Pandora Report: 9.6.2019

Happy Friday! We hope you had a lovely week as the summer winds down. If you’re considering reading the latest Richard Preston book, you might want to check out this review.

Journal of Biosecurity, Biosafety and Biodefense Law 
Volume 10 is now available, which “offers both a legal and scientific perspective on current issues concerning bioterrorism, public health and safety, and national security. Edited by an international board of leading scholars from all the continents, our journal is aware that bioterrorism related issues are global problems. Our goal is to develop a unique international community of legal scholars, scientists and policy experts who will address current issues in these fields.” Within this latest volume, you can find articles on vaccine exemptions, the looming threat of agroterrorism, the history of tuberculosis quarantine, and much more.

The Oversecuritization of Global Health: Changing the Terms of Debate
“Linking health and security has become a mainstream approach to health policy issues over the past two decades. So much so that the discourse of global health security has become close to synonymous with global health, their meanings being considered almost interchangeable. While the debates surrounding the health–security nexus vary in levels of analysis from the global to the national to the individual, this article argues that the consideration of health as a security issue, and the ensuing path dependencies, have shifted in three ways. First, the concept has been broadened to the extent that a multitude of health issues (and others) are constructed as threats to health security. Second, securitizing health has moved beyond a rhetorical device to include the direct involvement of the security sector. Third, the performance of health security has become a security threat in itself. These considerations, the article argues, alter the remit of the global health security narrative; the global health community needs to recognize this shift and adapt its use of security-focused policies accordingly.”

The Soldiers Who Took On Yellow Fever
Battling Aedes aegypti to help combat Yellow Fever isn’t for the faint of heart and here’s insight into how it went down. “The Yellow Fever Board, led by then-Major Walter Reed and Jesse Lazear, had convened at the Army’s Columbia Barracks in Cuba, at the height of a deadly yellow fever epidemic ravaging Cuba in 1900. Today, we know that yellow fever spreads when Aedes aegypti mosquitoes bite infected people, then carry the virus to the next person they bite. But in 1900, American doctors weren’t sure if the virus spread through infected blood, or through traces of infected material on bedding. Volunteer soldiers subjected themselves to living in yellow fever survivor filth, and later to mosquito bite tests, to advance understanding of disease transmission.”

Lyme Disease – It’s Not A Bioweapon… 
In case you missed the several other times we mentioned how Lyme disease isn’t an escaped bioweapon….here’s another breakdown. “One of the most important characteristics of a biowarfare agent is its ability to quickly disable target soldiers. The bacteria that cause Lyme disease are not in this category. Many of the agents that biowarfare research has focused on are transmitted by ticks, mosquitoes, or other arthropods: plague, tularemia, Q fever, Crimean Congo hemorrhagic fever, Eastern equine encephalitis or Russian spring summer encephalitis. In all of them, the early disease is very debilitating, and the fatality rate can be great; 30 percent of Eastern equine encephalitis cases die. Epidemic typhus killed 3 million people during World War I. Lyme disease does make some people very sick but many have just a flu-like illness that their immune system fends off. Untreated cases may subsequently develop arthritis or neurological issues. The disease is rarely lethal. Lyme has a weeklong incubation period – too slow for an effective bioweapon. And, even though European physicians had described cases of Lyme disease in the first half of the 20th century, the cause had not been identified. There was no way the military could have manipulated it because they did not know what ‘it’ was.”

Why We Need More Open-Source Epidemiological Tools 
“A newer tool, though, is changing the game in outbreak response and modeling. The Spatiotemporal Epidemiologic Modeler (STEM) is an open-source software that is available to the global health community. This is not just a rigid instrument against disease, in that it is not pre-set to a specific disease or environment and has the flexibility for hundreds of variations. ‘STEM has been used to study variations in transmission of seasonal influenza in Israel by strains; evaluate social distancing measures taken to curb the H1N1 epidemic in Mexico City; study measles outbreaks in part of London and inform local policy on immunization; and gain insights into H7N9 avian influenza transmission in China. A multi-strain dengue fever model explored the roles of the mosquito vector, cross-strain immunity, and antibody response in the frequency of dengue outbreaks,’ the authors of a briefing in Health Security wrote.
The latest version was just released this year and allows users to really refine it based on their needs. From Ebola in West Africa to Salmonella in Germany, it has been used by agencies and universities alike. In fact, one of the authors, Nereyda Sevilla, PhD, used it for her doctoral dissertation work to model SARS, H1N1, and pneumonic plague in air travel in order to assess its role as a vector in the transmission of infectious diseases. What makes STEM so helpful to users is not only that it’s open access, but also its wide application and historical usage in tracking multi-strain vector-borne diseases, human behavioral responses, earth science data, pathogens from farm to fork, and so much more.”

Ebola Outbreak Updates
This week, cases of Ebola virus disease continued to rise in the DRC, as 6 were reported over 4 days, bringing to the outbreak to 3,043 cases and 2,035 deaths. The epidemiological investigation into the 9-year-old girl who died from Ebola in Uganda last week is also pointing to a potential nosocomial source for her infection. “The cases were confirmed during a weekend of unrest throughout the outbreak region, including Kalunguta, where a motorcycle was burned and several people clashed with local Ebola response agents who were attempting to perform a safe and dignified burial for a patient. According to translated media reports, the conflict began when family members protested the declaration of the deceased as an Ebola patient. In the latest update from the World Health Organization’s (WHO’s) African regional office, the WHO says the new ‘hot spot’ status of Kalunguta is of highly worrisome. ‘A review of key performance indicators at week 34 (19-25 August 2019) shows, in comparison with the previous week, an increase in the number of new confirmed cases, a decrease in the proportion of deaths on notification, persistence of the low proportion of new confirmed cases listed as contacts and an extension of affected health areas,’ the WHO said. ‘All these, along with the addition of Kalunguta as a hot spot area, are of grave concern’.”

Restricting the Use of Riot-Control Chemicals 
Mounting discussions to restrict the use of riot-control chemicals have come in the face of use in Hong Kong and the US-Mexico border. “Police forces use these riot-control chemicals to clear crowds or to stop fighting. In theory, exposure should be minimal — a group should disperse within minutes to avoid the gas. The line between civilian and military applications of these chemical agents is a fine one. Rules governing their use are confused. Reference books and training materials continue to cite toxicology studies from the 1950s. And those were done on animals and soldiers, not the public. The chemicals involved are mainly CS (2-chlorobenzalmalononitrile, the primary component of tear gas) and OC (oleoresin capsicum, a chilli-pepper extract used in pepper spray). Tear gases were developed to harass the enemy or to clear bunkers and tunnels in conflicts such as the Vietnam War, as alternatives to deadly force. Pepper sprays came into use in the 1980s for police and self-defence use after being developed as an animal repellent in the 1960s.”

Identifying and Responding to Newly Resistant Infections
Infection preventionist and GMU biodefense doctoral alum Saskia Popescu discusses the frontlines of antimicrobial resistance surveillance and response. “In the world of growing antimicrobial resistance, the identification of patients with highly resistant (or newly resistant) infections is critical. Because this is an emerging challenge, national and international surveillance efforts are still being strengthened to tackle all the avenues that contribute to antimicrobial resistance. The frontline identification of these newly resistant infections is critical though and surveillance is not only the first step in identifying and understanding the problem, but it also allows us to properly isolate the patient to avoid further transmission. Bacteria like Klebsiella pneumoniae are increasingly developing resistance to antimicrobials and can easily be spread through health care facilities. Klebsiella bacteria are also showing a relatively new resistance to the carbapenem class of antibiotics. Typically, these bacteria cause infections like pneumonia, bloodstream infections, wound or surgical site infections, and even urinary tract. A recent publication in the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) described experiences surrounding the identification of a Klebsiella pneumoniae isolate that had 3 carbapenem-resistant genes (CR-Kp) and was related to urinary procedures.”

Surgical Masks vs. N95s
In the battle against influenza, there can only be one..”In outpatient settings, surgical masks and more expensive respirator masks appear to be equally effective for protecting health workers against flu and other respiratory viruses, according to a new study based on data over four flu seasons. Earlier studies comparing the two forms of respiratory protection have shown mixed results. Uncertainty over which is better has been a sticking point in forming recommendations on how best to protect healthcare workers, especially during the 2009 H1N1 pandemic. And the new findings come in the wake of 2018 research that showed that flu likely also spreads by small aerosol particles, not just by respiratory droplets. Tighter-fitting N95 masks are designed to filter at least 95% of airborne particles, but some healthcare workers find them less comfortable than surgical masks, leading to problems with adherence. During the 2009 H1N1 flu pandemic, some hospitals and clinics had problems restocking their N95 supplies.”

