Pandora Report 5.5.2017

Welcome to your weekly dose of all things biodefense. We hope you’ll celebrate World Hand Hygiene Day today by practicing awesome hand hygiene to help stop the spread of germs! Will Bill Gates save us from the next Ebola?

Summer Workshop Discount Extended
We’re excited to announce that the early registration deadline has been extended to June 1st for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security! This is a great opportunity to experience a 3-day workshop led by some of the top biodefense people in the field, not to mention networking opportunities with fellow global health security gurus. Don’t miss out on this July 17-19th workshop in which you’ll learn about bioterrorism, synthetic biology, dual-use research of concern, and how experts are working to stop the next pandemic.

Three Insights from the World Bank’s Tim Evans on Global Health
“While in the previous year the U.S. was the biggest single source of development aid finance for health at $12.8 billion — 34 percent of the global total — its future position is less clear. Specifics on U.S. commitments to global health were lacking in U.S. President Donald Trump’s ‘skinny budget‘ released in March. The latest budget document released this week, meanwhile, shows proposed cuts to USAID’s global health funds.” At a recent event hosted by the Kaiser Family Foundation and the Center for Strategic and International Studies, Tim Evans, senior director of health, nutrition, and population at the World Bank Group, pointed to three important lessons. Firstly, we must catalyze domestic resource mobilization. Domestic spending impacts a country’s capacities and universal healthcare development. “Evans said the global health community needs to rethink the way it views and packages development assistance, from largely being linked to service provision to one that can strengthen countries’ domestic resource mobilization.” Second, he notes that it is crucial to build a demand for health. Policy shifts and economic strain increasingly threaten global health security efforts. He notes that there is a “very strong need to think about building demand and not to pretend that because you’re doing health and saving lives that everybody thinks that’s a great idea,”. “Actively cultivate that community, because you know if you don’t, then it doesn’t take much of a counter force — and we’ve seen this in the areas of vaccines and immunizations — to erode that base of support.” Lastly, the growing threat of disease requires that we expand beyond the “public sector-only mindset”. It’s critical to consider and utilize the private sector for public health efforts. He mentioned that “the public sector has massively important functions. But we have to look in a granular way, various ways, in which the private sector is active, will be active, and work with that in ways that are going to address burden of disease in cost effective manners,”.

Has The Deep State Hoodwinked Trump?
GMU Professor Charles P. Blair and biodefense MS student Rebecca Earnhardt are pointing to Trump’s recent military action in Syria and what really happened behind closed doors. “Though many of the administration’s more centrist supporters cheered the US missile strike on the Syrian air base, characterizing it as a bold move necessitated by the weakness of Barack Obama, other Trump supporters argued that the president had been tricked into a grand mistake. Was Trump the victim of a ruse by the ‘deep state’—a monolithic alignment of federal power centers so intent on maintaining command that it was willing to derail the new administration by encouraging it to pursue unwise military action? Or was the president misled by an even more ominous version of the deep state: one that subverts legitimate civilian leadership in a bid to recouple the United States to ‘regime change’ and similar globalist policies of militant ‘humanitarian’ interventionism?” Blair and Earnhardt look at this history of “deep state”, the rise of the “new world order”, and the growth of fringe beliefs in conspiracy and the notion of a hidden organization (think The X-Files, Men in Black, and the Matrix). “This elevated circulation of cross-pollinated conspiratorialism, now manifest in the increasingly normalized views of the fringe far right, has been facilitated not just by television and movies, as discussed above, but also by Internet platforms.” While not all associate the deep state with some totalitarian global group (which reminds me of James Bond‘s Spectre and Mission Impossible‘s Syndicate), the increasing belief in “sanitized conspiracies” has highlighted some changes how we form beliefs and what that translates to. Earnhardt and Blair also note that that while such beliefs have increased while faith in government, science, and the press have declined.

Why Are We More at Risk Than Ever for a Global Pandemic? 
GMU Biodefense PhD student, Saskia Popescu, looks at the seven reasons we’re more at risk than ever for a global pandemic. While concurring with a recent list following CNN’s pandemic documentary, she highlights two gaps within it – attitude towards infectious diseases and the role of healthcare infrastructure. “The current attitude towards infectious diseases puts us more at risk. Ebola brought the realities of borderless outbreaks to the forefront, especially with availability of faster information. Industrialized countries view diseases—emerging infectious diseases, in particular—differently than developing countries. In the United States, we relish our vaccine availability enough that we refuse it and often see emerging diseases as third world problems. Ebola showed us two things; the unfounded and irrational fear that occurred in the United States, and the lack of preparedness or acknowledgement that a disease in West Africa could venture across the pond.” She highlights the damaging implications of viewing emerging infectious diseases as “third world country problems” and what cultural shift is needed for this to change. The second missing component to the list is healthcare infrastructure and infection control efforts. “Physicians and nurses alike are desperately needed in developing countries; however, it is important to include another role that is often forgotten: infection control and prevention. Although there are fewer doctors and nurses in outbreak regions, there is also something to be said about the grossly underfunded and underutilized role of infection control as a preparedness and response tool. Whether it is in the United States or in a developing country, infection prevention and control programs are vital for both patient and employee safety, frequently understaffed, and economically strained.” Highlighting the nosocomial cases in Dallas, TX, she notes that infection control is bigger than just hospital-acquired infections and trickles down to antimicrobial resistance, communicable disease reporting, and patient isolation. “Overall, the way we look at emerging infectious diseases, our role in preventing and responding to them, and how we utilize (or fail to utilize) healthcare have created a substantial vulnerability for future public health threats. We have more than enough proof to show how vulnerable we all are to infectious diseases and how vital hospital infection control is to not only internal infections, but also preventing the spread from the community. Now is the time to truly utilize a holistic approach—including infection control programs, public education and cultural awareness, and more—to prevent the next pandemic.”

U.S. Biodefense Failures
Despite the bipartisan nature of biothreat preparedness, the U.S. struggles to to support such efforts. A recent Blue Ribbon Study Panel on Biodefense meeting highlighted yet again, the lack of leadership for U.S. biodefense efforts -whether that be an agency or person. “For at least two decades, infectious disease experts have been urging the U.S. government to do more to keep the country prepared for outbreaks of diseases such as a new strain of flu, Ebola and severe acute respiratory syndrome, or SARS. They’ve also noted that other countries have prepared biological weapons such as smallpox and anthrax and have used chemical weapons — such as Syria’s use of sarin gas against its own citizens.” Despite the constant supply of warnings from experts regarding the eventuality of a new flu pandemic, the 2014 Ebola outbreak, and concerns over dual-use research and gene editing, we just can’t seem to get it together. We know what the threat of infectious diseases, whether it be natural, intentional, or accidental, is real and will only increase as populations grow and globalizations strengthens. “The United States needs to be ready ahead of time, with stockpiles of drugs, vaccines and equipment, plans for deploying them and someone with the authority to make fast decisions, Cole and other experts said. The 2017 budget agreement worked out early Monday by Congress would provide just $57 million specifically to prepare for a new pandemic of influenza.” The truth is that U.S. response tends to be more reactive than proactive. We’ve gotten lucky so far in that the diseases weren’t highly transmissible with high fatality rates, but the truth is that our luck won’t hold forever.

Contaminated CRISPR Kits
This is quite an interesting twist in the concerns over DIY-gene editing…. While many worry about the outcomes of biohackers and garage genome editors, a recent finding of contaminated CRISPR kits sold by the company, The Odin, has added a new worrisome layer. The kits are normally sold online for $150 for those interested in doing gene engineering at home however, this recent finding by the European Centre for Disease Prevention and Control (ECDC) has resulted in a halting of all CRISPR kits imported into Germany. The kits were meant to contain harmless laboratory strains of E. coli HME63, however multiple kits were found to be contamined with several pathogens, including some that are antibiotic resistant. Klebsiella pneumoniae, Enterobacter, and Enterococcus faecalis were the microbial culprits found in the contaminated kits. The ECDC has stated that there is a low risk for users “because the manipulation of the kit does not involve percutaneous injury-prone manipulations. However, infection resulting from the contamination of broken skin or mucous membranes may occur, even though the kit recommends and provides disposable gloves. Furthermore, the kit includes lyophilised materials that need to be reconstituted, which may lead to contamination of the mucosae of the eyes, mouth and nose. Finally, the risk of infection may be increased for immunocompromised or immunosuppressed persons.” You can find the ECDC statement here, which notes that LGL, the Bavarian Health and Food Safety Authority, issued the press release in late March. There is also concern related to the potential release of drug-resistant organisms into the environment, of which the ECDC noted, “the potential contribution of the contaminated kit to the increasing burden of antimicrobial resistance in the EU/EEA is marginal, and the associated public health risk is considered very low”. They also encouraged users of the kits to appropriately dispose of their used materials to avoid releasing any drug-resistant bacteria into the environment.

Eastern Europe Antibiotic Usage Report
A new WHO report is providing information regarding antibiotic consumption and usage in 11 non-EU countries and Kosovo from 2011-2014. “The most commonly used class of antimicrobials was beta-lactams, whose share of the total ranged from 35.4% in Belarus to 65.6% in Azerbaijan, the report says. Cephalosporins accounted for between 6.1% (Azerbaijan) and 30.3% (Turkey) of total consumption, while the share for quinolones ranged from less than 0.1% in Uzbekistan to 17% in the Republic of Moldova. The report notes that cephalosporins and quinolones are broad-spectrum antibiotics and are considered second-line drugs in many prescribing guidelines. The two groups combined accounted for 10% (Azerbaijan) to 38% (Moldova) of total consumption.”

Workshop on Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology
Don’t miss this May 25th event at the National Academy of Sciences Building! This meeting will be open to the public, and will run from 8:30am until 4:30pm. The committee will hear from speakers who will discuss the current state of the science in DNA synthesis, assembly, and engineering; pathogen engineering and zoonosis; and ease of use as it relates to synthetic biology. There will be question and answer periods following each panel discussion, and members of the public will be invited to ask questions of the panelists, so we invite you to attend in person, if you are able. You can also check out the draft agenda here. It will be interesting to see if the workshop will discuss CRISPR kits and the potential for contamination.

Stories You May have Missed:

  • NIH Sets Research Cap on Funding for Scientists–  On Tuesday it was announced that for the first time, the NIH will restrict the amount of funding any individual scientists can hold at a given time via a point system. It is “part of an ongoing effort to make obtaining grants easier for early- and mid-career scientists, who face much tougher odds than their more-experienced colleagues. According to the agency, just 10% of grant recipients win 40% of the agency’s research money. Advocacy organizations and groups that advise the NIH director have been urging the agency to address this inequality for more than a decade. They are also concerned that increasing competition for grant money drives researchers to spend more time on paperwork and personnel issues associated with grants, and less time in the lab.”
  • Yellow Fever Vaccine Levels Are Dangerously Low – The CDC recently announced that the supply of yellow fever vaccine will be depleted by this summer. France is said to be able to cover the U.S. populations in need of the vaccine by the time the U.S. supply runs out, however the ongoing manufacturing problems continue to strain response efforts. “A number of vaccine doses were lost while Sanofi was transitioning vaccine production from an old site to new construction, slated to open in 2018.The United States uses 500,000 doses of yellow fever vaccine each year, distributed to travelers and military personnel who will be visiting yellow fever–endemic regions. Just 1 dose of the vaccine confers lifelong immunity, with recipients showing 80% immunity to yellow fever virus 10 days after inoculation and 99% immunity within 30 days. According to unpublished data from Sanofi, approximately 60% of these doses are distributed among about 4,000 civilian clinical sites.”
  • Attacking Antibiotic Resistance With Behavioral Approaches
    A recent Dutch study looked at antimicrobial stewardship strategies and found that by letting providers determine the root-cause of inappropriate antibiotic prescribing, they were more effective in responding to the problem. “The aim of the study was to test the effectiveness of a stewardship approach in which prescribers were asked to determine the root causes of inappropriate antimicrobial prescribing in their department, then develop one or more interventions to improve prescribing based on those root causes. The theory behind this strategy is that if you respect prescriber autonomy and allow prescribers to create their own program to improve prescribing, they will value this approach more and show more commitment to it.  Overall, there were 21,306 clinical admissions during the baseline period and 15,394 clinical admissions during the intervention period, with the appropriateness surveys including 1,121 patients and 882 patients, respectively. In the baseline period, 64.1% of antimicrobial prescriptions were considered appropriate, compared with 77.4% in the intervention period, an increase of 20.7% that equaled 4,927 improved days of therapy.”

