Pandora Report 3.17.2017

Happy Friday! In honor of  John Snow‘s birthday (the father of epidemiology), our featured image is the Broad Street pump map he used to combat cholera in the 19th century. Don’t miss out on the early registration discount for our biodefense summer workshop!

NAS Calls for Increased Federal Regulatory Agency Preparation for Growing Biotechnology Products 
The National Academies of Science (NAS) recent press release is emphasizing the need for federal regulatory agencies to prepare for greater quantities and ranges of biotechnology products. As the biotech world constantly evolves, regulatory agencies have struggled to keep up and this latest report states that in the next five to ten years, the pace will outmatch the U.S. regulatory system. According to the report, biotechnology, like CRISPR, has a rapidly growing scale and scope, which already stresses existing staff, expertise, and resources available at agencies like the EPA, FDA, and USDA. “To respond to the expected increase and diversity of products, the agencies should develop risk-analysis approaches tailored to the familiarity of products and the complexity of their uses, the report says. For biotechnology products that are similar to products already in use, established risk-analysis methods can be applied or modified, and a more expedited process could be used. For products that have less-familiar characteristics or more complex risk pathways, new risk-analysis methods may need to be developed.  Regulatory agencies should build their capacity to rapidly determine the type of risk-analysis approaches most appropriate for new products entering the regulatory system.” Within the report, NAS notes that the federal government needs to develop a strategy to combat the current issues and strengthen their ability to scan for future biotechnology products to better prioritize.

GMU Schar School Master’s Open House 
Have you ever wanted to study topics like CRISPR, bioterrorism, global health security, and pathogens of biological weapons? Good news – we’ve got just the program for you! Come check out GMU’s biodefense MS program at our Open House on Wednesday, March 22nd at our Arlington Campus, Founders Hall (Room 126) at 6:30pm. You can talk to some of our biodefense faculty and learn about our program. Whether you’re looking to take classes in person or earn a degree online, the biodefense MS is the best for the intersection of science and policy.

DARPA Works Towards “Soldier Cell” To Fight Bioweapons 
A bio-control system to fight off invading pathogens? Sounds like something out of a science fiction movie! Well, researchers at Johns Hopkins University just received funding from DARPA to develop the capacity to “deploy single-cell fighters” that would target and eliminate the lethality of certain pathogens. “‘Once you set up this bio-control system inside a cell, it has to do its job autonomously, sort of like a self-driving car,’ said Pablo A. Iglesias, principal investigator on the project. Iglesias, a professor of electrical and computer engineering in the Whiting School, shifted his research focus from man-made to biological control systems about 15 years ago. ‘Think about how the cruise control in your car senses your speed and accelerates or slows down to stay at the pace you’ve requested,’ Iglesias said. ‘In a similar way, the bio-control systems we’re developing must be able to sense where the pathogens are, move their cells toward the bacterial targets, and then engulf them to prevent infections among people who might otherwise be exposed to the harmful microbes’.” This angle, which is being focused on bacteria outside of the body, is just one potential tool in the biodefense arsenal.

Yellow Fever Outbreak in Brazil 
Since December of 2016, Brazilian health officials have reported an ongoing outbreak of yellow fever. The CDC has moved the alert to a  Level 2 – Practice Enhanced Precautions. A report recently published in the New England Journal of Medicine looks at the outbreak and the potential for cases in U.S. territories. In Brazil, there were 234 cases and 80 deaths reported between December and February. “Although it is highly unlikely that we will see yellow fever outbreaks in the continental United States, where mosquito density is low and risk of exposure is limited, it is possible that travel-related cases of yellow fever could occur, with brief periods of local transmission in warmer regions such as the Gulf Coast states, where A. aegypti mosquitoes are prevalent.”

GMU Biodefense Represented At Biothreats Conference
If you missed out on our coverage of ASM’s 2017 Biothreats conference, here’s a spotlight on GMU biodefense students attending this captivating three-day event. GMU’s biodefense program sent four graduate students to experience and report on the conference, which addressed biothreat research, policy, and response. “The program was exciting, according to the George Mason students in attendance. Mercer and Goble recall that the conference engaged topics of specific interest to them, their degree, and their futures. ‘I attended a panel that was very closely related to disease forecasting, my graduate thesis topic,’ Mercer said. ‘I was able to hear some of the cutting-edge research in that field, which was really helpful’. ‘I didn’t really have a part I didn’t like,’ Goble said. ‘I enjoyed the niche topics that were presented in both panel discussions and poster  sessions, from emergency operations to the FDA. All of these specific topics were extremely interesting to hear about and to know they are being researched’.”

Just How Well Did the 2009 Pandemic Flu Vaccine Strategy Work?
Researchers from the University of Nottingham recently looked at the success of vaccines in terms of preventing pandemic flu and reducing hospitalizations. Their work looked at the 2009 WHO-declared pandemic of the novel A(H1N1) virus, which infected around 61 million people around the world. Vaccines against the virus were rolled out globally between September and December of 2009, with the majority being inactivated A(H1N1)pdm09 influenza virus. Their work involved reviewing 38 studies between June 2011 and April 2016 regarding the effectiveness of the inactivated vaccine, which covered around 7.6 million people. “We found that the vaccines produced against the swine flu pandemic in 2009 were very effective in both preventing influenza infection and reducing the chances of hospital admission due to flu. This is all very encouraging in case we encounter a future pandemic, perhaps one that is more severe,” noted Professor Van Tam said. “Of course, we recognize that it took five to six months for pandemic vaccines to be ready in large quantities; this was a separate problem. However, if we can speed up vaccine production times, we would have a very effective strategy to reduce the impact of a future flu pandemic.” The 2009 pandemic A(H1N1) vaccine was 73% effective against laboratory confirmed cases and 61% against preventing hospitalizations. Interestingly, when looking at the vaccines’ effectiveness in different age groups, “they were shown to be less effective in adults over 18 years than in children, and effectiveness was lowest in adults over 50 years of age. Adjuvanted vaccines were found to be particularly more effective in children than in adults against laboratory confirmed illness (88 per cent in children versus 40 per cent in adults) and hospitalization (86 per cent in children versus 48 per cent in adults).”

Deadly Fungal Infection Arrives in U.S. 
While many are asking if surveillance methods for tracking the deadly CRE bacteria are adequate, a new issue is emerging in U.S. hospitals. Despite WHO’s recent plea for increased R&D surrounding certain resistant pathogens, it seems that more and more organisms of concern are springing up in U.S. hospitals. Since last summer, roughly three dozen people have been diagnosed with a highly resistant Candida auris infection. The fungal infection has caused worry ever since it was identified in 2009 due to its capacity as an emerging and resistant organism. Candida yeast infections are pretty common and known to cause urinary tract infections however, this strain is especially concerning because it easily causes bloodstream infections, has a stronger capacity for transmission between people, and is much more hardy in terms of living on skin and environmental surfaces. “Of the first seven cases that were reported to the CDC last fall, four patients had bloodstream infections and died during the weeks to months after the pathogen was identified. Officials said they couldn’t be sure whether the deaths were caused by the infection because all the individuals had other serious medical conditions. Five patients had the fungus initially isolated from blood, one from urine, and one from the ear.”

CDC Director Warns Loss of DHHS Funds Could Weaken Infectious Disease Prevention
Acting CDC director, Anne Schuchat, recently testified before Congress to make the case for for increased funding for several programs (one being the DHHS’s Prevention and Public Health Fund). Among other things, the Prevention and Public Health Fund is responsible for 12% of the CDC’s budget. Dr. Schucat’s testimony emphasized the previous usage of these funds in terms of vaccine delivery, disease surveillance, monitoring of water supplies, and tracking hospital-acquired infections. The growth of antibiotic resistance made her testimony and plea to Congress that much more relevant and urgent. “The CDC and other government agencies have in recent years cited the numerous public health threats posed by infectious diseases in general, and have lobbied officials for increased funding for research and development of novel vaccines and treatments as well as programs to effectively distribute interventions as needed. In 2016, for example, the CDC, DHHS, and National Institutes of Health requested federal funding to combat Zika, a request that was not approved until late in the year.”

