Pandora Report: 6.3.2016

Which country do you think is the biggest consumer of antibiotics? You’ll be shocked to see the results in this infographic. The organization, No More Epidemics, has also created an infographic on pathogens and poverty, depicting the “general trajectory of infectious disease outbreaks from outbreak to epidemic, showing the potential power of interventions to interrupt the course of progression.” You may want to rethink baking this weekend as the CDC is currently working to control an E. coli outbreak related to General Mills flour. Before we start our adventure down the biodefense rabbit hole, check out this experiment showing just how far sneezes really spread (brace yourself for a “violent explosion of saliva and mucus”).

The Importance of a Resilient Health System
Sure, this may seem like a pretty obvious concept but it’s something we still struggle with. The 2014 Ebola outbreak proved it and Zika virus is just adding some salt with a side of lime juice to the wound. Between climate change, spillover, and antibiotic resistance, the need for a resilient and robust public health system has never been more dire. “The point is that resilience in the health sector is not static but rather an ongoing and evolving state of affairs. Well-performing health systems provide sustained, equitable access to essential services for all without financial hardship. They are better able to bounce back when adversity strikes; are prepared to detect and respond to emerging disease threats; are able to adapt to adverse conditions; address a wide range of health challenges; and offer innovative solutions by leveraging diverse skills and views.” USAID is working to help fix holes in the existing system through their initiatives like Fighting Ebola: A Grand Challenge for Development and the newer Combating Zika and Future Threats Grand Challenge. The world is moving at a rapid pace and with innovation and globalization, the potential for a pandemic is only a flight away. Now is the time to strengthen our public health system.

NSABB Select Agent & Gain of Function Progress
A few weeks back we discussed the National Science Advisory Board for Biosecurity’s (NSABB)’s meetings regarding Gain-of-Function (GoF) work and their risk assessment with subsequent recommendations for evaluation and oversight of proposed GoF research. Six meetings and two workshops later, NSABB approved the final proposal. The May 24th, 2016 version is similar to the earlier draft however, specific examples of “studies of concern” were provided. Seasonal flu GoF studies are not considered concerning and NSABB did modify its definition of GoF Research of Concern. “The report has new wording that is apparently aimed at critics who have argued that the HHS should not review studies it funds, because that would represent a conflict of interest. The report says the HHS review ‘should be structured to avoid real or apparent conflicts of interest,’ but doesn’t specify how that can be done.” While implementation will be challenging and require immediate initiation, it’s believed that agencies won’t have trouble adapting to the new policy. You can also check out Gryphon Scientific’s final analysis on the risks and benefits of GoF research. Enjoy Chapter 11 regarding the loss of trust in science -GMU Biodefense MS student Julia Homestead helped write it!

Ancient Plague Epidemiology F2.large
Get your Indiana Jones hat ready, we’re going back in time to look at bioarcheology and the Eyam plague outbreak of 1665-1666. Researchers used a stochastic compartmental model and Bayesian analytical models to study this outbreak that started in September 1665 in the Derbyshire village of Eyam. Updated data from parish records allowed scientists to study this specific outbreak in a more in-depth manner, leading to the discovery that both rodent-to-human and human-to-human transmission played an important role in the spread of the disease. “We also found that the force of infection was stronger for infectious individuals living in the same household compared with the rest of the village. Poverty significantly increased the risk of disease, whereas adulthood decreased the risk. These results on the Eyam outbreak contribute to the current debate on the relative importance of plague transmission routes.”

Health on the G7 Summit Agenda
Last week, international officials met for the G7 Summit and during this gathering the topic of infectious diseases and control methods came to the table. “At the G7 Ise-Shima Summit, leaders will consider issues including strengthening the response to public health emergencies, by taking into account the lessons learned from previous outbreaks, such as Ebola. In addition, they will discuss ensuring the provision of lifelong healthcare services, from maternal, newborn and child health, through to non-communicable diseases and aging, in the pursuit of universal health coverage (UHC)”. Ebola, Zika virus, and Yellow Fever are all hot topics (see what I did there…) of concern. Improving investment in pandemic response was a vital part of the G7, as well as endorsement of the Global Health Security Agenda. Hopefully, with more international awareness and investment, the practice of putting out infectious disease fires will be a thing of the past.

Zika Weekly Roundup
The WHO has released their latest global response report on the Zika virus outbreak. The report gives an overview regarding the Strategic Response Framework and Joint Operations Plan as well as current funding gaps for “critical activities until the end of June 2016, as well as the approach to setting a new strategy from July 2016 onwards.” You can also find a scoping review of the Zika literature here. 233 studies were compiled with findings that “several knowledge gaps were identified by this review with respect to ZIKV epidemiology, the importance of potential non-human primates and other hosts in the transmission cycle, the burden of disease in humans, and complications related to human infection with ZIKV.” A woman in New Jersey has given birth to a baby girl with microcephaly, making her the second Zika-related microcephaly case in the U.S. Entomologists and medical experts are participating in a Zika Symposium and you can check out some of the presentations here. President Obama commented on the need for Zika funding during his speech in Elkhart, IN, this week, noting that “we need more who are willing to work with us to lower health care costs, give us the funding we need to fight public health challenges like Zika and the opioid epidemic — Joe Donnelly is working on that diligently.” Researchers are looking at the risk factors for eye abnormalities in congenital Zika infections and scientists are now raising concern over transmission related to oral sex. Lastly, as of June 1st, 2016, the CDC has reported 618 travel-associated cases in the U.S. 

