Pandora Report: 8.5.2022

This week we cover monkeypox updates, the WHO’s reporting on healthcare in Ukraine, and the planned BWC consultative meeting following Russia’s invocation of Article V of the convention. We also cover new publications, upcoming events, monkeypox debunkings, and our RSS feed. Have a safe weekend!

Monkeypox- US Declares Public Health Emergency Amid Lagging Response

This week, US Department of Health and Human Services Secretary Xavier Becerra declared monkeypox a public health emergency, seeking to improve response efforts as the outbreak passes 7,100 cases in the US alone. President Biden also selected a White House monkeypox coordinator-Robert Fenton, who is currently a regional administrator with FEMA and has twice served as the acting FEMA administrator. However, many view this as too little too late as concerns about vaccine access continue to rage.

The New York Times writes this week, “The shortage of vaccines to combat a fast-growing monkeypox outbreak was caused in part because the Department of Health and Human Services failed early on to ask that bulk stocks of the vaccine it already owned be bottled for distribution, according to multiple administration officials familiar with the matter. By the time the federal government placed its orders, the vaccine’s Denmark-based manufacturer, Bavarian Nordic, had booked other clients and was unable to do the work for months, officials said — even though the federal government had invested well over $1 billion in the vaccine’s development.”

The same article goes on to explain that the US government is now distributing about 1.1 million doses, despite estimates that 3.5 million are needed to contain the outbreak. It also does not expect the next delivery of 500,000 doses until October, and the other 5.5 million the US has ordered will not be delivered until next year as Bavarian Nordic nears the planned closure of its European production plant for part of this year. As the US has invested nearly $2 billion in this vaccine, this is a major point of concern for critics. The US also has ACAM2000 in its stockpile, a vaccine licensed for smallpox that, like JYNNEOS, can also be used for monkeypox, however additional paperwork and criteria are required, and its side effects can be severe for those who are immunocompromised or have certain conditions.

Worse yet, particularly with this manufacturing plant closure, many countries will be dependent on high-income countries donating vaccines to help them contain the spread of monkeypox. However, the surprise of this outbreak has in large part been defined by the silencing of those who have experience with monkeypox from working in places where it is endemic, helping cast serious doubt that any serious improvements in vaccine equity will have been made in the last few years. For example, NPR recently published an article on Dr. Dimie Ogoina’s experience with the disease in late 2017 in Nigeria, and that outbreak’s role in the current crisis.

Source: CDC Public Health Image Library. This digitally-colorized electron microscopic (EM) image depicted monkeypox virus particles, obtained from a clinical sample associated with the 2003 prairie dog outbreak. It was a thin section image from of a human skin sample. On the left were mature, oval-shaped virus particles, and on the right were the crescents, and spherical particles of immature virions.

WHO’s Response to Russia’s War in Ukraine

The WHO recently released an interim report on the organization’s response to Russia’s offensive in Ukraine, discussing core objectives, refugee management, planning, and funding and partnerships. This comes as the WHO’s Ukraine emergency coordinator, Heather Papowitz, was quoted earlier this week explaining that healthcare teams in Ukraine are likely used to working with shellings going on outside their facilities, offering a stark reminder that this horror is far from over. In fact, of the 615 attacks on healthcare facilities tracked by the Surveillance System for Attacks on Health Care this year, 434 of those have occurred in Ukraine. WHO’s most recent situation report on the matter also confirms there have been 9.9 million border crossings, 6.1 million refugees recorded across Europe, 6.3 million internally displaced, 12,272 civilian casualties, and 5,237 civilian deaths since Russia’s invasion earlier this year.