Stories You May Have Missed:

  • Science on Screen – Don’t miss this great event hosted by Lawrence Livermore National Laboratory! On March 18th, you can watch the second installment of the Science on Screen series, featuring “Lawrence Livermore scientists Monica Borucki and Jonathan Allen, who will present ‘Reconstructing a Rabies Epidemic: Byte by Byte.’ This informative and entertaining lecture will explain how biologists and computer scientists used cutting-edge, ultra-deep sequencing technology to study the dynamics of a 2009 rabies outbreak. This case study, based on a dramatic increase (more than 350 percent) in the gray fox population infected with a rabies variant for which striped skunks serve as the reservoir hosts, will be used to help illustrate the changes in the viral genome during cross-species viral transmission. This lecture is appropriately paired with the feature-length film, “Contagion” (PG-13).”
  • Clorox Gets Spot on EPA A-Team – Clorox just earned its varsity spot on the team against hospitality-acquired infections. The EPA approved two of the company’s products in killing clostridium difficile spores. C-diff is a constant battle in healthcare facilities, so having the new tool in the infection prevention and environmental disinfection toolkit, is a huge advantage for many. “In addition, the cleaners and wipes recently become EPA-registered to disinfect against other bacterial infections, such as those caused by Staphylococcus epidermidis, Candida glabrata, and Enterococcus hirae. Moreover, the products are also effective against several viral pathogens, such as Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS), measles, and Influenza A and B, among others.”

 

Pandora Report 3.3.2017

Welcome to March! On Tuesday, Russia cast its seventh veto and China cast its sixth veto to aid in protecting the Syrian government from UNSC actions and sanctions regarding chemical weapons attacks.

DIY Gene Editing Gets Faster, Cheaper, and More Worrisome
CRISPR/Cas-9 lab projects may not have been a possibility when I was in high school, but today’s students are getting a taste for genome editing. The technology has allowed relative amateurs to easily and cheaply learn gene editing tactics. “The question is, can we rely on individuals to conduct their experiments in an ethical and appropriately safe way?” says Maxwell Mehlman, a professor of law and bioethics at Case Western Reserve University, who is working with do-it-yourself scientists to develop DIY Crispr ethical guidelines. “The jury is out,” he says. “Crispr is too new. We have to wait and see.” GMU’s Dr. Koblentz has noted dual-use research is a wicked problem, and it seems that CRISPR/Cas-9 is one as well. Do-it-yourself (DIY) CRISPR kits can be purchased online for $150 and you can even get a handful of tutoring sessions for $400. While these products and experiments utilize harmless organisms, it’s not hard to see why so many are worried about the potential for misuse. Harvard University’s Dana Bateman visits high school classrooms for a lesson on CRISPR and during her time, she poses several ethical questions to the students. Dr. Bateman “asked a group of seventh-grade students whether Crispr should be deployed to bring extinct animals back to life. After a spirited discussion, one student asked, ‘How can we decide if we aren’t sure what will happen?’ Ms. Bateman replied that such questions will increasingly be part of public debate, and that everyone, including 12-year-olds, can benefit from learning about Crispr.” Learning the ins and outs of CRISPR isn’t so easy that it’s comparable to switching batteries in a remote, but probably closer to a complex set of IKEA instructions (ok, that’s a bit of an over simplification, but you catch my drift). Simply put, CRISPR does make DIY gene editing easier and cheaper, but foundational knowledge or instruction is still necessary. In this moment, we’re racing to catch up with the pace of innovation and understanding the risks versus rewards is proving more difficult. What are your thoughts on this hot topic?

China’s New BSL-4 Lab Plans 10729_lores
The Chinese mainland is hoping to see the construction of at least five BSL-4 labs by 2025. A laboratory in Wuhan is currently in the accreditation and clearance phase to work with the most deadly pathogens we face. While many celebrate the building  of this new lab, others are concerned about the biosafety and biosecurity risks. The increase in biodefense labs and programs has created several trade-offs for work with such high-risk pathogens.  Each new lab presents a new risk – for both biosafety failures and biosecurity failures. Biosafety failures are already plaguing U.S. labs – will this be the case with China’s labs? “The Wuhan lab cost 300 million yuan (US$44 million), and to allay safety concerns it was built far above the flood plain and with the capacity to withstand a magnitude-7 earthquake, although the area has no history of strong earthquakes. It will focus on the control of emerging diseases, store purified viruses and act as a World Health Organization ‘reference laboratory’ linked to similar labs around the world.” Skeptics have pointed to several escapes of SARS from a high-level containment facility in Beijing. Several biosafety and biosecurity experts are highlighting the need for transparency and an open and responsible culture. Addressing issues with staff at all levels and opening the floor for an honest and frank discussion regarding concerns from those working in the environment is vital to addressing the issues that may not be seen at a higher level.

WHO’s List of Superbug Super Offenders  screen-shot-2017-02-28-at-10-19-28-am
If there was an A-list for multi-drug resistant organisms, this would be it. This first-of-its-kind list, highlights the “priority pathogens” that comprise of twelve families of bacteria “that pose the greatest threat to human health”. “The list was developed in collaboration with the Division of Infectious Diseases at the University of Tübingen, Germany, using a multi-criteria decision analysis technique vetted by a group of international experts. The criteria for selecting pathogens on the list were: how deadly the infections they cause are; whether their treatment requires long hospital stays; how frequently they are resistant to existing antibiotics when people in communities catch them; how easily they spread between animals, from animals to humans, and from person to person; whether they can be prevented (e.g. through good hygiene and vaccination); how many treatment options remain; and whether new antibiotics to treat them are already in the R&D pipeline.” Not only is the publishing of this list an indicator as to the seriousness of the issue, but it signals a desperate plea for the pharmaceutical industry to develop new antibiotics. The three most critical bacteria on the list are carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, and Enterobacteriaceae that are both carbapenem-resistant and ESBL-producing.

Kim Jong Un and the Case of the of VX Nerve Agent 
Last week saw the shocking revelation by Malaysian police that Kim Jon-nam, half-brother to North Korea’s Kim Jong-un, had been assassinated with the nerve agent, VX. The use of VX has left many wondering gif Kim Jong-un decided to use this overt form of assignation to signal his possession and willingness to use it or was this a botched assassination that was supposed to look like a natural death? Since this event has taken us into uncharted territory, many chemical and biological weapons experts are weighing in on what this means. GMU biodefense professor and graduate program director, Gregory Koblentz, pointed out that “it’s very hard to make an accurate intelligence assessment”. The dual-use nature of bio-chem weapon production facilities and materials makes intelligence gathering that much more difficult. “While Kim Jong-un is unpredictable, seasoned Korea watchers see method in what may sometimes seem like madness. And that leads them to doubt that he actually intends to use nuclear weapons — which make more sense as a bargaining chip in dealing with the US and other powers. Pyongyang’s chemical arsenal is a different prospect, however. ‘If there’s a conflict on the Korean peninsula, North Korea would probably use chemical weapons early on,’ Koblentz said.”

PHEMCE Review: Accomplishments and Future Areas of Opportunity 
GMU Biodefense PhD student and VP of Marketing at Emergent BioSolutions, Rebecca Fish, is looking at the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) and their recent strategic implementation plan. Highlighting their four goals and sample accomplishments, Rebecca looks at their work on emerging infectious diseases (EIDs) like Ebola response and Zika. While PHEMCE has made great progress, there is still room for engagement and opportunity. Rebecca points to their plans to incentivize innovation, “while biotechnology is increasing at an exponential rate, and the opportunity for misuse (bioterrorism) is increasing, the number of companies interested in making significant investment in medical countermeasures development is decreasing. There are important MCM innovation gaps that need to be addressed.” She notes that PHEMCE activity encompasses a great deal of federal agencies, which can make work that much more challenging. “However, the PHEMCE effort still requires strong, centralized leadership and a comprehensive strategic plan with measurable outcomes against which progress can be reported. It’s impressive that so many groups are working on these challenges, but who is determining the overall strategic plan? How does it come together? Which single individual has responsibility for the entire biodefense strategic effort? Who is managing the enterprise U.S. biodefense budget? No one. No one has clear accountability for the U.S. biodefense strategy, and this puts our country at risk.”

Johns Hopkins Center for Health Security Announces 2017 Emerging Leaders in Biosecurity
The Center for Health Security at Johns Hopkins University has announced the new class of emerging leaders in biosecurity. GMU is happy to announced that one of our Biodefense PhD students, Saskia Popescu, was named among the 2017 emerging leaders. “The program’s goal is to build a multidisciplinary network of biosecurity practitioners and scholars. ELBI is supported by a grant from the Open Philanthropy Project. As part of its commitment to grow and support the field of biosecurity, the Center has selected 28 Fellows from the US, the UK, and Canada. As in previous years, this year’s Fellows have backgrounds in government, the biological sciences, medicine, national security, law enforcement, public health preparedness, and the private sector.” Congrats to the new class of emerging leaders!

