does not retain “the capability and intent to do so.”

Shanghai Lockdown Ends

Shanghai’s lockdown of the city’s nearly 25 million people ended this week after 65 days, to much celebration across the area. While most in the city can now return to life as normal, the Chinese media appears to have been instructed to report on this without actually referring to ending the lockdown, according to the Guardian. The directive, leaked to California-based China Daily Times, reads in part:

1. Do not use the phrase “ending the lockdown.” Unlike Wuhan, Shanghai never declared a lockdown, so there is no “ending the lockdown.” All parts of Shanghai underwent static management-style suppression and suspensions, but the city’s core functions kept operating throughout this period. Emphasize that related measures were temporary, conditional, and limited. The resumption on June 1 will also be conditional: it is by no means the case that every person in every district across the whole city will be able to freely head out at once, nor that this is a uniform relaxation. Reports should not play up “comprehensive relaxation” or “comprehensive [return to] normality” ….

Furthermore, while Shanghai and other cities are ending their lockdowns, the Party still insists on sticking to its Zero COVID strategy, despite ongoing concerns about lack of access to quality vaccines and other issues challenging the strategy. This Monday, China’s National Health Commission reported just 97 cases in the country, again calling into question the reliability of their numbers. While the use of roundabout ways to describe the lockdown are not necessarily surprising, they again demonstrate that the Party remains committed to maintaining its narratives above all else.

Say “Hello” to the World Organisation for Animal Health

The Office International des Epizooties (more commonly known simply as OIE) has rebranded to the World Organisation for Animal Health (WOAH, or OMSA in French and Spanish for L’Organisation mondiale de la santé animale and Organización Mundial de Sanidad Animal respectively). The change is part of an effort to promote solutions which understand animal health as intrinsically linked to human health. Learn more about the change and WOAH’s future with this video from the organization.

“Towards a Global Guidance Framework for the Responsible Use of Life Sciences: Summary Report of Consultations on the Principles, Gaps and Challenges of Biorisk Management, May 2022”

This new summary report from the WHO discusses challenges in maintaining high scientific, safety, security and ethical standards in the life sciences. As a result of growing challenges and concerns in this area, WHO is developing a Global Guidance Framework for the Responsible Use of Life Sciences. As part of this process, WHO formed four working groups of experts, whose work and recommendations are summarized in this report. It includes a number of recommendations, including that universities and other research institutions “should promote a culture of biosafety and biosecurity in research environments at every stage of basic and applied life sciences,” and “publishers should promote and practise a culture of biorisk management in scientific publishing.” Biodefense Program Director Dr. Gregory Koblentz served on three of the four working groups included in the report.

“Oversight of Gain of Function Research with Pathogens: Issues for Congress”

Tom Kuiken, Science and Technology Policy Analyst at the Congressional Research Service, discusses core concepts and policy challenges surrounding gain of function (GOF) research in this report prepared for Congress in May. He focuses on the challenges of minimizing risks, optimizing outcomes, and addressing diverse stakeholder concerns throughout, writing “The general public is at the center of the GOF debate, with experts on each side invoking the public’s well-being as reasoning for their positions. Currently there is limited public engagement around GOF research on pathogens and the role the U.S. government has in its funding and oversight. When weighing options addressing these complex and intertwined policy issues, Congress may have to balance competing and, in some instances, conflicting national and international priorities.”

BARDA Strategic Plan, 2022-2026

The Biomedical Advanced Research and Development Authority’s newest strategic plan was recently released, covering years 2022 through 2026. This five year plan focuses on improvement goals in four areas-preparedness, response, partnerships, and workforce. It pays particular attention to developing strong, multi-purpose medical countermeasures to improve pandemic response and creating more flexible partnerships across sectors to do so.

“COVID-19 Impact on Antimicrobial Stewardship: Consequences and Silver Linings”

Zhou et al.’s article in Contagion Live discusses both the positive and negative impacts the COVID-19 pandemic has had on antimicrobial stewardship programs. They discuss negatives in the context of burnout and overuse of antimicrobials throughout the pandemic. However, they also note this situation has brought more attention to antimicrobial stewardship experts while strengthening multidisciplinary work, both of which are clear positive outcomes.

“Countering Weapons of Mass Destruction: DHS Could Improve Its Acquisition of Key Technology and Coordination With Partners”

This April report from the Government Accountability Office discusses the more than three years of delays the Department of Homeland Security has endured in trying to acquire new radiation portal monitors. GAO writes, “The Department of Homeland Security works with federal, state, and local partners to combat chemical, biological, radiological, and nuclear threats. As part of these efforts, DHS is replacing radiation portal monitors that scan cargo at U.S. ports. The new monitors were intended to reduce nuisance alarms from naturally occurring radiation in consumer goods—reducing unnecessary delays. But, the new monitors have been delayed by more than 3 years, and those being tested have higher nuisance alarm rates than monitors currently in use at ports. We recommended that DHS reassess its acquisition strategy for radiation portal monitors.”

“Implication of the Pandemic for Terrorist Interest in Biological Weapons: Islamic State and al-Qaeda Pandemic Case Studies”

This new report from RAND explores two key questions: 1) “What if the IS or al-Qaeda obtained and spread a highly contagious virus in a community or country that they sought to punish?” and 2) “With the pandemic highlighting weaknesses in response efforts, will these groups now seek to obtain infectious viruses to achieve these same deadly results?” Though it determines that the pandemic is unlikely to increase these groups’ interest in BW, it does also note that, “COVID-19 and the effects of global climate change are stern prompts to reimagine threats to national and international security.” It offers a number of cogent recommendations, including improving collaboration between animal and human health.