Pandora Report 4.21.2017

If you missed the Infectious Disease Mapping Challenge webinar last week, you can catch the recording here! Ongoing reports are highlighting that the Trump administration is unprepared for a global pandemic.

How Prepared Is The U.S. For Disease Threats?
Scientific American sat down with former CDC director Tom Frieden to discuss his experiences and what he worries may be on the horizon for public health threats. When asked about immediate health issues facing the current administration, Frieden highlights the ongoing Zika outbreak, antibiotic resistance, emerging infections, and the ever-present risk of influenza. In terms of CDC preparedness, Frieden says that, “It’s a big problem that when there is an emerging threat, we are not able to surge or work as rapidly as we should, as a result of a lack of additional funding and legislative authority. When there is an earthquake, the Federal Emergency Management Agency doesn’t have to go to Congress and say, ‘Will you give us money for this?’ But the CDC does. We have made a really good start working with 70 countries to strengthen lab systems, rapid-response and field-monitoring systems, but it is going to take a while before countries around the world are adequately prepared. A blind spot anywhere puts any of us at risk.”

Bill Gates Warns of Increased Bioterrorism Threat
The entrepreneur and philanthropist has been drawing increasing attention to the threat of infectious diseases, especially in regards to bioterrorism. Speaking at the Royal United Services Institute in London (RUSI), Gates stated that, “bioterrorism is a much larger risk than a pandemic.” “All these advances in biology have made it far easier for a terrorist to recreate smallpox, which is a highly fatal pathogen, where there is essentially no immunity remaining at this point.” He goes further to point out the unique aspects of infectious disease threats that make them more deadly than nuclear bombs. “When you are thinking about things that could cause in excess of 10 million deaths, even something tragic like a nuclear weapons incident wouldn’t get to that level. So the greatest risk is from a natural epidemic or an intentionally caused infection bioterrorism events. Whether the next epidemic is unleashed by a quirk of nature or the hand of terrorist, scientists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year. So the world does need to think about this.” Gates pointed to the insufficient public health response in countries that are likely to experience emerging infections and the importance of foreign aid. Moreover, he highlights two major advancements since the 1918 pandemic – globalization and genetic editing. The DIY biohacker and potential for a single infectious person to travel around the globe in a day are all making the threat of a pandemic that much more real. Lastly, Gates emphasizes that the stability of a country and that of its health systems are vital in that an outbreak is more likely to become an epidemic in a country where both qualities are poor.

Biopreparedness – Developing Vaccines For An Eradicated Disease
Speaking of smallpox and the risk of bioterrorism…Filippa Lentzos is pointing to the smallpox vial discovery at the NIH and that despite the eradication of the disease, a biotech company, Bavarian Nordic, is still working to develop a vaccine. She notes that “possible avenues for the re-emergence of smallpox, including the impact of developments in synthetic biology, and it gives an inside view on the biodefence industry and its unusual business model.” Lentzos is an expert in the field of biodefense and focuses her work on the governance of emerging technologies like synthetic biology.

A Scope, A Resistant Germ, and Missing Data Walk into a Bar
GMU Biodefense PhD student Saskia Popescu is looking into the rise of the resistant bug and how medical equipment can pose increased risks for such infections. In 2015 several outbreaks occurred in patients following a procedure with a type of duodenoscopes made by Olympus. These scopes are “flexible medical devices that look like thin tubes and are inserted through the mouth, throat, and stomach into the small intestine—are reusable $40,000 medical devices that contain many working parts, including a camera, and are used for more than half a million procedures a year. The successful dynamics of the device also make it challenging to clean and disinfect. Just over two years ago, cases of drug-resistant infections started popping up in patients who had recently had the procedure that commonly uses duodenoscopes (endoscopic retrograde cholangiopancreatography or ERCP).” Following an outbreak of the highly resistant carbapenem-resistant Enterobacteriaceae (CRE) at UCLA Medical Center, the scopes were recalled and interim cleaning guidance was provided by the CDC. Unfortunately, there is growing concern that the issues with the scope weren’t fully remedied. “In fact, Sen. Murray highlighted a recent outbreak in Europe (location not disclosed within the US Food and Drug Administration report) tied to the modified scopes. Although, modifications made by Olympus were done in response to the previous outbreaks and meant to reduce the risk of bacteria getting into the device’s channels and preventing proper cleaning and disinfection, Sen. Murray is now questioning Olympus regarding the devices and the role they played in this most recent outbreak. The senator is specifically asking for data proving that the repaired scopes could be properly disinfected between patient use.” As the threat of antibiotic resistance rises, the role of medical devices and manufacturer accountability will become increasingly relevant.

CRISPR Breakthrough Gives Hope for Disease Diagnostics 
CRISPR technology news often comes with a bit of controversy, but research recently published in Science is pointing to exciting new diagnostic capabilities. Feng Zhang and eighteen colleagues “turned this system into an inexpensive, reliable diagnostic tool for detecting nucleic acids — molecules present in an organism’s genetic code — from disease-causing pathogens. The new tool could be widely applied to detect not only viral and bacterial diseases but also potentially for finding cancer-causing mutations.” If you’re a fan of 221b Baker Street, you’ll be pleased to hear that the new tool is named SHERLOCK – Specific High Sensitivity Enzymatic Reporter UnLOCKing. The SHERLOCK tool utilizes the viral-recognition within CRISPR to detect genetic pathogen markers in some one’s urine, blood, saliva, or other body fluids. “They report that their technique is highly portable and could cost as little as 61 cents per test in the field. Such a process would be extremely useful in remote places without reliable electricity or easy access to a modern diagnostic laboratory.” This new finding has amazing potential for public health and rapid disease detection in rural areas to improve time to treatment, isolation, and prevention efforts.

National Science Advisory Board for Biosecurity May 2017 Meeting
Don’t miss this May 11th meeting (2-4:30pm EST)! Items include presentations and discussions regarding: (1) the Blue Ribbon Panel draft report on the 2014 variola virus incident on the NIH Bethesda campus; (2) stakeholder engagement on implementation of the U.S. Government Policy for Institutional Oversight of Life Sciences Dual Use Research of Concern (DURC); and (3) other business of the Board.  A detailed agenda and other meeting material will be posted on this website as they become available. This meeting will be a conference call only; there will be no in-person meeting. To join the call as a member of the public, please use the dial-in information below. The toll-free teleconference line will be open to the public at1:30 P.M. to allow time for operator-assisted check-in.  Members of the public planning to participate in the teleconference may also pre-register online via the link provided below or by calling Palladian Partners, Inc. (Contact: Carly Sullivan at 301-318-0841).  Pre-registration will close at 12:00 p.m. Eastern on May 8, 2017. Make sure to check the website for the public conference line and passcode.

Synthetic Bioterrorism – US Developing Medical Response 
Preparedness efforts against biological threats are now expanding to include synthetic biological threats. “Dr. Arthur T. Hopkins, acting assistant secretary for Nuclear, Chemical, and Biological Defense Programs at the U.S. Department of Defense (DOD), testified that…’emerging infectious diseases, synthetic biology and engineered diseases…[is] an area where we are focusing and we have to continue to focus.’ To counter such current and emerging threats, DOD’s Chemical and Biological Defense Program is developing new strategies to more rapidly respond, especially in the area of medical countermeasures, Hopkins said.” He noted that the DoD has commissioned the National Academy of Science to lead a study on the potential for such an event and its impact on national security.

Chemical Reaction: North Korea’s Chemical Weapons Are A Big Threat- And China Needs to Help Deal With Them
GMU Biodefense PhD alum Daniel M. Gerstein is looking at the “role that China could play with respect to North Korea, in particular dissuading the use of chemical weapons. While tensions are high, the use of chemical weapons could be the “spark that could bring the region to war.” Gerstein notes that while the focus in Syria is internal, if Kim Jong Un used chemical weapons it would most likely be external- against South Korea or Japan (or even the U.S.). It is vital that there be a clear-cut response to the use of chemical weapons and action from China may just be the clear message that’s needed. “To prevent the unthinkable from occurring, the North Koreans must be dissuaded from using chemical weapons. They must be convinced that the use of chemical weapons is a red line that cannot be crossed. China should consider being the messenger for this message. China also should consider taking an active, forward-looking approach to prevent the use of chemical weapons by North Korea. When Syria deployed chemical weapons, there was speculation that Russia may have been complicit or at least aware of plans to conduct the attack.” Or perhaps some friendly games of volleyball are in order?

Wildlife Disease Biologists – An Unstoppable Force 
Neither rain nor sleet could keep APHIS wildlife disease biologists out of the field collecting samples. Animal diseases are a major source for infections coming down the pipeline for humans (i.e. spillover events) and these researchers are on the front lines trying to make sure we have a heads up. APHIS’ Wildlife Services (WS) program includes 36 wildlife disease biologists who work diligently to collect samples from wild birds for avian influenza testing (among other things). “‘By monitoring the avian influenza strains circulating in wild birds, WS and its partners are able to provide an early warning system to America’s poultry producers,’ states Dr. Tom DeLiberto, Assistant Director of WS’ National Wildlife Research Center. ‘Our experts focus their sampling on waterfowl species and locations where we are most likely to detect avian influenza. This ensures our efforts are as efficient and informative as possible’.” I think we can all appreciate the brave few who venture into frigid waters to help trap and test wild birds to help detect the spread of infectious diseases.

Stories You May Have Missed: 

  • Trends in Apocalyptic and Post-Apocalyptic Fiction – Writers frequently use an apocalyptic or post-apocalyptic backdrop for fictional stories. The Doomsday Clock is a visual representation of the general mood and often represents the fear and unease in the environment. Whether it be an environmental event or a killer virus, the end of humanity has been a frequent topic for many writers. “Often it is a fear of a naturally-evolving virus, as in Max Brooks’s World War Z: An Oral History of the Zombie War (2006) or Emily St. John Mandel’s Station Eleven (2014). Yet, with the advent of new biotechnologies, authors also considered the impact a malignant engineered virus would have on humanity, as seen in Margaret Atwood’s Maddadam trilogy (2003 onwards) and Justin Cronin’s The Passage trilogy (2010 onwards).”
  • Ebola Theme Issue – The Royal Society – Philosophical Transactions of the Royal Society B is focusing their latest biological sciences journal on the 2013-2016 Ebola outbreak in West Africa. In this edition, you can find opinion pieces discussing the contribution of engineering and social sciences, old lessons on new epidemics, and a wealth of information on outbreak evaluation and notes from the field.

Pandora Report 3.24.2017

Welcome to the start of the weekend and World TB Day! The WHO estimates that just in 2015, 1/3 of people with TB missed out on quality care and 480,000 people developed multidrug-resistant TB.