WHO also reports that, “WHO has supported the health response in Ukraine by providing, among other things: training on COVID-19, chemical preparedness and response and mass casualty management; technical expertise on the national immunization strategy; trauma and burn kits, and support for medical evacuation (medevac) after the attacks on Vinnytsya; technical expertise on environmental health issues, including water-related preparedness and response measures, in view of a potential cholera outbreak”

Russia Requests BWC Consultative Meeting, SCO Issues Joint Statement on the BWC

In related UN news, the UN Office for Disarmament Affairs released a statement and document regarding Russia’s June 29 request for the convening of a formal consultative meeting under Article V of the BWC and the Final Declarations of the Convention’s Second and Third Review Conferences. In a July 28 letter from Ambassador Aidan Liddle of the United Kingdom of Great Britain and Northern Ireland, it is determined that the meeting will be opened on August 26 for a brief procedural meeting before resuming on September 5 for four days. Ambassador Gyorgy Molnar of Hungary will chair the consultative meeting. Russia’s invocation of Article V is the first time this has been done since the Cubans accused the US of spraying Thrips palmi on its crops in 1997, a fact that is discussed alongside analysis of Russia’s lead-up to using this rare diplomatic procedure by Filippa Lentzos and Jez Littlewood in The Bulletin of the Atomic Scientists.

On July 29, the PRC Ministry of Foreign Affairs (MFA) announced that the Shanghai Cooperation Organization (SCO) issued a joint statement on the BWC. The SCO is comprised of China, India, Kazakhstan, Kyrgyzstan, Pakistan, Russia, Tajikistan, and Uzbekistan, in addition to several observers and dialog partners. However, India was not part of the joint statement. Zhao Lijian, a spokesperson for the PRC MFA stated the PRC’s position on the SCO’s statement, saying “The joint statement affirms the significance of the BWC for international security, emphasizes the need to comply with and strengthen the Convention, calls for resuming negotiations on a verification protocol, and expresses concern over the absence of a verification mechanism under the BWC framework. The statement expresses support for a balance between security and development and upholding all countries’ lawful rights to the peaceful use of biotechnology. It also notes the initiatives proposed by various parties to enhance global biosecurity governance, including the call by Russia and China to include information on the overseas military biological activities by the BWC States Parties in the reporting form, the Tianjin Biosecurity Guidelines for Codes of Conduct for Scientists put forward by China, and the creation of an International Agency for Biological Safety proposed by Kazakhstan. This joint statement fully demonstrates the parties’ sense of responsibility and firm resolve to practice true multilateralism and strengthen global biosecurity governance.

Biosecurity bears on the security and development interests of all countries. When putting forward the Global Security Initiative, President Xi Jinping stressed that we need to jointly maintain world peace and security and work together on global challenges such as biosecurity. The BWC Ninth Review Conference will be held at the end of this year. The international community should work in concert for a substantive conference to strengthen the BWC mechanisms and ensure universal compliance. We stand ready to work together with all parties to further advance dialogue and cooperation on biosecurity under the SCO framework, strengthen the BWC mechanisms, and improve the global biosecurity governance system.”

“As Bioweapons Negotiators Prepare to Meet Amid a Pandemic and Torrents of Disinformation, Can They Accomplish Anything?”

Biodefense PhD Program alumnus Yong-Bee Lim recently authored this piece for The Bulletin of the Atomic Scientists discussing the current state of the BWC, main challenges, and potential outcomes at the BWC Review Conference later this year. He writes in part, “On the other hand, the meeting could end with tangible progress on major priorities. Treaty members could agree to form working groups to discuss thorny issues like assuring compliance with the treaty or even sanction negotiations around these issues. The United States, Russia, and China have each suggested interest in strengthening compliance mechanisms within the treaty, after negotiations around a verification protocol fell apart in 2001. “The three countries have different visions, but share the idea of having specialized working groups explore how to strengthen and revitalize the treaty.” Littlewood and biosecurity expert Filippa Lentzos wrote in the Bulletin in March.”