Lobes and Robes Podcast, “Episode 6: : Chemical Weapons: The Science and the Policy”

This episode features American University Chemistry Professor Stefano Costanzi, an expert both on the harm chemicals pose to living organisms and global security policies aimed at protecting the public from those dangers. In conversation with Drs. Carle and Davidson, Dr. Costanzi discusses the gaps in current policies and practices that allow chemical weapons to proliferate as well as some of his ideas about solutions and tools to narrow those gaps. Dr. Costanzi’s work itself bridges the neuroscience and public policy divide, and in so doing he models how science and policy can be brought into communication with each other.

North Korea’s COVID Outbreak: A Conversation with Kee B. Park, MD

Early in the pandemic, North Korea shut its borders to the outside world to prevent the spread of COVID-19 domestically. For the last two years, North Korea’s border controls have largely protected the population from the pandemic but that changed in early May when Pyongyang announced its first confirmed case of COVID-19 and large numbers of a quickly-spreading fever. Join KEI for a discussion with Kee B. Park, MD about how North Korea is handling the outbreak of COVID-19 and how the international community could help. Dr. Park is a Lecturer on Global Health and Social Medicine at Harvard Medical School and the Director of the North Korea Program at the Korean American Medical Association. He leads the collaboration between U.S. and North Korean physicians. Since 2007, he has made 19 visits to North Korea, most recently in November 2019. This event will take place June 6, 2022 at 11:30am EST. RSVP here. The discussion will also be livestreamed via YouTube.

RADx® Initiative & COVID-19 Solutions: Bioengineering at Unprecedented Speed and Scale

This Council on Strategic Risks webinar will discuss the RADx Initiative, which was launched in April 2020 by the National Institutes of Health (NIH) to speed innovation in COVID-19 testing. The initiative has been incredibly successful in supporting the development and implementation of accurate, easy-to-use, and accessible testing technologies, and it serves as a useful model for current and future public-private partnerships and interagency collaboration. The event will feature three fantastic panelists who have been deeply involved in RADx: Dr. Bruce Tromberg, Dr. Jill Heemskerk, and Dr. Rachael Fleurence. CSR CEO and Nolan Center Director Christine Parthemore will moderate. This webinar is open to the public, and will include a Q&A session for our experts to answer the audience’s questions. It will take place on June 8 at 1pm EST. Registration is open here. It will be recorded and posted on CSR’s Youtube channel.

Schar School Master’s and Certificate Virtual Open House

The Schar School is hosting a virtual open house for all of its master’s and certificate programs, including those in biodefense, on June 8, 2022 at 6 pm EST. This is a great opportunity to learn more about all our programs and to meet key faculty members! Register here.

Medical, Biomedical and Biodefense: Support to the Warfighter

The Offices of Senator Richard Burr, Senator Thom Tillis, the North Carolina Military Business Center and the North Carolina Biotechnology Center will host the Medical, Biomedical & Biodefense: Support to the Warfighter Symposium in Chapel Hill, North Carolina on June 8-9, 2022. Of particular interest, it will include a panel on biodefense moderated by David Lasseter, Former Deputy Assistant Secretary of Defense for Countering Weapons of Mass Destruction, on June 9 at 3 pm EST that will feature a number of fantastic experts.

Medical Support to the Warfighter will connect businesses in North Carolina with military and other federal agencies that require or purchase medical supplies, equipment, devices, pharmaceuticals, medical information technology and medical services. Representatives from the Departments of Defense, Veterans Affairs and Health and Human Services, including their prime vendors and major contractors, will highlight current resource gaps and needs, future requirements and procurement processes to supply military and federal medical facilities. Learn more and register at the link above.

Russian WMD Disinformation Resources

We are currently working on creating a searchable collection of resources on Russian WMD disinformation on the Pandora Report site. The page is currently under construction, and now just lists resources we have highlighted in the past. While we do not have a new one to add to the list this week, here is an interesting read on President Putin’s past with red mercury, a fake chemical compound with supposed nuclear applications that was popular on the black market as the Soviet Union collapsed.

MAY THE FOURTH BE WITH YOU

First, a little Biodefense Graduate Program-Star Wars parody to kick off the festivities.

Happy Star Wars Day! A long time ago in a galaxy far, far away…there were also biological weapons, believe it or not. While certainly not an elegant weapon for a more civilized age, these bioweapons (BW) varied in sophistication and caused their victims much suffering. They were a threat in most major conflicts throughout the history of the galaxy and were a research priority of the Galactic Empire. Fortunately, the Alliance to Restore the Republic prioritized destroying Imperial BW facilities throughout the Galactic Civil War and beyond. Join us for a recap on uses of BW throughout Star Wars Canon and Legends and don’t forget to re-watch your favorite Star Wars movie or show (and by that we mean Episode V) today and see if you can spot some of these examples. This is the way.

Refresher: Canon vs Legends

Since the premier of Episode IV: A New Hope in 1977, the epic space-opera franchise we all know and love has grown massively. Today this includes the nine films of the Skywalker Saga, the two anthology films (Rogue One and Solo), a whole array of TV shows from Droids and Ewoks in the 1980s to The Mandalorian and The Book of Boba Fett today, and countless books, games, and comics. It is a lot to keep up with. Originally, everything outside of the films and certain other productions (like The Clone Wars TV show) was considered the Expanded Universe (EU). The EU covered events from more than 36,000 years before the events of Episode I: The Phantom Menace in the Dawn of the Jedi comics to over 100 years after Episode VI: Return of the Jedi in the Legacy comics. Interestingly, the EU is also technically older than the films themselves. This is because the novel adaptation of Episode IV was released six months before the film in 1977.