Multivariate Analysis of Radiation Responsive Proteins to Predict Radiation Exposure in Total-Body Irradiation and Partial-Body Irradiation Models
GMU Biodefense PhD student, Mary Sproull, is working to strengthen medical countermeasures in the event of a radiological or nuclear attack. Advanced screening and medical management of those exposed are vital during such an event. “In such a scenario, minimally invasive biomarkers that can accurately quantify radiation exposure would be useful for triage management by first responders. In this murine study, we evaluated the efficacy of a novel combination of radiation responsive proteins, Flt3 ligand (FL), serum amyloid A (SAA), matrix metalloproteinase 9 (MMP9), fibrinogen beta (FGB) and pentraxin 3 (PTX3) to predict the received dose after whole- or partial-body irradiation.” Researchers found that the novel combination of radiation responsive biomarker proteins are an efficient and accurate tactic for predicting radiation exposure. You can read the paper here.

Stories You May Have Missed:

  • OPCW Call for Nominations For A Workshop on Policy & Diplomacy for Scientists – The OPCW Technical Secretariat is organizing a workshop, “Introduction to Responsible Research Practices in Chemical and Biochemical Sciences”, from September 12-15, 2017. “The objective of the workshop is to raise awareness among young scientists on the policy and diplomacy aspects that are related to the use of chemicals in various scientific disciplines, including chemistry, biochemistry, biotechnology, and other related fields.” Check out their link for more info on applying for admission and/or a scholarship.
  • Epidemic Tracking Tool Wins Open Science Grand Prize – A new prototype, Nextstrain, has won the new Open Science Prize. This tool analyzes and tracks genetic mutations during the Ebola and Zika outbreaks and they’re hoping to use it for other viruses. “Everyone is doing sequencing, but most people aren’t able to analyze their sequences as well or as quickly as they might want to,” Bedford said. “We’re trying to fill in this gap so that the World Health Organization or the U.S. Centers for Disease Control and Prevention — or whoever — can have better analysis tools to do what they do. We’re hoping that will get our software in the hands of a lot of people.”

Pandora Report 9.23.2016

Welcome to the first few days of Fall 2016! We need to really ramp up our investment in vaccines – an ounce of prevention is worth a pound of cure. Doctors in Saskatchewan are imploring the province to declare a medical state of emergency over a surge of HIV/AIDS cases. Johns Hopkins University is currently working on a study to assess why healthcare workers catch the flu – what’re your thoughts? Poor PPE use, isolation precautions, and/or hand hygiene is my guess. New research from the World Bank shows that antibiotic resistance is likely to increase poverty and by 2050, could cause global economic damage on par with the 2008 financial crisis. The Blue Ribbon Study Panel on Biodefense has received a $1.3 million grant to continue work on assessing American biodefense systems, informing policymakers, etc. Before we start with the latest in global health security, you can now access (for free!) the Global Health Impacts of Vector-Borne Diseases workshop summary here.

The Uncertain Future of Plum Island 
Established in 1945, Plum Island Animal Disease Center (PIADC) (Orient Point, NY), “has served as the nation’s premier defense against accidental or intentional introduction of transboundary animal diseases (a.k.a. foreign animal diseases) including foot-and-mouth disease (FMD). PIADC is the only laboratory in the nation that can work on live FMD virus (FMDV). The lab and its staff of nearly 400 employees provide a host of high-impact, indispensable preparedness and response capabilities, including vaccine R&D, diagnostics, training, and bioforensics among others.” Not immune to controversy or a theme in horror movies, Plum Island is a research facility that hosts BSL-2, BSL-3 Enhanced, and Animal Biosafety Level 3 and Biosafety Level 3 Agriculture laboratories and animal research facilities that maintain highly restricted access and trained security professionals. The nostalgia of Plum Island is fast approaching as the research center is set to be closed within the next decade. The research campus will move to Kansas and the 840-acre island is up for sale. “Located 100 miles east of New York City, with sweeping water views, the island has already drawn unsurprising interest from local real estate agents and developers, including, yes, Donald J. Trump. Many people in the area, however, want the island preserved as a nature sanctuary or perhaps a park. In July, a coalition of environmental groups and activists filed a federal lawsuit to stop the sale, and there is a similar legislative push in Congress.” Since its inception and through its new ownership in 2003, (when DHS took it over) the biggest concern of Plum Island has always been containment as the infectious livestock samples and animals could introduce diseases, like food-and-mouth disease, to a susceptible population. The facility takes great care to mitigate any risk through “stringent security clearances and background checks, the boiling of all water discarded from the lab and the requirement that anyone who works within the biocontainment lab must shower twice before leaving. As for the cattle, pigs and other animals used for vaccine and other kinds of testing, they are kept in indoor, secured living quarters, said Dr. Luis L. Rodriguez, who leads research at the center’s laboratories.” In the event a deer should swim onto the island, it’s killed and immolated. Aside from the “Island of Dr. Moreau” vibe that is often felt when discussing the island, it has water views and sandy beaches that are met with a green terrain. While the future of the island is up in the air, the zoning stipulates that it must be reconstructed for similar use (i.e. research). Any takers?

Don’t Miss the Biological Threats in the 21st Century Book Launch!
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On October 14th, join us in celebrating the book launch of Biological Threats in the 21st Century! Biological Threats in the 21st Century introduces readers to the politics, people, science and historical roots of contemporary biological threats through rigorous and accessible chapters written by leading scholars and supplemented by expert point-of-view contributions and interviews. The book launch will feature a panel discussion on the threat of biological weapons and the role of scientists in bioweapons non-proliferation and disarmament. The event is free and open to the public. Lunch will be available beginning at 11:45 AM so please RSVP. Attendants will also be able to pick up the book at a 15% discount.

Screen Shot 2016-04-21 at 1.28.57 PMGMU Biodefense Graduate Program Informational Videos
Curious about a graduate degree in biodefense but unable to attend an information session? We’re happy to show off our new informational videos on both our MS and PhD biodefense programs at GMU. Check out what students are saying about our MS programs (we have both an online and an in-person tract) and our PhD program. You’ll also get to hear from biodefense guru and graduate program director, Dr. Koblentz, throughout the videos!

Bioresearch Labs and Inactivation of Dangerous Pathogens Hearing                                   

The Committee on Energy and Commerce, Subcommittee on Oversight and Investigations will be holding a hearing today at 9am regarding bioresearch labs and the inactivation of dangerous pathogens. While witnesses are by invitation only, the hearing webcast will be available here – don’t miss it! You can also read a recent GAO report on high-containment laboratories: improved oversight of dangerous pathogens needed to mitigate risk. 

The Global Implications of Antibiotic Resistance
I love a good zombie movie like the next person, but where are the horror movies about antibiotic resistance? Show me a film that depicts the global threat of losing all effective antibiotics – that is a real horror movie. The UN General Assembly held a high level meeting on Wednesday about the growing threat of antimicrobial resistance (AMR). Despite increasing surveillance and high-level attention to the rise of the resistant bugs, it will take more than the efforts of a few countries. We’ve passed the golden age of antibiotic development and the “pipeline of new antibiotics has been running dry”. Colistin-resistant bacteria continue to sporadically pop up, highlighting that once again, germs know no borders and are skilled in the art of travel. Hopefully, with the recent UN General Assembly meeting, it will send a clear message that the threat of antibiotic resistance is being taken seriously and for more world leaders to really hone in their efforts for surveillance and prevention through the GHSA. Sadly, a recent study found that antibiotic usage hasn’t changed in hospitals, despite the growing threat of AMR. Researchers looked at patient discharge records in over 300 US hospitals between 2006 and 2012 and “found that 55.1% of patients discharged received at least one antibiotic during their stay, with little change in that proportion between 2006 and 2012. The overall rate of antibiotic use for all study years was 755 days of therapy per 1,000 patient-days, a rate that also saw little change over the period of the study. But the study also showed significant increases in the use of carbapenem antibiotics, third- and fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitor combination antibiotics, tetracyclines, and vancomycin.”

Next Generation Global Health Security Network Webinar – Our Antimicrobial Anthropocene: UNiting against Pan-Epidemic AMR
As you know, a key component of responding to (and preparing for) outbreaks is the ability to treat them. But how can we make sure that the drugs we have to treat diseases will work? How can we combat the growing trend of antimicrobial resistance? In line with the recent high-level meetings by the Presidential Advisory Committee (see here) and the UN, the Next Generation Global Health Security Network is pleased to present the first of an ongoing series of webinars, this one focused on Antimicrobial Resistance (AMR). These webinars are intended to provide unique learning opportunities for global health security professionals through educational sessions about important GHS topics and situate emerging issues for a global health audience.  Please join the event on Tuesday, September 27 from 6:00-7:00pm EST as the Next Generation Global Health Security Leaders Network and CRDF Global host a webinar by Dr. Dan Lucey titled “Our Antimicrobial Anthropocene: UNiting against Pan-Epidemic AMR”.  There will also be limited in-person space for those in the DC metro area who wish to attend.  If you wish to attend in person, please RSVP by email (nextgenghsa@gmail.com)

Your Weekly Dose of Zika News
The Zika virus outbreak has pointed out several international challenges when it comes to infectious disease outbreaks – funding, vector control, long-term health effects, and international events. Sandro Galea points to the poet John Keats as a potential role model for how we should approach such events. Trained as a surgeon, Keats had a solid background in the scientific method, however the quality he “emphasized was not the scientist’s finely tuned analytic instrument, but the ability to exist comfortably amidst uncertainty and doubt.” Galea notes that the Zika outbreak is a prime example of how scientists should start thinking more like poets, living in the space of inevitable ambiguity and the new norm of the grey area. Here is the ECDC’s epidemiological update on Zika. The CDC is ramping up testing support in Florida to aid in rapid diagnostics. A recent study published in the Lancet points to a low risk of sexual transmission and questions the sustainability of Zika transmission without the presence of a vector. The CDC is reporting 3,358 cases of Zika virus in the US as of September 21st. Of these cases, 43 are locally acquired related to mosquitoes.