GMU Research Team Sequence Komodo Dragon Genome
“George Mason University researchers Monique van Hoek and Barney Bishop and their collaborators have released their findings on sequencing the Komodo dragon genome, revealing multiple clusters of antimicrobial peptide genes that could prove instrumental in the fight against multi-drug resistant bacteria. Their work, which was published in the latest issue of BMC Genomics, identified key clusters of Komodo dragon antimicrobial peptide genes, which are protein-like molecules that contribute to the front line defense of its immune system. Komodo dragons are resilient reptiles with robust immune systems that regularly dine on dead and decaying flesh and whose saliva is known to be rich in bacteria.”

Stories You May Have Missed:

  • Brooklyn Measles Outbreak Over – “Today the Centers for Disease Control and Prevention (CDC) confirmed 19 new measles infections, raising the 2019 total to 1,234 cases in 31 states. One additional state has been affected since the CDC’s last update, but the number of active outbreaks has been reduced to four, down from six noted last week. As of Aug 29, 125 of measles case-patients had been hospitalized, and 65 reported having complications, including pneumonia and encephalitis, the CDC said. More than 75% of measles cases recorded in 2019 have come from two outbreaks among New York State’s Orthodox Jewish communities—one in Williamsburg, Brooklyn, and one in Rockland County.”

Pandora Report: 8.30.2019

Alumna Spotlight: Biodefense Grad Tam Dang, Dallas County Epidemiologist
“Tam Dang started in the biology world, earning her Bachelor’s of Science degree from George Mason University in 2008. But it was her course of study in the Master’s in Biodefense program at the Schar School that put her on her present career path. The degree, she said, ‘introduced me to the public health field, and offered a unique perspective from a biosecurity and bioterrorism standpoint.’ Today, Dang is an epidemiologist for the Dallas County Department of Health and Human Services in Dallas, Texas. She works in the Acute Communicable Disease Epidemiology Division, helping to lead epidemiological investigations for infectious disease outbreaks or potential bioterrorism events. She monitors local, regional, and state data sources related to infectious diseases, and helps develop outbreak and bioterrorism plans to help support public health preparedness. Her work is at the intersection of public health and health security, an important field in the modern era.”

BioWatch Data Stored on Vulnerable Contractor Website for Years
Well that’s a big oops… “For more than a decade, the Department of Homeland Security failed to properly secure sensitive information on the primary BioWatch information portal, which contained bioterrorism surveillance testing information and response plans that would be put in place in the event of an attack. In August 2016, Harry Jackson, who worked for a branch of Homeland Security that deals with information security, was assigned to the BioWatch program. Three months later, he learned about biowatchportal.org and demanded the agency stop using it, arguing that it housed classified information and that the portal’s security measures were inadequate. A security audit completed in January 2017 found ‘critical’ and ‘high risk’ vulnerabilities, including weak encryption that made the website ‘extremely prone’ to online attacks. Internal Homeland Security emails and other documents reviewed by the Los Angeles Times show the security issue set off a bitter clash within the department over whether keeping the information on the dot-org website run by Logistics Management Institute posed a threat to national security.”

Oversight of Lab-Created Potential Pandemic Pathogens and the BWC
Lynn C. Klotz discusses accidental releases and research with pathogens of pandemic potential in relation to the Biological Weapons Convention. “Seeding a pandemic is not a problem for future consideration; the possibility is upon us now. There is an urgent need for international oversight and regulation of this research. The countries that are party to the Biological Weapons Convention  (BWC) may not believe it to be within the BWC mandate to oversee academic research whose goal is public health. But if the parties decide this kind of oversight is within the BWC mandate (under Article XII), guidelines and regulations could be enacted fairly quickly. At the very least, the parties could act as a catalyst, launching discussions toward a new international treaty on oversight and regulation of this dangerous research. In the meantime, since enacting new treaties is an uncertain and long process, the BWC parties should work to pass legislation in their nations.” Klotz breaks down if such a release could result in a pandemic and if those pathogens could be classified as a biological weapon. “For lab-created potentially pandemic pathogens, any quantity, however small, could seed an outbreak or pandemic. In this circumstance, development also implies production and stockpiling, since a single vial of infectious agent and one to a few infected individuals are all that is necessary to launch an attack. From a military tactical point of view, however, lab-created pandemic pathogens would not be good biological weapons; they would boomerang back on the attackers since they are highly transmissible. Nonetheless, a suicidal terrorist group or a desperate country might employ them as a last resort, or threaten to employ them as a means of extortion.” Klotz ultimately notes that there is a need for action from the parties of the BWC – “Hopefully, the states that are party to the BWC will set in motion a process for overseeing relevant new research and technologies. If they decide that lab-created potentially pandemic pathogens are within the BWC mandate under Article XII, they could speed up the enactment of guidelines and regulations.”

Data Collection Gaps Are Damning the Ebola Outbreak
The outbreak in the DRC is continuing to spread as 14 new cases were reported on Wednesday and the South Kivu cluster has grown by 5, bringing the outbreak closer to 3,000. GMU Biodefense PhD alum Saskia Popescu discusses the implications of the data gaps within the current Ebola outbreak in the DRC. “Late last week 2 Ebola virus disease (EVD) cases were confirmed in the South Kivu region of the Democratic Republic of the Congo (DRC), some 400 miles away from where the outbreak first began. The cases were reported in a woman, who had been vaccinated, and her child who had traveled from Beni. The government is currently working to vaccinate and monitor 120 contacts of these 2 individuals. In the face of this expanding outbreak that has surpassed 2700 confirmed cases, there has been much attention on the drug and vaccine trials that are ongoing. Unfortunately, in the fervor of excitement surrounding the promise of treatment, few have paid attention to the quality of data that is made available. Pierre Rollin, MD, a veteran Ebola fighter, recently drew attention to some deeply concerning issues in the outbreak response in an article in The Lancet Infectious Diseases. Rollin underscored that although there was initial confidence in the response to the outbreak, mostly due to therapeutics and experienced personnel, leadership and coordination failures amid a conflict zone and community mistrust all helped the outbreak spiral. One component of Rollin’s review is deeply concerning—the ‘ineffectiveness of the collection, analysis, and diffusion of epidemiological data, the centerpiece of any response, is predictive of the situation worsening.’ Similar to what was felt by many on the ground during the 2014-2016 West African Ebola outbreak, the various databases between agencies, groups, etc., all made situational awareness and response that much more challenging.”

How Does USAMRIID’s Shutdown Impact US Biodefense and Bioterrorism Laboratory Response Network?
“The Laboratory Response Network (LRN) is a collaborative federal effort run by the U.S. Centers for Disease Control and Prevention in cooperation with other federal agency and public health partners. Most state public health laboratories participate as reference laboratories of the LRN. These facilities support hundreds of sentinel laboratories in local communities throughout the U.S. and its territories, providing confirmatory diagnosis and typing of biological threats used in a bioterrorist attack or causing a public health emergency. The U.S. Army Research Institute of Infectious Diseases (USAMRIID) Special Pathogens Laboratory at Fort Detrick is one of only three National Laboratories at the top of the protective umbrella of the LRN structure, along with those operated by the CDC and the Naval Medical Research Center (NMRC), responsible for specialized characterization of organisms, bioforensics, select agent activity, and handling highly infectious biological agents. It begs the question then, what happens when an important component of the nation’s biopreparedness infrastructure fails to meet CDC biosafety requirements and has its Federal Select Agent certification pulledGlobal Biodefense submitted requests to USAMRIID and the CDC on Aug. 6 for information on the status of the Institute in the LRN structure and whether another Biosafety Level-4 laboratory will be designated as an interim substitute National Laboratory.”

Identifying and Responding to Newly Resistant Infections
“In the world of growing antimicrobial resistance, the identification of patients with highly resistant (or newly resistant) infections is critical. Because this is an emerging challenge, national and international surveillance efforts are still being strengthened to tackle all the avenues that contribute to antimicrobial resistance. The frontline identification of these newly resistant infections is critical though and surveillance is not only the first step in identifying and understanding the problem, but it also allows us to properly isolate the patient to avoid further transmission. Bacteria like Klebsiella pneumoniae are increasingly developing resistance to antimicrobials and can easily be spread through health care facilities. Klebsiella bacteria are also showing a relatively new resistance to the carbapenem class of antibiotics. Typically, these bacteria cause infections like pneumonia, bloodstream infections, wound or surgical site infections, and even urinary tract. A recent publication in the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) described experiences surrounding the identification of a Klebsiella pneumoniae isolate that had 3 carbapenem-resistant genes (CR-Kp) and was related to urinary procedures.”