Anyway, in 2014, in preparation for the sequel trilogy, Lucasfilm (acquired by Disney in 2012) announced that everything previously considered EU was going to be re-branded as Legends and would no longer be adhered to. This meant that there was now new continuity consisting of the original six films, Star Wars: The Clone Wars, and any future material- this became the official canon. In January 2021, Lucasfilm announced six new eras dividing all of the canonical content to help organize the expanding franchise: The High Republic, The Fall of the Jedi, The Reign of the Empire, The Age of Rebellion, The New Republic, and The Rise of the First Order. Right now, the canon consists of 12 movies (the nine films of the Skywalker Saga, the two anthology films, and the 2008 animated film, The Clone Wars), several television shows (The Clone Wars, Rebels, The Mandalorian and The Book of Boba Fett), EA’s video games (Battlefront, Battlefront II, Jedi: Fallen Order, and Squadrons), and a ton of books. Everything published or produced after 2014 is canon; everything else is considered Legends. There are at least 381 novels under the franchise, including famous series like Timothy Zahn’s Thrawn Trilogy and his follow-up Thrawn Duology. There are also well over 100 comic series between those published by Marvel and Dark Horse Comics. So, as you can imagine, there have been plenty of opportunities over the years for bioweapons to make an appearance or two in this franchise, some of which we’ll cover today.

Biological and Toxin Weapons in Star Wars Canon

Do you recall any examples of BW use in Star Wars over the years? There is a great chance you don’t. Fortunately, some of us had a lot of free time before graduate school and, as a result, are all too aware of these instances. While we don’t know a ton about BW use in the early history of the canon, we do know that the Empire was very interested in these weapons (particularly neurotoxins and defoliants) throughout its rule. The Separatists during the days of the Galactic Republic were also interested in biological and toxin weapons, most notably Blue Shadow Virus.

Fall of the Jedi- Blue Shadow Virus

This virus makes appearances in both Canon and Legends stories, but in the canon, it is said to have spread across the galaxy like a plague many years before the Clone Wars. Blue Shadow Virus is a waterborne virus that the majority of carbon-based lifeforms were susceptible to. It is said that patients infected with this virus had only 48 hours before the resulting disease would prove fatal, with 96% of carbon-based life-forms succumbing to the virus. Patients generally experienced coughing and fatigue in addition to developing visible blue veins over their bodies. Originally infamous for being incurable, it was discovered that a cure (described in the franchise as an antidote) could be derived from the reeska root, a rare plant originating only on the planet Iego in the Outer Rim Territories.

Because of its wide spread thousands of years before the Clone Wars, efforts were successfully made to eradicate it. However, Dr. Nuvo Vindi (pictured in the Tweet below), working under the Confederacy of Independent Systems, created and weaponized an airborne version of the virus during the Clone Wars. He planned to use bombs to spread the weapon across the galaxy, working on his plot in a Separatist laboratory hidden in the swamps of Naboo. Eventually, the Royal Naboo Security Forces intercepted a tactical droid returning to the lab, prompting Senator Padmé Amidala and Representative Jar Jar Binks to return to their home planet to investigate. They were captured by Vindi’s battle droids, though they were later rescued by Jedi Generals Obi-Wan Kenobi and Anakin Skywalker and Anakin’s Padawan, Ahsoka Tano. They thwarted Vindi’s plot but, as the facility was being decontaminated, a service droid stole a sample of the virus and detonated one of the remaining devices, trapping Amidala, Tano, Binks, and Captain Rex and his squad in the lab with a few remaining battle droids. As the clock ticks, Kenobi and Skywalker travel to Iego to collect the reeska root, eventually returning to Naboo with the cure just in the nick of time.

The Reign of the Empire and Beyond

In Aftermath: Life Debt, Imperial Navy Vice Admiral Perwin Gedde oversaw one of the Empire’s largest, most brutal BW programs. Under his direction, “ancient diseases” were tested on annexed planets’ civilians. After the Empire was defeated on Endor, he escaped and hid out on Vorlag with Slussen Canker, a slaver and crime lord. Gedde was wanted by the New Republic for his war crimes and was eventually tracked down by a team of Imperial hunters led by Norra Wexley following a galaxy-wide manhunt. While Gedde temporarily subdued his hunters with the assistance of Jas Emari, she later betrayed him, leading to Gedde being imprisoned on the Halo as the team returned to Chandrila. Under the orders of Imperial Navy Admiral Rae Sloane, he was poisoned with a mycotoxin by the bounty hunter Mercurial Swift so that he could not provide information about his BW work to the New Republic.

In Star Wars: Commander (a mobile strategy game), it is revealed that the Imperial Military Department of Advanced Weapons Research organized a program called Project Blackwing on Dandoran. The project was tasked with discovering how to create immortality, principally by using Sith alchemy to create a virus that could reanimate the dead. However, this did not go according to plan as there was the accidental creation and release of the Blackwing virus, AKA “the Sickness”, sometime between the Battles of Yavin and Hoth. The virus killed its hosts and turned them into cannibal zombies. While the zombies did move slower than their living hosts had previously, they had much more stamina and strength than before. Worse yet, the virus allowed the zombies to act as one and to learn from others, allowing them to use weapons and pilot starships. The outbreak spread across the secret installation, earning the new Undead Troopers the collective name “Army of the Dead” as they eventually came to be supplemented by Heavy and Scout Undead Troopers. Both the Empire and the Rebel Alliance worked to contain this threat, eventually succeeding, though the rebels did have to contain a second outbreak later on. This virus also appears in Legends work.

Finally, Battlefront: Twilight Company reveals that during the Galactic Civil War, the Empire hosted a BW research facility on Coyerti. The Distillery was the main hub of the BW operation on the planet, making it an important strategic target during the Coyerti campaign. Though there are not many specifics, it is known that the Distillery created, tested, and exported toxin (and even some chemical) weapons. During the Coyerti campaign, the Alliance’s 61st Mobile Infantry (AKA Twilight Company) successfully destroyed the Distillery. However, weapons from the Distillery stockpiled on Nakadia were later used on Twilight Company, claiming many rebel soldiers, including Maediyu after her internal organs liquified.

“These aren’t pesticides. They’ve got military-grade bioweapons, be careful.”

Hazram Namir, Battlefront: Twilight Company

That wraps up examples in the canon. Check out Star Wars: The Clone Wars S1:E17 and 18 (“Blue Shadow Virus” and “Mystery of a Thousand Moons”) to see Blue Shadow Virus in action. And before you say, “But what about the Kamino saberdart?” Well…more on that at the end.

