Pandora Report 8.17.2018

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

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

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

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

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

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

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

Stores You May Have Missed:

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

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

Pandora Report: 7.20.2018

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
This week Schar Biodefense hosted a three-day workshop on all things health security, from anthrax to Zika. Highlights from the first two days include a rousing discussion by Dr. Robert House surrounding medical countermeasures and the potential for nefarious actors to highjack the immune system, Sandy Weiner delving into the history of the 1976 influenza pandemic, GMU professor and virologist Dr. Andrew Kilianski breaking down some hard realities of biosurveillance, and Edward You of the FBI discussing the importance of working with the DIY biohacker community and protecting the bioeconomy. While the workshop continues through today, make sure to check back next week for more coverage.

 Vaccine Causing Polio in Africa? Context From An Expert
GMU Biodefense PhD alum Christopher K. Brown sat down with Lucien Crowder of the Bulletin of the Atomic Scientists to discuss vaccine derived polio and the implications of these outbreaks. Brown discussed the vaccine production process, how they can cause an “infection light”, and the current outbreak in the DRC. “In the Democratic Republic of the Congo, a vaccine-derived type 2 poliovirus is responsible for the current outbreak, even though it is no longer a component of the live, attenuated oral vaccine that most countries use (when, that is, an oral, attenuated vaccine is used instead of a fully inactivated injectable formulation that is safer but potentially less effective). Despite a World Health Organization–led switch from the three-type, or trivalent, vaccine to a bivalent preparation, the vaccine-derived type 2 virus continued to spread from person to person undetected, slowly mutating to regain the neurovirulence that can cause paralysis in those who are infected. Now, to stop the current outbreak, health officials are deploying a monovalent vaccine formulated specifically for type 2 poliovirus. The key is to reach susceptible individuals—namely, those who did not receive the trivalent option previously—with the vaccine before the virulent strain of the virus does. If enough people are vaccinated, the mutated, vaccine-associated strain will not continue to infect new people and the outbreak will subside.” Brown took care to discuss how these incidents are high-jacked by the anti-vaccination movement, but that “the argument that vaccines cause injury often focuses on the myth that certain chemicals in vaccines—including preservatives, like Thiomersal, that are no longer used in vaccine formulations—cause autism. The polio outbreak in the Democratic Republic of the Congo is a case in which a strain of virus that was rendered safe for vaccinating most people has regained some of its disease-causing abilities through genetic mutation. That’s sort of similar to why bugs that are more common problems in developed countries, like staphylococcus and gonorrhea, stop responding to antibiotics: They acquire genetic mutations that make them resistant to certain drugs. What is most important here is to consider the level of risk associated with vaccine-linked outbreaks, or cases of paralysis, compared to the effects of polio in an unvaccinated population. While the attenuated poliovirus in the vaccine itself may lead to no more than four or five cases of paralysis among every million individuals vaccinated, there would likely be thousands of cases of serious disease among a million exposed, unvaccinated people.”

Why Aren’t We More Worried About The Next Epidemic?
In the past couple of months, we’ve seen outbreaks of Ebola, MERS, Zika, Nipah virus, Rift Valley fever, and Lassa fever – so why aren’t we more worried about the next epidemic? Globalization makes the movement of people and goods easier and faster – consider that 107 countries received frozen vegetables now being recalled for Listeria. The good news is that information technology allows us to know about these outbreaks and have the ability to notify necessary agencies and resources at a rapid pace. “Several major factors are to blame for why the world is seeing more of these increasingly dangerous pathogens. The combination of massive widespread urbanization, explosive population growth, increased global travel, changing ecological factors, steady climate change and the exploitation of environments is driving an era of converging risk for outbreaks, experts say.” Dr. Thomas Inglesby, director of the Johns Hopkins Center for Health Security, noted that ‘We don’t know when the next Ebola outbreak will come but we do know it will come again, and again, and again’.” Outbreaks like SARS and Ebola have shown the devastating impact outbreaks have on not only the healthcare system, but also the economy. Unfortunately, emergency preparedness and healthcare response is a tough problem to fix. The CDC director of the Center for Global Health, Rebecca Martin, stated that “Gaps in public health emergency response capabilities remain a serious vulnerability for the entire world,” she added. “While we don’t know when or where the next pandemic will occur, we know one is coming”. We know the next pandemic is coming, the unknowns are from where, when, and what it will look like. This makes response, including medical countermeasures, that much more difficult. R&D is a critical component to this, but as Dr. Inglesby noted, “The problem with public health in particular and with R&D is what we’re ultimately trying to do is prevent bad things from happening. When you succeed, it’s relatively invisible ― so the public doesn’t get to see why investment is so important.” Inglesby also recently highlighted the six ways countries can prepare for the next pandemic. From enhancing capabilities to develop new vaccines/medical countermeasures, to investing in more robust public health systems, there are several ways we can facilitate stronger national capacity to respond to pandemics.

Crucial Steps Forward: the National Academies of Science’s 2018 Study, “Enhancing Global Health Security through International Biosecurity and Health Engagement Programs”
GMU biodefense MS student Alexandra Williams recently attended the NASEM meeting regarding global health security through international biosecurity and health engagement programs. Within her recap, Williams discusses the background of CBEP (Cooperative Biological Engagement Program) and CTR (the DoD’s Cooperative Threat Reduction program), noting their efforts to strengthen health security within the U.S. and abroad. “As challenges continue to arise in timely and accurately detecting and responding to disease outbreaks—as we saw in 2014 with Ebola in West Africa, and in 2016 with Zika—U.S. health and security agencies are working to better meet these challenges, and examine how they need to evolve to meet unforeseen hurdles that lay ahead. This NASEM study is timely and critical because it addresses and examines these issues head-on, and will serve as the launch point for how the U.S. can rethink, reshape, and improve its already critical and successful work in biosecurity and global health security.”

Book Review – Dirty War: Rhodesia and Chemical Biological Warfare
Glenn Cross, GMU biodefense PhD alum, has taken great care to investigate and detail the history of Rhodesia’s chemical and biological warfare program against insurgents from 1975 to 1980. If you’re on the fence about adding a new book to your reading list, check out Ryan Shaffer’s latest review. “Organized topically, the book’s preface offers a brief overview of Rhodesia’s colonial history and demographics, discussing the ethnic and racial divisions arising from a white minority’s control of the government over a disenfranchised and mostly rural black African population. Cross describes the Rhodesian War with emphasis on “the regime’s inability to defeat decisively a growing guerrilla insurgency through conventional arms alone.” (39) He explains the conflict’s evolution in the context of post-war British decolonization and the manner in which the Unilateral Declaration of Independence was designed to maintain white minority rule, as well as the ensuing international sanctions that isolated Rhodesia. By the late 1960s, government opponents shifted strategy, believing the only way to change the country was to forcibility seize control. Meanwhile, the CIO had penetrated the opponents’ ranks, gathering intelligence and setting up the Selous Scouts to work against the guerrillas.” Shaffer notes that “the book is a well-researched study that sheds light on the reasons a government broke international norms to use CBW, a tactic more likely to target local non-state actors than foreign militaries.”