NTI’s Educational Resources
Whether you’re a student or an educator, you’ll love these resources from NTI’s Education Center. “You’ll find teaching tools, such as the new Building Security Through Cooperation report about working with North Korea on denuclearization and Middle East Missile Mania, our new comprehensive interactive map and analysis detailing the history of missile programs in 12 countries across the Middle East. Do you want to know more about what’s making headlines but only have a few minutes to catch up? We have a new U.S.-Russian arms control infographic and a one-page fact sheet on the INF Treaty. You may also want to watch our 3-minute video about the importance of the New START treaty. Those wanting a deeper dive for their advanced classes might want to check out our updated Global Incidents and Trafficking database, which tracks global incidents involving nuclear or other radioactive material, or the North Korea Missile Test Database.”

Stories You May Have Missed:

  • Outbreak of Resistant Salmonella Newport Tied to Soft Cheese-“The Centers for Disease Control and Prevention (CDC) today detailed an unusual 255-case outbreak of Salmonella Newport infections in 32 states tied to both beef and soft cheese and showing resistance to multiple antibiotics. ‘Infections were linked to beef obtained in the United States and soft cheese obtained in Mexico, suggesting that this strain could be present in cattle in both countries,’ the CDC said in an overview emailed to physicians as part of its Clinician Outreach and Communication Activity (COCA) efforts.

Pandora Report: 8.16.2019

 Pandemic Bonds – Designed to Fail Ebola 
Is the World Bank’s funding approach to outbreak response hurting the DRC during their fight against Ebola? Olga Jones discusses how the Pandemic Emergency Financing Facility (PEF) works and how it is ultimately helping investors but not health security. “The World Bank has said that the PEF is working as intended by offering the potential of ‘surge’ financing. Tragically, current triggers guarantee that payouts will be too little because they kick in only after outbreaks grow large. What’s more, fanfare around the PEF might have encouraged complacency that actually increased pandemic risk. Following false assurance that the World Bank had a solution, resources and attention could shift elsewhere. Rather than a lack of funds, vigilance and public-health capacity have been the main deficiencies. When governments and the World Bank are prepared to respond to infectious-disease threats, money flows within days. In the 2009 H1N1 influenza outbreak in Mexico, clinics could diagnose and report cases of disease to a central authority that both recognized the threat and reacted rapidly. The Mexican government requested $25.6 million from an existing World Bank-financed project for influenza response and received the funds the next day.” Jones notes that “the best investment of funds and attention is in ensuring adequate and stable financing for core public-health capacities. The PEF has failed. It should end early — and IDA funds should go to poor countries, not investors.”

Maximizing Opportunities for US Bioeconomy Growth and National Security with Biology
“Recently, the Johns Hopkins Center for Health Security and Gingko Bioworks convened key science, technical, academic, and industry experts for a meeting to solicit stakeholder input on specific ways that national policy can strengthen the US bioeconomy. Their recommendations are synthesized in a summary report, released today. Participants considered the benefits to the US if its bioeconomy were to be expanded; examined the current health of the US bioeconomy; discussed existing US government programs, policies, and initiatives related to the bioeconomy; and identified priorities for strengthening the US bioeconomy.”

DRC Ebola Outbreak Updates
Beni and Madnima continue to be hotspots for the disease as they have accounted for 60% of recent cases, not to mention ongoing violence and unrest. “The security situation increased in volatility as a result of a surge in attacks from suspected ADF elements in Beni Health Zone and successive demonstrations,” the WHO said. “A recent attack in Mbau on the Beni/Oicha axis led to the deaths of six civilians, including a prominent civil society leader. EVD operations in the area were temporarily suspended with resumption pending improvement in the security situation.” On a more positive note, two outbreak treatment trials are showing promise. “An independent monitoring board meets periodically to review safety and efficacy data, and at their Aug 9 review recommended that the study be stopped and all future patients be randomized to receive either Regeneron, an antibody cocktail, or mAB 114, an antibody treatment developed from a human survivor of the virus. The other two drugs involved in the original trial were zMapp, which in an earlier trial didn’t show  statistically significant efficacy but performed better than standard care alone, and Remdesivir, an antiviral drug. Earlier in the outbreak, an ethics committee in the DRC approved the four experimental treatments for compassionate use, and patients at all of the country’s Ebola treatment centers have had access to them, along with safety monitoring. However, the formal clinical trial has been under way since November at four treatment centers with the help of the Alliance for International Medical Action (ALIMA), the International Medical Corps (IMC), and Doctors Without Borders (MSF). At a media telebriefing today, Anthony Fauci, MD, director of the National institute of Allergy and Infectious Diseases (NIAID), said Regeneron was the drug that crossed the efficacy threshold, triggering a pause in the study. And he said the group recommended proceeding with mAb 114, because there were only small differences in the data between the two drugs.”

Combatting Legionella and Carbon Footprints
Can we reduce the burden of Legionnaire’s disease while reducing our carbon footprint? GMU Biodefense PhD student and infection preventionist Saskia Popescu discusses a new strategy to preventing this water-based bug. “Typical health care control methods range from routine sampling to temperature control measures, like keeping cold water below 20°C and hot water at a minimum of 60°C. This has been the tried and true approach to Legionella control since there will always be some small level of the bacteria in water and the ultimate goal is to avoid growth that can cause human disease. Investigators in the United Kingdom recently published a study assessing a large health care facility’s approach to reducing Legionella risk through use of copper and silver ionization at hot water temperatures that were deliberately reduced to 43°C within a new water system. The research team collected 1589 water samples between September 2011 and June 2017, looking for not only Legionella bacteria, but also copper and silver ion levels, and total viable counts. To also assess the internal costs and function of this system, investigators collected data on energy consumption and water usage.”

2015 HPAI Outbreaks in the US – Insight Into Airborne Transmission 
“The unprecedented 2015 outbreaks of highly pathogenic avian influenza (HPAI) H5N2 in the U.S. devastated its poultry industry and resulted in over $3 billion economic impacts. Today HPAI continues eroding poultry operations and disrupting animal protein supply chains around the world. Anecdotal evidence in 2015 suggested that in some cases the AI virus was aerially introduced into poultry houses, as abnormal bird mortality started near air inlets of the infected houses. This study modeled air movement trajectories and virus concentrations that were used to assess the probability or risk of airborne transmission for the 77 HPAI cases in Iowa. The results show that majority of the positive cases in Iowa might have received airborne virus, carried by fine particulate matter, from infected farms within the state (i.e., intrastate) and infected farms from the neighboring states (i.e., interstate). The modeled airborne virus concentrations at the Iowa recipient sites never exceeded the minimal infective doses for poultry; however, the continuous exposure might have increased airborne infection risks. In the worst-case scenario (i.e., maximum virus shedding rate, highest emission rate, and longest half-life), 33 Iowa cases had > 10% (three cases > 50%) infection probability, indicating a medium to high risk of airborne transmission for these cases. Probability of airborne HPAI infection could be affected by farm type, flock size, and distance to previously infected farms; and more importantly, it can be markedly reduced by swift depopulation and inlet air filtration.”

Serbia Suspects African Swine Fever – Implications for Imports 
One Health in a nutshell – the economic implications of zoonotic diseases like African swine fever (ASF). “Serbia has reported four suspected outbreaks of African swine fever among backyard pigs, the Paris-based World Organisation for Animal Health (OIE) said on Monday, prompting neighbouring countries to ban imports of the animals. Three of the cases were detected in the Belgrade area and one in the district of Podunavski, the OIE said, citing a report from Serbia’s Agriculture Ministry. The suspected cases of the disease killed seven pigs while another 114 were slaughtered, the report showed. Bosnia, Montenegro and North Macedonia banned imports of pigs, wild boar and related products from Serbia to prevent the spread of the outbreak, the countries’ veterinary authorities said.”

A New Drug to Tackle Extensively Drug-Resistant TB
XDR-TB is a disease that causes significant health issues on a global scale and the effort to try and treat can be costly. A “new drug, pretomanid, has been approved by the US Food and Drug Administration (FDA) for use in a treatment for XDR-TB. Amazingly, it’s the first time that a treatment for XDR-TB infections has been recognized for actually working—no other treatment has demonstrated any consistent effectiveness. Up until now, people with XDR-TB had to suffer through up to two years or more of toxic treatment that worked only one third of the time. Today’s news means that treatment time is drastically reduced—to six months—while the effectiveness of treatment is significantly improved. We welcome this approval as it shows the real-world impact of US government investment in finding new cures and vaccines for the world’s deadliest diseases. The developer of pretomanid, the nonprofit organization TB Alliance, could not have succeeded in advancing this breakthrough without support from the American people, through the US Agency for International Development (USAID) and National Institutes of Health (NIH).”