Stories You May Have Missed:

  • Are We Prepared For Another Ebola Outbreak? In response to last week’s Ebola and Zika: Cautionary Tales article, John LaMattina is digging into the realities of R&D. “Actually, a check of clinicaltrials.gov lists 71 studies ongoing in Ebola, the majority of which involve studying novel vaccines or drugs in humans. Furthest along appears to be Merck with planned regulatory filings for its vaccine in 2017.” He notes that while Ebola may not be making headlines, that shouldn’t be translated into a total lack of preparedness for another outbreak. You can also read the latest article in NaturePublic Health: Beating Ebola.
  • Glory in the Guts- If you’re a fan of Mary Roach’s books (Stiff, Spook, etc.), you’ll love hearing what GMU Biodefense MS student, Greg Mercer, thinks of her latest book, Grunt. Roach’s latest book looks at the life of soldiers and how the military keeps them alive. “The only gun that interests her is the one that fires chicken carcasses at military aircraft to test their birdstrike resilience. Roach isn’t squeamish, though. She participated in a training simulation as a victim of smoke inhalation burns, experienced a live-fire demonstration of the importance of hearing protection, and endured a treadmill trip in the 104-degree “cook box” to witness just how easy it is to become dehydrated while lugging 80 pounds of gear.”
  • Global Capacity for EID Detection – In the most recent CDC Emerging Infectious Disease online report, researchers are evaluating the global improvements of disease detection and communication during 1996-2014. “Improvement since 1996 was greatest in the Eastern Mediterranean and Western Pacific regions and in countries in the middle HDI quartiles. However, little progress has occurred since 2010. Further improvements in surveillance will likely require additional international collaboration with a focus on regions of low or unstable HDI.”

Pandora Report 4.29.2016

TGIF- We’ve got your weekly dose of biodefense and much more in this edition of the Pandora Report! Kurdish Peshmerga soldiers are saying that recent ISIS attacks have involved chemical weapons. Heads up- you may want to avoid a spiced herbal tea commonly sold at CVS due to a potential contamination with Salmonella. Check out a new study on biodiversity in swine flu and the potential for spillover.  Monday, April 25, 2016 was World Malaria Day! Lastly, here’s a chuckle to help start your weekend.

2016 Survey on U.S. Role in Global Health
A recent survey of Americans performed by the Kaiser Family Foundation addressed the public perception, knowledge, and attitude regarding the role of the U.S. in global health. The survey addressed topics like American awareness of Zika virus and the health issues that are most urgently facing developing countries. The survey found that a “majority of the public wants the U.S. to take either the leading role or a major role in trying to solve international problems generally, as well as in improving health for people in developing countries specifically.” Interestingly, the importance of improving health for developing countries was not ranked as a top priority like protecting human rights, etc. “Seven in ten Americans believe that the current level of U.S. spending on health in developing countries is too little or about right, yet the public is somewhat skeptical about the ability of more spending to lead to progress, with more than half saying that spending more money will not lead to meaningful progress. Republicans and independents are more skeptical than Democrats, and these partisan differences have increased over time. Another notable trend is the decreasing visibility of U.S. efforts to improve health in developing countries; just over a third of the public says they have heard “a lot” or “some” about these efforts in the past 12 months, a decrease of 21 percentage points since 2010.” The survey also found that while Americans believe the U.S. should help women in Zika-affected countries, there was a divide regarding involvement in their family planning and preventative health measures.

GMU Biodefense Alum Awarded Mirzayan Science & Technology Fellowship
Congrats to GMU Biodefense alum, Dr. David Bolduc, on being named a Christine Mirzayan Science and Technology Policy Graduate Fellow! David graduated from GMU with a PhD in Biodefense in 2011 and doctoral work focused on the threats and mechanisms of chemical, biological, radiological and nuclear (CBRN) agents and CBRN proliferation issues such as treaties, histories and the managing of related mass casualty incidences. David is currently a Principal Investigator at the Armed Forces Radiobiology Research Institute. The Mirzayan Fellowship is a very prestigious award – as a program of the National Academies, it is designed to provide mentorship and professional development opportunities to early-career leaders in the field of science and technology policymaking.

Global Health & Military Expenditure 2013_numbers_subregions_2
Last week we discussed the financing of global health versus military.  There was a recent publication by Sipri (Stockholm International Peace Research Institute) that looked at global military expenditure versus health expenditure (in 2015, it was $1676 billion or about 2.3% of the world’s Gross Domestic Product). They utilized the WHO’s recent estimates of government health expenditure as a share of GDP. They reviewed 2013 data and found that “governments worldwide spent just over two and a half times as much on health than on the military in 2013: 5.9% of global GDP went to public health spending, compared with 2.3% for the military.” Here’s the interesting part – it varied regionally. While the U.S. spends a lot on military, healthcare expenditure is still very high. Western and Central Europe spent 7.8% of their GDP on health and 1.5% on military. The Middle East spent 4.6% of their GDP on military versus 3.0% on health expenditures. The study also looks at reallocation of military spending and what that may translate to regarding the UN’s Sustainable Development Goals (SDGs). “Reallocating only around 10% of world military spending would thus be enough to achieve major progress on some key SDGs, supposing that such funds could be effectively channelled towards these goals and that major obstacles, such as corruption and conflict, could be overcome.”

Did Newcastle Disease Virus Sneak Out of the Lab?
Newcastle disease virus (NDV) is a highly infectious disease that impacts domestic poultry and other birds. Virulent NDV strains have been endemic in poultry throughout Asia, Africa, and some countries within South America. Current outbreaks continue to cause food safety and agricultural issue. In the 1940s, the first NDV panzootic occurred, specifically genotypes II, III, and IV. Other genotypes have continued to circulate and cause outbreaks. A recent study performed a complete genomic sequence of contemporary isolates from China, Egypt, and India. Researchers performed genetic analysis to distinguish historical isolates (the outbreak from the 1940s) from currently circulating genotypes (V, VI, VII, and XII through XVIII). Through their work, they found that isolates of genotypes II and IX (which are not normally circulating viruses in the environment) were found to be identical to the historical viruses that were isolated in the 1940s. “The low rates of change for these virulent viruses (7.05 × 10−5 and 2.05 × 10−5 per year, respectively) and the minimal genetic distances existing between these and historical viruses (0.3 to 1.2%) of the same genotypes indicate an unnatural origin.” The virulent strains isolated during the 1940s have been used in labs and research studies. Researchers noted that it is highly unlikely these viruses remained viable in the environment for over sixty years, which means its very possible (and scary…) that the source of these viral samples, taken from poultry and wild birds, may in fact be from a laboratory. So now we have to wonder…how did these specific virulent viral isolates find their way out of laboratories and into nature?

Is Open Science the Secret Weapon Against Zika and Future Pandemics?
Gene editing tools like CRISPR-Cas9 have the potential to combat diseases like HIV and malaria, but there’s also a potential dual-use for these technologies that is much more sinister. The price of laboratory equipment for some synthetic biology experiments is dwindling and many are becoming concerned about potential for misuse. Should science be left open and researchers ultimately allowed to make the call about potential dual-use or should scientific work/publications be regulated to avoid publications of research that could be used to build a biological weapon? Some are saying that the best way to combat global issues is through global cooperation and communication and thus, open-source information. Should Zika be the first in the test subjects of open science and its application in the global health security toolbox? Many have argued that if a research project is receiving public funding, it should be open sourced (including the data). Would this have helped the Ebola outbreak? “When Ebola was raging through West Africa in the summer of 2014, a group at the Broad Institute in Cambridge, Mass. published open repository sequence data for 99 Ebola genomes taken from patients in Sierra Leone’s Kenema government hospital. This open sourcing of critical scientific data was the second instance in the outbreak. A team of international researchers had initially published three genomes from patients in Guinea in April. For the next three months, no more genomic data was released to the public data repositories that had become the go-to source for scientists studying Ebola. The silence puzzled many prominent scientists. A formidable array of genomic sequencing technology was aimed squarely at the virus. Yet the data was not shared.” Since this outbreak, many have pushed more for open science, especially in the wake of a global outbreak like Zika.