 Antibiotic Prescribing Failures in Urgent Care Centers
Disrupting antibiotic resistance is challenging due to not only the vast array of sectors that play a role, but also the cultural components. Prescribing habits are one of those culturally-engrained practices that can be difficult to alter. A new study has found that antibiotic stewardship is desperately needed in urgent care facilities. “Researchers with the Centers for Disease Control and Prevention (CDC), the University of Utah, and the Pew Charitable Trusts report that 45.7% of patients who visited urgent care centers in 2014 for respiratory illnesses that don’t require antibiotics end up with prescriptions for those conditions, followed by 24.6% of patients treated in emergency departments (EDs), 17% of patients who went to medical offices, and 14.4% of patients who visited retail clinics. The findings are based on analyses of 2014 claims data from patients with employer-sponsored health insurance. Previous estimates of outpatient antibiotic prescribing by some of the same researchers had pegged the amount of unnecessary prescribing at 30%, a number that some experts believe is conservative. Study coauthor David Hyun, MD, a senior officer with Pew’s antibiotic resistance project, said the findings suggest that could very well be the case.” The sad reality is that these numbers are likely to be higher across the U.S. as inappropriate prescribing practices are a systemic issue. This finding is one piece of the puzzle, which underscores the progress that needs to be made. Fortunately, countries are working to reduce antimicrobial resistance and while it’s slow, some movement forward is better than none at all.

Rift Valley Outbreak in Uganda
Uganda has reported an outbreak of Rift Valley fever across two districts. Rwanda is also reporting cases in animals and potential cases in humans. “The WHO said the affected districts are in the ‘cattle corridor’ that stretches from the southwest to the northeast regions of the country. ‘The outbreak in Uganda is occurring at a time when Kenya is having a large RVF outbreak and Rwanda is experiencing an epizootic, with suspected human cases,’ the WHO said. In Kenya, where an outbreak has been under way since May, four more Rift Valley fever cases have been reported, raising the outbreak total as of Jul 4 to 94, 20 of them confirmed. Ten deaths have been reported. Illnesses have been reported in three counties: Wajir, Marsabit, and Siaya. The country’s agriculture ministry has reported several outbreaks in animals over the past few months, especially in areas that had experienced flooding after heavy rainfall.”

Stories You May Have Missed:

  • The Strange and Curious Case of the Deadly Superbug Yeast- Maryn McKenna discusses the latest resistant bug we’re worrying about – “It’s a yeast, a new variety of an organism so common that it’s used as one of the basic tools of lab science, transformed into an infection so disturbing that one lead researcher called it “more infectious than Ebola” at an international conference last week. The name of the yeast is Candida auris. It’s been on the radar of epidemiologists only since 2009, but it’s grown into a potent microbial threat, found in 27 countries thus far.”

Pandora Report 7.6.2018

 

We hope you had a lovely holiday this week and are ready to get back into the world of biodefense! News is still unfolding regarding the two British citizens who were hospitalized after exposure to the nerve agent, Novichok, but we’ll keep you updated as more information becomes available.

Summer Biodefense Workshop – Pandemics, Bioterrorism, and Global Health Security
In less than two weeks the summer workshop on all things health security, from anthrax to Zika, will be taking place – are you registered? This three-day workshop will cover everything biodefense from the most recent Ebola outbreak, to DIY biohackers and vaccine development, and also the challenges of defending against biothreats. Speakers include experts in the field like David R. Franz, who 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. His current standing committee appointments include the Department of Health and Human Services National Science Advisory Board for Biosecurity (NSABB), the National Academy of Sciences Committee on International Security and Arms Control, the National Research Council Board on Life Sciences, and the Senior Technical Advisory Committee of the National Biodefense Countermeasures Analysis Center. Jens H. Kuhn will also be speaking on filoviruses and what it was like to be the first western scientist with permission to work in a former Soviet biological warfare facility, SRCVB “Vektor” in Siberia, Russia, within the US Department of Defense’s Cooperative Threat Reduction (CTR) Program. These are just two of our speakers who will be leading discussions over the three days – come join the conversation at our workshop from July 18-20!

All Hands on Deck – U.S. Response to Ebola in West Africa
Princeton University’s Innovations for Successful Societies has just released their report on the quality of the U.S. response to Ebola. The case study is part of a series on Liberian response to the outbreak and includes great information on coordination, political response, and the challenges of international outbreak management. “Although the deployment, which scaled up earlier assistance, took place five months after the first reported cases and required extensive adaptation of standard practices, it succeeded in helping bring the epidemic under control: the total number of people infected—28,616—was well below the potential levels predicted by the CDC’s models. This US–focused case study highlights the challenges of making an interagency process work in the context of an infectious disease outbreak in areas where health systems are weak.”

Bats and Military Defense
Sure, your first inclination might be a vampire or Batman joke, but there’s actually a significant history regarding the U.S. military and utilization of these mammals. Historically, efforts focused on employing them as bombs in Japan but a more modern plan focuses on their uncanny ability to carry deadly diseases. “‘What we are trying to do is to study bat immunology, but that turned out to be a very difficult thing to do when starting from scratch,’ said Thomas Kepler, a professor of microbiology at Boston University. It took decades to create the reactive substances necessary to study human or mouse antibodies. With bats, he explained, they were starting from zero.” Battling potential Russian bioweapons means thinking outside of the box, right? The truth is that fruit bats have a pretty amazing weapon of their own – a super immunity that might just lend itself to curing Marburg and other devastating infections. “The Marburg virus is classed as a Category A bioterrorism agent by the Centers for Disease Control and Prevention, and Kepler’s study was supported by the Defense Threat Reduction Agency, a Defense Department division established during the Manhattan Project era to combat weapons of mass destruction. If the virus is ever deployed as biological warfare, the fruit bat’s super-immunity may hold the answer to preventing its spread. But it may also go some way toward redeeming the bat in the eyes of the U.S. military — and could even make the animal an unlikely hero.”

 NASPAA Pandemic Simulation
How would you handle a pandemic? GMU’s Schar School team qualified for the final round of the Network of Schools of Public Policy, Affairs, and Administration (NASPAA) pandemic simulation, in which student teams had to respond to a constantly evolving situation and make real-time decisions regarding quarantine, trade, etc. “‘The simulation is an especially valuable experience for the biodefense students since the pandemic crisis provided students with complex problems like those that they will tackle in their professional careers,’ said director of the Schar School’s biodefense graduate program, Gregory Koblentz. ‘These exercises also test the students’ ability to bridge the gap between the science and policy-making, a key goal of the biodefense programs’.”

Gene Editing – Last Week Tonight With John Oliver and How DARPA Wants to Boost Body Defense Through Gene Editing
This week’s episode of Last Week Tonight featured one of our favorite topics – gene editing! While there’s only so much you can cover in the span of 20 minutes, it was nice to see some of the complexities, personalities, and technical hurdles, covered by John Oliver. From biohackers to germline edits, Oliver mixed humor into a discussion on the very real issues surrounding gene editing technologies like CRISPR (although his version of the acronym is much more comical – Crunchy Rectums In Sassy Pink Ray-bans). Make sure to check out the episode to get a humorous overview on this gene-editing technology. Meanwhile, DARPA (the Defense Advanced Research Projects Agency) is actually working to harness gene editing to make your body’s natural defenses that much stronger through specific gene expressions. The project is called PREPARE (PReemptive Expression of Protective Alleles and Response Elements) and works to provide temporary boots to your natural defenses. “In contrast to recent gene-editing techniques, such as CRISPR, which focus on permanently changing the genome by cutting DNA and inserting new genes, the PREPARE program will concentrate on techniques that don’t make permanent changes to DNA. These techniques target the ‘epigenome,’ or the system that controls gene expression. Genes can be turned on or off by making external modifications to DNA, which don’t change the DNA sequence, but instead affect how cells ‘read’ genes. To start, the PREPARE program will focus on four key health challenges: influenza viral infection, opioid overdose, organophosphate poisoning (from chemicals in pesticides or nerve agents) and exposure to gamma radiation, the statement said.” While there are a lot of hurdles to overcome, the overall goal is to extend the platform to known and unknown threat application.