Public Health Concerns in Trump’s New Budget
President Trump’s newly released proposed budget blueprint makes drastic cuts to many programs, of which, one of the hardest hit is HHS. On top of the cuts to science and public health, there is something buried within the budget that is concerning ex-CDC director, Dr. Tom Frieden. Frieden worries about the proposal to award block grants to states, which would allow them to decide how to respond to public health issues (think Ebola, Zika, etc.). “That proposal is ‘a really bad idea,’ according to Dr. Tom Frieden, who until this past January was director of the U.S. Centers for Disease Control and Prevention. Currently, the CDC experts work with state and local governments to devise evidence-based plans to respond to public health issues, such as foodborne and infectious disease outbreaks. With a block grant, states can use the federal money to replace their own spending in certain areas or spend the money unwisely, ‘and never have to report what they have done or be held accountable for it,’ Frieden said.” A withdrawal of one fifth of NIH’s budget would mean a deep slash to biomedical and science research funding.  These cuts will also impact foreign aid, which has many worried about the role of public health interventions in foreign countries. Bill Gates recently talked to TIME magazine regarding the safety implications of cutting foreign aid. “I understand why some Americans watch their tax dollars going overseas and wonder why we’re not spending them at home. Here’s my answer: These projects keep Americans safe. And by promoting health, security and economic opportunity, they stabilize vulnerable parts of the world.” Gates points to the role of overseas public health work like polio eradication, Ebola outbreak response, and America’s global HIV/AIDS effort (PEPFAR), which points to the stabilizing role that strengthening public health can have in a country.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
From Anthrax to Zika, we’ve got the place to be in July for all things biodefense. This three-day workshop will provide you with not only seminars from experts in the field, but also discussions with others interested in biodefense. You can check out the flyer and register for the event here. The best part is that we’re doing an early-bird registration discount of 10% if you sign up before May 1st. A returning participant, GMU student/alumni, or have a group of three or more? You’re eligible for an additional discount! Check out the website to get the scoop on all our expert instructors and the range of topics the workshop will be covering.

Unseen Enemy Documentary 
Mark your calendars for this upcoming infectious documentary on the lurking pandemics that worry experts. Airing on April 7th, Unseen Enemy will follow researchers looking for the early warning signs of diseases that could cause the next pandemic. The National Academy of Medicine will be hosting a special D.C. premiere of the film on April 2nd, that you can even attend.

Expert Views on Biological Threat Characterization for the U.S. Government: A Delphi Study 
Biological threat characterization (BTC) is mixed bag of risk and reward. The laboratory research involving deadly pathogens as a means for biodefense can translate to better risk assessments but also the potential for biosafety failures. To better address this issue, researchers performed a Delphi study to gather opinions from experts around the country. “Delphi participants were asked to give their opinions about the need for BTC research by the U.S. government (USG); risks of conducting this research; rules or guidelines that should be in place to ensure that the work is safe and accurate; components of an effective review and prioritization process; rules for when characterization of a pathogen can be discontinued; and recommendations about who in the USG should be responsible for BTC prioritization decisions.” Following their assessment, the researchers found that experts agree that BTC research is necessary, but there is also a need for continued oversight and review of the research to reduce as much risk as possible. “It also demonstrates the need for further discussion of what would constitute a ‘red line’ for biothreat characterization research—research that should not be performed for safety, ethical, or practical reasons—and guidelines for when there is sufficient research in a given topic area so that the research can be considered completed.”

GMU Schar School PhD Info Session
If you love global health security and have been wanting to further your education, come check out our PhD info session next Wednesday, March 29th at 7pm in Arlington. You can come learn about our biodefense PhD program from the director, Dr. Koblentz, and hear from several students about their experiences. The info session is a great way to find out what a GMU Schar PhD entails, the application process, and what current students think!

What Biosecurity and Cybersecurity Research Have In Common
Kendall Hoyt is looking at the similarities between these two research fields and how work into the unknown can often expose and create vulnerabilities. Did I mention Kendall is one of the instructors at our biodefense Summer Workshop? Hoyt provides two examples to really hone in on this point – to defend against a dangerous pathogen, we have to isolate and grow it to try and develop treatment or a vaccine and to defend against a cyberattack, we need to know how to break into the computer system. That whole dual-use dilemma creates a lot of risk-versus-reward scenarios for biosecurity and cybersecurity researchers. While the research is highly relevant and necessary, government efforts to control or maintain oversight have been challenging. Do we pull back the reigns on innovation or run the risk of a security breach or a big “whoops” moment? “Intellectual property and cybersecurity legislation—namely the Digital Millennium Copyright Act and the Computer Fraud and Abuse Act—has similarly stifled legitimate scientific and commercial activities and delayed defensive applications. In one well-known example, fear of prosecution under DMCA deterred a Princeton graduate student from reporting a problem that he discovered: Unbeknownst to users, Sony BMG music CDs were installing spyware on their laptops.” Hoyt also points out the biosecurity efforts that have begun looking not just at the pathogens and publications, but the laboratory techniques that are used for such research. Certain experiments (like gain of function work) have the capacity to increase transmissibility or host range. “For all of their similarities, key differences between biosecurity and cybersecurity risks and timelines will dictate varied regulatory strategies. For example, zero-day exploits—that is, holes in a system unknown to the software creator—can be patched in a matter of months, whereas new drugs and vaccines can take decades to develop. Digital vulnerabilities have a shorter half-life than biological threats. Measures to promote disclosures and crowd-sourced problem-solving will therefore have a larger immediate impact on cybersecurity. Still, both fields face the same basic problem: There are no true ‘choke points’ in either field. The U.S. government is not the only source of research funds and, thanks in large part to the internet itself, it is increasingly difficult to restrict sensitive information.” In the end, Hoyt notes that both fields and their regulations will need to relax the governance process and be a bit more flexible and mobile with how they control items. Both fields are constantly evolving, which means regulators need to be just as fluid.

How To Prepare For A Pandemic
NPR decided to create a “Pandemic Preparedness Kit” based off the continuous questions related to the ongoing news of increasing infectious disease threats but little info in terms of practical things people can do. While these aren’t things you can go out and buy for your home, the list hits close to home in terms of things we should be focusing our efforts and funding on. Firstly, vaccines. This is a no brainer and yet, we’ve become the habitual users of the theme “create it when we’re struggling to contain an outbreak”. Secondly, virus knowledge. “One of your best weapons during a disease outbreak is knowledge, says Dr. Jonathan Temte of the University of Wisconsin. ‘Keep up with the news and try to understand what threats might be out there,’ he says. For example, new types of influenza are one of the biggest threats right now — in terms of pandemic potential, Temte says. But if you know how to protect yourself from one type of influenza, you can protect yourself from all of them.” Lastly, and my personal favorite, is very clean hands. While every disease is different, one of the most basic and fundamental truths for infection prevention and control is hand hygiene. These three are solid ways to better prepare for future outbreaks, pandemics, emerging infectious diseases, and just about anything infectious that makes you a bit worried.

CARB-X MissionWhen I first read the name of this group, I thought it was some kind of fitness fuel, but I was pleasantly surprised to see this initiative is working to fight antibiotic resistance. CARB-X is a collaboration between NIAID and BARDA to help accelerate the development of antibacterials over the next 25 years. The goal is to help combat antimicrobial resistance through a diverse portfolio and partnership. Make sure not to miss their March 30th meeting from 11am-noon on antibiotic resistance. “CARB-X (Combating Antibiotic Resistant Bacteria Accelerator) was launched in August 2016 to accelerate pre-clinical product development in the area of antibiotic-resistant infections, one of the world’s greatest health threats. CARB-X was established by BARDA and NIAID of the U.S. Department of Health and Human Services along with Wellcome Trust, a global charitable foundation dedicated to improving health. This partnership has committed $450 million in new funds over the next five years to increase the number of antibacterial products in the drug-development pipeline.” While CARB-X may not be the latest workout supplement, it’s definitely a boost to performance in the fight against antimicrobial resistance.

New Roles and Missions Commission on DHS Is Urgently Needed
GMU biodefense PhD alum, Daniel Gerstein, is looking at DHS and pointing to the need for a Roles and Missions Commission. It’s been almost 15 years since DHS was created under rapid and urgent circumstances, which means that it’s time to look introspectively. “More generally, a roles and missions review could also examine whether the department is properly resourced for all its missions. For example, a joint requirement council was recently established for the department composed of less than 10 government civilians. Is this adequate for supporting requirements development activities for a department of over 240,000 personnel?” Gerstein looks at some of the big issues that require a comprehensive review, like centralization versus decentralization, management of R&D and engineering, and critical infrastructure issues related to national security and safety. Another component needing review is the human factors issue that impacts homeland security. How are the relationships between departments, with state and local authorities, or with the public? “The effort should not necessarily be viewed as a requirement for change, but rather an opportunity to reexamine DHS and its relations with the rest of government, the nation and its citizens, and even with our international partners across the globe. Finally, a homeland security roles and mission commission would be an ideal lead-in to a much needed update to the original 2002 authorizing legislation.”

Deadliest Enemy: Our War Against Killer Germs
Don’t miss this event on Thursday, March 30th, hosted by New America with speakers Michael T. Osterholm and Mark Olshaker. “In today’s world, it is easier than ever for people and material to move around the planet, but at the same time it is easier than ever for diseases to move as well. Outbreaks of Ebola, MERS, yellow fever, and Zika have laid bare the world’s unpreparedness to deal with the threat from infectious diseases. In Deadliest Enemy: Our War Against Killer Germs Dr. Michael Osterholm and Mark Olshaker marshal the latest medical science, case studies, and policy research to examine this critical challenge.”

Stories You May Have Missed:

  • The Feds Are Spending Millions to Help You Survive Nuclear War – North Korea’s recent firing of four ballistic missiles from Pyongyang into the ocean off Japan’s coast has brought back worries of nuclear attacks. While the days of stocking a bomb shelter are in the past, the U.S. government isn’t slowing down efforts to protect Americans. “Over the last ten years the US has poured millions of dollars into technologies and treatments it hopes to never have to use, but could, in the event of a nuclear catastrophe. From assays that measure radiation exposure to cell therapies that restore dwindling blood cells to liquid spray skin grafts, government officials are now far better equipped to deal with diagnosing and treating people if the unthinkable were to happen. And the next generation of treatments are being funded right now.” DHHS projects like BARDA and Project BioShield are just some of the sources for ongoing research to strengthen protection, whether it be a nuclear blast or reactor melt-down.
  • Disinfection and the Rise of the Superbug – GMU biodefense PhD student Saskia Popescu is addressing the growing disinfection needs as we teeter on the edge of the antibiotic abyss. Disinfection is already a challenge in healthcare however, the rise of more resistant germs means that efforts often need to be ramped up. The recent influx of Candida auris infections that we talked about last week really brings this issue to point in that this emerging infection is difficult to get rid of via traditional disinfection routes. “As new organisms are identified and existing ones become resistant to antimicrobials, the availability of strong disinfecting products has become even more pivotal.”
  • China and EU Cut Brazilian Meat Imports Amid Scandal– If you’re a fan of importing Brazilian meat, you may have to hold off for a while. A recent police anti-corruption probe is accusing inspectors of taking bribes to allow the sale of rotten and salmonella-contaminated meats from the largest exporter of beef and poultry. As the news unfolds, the Brazilian government is criticizing gate police as alarmist. “As the scandal deepened, Brazil’s Agriculture Minister Blairo Maggi said the government had suspended exports from 21 meat processing units.”
  • Study on Interferon for Treatment of Ebola Infection – The common hepatitis treatment is now being tested out on Ebola patients to help alleviate their symptoms. The pilot study was performed from March-June of 2015 and  had some interesting results. “When compared to patients who received supportive treatment only, 67 per cent of the interferon-treated patients were still alive at 21 days in contrast to 19 per cent of the former patients. Additionally, the viral blood clearance was faster in those patients treated with Interferon ß-1a. Many clinical symptoms such as abdominal pain, vomiting, nausea and diarrhea were also relieved earlier in the interferon-treated patients. A further 17 patients in other Guinean treatment centres who matched the interferon-treated patients based on age and the amount of Ebola virus in their blood were included in the analysis. These added patients, who did not receive interferon, more than doubled their risk of dying as a result of not being treated with the drug.”