The Other Side of the Spectrum – How Genetic Editing Became a National Security Threat
You may recall in February, Director of National Intelligence, James R. Clapper, stated in his World Wide Threat Assessment testimony that gene editing had become a global danger and should be considered a weapon of mass destruction. The history of genetic research has seen a burst of developments since the discovery of the double helix in 1953. CRISPR-Cas9 is the newest in the genetic engineering arsenal…and at at a fraction of the historical price. If it were only so simple as to do away with malaria by genetically modifying mosquitoes to avoid carrying the parasite. Alas, the realities are a bit darker. The truth is that genome editing of wildlife can alter entire ecosystems, not to mention the risk for accidents and negligence, which is a very real possibility. Those concerns aren’t even touching on the frightening potential for biological weapons. “Gene editing techniques could produce forms of diseases that barely resemble their naturally occurring counterparts. Such engineered pathogens could sicken or even kill hundreds of thousands of people. Armed with the proper genetic sequences, states or bioterrorists could employ genome editing to create highly virulent pathogens for use in such attacks. They could, for example, change a less dangerous, non-pathogenic strain of anthrax into a highly virulent form by altering the genome, or recreate pathogens such as the deadly smallpox virus, which was eradicated in the wild in 1980. Or they could develop specific weapons that target either individuals or even entire races: With the right manipulations, a pathogen could be made to have greater invasiveness or virulence in a target population.” So where do we go from here? With no governance of do-it-yourself facilitates, no training for the at-home gene editing experimenters, and endless debate about the dangers of gain-of-function research, what is being done? Many are saying UN Resolution 1540 should be strengthened to consider this technology and the Dual-Use Research of Concern (DURC) policy shouldn’t just apply to research funded by the government, but also small labs and individuals. With the notion of open science and DURC still up for debate, the stakes will only get higher as global outbreaks, like Zika, continue to burn through countries.

Why We Should Be Afraid of Yellow Fever
Angola is getting hit hard by yellow fever and the vaccine shortages only amplified the outbreak. With all eyes on Zika and a century since Rio saw its last case of yellow fever, where’s the link? Global supplies of yellow fever vaccines are pretty much depleted and BioManguinhos/FioCruz in Rio (one of four…yes four… yellow fever vaccine producers in the world) is having production problems. All available vaccines are being rushed to Angola and cases are spilling over into the DRC, Mauritania, and Kenya. Here’s more – “What most people don’t know is that there are a lot of Angolans coming every year to Brazil, and the more who arrive here unvaccinated, but have been exposed to yellow fever in Africa and may be carrying the virus, the greater the risk that they will infect Rio mosquitoes, allowing them to transmit yellow fever to residents and tourists.” Brazil is already waging a massive war against Zika. Add in yellow fever and it’ll be like adding a gallon of gasoline to a house fire. Mosquito control is imperative and now we’re paying the costs of historically lackadaisical efforts.

Zika Updates
The WHO announced that the number of Zika virus cases is dropping in Brazil. A recent study reports that dengue virus antibodies enhance Zika virus infection. Researchers suggest that pre-existing dengue immunity will enhance a Zika infection in vivo and can increase the severity of disease. Many are calling for more research to be done regarding the relationships between Zika and dengue infections. You can also find a timeline of Zika virus here. There are growing concerns regarding blood donations as Zika spreads internationally. The Canadian Blood service noted that new rules to protect against Zika transmission are putting stress on the blood supply. A new study looks at the impact of Zika and the challenges we many face due to the increasing frequency of viral outbreaks. As of April 27, 2016, there were 426 travel-associated cases in the U.S.

Rewiring Outbreak Preparedness and Response
Let’s take more of a deep-dive into why we should apply U.S. biodefense practices to managing and preparing for outbreaks. Hoyt and Hatchett emphasized why we should learn from American biodefense strategies to better fight infectious disease outbreak. “SARS was responsible for 800 deaths but cost $40 billion globally and Ebola has cost West African economies $6 billion plus an additional $4.3 billion in international contributions. Now, consider the cost of developing a vaccine. Hoyt and Hatchett point out that at the most expensive point, it can cost $1.8 billion to develop a vaccine (others argue that is it much closer to $500 million).”

Stories You May Have Missed:

  • Neurological Problems in Ebola Survivors – a recent NIH study found that nearly all Liberian Ebola survivors reported neurological symptoms following their recovery. Symptoms were noted to have persisted for over a year, including headaches, difficulty walking, overall muscle weakness, loss of memory, and depression. Hallucinations during treatment in Ebola treatment units was prevalent in 25% of patients, with 4% having persistent hallucinations at follow up.
  • Ebola in America: Epidemic of Fear – The Center for Strategic & International Studies has put together a video on the fear and U.S. response to Ebola cases in the U.S. and in West Africa. The video discusses stigma and how Ebola was experienced in the Fall of 2014.
  • Biodefense World Summit – The 2016 event will be hosted in Baltimore, MD on June 27-30, 2016. The Knowledge Foundation’s Second Annual Biodefense World Summit brings together leaders from government, academia, and industry for compelling discussions and comprehensive coverage on pathogen detection, sample prep technologies, point-of-care, and biosurveillance. Across the four-track event, attendees can expect exceptional networking opportunities in the exhibit hall, across panel discussions, and shared case studies with members of the biodefense community from technology providers to policy makers

 

Pandora Report 4.22.2016

Happy Friday from your friends at GMU Biodefense! We’ve got some great updates in your weekly dose of global health security. First, check out this wonderful infographic on the hurdles ahead for Zika virus response. France, Myanmar, and Taiwan have all recently reported avian influenza outbreaks. Good news- researchers have found that a new technique of low-energy nuclear reaction imaging is able to detect concealed nuclear materials (weapons-grade uranium and plutonium).

Findings of Investigations into 2014 NIH Smallpox Discovery
Following the recent GAO report on security of U.S. bioresearch labs, the House Energy and Commerce Subcommittee on Oversight and Investigations released its own memo ahead of the hearing on Wednesday, April 20, 2016 (you can watch it here). The hearing addressed the investigations that surrounded the finding of potentially live smallpox in cardboard boxes in cold storage rooms within the NIH.  Some of the issues that were identified and discussed were: failure to account for regulated select agents, failure to conduct comprehensive inventory of all select agent material, and failure to restrict unauthorized access to select agents. “There’s a problem when the government somehow loses track of smallpox and other deadly agents, only to have them turn up in a soggy cardboard box. What’s worse, the urgency that should accompany such a discovery has failed to spur absolutely necessary changes,” said full committee Chairman Fred Upton (R-MI) and Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA). “Today serves as an important opportunity to ask some of the agencies in question about their next steps to ensure safety for those working in the labs, as well as the general public.”

Re-Wiring the Funding of Pandemic Response 
Jeremy Farrar, head of biomedical research charity, the Wellcome Trust, believes that governments should invest in fighting and defending against pandemics the same way they invest in the military. “We spend gazillions to defend ourselves from military attacks, but from the beginning of the twentieth century far more people have died from infection. We are hugely vulnerable from a public health perspective,”. He emphasizes that public health funding shouldn’t be left to private companies, as they will ultimately make decisions based upon commercial return. Globalization means that a disease can jump from one country to the next through a single flight and we need to be able to respond just as quickly. “We’ve had Ebola for the last two to three years, now Zika. Since 1998 I’ve been involved in about eight major epidemics including SARS and bird flu. This is the new world. These are not rare events,”. If nothing else, it’s important to consider the economics of an outbreak. The financial cost of an epidemic is staggering – cited at $60 billion annually. He notes that now is the time to share information and work towards quicker vaccine and diagnostic interventions.

Neglected Dimensions of Global Security
Researchers are discussing the Global Health Risk Framework Commission’s strategy to defend human and economic security from pandemic threats. Global health threats, like that of SARS and Ebola, have forced leaders to consider not just response, but also preparedness. “In each case, governments and international organizations seemed unable to react quickly and decisively. Health crises have unmasked critical vulnerabilities—weak health systems, failures of leadership, and political overreaction and underreaction.” Global coordination in the event of a health crisis is extremely challenging, as we saw with Ebola, and these authors are pointing to the need for “international norms and well-functioning institutions”. The recommendations also include public accountability for timely reporting and multilateral financing for pandemic preparedness and response resources.