Stories You May Have Missed:

  • Mega Malaria Vaccine Test Postponed in Kenya – “Kenya has postponed a large-scale pilot test for a malaria vaccine that could reduce the burden of the disease. The World Health Organisation (WHO) chose Malawi, Ghana and Kenya to vaccinate 360,000 children per year; and while the two nations began the rollout in April, Kenya is yet to start. The introduction in Kenya, planned for this Thursday, was postponed by the Ministry of Health. ‘I regret to inform you that the stakeholders breakfast meeting planned for this Tuesday, August 13, and the launch planned for Thursday, August 15, have been postponed to a later date to be communicated to you shortly. This is due to the upcoming Health Summit scheduled on August 14 and 15,’ head of the National Vaccines and Immunisation Programme, Dr Collins Tabu, said.”

Pandora Report: 8.9.2019

From Legionella to the BWC, we’re the spot for all things biodefense. Did you know that China recently approved an ethics advisory group after the CRISPR-babies scandal? Welcome to your weekly dose of global health security news!

Launch of the 2019 Next Generation Biosecurity Competition
Are you a global health security and biosecurity student or professional? “NTI | bio is partnering with the Next Generation Global Health Security (GHS) Network to advance the biosecurity and biosafety-related targets of the Global Health Security Agenda (GHSA). Together, we are launching the third annual joint competition to foster a biosecurity professional track within the Next Generation GHS Network. The 2019 competition will spur next generation experts in health security to discuss catalytic actions that can be taken to reduce biological risks associated with advances in technology and promote biosecurity norms. For the 2019 Next Generation for Biosecurity Competition, we will publish creative and innovative papers that promote regional, multi-sectoral, and global collaboration.  Each team can include up to three people and should: 1) explore concrete collaborative actions that can be taken to build national, regional, and global norms for preventing deliberate and/or accidental biological events; and 2) promote cross-sectoral and cross-regional partnerships to advance biosecurity and biosafety. Papers should directly address the biosecurity targets included within the World Health Organization Joint External Evaluation and the GHSA Action Package on Biosecurity and Biosafety (APP3).” If you’re a GMU biodefense student or alum – you’re in luck as we’ve got a Next Generation Global Health Security Network chapter (membership is a requirement for the competition).

CSIS- Federal Funding for Biosafety Research is Critically Needed
The Center for Strategic & International Studies (CSIS) has just released their report on why we desperately need to provide funding for biosafety research in the face of new biotech and emerging infectious disease threats. “Currently, we lack the evidence basis to take new, needed measures to prevent accidents in biological laboratories, which, as mankind continues to expand its capabilities to manipulate life (including the viruses and bacteria that cause disease), leaves us more vulnerable to the accidental initiation of disease outbreaks with potentially dangerous consequences locally, regionally, and beyond. New biotechnologies are enabling scientists to design or modify life in ways not previously possible. These biotechnologies enable professional and amateur researchers to use simple life forms (e.g., bacteria and yeast) to create simple sensors and produce industrial chemicals, materials, and pharmaceuticals cheaply and from commonplace reagents. The manipulation of pathogens (the microbes that cause disease) fosters a better understanding of how these agents evolve and interact with the body, enabling the development of next generation cures. Despite the significant U.S. and global investment in biotechnology, concern has been voiced by scientists, policy experts, and members of the community  that scientists may be ill-equipped to handle novel, manipulated microbes safely, potentially resulting in accidental infection of themselves or their local communities, accidental release into the environment, or even the initiation of a global pandemic.”

Biological Weapons Convention Meeting of Experts – Updates and Deciding on Emergency Assistance in Cases of Bioweapons Use
If you’ve been missing the MXs, Richard Guthrie has you covered with his daily accounts of these meetings and events. Thursday was the closing day of MX4 and focused on the financial situation. “The Chair of the 2019 Meeting of States Parties (MSP), Ambassador Yann Hwang (France), held informal consultations with delegates from states parties to discuss the financial situation for the BWC which remains difficult. Non- payments of agreed assessments by a number of states parties continue to cause problems. While some of these eventually appear as late payments, the ongoing deficit is sufficiently large to put the MSP at risk. As the financial accounting period is the calendar year, the MSP at the end of the year is always going to be the most vulnerable activity if there is a financial shortfall. In 2018, some economies were made on the MSP by having one informal day of activities without interpretation, putting a number of delegates at a disadvantage. The government of France has a clearly stated position on multilingualism within multilateralism and so the MSP Chair would be extremely reluctant to implement a similar route to financial savings. The Working Capital Fund established by the 2018 MSP is specifically designed not to subsidise non-payment, but to smooth out cash flow during the year. Depleting the fund — which is not even close to its target value – in its first year to cover the costs of the MSP would render it useless for purposes of supporting core activities such as the ISU. There are also financial implications of decisions that will need to be taken in relation to the Ninth Review Conference to be held in 2021.” Dr. Jean Pascal Zanders was also in attendance and has reported out on discussions surrounding Article VII – “Being one of the more obscure provisions in the BTWC, Article VII only attracted state party attention over the past ten years or so. In follow-up to the decision of the 7th Review Conference (2011), parties to the convention looked for the first time more closely at the provision during the August 2014 Meeting of Experts (MX). As it happened, the gathering coincided with the expanding Ebola crisis in West Africa. The epidemic gave urgency to the concrete implementation of Article VII. The daily images of victims and fully protected medical staff broadcast around the world left lasting impressions of how a biological attack from another state or terrorist entity might affect societies anywhere. Operationalising Article VII has proven more complex than anticipated. The provision comprises several clauses that fit ill together upon closer inspection and hence obscure its originally intended goals. In addition, it contains no instructions about how a state party should trigger it or the global community respond after its invocation.”

CSIS Commission on Strengthening America’s Health Security Meeting
“On June 26, 2019, the CSIS Commission on Strengthening America’s Health Security convened for the third time since its launch in April 2018. The Commission’s core aim is to chart a dynamic and concrete vision for the future of U.S. leadership in global health security—at home and abroad.” “On June 26, Commission members—a diverse group of high-level opinion leaders who bridge security and health and the public and private sectors, including six members of Congress—met to discuss a proposed U.S. doctrine for global health security. Commission members deliberated and reached a broad consensus endorsing a doctrine of continuous prevention, protection, and resilience, which would protect the American people from the most pressing global health security threats we face today. The measures outlined in the paper are affordable, proven, and draw support from across the political spectrum. The time to act is now.” Participants called for Congress and the administration to take action across seven areas, including ensuring full and sustained, multi-year funding for the GHSA, ensuring ample and quick-disbursing finances, establishing a global health crises response corps, etc.

Combatting AMR Through Payment Shifts
In the battle against the resistant bug, sometimes you have to change tactics and bring in the big guns – like the Centers for Medicare and Medicaid Services (CMS). Developing antimicrobials has been a particular challenge, despite efforts to push and pull research and development. BARDA Director Rick A. Bright recently discussed this problem, but now a new CMS rule could help guide change. “Without payment reform, the antimicrobials marketplace will not survive. CMS Administrator Seema Verma understands this reality and the necessity for a strong marketplace for both public health and national security purposes. On Friday, August 2, CMS issued its fiscal year (FY) 2020 Hospital Inpatient Prospective Payment System (IPPS) Final Rule. Among other changes to the way CMS pays for Medicare services, CMS recognized the need for greater payment of newer, potentially safer and more effective antimicrobial drugs. The new rule will (1) change the severity level designation for multiple ICD-10 codes for antimicrobial drug resistance from ‘non-CC’ to ‘CC’ (which stands for complications or comorbidities) to increase payments to hospitals due to the added clinical complexity of treating patients with drug-resistant infections, (2) create an alternative pathway for the new technology add-on payment (NTAP) for qualified infectious disease products (QIDPs), under which these drugs would not have to meet the substantial clinical improvement criterion, and (3) increase the NTAP for QIDPs from 50 percent to 75 percent. This final rule lessens economic incentives to utilize older antimicrobial drugs such as colistin, and shift medical practice to employ more appropriate, newer generation antimicrobials. Payment more closely aligned with the value of these lifesaving medicines will shift the current market realities of these drugs for companies, investors, and patients. No single action will solve the antimicrobial resistance problem; however CMS’ efforts undoubtedly can improve the marketplace and re-catalyze innovation in basic science discovery, and research and development efforts. We appreciate and congratulate Administrator Verma for taking such bold leadership in this fight. ”

Ebola in the DRC
The latest WHO dashboard is showing that the outbreak has reached 2,787 cases. Seven cases were reported from the DRC ministry of health earlier this week and there is growing concern about the impact the outbreak is having on children in the area. “Last December UNICEF sounded the alarm about the high number of children infected in the outbreak, noting that one of every third people confirmed infected in the DRC’s outbreak was a child, unusual for Ebola epidemics. The agency noted that 1 in 10 children were under age 5 and that kids were more likely to die from the disease than adults. Save the Children said in its statement yesterday that around 737 children have been infected with Ebola in the DRC’s outbreak. And based on the latest numbers, the impact on kids has increased. In the first 6 months of the outbreak, which was declared on Aug 1, 2018, just under 100 deaths in children had been reported. However, in the 6 months that followed, over four times as many have died. Heather Kerr, Save the Children’s country director in the DRC, said, ‘This is another grim milestone in a crisis that is devastating children in its path, especially the youngest. Some 40% of children who have contracted the disease are under the age of five, and many of them have died.’ She also said the outbreak has had a wider impact on children because of the high overall fatality rate from the virus, with thousands losing at least one of their parents or separated from their families.”