“Adrienne Mayor on Greek Fire, Poison Arrows, and Scorpion Bombs”

Check out this work form Princeton University Press with Adrienne Mayor answering questions about her book, Greek Fire, Poison Arrows, and Scorpion Bombs, including her motivations for writing about CBW in the ancient world and what to expect from the new revised edition.

“A Better Way to Detect the Origins of a Pandemic”

Angela Kane and Jaime Yassif tackle pandemic origin debates during times of international conflict and uncertainty in their new piece for Arms Control Today. They write, “To meet this need, it will be important to bolster the capabilities of the United Nations to investigate the origins of high-consequence biological events. This includes strengthening and investing significantly more resources in existing capabilities such as the UN Secretary-General’s Mechanism for Investigation of Alleged Use of Chemical and Biological Weapons, which has the authority to investigate allegations of deliberate biological weapons use.”

Regional Perspectives on Strengthening the Nuclear Non-Proliferation Treaty: Lessons from the Nuclear Threat Initiative’s Global Enterprise Project

The Nuclear Threat Initiative (NTI), with the support of the Norwegian Ministry of Foreign Affairs, is pleased to present a side event at the 10th Nuclear Non-Proliferation Treaty (NPT) Review Conference (RevCon) focused on sharing regional perspectives on strengthening the NPT. The session will present insights from NTI’s Global Enterprise project, which has convened officials and experts for a series of discussions in recent years aimed at developing concrete measures to advance the goals of the NPT. The project has also held three meetings – one in Brazil in 2019, one in Ghana in 2020, and one in Indonesia in 2022 – dedicated to understanding how different regions view the NPT and considering regional challenges and priorities for nonproliferation, nuclear risk reduction, and disarmament, as well as opportunities for cooperation. The side event will feature an overview of the Global Enterprise project and a  moderated discussion with a panel comprised of one participant from each of the three regional meetings.

The event will take place on August 15, 2022 from 1:15 p.m. to 2:30 PM in CR-4 and will also be available via livestream on UN Web TV. Sign up to receive the livestream link here.

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Disinformation Resources-Monkeypox Edition!

It’s the gift that keeps on giving, even when you desperately wish it would stop! We have now added a monkeypox section to our running list of disinformation resources, so you can find updates here on the site or at the end of the weekly issue.

Polygraph.info- “There is No Evidence Monkeypox is a Bioweapon”

William Echols tackles online claims, including those of Dr. Meryl Nass and Children’s Health Defense, that the current monkeypox outbreak is the result of a biological weapon in this piece. Echols also discusses USG’s approving of JYNNEOS in 2019 and current claims that this is evidence the current outbreak is the result of an intentional release.

Pandora Report: 7.29.2022

This week we bring more updates on monkeypox and discuss two new publications in Science that indicate SARS-CoV-2 very likely originated in the Huanan Seafood Wholesale Market in Wuhan. We also cover other new publications, upcoming events, and the launch of ASPR TRACIE’s new DASH tool.

Monkeypox Updates

WHO Declares Monkeypox PHEIC, US Cities Declare Local Health Emergencies

The global monkeypox case count has now reached 21,148 cases, with 20,804 of those in countries that have not historically reported monkeypox. In total, 78 countries are reporting cases, with only seven of them having historically done so. This weekend, the World Health Organization officially declared monkeypox a public health emergency of international concern (PHEIC), in an effort to heighten global alarm and improve response efforts. Max Kozlov explains in Nature, “In an unprecedented move, WHO director-general Tedros Adhanom Ghebreyesus declared the PHEIC on 23 July, after a panel of advisers failed to come to a consensus. Although the panel doesn’t formally vote, six members were in favour of declaring a PHEIC, while nine were against, Tedros said at a press conference announcing his decision. The panel had previously met in late June, but at that time only three members were for declaring a PHEIC and 11 were opposed, so Tedros decided against sounding the alarm at the time.”