GMU Biodefense Students Earn Prestigious Fellowship
We’re excited to provide an official announcement and interview with GMU Biodefense students, Fracisco Cruz and Siddha Hover, regarding their acceptance into the Emerging Leaders in Biosecurity (ELBI) Fellowship. Francisco earned his MS in 2015 and Siddha is a current PhD student in GMU’s Biodefense program. Check out their comments on both the ELBI Fellowship and their experiences within GMU’s Biodefense graduate programs. “For two George Mason Biodefense students to be selected for this prestigious fellowship is a great recognition of the contribution that our students and alums are already making to biodefense and global health security and the potential they have to play even stronger roles in the future,” said Associate Professor Gregory D. Koblentz, director of the Biodefense program in Mason’s School of Policy, Government, and International Affairs.

Federal Research Database on Genomic Data 
The new GenPort database will allow researchers to access enormous amounts of genomic data from research studies. The benefit of the new system is that it will allow people to review several studies at the same time and track individuals within different trials, creating “synthetic cohorts”. “The Health and Human Services Department is currently looking for small businesses who can help build that hub, so even researchers without informatics or genomics training can make ‘practical use’ of data from cohort studies other scientists have already conducted.” The plan is for GenPort to be open source, transportable, and freely shared via a cloud. Let’s just hope genomic data from certain deadly pathogens doesn’t make its way onto the cloud!

Drug-Resistant Gonorrhea Sparks Concern
While Zika virus and Ebola are quick to grab the headlines, there is another global health security threat we should be worried about. Antibiotic resistance may not have the hype that emerging infectious disease outbreaks do, but the realities of a world without effective antibiotics are pretty terrifying. Consider the re-emergence of diseases we had long eradicated and now have no effective treatment methods. With the rising incidence of multi-drug resistant organisms, the threat of a drug-resistant sexually transmitted infection is pretty terrifying. Public health officials in England are urging the public to practice safe sex with the growing rates of Azithromycin-resistant gonorrhea. Cases initially started in November 2014 however, they have been increasing. The CDC has also issued information about the threats of antibiotic-resistant gonorrhea.

The Fight Against Zika VirusScreen Shot 2016-04-19 at 8.59.38 AM
Where are we with Zika? What does the future hold for this ever-changing  outbreak? Some are saying that it is a delayed epidemic. The long-term effects of the disease means we’re all trailing behind it. The lack of a vaccine or commercially available test makes it even more challenging. “Human Zika virus infection appears to have changed in character while expanding its geographical range,” the WHO paper concludes. “The change is from an endemic, mosquito-borne infection causing mild illness across equatorial Africa and Asia, to an infection causing, from 2007 onwards, large outbreaks, and from 2013 onwards, outbreaks linked with neurological disorders.” With Zika, it seems like we’re constantly rushing to catch up. Shifting U.S. funds from Ebola to Zika is just another example of the reactive approach public health tends to take. Why are we constantly rushing from fire to fire? The recent cuts to public health funding are also being highlighted since the Zika outbreak began. Many are pointing to the inability to truly prepare or respond with limited public health resources. In the mean time, many cities, like New Orleans, are organizing preparedness plans as the rainy season approaches. There are also concerns regarding the growing threat of Zika as new maps reveal 2.2 billion people reside in “at risk” areas. The Senate may also be closer to an agreement regarding emergency funding for Zika virus response. 

Americans Want More Biosecurity Preparedness Investment
A survey performed by the Alliance for Biosecurity, the Blue Ribbon Study Panel on Biodefense and Trust for America’s Health, looked at the general public’s perception of preparedness and where they think we should be. Findings noted that eight out of ten Americans are concerned about naturally-occurring diseases like Ebola and Zika, and nine out of ten are concerned about the use of chemical or biological weapons by terrorists against the U.S. The survey found that only half of Americans have confidence that the U.S. government is prepared to address the next biosecurity threat. The survey also found that 88% of Americans support increasing the budget for preventative measures for biological threats.

Stories You May Have Missed:

  • Health Security Special Issue on Climate Change – Check out the special edition of Health Security that includes articles on adapting to health impacts of climate change and the potential for Zika and microcephaly epidemics in post-Ebola West Africa. 
  • Science Perfects the Art of Hand-Sanitizing Techniques – infection prevention researchers at Glasgow Caledonian University recently released a report on the most effective way to use alcohol-based hand sanitizer. Reviewing bacterial count, they published in hopes of reducing the spread of disease in healthcare through better hand hygiene.
  • MERS Contamination – MERS-CoV has caused considerable concern regarding transmission in healthcare settings since the large 2015 outbreak in South Korea. Researchers have found that MERS-CoV contamination occurred in the air and surrounding environment within the MERS outbreak units. MERS-CoV was found in 4/7 air samples from two patient rooms, one patient’s restroom, and one common corridor. “In addition, MERS-CoV was detected in 15 of 68 surface swabs by viral cultures. IFA on the cultures of the air and swab samples revealed the presence of MERS-CoV. EM images also revealed intact particles of MERS-CoV in viral cultures of the air and swab samples.”
  • California Salmonella Outbreak– California continues to investigate a five-month long Salmonella outbreak. Public health officials are considering a Mexican-style soft cheese and are currently testing samples from a woman’s home. These specific samples are being considered as the woman imported cheese from Mexico (via family members) and was selling it online.

Pandora Report: 3.25.2016

Happy Friday! Ready for some global health security news? Down the rabbit hole we go….the FDA has just approved ANTHIM injection, a new treatment for inhalation anthrax in adults and children. Researchers are considering the possibility that the highly virulent E. coli O104:H4 strain that hit Germany in 2011 may have been an intentional act. “The sudden and unexplainable emerging of a fast increasing number of cases and deaths from bloody diarrhea and HUS might have been caused naturally, accidentally, or intentionally,” a Serbian-German research team writes in the European Journal of Public Health Advance Access for April 15.

The Finances of A Pandemic
From SARS to Ebola and now Zika, the growing threat of emerging infectious diseases doesn’t seem to be slowing down. Has this become our new normal? Will we learn from these outbreaks and start putting the resources and support into prevention? “Ebola has infected almost 30,000 people, killed more than 11,000 and cost more than $2 billion in lost output in the three hardest-hit countries. SARS infected 8,000 and killed 800; because it hit richer places, it cost more than $40 billion. Predicting these losses is hard, but a recent report on global health risks puts the expected economic losses from potential pandemics at around $60 billion a year.” So how do we defend against these international security threats? America’s National Academy of Medicine recently made the suggestion that $4.5 billion a year solely dedicated to pandemic preparedness and defense could halt this impending reality. Even more interesting? This estimate accounts to roughly 3% of what “rich countries spend on development aid”, while the world spends about $2 trillion annually on defense.

U.S. Biothreat Defense Inadequate
American response to Ebola and now Zika reveals a startling trend of slow response, inadequate supplies, and poor cooperation and coordination between agencies. Director of National Intelligence, James Clapper states that “Gaps in disease surveillance and reporting, limited health care resources, and other factors contributed to the outpacing of the international community’s response in West Africa,”. The National Biosurveillance Integration Center (NBIC) is one such agency that was developed in 2007 in attempts to “be a hub of information and coordination for federal agencies tracking disease and biological threats”, however it has been frustrated by poor relationships and sharing from other agencies like the CDC. In essence, agencies that are developed for global health security, like NBIC, suffer from poor cooperation that then trickles into their reputation and capabilities in the eyes of their federal partners. “Congress has put forth a potential legislative fix. The CBRNE Defense Act of 2015 would create a new office within DHS, the Chemical, Biological, Radiological, Nuclear, and Explosives Office, which would place both NBIC and BioWatch under integrated new management.” Just as we reported from the Blue Ribbon Study Panel, federal biodefense efforts and resources need to be better organized and developed.

Rare Blood Infection Outbreak
Elizabethkingiam is currently causing dozens of cases in Wisconsin and now a Michigan resident is suffering from the bloodstream infection. The bacteria that causes the infection, Elizabethkingia meningoseptica, is commonly found in soil but has also caused infections in hospitals. Typical infections have resulted in bacteremia and neonatal meningitis related to the gram-negative bacillus, although it is naturally found in soil, fresh water, and salt water. Most of the 54 cases in Wisconsin have been in patients 65 years and older, of which 17 have died. Public health officials are working to identify the source of the outbreak and the links between the Michigan case and those in Wisconsin. The concerning aspects of this rising outbreak is also the difficulty in treating the organism and prevalence of multi-drug resistant organisms in seniors.

