This week’s Pandora Report covers the recently updated priority pathogens list from the World Health Organization (WHO) and insights from the process of its development, the WHO’s plan to distribute polio vaccines in Gaza, recent research that suggests H5N1 is more widespread than previously thought, and more.
WHO Updates List of Most Dangerous Viruses and Bacteria
The WHO recently published a report outlining the findings of its global pathogen prioritization process that involved more than 200 scientists who evaluated evidence related to 28 viral families and one core group of bacteria, covering 1,652 pathogens. This updated priority pathogens list has grown to more than 30 pathogens, now including influenza A virus, monkeypox virus, and dengue virus. The pathogens were selected due to their potential to cause a global public health emergency in humans. According to the WHO report, the process emphasized “the imperative nature of collaborative efforts to attain global resilience against epidemics and pandemics.”
Furthermore, “…the approach used advocates for a scientific framework to enhance preparedness for forthcoming outbreaks, Public Health Emergencies of International Concern (PHEICs), and pandemics by focusing on research of Viral and Bacterial Families, rather than isolated pathogens deemed to present global risks.”
Previous efforts by WHO in 2017 and 2018 identified about a dozen priority pathogens, but it is important to frequently revisit and revise these lists to account for “major global changes in climate change, deforestation, urbanization, international travel, and more,” Neelika Malavige, an immunologist at the University of Sri Jayewardenepura in Colombo, Sri Lanka told Nature.
Furthermore, as Smriti Mallapaty explains in the same Nature news article, the researchers involved with this process also created a list of “prototype pathogens,” “which could act as model species for basic-science studies and the development of therapies and vaccines.” The goal of these is to help encourage more research into under- and less-studied pathogens. Mallapaty writes, “For example, before the COVID-19 pandemic, there were no available human vaccines for any of the coronaviruses, says Malik Peiris, a virologist at the University of Hong Kong, who was part of the Coronaviridae research group. Developing vaccines for one member of the family will bring confidence to the scientific community that it is better placed to address a major public-health emergency for those viruses, he says. This applies to treatments, too, he says, because “many antivirals work across a whole group of viruses”.’
WHO Plans to Send 1.2 Million Polio Vaccines to Gaza
The WHO recently announced it plans to send more than one million polio vaccines to Gaza following the detection of poliovirus in wastewater samples. WHO Director-General Tedros Adhanom Ghebreyesus explained the situation and his agency’s plan in a piece published by The Guardian, writing in part “Across Gaza, more than 39 000 people have been killed, 89 000 wounded, and more than 10 000 are estimated to be missing. Most hospitals are no longer able to function. Already, diarrhoeal diseases, respiratory infections and hepatitis A, among others, are raging through Gaza. Nearly everyone in Gaza is facing acute food insecurity and catastrophic hunger. Thousands of children are malnourished, making them even more susceptible to disease.”
“About 2.3 million people live in the 365 sq km (141 sq mile) Gaza Strip, which has become even more concentrated amid limited access to clean and safe water, and deteriorating sanitary conditions.”
He continued later, writing “While no cases of polio have been recorded yet, without immediate action, it is just a matter of time before it reaches the thousands of children who have been left unprotected. Children under five years are at risk, and especially infants under two because many have not been vaccinated over the nine months of conflict.”
“The World Health Organization (WHO) is sending more than 1m polio vaccines to Gaza, which will be administered in the coming weeks to prevent children being struck down by the disease. However, without an immediate ceasefire and a vast acceleration of humanitarian aid, including a targeted vaccination campaign focused on young children, people will continue to die from preventable diseases and injuries that are treatable.”
The Director-General later discussed other recent examples of polio thriving in places ravaged by conflict and instability: “In 2017, in wartorn Syria, an outbreak of variant poliovirus – a mutated form of the wild virus that can spread in under-immunised populations – left 74 children paralysed. In Somalia today, a decade-long civil war has resulted in the longest unbroken chain of variant poliovirus transmission globally, circulating since 2017. In Afghanistan and Pakistan, the last two countries where children are paralysed by wild polio, humanitarian crises and insecurity have prevented the world from stomping out the virus for good.”