Improving Mass Casualty Management: The Role of Radiation Biodosimetry 
How would we handle the medical response of large-scale radiological exposure? GMU Biodefense PhD student Mary Sproull presented on this very topic and the work she and her team are doing, which is aimed at making testing more efficient and effective. “Drs. Sproull and Camphausen are working to make the medical management process more efficient and effective in the event of a mass casualty radiation exposure. Specifically, they are developing a dosimetry dose prediction model to determine how radiation biodosimetry diagnostics can help physicians estimate just how much radiation exposure a patient has experienced. (Radiation biodosimetry diagnostics estimate a person’s radiation exposure by measuring changes in biological markers that include cytogenic assays like dicentric chromosome assay.)”

Everything You Need to Know About Ricin
A few weeks back a Tunisian man was arrested by German police regarding suspected plans for a bioterrorism attack with ricin. German police were searching his residence in Cologne and found enough ricin for 1,000 toxic doses. During the fervor of the news, it was reported that such a a plot could have been more devastating than 9/11 – but what’s the reality behind ricin? Check out this comprehensive review of what ricin is (a naturally occurring biological poison), its history as a biological weapon and WMD, and more. “In summary, ricin’s status as a biological weapon is quite mixed. In terms of actual potential for harm, it is more at the level of knives than bombs. Its status as a WMD is a legal one, not so much a practical one. It would be useful to the public debate and our general social assessment of risk if the media could reflect this, rather than churn out hysterical reporting.”

Stories You May Have Missed:

  • VA Study Reveals Antibiotic Prescribing Habits – “A team of researchers establishing baseline data on antibiotic use by the Veterans Administration (VA) healthcare system in Pittsburgh found that about 75% of all antibiotic prescriptions were inappropriate, meaning they were either not indicated or were used for a duration that’s not recommended. The study, which took place over 12 months, looked at prescribing information, medical records, and charts of 40,734 patients, who were written 3,880 acute antibiotic prescriptions by 76 primary care providers (PCPs). The median antibiotic index was 84 antibiotic prescriptions per 1,000 patients per year.”
  • Drone Crashes Into French Nuclear Plant – “GREENPEACE activists say they have crashed a drone into a French nuclear plant to highlight the lack of security around the facility. The drone, which was decked out to resemble a tiny Superman, slammed into the tower in Bugey, 30 kilometers (20 miles) from the eastern city of Lyon, according to a video released Tuesday by Greenpeace. The environmental group says the drone was harmless but it showed the lax nuclear security in France, which is heavily dependent on nuclear power, using it for about 75 percent of its energy needs.”

Pandora Report 6.29.2018

The month of June is nearly over, which means there’s only a few more weeks to register for the Workshop on Pandemics, Bioterrorism, and Global Health Security. Don’t miss out on the early registration discount if you sign up before July 1st!

Cost Analysis of 3 Concurrent Public Health Response Events: Financial Impact of Measles Outbreak, Super Bowl Surveillance, and Ebola Surveillance in Maricopa County
Have you ever wondered the cost of public health response for local health departments during a crisis? Imagine that within the course of six months, your county sees a measles outbreak, super bowl surveillance requirements, and Ebola surveillance. A new article is addressing the cost of this trifecta for the largest county health department in Arizona. GMU biodefense PhD student Saskia Popescu was a part of not only this response, but also aided in developing the research so that we can truly address the financial burden of public health events. “Maricopa County Department of Public Health (MCDPH) in Arizona. The nation’s third largest local public health jurisdiction, MCDPH is the only local health agency serving Maricopa’s more than 4 000 000 residents. Responses analyzed included activities related to a measles outbreak with 2 confirmed cases, enhanced surveillance activities surrounding Super Bowl XLIX, and ongoing Ebola monitoring, all between January 22, 2015, and March 4, 2015. Total MCDPH costs for measles-, Super Bowl-, and Ebola-related activities from January 22, 2015, through March 4, 2015, were $224,484 (>5800 hours). The majority was for personnel ($203,743) and the costliest response was measles ($122,626 in personnel costs). In addition, partners reported working more than 700 hours for these 3 responses during this period.” Public health is chronically underfunded, but the response efforts can be immensely expensive. Based off these events and the cost of response, perhaps it’s time we start investing more in public health.

Forget RoboCop, Meet the DNA Cops
Biotechnology is moving at a rapid pace and the ability for DIY biohacking means that frank conversations need to be had regarding the potential for someone to build a lethal biological weapon. Ginkgo Bioworks has just the team to overcome this herculean task. Remember that horsepox synthesis last year? “The study’s publication ‘crosses a red line in the field of biosecurity,’ wrote Gregory Koblentz, a professor in the biodefense department at George Mason University, in a public comment to the journal. ‘The synthesis of horsepox virus takes the world one step closer to the reemergence of smallpox as a threat to global health security’.” Hoping to get a leg up on the threat, the intelligence community is working with Ginkgo Bioworks to address the science, security, and safety. “Gingko quickly saw the potential security risks in its work. It began working with Weber, the former Obama administration official, in 2016 to get advice on how to best preserve national security.  ‘We are doing more of this genetic engineering than anybody, we think we’re going to get better at it than anybody, so we have a responsibility to be keeping our eye on both sides of that coin,’ Kelly said. ‘How do we protect and defend against that while protecting our ability to get all the positive outputs of biotechnology?’” Synthetic biology has the potential to do damage, but also the chance to counter these threats (and even emerging infectious diseases) through vaccine development. Joint efforts like those between Ginkgo Bioworks and agencies like IARPA, are critical during this time when the technology is still spreading and evolving.

Genome Editing and Security: Governance of Non-Traditional Research Communities?
GMU Biodefense doctoral student Katherine Paris has provided a detailed account of the latest National Academies webinar on gene editing and biosecurity/biosafety developments. Paris notes that “at the workshop, concerns were expressed over the extent that advancements in technology allow a greater range of people to access, and possibility misuse, genome editing technologies.  Dr. Millet and Dr. Kuiken addressed these concerns during the webinar by describing what two non-traditional research communities—the International Genetically Engineered Machine (iGEM) competition and do-it-yourself biology (DIYbio) community laboratories—are doing to foster biosafety and biosecurity.” Check out her account of this informative talk to learn more about how iGEM is demonstrating real-world application of biosecurity and biosafety practices.