Biological and Toxin Weapons in Star Wars Legends

As you might have guessed, BW is much more prevalent throughout the much larger Legends side of the franchise. While we can’t possibly cover it all in this post, we will hit some of the highlights. Much like in the canon, it is known that bioweapons have been used across time and space in the galaxy. Ship, the sentient spacecraft who existed in the intergalactic void, recalled the use of the Plague bomb during a war in a distant galaxy. Ship reveals in “Star Wars 38: Riders in the Void” that the bomb destroyed the home world of Ship’s pilot, with the pilot being the only known member of the species to survive the outbreak. The Charon are also known to have used BW frequently.

More recently, the Old Republic era saw the use of many bioweapons, such as Trihexalon in the Star War: Jedi Starfighter game. Trihexalon, AKA hex or dragon’s breath, was a weapon created by the Trade Federation using ore from Mount Merakan. It was said to cause “complete biomass conversion” in targets and it could be either tailored to target a specific individual or used against an entire planet. Once refined, hex was a dust that was inert and stable at very low temperatures. This was kept in vials that allowed the agent to be released when ready, causing a massive energy burst. A palm-sized sample was enough to kill as many as 300 Wookies, though this depended on the blast size generated by the special vial.

Later on, the Empire developed nano-destroyers, engineered viruses designed to destroy a victim’s body a single cell at a time. These were first introduced in Champions of the Force and have since been briefly mentioned in The New Rebellion and The New Jedi Order: Agents of Chaos I: Hero’s Trial. The destroyers were said to bind to the victims’ cells, causing them to have powers such as increased strength and speed or rapid healing. However, they also caused the victims to mutate and turn into mindless beings who fed on others. Though there is mention of a cure developed on Carida, little other information is provided about it.

A Sith scientists named Vul Isen developed a weapon using “viral spores” during the Second Imperial Civil War for use as a force multiplier against rebelling planets. Essentially, these weapons killed every living creature in a target planet’s oceans within a matter of days, rendering the oceans totally uninhabitable and eventually killing off the entire population of the planet. He developed several versions of this weapon before finally creating one potent enough so that one vial had the destructive capacity to end life on an entire planet. He intended this final strain to be used on Utapau, where remnants of the Galactic Alliance maintained a base. Later, Isen was ordered by Darth Wyyrlok to release the spores on Dac to punish the Mon Calamari for aiding the Alliance. Within a few days of doing so, millions of Dac’s inhabitants died, floating on the water’s surface and prompting Rogue Squadron to incorrectly conclude that a new landmass had formed on the planet because of the size of the collection of corpses. Galactic Alliance Admiral Gar Stazi became aware of the plot and successfully organized a massive evacuation of Dac, allowing 20% of the planet’s inhabitants to escape before the rest succumbed to the spores. This attack outraged many across the galaxy and set Jedi Cade Skywalker on a warpath for Isen, whom he called the “Butcher of Dac”.

“Poisons? Toxins? Destroy them from space with bombs!”

“As I have explained before, Darth Azard, we’re not here to make the inhabitants really, really sick. We’re to make certain they all die.”

Vul Isen to Darth Azard in Legacy 49: Extremes, Part 2 (2006)

The last one we’ll touch on today is Vira606, a virus engineered by the Imperial Security Bureau that appeared in the Stars Wars: The Roleplaying Game campaign book, The Far Orbit Project. Basically, the ISB created this virus to be 100% fatal, though it was not contagious. There was, however, a very specific series of serum injections that could keep it at bay for a time, preventing death until another series was needed. The ISB used this to maintain control over enemies and agents, ensuring their loyalty and forcing them to do tasks in order to get a ration of the injections in time.

Final Thoughts and Further Reading/Nerding

In case it isn’t clear, some times the Star Wars universe confuses BW and CW and sometimes the causative agents and mechanisms of these weapons just do not add up. While it is likely that societies in a galaxy where inter-planetary travel and jumps through hyperspace are common have more advanced bioweapons than those in real life, their designs are not always clear to us here in this galaxy. However, it is still interesting to see how these kinds of weapons are represented in popular culture, especially since BW doesn’t quite have a key, iconic representation in film a la Dr. Strangelove.

BW’s presence in pop culture did grow during the Cold War, though it has appeared in written and film media for much longer (check out Albert Robida’s La Guerre au vingtième siècle/The War in the Twentieth Century for a 19th century take on weaponized disease, for example). Some of this mid-20th century fascination seems to have influenced parts of Star Wars’ take on BW as well. For example, Dr. Nuvo Vindi speaks with a distinctly German accent. He also weaponizes a previously eradicated pathogen, paralleling the real-life threat of smallpox weapons following the disease’s eradication and the end of civilian vaccination campaigns. Of course, in recent years, zombie films have been huge in the United States, though the South Koreans definitely do zombie movies best. Iconic outbreak films like Outbreak, Contagion, and I Am Legend also naturally experienced renewed popularity in 2020. Whatever the era or genre, it seems we just can’t get enough of the psychological terror the idea of an infectious disease killing everyone off brings- even in the classic space opera in a galaxy far, far away.

For more BW+space opera fun, this Wookiepedia page offers a great jumping point to learn more about all the uses of BW in Legends materials. This one offers examples of BW use appearing in canon work. If you’re more interested in CW, check out this Wookiepedia listing for weapons that use different chemicals (including lots of assassination weapons). Make sure to check out this post on the Star Wars official site called the Phlegmpire Strikes Back, which discusses other bioweapons and naturally-occurring illnesses in the galaxy. Finally, if you want a video on the Imperial BW Program, check out EckhartsLadder’s video on the program here on YouTube. Now, about that saberdart…

The canon isn’t always clear on if the Kamino saberdart uses a toxin or a poison to kill, but it is more clear in Legends work that these darts can use either type of weapon. Love or hate the Dex’s Diner scene in Episode II, this weapon helped drive the plot along while establishing that CBW are also used for assassinations in this galaxy. Now if only we knew more about disinfo campaigns in the galaxy…

That wraps up this special feature. May the fourth be with you all, Pandora Report readers. We’ll see you on Friday for the weekly newsletter!