SWP Comment- Why the Containment of Infectious Diseases Alone Is Not Enough
You can now access this commentary by Daniel Gulati and Maike Voss here, which discusses the current DRC Ebola outbreak and that in “crisis situations like these, the interdependencies between health and security are highly complex. Which population groups and which diseases are perceived as suspected health risks, and why, is a normative question for donor countries. It has political consequences above all for affected developing countries. Where health and security are common goals, it is not enough to contain infectious diseases in developing countries. Instead, resilient, well-functioning, and accessible health systems must be established. This fosters the implementation of the human right to health, creates trust in state structures, and takes into account the security interests of other states. In the United Nations (UN) Security Council, the German government could advocate for policies based on the narrative ‘stability through health’.” 

Stories You May Have Missed:

  • MERS and Healthcare Transmission– “Since its last update in June 2018, 219 cases were reported in four countries: Saudi Arabia (204), Oman (13), South Korea (1), and the United Kingdom (1). However, of the 97 secondary cases reported to the WHO, 52 were linked to transmission in hospitals, including 23 infections in healthcare workers. Since the virus was first detected in humans in 2012, 2,449 cases have been reported through Jun 30, 84% of them in Saudi Arabia. The virus is known to spread more easily in healthcare settings, and research is under way to better understand the factors that drive transmission. The WHO said awareness of the disease is still low, and the nonspecific early symptoms can make it difficult to identify cases. Gaps in infection prevention and control measures also contribute to disease spread. ‘Much more emphasis on improving standard IPC [infection prevention and control] practices in all health care facilities is required,’ the WHO said.”
  • Managing Measles: A Guide to Preventing Transmission in Health Care Setting– “Perhaps one of the most challenging aspects of this outbreak from a health care perspective is preparation. Although some may not consider this to be a concern, between 2001-2014, 6% of US measles cases (that were not imported) were transmitted within a health care setting. Sadly, I experienced this firsthand during a 2015 exposure at the health care facility I worked at, in which a health care worker was exposed to the virus while treating a patient and subsequently became infected. As a result of the health care worker’s infection, 380 individuals were exposed and the response efforts were extensive and significantly disruptive to the daily infection prevention duties. Due to the fact that hospitals can easily act as amplifiers for airborne diseases like measles, the CDC has provided interim infection prevention and control recommendations for measles in health care settings. At its core, this guidance focuses on health aspects of both the employee and the patient. For health workers, it is critical to ensure presumptive evidence of immunity to measles and manage exposed/ill health care workers properly. On the patient side, rapid identification and isolation of known or suspected cases and proper isolation maintenance is critical. “

Pandora Report: 3.22.2019

Non-Medical Obstacles Impacting Public Health Responses
GMU Biodefense doctoral alum Jennifer Osetek is discussing non-medical challenges of public health preparedness and responses. “Clearly, for most populations, receiving medical therapies and supplies saves lives; however, medications unable to reach their intended targets prove worthless. ‘Vaccines that remain in the vial are 0% effective’ (Orenstein, Seib, Graham-Rowe, & Berkley, 2014). Outside obstacles stand between patients and the administration of critical health care resources (CHCRs) including medical countermeasures (MCMs), equipment, and supplies. These obstacles can, therefore, result in severe consequences. From a public health perspective, resources that do not reach those affected during an outbreak can mean the difference between a contained disease cluster or the disease spreading and threatening national or even global health security. This is especially relevant as ‘the problem of infectious disease is no longer only one of prevention, but also—and perhaps even more—one of preparedness’ (Lakoff 2008). Obstacles preventing sick people from accessing available resources is not a hypothetical concern any longer. Instead, it is one continually being played out both domestically and internationally in routine and emergency response situations. These obstacles are rooted in various causes and require more specific identification and analysis to prevent inadequate public health responses. Barriers to the delivery of care cost hundreds of thousands of lives simply because they are not defined or incorporated into public health planning and execution operations.”

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Come spend 3.5 days with some of the top minds in the biodefense field this July at our summer workshop. From vaccine development to biosecurity as a wicked problem, we’ll be having frank conversations regarding the toughest issues in health security. Register before May 1st for an early discount and get another discount if you’re a returning student, GMU alum/current student/professor, or registering with a large group.

HHS’ BARDA Funds Its First Marburg Vaccine
In pursuit of making progress against those viruses causing hemorrhagic fevers, HHS has partnered with Public Health Vaccines to help develop a Marburg virus vaccine. “The Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response, awarded an initial 2-year, $10 million contract to Public Health Vaccines, LLC to begin development of a vaccine to protect against Marburg infection. ‘This vaccine candidate is the first BARDA has funded against the Marburg virus, and it is an important step toward meeting an urgent public health and biodefense need,’ said BARDA Director Rick Bright, Ph.D. ‘We will leverage our experience in establishing public-private partnerships that bring results that are critical to saving lives and protecting Americans – and possibly people across the globe – from health security threats.’ The Public Health Agency of Canada initially developed the vaccine and licensed it to Public Health Vaccines, LLC. This approach is similar to the one Merck & Co. used to develop its Ebola vaccine. Under the agreement with BARDA, Public Health Vaccines will conduct preclinical development to demonstrate the proof of concept that the vaccine can protect against Marburg virus. If that initial development succeeds, BARDA has the option to provide additional funding for a total of up to $72 million to advance the Marburg virus vaccine through a Phase 2 clinical trial, and begin development of a vaccine candidate against the Sudan ebolavirus, a closely related virus, as well.”

Ebola Outbreak Updates
The outbreak in the DRC has been gaining speed in recent days at eight new cases were reported on Tuesday. “The illnesses lift the overall outbreak total to 968 cases, which includes 903 confirmed and 65 probable infections. Health officials are still investigating 234 suspected cases. Three more people died from Ebola, including two in community settings—one in Katwa and one in Mandima. The other fatality occurred at Butembo’s Ebola treatment center. The developments increase the overall number of deaths to 606. In its weekly diseases and health emergencies update, the WHO’s African regional office said though Katwa health zone is still the main epicenter, responsible for 44% of cases over the past 3 weeks, seven health zones have reported new confirmed cases over the past 3 days and remain a concern. Besides Katwa they include Masereka, Vuhovi, Butembo, Kyondo, Mandima, and Kayina.” Overall, there have been 44 cases reported in the last 5 days, which is deeply concerning and brought an end to the downward trend we were seeing. 

WHO Panel Calls for Registry of Human Gene Editing Research
Two days into a panel meeting of gene editing experts and the WHO is calling for a registry to facilitate transparency in human genome editing research. The panel was created as a result of CRISPR baby experiment and is in the process of setting up the registry to help guide work while ensuring safety. “The WHO panel’s statement said any human gene editing work should be done for research only, should not be done in human clinical trials, and should be conducted transparently. ‘It is irresponsible at this time for anyone to proceed with clinical applications of human germline genome editing.’ The WHO’s director-general, Tedros Adhanom Ghebreyesus, welcomed the panel’s initial plans. ‘Gene editing holds incredible promise for health, but it also poses some risks, both ethically and medically,’ he said in a statement. The committee said it aims over the next two years to produce ‘a comprehensive governance framework’ for national, local and international authorities to ensure human genome editing science progresses within agreed ethical boundaries.”