As of July 28, the US is tracking 4,906 monkeypox cases, making it the highest case count in a non-endemic country, surpassing Spain and the United Kingdom. According to CIDRAP, “Almost all US patients (99%) have experienced a rash, while 70% have reported malaise, 64% fever, and 63% swollen lymph nodes.” In absence of a federal emergency declaration, US cities are considering declaring their own health emergencies. For example, San Francisco declared a local health emergency that will go into effect on Monday. It is a legal action that will ideally help city departments to mobilize against monkeypox more effectively. The State of New York’s Health Commissioner, Dr. Mary T. Bassett, declared an imminent threat to public health recently, citing the rapid spread of the virus. “This declaration means that local health departments engaged in response and prevention activities will be able to access additional State reimbursement, after other Federal and State funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities,” she said in a statement.

Vaccine and Testing Access Remain Limited

These declarations come as the Biden administration is under fire for what many view as a sluggish response to monkeypox and concerns that the window of opportunity to contain the virus is rapidly closing. Specifically, nearly 800,000 doses of vaccine were held as the FDA completed a review of them and, earlier, as the virus spread in New York and other communities, 300,000 doses owned by the US sat in a facility in Denmark waiting to be shipped. Though US federal agencies helped develop the JYNNEOS vaccine, the Strategic National Stockpile held just a few thousand doses initially. As this vaccine is produced by a small company in Denmark, Bavarian Nordic, access to this specific vaccine has been constrained.

The US had a much larger supply of another smallpox vaccine that can be used for monkeypox under an Expanded Access Investigational New Drug application-ACAM2000. However, ACAM2000 shouldn’t be used in people who have things like different immunodeficiency diseases, certain skin conditions, or who are currently pregnant. The immune response takes about 14 days from the second dose of JYNNEOS (taken four weeks after the first dose), as opposed to the four weeks it takes after ACAM2000 (which is just one dose). JYNNEOS in an attenuated live virus vaccine and is replication-deficient, whereas ACAM2000 is replication-competent and uses the vaccinia virus, which can cause serious complications for some, especially those who are immunocompromised.

“We believe we have done everything we can at the federal level to work with our state and local partners and communities affected to make sure we can stay ahead of this and end this outbreak,” Xavier Becerra, head of the Department of Health and Human Services, told reporters on a call. NPR writes that he also “added that local health officials “must do their part. … We don’t have the authority to tell them what to do.””

Some at the local and state level argue that HHS does not understand the full breadth or severity of this crisis. New York, San Francisco, and Washington DC have now stopped scheduling appointments for second Jynneos doses, citing limited supplies and a desire to get first doses into more people. CIDRAP writes, “The CDC maintains that two doses of Jynneos should be administered 28 days apart, with full protection achieved 14 days after the second dose. But some local health officials are changing protocols. In Washington DC, health officials are postponing some second doses of monkeypox vaccine in a strategy to give first doses to more people.”

Social Stigmas Harming the Monkeypox Response

To make matters worse, public discourse on the monkeypox crisis is riddled with blatant homophobia and there continues to be a lack of access to resources in non-western countries currently experiencing outbreaks. NPR explains that, “In fact, the WHO emergency committee that had previously considered whether to issue such a declaration was unable to reach a consensus in part because of concerns about the risk of stigma, marginalization and discrimination against the communities hit hardest by the virus.”

As the US and other countries continue to mostly see cases in those who identify as men who have sex with men, it is important to both acknowledge what risks this poses while also understanding that, “While we may be seeing clusters primarily in certain groups of people, viruses do not discriminate by race, by religion, or by sexual orientation,” as Dr. Boghuma Titanji told NPR. The WHO has asked those in this community to limit their number of sexual partners or reconsider having sex with new partners.

From CDC PHIL: This 1997 image was created during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo (DRC), formerly Zaire, and depicts the dorsal surfaces of the hands of a monkeypox case patient, who was displaying the appearance of the characteristic rash during its recuperative stage. Even in its stages of healing, note how similar this rash appears to be when compared to the recuperative rash of smallpox, also an Orthopoxvirus.