Pandora Report 11.18.2016

 Welcome to World Antibiotic Awareness Week! We all have a part in reducing microbial resistance, including companies like McDonalds, KFC, and large chain restaurants. A recent report from Clinical Microbiology is reanalyzing the threat of bioterrorism. The EU has released their action plan for combatting antimicrobial resistance and you can read the roadmap here. Leishmaniasis infections are on the rise in the U.S. due to ecotourism and military campaigns in Iraq and Afghanistan. CRISPR gene-editing was just tested in a person for the first time. The Chinese research group delivered modified cells into a patient with aggressive lung cancer as part of a clinical trial. The cells were modified to disable a gene that codes for protein PD-1 (this normally would restrict immune response and is frequently manipulated by cancer) and the hope is that without the PD-1, the edited cells will be able to overcome the cancer. Did you know that your birth year can help predict how likely you are to get extremely sick from an outbreak of an animal-origin influenza virus? Don’t miss the Next Generation Global Health Security Network Info Session – today at 11a EST!

ISIS Forces Fired Toxic Chemicals in Iraq
Three chemical attacks were launched by ISIS against the Iraqi town of Qayyarah in September and October. The use of chemical weapons was in retaliation after Iraqi government forces retook the town in late August. “ISIS attacks using toxic chemicals show a brutal disregard for human life and the laws of war,” said Lama Fakih, deputy Middle East director. “As ISIS fighters flee, they have been repeatedly attacking and endangering the civilians they left behind, increasing concerns for residents of Mosul and other contested areas.” Victims of the attacks experienced painful symptoms of blister agents, or “vesicants”. The use of chemical weapons is in direct violation of the 1993 Chemical Weapons Convention. The use of these weapons would be classified, under the Rome Statue, as a war crime.

What Will Be the Next Pandemic?
Researchers at the recent International Meeting on Emerging Diseases and Surveillance discussed what the next SARS or Zika-like disease will be. Kevin Olival of EcoHealth used a predictive formula and pointed to flaviviruses that we normally don’t hear about – Usutu, Ilheus, and Louping. “All three have on rare occasions infected people, but they also infect a number of other animal species, which suggests they may have what it takes to jump species. Virologists sometimes call viruses that can do this ‘promiscuous.’ That means ‘it’s more flexible in its ability to infect across hosts, including mammals,’ Olival said.” While the scarcity of human cases proves difficult for gaining funding, emerging diseases tend to hit us by surprise, pointing to the need to expand the scope of surveillance and preparedness.

PCAST Letter to the President to Protect Against Biological Attacks
In a letter to the President, the President’s Council of Advisors on Science and Technology (PCAST) points to the to the unique challenge of bioterrorism threats in that they could be exacerbated by the rapid pace of biological science and technology developments. PCAST emphasizes the need for a renewed effort since Federal leadership can help state and local infrastructure share data and identify patterns during such an event. “Continuing scientific, technical, and regulatory developments allow the medical community to respond to new outbreaks faster than ever before. Developing medical countermeasures to naturally occurring outbreaks today lays the groundwork for responding to potential engineered biological threats in the future. PCAST supports extending this progress into the foreseeable future, setting the ambitious ten-year goal that, for infectious organisms for which effective approaches to creating vaccines exist, the United States should have the ability to accomplish, within a six-month period, the complete development, manufacture, clinical testing, and licensure of a vaccine. ”

Comic Book Explores a World Without Antibiotics  screen-shot-2016-11-15-at-8-40-41-am
A new, dystopian comic book is transporting us to 2036 London. The world is a bleak place where antibiotics have run out. Surgeon X looks at a time where simple infections and hospitalization means certain death, while the government cracks down to maintain selective control over the few drugs that are available via  a”Productivity Contribution Index”, which determines who gets access to medication. Readers follow a surgeon, Rosa, through her work at a secret clinic and the internal dialogue that comes with a repressive government, Hippocratic oath, and constant threat of infectious disease. Sara Kenney, the author of Surgeon X, notes that her own experiences with two premature children frame much of her comments on microbial resistance. Kenney noted that “it was only when she started building for herself what she calls the ‘story world’ that she realized antibiotic resistance is such a threat to medicine that it needed to be in her narrative as the obstacle the protagonist must overcome. ‘I realized the antibiotics crisis we’re facing is probably one of the most extreme obstacles you could throw at a surgeon,’. She found the complexities of the problem—resistance is believed to kill 700,000 people around the world each year—to be staggering.”

WHO Global Action Plan on Antimicrobial Resistance cxt8sslxgaajprd-jpg-large
The WHO has just released their action plan to fight antimicrobial resistance. Countries have committed to having a national action plan by May of 2017 to better support the radical shift that is needed to combat antibiotic resistance. Antimicrobial resistance (AMR) threatens the foundation of modern medicine and public health capacity. There have been little advancements in the world of antibiotics, however we continue to see a growth of AMR. The WHO global action plan has five objectives: to improve awareness and understanding of antimicrobial resistance through effective communication, education and training; to strengthen the knowledge and evidence base through surveillance and research; to reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures; to optimize the use of antimicrobial medicines in human and animal health; and to develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.

BWC RevCon 
While the 8th Review Conference is underway, there have been some reports from attendants that civil society/NGO’s were asked to leave the room, which goes against precedent for the last two RevCon’s. Some have noted that Iran was seeking to deny NGO’s access to Committee of Whole by using rules of procedure but there has not been consensus yet. While these comments have been coming in from attendants’ Twitter accounts, as of Tuesday afternoon, it appears that the issue has been resolved – as news continues to trickle in, we’ll keep you posted. You can get daily updates on RevCon here, with the most recent one covering the cross-cutting plenaries that are focusing on implementation, article III, solemn declaration and more. These daily reports are the best way to get detailed play-by-play information as to how RevCon is going.

Zika Updates
A recent study found that women are at greater risk for Zika infections due to suppressed vaginal immune response. “Scientists at the Gladstone Institutes discovered that the vaginal immune system is suppressed in response to RNA viruses, such as Zika. The delayed antiviral immune response allows the virus to remain undetected in the vagina, which can increase the risk of fetal infection during pregnancy.” The Brazilian state of Parana has banned aerial spraying of pesticides in urban areas. Florida’s Department of Healthy has their daily Zika updates here, which shows three new locally acquired cases as of 11/16. The CDC has reported 4,255 cases in the U.S. as of November 16, 2016.

Stories You May Have Missed:

  • How NY Hunts for Early Hints of an Outbreak– the New York City Department of Health and Mental Hygiene has a secret weapon in the war against infectious disease outbreaks – a computer program called SaTScan.  This program utilizes big data to help detect and model infectious diseases. It monitors, maps, and detects disease outbreaks throughout the state by utilizing the data that is reported to the health department daily. “It is just not possible to effectively monitor every communicable disease in real time with human eyes alone,” Sharon Greene said. “To be able to quickly and effectively and precisely detect an outbreak, to kick off an outbreak investigation process — the earlier that you can begin this it helps to limit sickness, it helps to limit death, and it makes it more likely that you will successfully solve the outbreak.”
  • Exposure Patterns in 2014 Ebola Transmission – Researchers are presenting new information regarding the largest Ebola outbreak in history by looking at the drivers of transmission and where control efforts could be strengthened. They reviewed data from over 19,000 cases across Guinea, Liberia, and Sierra Leone. “We found a positive correlation (r = 0.35, p < 0.001) between this proportion in a given district for a given month and the within-district transmission intensity, quantified by the estimated reproduction number (R). We also found a negative correlation (r = −0.37, p < 0.001) between R and the district proportion of hospitalised cases admitted within ≤4 days of symptom onset. These two proportions were not correlated, suggesting that reduced funeral attendance and faster hospitalisation independently influenced local transmission intensity. We were able to identify 14% of potential source contacts as cases in the case line-list. Linking cases to the contacts who potentially infected them provided information on the transmission network. This revealed a high degree of heterogeneity in inferred transmissions, with only 20% of cases accounting for at least 73% of new infections, a phenomenon often called super-spreading.” Future Ebola outbreak response will need to consider super spreaders, safe funeral practices, and rapid hospitalization.
  • Rick Bright Selected as New BARDA Director – DHHS recently announced that Dr. Rick Bright will be the new Deputy Assistant Secretary for Preparedness and Response and Director of BARDA. Dr. Bright has been with BARDA since 2010 and served in their Influenza and Emerging Infectious Diseases division.

 

Pandora Report: 4.8.2016

Happy National Public Health Week! The American Public Health Association is celebrating the importance of public health partnerships with a full week dedicated to increasing awareness and participation. Enjoy some vaccine history by taking a trip down memory lane with this great infographic. Before we get started, researchers have found a possible pathway for the emergence of zoonotic malaria.

GMU Master’s and PhD Open Houses!
Whether you’re looking to get a Master’s Degree (we have both online or in-person programs!) or a PhD in Biodefense, we’ve got you covered. Come check out the GMU’s School of Policy, Government, and International Affairs (SPGIA) open houses. The Master’s Open House is on Thursday, April 14, 2016 at 6:30pm in our Arlington Campus, Founders Hall, room 126. GMU Biodefense professor and graduate program director, Dr. Koblentz, will be there to answer questions and then lead a biodefense break-out (or should I say outbreak?) session afterwards. If you can’t attend in person, we’re offering the biodefense info session virtually around 7pm (give or take a few minutes) that night. The PhD informational session will be Thursday, April 21, 7-8pm in our Arlington Campus, Founders Hall, room 126. 

MSF Ebola Research
Medecins Sans Frontières (MSF) has released their report on the research they undertook throughout the Ebola outbreak in 2014. MSF was perhaps the strongest and most well coordinated response team on the ground during this outbreak. While their work heavily focused on medical care, they also performed a wide variety of research that ranges from public health to anthropology, and much more. “MSF carried out research in a number of areas including epidemiology (describing the disease and its spread), vulnerable patient groups, clinical trials for new treatments, community views of Ebola, operational issues and effects of the outbreak on general healthcare.” Their report ties together their research with the six pillars of Ebola control – isolation of cases and supportive medical and mental health care in dedicated ETC’s, contact tracing, awareness raising in the community, a functioning surveillance and alert system, safe burials and house spraying, and maintaining healthcare for non-Ebola patients. MSF research on vulnerable groups and community response to returned survivors is both fascinating and important for better response in future outbreaks.

Islamic State Hijacks Mosul University Chemistry Lab to Make Bombs
Having gained control of the “well-stocked university chemistry lab” in Mosul, Iraq, ISIS has been working for the past year to build “a new generation of explosive devices and train militants to make them”. General Hatem Magsosi, Iraq’s top explosives officers, notes that gaining control of this lab has highly strengthened the Islamic State’s capabilities. “They have found ‘peroxide-based chemical bombs and suicide bomb vests like the ones used in the Brussels attacks and by at least some of the Paris attackers.’ The lab also contained ‘nitrate-based explosives and chemical weapons.”

GMU Biodefense Student Awarded ASIS Scholarship
Congrats to Biodefense MS student, Rebecca Earnhardt for receiving the ASIS National Capital Chapter Scholarship! The ASIS scholarship helps support and encourage students to follow a career in the security field. We love getting to celebrate the awesome work and achievements of our biodefense students, and between her dedication to the global health security field, scholarship, and work at START, we’re so happy to have her apart of the GMU Biodefense program!