Lab Failures – How Dangerous Pathogens Are Escape Artists
Any research with dangerous pathogens brings with it an inherent risk, whether it be biosafety or biosecurity related. Unfortunately there are a lot of opportunities for failure during such work and recent efforts have looked to incidents to try and identify trends. “It looks like there are many different points of failure — machinery that’s part of the containment process malfunctions; regulations aren’t sufficient or aren’t followed. Human error means live viruses are handled instead of dead ones. Sometimes, these errors could be deadly. ‘If an enhanced novel strain of flu escaped from a laboratory and then went on to cause a pandemic, then causing millions of deaths is a serious risk,’ Marc Lipsitch, a professor of epidemiology at Harvard, told me.” Breaches can occur as a result of carelessness or just pure human error. “The blizzard of dangerous errors over only a few months in 2014, and the additional errors uncovered by subsequent investigations, inspired the US government to change its practices. The government called on all labs that handle secure substances to immediately improve their inventory policies and review their procedures, and to provide written documentation that they’d done so. It launched government-wide reviews to better understand how to safely regulate pandemic pathogens. The FDA began providing better training and conducting periodic audits to make sure that the safety procedures that were ignored in this case are being followed.”

 A Modern Take on the Broad St. Pump Outbreak
GMU Biodefense doctoral student and infectious disease epidemiologist Saskia Popescu is taking a look into an outbreak linked back to contaminated wells and how this reminds us all of the cholera outbreak in 19th century London. “A city, an outbreak, and a contaminated well. Surely this sounds like some kind of modern version of the John Snow cholera outbreak and the Broad St. pump. But unfortunately, it’s this week’s US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report with a much more recent example of how bad sanitation and contaminated water can affect a city. In 2017, a city in Nebraska experienced an outbreak of Campylobacter jejuni that drove home the realities of One Health, the theory that the health of humans, animals, and the environment are all connected. It all began on a March day in 2017, when the Southwest Nebraska Public Health Department got a call regarding a spike in campylobacteriosis cases—5. The condition, campylobacteriosis –infection due to Campylobacter jejuni, is reportable, indicating labs and hospitals are required to report them to the health department. Typically, a single case of Campylobacter was reported in this particular city every 3 years, making the infection quite rare. ”

How A Measles Quarantine Can Lead to Eviction
Vaccine-preventable diseases have been a topic of conversation lately with a surge of measles cases and presence of the anti-vaxxer movement. One particular aspect of public health and managing outbreaks of vaccine-preventable diseases though, is quarantine. A recent article discusses the need for paid medical/sick leave and how those quarantined during outbreaks have faced financial hardships. “The health department persuaded the restaurants where the families worked to not fire them, but the families nevertheless faced steep consequences from avoiding work, according to Archer and Edsall. One family missed so many paychecks that they were evicted. Several people had their phones shut off after unpaid bills racked up. Ultimately, the health department had a collection among its own employees to raise money to donate to the quarantined families. Much of this could have been avoided if the United States had a mandatory-paid-sick-leave policy, Archer and Edsall argue. The Family and Medical Leave Act of 1993 protects the jobs of some workers for up to 12 weeks for medical reasons, but it does not guarantee pay, and it doesn’t cover more than 40 percent of all American workers. Ten states and 33 cities have their own sick-leave policies, but still, 28 percent of American workers lack access to any kind of sick leave. The United States and South Korea are the only countries in the Organization for Economic Cooperation and Development that do not mandate paid sick leave.”

‘TIS the Way to Transport Highly Contagious Patients by Air
“U.S. Air Force personnel conducted training on the Transportation Isolation System (TIS), an enclosure the Defense Department can use to safely transport patients with highly contagious diseases, aboard a C-17 Globemaster III last week in South Carolina. First implemented after the Ebola virus outbreak in 2014, the TIS was engineered to ensure service members get the proper treatment in the event they get infected with any disease during relief missions to affected areas while protecting the aircrew and support personnel. TIS training takes place roughly three times a year and lasts for four days. The training goes from initial donning and doffing protocols for personal protective equipment to actual patient transport and care. This can include treating simulated patients at the “infection scene” all the way to securing them within the TIS unit and even taking part in a simulated in-flight transport.”

Antibiotics, Orchards, and A Citrus Scourge That Instigated Public Health Fear
I’m just going to say it – if I want to know what’s really going on in the world of antimicrobial resistance, I’m looking to Maryn McKenna. Call her our canary in the AMR coal mine. Yet again, she’s giving insight into a concerning avenue for antimicrobial resistance and over usage in the citrus world – this time combatting citrus greening. “The US Environmental Protection Agency (EPA) is in the process of allowing growers to use streptomycin and oxytetracycline as routine treatments, spraying trees several times per year, beginning with the ‘first flush’ of leaves this spring. Growers in the state could end up using as much as 440,000 kilograms of the drugs. Although the compounds, which are both used in human medicine, have been sprayed on other crops in the past and applied in limited amounts to citrus groves, the scale of this application has researchers and public-health advocates alarmed. ‘They are doing a huge experiment with limited monitoring,’ says Steven Roach, a senior analyst in Iowa City at Keep Antibiotics Working, a coalition of research and advocacy groups that has formally objected to the plan with the EPA.” That’s right, as mounting pressure has been focused on reducing antibiotic usage in agriculture, these farmers are planning to use more. Even more frustrating is the lack of evidence for both efficacy of use but also the implications of long-term use. As McKenna notes, “Academic researchers disagree on how much ecological harm or antibiotic resistance will result.” She further points out that “The EPA has specified certain rules to reduce the risk of resistance emerging. Spraying is limited to a few times per year; farm workers must wear full protective clothing; and groves cannot be fertilized with uncomposted manure. It has also set a deadline of seven years for re-evaluating the programme, half the time that it would normally impose for an agricultural chemical.”

Assessing the Need for and Uses of Sequences of Interest Database
You can now find the report on the proceedings from this two-day workshop here. “Over the past decade, the biotechnology economy has experienced remarkable growth, resulting in the rapid expansion of biological knowledge and application. Such advances have lowered the technical and financial barrier to entry for bioexperimentation outside the traditional environments of academia and industry. Together these developments provide exciting new opportunities for scientific growth. However, they create openings for actors with malicious intent to harness readily available tools and techniques to create biological threats or bioweapons. In this report, we present the results of a workshop designed to convene key experts from diverse stakeholder groups to understand how a genetic database of “sequences of interest” (SOIs) can best support stakeholders—government agencies, academic researchers, and commercial groups—to improve the utility, safety, and security of biotechnology research endeavors. The sessions consisted of a mix of presentations, panel discussions, and small and large group discussions. This report should be viewed as an exploratory first step in discussing a very complex topic with broad and often conflicting stakeholder interests.”

Attacks on Medicine Machine Learning: Cyberbiosecurity
“With public and academic attention increasingly focused on the new role of machine learning in the health information economy, an unusual and no-longer-esoteric category of vulnerabilities in machine-learning systems could prove important. These vulnerabilities allow a small, carefully designed change in how inputs are presented to a system to completely alter its output, causing it to confidently arrive at manifestly wrong conclusions. These advanced techniques to subvert otherwise-reliable machine-learning systems—so-called adversarial attacks—have, to date, been of interest primarily to computer science researchers (1). However, the landscape of often-competing interests within health care, and billions of dollars at stake in systems’ outputs, implies considerable problems. We outline motivations that various players in the health care system may have to use adversarial attacks and begin a discussion of what to do about them. Far from discouraging continued innovation with medical machine learning, we call for active engagement of medical, technical, legal, and ethical experts in pursuit of efficient, broadly available, and effective health care that machine learning will enable.”

Stories You May Have Missed:

  • H3N2 Cases Keep Flu Activity High – “Though flu activity decreased slightly last week, a wave of H3N2 virus activity has led to severe illnesses across the country and four more children have died from the disease, according to this week’s FluView report from the Centers for Disease Control and Prevention (CDC). This is the second week in a row the CDC recorded more H3N2 cases that H1N1, the virus subtype that dominated the first part of the 2018-19 flu season. ‘H3N2 viruses are typically associated with more severe illness in older adults, and flu vaccine may protect less well against H3N2 illness in older adults, making prompt treatment with flu antivirals in this age group especially important during the current period of H3N2 predominance,’ the CDC said today in a summary of the report.”
  • Changing the Game in Pediatric Diagnosis of Serious Bacterial Infections – “Figuring out why that 2-month-old with a fever is crying often includes spinal taps, which are painful and risky, alongside rapid antibiotic treatment to avoid meningitis. Bacterial meningitis can be deadly, especially in infants; the US Centers for Disease Control and Prevention (CDC) reports that between 2003 and 2007, there were 4100 cases of bacterial meningitis reported in pediatric patients in the United States, as well as 500 deaths. Given these rates and the risk of life-threatening infections, it’s not unusual that pediatricians would want to perform a spinal tap or administer antibiotics until further diagnostics can be performed. Fortunately, a new protocol has been developed that could not only make a diagnosis of bacterial infections in infants easier but would remove the need for spinal taps and unnecessary antibiotic treatments. Investigators from the Pediatric Emergency Care Applied Research Network (PECARN) created a new protocol from a study of more than 1800 infants seen across 26 emergency departments in the United States.”