Notably, an outbreak of polio in Ukraine that was detected in October 2021 was declared over in September 2023, again highlighting both the dangerous relationship between conflict and infectious disease as well as the global threat diseases like polio continue to pose.
New Study Suggests H5N1 Cases Are Going Undetected in Humans
A team at the University of Texas Medical Branch (UTMB) recently published research that “…revealed evidence of highly pathogenic H5N1 avian flu infections in two Texas farmworkers not previously confirmed to have the disease, and the investigators also cultured infectious H5N1 virus from milk and cattle samples taken from two Texas dairy farms that previously had H5N1 outbreaks.” Their article-“A One Health Investigation into H5N1 Avian Influenza Virus Epizootics on Two Dairy Farms”-is currently available as a preprint.
The team “detected signs of prior bird flu infections in workers from two dairy farms that had outbreaks in Texas earlier this year. They analyzed blood samples from 14 farmworkers who had not been tested for the virus and found antibodies against it in two. This is a nearly 15% hit rate from only two dairy farms out of more than 170 with bird flu outbreaks in 13 states this year,” explains KFF Health News’ Amy Maxmen.
Maxmen further explains, “As bird flu cases go underreported, health officials risk being slow to notice if the virus were to become more contagious. A large surge of infections outside of farmworker communities would trigger the government’s flu surveillance system, but by then it might be too late to contain.”
In a statement to NPR, Gregory Gray (senior author on the paper) said “I am very confident there are more people being infected than we know about…Largely, that’s because our surveillance has been so poor.”
“COVID-19: Lessons Can Help Agencies Better Prepare for Future Emergencies”
This recent report from the Government Accountability Office draws several important lessons learned from the US government’s response to the COVID-19 pandemic: “The nation continues to recover from the public health and economic effects of the COVID-19 pandemic. For example, COVID-19 was the tenth leading cause of death in 2023, as compared to being the third leading cause of death in 2020 and 2021. Available data also show that inflation declined between March 2023 and March 2024, but remained higher than pre-pandemic levels.”
“GAO identified lessons from the COVID-19 pandemic that could help federal agencies better prepare for, respond to, and recover from future emergencies. These lessons draw on GAO’s COVID-19 oversight work, which includes 428 recommendations to federal agencies and 24 matters for congressional consideration as of April 2024. Of these recommendations, 220 remain open. Moreover, these recommendations include those related to the three areas GAO added to its High Risk List during the COVID-19 public health emergency:
- the Department of Health and Human Services’ leadership and coordination of public health emergencies,
- the Department of Labor’s Unemployment Insurance system, and
- the Small Business Administration’s emergency loans to small businesses.”
“Agencies across the government could improve their preparedness for future emergencies by fully implementing GAO’s recommendations.”
“Lessons that could help federal agencies better prepare for future emergencies fall into seven topic areas. These lessons highlight instances where government agencies did well in responding to the pandemic, as well as instances where the government response could have been much better.”
“Yemen: Houthis Obstructing Aid, Exacerbating Cholera”
This piece from Human Rights Watch reports on Houthi obstruction of aid work and information access in Yemen amid a widespread cholera outbreak in the country. It explains that “Yemen’s authorities are obstructing aid work and exacerbating a deadly cholera outbreak that is spreading across the country, Human Rights Watch said today. Parties to the conflict, including the Houthis, the Yemeni government, and the Southern Transitional Council (STC), have obstructed aid and access to information and have failed to take adequate preventative measures to mitigate the spread of cholera. Houthi security forces also have detained and threatened civil society staff, including humanitarian aid workers, in their recent arrest campaign.”
“Data collected by aid agencies indicate that between January 1 and July 19 there have been about 95,000 suspected cholera cases, resulting in at least 258 deaths, according to an individual working with the Yemen Health Cluster, a group of aid organizations, authorities, and donors led by the World Health Organization (WHO). All parties to the conflict should end their violations and abuses of Yemenis’ right to health, and the Houthis should end their arbitrary detentions of civil society and humanitarian aid workers.”