The Culture of Biosafety, Biosecurity and Responsible Conduct in the Life Sciences
Curious about biosecurity, biosafety, and what it means to have a culture of responsibility in the life sciences? Look no further than this amazingly comprehensive literature review by ABSA International, which happens to include former GMU Biodefense student Kathleen Danskin and current doctoral student Elise Rowe. Identifying over four thousand unique articles published between 2001 and 2017, they reviewed 326 articles to truly evaluate the literature on ways to strengthen the biosafety/biosecurity culture. “We found that while there were discussions in the literature about specific elements of culture (management systems, leadership and/or personnel behavior, beliefs and attitudes, or principles for guiding decisions and behaviors), there was a general lack of integration of these concepts, as well as limited information about specific indicators or metrics and the effectiveness of training or similar interventions. We concluded that life scientists seeking to foster a culture of biosafety and biosecurity should learn from the substantial literature in analogous areas such as nuclear safety and security culture, high-reliability organizations, and the responsible conduct of research, among others.”

Roadmap for Implementing Biosecurity and Biodefense Policy in the U.S. 
This new report and roadmap from Gryphon Scientific, National Defense University, and Parsons, analyzes biosecurity and biodefense policy within the United States. “We developed a framework for analyzing opportunity costs of new or changing regulations (the opportunity cost analysis framework), and a framework for evaluating the successful implementation of biosecurity and biodefense policies. These analyses enabled the development of a roadmap for implementing U.S. biosecurity and biodefense policy to maximally leverage science and technology advances while simultaneously, minimizing risks. This project was funded by a generous grant from the U.S. Air Force Academy and Defense Threat Reduction Agency under their Program on Advanced Systems and Concepts for Countering Weapons of Mass Destruction.” The report includes policy and opportunity cost case studies, as well as evaluation metrics framework.

How Will Trump Lead During A Pandemic and How Well Prepared Is Your Country?
Between several science vacancies within the administration and the fundamental truth that a global epidemic is on the horizon, many are concerned about what a response would be like under Trump. “’There is a real reason for us to be scared of the idea of facing this threat with Donald Trump in the White House,’ said Ron Klain, who served as President Obama’s Ebola czar, at the Spotlight Health Festival, which is co-hosted by the Aspen Institute and The Atlantic. Klain said the ‘president is anti-science’ and ‘trades in conspiracy theories. All those things would lead to the loss of many lives in the event of an epidemic in the United States, where we need the public not to trade in conspiracy theories, not to believe that the news was fake, but to respect scientific expertise,’ said Klain, a veteran Democratic operative who served in both the Clinton and Obama administrations.” Klain underscores the importance of having pro-science leadership, which isn’t exactly something the current administration is known for. He points to several gaps within U.S. preparedness – funding, leadership, science, policy, etc. “But the biggest gap, he said, is the global gap: ‘We can’t be safe here in America when there’s a risk of pandemics around the world,’ Klain said. ‘The world’s just too small. Diseases spread too quickly … There is no wall we can build that is high enough to keep viruses and the disease threat out of the United States. We have to engage in the world’.” If you’re curious about the current state of preparedness around the globe, check out the latest site from Resolve to Save Lives, the initiative run by former CDC director Dr. Tom Frieden. Prevent Epidemics is a tool that rates countries from 0-100 on their ability to find, stop, and prevent outbreaks. “ReadyScore is calculated using data from the Joint External Evaluation (JEE), a rigorous, objective and internationally-accepted epidemic preparedness assessment developed by the World Health Organization (WHO) and other partners. The ReadyScore consolidates key information from the JEE about a country’s preparedness in the form of a simple and easy-to-understand number that makes it easy for countries to measure their preparedness gaps and fill them”

UK, Allies – Empower Chemical Arms Watchdog to Assign Blame For Attacks
The UK, US, and EU are pushing a new proposal to increase the powers of the Organization for the Prohibition of Chemical Weapons (OPCW) in efforts to strengthen the ban on chemical weapons and the ability to hold countries, like Syria, accountable for use. “‘The widespread use of chemical weapons by Syria in particular threatens to undermine the treaty and the OPCW,’ said Gregory Koblentz, a non-proliferation expert at George Mason University, in the United States. ‘Empowering the OPCW to identify perpetrators of chemical attacks is necessary to restoring the taboo against chemical weapons and the integrity of the chemical weapons disarmament regime’.”

Stories You May Have Missed:

  • Pull Incentives – A New Strategy for AMR – The World Economic Forum is supporting these initiatives to help spur the development of new antibiotics and facilitate their profitability. The financial challenges for antibiotic development can be significant hurdles – demand is unpredictable, stewardship efforts seek to decrease use which decreases sales, and clinical trials are costly. “Existing incentives for developing new antibiotics are mostly of the ‘push’ type, the report notes. Push incentives provide support for research and development, but they don’t ensure that a company can get an adequate return on a new antibiotic once it wins approval. The concept of pull incentives has attracted increasing attention in recent years. A chart in the report shows that 10 current research and development initiatives on antimicrobial resistance (AMR) involve push incentives, while no such initiatives involve pull incentives exclusively. Combinations of push and pull incentives are being used to support four existing R&D initiatives, the chart indicates, but it doesn’t give any details on those.”

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

Pandora Report: 5.18.2018

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report: 4.20.2018

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report 4.13.2018

Welcome to your Friday biodefense fix! Have you registered for the summer workshop on pandemics, bioterrorism, and global health security? Don’t miss the chance to learn from the top minds in the field on everything from anthrax to Zika.

Blue Ribbon Study Panel Meeting – Transnational Biological Threats & Global Security
On April 25th, the Blue Ribbon Study Panel on Biodefense will be hosting a meeting regarding transnational biological threats. From 10am to 3pm, you can attend (or watch live!) this event. “Biological threats to the Nation increase continuously, recognizing no borders. As emerging and reemerging naturally occurring diseases continue to spread throughout the world, terrorists continue to pursue biological weapons to add to their arsenal, and nation states are establishing new and reinvigorating old offensive biological weapons programs. This meeting of the Study Panel, chaired by former Senator Joe Lieberman and Governor Tom Ridge, will provide the Study Panel with a better understanding of: Current transnational biological threats, Homeland defense and security in the global context, Global security efforts to combat these threats, International public health security efforts; and the need to elevate global health security as a national and global priority”.

Chemical Weapons Attack in Syria
This past weekend saw a horrific suspected chemical weapons attack upon the rebel-held Syrian city of Douma. Victims began seeking medical care on Saturday evening with the telling signs of chemical weapons exposure. Rough estimates are that 500 people sought medical care related to the attack and the WHO has demanded “immediate unhindered access to the area to provide care to those affected, to assess the health impacts, and to deliver a comprehensive public health response.” Healthcare workers on the ground have reported patients with symptoms, “which included frothing at the mouth, suffocation, dilated and constricted pupils, corneal burns, central cyanosis – a blue tinge to the skin – and a chlorine-like odour, were consistent with exposure to an organophosphorus compound. Sarin gas is such a chemical”. Sadly, the use of chemical weapons is becoming increasingly common in Syria, as the Assad regime has revealed an appreciation for the abhorrent tactic. “Gregory D. Koblentz, the director of George Mason University’s Biodefense Graduate Program, said the attack appeared to reflect how much the clout of U.S. policy has faded in Syria. ‘Assad is less concerned about Beltway politics, less concerned by who is in the White House. His calculation is based on whether it will help his chances in achieving gains on the ground, or punishing the rebels,’ he said.” “The possibility of western intervention against Assad was heightened on Tuesday after Russia and its western opponents, the US, UK and France, respectively vetoed duelling resolutions at the UN security council over the latest atrocity. The UN high commissioner for human rights said the world must react to the use of chemical weapons or risk dire consequences. ‘After decades when we thought we had successfully outlawed the use of chemical and biological weapons, the world is sitting idly by while their use is becoming normalised in Syria,’ said Zeid Ra’ad al-Hussein. ‘This collective shrug to yet another possible use of one of the most ghastly weapons ever devised by man is incredibly dangerous’.” What is to be done? President Trump’s recent Twitter activity points to planned use of “smart” missiles, but U.S. Defense Secretary Jim Mattis said on Wednesday that the U.S. is still assessing intelligence about the suspected chemical weapons attack. The OPCW (Organisation for the Prohibition of Chemical Weapons) is set to meet on April 16th to discuss the “alleged use of chemical weapons” in Syria. The OPCW team is also currently en-route to Syria for investigation into the suspected attack. “‘I think it looks pretty clear that a chlorine weapon was used’ on the civilians, said Charles Duelfer, former deputy head of the U.N. inspections team in Iraq, in an interview with NPR.”