Pandora Report 11.16.2018

We’re back from the 5th Ministerial Meeting of the Global Health Security Agenda (GHSA)! We’ll be reporting out on this event in the coming weeks, so keep an eye out for all things GHSA. Influenza season is ramping up and you’ll want to check out the latest article on looking beyond the decade of vaccines.

Preventing Pandemics and Bioterrorism: Past, Present, and Future
We’re just weeks away from this exciting event – are you registered? Preventing Pandemics and Bioterrorism: Past, Present, and Future is a special event in celebration of the 15th anniversary of the George Mason University Biodefense Program at the Schar School of Policy and Government. We invite you to attend this exciting opportunity to hear from Dr. Kadlec of ASPR about lessons learned for pandemic preparedness since the 1918-1919 influenza pandemic, plans for implementing the new National Biodefense Strategy, and the importance of education for the future of biodefense. Following his speech and Q&A session, you are invited to an informal reception for academic and professional members of the biodefense community to socialize and network. Make sure to RSVP soon as seats are limited for this December 4th event.

Russian Disinformation & the Georgian “Lab of Death”
A recent BBC investigation has found some disturbing information regarding Russian media making false claims about a U.S.-funded lab in Georgia. “The Russian Foreign Ministry, Defence Ministry and pro-Kremlin media claimed recently that untested drugs were given to Georgian citizens at the lab, resulting in a large number of deaths. The US has accused Russia of disinformation in order to distract attention away from incidents such as the Salisbury poisonings.” This episode is part of a series the BBC is providing on disinformation and fake news.

Ebola Outbreak Updates
The Ebola virus disease outbreak in the DRC continues to grow. 15 cases were reported on Monday as well as another violent attack in Beni. “WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said on Twitter that he had been briefed on a violent attack that occurred in Beni on the night of Nov 10. ‘All WHO staff safe, but my heart goes out to families who have lost loved ones in this appalling and unacceptable attack, which we condemn in the strongest terms,’ he wrote. According to a local media report translated and posted by H5N1 Blog, which focuses on infectious disease news, at least five civilians were killed and several children kidnapped in an attack by rebels with the Allied Democratic Forces (ADF) in Beni’s Mayimoya district. The report said two other people were killed in two other attacks the same day in Beni’s Runwenzori neighborhood, one linked to ADF rebels and the other by suspected Mai Mai militia members.” The latest situation report lists 333 cases and 209 deaths, with 31 new confirmed cases reported during the reporting period (Nov 5-11). Early this morning, the DRC announced three more cases and 1 death. Health officials are also reportedly planning to launch a clinical trial of three antibody treatments and an antiviral drug, within the area. These drugs are currently in utilization in the Ebola treatment centers within the area but only under compassionate use. The UK is contributing funds to help Uganda step up prevention and preparedness efforts as well. “On a recent visit to The Medical Research Council/Uganda Virus Research Institute (URVI) and the London School of Hygiene and Tropical Medicine Research Unit in Entebbe, UK Minister for Africa Harriett Baldwin announced that the UK will support Uganda’s National Task Force with up to £5.1 million ($6.6 million USD) to support Ebola preparedness and prevention efforts in Uganda. This funding will support surveillance in high-risk districts at the border with the Democratic Republic of Congo (DRC); risk reduction communication in communities; infection prevention and control measures as well as provide for improved case management.” Peter Salama, WHO Emergency Response Chief, has noted that the outbreak could last another six months – “It’s very hard to predict timeframes in an outbreak as complicated as this with so many variables that are outside our control, but certainly we’re planning on at least another six months before we can declare this outbreak over,”.

ELBI Fellowship Application Opens
The Emerging Leader for Biosecurity Initiative (ELBI) run by the Center for Health Security is now accepting applications. This is a great opportunity that several Biodefense students have been able to take advantage of for the last several years. GMU Biodefense has had several fellows – Yong-Bee Lim  is currently an ELBI fellow and Saskia Popescu, Siddha Hover, and Francisco Cruz have represented our biodefense program in previous years. If you’re a current GMU biodefense student or alumni and are interested in applying and plan to request a letter of recommendation from the Biodefense program director, please do so ASAP. Dr. Koblentz asks that applicants send a copy of their application materials (personal statement, essay, and current resume or cv) and an unofficial GMU transcript by December 5, 2018.

 One Health in the 21st Century Workshop
The One Health in the 21st Century workshop will serve as a snapshot of government, intergovernmental organization and non-governmental organization innovation as it pertains to the expanding paradigm of One Health. One Health being the umbrella term for addressing animal, human, and environmental health issues as inextricably linked, each informing the other, rather than as distinct disciplines. This snapshot, facilitated by a partnership between the Wilson Center, World Bank, and EcoHealth Alliance, aims to bridge professional silos represented at the workshop to address the current gaps and future solutions in the operationalization and institutionalization of One Health across sectors. The workshop will be held on November 26th at the Wilson Center. You can RSVP here.

USDA ARS 5th International Biosafety & Biocontainment Symposium: Biorisk and Facility Challenges in Agriculture
Registration is open for this February 11, 2019 event! The symposium will provide 2.5 days of scientific presentations and exhibits regarding agricultural biosafety and biocontainment.

WHO Report on Surveillance of Antibiotic Consumption
The WHO has just released their report on global antibiotic consumption and the surveillance methods surrounding efforts to reduce antimicrobial resistance. “Since 2016, WHO has supported capacity building in monitoring antimicrobial consumption in 57 low- and middle-income countries through workshops, trainings and technical support. At this stage, 16 of these countries were able to share their national data with WHO. Other countries are currently in the process of data collection and validation.In total, 64 countries and Kosovo1 contributed data on antibiotic consumption for this report, with the bulk of data coming from the European region and countries with pre- existing, mature surveillance systems. The consumption data showed wide intra- and interregional variation in the total amount of antibiotics and the choice of antibiotics consumed. The overall consumption of antibiotics ranged from 4.4 to 64.4 DefinedDaily Doses (DDD) per 1000 inhabitants per day.”

Stories You May Have Missed:

  • Influenza Vaccine Efficacy Among Patients with High-Risk Medical Conditions in the U.S. – Researchers utilized data from the US Influenza Vaccine Effectiveness Network from 2012-2016 to analyze vaccine effectiveness (VE) “of standard-dose inactivated vaccines against medically-attended influenza among patients aged ≥6 months with and without high-risk medical conditions. Overall, 9643 (38%) of 25,369 patients enrolled during four influenza seasons had high-risk conditions; 2213 (23%) tested positive for influenza infection.Influenza vaccination provided protection against medically-attended influenza among patients with high-risk conditions, at levels approaching those observed among patients without high-risk conditions. Results from our analysis support recommendations of annual vaccination for patients with high-risk conditions.”

 

 

Pandora Report 9.28.2018

Happy Friday biodefense gurus! October is right around the corner, which means the flu vaccine will be available soon. Make sure to get vaccinated this season, as the CDC just announced that 80,000 people died of the flu during the 2017/2018 season, which is the highest death toll in 40 years.

GMU Global Health Security Ambassador
We’re excited to announce that two graduate students from the Schar biodefense program will be attending the 5th GHSA Ministerial Meeting in Bali, Indonesia. The two students, Annette Prieto and Saskia Popescu, will observe the Global Health Security Agenda in action and the the GHSA 2024 planning. Following their attendance in early November, we’ll be providing a report out on the events. Meet our two GMU Global Health Security Ambassadors – Annette Prieto has a background in Microbiology and Immunology and is currently a Biodefense student in the Master’s Program here at George Mason University. Before coming to George Mason, Annette focused on medical Microbiology at the University of Miami before moving into the laboratory and becoming a Teacher’s Assistant. From there, Annette became an Adjunct Instructor at Daytona State College and taught for a year before entering the Biodefense Program. Annette is also a part of the Next Generation Global Health Security Network. Saskia Popescu is a biodefense doctoral candidate at GMU and infection preventionist. She worked as an infection preventionist during the Dallas Ebola cluster, a 2015 measles outbreak, and is an external expert for the ECDC. She is a 2017 ELBI fellow and trained infectious disease epidemiologist. Saskia’s research focuses on the utilization of infection control in the U.S. healthcare system and it’s impact on biodefense. Make sure to check back in the weeks following their trip to learn about their experiences at the ministerial meeting.