Stories You May Have Missed:

  • First Locally-Acquired Chikungunya Case in Texas–  The Texas Department of State Health Services has confirmed the first case of local transmission. ” A Cameron County resident got sick with the illness in November 2015 and was diagnosed with a lab test in January 2016. The case, however, was not reported to the local health department until last month. The investigation performed by the Cameron County Department of Health and Human Services determined the patient had not traveled, and the case was confirmed last week by testing at the US Centers for Disease Control and Prevention.”
  • Edge of the Antibiotic Abyss – There’s been a lot of talk about antibiotic resistance and the impending dangers if we don’t act soon. Here’s an overview of the concerns and recent case that is causing so much worry. While it may not get the media attention of Zika virus, this is a very real issue and recent estimates indicate that we’re teetering on the edge of the antibiotic abyss.
  • India’s HIV Blood Transfusion Transmission Reality– The National AIDS Control Organization has released their report following a petition by activist Chetan Kothari, revealing that at least 2,234 Indians have contracted HIV while receiving blood transfusions. Scarier yet, these cases occurred in the past 17 months. Kothari has pushed for investigations, citing that while it is mandatory for hospitals to screen donors, the cost of the test and limited availability of testing facilities (Mumbai has only three private hospitals with HIV testing facilities) makes this a growing threat to anyone requiring blood transfusions. India currently has around 2.09 million people living with HIV/AIDS.
  • The European Centre for Disease Prevention and Control – The ECDC has updated its rapid risk assessment for the current yellow fever outbreak that is impacting Angola, DRC, and Uganda. “In the EU/EEA, the risk of yellow fever virus being introduced is limited to unvaccinated viraemic travellers coming from areas with active local transmission.”

Airborne Bird Flu Transmission: Balancing Scientific Recourse and National Security

By Chris Healey

Articles recently published in the scientific journal Cell mark the end of a long battle for one researcher in his endeavor to publish research that raises security concerns.

Ron Fouchier, a virologist with Erasmus University Medical Center in the Netherlands, published an article in Cell explaining how H5N1, the causative agent of bird flu, can be genetically modified for airborne transmission between mammals. Dr. Fouchier says his research can help prevent bird flu pandemics. However, others in the scientific community believe Dr. Fouchier will cause what he seeks to prevent.

David Relman, a researcher at Stanford University, says Dr. Fouchier is essentially giving would-be terrorists instructions on how create a deadly contagion.


The controversy began in December 2011 when the  National Science Advisory Board for Biosecurity (NSABB), a federal advisory committee composed of twenty-five members who provide expertise in areas such as molecular biology and infectious diseases, advised all scientific journals to refrain from publishing Dr. Fouchier’s H5N1 airborne transmission research.

In February of 2012, the World Health Organization released its own evaluation of the research. The WHO stated Dr. Fochier’s work had scientific value and should be shared in its entirety. Shortly after the WHO’s report, the NSABB reevaluated the research findings. In March 2012, it retracted its recommendation to refrain from publishing. The complete study, along with all its findings, was finally published in Cell on April 10, 2014.

By its nature, science is a cumulative process. Communication among professionals is essential to promote progress and mutual understanding. Experts agree scientific advancement progresses best when least inhibited by authority. Government intervention generally pushes great minds away from heavily-scrutinized areas into those less regulated.

However, national security remains a priority and precedent exists for controlling scientific literature. The Atomic Energy Act of 1946 was passed to control and restrict nuclear weapons research conducted in the United States during WWII. No similar legislation exists to prevent communication of biological findings. However, the government can take steps to restrict research with dual use findings.

Government information classification, colloquially known as identifying information as top secret, secret, or confidential, is useful for keeping government-owned information away from the public. However, research the government had no part in creating, either through federal funding or conducted by government employees cannot be given a sensitivity label.

A common practice in government funding of scientific research is the requirement of funding to be contingent upon acceptance of sensitive but unclassified contract provisions. Those provisions allow the government to have authority on whether research findings can be published.

Dr. Fouchier’s research was precarious because it was conducted in a foreign university but supported by U.S federal funds. Outside the United States, the federal government has less control over research conducted under its auspices. It is unclear if Dr. Fouchier’s research was subject to a sensitive but unclassified contract provision.

With the power of the purse, the federal government can influence research and publication decisions through threat of funding withdrawal. While federal money funds much scientific research, simply pulling funding is not a fool-proof censorship method. Private benefactors can step in for lack of government support. The government can wield no financial influence on those sources receiving no government funding, including research funded by foreign governments.

Outside of financial influence, the government can best stop publication of sensitive material through NSABB recommendation. The committee has many ties to scholarly publications and is generally well respected. Initial recommendations not to publish Dr. Fouchier’s research were very influential; it was not published until well after committee approval.

There is no straight-forward answer to questions concerning science and security dissidence. Benefits of sharing scientific research must be weighed with harm that could arise from that research.

 

Image Credit: James Jin/Flickr