­­The Hidden Pandemic: COVID-19’s Impact on Antimicrobial Resistance

By Theresa Hoang, Biodefense MS Student

Introduction

The COVID-19 global pandemic has threatened public health security by adversely altering the health of patients and overwhelming hospital systems throughout the world. Not only is COVID-19 a global health threat, but antimicrobial resistance (AMR) is a public health crisis too. AMR happens when microbes become resistant to antimicrobials that are designed to kill them.[1] AMR contributes to healthcare-associated infections (HAI)­ in patients, which spreads within healthcare facilities and throughout the community and environment.[2] The CDC reports that “each year in the U.S., at least 2.8 million people are infected with antibiotic-resistant bacteria or fungi, and more than 35,000 people die as a result.”1 AMR is a serious public health concern, especially during the pandemic, because experts have noted that COVID-19 may have reversed the progress on reducing AMR by creating a “perfect storm” for antibiotic-resistant infections in healthcare settings.[3] How has the COVID-19 pandemic impacted AMR in clinical patients, and why is it important? This issue is important because it affects patients, who are undergoing antibiotic treatments, and healthcare systems that are trying to prevent the spread of AMR. The current literature has discussed extensively the direct and indirect effects of the COVID-19 pandemic on AMR. A group of authors focuses on the increase of secondary drug-resistant infections and how they are affecting COVID-19 patients. Another group discusses the deterioration of healthcare systems allowing AMR transmission to escalate. Other authors analyze the disruption of antibiotic stewardship and its adverse effects during the pandemic. To fight against this growing pandemic, patients should work together with their healthcare providers to learn about the troubling effects of AMR and how to prevent it from spreading by practicing enhanced antimicrobial stewardship.

Secondary Drug-Resistant Infections from AMR

The surge in AMR during the pandemic has resulted in a rise of secondary drug-resistant infections. The three drug-resistant microorganisms that will be discussed are methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacterales (CREs), and Candida auris.

Scanning Electron Micrograph of MRSA (from CDC)

Methicillin-resistant Staphylococcus aureus

MRSA is commonly spread in healthcare facilities and communities, and it can cause staphylococcus infections that are usually difficult to treat because of its resistance to some antibiotics.[4] Segala et. al explain that, during the pandemic, MRSA co-infections have increased significantly in COVID-19 patients who were admitted to intensive care units (ICUs).[5] “Up to 86.4% of all COVID-19 patients admitted to the ICU received a wide spectrum antibiotic therapy,” which helps treat against a vast majority of co-infections, including MRSA.5 However, exposing patients to these unnecessary antibiotics in a combination therapy can induce AMR. In another case study completed in Italy on mechanically ventilated patients, researchers compared the proportion of ventilator associated pneumonia (VAP) due to MRSA, between COVID-19 patients and non-COVID-19 patients.5 They found VAP rates were significantly higher in COVID-19 patients due to receiving a broad spectrum antibiotic therapy. Their findings also suggest there is higher rate of MRSA colonization and environmental contamination in COVID-19 ICUs.5 MRSA has not only evolved to become more resistant to antibiotics, but it continues to spread and colonize in healthcare facilities and other communities, in addition to infecting COVID-19 patients at increasing rates.

Infographic of the Risk of CRE Infections (from CDC)

Carbapenem-Resistant Enterobacterales (CREs)

Carbapenem-resistant Enterobacterales (CREs), formerly known as CR Enterobacteriaceae and nicknamed “Nightmare bacteria,” are a large group of different types of Gram-negative bacteria, such as Escherichia coli (E. coli) and Klebsiella pneumoniae, that commonly causes multiple infections in humans and in healthcare settings. CREs also develop resistance to a group of antibiotics called carbapenems.[6] CRE infections are spread from person-to-person by infecting or colonizing people (without causing infections or symptoms), specifically contact with wounds or stool, and through medical devices that have not been properly cleaned.[7]

CREs are a threat to public health because they are difficult to treat and are resistant to almost all available antibiotics.6 Their resistance comes from producing carbapenemases, which are enzymes that spread to other germs and cause resistance in carbapenems, rendering them ineffective.4 The CDC states that high levels of antibiotic resistance in CREs necessitate more toxic and less effective treatments, harming patient outcomes.7

Studies have shown that CRE infections are increasing among COVID-19 patients. According to a recent review on CRE infections during the pandemic, “secondary infections caused by CR-Klebsiella pneumoniae (Cr-Kp) show high prevalence of co-infection in COVID-19 patients.”5 Researchers have noticed that CR-Kp colonization and infections were associated with a high mortality rate in COVID-19 patients and increased use of antimicrobial agents.5 This represents a significant challenge for both infection control and clinical practice because as new antibiotics continue to be overused, CRE infections continue to rise and manifest in healthcare facilities and throughout communities.

Candida auris on CHROMagar Candida after Salt Sab Dulcitol Broth enrichment (from CDC)

Candida auris

Candida auris is an emerging multidrug-resistant (MDR) yeast that brings severe infections and spreads easily between hospitalized patients and nursing home residents through skin-to-skin contact.4 It can also cause invasive infections by entering the bloodstream, and even cause wound and ear infections.[8] Moreover, C. auris can trigger outbreaks in healthcare settings by contaminating hospital surfaces and medical equipment, especially if they are used for COVID-19 critical care. This indicates that patients are at high risk of C. auris colonization and infections.[9]

C. auris is an extreme public health threat to communities, and it has become a more serious concern during the pandemic. Since some patients with severe COVID-19 have required intubation and other invasive devices, they are put at a higher risk of C. auris infections; the pandemic may have contributed to an increase in these cases.[10] In another report from the CDC, 39 cases of C. auris have appeared in Florida during the pandemic that were attributed to “unconventional personal protective equipment (PPE) practices and environmental contamination.”[11] Risk factors like these have caused critically ill COVID-19 patients with C. auris infections to stay longer at ICUs and require antifungal drugs for long periods of time.5 This proves that improper and extended use of PPE has played a role in self-contamination and transmission of C. auris among COVID-19 patients.5 To prevent C. auris from spreading, especially among COVID patients, it must be detected immediately and IPC practices must be implemented.