Leaked UN Report Highlights Poor Sanitation at Haiti Bases

Courtesy of The Haitian Times
Courtesy of Haitian Times

Despite consistent denial regarding their role in the cholera outbreak during the 2010 recovery efforts in Haiti, recent documents have supported the UN’s responsibility. “The report, which was commissioned a month into the cholera crisis in November 2010, found a series of alarming problems in several UN peacekeeping bases including sewage being dumped in the open as well as a lack of toilets and soap.” The authors of the report also alerted UN leadership regarding the ramifications of the sewage disposal failures and “and the poor oversight of contractors carrying out this work has left the mission vulnerable to allegations of disease propagation and environmental contamination.” The recently released report will not only add pressure upon the UN to admit internal failures, but also support the recent lawsuit that was brought forth from 1,500 Haitians. Sadly, the UN has maintained a steadfast refusal to accept liability, despite growing data to support their responsibility for the outbreak. The lawsuit focusses on UN failure to screen the peacekeepers from Nepal for cholera and how a UN-hired contractor neglected to ensure “sanitary conditions and adequate infrastructure” for the UN camps.

Your Weekly Dose of Zika
On Wednesday, it was announced that federal funds left over from Ebola response will be moved to fight Zika virus. $589 million will be provided to aid in research and help limit the spread of the disease. The use of unspent funds was planned for helping to implement the GHSA, however now the focus will now be on Zika virus R&D. For many, the greatest concern is reaching women in their child-bearing years. The WHO is highlighting a case study in Martinique, specifically their first case of Zika-related microcephaly.  You can read the letter here, but the goals of such case-studies are to help researchers better understand the infection, especially the high-risks associated with infection during pregnancy. Following the CDC Zika Summit, some are wondering if the U.S. can coordinate response efforts and cope with the impending advance of mosquitoes.  The Aedes aegypti mosquitoes require a unique approach to vector elimination due to their propensity to live in and around homes.  “CDC Director Dr. Thomas Frieden said health departments need to take a ‘four corners approach,’ targeting the Aedes aegypti mosquitoes indoors and outdoors as well as focusing on killing both larvae and adult insects.” As of March 7, there have been 346 travel-associated cases in the U.S.

Ebola vs. Zika- Why Did the WHO Respond So Differently?
Many have wondered, why was the WHO so quick with Zika, but so slow with Ebola? Interestingly, political science and the workings of international organizations are helping Amy Patterson from The Washington Post, ask these very questions. Firstly, it starts with an outbreak being declared a Public Health Emergency of International Concern (PHEIC). The WHO was slow to call Ebola a PHEIC, especially since it had only used the designation twice before. While the WHO blames the delayed response on budget cuts and poor communication between the ground teams and the WHO headquarters, it has also said that the quick response for Zika was due to a “need for greater scientific knowledge”, not to mention trying to repair their reputation from the slow Ebola response. “Political scientists would argue that the story is still more complicated. In ‘Rules for the World,’ Michael Barnett and Martha Finnemore show that international organizations’ internal workings and technical expertise influence their actions in ways that are sometimes at odds with the goals of the countries that set up these organizations to work on their behalf.” Patterson notes several factors – the WHO has six autonomous regional offices that behave differently, the WHO cares about its reputation among powerful countries, and the message matters. This last point drives home the role of health issue framing and the way messages are conveyed for audiences and policymakers. “What’s more, Ebola aligned with what Priscilla Wald terms the “outbreak narrative.” That’s the conventional view that poor countries have disease outbreaks, and that powerful states only care about those outbreaks when their spread threatens those states. Zika hit far closer to powerful countries — and hit “threat perception” level before Ebola.”

Stories You May Have Missed:

  • Global Health Impacts of Vector-Borne Diseases – The resurgence of vector-borne diseases in new locations and with new organisms has shown devastating global impacts. “Domestic and international capabilities to detect, identify, and effectively respond to vector-borne diseases are limited. Few vaccines have been developed against vector-borne pathogens.”
  • Angola Battles Yellow Fever – Over 450 people have been infected in the worst yellow fever outbreak Angola has seen in 30 years. There have been 178 deaths and the global shortage of yellow fever vaccine is alarming many in the world health community. There have also been imported, travel-associated cases in China and Kenya.
  • FDA Releases Final Rule to Ensure Food Safety During Transport- a new food safety rule was finalized by the FDA under the Food Safety Modernization Act (FSMA). The new rule “will help to prevent food contamination during transportation. The rule will require those involved in transporting human and animal food by motor or rail vehicle to follow recognized best practices for sanitary transportation, such as properly refrigerating food, adequately cleaning vehicles between loads and properly protecting food during transportation.”

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

Pandora Report: 2.26.2016

It’s been quite a week for global health security. Even the X-Files covered worldwide pandemics (that’s right, multiple diseases), CRISPR-Cas9, and military vaccination programs. Measles is hitting Nigeria hard as Lagos state officials announced the deaths of 20 children related to the outbreak. A recent study released by the University of Pennsylvania’s Annenberg Public Policy Center found that more than one third of participants believed Zika virus was a conspiracy theory related to genetically modified mosquitoes. Maybe they were also watching the X-Files? Before we begin, meningitis vaccine efforts were celebrated at the Meningitis Vaccine Project (MVP) conference, due to success within Africa’s meningitis belt.

GMU Biodefense Students Awarded UPMC Biosecurity Fellowship
We’re happy to announce that two GMU Biodefense students have been selected as Fellows for the UPMC Emerging Leaders in Biosecurity Initiative (ELBI)! Congrats to biodefense MS alum Francisco Cruz, and PhD candidate Siddha Hover! “The Emerging Leaders in Biosecurity Initiative is a competitive fellowship program designed to create and sustain an energetic, multidisciplinary, and intergenerational biosecurity community made up of motivated young professionals as well as current leaders. UPMC has selected 28 US and international emerging leaders in biosecurity from a wide array of backgrounds, including biological science, medicine, policy, the military, law, public health and the private sector.” Siddha Hover works for BAI, Inc. as an embedded contractor with the Department of Homeland Security, where she serves as DHS’s sole treaty analyst. In her role, she is responsible for reviewing all relevant DHS-sponsored research and activites for compliance with applicable arms control agreements. Siddha is currently pursuing her PhD in Biodefense. She holds a MSc in Biodefense from George Mason University and a MSc in International Relations from the London School of Economics. Siddha notes that, “the GMU Biodefense program provided me with the foundational knowledge necessary to confidently begin a career in biodefense and enabled me to successfully apply for the ELBI Fellowship.” Francisco is a biologist in the Field Operations Branch of the U.S. Environmental Protection Agency’s (EPA) Chemical, Biological, Radiological, and Nuclear Consequence Management Advisory Division (CBRN CMAD). As CBRN CMAD’s Biologist, Francisco provides operational guidance to federal, state, and local responders in the areas of decontamination and emergency response related to biological incidents. Francisco holds a B.A. in Biological Sciences from the University of Delaware. During his time at GMU, Francisco earned a Graduate Certificate in Critical Analysis and Strategic Responses to Terrorism, and earned his M.S. in Biodefense in December 2015. Congrats to Siddha and Francisco in their work furthering the field of global health security and representing GMU Biodefense in the ELBI program!

GMU Biodefense Course Sampler- “Biosecurity as a Wicked Problem”
If you’re on the fence about going back to school, curious about our program, or just want to hear what a class in biodefense would be like, check out our course sampler on Wednesday, March 2nd, at 7pm, in our Arlington Campus in Founders Hall, Room 502. “The United States and the world face unprecedented threats to global biosecurity, including emerging infectious diseases, pandemics, natural disasters, bioterrorism, and laboratory accidents. Find out about the challenges posed by these threats and strategies for enhancing global health security.” How many times can you sample a course from not only an expert in the field, but also the director of the program? Dr. Koblentz will be your host for this evening lecture on biodefense, dual-use research, CRISPR-Cas9, biosecurity, and much more. Can’t attend in person? Don’t worry – we’re also live-streaming here. Come join us for a look behind the curtain of not only our GMU graduate programs, but also the world of global health security.

CRISPR and The Battle of Genetically Modified Mosquitoes 
CRISPR-Cas9 technology has been a hot topic since it was discovered and things have only ramped up since a Chinese research team announced last Spring that they successfully edited human embryo genes. While many raised concerns over “designer babies” and genetically modified livestock, the case for genetically modified mosquitoes has also been discussed. What if science could modify mosquito capabilities to carry disease? CRISPR-Cas9 research is getting much closer to making this a reality with the help of two research teams. “The first group, led by Valentino Gantz and Ethan Bier at the University of California–San Diego, and Anthony James at the University of California–Irvine, engineered a gene drive carrying a pair of genes designed to kill the malaria parasite inside the mosquito.The second group, led by Nikolai Windbichler, Andrea Cristanti, and Tony Nolan at the Imperial College London, developed a more brute force approach, building a gene drive that breaks an important mosquito gene and renders the females sterile—a strategy designed to decimate a mosquito population. Both groups reported that, when the genetically modified insects were crossed with wild ones, as much as 99 percent of the offspring carried the modified genes, a clear sign that the gene drives were working.” While field tests are still necessary to establish efficacy, it’s important to note the researchers are taking great strides to ensure public buy-in given the sensitivity of such work. Gene drive is becoming more accessible and the applications appear limitless however, ethical use of this pioneering innovation is crucial for future work.

Climate Change & Zika Virus – What’s the Link?
Somewhere between reporting on CRISPR-Cas9 mosquitoes and Zika updates, it seems like a perfect place to discuss what kind of impact climate change is having on infectious diseases…especially Zika virus. GMU Biodefense MS student and one of our contributors, Greg Mercer elaborates on the role climate change may have on the growing geographical distribution of mosquitoes that pose some of the biggest threats. Greg points out that “exactly how climate change drives the spread of Zika and other diseases is hard to define. In 2013, researchers at the University of Arizona published a paper examining the effect of climate factors on dengue and its Aedes vectors. Their conclusion highlighted just how far scientists still have to go in understanding the climate-disease link: ‘Climate influences dengue ecology by affecting vector dynamics, agent development, and mosquito/human interactions,’ they wrote, but ‘although these relationships are known, the impact climate change will have on transmission is unclear.’ Climate change introduces additional complications into an already complex system, the study authors explained: It’s difficult enough to understand how weather, climate, human interaction, or mosquito behavior contribute to the spread of a virus.” Researchers are now comparing the global distribution of Aedes mosquitoes and the spread of Zika, which leaves many to wonder if the threat of global disease will evolve with that of global climate change.

BARDA Seeks Advanced Public Health Consequence Modeling
The Biomedical Advanced Research and Development Authority (BARDA) is currently working to find partners that can aid in the development of a modeling system that would support federal decision makers in their planning and response to CBRN events. “The tools developed under this acquisition will assist Federal decision makers with medical and public health decision making for the advanced development and implementation of an integrated National medical countermeasures infrastructure (e.g., vaccines, therapeutics, diagnostics, and medical devices).” They’re hoping to build partnerships to establish a network for medical consequence modeling, simulation, visualization, and decision support. BARDA plans to include two functional areas within the network, 1- decision support, reach back, analysis, and modeling (DREAM), and 2- professional services and systems integration (PSSI). “These activities include assisting government decisions makers during the development of preparedness plans, the implementation of response strategies, and communications with a wide variety of stakeholders, both during day to day operations and in the course of declared public health emergencies as part of the BARDA Modeling Coordination Group.” Each functional area will have multiple Indefinite Delivery/Indefinite Quantity (IDIQ) awards that can be earned and they are encouraging interested stakeholders to submit proposals.