Who Owns Smallpox?: The Nagoya Protocol and Smallpox Virus Retention
This week the Center for the Study of WMD held a talk on smallpox stockpiles. Spotlight speaker Michelle Rourke discussed her article regarding the convention on biological diversity and the Nagoya Protocol. If you missed the event, GMU biodefense graduate student Morasa Shaker was able to attend and has provided a detailed account of the day. “While the case can be made that endangered species pose an intrinsic value to the world’s genetic diversity, it is has proven less feasible to make the same case for a virus, specifically the variola virus—the causative agent of smallpox. Nevertheless, Michelle Rourke, a Fulbright scholar at Georgetown University’s O’Neill Institute for Domestic and Global Health Law, led an in-depth educational seminar organized by the Center for the Study of Weapons of Mass Destruction to support that very case—the smallpox virus is worthy of our conservation efforts.”

Controlling Dangerous Biological Research
Filippa Lentzos is asking a question we’ve been trying to avoid for a while – how can we control biological research that is inherently dangerous? The desire to advance technologically and in the life sciences pushes researchers and defense programs to invest in biological sciences, like synthetic biology. Just as we make gains in such research, we also worry that adversaries could use the same technologies against us. “Washington, Moscow, and other governments say they are focused only on ‘defensive’ biosecurity activities, but there is a fine line between ‘defensive’ and ‘offensive’ in this realm, and the alarming military focus on synthetic biology may cause people to wonder if there is some way to control the weaponization of biology.” Lentzos calls upon the international community to face the monster head on – let’s discuss how to address biological research that pushes the boundary of defense into offense. “To accomplish any of this, we have to be able to both characterize and evaluate biological research with high misuse potential. This is exceptionally difficult to do, and continues to elude both the international community and national policymakers.” Lentzos points to the horsepox synthesis experiment as a good example of the failures that occurred along the way and that ultimately, risk-benefit analysis is the wrong approach to biosecurity review. “Good security rests not on evaluating risks and benefits, but rather on managing uncertainty, ambiguity, and ignorance—sometimes even situations where we don’t know what we don’t know. Standard risk-benefit calculations are the wrong approach to evaluating biological research with high misuse potential.”

HHS Large-scale Exercise Moving Highly Infectious Patients
How do you transport a highly-infectious patient? The care of Ebola patients in the United States during the 2014/2015 outbreak highlighted the challenges of moving such patients to regional treatment centers. HHS sponsored a large-scale exercise that took place this week, with a hot-wash today. “The exercise focuses on moving seven people acting as patients with Ebola symptoms in different regions of the country. The patients, including one pediatric patient, first present themselves at one of the following healthcare facilities: CHI St. Luke’s Health-The Woodlands Hospital in The Woodlands, Texas; Medical University of South Carolina in Charleston, South Carolina; Norman Regional Hospital in Norman, Oklahoma; St. Alphonsus Regional Medical Center in Boise, Idaho, and St. Luke’s Regional Medical Center in Boise, Idaho.At each facility, healthcare workers will collect and ship samples for diagnostic tests to state laboratories, which in turn will practice running the necessary laboratory tests to diagnose the patients with Ebola. As part of the exercise, each patient will receive a positive diagnosis. Using appropriate isolation techniques and personal protective equipment, health care workers then must take steps to have six of the patients transported by air to designated Regional Ebola Treatment Centers. These patients will be placed into mobile biocontainment units for these flights. The pediatric patient will be placed into protective equipment and transported by ground ambulance.” The drills will also involve several airports, which include LAX, Charleston International, etc.

NASEM Bio, Chem, and Health Security Luncheon: April
Don’t miss the National Academies-hosted lunch today from noon to 1:30PM EDT. “April’s event features features George Korch, Senior Science Advisor to the Assistant Secretary for Preparedness and Response (ASPR) in the Department of Health and Human Services and Dana Perkins, Senior Science Advisor in ASPR’s Office of Policy and Planning. Dr. Korch will discuss recent developments and ASPR strategic priorities in support of the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE). Dr. Perkins will talk about implementation of the recommendations arising from the Federal Experts Security Advisory Panel (FESAP) and current activities for 2018. This event is free and open to the public, but you must register to attend. This event will not be webcast, and a summary will not be provided after the fact, so please register to attend in person if you are interested! A light lunch and beverages will be provided for all attendees.”

Cyberbiosecurity – A New Way To Protect The Bioeconomy and Gene Editing for Good
How can we better ensure cybersecurity and biosecurity? Researchers are bringing forth this emerging hybrid field that we should be giving more attention to. Life sciences and biotech are heavily engrained in cyber systems. Consider 3-D printing, personalized genomics, medical labs and surgical robots, etc.  “We propose ‘Cyberbiosecurity’ as an emerging hybridized discipline at the interface of cybersecurity, cyber-physical security and biosecurity. Initially, we define this term as ‘understanding the vulnerabilities to unwanted surveillance, intrusions, and malicious and harmful activities which can occur within or at the interfaces of comingled life and medical sciences, cyber, cyber-physical, supply chain and infrastructure systems, and developing and instituting measures to prevent, protect against, mitigate, investigate and attribute such threats as it pertains to security, competitiveness and resilience’.” Promoting this field and strengthening educational strategies is key to inform people on cyberbiosecurity and ensure a trajectory that can be supported. How do we move cyberbiosecurity forward though? “Academia, industry, government or non-profits (including policy, regulatory and legal experts) need to begin to learn to communicate with and educate each other, harmoniously identify and develop priorities, opportunities and specify ‘next steps.’ A major opportunity exists right now to propose a unified structure and common vernacular. Lastly, while definition and assemblage of Cyberbiosecurity is occurring, national or international strategies should be pursued to harmonize the emerging enterprise and foster measurable value, success and sustainability.” As the talks surrounding cyberbiosecurity grow, it’s hard not to consider some of the technologies we’re discussing and their potential. Bill Gates recently wrote for Foreign Affairs regarding the good that CRISPR could do. “the next decade, gene editing could help humanity overcome some of the biggest and most persistent challenges in global health and development. The technology is making it much easier for scientists to discover better diagnostics, treatments, and other tools to fight diseases that still kill and disable millions of people every year, primarily the poor. It is also accelerating research that could help end extreme poverty by enabling millions of farmers in the developing world to grow crops and raise livestock that are more productive, more nutritious, and hardier. New technologies are often met with skepticism. But if the world is to continue the remarkable progress of the past few decades, it is vital that scientists, subject to safety and ethics guidelines, be encouraged to continue taking advantage of such promising tools as CRISPR.” Gates points to several avenues for good – feeding the world, ending malaria, etc. He also notes though that there are legitimate questions regarding the potential for misuse and risks, and that regulations for genetic engineering are decades old and need revision to remain applicable. Part of the process for truly utilizing CRISPR is also to responsibly assess risks and communicate openly.