Overall, the three different pathogens share a common goal, which is to induce AMR and increase secondary infections among patients. These drug-resistant microorganisms are a few out of the many other agents that have impacted patients during the COVID-19 pandemic.

AMR Implications for Healthcare Systems

Additionally, during the COVID-19 pandemic, the exacerbation of healthcare systems has increased transmission of AMR. Studies have shown that the rise of AMR in healthcare facilities was caused by a variety of factors, such as prolonged stays in the ICU,[12] overcrowding,[13] “contaminated PPE, increased workload among hospital staff, and prolonged glove usage.”[14] Furthermore, “shortages of PPE, staff shortages, fatigue, and deployment of inexperienced staff members with only basic training” are other factors that may contribute to the increased risk of AMR.[15] These determinants not only led to a surge in AMR, but also increases in morbidity, mortality, and healthcare costs for patients.14

To reduce AMR from escalating any further, Rawson et. al propose that social distancing, increased hand hygiene practice, and pre-emptive discharge of patients and cancellation of routine procedures are potential interventions that healthcare systems can implement during the pandemic.13 In addition, Knight et. al mention “enhanced infection prevention and PPE usage and control measures, in response to the COVID-19 pandemic, will help prevent infections and limit the spread of AMR.”15 Therefore, better health infrastructure and enhanced IPC measures set in place mean minimization of AMR amongst patients.

Disruption of Antimicrobial Stewardship

Disruption of antibiotic stewardship is another problem that needs to be addressed with the rise of AMR driven by COVID-19. Antimicrobial stewardship (AMS) is “promoting the appropriate use of antimicrobials, improving patient outcomes, reducing AMR, and decreasing spread of infections caused by multidrug-resistant organisms (MDROs).”[16] However, AMS has not been emphasized enough during the pandemic. For instance, researchers are concerned that increased antibiotic use during the pandemic could enhance the long-term threat of AMR.[17] Popescu states that “misuse and overprescribing of antibiotics, poor stewardship, and generalized lack of surveillance,” are some reasons why AMR continues to be a public health problem.[18]

Moreover, misinformation on antibiotic use (whether it is low public awareness or increased consumption of them) is another factor that may enhance the rise and spread of AMR.[19] For example, Arshad et. al explain that 44% of respondents to a population survey in Australia assumed that antibiotics could treat or prevent COVID-19, and university students in Jordan who believed in conspiracy theories around COVID-19 also thought antibiotics can cure it.[20] Additionally, clinical uncertainty about the disease process and pathology of an infection can increase antibiotic use. “When clinicians do not have all the necessary information to truly understand what is happening to the patient, they tend to prescribe more antibiotics.”17 Altogether, these factors can increase the spread of AMR and disrupt AMS.

In contrast, Toro-Alzate et. al argue that “telemedicine consultations could be useful to educate patients on improving antibiotic use.”19 But at the same time, they mention how telemedicine can also increase over-prescription of antibiotics due to physicians’ decision making.19 Because they are not with patients in-person, healthcare providers tend to misdiagnose more often and not order as much lab tests with these remote services.

#BeAntibioticsAware: Do I really need antibiotics? (from CDC)

Another AMS strategy is using social media to manage online media campaigns that combat misinformation of antibiotic use. Some organizations, such as WHO and Nigeria Centre for Disease Control, correct antimicrobial misinformation and discuss ineffectiveness of antibiotics as a treatment for COVID-19 by using their digital platforms.20 Taking everything into consideration and how the pandemic impacted the public health community, AMS must be further improved and emphasized among patients and healthcare providers to reduce AMR.

Are Hospital Stays of COVID-19 Patients (with AMR) Longer than Those of Non-COVID Patients?

The literature does not yet analyze the question of whether the length of hospital stays for COVID-19 patients with AMR are longer compared to hospital stays of non-COVID-19 patients. One study has claimed that AMR has led to adverse consequences for patients, including “more prolonged hospital admissions.”[21] Srinivasan mentions and compares the patient discharge data and AMR rates between patients with influenza-like illness and COVID-19.11 Yet, the data between patients with flu and COVID-19 were collected at different time frames.

Source: CAPT Arjun Srinivasan, MD, USPHS (CDC PowerPoint)

In the current literature, there is no evidence and comparison recorded between hospital stays of COVID-19 and non-COVID patients during the pandemic, over the same time period. Considering that the surge in AMR has been driven by the pandemic, and that it has caused ill patients to stay at hospitals based on their conditions, it is hypothesized that COVID-19 patients with AMR have stayed at the hospitals much longer than non-COVID patients during the pandemic. To examine this gap, further research needs to be conducted by attempting to gather data through a survey and compare hospital stay rates between COVID-19 and non-COVID patients from different hospitals in the Northern Virginia area. This would also explore the critical steps needed to treat patients with AMR and to mitigate its transmission before discharging patients.

Conclusion

Antibiotics save lives but any time antibiotics are used, they can induce side effects and lead to AMR.4 Along with the rise in AMR, COVID-19 has compounded this issue, creating more challenges for patients and hospital systems to overcome. The surge of secondary infections among patients, the exacerbation of hospital infrastructures, and the disruption of antimicrobial stewardship are the results of COVID-19’s impact on AMR.

Bibliography

Arshad, Mehreen, Syed Faisal Mahmood, Mishal Khan, and Rumina Hasan. 2020. “COVID-19, Misinformation, and Antimicrobial Resistance.” BMJ371 (November): m4501. https://doi.org/10.1136/bmj.m4501.

CDC. 2021. “Candida auris.” Centers for Disease Control and Prevention. July 19, 2021. https://www.cdc.gov/fungal/candida-auris/index.html.

CDC. 2021. “CRE: Healthcare-Associated Infections (HAI).” Centers for Disease Control and Prevention. April 7, 2021. https://www.cdc.gov/hai/organisms/cre/index.html.

​​CDC. 2021. “Patients | CRE | HAI”. Centers for Disease Control and Prevention. February 18, 2021. https://www.cdc.gov/hai/organisms/cre/cre-patients.html.

CDC. 2020. “What Exactly Is Antibiotic Resistance?” Centers for Disease Control and Prevention. March 13, 2020. https://www.cdc.gov/drugresistance/about.html.

CDC. 2020. “Where Antibiotic Resistance Spreads.” Centers for Disease Control and Prevention. March 10, 2020. https://www.cdc.gov/drugresistance/about/where-resistance-spreads.html.

Centers for Disease Control and Prevention (U.S.). 2019. “Antibiotic Resistance Threats in the United States, 2019.” Centers for Disease Control and Prevention (U.S.). https://doi.org/10.15620/cdc:82532.

Jul 27, Chris Dall | News Reporter | CIDRAP News | and 2021. n.d. “CDC Reports Two Outbreaks of Pan-Resistant Candida Auris.” CIDRAP. Accessed October 6, 2021. https://www.cidrap.umn.edu/news-perspective/2021/07/cdc-reports-two-outbreaks-pan-resistant-candida-auris.

Chowdhary, Anuradha, and Amit Sharma. 2020. “The Lurking Scourge of Multidrug Resistant Candida Auris in Times of COVID-19 Pandemic.” Journal of Global Antimicrobial Resistance 22 (September): 175–76. https://doi.org/10.1016/j.jgar.2020.06.003.

“COVID-19 & Antibiotic Resistance | CDC.” 2021. June 8, 2021. https://www.cdc.gov/drugresistance/covid19.html.

Hsu, Jeremy. “How Covid-19 is Accelerating the Threat of Antimicrobial Resistance.” BMJ: British Medical Journal (Online) 369, (May 18, 2020). http://dx.doi.org.mutex.gmu.edu/10.1136/bmj.m1983.

Knight, Gwenan M., Rebecca E. Glover, McQuaid C. Finn, Ioana D. Olaru, Gallandat Karin, Quentin J. Leclerc, Naomi M. Fuller, et al. 2021. “Antimicrobial Resistance and COVID-19: Intersections and Implications.” ELife 10. http://dx.doi.org/10.7554/eLife.64139.

Majumder, Md Anwarul Azim, Sayeeda Rahman, Damian Cohall, Ambadasu Bharatha, Keerti Singh, Mainul Haque, and Marquita Gittens-St Hilaire. 2020. “Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health.” Infection and Drug Resistance 13: 4713–38. http://dx.doi.org/10.2147/IDR.S290835.

Manning, Mary Lou, Edward J. Septimus, Elizabeth S. Dodds Ashley, Sara E. Cosgrove, Mohamad G. Fakih, Steve J. Schweon, Frank E. Myers, and Julia A. Moody. 2018. “Antimicrobial Stewardship and Infection Prevention—Leveraging the Synergy: A Position Paper Update.” American Journal of Infection Control 46 (4): 364–68. https://doi.org/10.1016/j.ajic.2018.01.001.

Popescu, Saskia. 2019. “The Existential Threat of Antimicrobial Resistance.” Bulletin of the Atomic Scientists 75 (6): 286–89. https://doi.org/10.1080/00963402.2019.1680053.

Rawson, Timothy M, Luke S P Moore, Enrique Castro-Sanchez, Esmita Charani, Frances Davies, Giovanni Satta, Matthew J Ellington, and Alison H Holmes. 2020. “COVID-19 and the Potential Long-Term Impact on Antimicrobial Resistance.” Journal of Antimicrobial Chemotherapy 75 (7): 1681–84. https://doi.org/10.1093/jac/dkaa194.

Segala, Francesco Vladimiro, Davide Fiore Bavaro, Francesco Di Gennaro, Federica Salvati, Claudia Marotta, Annalisa Saracino, Rita Murri, and Massimo Fantoni. 2021. “Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review.” Viruses 13 (11): 2110. https://doi.org/10.3390/v13112110.

​​Srinivasan, Arjun. “The Intersection of Antibiotic Resistance (AR), Antibiotic Use (AU), and COVID-19.” Centers for Disease Control and Prevention. February 10, 2021. https://www.hhs.gov/sites/default/files/antibiotic-resistance-antibiotic-use-covid-19-paccarb.pdf.

Sun Jin, Louisa and Fisher, Dale. 2021. “MDRO Transmission in Acute Hospitals during the COVID-19 Pandemic.” Wolters Kluwer Health, Inc. (34) 4: 365–371.

Toro-Alzate, Luisa, Karlijn Hofstraat, and Daniel H de Vries. 2021. “The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance.” International Journal of Environmental Research and Public Health 18 (16): 1–20. https://doi.org/10.3390/ijerph18168766.        

Vidyarthi, Ashima Jain, Arghya Das, and Rama Chaudhry. 2021. “Antimicrobial Resistance and COVID-19 Syndemic: Impact on Public Health.” Drug Discoveries & Therapeutics 15 (3): 124–29. https://doi.org/10.5582/ddt.2021.01052.


[1] CDC. 2020. “What Exactly Is Antibiotic Resistance?” Centers for Disease Control and Prevention. March 13, 2020. https://www.cdc.gov/drugresistance/about.html.