Complex Engineering by Violent Non-State Actors
Check out this special issue on complex engineering by violent non-state actors (VSNAs). “Why and how different VNSAs remain low-level and localized or undertake and achieve complex engineering tasks in pursuit of their objectives are at the heart of understanding the threat environment faced by states.” The authors address several terrorist groups like Aum Shinrikyo (the chapter was actually co-authored by GMU Biodefense Alum Benjamin Ash!), Hamas (also co-authored by GMU Biodefense Alum Alena James!), the Provisional Irish Republican Army (PIRA), etc.  “The approach of this collection moves beyond weapons and embraces facilitating or logistical aspects that support the operations and objectives of the various actors”. This special edition, with an introduction by Jez Littlewood, reviews these organizations and their resources and strategies. The authors also consider the attitudes of leadership regarding innovation in detail to assess the role of complex engineering by VSNAs. Through this close look into the VSNA use of complex engineering, further research and preparedness can occur to understand the threats posed by these actors.

All Roads Lead to Zika 
Now that Spring has officially begun, the impending summer rains are right around the corner, and with those – mosquitoes. Many worry about the potential for local transmission in countries where imported cases have already been identified. The US isn’t immune to these concerns as the CDC reports 273 travel-related cases. Dr. Nabel mirrors the sentiments of Sanofi’s global R&D head, Dr. Elias Zherouni, who emphasizes the need for changes in global public health outbreak response. He notes that “we just run from one crisis to another. It’s not an optimal way to respond. Not when the stakes are so high and when so many people can either lose their lives or have their whole lives changed because of one five-day infection. That’s no way to protect the world’s population. We have to step back and we have to say, ‘Is there a more systematic way to gather the intelligence that we have about these viruses, recognize where they stand in terms of the threat level, and then develop a systematic program where, when the next Ebola outbreak occurs, it’s not that we haven’t done anything since the last outbreak, that we’ve actually moved things forward?’ That’s all possible. It’s just that we have not had the collective will to do it.” Panama has also announced their first case of microcephaly linked to Zika virus outside of Brazil. Chris Mooney from The Washington Post discusses why Zika virus, among other diseases, could disproportionally impact America’s poorer populations.  He notes that scientists have found that more mosquitoes are found in lower-income neighborhoods due to persistent trash and abandoned buildings, which creates a ripe environment for standing water and thus mosquito breeding. Researchers found that when compared to wealthier neighborhoods in New Jersey, “poverty was positively correlated with number of [Asian tiger mosquitoes] captured and accounted for over half the variation”. Many are saying that the “U.S. is botching the Zika fight” due to the problems within the FDA and the Agriculture Department regarding turf. “A genetically tweaked mosquito could stop the illness, but regulators won’t test it. Why would that be?” The combination of worrying reasons, like “budgetary concerns and antagonism to genetic engineering among some senior USDA officials”, leave many feeling that instead of getting ahead of the outbreak, “the U.S. is falling behind, solely because of bureaucratic muddle.” On the other hand, on Friday, the WHO rallied for pilot projects on two projects that would involve genetically modified mosquitoes to help stop the spread of Zika virus. In the meantime, the FDA gave emergency approval for a 3-in-1 test for Zika, Chikungunya, and Dengue.

Syria and the Future of the Chemical Weapons Taboo 

Courtesy of E-International Relations
Courtesy of E-International Relations

Brett Edwards and Mattia Cacciatori tackle the responses that the international security community has taken regarding the use of chemical weapons in Syria and the resulting reinforcement of “a long standing prohibition norm.” The authors discuss the characteristics of chemical weapons taboo and and the significance that the international community gives to these weapons. “This alone does not support the claim episode has strengthened the global norm against chemical weapons. In this piece we have highlighted how this is not immediately apparent due to the fact that problem cases tend to be externalized from dominant institutional discourses, often justified in terms of the need to protect the sanctity of the chemical weapon norm, as well as those institution’s which embody the norm – especially the OPCW.” Overall, the more problematic cases, like those of incapacitating chemical agents, will grow to alter the existing foundation of chemical weapons norms if left ignored or unchecked.

New Ebola Flare Up
The west African Ebola outbreak is like a campfire that wasn’t put out properly – everyone thinks the flames are extinguished, but those hidden embers lurking in the ash end up causing a spark that leads to a massive forest fire. A fifth person has died from the recent flare in Guinea. The most recent death occurred in a man 200k from the initial four cases. Prior to this death, a young girl died from the village of Korokpara following her hospitalization in an Ebola treatment facility in Nzerekore. It’s still not clear how this specific surge began, but many worry about the lingering traces of the virus in the eyes, CNS, and bodily fluids. In response to the fifth death, Liberia has partially shut its bordersEmergency meetings are now underway and the WHO is sending specialist teams in to try and stop the outbreak before it grows beyond the 11,300 mortality count. On a positive note, Sierra Leone has gone two incubations periods (42 days) without a case, which means they’re Ebola-free since their last flare up.

GMU SPGIA Gettysburg Trip
GMU students interested in learning more about the battle of Gettysburg- the Center for Security Policy Studies (CSPS) will be hosting an informational session on April 6th from 4:30-6pm in Merten Hall 1203 regarding the April 9th trip! GMU students and staff will walk the battlefield, discussing the factors that caused the battle to unfold as it did. They will also link the battle into larger discussions about the causes of war and grand strategy.  The cost for the trip will be $35.  Bus transportation will be provided, and will pick up participants from both the Fairfax and Arlington campuses.

Stories You May Have Missed:

  • U.N. Sued Over Haiti Cholera Outbreak– starting in October of 2014, Haiti was hit with an intense wave of cholera that is believed to have started with U.N. peacekeepers. “Poor sanitation at a U.N. camp for peacekeepers allowed cholera-contaminated sewage to enter a tributary of Haiti’s largest river, the Artibonite. Within days, hundreds of people downstream, like Jean-Clair Desir and his mother, were falling ill. The disease subsequently spread to the entire country.” The case is currently being reviewed in US courts and the lawsuit was brought forth by the Institute for Justice in Democracy, asking that the U.N. “end cholera by installing a national water and sanitation system; pay reparations to cholera victims and their families; and publicly apologize for bringing cholera to Haiti.”
  • Exploiting the Challenges to Bioweapons Development – Janne E. Nolan discusses GMU Biodefense Professor, Dr. Sonia Ben Ouagrham-Gormley’s book, Barriers to Bioweapons, in regards to the misleading and often exaggerated notion of easy WMD development. Nolan discusses that understanding both the internal and external factors that impact BW program success would allow the international community to “devise better ways to realistically stem BW proliferation”. He notes that “Ben Ouagrham-Gormley s book is a fascinating study of the phenomenology of scientific knowledge, providing a compelling analysis of how knowledge is acquired, developed, transmitted, and, at the same time, diluted or lost as a result of organizational, social, economic, political, and ultimately very human factors that vary widely within countries and over time.” You can also access it here: Nolan final
  • Five Outbreaks That Stump Epidemiologists– As much as I’d love to say that all outbreaks are investigated and solved, the truth is that epidemiologists are often left with the nagging of an unresolved case. Outbreaks are squirrelly at best, often challenging even the best teams with confounders and biases. Here are some that have stumped public health teams over the years.
  • Lassa Fever Outbreak– Three people are suspected of having the viral infection after coming into contact with an infected American. The initial case was a medical director of a missionary hospital in Togo, who died last month. While there are conflicting reports of disease confirmation, several sources are saying the three contacts of this initial case have been diagnosed and are under observation. The outbreak in Nigeria and Benin has continued to grow, resulting in CDC travel warnings. In Nigeria there have been 254 cases and Benin has seen 71.

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Pandora Report 2.12.2016

This week we saw a lot of movement on the Zika response front – from increased funding to research teams prepping for field work, the outbreak hype is picking up traction as the horrors of Ebola are still fresh. Natural outbreaks aren’t the only thing drawing concern this week, as James Clapper, Director of US National Intelligence, added gene editing to the list of dangers posed by “weapons of mass destruction and proliferation.” The annual worldwide threat assessment report stated that, “research in genome editing conducted by countries with different regulatory or ethical standards than those of Western countries probably increases the risk of the creation of potentially harmful biological agents or products,”. Good news for hospital preparedness, the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response and the CDC have announced continued funding for the Hospital Preparedness Program (HPP). The HPP supports critical healthcare preparedness efforts in order to reduce the “supplemental state and federal resources during emergencies, and enables rapid recovery.” If you’re trying to work some biodefense into your Valentine’s Day, you’ve got a few options via Jane Austen-inspired zombie adventures in Pride and Prejudice and Zombies or episodes of The Walking Dead. Whichever zombie adventure you choose, just remember to avoid cuddling with any armadillos (read on to find out why). Happy Friday!

Lassa Fever Outbreak Grows
The Lassa fever outbreak that began hitting Nigeria in August 2015 has continued to spread, worrying many health officials. 101 people have already died from the infection and roughly 175 people have become infected. The Nigeria Centre for Disease Control (NCDC) stated, “As of today, 19 [including Abuja] states are currently following up contacts, or have suspected cases with laboratory results pending or laboratory confirmed cases.” Annually, Lassa fever causes 100,000-300,000 infections and 5,000 deaths in west Africa. Nigeria’s neighbor, Benin, is also seeing an increase in cases, in which seventeen have died and fifty have been infected.