“The Influence of Synthetic Biology on National Bioeconomy Strategies”
Konstantinos Vavitsas discusses policymakers’ perceptions of synthetic biology and the intersection of this with national bioeconomy strategies, writing in part “Perhaps the most highlighted policy actions around synthetic biology revolve around biosecurity. The US Congress appointed the National Security Commission on Emerging Biotechnology (NSCEB), chaired by Ginkgo’s CEO Jason Kelly, with the mission to examine the national security implications of emerging biotechnology. “When people think “biotech” plus “national security,” they usually think “biosecurity.” That’s a deeply important topic, but it’s not the core of our mission,” Caitlin Frazer, Executive Director of NSCEB, told me. “We’re looking at issues like how the military could use emerging biotechnology to fuel, feed, and heal our servicemembers, how we can use biotech to shore up vulnerable supply chains. How can we create economic opportunity in the U.S. through biomanufacturing? And, of course, how we protect against misuse of these powerful technologies by countries that don’t share our values.”’
“Software Tools for Strategic Chemical Trade Control Enforcement: Workshops Spotlight Challenges and Tools”
Christina McAllister and Braden Holt discuss a series of workshops hosted by the Stimson Center’s Partnerships in Proliferation Prevention Program in this piece, explaining in part “Several themes emerged across discussions in both workshops that provided important feedback for the development of tools to support strategic trade controls for chemical weapons nonproliferation. Cost was one – many agreed that national customs offices would benefit from tools, but said they needed to be affordable and accessible. Short timelines available to border and customs officials when performing checks on chemical imports and exports also reinforced the need to utilize systems when shippers submit documents, allowing for early detection of controlled chemicals. Emphasis was also placed on the need for tools to work in a variety of environments, including instances where internet or Wi-Fi is unavailable. There was broad agreement that, taking these concerns under consideration, better access to these tools would strengthen strategic chemical trade control enforcement.”
ICYMI: The Global Pandemic Preparedness Summit 2024
The 2024 Global Pandemic Preparedness Summit was held July 29-30 in Rio de Janeiro. Watch recordings of the proceedings (available in both English and Portuguese) here.
Assessing and Navigating Biosecurity Concerns and Benefits of Artificial Intelligence Use in the Life Sciences – August Information Gathering Meeting
From the National Academies: “This is the first in-person meeting of the consensus study, Assessing and Navigating Biosecurity Concerns and Benefits of Artificial Intelligence Use in the Life Sciences. The open session of this information gathering meeting will include initial briefings containing information relevant to study issues. The committee will also meet in closed session for project planning and review of topics and speakers for remaining meetings.”
This event will take place on August 13 and 14. Learn more and register here.
H5N1: Protecting High Risk Communities
From the Pandemic Center at Brown: “On August 16th at 12:00PM ET the Pandemic Center will host a webinar titled H5N1: Protecting High Risk Communities.”
“As H5N1 has spread among livestock, farm workers have been at increased risk of infection. Though H5N1 cases in the US have so far largely been mild, severe illness is still a possibility. There is an urgent need to protect farm workers from the worst this virus has to offer, but there has been little discussion about how to increase farm workers’ access to lifesaving tools, such as vaccines, tests and treatments. This webinar will discuss H5N1 severity and what strategies we should be using to protect the health and safety of high-risk groups.”
“This event will convene a panel of experts to discuss the current H5N1 vaccine landscape. It will be hosted by Jennifer Nuzzo, Director of the Pandemic Center and Professor of Epidemiology at the Brown University School of Public Health. The panel will include:
Nahid Bhadelia, Founding Director, Boston University Center on Emerging Infectious Diseases (CEID)
Rick Bright, CEO & Founder of Bright Global Health and Former Director of BARDA”
“This webinar is part of the Pandemics & Society series, which focuses on current pandemic threats and response systems as well as how to build preparedness for the future.”
“Please contact pandemic_center@brown.edu with any questions.”
Register here.
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