3MT Competition 
The George Mason University 3-Minute Thesis competition took place this past weekend and we’d like to congratulate Biodefense PhD student Chris Brown on his participation in this exciting event! He was one of ten finalists who competed to explain their dissertation to a non-specialist audience in 3 minutes. Chris described his dissertation regarding protecting critical workers against emerging infectious diseases – “Many different types of workers, including those who provide essential services the rest of us frequently depend on, are at risk of exposure to emerging infectious diseases that spread through the general population. Although many factors play into these types of workers being exposed on the job, protective gear—equipment like gloves, gowns, goggles, and respirators—is an essential part of infection prevention programs aimed at keeping workers healthy. During recent outbreaks, the public health enterprise has tended toward reinventing guidelines for each new infectious disease we face. That can lead to confusion about what guidelines for worker protection should be followed, as well as delays in implementing protective measures as science works to understand the disease agent and its transmission mechanisms. Pivoting toward a system based on worker exposures associated with various job tasks instead of one built around accurately characterizing transmission routes, my research offers a guideline for protective gear that is applicable to a wide range of diseases and that can be used as soon as outbreaks begin. It serves as an off-the-shelf solution for worker protection until empirical evidence supports using disease-specific infection prevention practices.”

Stories You May Have Missed:

  • In Pictures: Decades of Navy Efforts To Combat Malaria – “Malaria is ranked by the Department of Defense as the number one infectious disease threat to military personnel deployed to areas where malaria is endemic. This includes countries spanning the tropical and subtropical regions of the world, including most of sub-Saharan Africa and larger regions of South Asia, Southeast Asia, Oceania, central Asia, the Middle East, Central and South America and the Caribbean.”

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

Pandora Report 4.6.2018

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

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

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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

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

Pandora Report 3.23.2018

TGIF and Pandora Report day! Tomorrow is World TB Day, in which we celebrate the progress made to eradicate TB, but also recognize the work that still needs to be done. Did you know that 53 million lives were saved through effective TB diagnosis and treatment from 2000-2016? In 2016 alone, there were nearly 500,000 cases of multidrug-resistant TB around the world and it takes $2.3 billion a year to fill the resources needed for existing TB interventions. If you happen to be traveling by air anytime soon, make sure to read these tips from public health experts.

How Prepared Are You For the Next Pandemic? Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
Three days filled with global health security and all things biodefense from anthrax to Zika – what more could you want in a workshop? Learn from the top minds in the field when it comes to pandemic preparedness, vaccine development, biosecurity, etc. Between the centennial of the 1918 influenza pandemic, the recent horsepox synthesis, and the lift on the gain-of-function research moratorium, these three days will be packed with exciting topics and discussions. From July 18-20th, come get your biodefense on with us in Arlington, VA – registration prior to May 1st also gets an early bird discount!

Shining A Spotlight On Soviet Nerve Agents
A nerve agent attack in the UK has made the poison, Novichok, a household name, but also pointed a very large spotlight on Russia’s scientists and defense labs. “Few experts in the rarefied area of chemical weapons defense are willing—or able—to shed further light on them. Information about the Novichok nerve agents is classified, says one U.S. military scientist who, like other U.S. government scientists, declined to speak with Science.” Whatever the plan, this failed attempt for the quick deaths of Skripal and his daughter have left many questions about delivery of the agent and how this heavily guarded secret nerve agent found its way onto UK soil. An article from The Trench discusses the use of these nerve agents, formal accusations from the UK, and compliance of the Chemical Weapons Convention (CWC). “The OPCW experts travel to the UK under Article VIII, 38(e), which qualifies their activity as a ‘Technical Assistance Visit’ to help with the evaluation of an unscheduled chemical (the Novichock agent) is not listed in any of the three schedules in the Annex on Chemicals).  They will likely visit the sites of investigation and collect their own samples (if for no other reason than to validate any laboratory samples they may receive), take all materials and documents related to the forensic investigation back to the Netherlands where the sample will be divided up and sent to two or more designated OPCW laboratories.” On Wednesday, Russian diplomatic and military officials reportedly accused the UK of hiding evidence in the investigation of the attack. “Speaking to a lecture hall of diplomats, Vladimir Yermakov, deputy head of the ministry’s department for non-proliferation, suggested that the UK was ‘hiding facts’ about the case that may later ‘disappear’.” British diplomat Emma Nottingham noted that “Russia has offered us so far no explanation of how this agent came to be used in the United Kingdom and no explanation as to why Russia has an undeclared chemical weapons programme in contravention of international law,”.

Pandemic Preparedness
“Are we prepared for the next pandemic?” Such a question pulls at the string of a much larger web that tends to leave many feeling unsettled. The scary truth is that we’re not ready. We know there will be a pandemic – history, science, and society, all tell us this. Encroachment on nature, increasing globalization and populations, and struggles against more frequent threats like seasonal flu and even antimicrobial resistance, all reveal a severe vulnerability to infectious diseases. Lessons from HIV, Ebola, and Zika, are just the latest and on the centennial of the 1918/1919 influenza pandemic, many hope that we learned from such events and can help prevent future ones. Predictions trickle across many sectors – loss of healthcare worker lives, financial and economic struggle, etc. “Such a pandemic could cause a global stock market crash that obliterates the livelihoods and savings of millions of survivors. ‘A severe and prolonged global pandemic could … hit global GDP by as much as 5-10% in the first year,’ noted the authors of the Bank of America/Merrill Lynch 2015 Global Pandemics Primer report. Oxford Economics has suggested that the cost of a global pandemic, including spillover across industry sectors, could be as great as $3.5tn – an impact far greater than the magnitude of the great financial crisis of 2008.” With funding for the GHSA in peril, the question of preparedness becomes even more relevant…and pessimistic. The tricky thing about infectious disease threats is that we’re not sure where the next one will come from. We have hints and sometimes we’ll get a whiff of which way the wind is blowing before the storm hits, but ultimately, there is so much we can’t predict. Given these challenges, prevention efforts, like those of the GHSA, should be seen as even more critical. Infectious disease prevention strategies are always a good return on an investment. It’s also the unexpected that impacts disease control and surveillance efforts. Local news is one that doesn’t often come to mind when considering epidemiology and infectious disease forecasting. “Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories. ‘We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,’ said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.”

GMU Biodefense MS Open House & PhD Information Session
Looking to earn a Masters or PhD in a field that’s at the nexus of foreign policy and public health? GMU Biodefense is just the place for that. We’re hosting two information sessions for our biodefense graduate degrees – the MS Open House is next Wednesday at 6:30pm (Arlington Campus) and the next PhD Information Session is on Wednesday, April 18th at 7pm, in Arlington, VA. These are great opportunities to hear from faculty and students in each biodefense program about not only the application process, but also the classes and what it’s like to study what you love!