To Zika and Back 

Courtesy of the Council on Foreign Relations
Courtesy of the Council on Foreign Relations

As Zika virus continues to spread and South Africa reports the first of their cases, many are wondering how these outbreaks tend to go from 0-60 in a hot minute. NIAID director, Anthony Fauci, discusses the reality of disease surveillance and revealed this slide during an interview, of which you can see the global examples of emerging and re-emerging infectious diseases. Dr. Fauci points to the unpredictable nature that is public health and global health security. Global public health is still reeling from the effects and imperfect response of Ebola 2014, coupled with the scrutiny of a response to H1N1 that was considered too zealous. I’ve always considered public health and disease prevention to be the kind of work where few realize when you’ve done your job correctly but when you fail, it’s something you’ll be hearing about for decades. Global health security is challenging on a good day and public health tends to get little funding, especially in the countries that need it most. After the devastation of Ebola and all the after-action reports, many are wondering how did we miss the rise of Zika virus? Dr. Ken Stuart, director of the Center for Infectious Disease Research in Seattle, says, “We were unaware of the severity of the disease … [and] were unaware this virus had the capability for getting distributed so rapidly.” Regarding the funding issues that often plague infectious disease efforts, he noted that “this really goes back to funding priorities. Much of the funding devoted to infectious disease today is in reaction to outbreaks. Therefore, we’re not generally prepared to respond quickly. In other cases there are diseases that are very rare but they have an advocacy group that generates research activities. In the case of diseases like Zika, which were isolated in remote areas of the world where that population had no resources or advocacy group, there was no push to do research.We’re not stuck with what we’ve got. There are conversations between federal funding agencies and private organizations to try to prioritize the utilization of their resources, and I would say the NIH has been a leader in supporting the fundamental research that actually, probably positions us best to be prepared to respond to these disease outbreaks.” In other Zika news, a CDC team just arrived in Brazil to study the associated birth defects and the White House is urging Congress to provide emergency funds to support Zika response efforts, rather than just re-directing funds from Ebola-related projects. You can also see a map tracing the spread of Zika and some background here. As of February 24, the CDC has reported 107 travel-associated cases in the U.S.

The Rise of Chikungunya
I always thought it sounded like the name of a monster and in some ways, that’s pretty spot on. The Pan American Health Organization (PAHO) reported 16,668 confirmed and suspected cases of Chikungunya in 2016 so far. Colombia shouldered the majority of 2016 disease burden, with a spike of 1,189 new cases added to their previous count of 5,752. The PAHO is still playing catch-up on their year-end reporting for 2015, but it looks like 28,722 additional infections were added to their 2015 data. These updates mean that this region experienced 726,478 cases in 2015, and with the the new cases reported as of February 19, this current outbreak has been responsible for 1.89 million infections. Starting in 2013, this outbreak began on St. Martin and has been gaining traction ever since. Hopefully with the mosquito-control efforts related to Zika virus, the mosquito population also responsible for Chikungunya will begin to decline.

Stories You May Have Missed:

  • Breaking Down the Barriers of MDRO’s:  Scientists in the UK have discovered how drug-resistant bacteria create and maintain their defensive wall. Using the Diamond Light Source machine to “investigate in tiny detail a class of bugs known as Gram-negative bacteria”, they were able to find a defensive wall and it’s assembly beta-barrel machinery (BAM). This new research means that future treatments can aim at preventing bacteria from building these defense measures versus just attempting to attack the bacteria itself.
  • Melbourne Measles Outbreak – 14 cases have already been confirmed in the suburb of Brunswick, of which 2 were children from a primary school. Students that attend the same school and are not fully immunized were instructed to stay home to avoid exposure.
  • E. coli Outbreak in Raw Milk – Not surprisingly, a recall has been issued related to unpasteurized raw milk from a local dairy farm in Fresno, CA. 10 people have been confirmed with Shiga-toxin producing E. coli 0157:H7. Thankfully the shelf-life of the product has passed and public health officials, while stating that the investigation is on going, have confirmed that no health alert was issued since the product is believed to no longer be within the marketplace. Moral of the story – avoid raw, unpasteurized milk.

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

Pandora Report 1.29.2016

Happy Friday! Now that winter storm Jonas is behind us, we can get back to tackling biodefense updates. Unless you’ve been avoiding the news, you’ve undoubtedly seen the surge in reports on Zika virus. Imported cases are popping up throughout the US, raising concerns about vulnerability and response. We’ll be covering the latest in Zika news, not to mention a pretty amazing disease modeling system, plague history, and how Brazil is prepping for the 2016 Olympics. Fun History Fact Friday: on January 28th, 2000, a US government study finally conceded that the cancer and premature deaths of several workers from a nuclear weapons plant (in service since WWII) were caused by radiation and chemicals and sticking with the nuclear weapon theme, on January 29th, 1964, Dr. Strangelove or: How I Learned to Stop Worrying and Love the Atomic Bomb premiered.

Open Source Disease Modeling: to Combat the Next Pandemic
GMU Biodefense PhD student, Nereyda Sevilla, has teamed up with Global Biodefense to discuss how transportation advances of the 21st century make outbreak preparedness and response extremely difficult. In most cases, health alerts and travel restrictions are reactionary to an outbreak that has already reached epic proportions. In response to this, scientists are working to predict disease spread and potential interventions through disease modeling. Spatiotemporal Epidemiological Modeler (STEM)  is one of these modeling systems that looks at several variables and parameters within the spread of an infectious disease and then models the efficacy of interventions. “The unique nature of STEM is that it is a multi-disciplinary, collaborative modeling platform.  The open-source characteristics of the system allow researchers and programmers to add, compare, refine, and validate different scenarios as well as add denominator data based on specialty.  For example, an infectious disease specialist in dengue working in South America may have unique disease characteristics and population data that could be tailored into STEM.” The best part? STEM is already pre-loaded with country data regarding national borders, transportation networks, air travel, and environmental conditions. Utilizing customized graphs and spatial maps, it can even be used to “create a spatial map of animal pens on a farm and to import that graph into the model to study the spread of a veterinary disease.” STEM can easily be downloaded and even has sample projects that many researchers from around the world have shared, like the 2014 Ebola outbreak, dengue fever, H1N1, etc. STEM is undoubtedly a significant weapon in the global health security arsenal to combat future pandemics.

Zika Virus Outbreak Updates
While 200,000 Brazilian troops are being mobilized to battle mosquitoes in a house-to-house strategy, Zika virus has reached 23 countries. As of January 28th, 2016, the WHO has set up an emergency team to respond to the growing epidemic. Meeting on Monday, the WHO team will decide if the Zika virus outbreak should be treated as a global emergency, as they are predicting “three to four million cases” in the Americas. Fear continues to grow in the US as cases are popping up in Los Angeles Country, CA Virginia, New York, and Arkansas, in a returned travelers. President Obama just called for a speeding up of Zika virus research to battle the growing outbreak. Sydney has also confirmed imported cases. While many worry that returning travelers are bringing the mosquito-borne disease back home, it’s important to note that it’s during the first week of infection that the virus is found in the blood and can be transmitted via mosquitoes.  Vertical transmission (from mother to child) is possible if the maternal infection is near the time of delivery, but there haven’t been cases of Zika virus in breast milk. To date, there has been one case of transmission through blood transfusions and one possibly spread through semen and sexual contact. Researchers are working to piece together the origins of this particular outbreak, but one hypothesis is that it came to Brazil from a major sporting event, specifically the 2014 World Cup. At this point, cases have been seen in 23 countries and the WHO has warned that it’s likely to “spread across nearly all of the Americas”. While no local transmission has occurred in the US, locally acquired cases are occurring in the Commonwealth of Puerto Rico. The CDC has also released interim guidance on the evaluation and testing of infants with possible congenital Zika virus.

Brazil’s Olympic Woes

Courtesy of The Guardian & EPA
Courtesy of The Guardian & EPA

The growing outbreak of Zika virus and subsequent concerns over fetal microcephaly are just another public health issue on the laundry list of concerns for Brazil in their Olympic preparations. Building the infrastructure to support such a massive event is taxing on even the most industrialized country. Despite Brazil’s initial dismissal of water quality issues, there have been flourishing concerns over water safety for Olympians (the linked BBC pictures alone would have me rowing the boat back to land at record speed). 13 of the 40-member US rowing team experienced gastroenteritis after a trial run in a lake. While the exact culprit of the GI illness was never identified, it amplified the already increasing fears regarding water quality. It’s never a good sign when rowers are warned not to splash water or jump in at the end of a race, or when a sailor has to be hospitalized due to a severe MRSA infection after field tests. As we mentioned a few months back, an Associated Press investigation found dangerous viral and bacterial levels in the Olympic and Paralympic water venues. “Extreme water pollution is common in Brazil, where the majority of sewage is not treated. Raw waste runs through open-air ditches to streams and rivers that feed the Olympic water sites. As a result, Olympic athletes are almost certain to come into contact with disease-causing viruses that in some tests measured up to 1.7m times the level of what would be considered hazardous on a Southern California beach.” Water issues aside, vector-borne diseases like Zika virus, dengue, malaria, and even yellow fever, can pose a threat to those attending and participating in the events. The Brazilian health ministry has announced response plans in wake of the growing Zika virus outbreak. These large-scale events also raise security concerns, especially after the Paris attacks. Brazilian officials have promised “to guarantee absolute peace”  during the Olympics.

Congrats to 2015 GMU Biodefense MS alum, Francisco Cruz, on his acceptance as a fellow in UPMC’s 2016 Class of Emerging Leaders in Biosecurity Initiative (ELBI) The UPMC ELBI is a highly selective program that brings together and fosters partnerships within the biosecurity field. Biodefense MS alum, Francisco Cruz, will accompany several other prominent members of the biosecurity community in meetings, conferences, and networking. Congrats Francisco!

DNA Investigations from the Great Plague of Marseille
Always a sucker for a mixture of history and epidemiology, I was excited to come across this archaeological gem. Despite its initial devastation in the fourteenth century, the bubonic plague resurged and hit Europe with another destructive wave, “leading to continued high mortality and social unrest over the next three centuries.” Considered to be the last outbreak of medieval plague in Europe, the Great Plague of Marseille (1720-1722) has provided archaeologists with samples that allowed them to reconstruct the complete pathogen genome. Harnessing DNA from the teeth of victims within the Marseille plague pits, their results point to the disease hiding within the shadows of Europe for hundreds of years. Computational analyst Alexander Herbig notes, “we faced a significant challenge in reconstructing these ancient genomes. To our surprise, the 18th century plague seems to be a form that is no longer circulating, and it descends directly from the disease that entered Europe during the Black Death, several centuries earlier”. While they continue their work on tracing the origins of the disease and its mysterious disappearance, I’m hopeful that archaeogenetics is the new inspiration for future Indiana Jones films…

Stories You May Have Missed: 

  • Listeria Outbreak Associated With Dole Salads- A Dole production plan in Springfield, OH, is being linked to an outbreak of Listeria throughout the US and Canada. Twelve cases were identified in the US and another seven were found across five provinces in Canada. All twelve cases involved hospitalization and there has been one associated death. The CDC is continuing updates here.
  • USDA Updates on Highly Pathogenic Avian Influenza Fall Plan- The USDA has updated their plans to combat the highly pathogenic avian influenza with more details regarding reimbursement on virus elimination activities and additional information on the August 2015 industry survey on preparedness.
  • British Government and Bill & Melinda Gates Foundation Roll Out New Plan to Combat Malaria –  The British government has teamed up with the Bill and Melinda Gates Foundation to pledge three billion pounds to help stop malaria in the next fifteen years. Bill Gates and British Chancellor George Osborne stated, “We both believe that a malaria-free world has to be one of the highest global health priorities.” Britain will invest 500 million pounds a year over the next five years and the Bill and Melinda Gates Foundation have put up $200 million this year and will continue with annual donations.
  • Tales from the Front Lines in the Ebola Fight-  Confusion, disorganization, fear, and communication gaps fill the notes from the ground in this interview with VICE correspondent, Danny Gold, during his time in West Africa during the outbreak.