“The Molecular Epidemiology of Multiple Zoonotic Origins of SARS-CoV-2” and “The Huanan Seafood Wholesale Market in Wuhan was the Early Epicenter of the COVID-19 Pandemic”

Two studies we previously discussed as preprints were recently published in Science, one determining that it is unlikely that SARS-CoV-2 was circulating widely in humans prior to November 2019 and that it likely resulted from multiple zoonotic events, and the other finding that the Huanan Seafood Wholesale Market in Wuhan was the cite of its emergence thanks to live wildlife trade. These help put to rest claims that SARS-CoV-2 originated in laboratory facilities, including the Wuhan Institute of Virology. Dr. Angela Rasmussen, one of the scientists who co-authored these papers, discussed their findings in this video with PBS News Hour:

“Regenerate: Biotechnology and U.S. Industrial Policy”

Ryan Fedasiuk of the Center for New American Security and Georgetown’s Center for Security and Emerging Technology recently authored this report, writing “A revolution in biotechnology is dawning at the precise moment the world needs it most. Amid an ongoing climate crisis, fast-paced technological maturation, and a global pandemic, humans must find new ways to reduce greenhouse gas emissions, improve food security, develop new vaccines and therapeutics, recycle waste, synthesize new materials, and adapt to a changing world. But incentive structures in the U.S. private sector are generally biased against risk, and therefore constrain development in ways that do not have the same effect on firms in China and other U.S. competitors. This puts the United States at a relative disadvantage and risks ceding American leadership over one of the most powerful and transformative fields of technology in recent memory.

The United States needs some form of industrial policy to promote its bioeconomy—one that is enshrined in democratic values and focused on improving access to four key drivers of bioeconomic growth: equipment, personnel, information, and capital. This report attempts to measure the health and outlook of the U.S. synthetic biology industry and broader bioeconomy by examining U.S. access to each of these four resources. It concludes that the United States still possesses an advantage in each of these fields—but that, absent a proactive strategy to ensure resource access, and without a significant infusion of capital, the U.S. bioeconomy risks languishing behind competitors such as China in the decades ahead.”

Revisiting Gain of Function Research: What the Pandemic Taught Us and Where Do We Go From Here

The US Senate Committee on Homeland Security and Governmental Affairs’ Subcommittee on Emerging Threats and Spending Oversight will hold this hearing on August 3 at 2:30 pm ET. More information, including the video conference link, will become available here.

Evaluating COVID-19-Related Surveillance Measures for Decision Making

The National Academies are hosting a webinar with the Societal Experts Action Network highlighting new and updated COVID-19-related data measures and surveillance strategies that have emerged. Throughout the COVID-19 pandemic, decision makers have made critical decisions in rapidly changing circumstances, with limited information and uncertainty about the best available data or evidence. As the pandemic has continued to evolve, the types of data available have changed with the identification of new variants, the availability of COVID-19 vaccines, the introduction of new COVID-19 therapeutics, the reopening of the economy, and the relaxing of mitigation measures. In addition to analyzing positive COVID-19 cases, hospitalization data, and vaccination rates, as was common earlier in the pandemic, decision makers may take into consideration surveillance strategies like wastewater surveillance and genome sequence testing and surveillance. This webinar is on August 3 at 3:30 pm ET. Register here.

Disaster Available Supplies in Hospitals (DASH) Tool Launched

ASPR TRACIE’s new tool, DASH, is now available at dashtool.org. Hospital emergency planners and supply chain staff can use DASH to estimate supplies categorized in four modules (pharmaceutical, burn, trauma, and PPE) that may need to be immediately available during various mass casualty incidents and infectious disease emergencies based on hospital characteristics. Each module also incorporates pediatric sizes and specific medication needs as appropriate. TRACIE is offering a webinar on the tool August 15 at 11:30 am ET. Register here.