CDC Selects New Director
Dr. Robert R. Redfield was just announced as the new director for the CDC. Redfield will take over for interim director Dr. Ann Schuchat, who many were hoping would take post. The new director has a background in HIV and is said to be a dedicated researcher and physician. Unfortunately, Redfield also comes with a rather novel history for CDC directors – he has never worked for a public health department. “Critics also point to a resume marred with controversy. In the 1990s, Redfield was accused of falsifying data about an experimental HIV vaccine he worked on. He was eventually cleared of those charges, but the data had to be corrected.” On Tuesday, Sen. Patty Murray (Wash.) raised concerns regarding his appointment, noting that, “This pattern of ethically and morally questionable behavior leads me to seriously question whether Dr. Redfield is qualified to be the federal government’s chief advocate and spokesman for public health.”

Brazil Calls for Country-Wide Yellow Fever Vaccination
Brazil has been battling a yellow fever outbreak since 2017 and vaccine shortages have only fueled the challenges of outbreak response. “Brazil announced yesterday that all citizens should be vaccinated against yellow fever. The country is currently experiencing a spike in cases in what has shaped up to become the largest yellow fever outbreak to hit the country since the 1940s.The Associated Press (AP) reported that Ricardo Barros, Brazil’s health minister, said all 27 of Brazil’s states will be targeted in a vaccination campaign that will aim to reach 78 million people by 2019. Before the announcement, the vaccine was recommended in all but four Brazilian states.”

Importance of GHSA
GMU Biodefense PhD student Saskia Popescu wants clinicians to understand the importance of the GHSA and why US investment is critical. “Like many components of public health and infectious disease, the importance of prevention is often forgotten until an outbreak occurs. Hospital preparedness and infection prevention were not necessarily ‘big ticket’ items in the United States until we had Ebola in Dallas, Texas, but it only takes 1 laboratory incident to remind us of the importance of biosecurity and biosafety.”

Food Defense Conference
The Food Protection and Defense Institute will be hosting this conference on May 22 & 24th in Minneapolis, MN. “As the food system is becoming ever more global, companies need to be prepared to protect not only their products but also their reputation. The Food Protection and Defense Institute will be hosting a 2-day Food Defense Certification Training Course on May 21 & 22, 2018 that will teach food industry professionals how to navigate basic food defense principles, recognize vulnerabilities, and create a tailored food defense plans.”

Stories You May Have Missed:

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

Pandora Report 2.9.2018

Happy Friday fellow biodefense enthusiasts! The Winter Olympics are already starting off with a bang as Korean health officials have confirmed 128 cases of norovirus among security personnel, police officers, and Olympic workers.

WHO Releases List of Blueprint Priority Diseases
The WHO has just released their annual review of the Blueprint list of priority diseases, which includes a special tool for “determining which diseases and pathogens to prioritize for research and development in public health emergency contexts”. While the list includes diseases like Ebola, MERS and SARS, Nipah, and Zika, it is the inclusion of Disease X that highlights the unknowns of infectious diseases in the future.  “Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown ‘Disease X’ as far as possible.”

BioWatch Documents Left Behind on Flight
Biowatch officials are doing a bit of a damage control at the moment as multiple copies of an official DHS document regarding performances during a bioterrorism simulation were left behind on an airplane prior to the Super Bowl. The errant document offered a critique of how officials performed during a simulated release of the infectious disease anthrax in Minneapolis on the day of the Super Bowl. Other sensitive material was also found, CNN said, without further description.” Ironically, it was a CNN employee who discovered the forgotten papers in the seat-back pocket of a commercial plane. “The reports were accompanied by the travel itinerary and boarding pass of the government scientist in charge of BioWatch, the DHS program that conducted the anthrax drills in preparation for Super Bowl LII in Minneapolis. The reports were based on exercises designed to evaluate the ability of public health, law enforcement and emergency management officials to engage in a coordinated response were a biological attack to be carried out in Minneapolis on Super Bowl Sunday.” CNN waited to publish the incident until after Sunday’s game, but the papers revealed significant areas for response improvement during a bioterrorism incident. While not surprising, the identification of such gaps is critical for improvement however, it is the concerning nature of which they were left behind. Vulnerabilities are always present, but that doesn’t mean we want them being aired in the open for nefarious actors to utilize.

 GMU Biodefense PhD Student Selected As ELBI Fellow 
The Biodefense Graduate Program in the Schar School of Policy and Government at George Mason University is proud to announce that PhD student Yong-Bee Lim has been selected for the prestigious Emerging Leaders in Biosecurity Fellowship (ELBI) program within the Johns Hopkins Center for Health Security. Selected from a group of over 120 international applicants, the 2018 ELBI class includes professionals and scholars with a passion for health security and biosecurity. This year-long fellowship will deepen the biosecurity expertise and broaden the network of those passionate about furthering the field. Yong-Bee was also the recipient of an internship with the Center for Global Security Research at Lawrence Livermore National Laboratory and the SB7.0 Fellowship, which supported his attendance of an international synthetic biology conference in Singapore. His selection also marks the third consecutive year that the Schar School’s Biodefense program has had graduate students named ELBI fellows. Congrats Yong-Bee!

Smallpox Signalling
It’s been a couple of weeks since PLOS One published the horsepox synthesis paper and the truth is that many are still in awe that not only such work was done, but that it was published. Where were broader discussions regarding the merits of this research? Conversations about need to publish it? Moreover, what about the importance of oversight in the private biotech arena and not just those with federal funding? One thing is for certain though, this is a critical moment for life sciences and DURC oversight. “A vaccine against smallpox already exists. The research was carried out unilaterally, without a broader discussion of the merits beforehand. There are apparently few oversight mechanisms when experiments are done with private funding. The restrictions that now cover dual-use research funded by U.S. government — which include an independent review process, and a weighing of the risks and benefits, as well as the ethics — should be expanded to private-sector research.”

Topics of Interest at the DHS Meeting on Sequences of Interest
Synthetic biology has led to the creation of new products, markets, companies, and industries. At the same time, this technology poses potential risks to biosafety and biosecurity, as recently demonstrated by the synthesis of horsepox virus, a cousin of variola, the virus that causes smallpox.  On January 29-30, 2018, the Department of Homeland Security (DHS) Science and Technology Directorate sponsored a workshop to discuss the evolving role of databases that contain genetic sequences of pathogens and toxins that pose safety or security concerns, termed “sequences of interest.” The workshop brought together stakeholders from government, industry, and academia to discuss the need for such databases, review current databases and those under development, explore potential applications and users of these types of databases, and consider the potential risks that they pose due to malicious or inadvertent misuse. The workshop provided a valuable opportunity to explore the scientific and technical aspects of constructing such databases, maintenance and sustainability challenges, and the trade-offs involving functionality, accessibility, affordability, confidentiality, and security. While the workshop did not produce a consensus on the best path forward, it played an important role in educating the participants on the most critical issues and facilitating a dialogue among a diverse range of stakeholders on this important topic.  The workshop also came at a propitious time as stakeholders grapple with the changing landscape of the biotech industry and advances in DNA synthesis technology.  For instance, the International Gene Synthesis Consortium, a group of the leading DNA synthesis companies that have adopted customer and sequence screening protocols to prevent the misuse of their products, has expanded in size and geographic scope and recently updated its biosecurity protocols. The U.S. government is also reviewing the customer and sequence screening guidance it issued in 2010 and is considering whether, and how, to update it.  Should a decision be made to proceed, stakeholder engagement would be a significant part of the review, just as it was a significant part of the guidance’s original development.