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

Pandora Report 12.4.2015

This week, Washington, DC hosted the Summit on Human Gene Editing, where the ethical and legal implications of gene editing technologies, like CRISPR-Cas9, were heavily discussed. In this week’s report, Greg Mercer works his magic, revealing the internet and social media trends following the shootdown of a Russian SU-24 on November 24th. We’re also reporting updates in the Zika virus and dengue fever outbreaks as well as the Harvard-LSHTM Panel Report on Global Response to Ebola. France is currently experiencing an increase of highly pathogenic avian influenza cases while a Black Angus beef cow in Alberta was discovered to have bovine spongiform encephalopathy (BSE). Fun history fact Friday – on December 3, 1967, the first human heart transplant was performed in Cape Town, South Africa and on December 4, 1945, the Senate approved US participation in the UN. Before we start our weekly roundup, make sure to mark your calendars to attend GMU’s seminar on Ebola surveillance and laboratory response this Monday, December 7th from 4:30-6pm at our Fairfax campus (details below!).

Zika Virus Outbreak – Updates
The growing outbreak of Zika virus has now seen locally acquired cases reach ten countries, causing the Pan American Health Organization (PAHO) to issue an alert, “urging countries in the region to be on the lookout for the disease and to watch for unusual patterns in newborn.” Brazil has been hit hard with a rise from 739 on November 27th, to 1,248 cases reported on November 30th. Six of the ten countries saw cases occur in November, hinting that the outbreak could just be starting. The growing concerns regarding the outbreak are also related to the newest evidence linking microcephaly and maternal cases. Zika virus genome was found in the amniotic fluid of two pregnant women and fetal diagnosis of microcephaly was performed via ultrasound. Even more so, French Polynesian health officials reported an unusual spike in nervous system malformations in babies that were born during a Zika virus outbreak in the region from 2014 to 2015. The concern regarding neurological conditions raises red flags as Brazilian health officials are reporting neurological complications, like that of Guillain-Barre syndrome, in Zika virus patients. The WHO reported 739 Brazilian microcephaly cases in newborns and while there is only ecological evidence linking the virus and microcephaly, investigations are ongoing. The outbreak first started in February 2014, on Easter Island (Chile) and has seen been identified in Colombia, Guatemala, Brazil, El Salvador, Mexico, Paraguay, Panama (confirmed cases as of December 4, 2015), Suriname, and Venezuela. Spread by Aedes mosquitoes, this vector-borne organism has similar symptoms to dengue fever and illness tends to last between four and seven days.

Event: Ebola Surveillance & Laboratory Response – Lessons for Global Health SecurityScreen Shot 2015-12-03 at 9.34.57 AM
Time/Location: Monday, December 7, 2015 from 4:30pm-6pm in Robinson A-203 at George Mason University.
As the recently released Harvard-London School of Hygiene and Tropical Medicine Independent panel on the Global Response to Ebola indicates, the West African Ebola epidemic highlighted
many gaps in national and international health and response systems that are critical for protecting global health security.  Join leaders and experts who helped to lead the U.S. response for Ebola to discuss the international response to the epidemic, the importance of robust biosurveillance systems, and how the experience with Ebola influences our approach to Global Health Security. Speakers:

  • Dr. Matthew Lim, Senior Policy Advisor for Global Health Security, HHS, fmr Civil-Military Liaison Officer to WHO
  • May Chu, Ph.D. fmr Assistant Director for Public Health, Office of Science Technology and Policy, White House; Senior Science Advisor, CDC
  • Jeanette Coffin, Manager U.S. mobile laboratory deployment, MRIGlobal

It’s Definitely Maybe World War 3
GMU’s Greg Mercer breaks down the November 24th Turkish shootdown of a Russian SU-24. Greg reviews the media attention following the event and the “immediate buzz about declarations of war, what exactly NATO owes Turkey vis-à-vis Russia, and the possibility of military confrontation between Russia and the West.” Through his use of google trends and Twitter, Greg shows just how much hype and concern the notion of WWIII got during this time. Take a look at his recap and debunking of the WWIII buzz and how quickly it caught like wild fire.

Reporting from the Panel on the Final Report of the Harvard-LSHTM Independent Review of the Global Response to Ebola
If you missed the Center for Strategic & International Studies (CSIS) Global Health Policy Center’s Launch of the final report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola, don’t worry! I was fortunate to attend and a great deal of the report (we reported on last week) heavily emphasized “on the ground” capacity. Dr. Peter Piot, Director and Handa Professor of Global Health, London School of Hygiene and Tropical Medicine (LSHTM), joined via video link and started by saying that this would not be a WHO-bashing event. As one of the original researchers on Ebola during its 1976 discovery, he mentioned that the Democratic Republic of Congo (DRC) is a great example of local capacity in their success of ridding themselves of the disease within a few months of the outbreak starting. Dr. Piot heavily emphasized the work of several countries and how the WHO brought together multiple ethicists to review research during such a terrible outbreak. Lastly, Dr. Piot noted that “we risk focussing too much on global and not enough on local” in our future efforts. Dr. Suerie Moon, Research Director and Co-Chair of the Forum on Global Governance for Health at Harvard Global Health Institute, then spoke on the “weak coordination of global response” and how it severely aided the spread of Ebola. Dr. Moon highlighted the need for a global strategy to ensure adequate funding (external financing for the poorer countries and transparent tracking of financing) and the necessity for external assessment of country capacity. She pointed to the need for political and economic incentives and disincentives to not only report cases but also discourage the hiding of outbreaks. Reviewing each recommendation, the panel noted that “human health is a vital part of human security”. In one of her closing comments, Dr. Moon stated that “there are many unanswered questions regarding ebola response and we need to address a number of aspects that went wrong” and “a major theme is accountability at all levels, across all types of players.” Dr. Moon pointed out that the necessity of so many reforms shows just how much work is needed and that now is the time to see political support occur. Muhammad Pate, former Nigerian Minister of State for Health, expressed that “one of the lessons, at the national level, in terms of surveillance and accountability to respond, was missing and something that national leaders need to own up to is building their own public health systems.” Dr. Sophie Delaunay, Doctors Without Borders/MSF, then discussed the role of medical innovations and how the outbreak provided us with a unique opportunity to collect data. Dr. Delaunay said it will “be a complete nightmare to connect all the dots” in this outbreak and there is a desperate need for better R&D regarding disease outbreaks and response. “We ask for governments and policy makers to support collaboration on R&D to demonstrate their willingness to be more effective in the next outbreak” noted Dr. Delaunay. She heavily pushed for global financing efforts to facilitate investment in R&D and response. After the initial panel, there was a secondary group that shared their thoughts on the report, including Dr. Tom Frieden (CDC Director), Julie Gerberding (Exec. VP for Strategic Communications, Global Public Policy and Population Health, Merck) and Ron Klain (Former US Ebola Response Coordinator, White House and General Counsel, Revolution LLC). Ron Klain pointed to the failure of the WHO and “if institutions failed us, individuals shined. We did see extraordinary compassion from the rest of the world and tremendous outpouring of support. ” Mr. Klain mentioned that “the scariest thing about Ebola is the warning signs of how badly we failed this when the threat could’ve been worse and the epidemic we face could be much much more dangerous in the future.” Dr. Frieden emphasized the need of human resources management improvement at the WHO and how global outbreak response could work to support each other better. Lastly, Dr. Frieden emphasized a topic near and dear to my heart; infection control and it’s necessity in global disease prevention. Overall, the panel touched on several key points to the outbreak, emphasizing the need for the biggest players (including MSF) to lead by example via data sharing, etc. The push for political support on incentives and local capacity/accountability was perhaps one of the biggest recommendations and points emphasized from this event.

Gene Editing and CRISPR!
This was a busy week in the biotech world. The International Gene Editing Summit kicked off in Washington, DC. Bringing together experts from around the world, the summit touched on the newest technical innovations, ethical and legal concerns, and even social implications of genome editing advances. Genome Web has provided a great overview of the summit. Nature also published their Four Big Questions related to genome editing, touching on points related to editing the human germline and the ethical implications for technology that “researchers are still grappling with the known unknowns”. Recently, biologist, Emmanuelle Charpentier, discussed CRISPR-Cas9 and that it’s simply too early to begin gene editing as “the tools are not ready” and “as of today, I’m in favor of not having the manipulation of the human germlines. As long as they’re not perfect and ready, I think it’s good to have this ban against editing the germline.” Buzzfeed noted that over the course of the conference, there was a substantial push for a delay in the use of genetic engineering in fertility clinics due to the risk of making “designer babies”. Given the heavily debated nature of this topic it’s not surprising that the US National Academy of Sciences, Engineering and Medicine, the UK’s Royal Society, and the Chinese Academy of Science, all agreed that it “would be irresponsible to proceed with any clinical use of germline editing.” While the future is left open to gene editing on humans, there was heavy accentuation throughout the conference on the ethics and societal views of these scientific breakthroughs and the necessity to revisit their applications on a regular basis.

Dengue Fever Outbreak in Hawaii 
The Dengue fever outbreak on Hawaii Island is still growing. Now at 122 confirmed cases, this is one of the biggest outbreaks they’ve seen with local transmission. As of 12/2, the confirmed cases involved 106 Hawaii Island residents and 16 visitors. The Hawaii Department of Health (HDOH) has published information, hoping to aid prevention efforts, regarding the Aedes aegypti and Aedes albopictus mosquitos that are responsible for spreading the disease. There have been 313 reported potential cases and you can even find a map of the case distribution here!

Stories You May Have Missed:

  • 2015/2016 Flu Season- Where Are We?– The CDC 2015/2016 influenza activity showed a bit of a spike during the November 15-21 week. Influenza A (H3) is still the predominant species in laboratory confirmed cases. If you’re looking to keep an eye on seasonal flu, Google Flu Trends may no longer be operational, but you can still keep an eye on Flu Near You or the CDC’s page.
  • MERS-CoV Severity and Incubation Period– The CDC & Emerging Infectious Diseases published a report regarding the association of severe MERS-CoV illness and a shorter incubation period. Analyses of 170 patents in South Korea revealed a longer incubation period associated with a decreased risk for death while “patients who died had a shorter incubation period.” This mirrors the results of a previous study that had similar results with SARS coronavirus.
  • Salmonella Outbreak Associated With Recalled Nut Butters – The CDC is currently investigating 11 illnesses across nine states that may be linked to recalled nut butters. The Salmonella serotype is Paratyphoid B variant L (+) tatrate (+) (previously called Salmonella Java) and has caused illness in California, Colorado, Georgia, Hawaii, Idaho, Illinois, North Carolina, and New Jersey.
  • Taiwan CDC Holds Bioterrorism Drill – Involving 70 participants, the course utilized a subway union station to allow people to simulate first responders and real-life operations. “CDC bioterrorism teams are tasked with the investigation and identification of biological threats and attacks. Members take on containment and mitigation of damage for any individuals that are harmed during and as a result of an attack.” Go Taiwan!

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

Pandora Report 10.23.2015

Happy Infection Prevention Week! Make sure to give any infection preventionists you know a big hug or at least a hearty handshake (only clean hands though!). Not only do we get to celebrate National Infection Prevention week, but it’s also National Biosafety Stewardship Month, so get your party hand sanitizer ready to go and let the frivolity begin! Foodborne illness is the name of the game this week and we’ll be discussing outbreaks. Friendly reminder – the influenza vaccine is available in most offices/clinics now, so get your flu shot as there have already been cases springing up across the US. Fun fact – did you know that a report published this week identified Yersinia pestis in the tooth of a Bronze Age individual, which means there were plague infected humans 3,300 years earlier than we thought!