[2] CDC. 2020. “Where Antibiotic Resistance Spreads.” Centers for Disease Control and Prevention. March 10, 2020. https://www.cdc.gov/drugresistance/about/where-resistance-spreads.html.

[3] “COVID-19 & Antibiotic Resistance | CDC.” 2021. June 8, 2021. https://www.cdc.gov/drugresistance/covid19.html.

[4] Centers for Disease Control and Prevention (U.S.). 2019. “Antibiotic Resistance Threats in the United States, 2019.” Centers for Disease Control and Prevention (U.S.). https://doi.org/10.15620/cdc:82532.

[5] Segala, Francesco Vladimiro, Davide Fiore Bavaro, Francesco Di Gennaro, Federica Salvati, Claudia Marotta, Annalisa Saracino, Rita Murri, and Massimo Fantoni. 2021. “Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review.” Viruses 13 (11): 2110. https://doi.org/10.3390/v13112110.

[6] CDC. 2021. “CRE: Healthcare-Associated Infections (HAI).” Centers for Disease Control and Prevention. April 7, 2021. https://www.cdc.gov/hai/organisms/cre/index.html.

[7] CDC. 2021. “Patients | CRE | HAI”. Centers for Disease Control and Prevention. February 18, 2021. https://www.cdc.gov/hai/organisms/cre/cre-patients.html

[8] CDC. 2021. “Candida auris.” Centers for Disease Control and Prevention. July 19, 2021. https://www.cdc.gov/fungal/candida-auris/index.html.

[9] Chowdhary, Anuradha, and Amit Sharma. 2020. “The Lurking Scourge of Multidrug Resistant Candida Auris in Times of COVID-19 Pandemic.” Journal of Global Antimicrobial Resistance 22 (September): 175–76. https://doi.org/10.1016/j.jgar.2020.06.003.

[10] Jul 27, Chris Dall | News Reporter | CIDRAP News | and 2021. n.d. “CDC Reports Two Outbreaks of Pan-Resistant Candida Auris.” CIDRAP. Accessed October 6, 2021. https://www.cidrap.umn.edu/news-perspective/2021/07/cdc-reports-two-outbreaks-pan-resistant-candida-auris.

[11] Srinivasan, Arjun. “The Intersection of Antibiotic Resistance (AR), Antibiotic Use (AU), and COVID-19.” Centers for Disease Control and Prevention. February 10, 2021. https://www.hhs.gov/sites/default/files/antibiotic-resistance-antibiotic-use-covid-19-paccarb.pdf.

[12] Vidyarthi, Ashima Jain, Arghya Das, and Rama Chaudhry. 2021. “Antimicrobial Resistance and COVID-19 Syndemic: Impact on Public Health.” Drug Discoveries & Therapeutics 15 (3): 124–29. https://doi.org/10.5582/ddt.2021.01052.

[13] Rawson, Timothy M, Luke S P Moore, Enrique Castro-Sanchez, Esmita Charani, Frances Davies, Giovanni Satta, Matthew J Ellington, and Alison H Holmes. 2020. “COVID-19 and the Potential Long-Term Impact on Antimicrobial Resistance.” Journal of Antimicrobial Chemotherapy 75 (7): 1681–84. https://doi.org/10.1093/jac/dkaa194.

[14] Sun Jin, Louisa and Fisher, Dale. 2021. “MDRO Transmission in Acute Hospitals during the COVID-19 Pandemic.” Wolters Kluwer Health, Inc. (34) 4: 365–371.

[15] Knight, Gwenan M., Rebecca E. Glover, McQuaid C. Finn, Ioana D. Olaru, Gallandat Karin, Quentin J. Leclerc, Naomi M. Fuller, et al. 2021. “Antimicrobial Resistance and COVID-19: Intersections and Implications.” ELife 10. http://dx.doi.org/10.7554/eLife.64139.

[16] Manning, Mary Lou, Edward J. Septimus, Elizabeth S. Dodds Ashley, Sara E. Cosgrove, Mohamad G. Fakih, Steve J. Schweon, Frank E. Myers, and Julia A. Moody. 2018. “Antimicrobial Stewardship and Infection Prevention—Leveraging the Synergy: A Position Paper Update.” American Journal of Infection Control 46 (4): 364–68. https://doi.org/10.1016/j.ajic.2018.01.001.

[17] Hsu, Jeremy. “How Covid-19 is Accelerating the Threat of Antimicrobial Resistance.” BMJ: British Medical Journal (Online) 369, (May 18, 2020). http://dx.doi.org.mutex.gmu.edu/10.1136/bmj.m1983.

[18] Popescu, Saskia. 2019. “The Existential Threat of Antimicrobial Resistance.” Bulletin of the Atomic Scientists 75 (6): 286–89. https://doi.org/10.1080/00963402.2019.1680053.

[19] Toro-Alzate, Luisa, Karlijn Hofstraat, and Daniel H de Vries. 2021. “The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance.” International Journal of Environmental Research and Public Health 18 (16): 1–20. https://doi.org/10.3390/ijerph18168766.          

[20] Arshad, Mehreen, Syed Faisal Mahmood, Mishal Khan, and Rumina Hasan. 2020. “COVID-19, Misinformation, and Antimicrobial Resistance.” BMJ 371 (November): m4501. https://doi.org/10.1136/bmj.m4501.

[21] Majumder, Md Anwarul Azim, Sayeeda Rahman, Damian Cohall, Ambadasu Bharatha, Keerti Singh, Mainul Haque, and Marquita Gittens-St Hilaire. 2020. “Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health.” Infection and Drug Resistance 13: 4713–38. http://dx.doi.org/10.2147/IDR.S290835.

Pandora Report: 5.15.2020

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

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

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

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

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

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

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

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

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

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

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

 

Pandora Report: 4.10.2020

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

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

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

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

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

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

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

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

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

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

Pandora Report: 2.28.2020

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

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

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

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

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

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

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

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