The US Can’t Afford to Reduce Public Health Funding
GMU biodefense PhD alum Daniel M. Gerstein is evaluating the decision to reduce funding for global epidemic prevention activities and just how dangerous that would be for the United States. “Recent reporting suggests that the Trump administration is preparing to downsize the Centers for Disease Control’s (CDC) global epidemic prevention activities in 39 of 49 countries starting in 2019 when funding first authorized by Congress in 2014 expires. Such a move is potentially dangerous and could place the U.S. at significant risk.” Gerstein points to the notion of shared responsibility in global health security and how important efforts like the GHSA are for global public health. He also notes that the last decade alone has revealed just how undeniable public health is as a national security issue. “Without renewed funding, the long-term outlook could include weakened global disease surveillance and response systems, less capable partner nations and an increased likelihood of global disease outbreaks that would undoubtedly threaten the U.S.” Wanting more information regarding the implications of CDC cutting back on their global health security funding? Check out this article regarding the funding cliff the CDC is about to fall off.

Biosecurity in Putin’s Russia
The latest book from Raymond A. Zilinskas and Philippe Mauger delves into the biodefense world of Putin’s Russia. “In March 2012, at a meeting convened by the recently reelected Russian president Vladimir Putin, Minister of Defense Serdyukov informed Mr. Putin that a plan was being prepared for ‘the development of weapons based on new physical principles: radiation, geophysical wave, genetic, psychophysical, etc.’ Subsequently, in response to concerns expressed both in Russia and abroad, the Russian government deleted the statement from the public transcript of the meeting. But the question remains: Is Russia developing an offensive biological warfare program?”

Global Monitoring of Disease Outbreak Preparedness
The Harvard Global Health Institute has released their new report that is “a step towards developing a shared framework and monitoring mechanism” for outbreak response and preparedness. “This report is primarily intended for the community of policymakers and researchers concerned about the rising risks of domestic, regional, and global infectious disease epidemics, and the collective failure to take the coordinated actions required to reduce such risks. These risks include the expected health, economic, and societal costs that are borne by countries, regions, and even all nations in the case of pandemics (which are worldwide epidemics). These risks also include the consequences of increasing antimicrobial resistance (AMR) and its spread within regions and globally.” The report focuses on strengthening public health capacity as a foundation, improving S&T, reinforcing risk analysis and incentives for action, strengthening global mechanisms, and revised shared monitoring framework and next steps.

 The Fearsome Future of Flu
This year has been rough for seasonal flu and while it has been a cold dose of reality in terms of hospital response, are we really learning our lesson or just running from fire to fire? 2018 marks the centennial of the 1918/1919 influenza pandemic and with a larger, more connected population, have we made ourselves safer? The next flu virus with pandemic potential will either enhance our response capabilities or exploit our most damning weaknesses. “And influenza viruses excel at the element of surprise. Few would have guessed Mexico as the origin of that 2009 H1N1 pandemic, for example, notes Fukuda. That outbreak was recognized in San Diego—never considered a hotspot—when a little girl happened to seek treatment at a clinic participating in a study focused on diagnosis, Adalja explains. That’s why he believes it is important to build up the diagnostic capacity for frontline clinicians, and not be satisfied with non-specific diagnoses—failing to pin down the specific microbial cause.” Unfortunately, we are still practicing the methods of frenzied response, delayed information sharing, and dangerous hysteria that can spread even faster through social media. These concerns highlight yet another reason why we need a universal flu vaccine.

Johns Hopkins Center for Health Security Event: Healthcare Disaster Resilience
Don’t miss this event at the National Press Club Holeman Lounge on Thursday, February 22nd from 8:30-10am EST. The Johns Hopkins Center for Health Security will release new policy recommendations for building a more effective disaster health system in the United States. Speakers include Dr. Luciana Borio from the White House National Security Council staff, Sally Phillips of HHS, Linda Langston from the National Association of Counties, as well as Drs.Tom Inglesby, Eric Toner, Monica Schoch-Spana from the Center for Health Security.

 Genetic Sequencing and the Dangers of DIY Genome Editing
Nebula Genomics will sequence your genome for just under $1,000 and you can even share it using a blockchain.  “Nebula is the brainchild of geneticist George Church, PhD student Dennis Grishin, and graduate Kamal Obbad, all from Harvard. Mirza Cifric, CEO of Veritas Genetics, which offers a genome-sequencing service for $999, is a founding advisor. When you pay to take a DNA test—through 23andMe, Helix, or Ancestry.com, for example—the company that does the testing owns your genetic data. Nebula wants to sequence people’s entire genomes and let them own it, allowing them to earn digital money by sharing it.” While professionals may be providing your genomic data through these companies, many are looking to actually learn to experiment with genes themselves. DIY gene therapy is becoming increasingly accessible, which has many worried and the FDA issuing a warning to the public. The FDA, on “November 21 cautioned against do-it-yourself (DIY) gene therapies. But even as the agency’s statement also warned that selling gene editing kits aimed at homemade therapeutics is illegal, CRISPR–Cas9 kits are available to buy online, and the number of providers is growing, raising concerns that DIY gene therapy enthusiasts could be putting themselves and others at risk.”

Biodefense Policy Landscape Analysis Tool
B-PLAT is a new tool from Pacific Northwest National Laboratory scientists Rachel Bartholomew and Kristin Omberg that aims to help coordinate national biodefense preparedness. It “captures and presents a slew of information about U.S. efforts to protect its citizens and others around the world from threats as diverse as the flu, diseases like Ebola, threats from terrorists, potential risks to water and food supplies, and myriad other concerns. The tool is freely available. In 2017, PNNL chartered an internally funded working group, the Policy Wranglers, to capture relevant biodefense policy directives, public laws, and corresponding sections of the U.S. Code, in a format conducive to visualization. The resulting tool can be utilized to better understand the current state of the U.S. biodefense enterprise.” A presentation on B-LAT will also be made at ASM’s Biothreats next week as part of a town hall on Tuesday.

Stories You May Have Missed:

  • US Battles IV Bag Shortage During Record-Setting Severe Flu Season – GMU biodefense PhD student Saskia Popescu is looking at the impacts of this IV bag shortage during the severe flu season. “Even prior to Hurricane Maria, the United States was already battling challenges with meeting the demand for IV fluids; however, the storm crippled Puerto Rico-based manufacturing sites for materials. In a news release on January 16, the FDA reported that they were taking additional steps to combat the shortages, such as ‘asking companies to submit data to extend expiration dates for these products.’ They noted that, ‘if expiration dates can be safety extended [for these products], it would allow some near-expiry product that remains at the hospital level to be used’.”
  • DARPA Program to Track Genetic Markers for Past WMD Material Exposure – “The program is being called Epigenetic Characterization and Observation (ECHO), and its endgame is the creation of a field-deployable system that could analyze someone’s epigenome and identify markers of whether or not–in that person’s entire lifetime–been exposed to WMD-associated materials. DARPA officials are billing it as worlds quicker than sending to a lab to test for biological or chemical agents in clothing or hair.”

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