Back Down the Zika Rabbit Hole
In response to the growing threat of Zika virus, the Obama administration announced on Monday that it would formally be requesting an emergency funding of $1.8 billion to combat the outbreak. The Department of Health and Human Services (including the CDC) would obtain the majority of the funds ($1.48 billion). CDC efforts will be ramped up as its emergency operations center was moved to a level 1 (the highest level) and teams are being coordinated to study the microcephaly-infection links. You can also check out the White House press release here. The WHO will be working to prioritize and fast-track research and development projects, of which Zika virus will be included. You can also find a great timeline here. According to the CDC, as of February 3, 2016, there were 35 travel-associated cases in the US. The Lancet also just released this piece discussing the labeling of Zika virus as a public health issue of concern.  On February 16, 2016, The National Academies of Sciences, Engineering, and Medicine are holding a workshop on research priorities to inform public health and medical practice for domestic Zika virus cases.

ASM-BiodefenseScreen Shot 2016-02-10 at 11.49.22 PM 
The 2016 American Society for Microbiology Biodefense and Emerging Diseases Research Meeting took place this week in Arlington, VA. For a biodefense fan, this was a pretty amazing three-day experience. Conference attendees were treated to presentations on antimicrobial resistance, applied biodefense, medical countermeasure developments, agroterrorism, and much more. Did I mention the keynote speaker was Dr. Tom Frieden, director of the CDC? I’m not even a little ashamed to admit how great it was to see Dr. Frieden emphasize that “nature is unpredictable but what is predictable is that we can be better prepared.” He also noted that “Zika is a rapidly changing situation” and the CDC would be sending a team within the next week to start a case-control study related to infection and microcephaly. Some highlights included getting to listen to Dr. Raymond Zilinskas discuss Russian biodefense efforts and how CBR training exercises increased in 2015. Dr. Jens Kuhn from the NIH wins the award for most humor during his fascinating presentation on Marburg and Ebola research within the Soviet bioweapons program. The infection preventionist in me greatly appreciated the session on antibiotic resistance and the role of medical tourism as an exposure for patients to CRE, not to mention how travel assists global clonal expansion. The Mayo Clinic’s Dr Tosh pointed out the short term (isolation of patients, hand hygiene, etc.), medium term (new microbial therapeutics, new diagnostics, etc.), and long term (specific pathogen therapy, decolonization, and immunologic therapy) response and control mechanisms for drug resistance. Last but not least, one of the biggest objectives from the applied biodefense presentations was the need for scientists to help inform policymakers about their work to drive the best policies. I would highly encourage anyone interested in the biodefense field to attend future conferences, as it was a wonderful learning experience and the poster/exhibitor sessions were an excellent way to learn about new research and network.

Lessons Learned: Using North Korea’s History to Better Understand Iran’s Nuclear Program
GMU biodefense professors, Dr. Thrall and Dr. Koblentz, discuss the use of North Korean nuclear history as a teaching tool regarding Iran’s nuclear program. By comparing and contrasting these two countries and their propensity for nuclear weapons, they look to similarities like the fact that both countries “are located in historically dangerous neighborhoods and face militarily superior adversaries. In North Korea’s case, South Korea and the United States; in Iran’s case, a Middle East full of Sunni Arabs and a nuclear-armed Israel. From a national security perspective, both countries have obvious reasons for pursuing a nuclear capability.” Given that both countries tend to be immune towards coercion, continued engagement and confrontation is vital. Using North Korea as a model for behavior, vigilant deterrence will be necessary to prevent Iran from cheating on the nuclear deal.

Managing Emerging Health Security Threats Since 9/11: The Role of Intelligence
Dr. Patrick F. Walsh, Associate Professor of Intelligence and Security Studies at Charles Sturt University in Australia, discusses the role of intelligence throughout the evolution of biosecurity since the 9/11 attacks. Dr. Walsh calls attention to the difficulties in defining biosecurity and that “cross-disciplinary focus is both a strength and weakness to understanding biosecurity threats. It is a weakness in that the presence of multiple players in the biosecurity field can result in a more fragmented understanding and operational response to various biosecurity threats. But it is also a strength in that, if intelligence systems are optimal, a multi-disciplinary approach allows a combination of expertise to assess and manage the bio-threat or risk.” Dr. Walsh presents the role of dual-use research, stolen biological agents, and the growing concern among biosecurity regulators and national security intelligence groups regarding the dwindling role of tacit knowledge and availability of equipment and technology. Dr. Walsh points out that the character of intelligence varies depending on the issue and one must account for the role of decision making. Lastly, he reminds us that “to conceptualize the role of intelligence in improving early warning of biosecurity threats is to examine how it can provide warning through various stages of the intelligence cycle, which includes the following stages—direction, collection, analysis, and dissemination.” While the role of intelligence will continue to evolve with biosecurity threats, Dr. Walsh emphasizes that strategic early warning capabilities are dependent upon the efficacy of intelligence framework. Improving these two facets of biodefense will allow critical infrastructure to not only respond to threats of bioterrorism and emerging infectious diseases, but also the growing threats of microbial resistance and dual-use research. You can also find the article here (2016 Walsh Health Security and Intelligence Jan).

Biosecurity in the Age of Big Data: A Conversation with the FBI
Advances in life science and technology can solve many health issues, but they can also pose a threat if used within the wrong context. Dual-use research of concern, CRISPR, and biotechnologies have led to some remarkable revolutionary advances, however, where do these fit within the FBI’s security concerns for bioweapons? Keith Kozminski of Molecular Biology of the Cell met with FBI Supervisory Special Agent (SSA) and head of the Biological Countermeasures Unit at their Washington, DC headquarters, Edward You, to discuss the security implications of Big Data. SSA You detailed his work with the American Association for the Advancement of Science and the United Nations Interregional Crime and Justice Research Institute to identify the security issues associated with Big Data when it comes to biology. Whether collaborating with companies like Amazon and IBM or government agencies like the CDC, SSA You has worked to identify potential vulnerabilities and how they can be addressed without halting innovation. SSA You states that “Over the last two years, we have had the issues with regard to the Centers for Disease Control and Prevention (CDC) and Department of Defense (DoD). A lot of discussion also came when the J. Craig Venter Institute synthesized that bacterial genome. There were a lot of calls and discussions about the scientific community needing more ethics training and the need to develop a greater culture of responsibility. From a law enforcement perspective those are necessary but not sufficient. What has been lacking is the scientific community being provided security awareness—something that augments how they approach the life sciences.” While there are vulnerabilities across the board, SSA You emphasized the need for partnership between biologists and WMD coordinators to not only safeguard science, but reduce threats.

UN- Protecting Humanity from Future Health Crises: Report of the High-level on the Global Response to Health Crises 
The UN has released an advanced copy of their report regarding global health safety. Highlighting the efforts and failures within the Ebola outbreak, this report emphasizes the global burden of communicable diseases and how better response and preparedness is needed. The report points out that only a third of the 196 State Parties have fully implemented the International Health Regulations (IHR, 2005) and there has been little global investment in R&D for emerging infectious diseases. 27 recommendations were made to address issues at the national, regional, and international levels, of which one of the first was for the WHO to build a new Centre for Emergency Preparedness and Response. The report also states that “all countries must meet the full obligations of the IHR” and “appropriate financing is required. Assistance should be provided to countries requiring additional support for IHR compliance, while WHO and the new Centre for Emergency Preparedness and Response must be resourced to meet global needs.” Overall, the use of the 2014 Ebola outbreak as a case study for health security recommendations echoes the sentiment that Dr. Frieden once noted– “a disease outbreak somewhere is a risk anywhere”

Stories You May Have Missed:

  • Vaccines & Therapeutic Conference– Mark your calendars for the 14th annual conference from May 17-19, 2016, in Washington DC, that covers biodefense, antimicrobial resistance, and emerging infectious diseases. Given the recent push for emergency funding for Zika virus research, this conference will be a great resource for up and coming research.
  • Quality Training for BSL-4 Biocontainment Laboratories– Interested in BSL-4 lab training? The FDA and University of Texas Medical Branch, Galveston National Medical Branch, will host training April 25-29, 2016. Held in Bethesda, MD, the course will include faculty and subject matter experts from the FDA, academia, and more.
  • Leprosy Spike in Florida– Florida has seen an increase in leprosy cases this year. Five cases have been reported in 2016 so far and 27 were reported in 2015. The spike in cases is suspected to be a result of armadillo transmission. If you find yourself traveling in Florida, you may want to avoid armadillo cuddling.