Why Poor Pandemic Preparedness is Deadly
Ebola response efforts in the DRC are struggling and were suspended earlier this week, after violence between rebels and armed forces. While outbreak response in Beni have resumed, events like these are a prime example of why outbreaks can quickly spread beyond control and ultimately emphasize the need for pandemic preparedness. Drs. Tom Inglesby and Eric Toner from the Johns Hopkins Center for Health Security recently discussed the importance of investing in biopreparedness and how their Clade-X tabletop revealed many of the existing weaknesses. “Could a natural or man-made pandemic happen today? Yes. New lethal viruses are emerging from nature, and dizzying developments in biotechnology mean that biological weapons no longer are the sole province of a few state-sponsored programs — a manufactured pandemic could be unleashed by a rogue regime or by terrorists utilizing one of the thousands of laboratories around the world capable of making a dangerous pathogen. If the worst-case scenario unfolds, strong pandemic preparedness planning would save millions of lives. But progress is possible only with effective leadership.”

Rebuilding Health Security in the Wake of Ebola
GMU Biodefense graduate student Stephen Taylor discusses the latest talk from Georgetown University on global health security following the 2013-2016 Ebola outbreak. “In the midst of this disaster, the U.S. Centers for Disease Control turned to health security experts at the Georgetown Center for Global Health Science and Security to support the expansion and augmentation of the Guinean public health infrastructure.  Dr. Alpha Barry, Dr. Erin Sorrell, Dr. Claire Standley, and Ms. Aurelia Attal-Juncqua supported on-the-ground efforts to develop and implement improved health security policy that would make Guinea more resilient against future infectious disease outbreaks.  The Guinean government’s priorities for capacity and capability building were to prevent further outbreaks of zoonotic diseases, improve the capacity of surveillance laboratories and capabilities of the healthcare workforce to identify outbreaks, and to better respond to outbreaks by streamlining and coordinating emergency response operations.  On September 14th, 2018, as part of its Global Health Security Seminar Series, Georgetown University hosted a panel discussion of Dr Sorrell, Dr. Standley, and Ms. Attal-Juncqua on their efforts in Guinea.”

 The AMR Challenge
The United Nations (UN) General Assembly was held this week and one particular topic captured our attention – antimicrobial stewardship and a new initiative to combat resistance. “The AMR Challenge is a way for governments, private industries, and non-governmental organizations worldwide to make formal commitments that further the progress against antimicrobial resistance. The challenge encourages a One Health approach, recognizing that the health of people is connected to the health and animals and the environment. The AMR Challenge launches at the United Nations (UN) General Assembly in September 2018. Organizations can make commitments beginning September 25, 2018 until September 2019. CDC will feature commitments throughout the year. At the 2019 UN General Assembly, antimicrobial resistance will continue to be a priority topic for world leaders.” Within the Challenge, there are commitments to tracking and sharing data, reducing the spread of resistant germs through infection prevention and control, improving antibiotic use, decreasing antibiotics and resistance in the environment, and investing in vaccines, therapeutics, and diagnostics.

NASEM – Review & Assessment of Planetary Protection Policy Development Processes
How do we protect the Earth from contamination following space exploration? How can we avoid bringing microorganisms from Earth to other planets and solar system bodies? The latest NASEM report discusses how scientists tackle these issues and implement such policies. As you read the text, you’ll also see one of the Center for Health Security’s ELBI fellows in there – Betsy Pugel of NASA. “For decades, the scientific, political, and economic conditions of space exploration converged in ways that contributed to effective development and implementation of planetary protection policies at national and international levels. However, the future of space exploration faces serious challenges to the development and implementation of planetary protection policy. The most disruptive changes are associated with (1) sample return from, and human missions to, Mars; and (2) missions to those bodies in the outer solar system possessing water oceans beneath their icy surfaces.” This gives new insight into a field we may not be considering in health security – what about interstellar health security?

The Spanish Flu, Epidemics, and the Turn to Biomedical Responses
We already discussed the impact of poor pandemic preparedness, but what about biomedical efforts? A recent article from AJPH discusses the role of the 1918/1919 pandemic in bringing biomedical approaches to the forefront of outbreak response. “A century ago, nonpharmaceutical interventions such as school closings, restrictions on large gatherings, and isolation and quarantine were the centerpiece of the response to the Spanish Flu. Yet, even though its cause was unknown and the science of vaccine development was in its infancy, considerable enthusiasm also existed for using vaccines to prevent its spread. This desire far exceeded the scientific knowledge and technological capabilities of the time. Beginning in the early 1930s, however, advances in virology and influenza vaccine development reshaped the relative priority given to biomedical approaches in epidemic response over traditional public health activities. Today, the large-scale implementation of nonpharmaceutical interventions akin to the response to the Spanish Flu would face enormous legal, ethical, and political challenges, but the enthusiasm for vaccines and other biomedical interventions that was emerging in 1918 has flourished.”

HHS Sponsors TPOXX
Speaking of biomedical measures…the Department of Health and Human Services (HHS) just announced its sponsorship of a new formulation of the world’s first approved smallpox treatment – TPOXX. This purchase will be used for the Strategic National Stockpile and will work with Siga Technologies to develop an IV formulation of the drug. “Purchase of TPOXX in pill form and development of an IV formulation will be completed under a contract between Siga Technologies and the Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response. BARDA will use funding from the Project BioShield Special Reserve Fund. The contract can be extended for up to 10 years and $629 million if necessary to complete development of the IV formulation.”

NASEM – Engaging the Private-Sector Health Care System in Building Capacity to Respond to Threats to the Public’s Health and National Security
Don’t miss the latest NASEM report on the intersection of preparedness and healthcare. From Ebola patients to natural disasters, and even terrorism, the private-sector healthcare system plays a critical role in response. “As a result, disasters often require responses from multiple levels of government and multiple organizations in the public and private sectors. This means that public and private organizations that normally operate independently must work together to mount an effective disaster response. To identify and understand approaches to aligning health care system incentives with the American public’s need for a health care system that is prepared to manage acutely ill and injured patients during a disaster, public health emergency, or other mass casualty event, the National Academies of Sciences, Engineering, and Medicine hosted a 2-day public workshop on March 20 and 21, 2018. This publication summarizes the presentations and discussions from the workshop.”

USDA ARS 5th International Biosafety & Biocontainment Symposium
ABSA has just announced this event being held on February 11-14, 2019 in Baltimore, Maryland. “The focus of the symposium will be Biorisk and Facility Challenges in Agriculture. Seven professional development courses will address topics including life science security, facility maintenance and operational issues, agricultural risk assessment, emergency response and preparedness for livestock disease outbreaks, waste management, and strategic leadership. Courses will be held on Monday, February 11. There will be 2 1/2 days of scientific presentations covering various topics including; governance updates, design methodologies, deferred maintenance, rabies, occ health laboratory to the field, gene editing, risk management and communication, and many others. The poster and networking reception will be held on Wednesday, February 13, attendees will have the opportunity to meet with presenters and discuss their presentations. Exhibits showcasing the latest biosafety, biosecurity, and biocontainment products and services will be open February 12-13.”

Next Generation Biosecurity Webinar 
Don’t miss this webinar today, Friday 9.28, at 11am (CDT, Mexico City). Hosted by Next Generation GHSA, this webinar will be with Luis Alberto Ochoa Carrera, Coordinator of Biosafety and Biochemistry of the GHSN and Coordinator of the Biosafety Laboratory Level 3 of the National Reference Laboratory (InDRE) of Mexico.

Stories You May Have Missed:

  • Airplanes and Airports – Hubs for Germs: GMU biodefense doctoral candidate Saskia Popescu discusses the latest on germ transmission during air travel. “Most people have a general sense that air travel tends to involve exposure to germs. Whether it’s through the thousands of people we will come into contact with, the sick person next to us on the plane, or the dirty surfaces, many of us get a sense of unease knowing there is a real chance we may arrive at our destination with a microscopic companion.”

 

Pandora Report 8.17.2018

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

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

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

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

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

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

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

Stores You May Have Missed:

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

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

Pandora Report: 7.20.2018

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

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

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

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

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

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

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

Stories You May Have Missed:

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

Pandora Report 7.6.2018

 

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

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

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

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

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

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

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

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

Stories You May Have Missed:

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