National Biosafety Stewardship Month – October is National Biosafety Stewardship Month (thanks NIH!) to celebrate and encourage people to focus on biosafety policies, practices, and procedures. Given the lab biosafety issues we’ve seen recently, I think we can all safely (or should I say, “biosafely”?) agree that a little extra attention to these issues and the promotion of better practices is a great thing. Institutions are encouraged to use more of a just culture approach to incident reporting and to promote public transparency. Happy National Biosafety Stewardship Month!

Water Quality for the Olympic Games in Rio De Janeiro, 2016
The 2016 Summer Olympics are fast approaching and with any large event, health issues become a main concern. The WHO is providing technical advice to the Brazilian national authorities regarding public health concerns, as well as to the International Olympic Committee and the Local Organizing Committee. Clean drinking water, sewage pollution, and a host of other health issues can become a nightmare during such a large-scale event. While there aren’t recommendations for specific viral testing of the water, the WHO does encourage additional testing in the event of an outbreak. Sanitary inspections and other preventative procedures are being recommended to avoid outbreaks and public health issues. As we get closer to the 2016 Olympics, it is very likely concerns over vector-borne diseases will be addressed through vector control and public health education.

CDC Launches Redesigned FOOD Tool for Foodborne Outbreaks 

Courtesy of CDC FOOD Tool
Courtesy of CDC FOOD Tool

The CDC has updated their online foodborne illness outbreak investigation tool! The Foodborne Outbreak Online Database Tool (FOOD Tool) allows the user to search the outbreak database by state, food, ingredient, year, location of food preparation, and organism. The FOOD Tool also provides the case information related to the outbreak, so users can see the number of affected persons, hospitalizations, deaths and laboratory-confirmed organisms. This database pulls from CDC’s Foodborne Disease Outbreak Surveillance System (FDOSS) and allows users to not only look at data and trends over time, but also compare their cases to other outbreaks.

Syrian Refugee Resettlement and Why We Should Be Letting Them All In 
Dr. Trevor Thrall, one of our amazing GMU Biodefense professors, has written a piece for The Atlantic on the importance and benefits of taking in all Syrian refugees. Dr. Thrall discusses the limitations of addressing the root cause of the Syrian conflict and how the US and its European allies should take in refugees. Discussing the military alternatives to the Syrian crisis, he states, “going in militarily is not the answer, then. Instead, those civilians under threat should get out. Refugees typically receive support in the countries to which they flee, but the vast numbers involved in this case threaten to overwhelm Turkey, Jordan, and Lebanon, which have so far accommodated the vast majority of the outflow.” Dr. Thrall points out that while resettlement would cost a substantial amount of money, it would cost far less than military intervention and you simply can not ignore the moral superiority in aiding refugees.

Chipotle’s Bad Tomatoes Came From Nation’s Largest Field Producer
To our readers in Minnesota, did you happen to eat at a Chipotle in August? If so, we hope you weren’t one of the affected individuals that contracted Salmonella Newport as a result of contaminated tomatoes. The Minnesota Department of Health investigated the 64 cases resulting from this outbreak, however it was just released that the contaminated tomatoes were actually supplied by Six L’s Packing Co (doing business as Lipman Produce), which is actually one of the largest tomato suppliers in the US. Packing 15 million boxes of tomatoes this past year, Lipman was later dropped as a supplier by Chipotle after learning of the source of contaminated produce. The tomatoes were removed but it’s estimated that during the window of exposure, roughly 560,000 people consumed Chipotle. The good news is that we’re out of the incubation period, so if you happened to eat at a Minnesota Chipotle, you’re in the clear.

Stories You May Have Missed:

  • 80 Illnesses Linked to Shigella Outbreak; CA Seafood Restaurant Closed –  Mariscos San Juan in San Jose, CA is currently closed after the Santa Clara County Health Department connected a recent outbreak of Shigella to their food. While the exact source hasn’t been identified, over 93 people were sickened in relation to contaminated food at the restaurant.
  • Subway to Phase Out Poultry Products Raised With Antibiotics–  On Tuesday, Subway Restaurants announced that they will be transitioning to only serve poultry products that have been raised without antibiotics by early next year. Other chain restaurants, like Chick-fil-A and Chipotle, are jumping on the train to phase out chicken and turkey products that were raised with antibiotics.
  • Scottish Nurse and Ebola Complications – Pauline Cafferkey continues to battle post-Ebola complications. Reports last week noted neurological issues and it was recently reported that she has meningitis after the virus persisted in her brain and CSF after her initial recovery. Ongoing research is looking into the long-term effects of the disease as the West African outbreak was the largest in history and researchers have never had the opportunity to look at chronic issues associated with disease recovery.

Pandora Report 10.2

All this rain and grey weather (at least in DC) makes us want to curl up with a good book and luckily, we’ve got just the reading list! This week we’re sharing some top-notch work by our phenomenal faculty and alumni for you to enjoy. Earlier this week, straight out of a James Bond movie, Elon Musk presented Tesla’s Model X and its Bioweapon Defense Mode. Google had its 2015 Science Fair and a pretty amazing high school student took home top honors for her work on Ebola. Did I mention Kansas is prepping for the zombie apocalypse? Needless to say, there was a lot going on this week in the world of biodefense, so let’s venture down the rabbit hole….

 Zombie Preparedness Month Starts for Kansas 
I’m thinking we may need to take a class trip to Kansas since Governor, Sam Brownback, will be signing a proclamation to officially designate October as “Zombie Preparedness Month”! Brownback’s rationale is to emphasize preparedness in any form, stating, “If you’re prepared for zombies, you’re prepared for anything. Although an actual zombie apocalypse will never happen, the preparation for such an event is the same as for any disaster: make a disaster kit, have a plan, and practice it.” During Zombie Preparedness Month, state emergency management services will have activities and information for residents to help get their preparedness on. They’ll also be using social media to engage people people on these topics. The one thing we’ve learned in biodefense, Gov. Brownback, is to never say never!

Connecticut Teen Wins Google Science Award By Developing Affordable Ebola Test
High school junior, Olivia Hallisey, just took home the Google Science Fair top prize for developing an affordable and easy Ebola test in her project, “Ebola Assay Card”, which quickly (we’re talking 30 minutes quick!) detects the virus and doesn’t require refrigeration. Each test only costs $25 and picks up antigens on photo paper. Hallisey summarizes, “In this new device, that is stable and stored at room temperature, 30µl drops of water were used to dissolve silk-embedded reagents, initiating a timed-flow towards a center detection zone, where a positive (colored) result confirmed the presence of 500pg/ml Ebola(+)control antigens in 30min, at a cost of $25,” Hallisey hopes this project will encourage other girls to pursue their passions in science. Hallisey is truly an inspiration and we tip our hats to her passion for solving world problems while encouraging her peers!

Let’s Talk Dual-Use!
Come listen and chat with Dr. David R. Franz, former commander of USAMRIID, about balancing research and regulations when it comes to dual-use!
Date & Time: Monday, October 5, 2015, 4:30-6pm
Location: Hanover Hall, L-003 George Mason University, Fairfax, VA, see map

​Dr. Franz was the Chief Inspector on three United Nations Special Commission biological warfare inspection missions to Iraq and served as technical advisor on long-term monitoring.  He also served as a member of the first two US-UK teams that visited Russia in support of the Trilateral Joint Statement on Biological Weapons and as a member of the Trilateral Experts’ Committee for biological weapons negotiations.  He previously served as member of the National Science Advisory Board for Biosecurity (NSABB). Dr. Franz currently serves on several committees including the National Academy of Sciences Committee on International Security and Arms Control and the National Research Council Board on Life Sciences. Dr. Franz is a leader in the areas of cooperative threat reduction and health security and an expert in the development of U.S. regulations for biological threat reduction and biological security.  Dr. Franz will discuss the history and current debates related to U.S. and international regulations for select agents, dual use research of concern, and gain-of-function experiments.

1977 H1N1 Influenza Reemergence Reveals Gain-of-Function Hazards
Dr. Martin Furmanski discusses the gain-of-function (GoF) research hazards in relation to the 1977 H1N1 strain and it’s laboratory origins. Highlighting a previous article on the GoF debate, Dr. Furmanski notes that “separating the risks of vaccine development from those of basic GoF research is inappropriate, because GoF research seeks to discover antigenic and genomic changes that facilitate human-to-human transmission and/or augment virulence, with the aim of preemptively producing vaccines.” He also notes that while the 1977 H1N1 epidemic originated in a lab and it’s release was unintentional, the culprit laboratory matters little in the GoF debate.

Define Acceptable Cyberspace Behavior
GMU Biodefense alum, Dr. Daniel M. Gerstein, discusses the US-China cybersecurity agreement and the Friday announcement between Chinese Premier Xi Jinping and President Barack Obama. The agreement highlights the mutual desire to prevent cybertheft of business secrets. Dr. Gerstein emphasizes that while this agreement is a step in the right direction, it points to larger preparedness and response capability gaps. He notes, “So while a U.S.-China agreement is a welcome step, it also underscores the greater issues facing the United States, and indeed the international community, in this largely ungoverned space.” Dr. Gerstein highlights the necessity to define cyberspace boundaries, especially as there are delays in DHS security system deployments while US vulnerabilities continue to develop.

Implementation for the US Government Policy for Institutional Oversight of Life Sciences Dual Use Research of Concern
As of September 24, 2015, all institutions and USG funded agencies are now required to comply with the policies. Agencies now must have “a mechanisms in place to evaluate research that is potentially Dual Use Research of Concern (DURC).” Institutions must also organize an Institutional Review Entity (IRE) to review and manage compliance with these requirements.

Dr. Sonia Ben Ouagrham-Gormley’s  new book, Barriers to Bioweapons, received glowing reviews in the latest issue of Perspective on Politics. Her work, which is a staple for biodefense courses, and particularly this text, focusses on the perception of risk and lethality of bioweapons while addressing the realities of these assumptions. Ouagrham-Gormley discusses the key role of tacit versus explicit knowledge in the development and dissemination barriers for bioweapons. “The author identifies important factors internal to a weapons-development program- talented individuals and cohesive groups, corporate culture, communities of practice, organization structure- as critical nodes or ‘reservoirs’ of knowledge that must be configured to optimize the sharing of ideas and information.” The case studies of Iraqi and South African programs, as well as Aum Shinrikyo, lay the foundation for her points on the role of internal and external variables that can hinder or help a bioweapons program. Whether you’re reading  it for class (GMU Biodefense folks, I’m looking at you!) or you’re looking to brush up on nonproliferation, this book is a well-written and captivating necessity to understand bioweapon development. Did I mention how awesome the cover is?
Our very own GMU Biodefense PhD alum, Dr. Denise N. Baken, has a wonderful new book being released – let’s check it out! Al Qaeda : The Transformation of Terrorism in the Middle East and North Africa examines violence and the way it is marketed by the global terrorism industry.  Authors Denise Baken and Ioannis Mantzikos frame the violence discussion through the prism of its use by Al Qaeda, Al Qaeda in the Arabian Peninsula (AQAP) and Islamic State of Iraq and Syria (ISIS).Baken and Mantzikos look at the business parameters of violence –its cost, return on investment, efficiency, and effectiveness; They propose a new approach to that violence. One that looks at violence as a controlled commodity that evolved from Al Qaeda’s initial presentation of future possibilities, AQAP exploited those possibilities and ISIS pushed the boundaries of usability.
Stories You May Have Missed: