Pandora Report 11.3.2017

Welcome to your weekly dose of all things biodefense. Today we get to celebrate Global One Health Day, in which the goal “is to build the cultural will necessary for a sea change in how planetary health challenges are assessed and addressed.”

High-Containment Laboratories: Coordinated Actions Needed to Enhance the Select Agent Program’s Oversight of Hazardous Pathogens
The latest U.S. Government Accountability Office (GAO) report is focusing on high-containment labs and how we can enhance the Select Agent Program’s oversight of hazardous pathogens. “Safety lapses continue to occur at some of the 276 laboratories in the United States that conduct research on select agents—such as Ebola virus or anthrax bacteria—that may cause serious or lethal infection in humans, animals, or plants, raising concerns about whether oversight is effective. GAO was asked to review the federal oversight approach for select agents and approaches from other countries or regulatory sectors. This report (1) evaluates the extent to which the Select Agent Program has elements of effective oversight and strategic planning documents to guide it, and (2) identifies approaches selected countries and regulatory sectors have used to promote effective oversight.” The Select Agent Program is managed through a partnership between DHHS and USDA, which oversees how labs handle these deadly pathogens. The biosecurity and biosafety failures that have occurred in recent years highlights the challenges of not only performing such work, but also oversight. The GAO report found that the Select Agent Program hasn’t assessed the risks of its current structure, has reviews that may not target the highest-risk activities, continues to have significant workforce and training gaps, etc. Eleven recommendations were made, which range from “To improve transparency, the CDC director of the Select Agent Program should work with APHIS to determine what additional information about laboratories’ use of select agents, incidents, and violations of the select agent regulations is appropriate for the program to share with registered laboratories” to “improve independence, the Administrator of APHIS should formally document the reporting structure for the APHIS component of the Select Agent Program from the APHIS director of the program to the Administrator of APHIS”. You can read the full report here or get the highlights here.

GHSA Ministerial Meeting
Last week’s Ministerial Meeting at Kampala was a success and a great time to reflect on GHSA accomplishments from member countries. You can get all the information here regarding the success stories across GHSA members. We will also be reporting on stories from those attendees who were able to join NextGeneration GHSA for the meeting, so don’t miss out on some great deep-dives from GMU biodefense students and their stories from Kampala!

COMMENTARY: Pandemic preparedness and missed opportunities             CIDRAP Director Dr. Michael T. Osterholm is honing in on a dogma for so many within public health – we need pandemic preparedness and we’re just not prepared. Unfortunately, sometimes our efforts to change this can result in a backfire. “Last week PATH issued a report titled, Healthier World, Safer America: A US Government Roadmap for International Action to Prevent the Next Pandemic. PATH, a leading international nonprofit organization, is widely recognized for its work to save lives and improve health, especially among women and children.” “The PATH report, if it commented only on epidemic preparedness, would be a home run. But by stating that the recommendations in the report will stem the risk of the next pandemic, the report ends up contributing to the ongoing mischaracterization about what pandemic preparedness truly means and what is needed to reduce any impact of a future pandemic. Understanding the difference between a pandemic and epidemic is absolutely necessary for consequential preparedness and response planning and action to be accomplished.  Let me illustrate the difference between the two and why it matters.” Osterholm points to this very vital misstep that can easily add confusion when working towards preparedness. He highlights the substantial difference between pandemics and epidemics and that ultimately, before we can truly address preparedness and response, we need to sincerely understand the discrepancies. Osterholm also highlights the biothreats we should be worried about for potential pandemics – influenza and antimicrobial resistance. Osterholm points to these two pandemic concerns while highlighting the importance of the GHSA, the vital role of early and effective detection to epidemic diseases, and that pandemic clocks are ticking. “The influenza and antimicrobial pandemic clocks are ticking; we just don’t know what time it is. Misunderstanding and misrepresenting what we need to do to be better prepared takes an understanding of what a pandemic is and what it isn’t. To date we are not doing a very good job of understanding that point and responding accordingly. The PATH report is a clear reminder.”

Early Insights from Madagascar’s Plague Outbreak: Lessons Learned from Ebola?
Have we really learned some of those difficult lessons from Ebola? Joshua Hutton, Doctoral Candidate at the University of Sussex is evaluating the current plague outbreak in Madagascar under the lens of Ebola. Hutton looks at the epidemiology and cultural impact of these diseases, their similarities and differences, and what lessons can be learned. Hutton looks at the health systems within Madagscar and the Ebola-affected West African countries, noting that Madagascar has 1 doctor per 100,000, while Liberia has 0.1 and Sierra Leone has 0.2 per 100,000. “Furthermore, both Ebola and plague elicit very strong emotional reactions. Ebola has been sensationalized by popular books and major motion pictures (such as Outbreak). Its haemorrhagic symptoms, exaggerated in popular culture, instil fear and remain memorable as an object of cultural anxiety.” “Despite these similarities, there are some obvious differences that affect the public health responses to these outbreaks. The first is that plague is a very different pathogen from Ebola. While Ebola is a virus, Y. pestis is a well-characterised bacterium. One important implication of this difference is that while treatments for Ebola remain elusive, antimicrobials to combat plague do exist. Plague is curable when caught early enough. This not only helps the response, but also reduces the heavy emotional burden placed on healthcare workers who felt helpless caring for Ebola patients without a treatment.” Hutton also notes the differences between public health responses, especially by the WHO – highlighting the lessons learned from the Ebola outbreak. “The early response to this anomalous outbreak of pneumonic plague in Madagascar seems to suggest that lessons are being learned from the Ebola outbreak. While there are distinct differences between the two outbreaks – not the least the availability of rapid diagnostics to identify infected individuals and the availability of antibiotics to treat them – the broader context, the rapid response, and the engaging of local communities produce a cautious optimism for the future.

US-Malaysia Workshop on BWC
The November 30-December 1st workshop at the Council Chamber, Palais des Nations, will focus on BWC-relevant developments by international experts. This workshop will feature expert presentations about global activities during the past year that strengthen the BWC. The purpose of the workshop is to inform States Parties about recent developments relating to national implementation, cooperation and assistance, preparedness and response, and science and technology; and to exchange ideas about their relevance to the Convention.

 My Time As An Emerging Leader in Biosecurity Initiative Fellow                         Take a journey down the biosecurity rabbit hole with GMU biodefense PhD student Saskia Popescu and her experience as a fellow at the Johns Hopkins Center for Health Security. “The Johns Hopkins Center for Health Security has maintained a fellowship since 2012 that seeks to provide opportunities for biosecurity professionals and helps to broaden their careers through contacts and experiences. The Emerging Leader in Biosecurity Initiative (ELBI) program is something I’ve been striving to join for years. I’ll admit it – it wasn’t my first time applying and while this is a highly competitive group, I was definitely disappointed when I didn’t get that acceptance email. Fortunately, 2017 was my year and I was selected as an ELBI fellow and that’s where this adventure begins.” Popescu describes her experiences at the three workshops, the engagement with some of the top minds in the field, and just how much fun it can be to geek out with fellow biosecurity nerds.

Fourth Annual Summit on Global Food Security and Health
Don’t miss this great opportunity to focus on the interrelationship between Food Security and National Security! Held at GMU’s Schar School of Policy and Government on Wednesday, November 15th, you’ll want to make sure you register for this full-day summit! “The conference is co-sponsored by the Stimson Center, RTI International, and The Policy Studies Organization. Our focus this year is on the interrelationship between food security and national security, progress and challenges under Feed The Future (FTF) and the Global Food Security Act, and the growing importance of food security private-public partnerships, resilience, critical indigenous food security challenges, nutrition and health issues. Summit speakers will represent a wide array of government, international organization, NGO, private sector, and academic experts. Our Summit follows the issuance of a recent USAID Feed The Future 2017 Progress Report, the enactment of the July 2016 Global Food Security Act, the related completion of new USAID global food security and food aid strategies, and the issuance of USAID’s December 2016 Feed The Future Global Performance Evaluation. The Summit will follow the World Food Prize Conference in Des Moines, Iowa , October 18 – 20 which addresses opportunities for innovative agriculture to eliminate the scourge of global hunger and poverty. Our GMU Summit takes place during a particularly important period marked by protracted uncertainty about U.S. support for International food aid, global food security, and foreign aid.”

Preppers: On the Frontline of U.S. Preparedness
Are you prepared for an apocalyptic event? GMU Biodefense PhD student and VP of marketing at Emergent BioSolutions student Rebecca Fish is taking us on a deep-dive into the world of preppers. “In 2015, Emergent BioSolutions undertook a multi-phase research project to better understand the prepper movement.  A random sample of 1,022 people aged 18-65 was surveyed to explore prepping behavior.  Findings suggested that the average prepper is not as extreme as many television programs would have you believe.  Rather, your average prepper is an ordinary person trying to do his/ her best for his/her family by preparing for emergency events.  The defining characteristic of a prepper is a belief in self-sufficiency and a desire to be prepared for whatever life throws at you.” This study found some interesting data on preppers – 67% are married and 43% earn over $100,000 per year, while 45% hold a college or advanced graduate degree. The volume and commitment of preppers is also indicative of a market for MCM product and other CBRNe products. “After the 2011 Fukushima Daiiche nuclear disaster in Japan, potassium iodide tablets stocked out everywhere due to overwhelming demand. Similarly, during the Ebola crisis, CBNBC reported that sales of one type of full-body protective suit increased 131,000 percent on Amazon. Gas masks and Ebola survival guides shot up the rankings as well.” As a further example, twenty four percent of preppers in our research own a gas mask.  These data suggest that preppers have demonstrated interest in CBRNe supplies and represent a market for some preparedness supplies.” Fish not only provides new insight into the Prepper community, but also encourages us to start learning more about this group and their interests in preparedness.

BARDA Industry Day
Don’t miss out on BARDA Industry Day next week, from November 7-8th, at the Ronald Reagan Building. “BARDA remains committed to engaging with our industry and government partners to fulfill our mission, saving lives and protecting America through the research and development of medical countermeasures against serious threats. The theme of BARDA Industry Day 2017 is: Innovation in products and partnerships for flexible, dynamic response capabilities.” The keynote speakers will be Robert Kadlec, Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, and Senator Tom Daschle, Founder and CEO of the Daschle Group.

 New Biosecurity Threats Appear in Less Familiar Forms                                    Following the anthrax attacks in 2001, focus within biodefense and biosecurity fell upon bioterrorism and the potential attack that could impact millions of Americans. Since then, health security has evolved to include a wider range of potential issues and threats – natural, manmade, and accidental. GMU biodefense PhD student Saskia Popescu highlights some of these newer threats and that while they may be less familiar to health professionals, it is vital we involve them in the narrative of hospital preparedness. Discussing the gaps within U.S. biodefense efforts, genetic engineering, and how dual-use research impacts bio-vulnerability, Popescu implores infectious disease practitioners to soak in this knowledge. “How can we, as infectious disease practitioners, prepare or respond? First, knowledge is key. It is crucial to understand the threats, whether they are a natural outbreak, a lab breach you read about, or even just a review of the signs and symptoms of organisms we tend to worry about but may not see in the United States (such as severe acute respiratory syndrome, Middle East respiratory syndrome, anthrax, etc). Researchers should also consider the implications of their work and take the necessary review processes to ensure the proper biosecurity measures are taken.”

Should FEMA Be a Stand Alone Agency?                                                                            GMU Biodefense PhD alum Daniel M. Gerstein is at it again – evaluating DHS and the potential for major realignments in the Department. “As Congress considers reauthorizing the Department of Homeland Security, principles guiding any major realignments could include assessing whether the organization would be performing operational or staff management functions. Additionally, those principles could examine whether mission effectiveness would be improved through those major realignments and whether implemented changes would introduce new points of friction or inefficiency.” Gertstein notes several major realignments under consideration – replace the National Protection and Programs Directorate at DHS with a new Cybersecurity and Infrastructure Security Agency, remove FEMA from the DHS and make it a stand-alone department, and standing up a counter WMD organization. “As part of comprehensive department legislation, these realignments should be considered with an eye towards increasing operational effectiveness and efficiency while minimizing organizational friction in the transformed organizations and avoiding loss of key support relationships.”

Stories You May Have Missed:

  • The Unforgiving Math That Stops Pandemics– Another prime example of herd immunity and the importance of vaccination – “When talking about vaccination and disease control, health authorities often invoke “herd immunity.” This term refers to the level of immunity in a population that’s needed to prevent an outbreak from happening. Low levels of herd immunity are often associated with epidemics, such as the measles outbreak in 2014-2015 that was traced to exposures at Disneyland in California. A study investigating cases from that outbreak demonstrated that measles vaccination rates in the exposed population may have been as low as 50 percent. This number was far below the threshold needed for herd immunity to measles, and it put the population at risk of disease.”
  • Biosecurity Implications for the Synthesis of Horsepox, an Orthopoxvirus– Gigi Gronvall evaluates the biosecurity and biodefense implications of the recent horsepox synthesis. “The ability to recreate horsepox, or smallpox, will remain no matter what policy controls are put into place. It will be impossible to close off all avenues for nefarious misuse of gene synthesis, or misuse of biological materials more broadly. As a result, we advocate for the implementation of policy, regulations, and guidance that will make illicit recreation harder, more burdensome, more detectable, and, thus, more preventable without having sweeping negative consequences for the research enterprise. As part of our biosecurity efforts, we must also encourage and enable scientists to participate actively and to do all they can to safeguard their technical fields from irresponsible or illicit actions.”

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 10.27.2017

TGIF and Pandora Report day! Buckle up because we’ve got an abundance of biodefense news that covers GHSA, chemical weapons, synbio, and more.

 Global Health Security – WHO & PATH Reports and GHSA Ministerial Meeting
As the Global Health Security Agenda Ministerial meeting in Kampala, Uganda takes place this week, several reports were released highlighting the deficiencies in global biosecurity and biosafety efforts, as well as the importance of investing in global health security. Fortunately, on the eve of the GHSA Kampala summit, the Trump administration endorsed the future of the GHSA. Don’t forget to stay tuned to our weekly reports as two GMU Biodefense graduate students are participating (as recipients of the George Mason Global Health Security Ambassador Fellowship) in the Ministerial meeting alongside NextGen GHSA and they’ll be reporting on their experiences in the coming weeks. The first report this week is from NTI, which called on countries to improve biosecurity after WHO demonstrated that there are substantial biosecurity/biosafety gaps worldwide. NTI analyzed 39 Joint External Evaluation (JEE) peer reviews and mapped the related biosecurity and biosafety related scores. Here are their findings: “74% of the assessed countries demonstrated limited or no capacity for a whole-of-government national biosafety and biosecurity system. 64% of the assessed countries demonstrated limited or no capacity for biosafety and biosecurity training and practices. 41% of the assessed countries demonstrated limited or no capacity for linking their public health and security authorities during a suspected or confirmed biological event.” The map they’ve created is also a great visualization for how truly weak biosecurity and biosafety efforts are on a global scale. NTI also used this information to track commitments and biosecurity assistance and partners. The next report comes from PATH, which just released their work: Healthier World, Safer America: A US government Roadmap for International Action to Prevent the Next Pandemic The latest PATH analysis focuses on global health security and global efforts to respond to threats. “This paper aims to examine the benefits of investments in pandemic preparedness, as well as recommends the US Administration and Congress come together behind a comprehensive US strategy, robust investments, and continued vigilance both at home and abroad. The recommendations focus on global leadership, a US plan for international action, and research and development; underpinned by the risks of unsustainable funding, with special focus given to the Ebola supplemental funding sunset set to occur in FY2019.”

Reauthorizing & Improving The Department of Homeland Security
Don’t miss the recent National Interest series by GMU Biodefense PhD alum Daniel Gerstein  on the DHS reauthorization bill. This three-part series starts with a focus on why it’s time to improve the Department of Homeland Security. Gerstein notes that “reauthorization of the Department of Homeland Security is vital to clarifying responsibilities and setting expectations for the continued evolution of the department.” The second part in the series highlights methods for fixing the fractured department. “The question is not whether reauthorization of DHS is necessary. It  most definitely is. However, we should also ask whether the bill goes far enough and what other issues should a comprehensive DHS bill encompass? This second commentary considers whether the DHS structure with  relatively weak central authorities should be reevaluated. Interestingly, each successive secretary has sought to consolidate power and authorities at the department level. Is it time to legislate this outcome? ” Lastly, Gerstein addresses why updating the DHS Acquisition System matters. “This third commentary considers how to better align the department’s requirements, research, development and acquisition processes. Currently, the processes are not synchronized and should be harmonized to better align these critical departmental systems.”

Global Health Security Forum 2017 
Don’t miss out on this November 7th event hosted by the Center for Strategic & International Studies. The all-day event will be held at the CSIS headquarters and will even include an entire session on “Hurtling Toward a Genomic 9/11”! Don’t miss out on the “CSIS’s annual flagship conference on the top challenges facing U.S. and global security. This year’s Forum will focus on national security priorities ten months into the Trump Administration and one year prior to U.S. midterm elections.”

 The Collision Of Civil War And Threat Of Global Pandemics
Infectious disease outbreaks can be challenging for even the most stable country and those experiencing civil war are even more impacted by such biological events. Currently, there are 30 civil wars going on around the world – between cholera in Yemen, polio in Syria, and yellow fever in the DRC, countries that have experienced civil war also tend to experience infectious disease outbreaks. “The Daedalus issue, “Civil War & Global Disorder: Threats and Opportunity,” explores the factors and influences of contemporary civil wars. The 12 essays look at the connection of intrastate strife and transnational terrorism, the limited ambitions of intervening powers, and the many direct and indirect consequences associated with weak states and civil wars. Barry and Wise believe there is significant technical capacity to ensure that local infectious outbreaks are not transformed into global pandemics. But those outbreaks require some level of organized and effective governance—and political will. Prevention, detection, and response are the keys to controlling the risk of a pandemic. Yet it’s almost impossible for these to coincide in areas of conflict.” Civil war impacts not only communication, but access to health resources and can challenge early detection and response of outbreaks. Moreover, the traditional hotspots for emerging infectious diseases (tropical and subtropical areas where spillover is likely) are also areas continually “plagued by civil conflict and political instability.”

Chemical Weapons and Syria
On Tuesday, Russia vetoed a vote at the United Nations Security Council that would “renew a mandate to continue an investigation into who was responsible for the use of chemical weapons during Syria’s civil war.” The Joint Investigative Mechanism (JIM) was initially set up in 2015 to help identify those responsible for chemical attacks and is currently reviewing the April nerve agent attack in Khan Sheikhoun. “But Russia could not get enough support and instead used its veto to block adoption. Russia, along with the UK, China, France and the US, have veto powers at the Security Council. It is the ninth time Russia has blocked action against its ally Syria, something rights group Amnesty called ‘a green light for war crimes’.” The United States has already released a statement through the State Department – “We are disappointed, we are very disappointed that Russia put what it considered to be political considerations over the Syrian people who were so brutally murdered,”.

The Good, The Bad, and The Ugly of Pandemic PredictionPreparation, and Medical Countermeasure Communication 
Pandemic preparedness often feels like a teetering game of picking your poison. Will we see an avian influenza like H7N9 or will it be a novel disease? The CDC “evaluates every potentially dangerous strain, and gives them two scores out of 10—one reflecting how likely they are to trigger a pandemic, and another that measures how bad that pandemic would be. At the top of the list, with scores of 6.5 for emergence and 7.5 for impact, is H7N9.” While there isn’t strong transmission capacity between humans with the H5 and H7 viruses, the H7 strains are more worrisome in that they require fewer mutations to get to that point. Our efforts against avian influenza pandemics go beyond surveillance, and also focus on vaccine responses. “In the meantime, vaccines are being developed to match the viruses seen in the fifth and current epidemic. Other control measures have waxed and waned. When the first of the epidemics struck, Chinese health ministries closed markets and slaughtered birds. But as Helen Branswell reports in STAT, some of those containment efforts became more lax in 2015 and 2016.” Preparedness and response exercises can also gives great insight into problems that may arise when dealing with a pandemic. A recent pandemic simulation was held during the World Bank’s annual meeting in Washington D.C., in which participants addressed everything from hospital closures to mass quarantine. “For the World Bank simulation, organizers looked at the impact on travel and tourism of an outbreak of a mysterious respiratory virus in a hypothetical country. Discussions during the 90-minute session were off the record. But in interviews after the event, organizers said the step-by-step scenario made the theoretical possibility seem very real for participants. In particular, it drove home the need for speedy, accurate information-sharing and strong coordination within and across governments and institutions.” These kinds of exercises are crucial to not only address gaps, but bring together a variety of people that will be critical to pandemic response and recovery. The Johns Hopkins Center for Health Security also just released their self-guided exercise scenario that focuses on communication dilemmas that occur during development of medical countermeasures. The exercise is aimed at public health communicator and risk communications researchers, and revolves around a novel coronavirus outbreak in 2025. “Over a 3-year period, the virus spreads to every US state and more than 40 countries, where case fatality rates vary depending on the capabilities of local health systems. In the United States, an existing drug is repurposed to treat SPARS symptoms while federal regulators work with a pharmaceutical company to fast-track the production of a SPARS vaccine. The response differs in other nations. What follows is a nationwide vaccination effort and lingering strains on the US healthcare sector from a steady stream of patients seeking treatment for serious post-SPARS complications.”

Security Implications of Genome Editing – Meeting of Experts in Hanover
Earlier this month, a meeting of scientists and experts on policy and security gathered to discuss the potential implications of genome editing technologies like CRISPR. GMU Biodefense professor Dr. Sonia Ben Ouagrham-Gormley attended, noting that “Over 100 CRISPR scientists form all over the world (China, India, U.S., Europe, Africa), and policy and security experts gathered in Hannover, Germany,  to discuss the security implication of the new gene-editing technique CRISPR.The group reviewed various threat scenarios and discussed potential policy responses. The meeting was particularly successful as both the scientists and security experts engaged in a productive dialogue about the importance of ensuring security without hampering the use of this new technology to promote progress in medicine and agriculture among other things.” The conference focused on establishing proactive international dialogue about genome editing and incorporating experts that range from ethics and philosophy to economics and political science. “Many workshop participants emphasised that it is vital to support and sustain a culture of responsibility and integrity in research and innovation and to engage with stakeholders. Moreover, researchers and policy makers must commit to continuing an open and inclusive dialogue that builds trust. As with other new and emerging technologies, a lack of communication about any uncertainties may undermine public confidence in science. Scientists and security experts should listen to concerns or fears regarding the misuse of genome editing, and provide their expertise on what is and is not likely.”

Synthesizing Biological Threats—A Small Leap From Horsepox to Smallpox
GMU biodefense PhD student Saskia Popescu discussed dual-use research concerns with GMU professor and graduate program director Dr. Gregory Koblentz and how these relate to healthcare and infectious disease professionals. Drawing on the recent horsepox synthesis, Dr. Koblentz emphasized how this opens Pandora’s box even wider for potential smallpox synthesis and misuse of synbio. Popescu highlighted these concerns and how important it is for healthcare workers to be aware of such events and vulnerabilities. “From the healthcare perspective, it may not seem like something we should worry about, but the direction of gene editing and dual-use research of concern is something that is intrinsically linked to public health. Nefarious outcomes of such experiments, regardless of the origin or intent, will inevitably make their way into an emergency department, urgent care, or worse, the community. Although we may not be seeing the implications today, as medical providers and healthcare workers, we must keep our ears to the ground, listening for these biotech advancements, and then thinking through what they mean for us tomorrow.”

Step Away From The Backyard Poultry
Do you keep poultry in your backyard? If so, you may want to rethink it as the number of Salmonella infections related to contact with backyard poultry has quadrupled since 2015. “This year, nearly every state has been pecked by outbreak strains; only Alaska and Delaware can crow about dodging them. The Centers for Disease Control and Prevention has confirmed 1,120 cases. Nearly 250 of those involved hospitalization, and one person died.But that is likely just scratching the surface of the real numbers, according to CDC veterinarian Megin Nichols. ‘For one Salmonella case we know of in an outbreak, there are up to 30 others that we don’t know about,’ she told the AP.” The issue is that chickens and other fowl can carry organisms without having symptoms and shed them in their feces. While some hatcheries will test prior to selling their birds, it’s important that owners be aware of the risks for such infections.

The Schar School of Policy & Government Presents: Strategic Trade and International Security: Policy and Practice
This Brown Bag Seminar Presentation by Dr. Andrea Viski is the place to be on Thursday, November 2nd, from noon to 1:30pm. “Dr. Andrea Viski is the founder and director of the Strategic Trade Research Institute, an independent organization dedicated to providing authoritative research on issues at the nexus of global security and economic trade. She is also the editor-in-chief of the Strategic Trade Review, a peer reviewed journal dedicated to sanctions, export controls, and compliance. She previously worked for Project Alpha at King’s College London and for the Stockholm International Peace Research Institute (SIPRI). She has published numerous articles and book chapters in the areas of strategic trade controls, nuclear non-proliferation, and international law. Dr. Viski received her Ph.D. from the European University Institute, her M.A from Georgetown University’s Institute for Law, Science and Global Security, and her B.A in International Politics from Georgetown University’s School of Foreign Service.” The seminar will be at Founders Hall 602, 3351 Fairfax Drive, Arlington, VA 22201.

Stories You May Have Missed:

  • Uganda’s Marburg Outbreak – Uganda has just confirmed the death of a 50-year-old woman as a result of the hemorrhagic fever, Marburg. “The victim, a 50-year old woman, died on October 11 at a hospital in eastern Uganda after “she presented with signs and symptoms suggestive of viral hemorrhagic fevers”, the minister said. The woman had nursed her 42-year old brother who died on September 25 with similar signs and symptoms and also participated in cultural preparation of the body for burial, she added.”
  • Big Chicken – Are you reading the latest book by Mary McKenna on antibiotic misuse in the poultry industry? “In Big Chicken, McKenna lays out in extensive detail the unintended consequences that resulted from experiments performed at Lederle Laboratories in December 1948 when scientist Thomas Jukes began adding trace amounts of the antibiotic aureomycin (later to be known as chlortetracycline) to chicken feed. The discovery that the drug could quickly fuel growth in chicks raised in confinement revolutionized the poultry industry, turning chicken into America’s favorite protein.”

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 9.1.2017

Craving some satyrical genome editing? Check out the Onion’s pros and cons list on this biotechnology.

The De Novo Synthesis of Horsepox Virus: Implications for Biosecurity and Recommendations for Preventing the Reemergence of Smallpox 

The recent de novo synthesis of horsepox by Canadian researchers has raised concern and spurred serious conversations about the future of orthopoxviruses, like smallpox, and the dual-use research that could bring them back. GMU biodefense associate professor and graduate program director Dr. Gregory Koblentz evaluates this horsepox experiment and what it means for biosecurity and efforts to prevent the reemergence of smallpox. Koblentz notes that this experiment represents a significant crossroads within the field of biosecurity and that the techniques for synthesis of such viruses are increasingly reducing barriers to potential misuse. Unleashing smallpox back into the world would be a global disaster as most of the world is no longer immune. Koblentz points out that “The threat of smallpox has been held at bay for the past 40 years by 2 conditions: the extreme difficulty of acquiring the virus and the availability of effective medical countermeasures. Synthetic biology is on the brink of erasing both of these formidable barriers to the reemergence of smallpox as a global health threat.” He highlights the limited and rather lackluster legal and technical safeguards against smallpox synthesis and that the increasing normalization and globalization of it will likely create a boom of researchers performing such experiments. Think of the gold rush, but rather the orthopoxvirus syntehesis rush. As orthopoxviruses, are being used to develop new vaccines and oncolytic medical treatments, its popularity and wider range of applications carries with it inherent risks that should be considered. “The combination of rising demand and increasing supply could lead to the global diffusion of the capability and expertise to create orthopoxviruses de novo as well as modify these synthetic viruses. With this diffusion will come an increased risk that scientists, acting on their own volition or on behalf of a terrorist group, might misuse their know-how to create variola virus, or that governments could use civilian biomedical research with synthetic orthopoxviruses as a cover for offensive applications. The release of the smallpox virus— whether due to a biosafety failure, a breach in biosecurity, or an act of biological warfare—would be a global health disaster.” Koblentz draws attention to the challenges that the normalization and globalization of orthopoxvirus synthesis poses to national and international systems working to ensure life sciences research is safely conducted. He points out that there is no clear international legal framework to prevent the synthesis of the variola virus, few comphresensive legal safeguards, and that the private DNA industry (the main supplier of large synthetic DNA fragments) has inconsistent regulatory interventions. With these concerns, Koblentz suggests several recommendations to prevent the return of smallpox, ranging from the WHO’s World Health Assembly (WHA) passing a resolution to enshrine the WHO’s Advisory Committee on Variola Research (ACVVR) recommendations on the handling and synthesis of variola virus DNA into international law, to efforts within the DNA synthesis industry to declare a temporary moratorium on the synthesis of orthopoxvirus DNA fragments until effective WHO oversight can be established. Overall, Koblentz points to the importance of this experiment in terms of how such work is performed and the lack of informed debate surrounding the dual-use nature prior to the start of research. He emphasizes  “the risks posed by the routine and widespread synthesis of orthopoxviruses that could lead to the creation of a widely distributed network of laboratories and scientists capable of producing infectious variola virus from synthetic DNA.”

GMU Biodefense Master’s Open House – September 14th
We’re two weeks away from the first Master’s Open House and you won’t want to miss the chance to learn about GMU’s biodefense MS program. From 6:30-8:30pm on Thursday, September 14th, at the GMU Arlington campus, you can speak to faculty, learn about admissions, and why biodefense students have a blast while getting their graduate degrees. From Anthrax to Zika, we’ve got the place for all things biodefense.

Stanford’s New Biosecurity Initiative  

Stanford University’s Freeman Spogli Institute for International Studies (FSI) just announced their new biosecurity initiative, the Stanford Biosecurity Initiative, which will be led by David Relman and Megan Palmer. “Relman said the biosecurity initiative will seek to advance the beneficial applications of the life sciences while reducing the risks of misuse by promoting research, education and policy outreach in biological security. His CISAC leadership gives him the know-how to lead such a wide-ranging effort across diverse disciplines and communities,”. Palmer is a senior research scholar at Center for International Security and Cooperation (CISAC) and leads research on risk governance in emerging technology development and is an all around biotechnology guru. The biosecurity initiative also includes key Stanford partnerships and expertise within the fields of life sciences, engineering, law, and policy. Palmer noted that, “Stanford has an opportunity and imperative to advance security strategies for biological science and technology in a global age. Our faculty bring together expertise in areas including technology, policy, and ethics, and are deeply engaged in shaping future of biotechnology policy and practices.” We look forward to seeing the amazing work this new initiative will accomplish!                                                                                         

NAS Symposium on Cooperative Threat Reduction (CTR) for the Next Ten Years and Beyond
Don’t miss out on this September 18-19 event at the Keck Center. “In 2009 the National Academy of Sciences (NAS) report Global Security Engagement: A New Model for Cooperative Threat Reduction concluded that expanding and updating U.S. Government Cooperative Threat Reduction (CTR) programs in both form and function would enhance U.S. national security and global stability. The NAS Committee on International Security and Arms Control (CISAC) is convening a symposium to examine how CTR has evolved since that time and to consider new approaches for CTR programs and related WMD elimination efforts to increase their ability to enhance U.S. security. Speakers will include Amb. Laura Holgate, former U.S. Representative to the Vienna Office of the UN and IAEA, Amb. Ronald Lehman, Counselor to the Director of LLNL, William Tobey, former Deputy Administrator for Defense Nuclear Nonproliferation at NNSA, Andrew Weber, former Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs, and other key thinkers and practitioners from CTR programs as well as experts from outside of CTR implementing agencies who have experience addressing complex international security problems. The symposium is sponsored by the Project on Advanced Systems and Concepts for Countering Weapons of Mass Destruction (PASCC) in the Naval Postgraduate School and will be open to the public. A ‘meeting in brief’ document will be issued by NAS after the symposium.”

International Biosecurity Fellows Reflect on SB7.0
The Johns Hopkins Center for Health Security recently partnered with Stanford’s Drew Endy to bring 32 emerging biosecurity leaders together for a fellowship program to attend the 7th International Meeting on Synthetic Biology (SB7.0) in Singapore. “In addition to attending the conference, fellows had the opportunity to engage with practicing experts and to discuss—with peers and senior scientists and government officials—biosecurity as it relates to synthetic biology. The fellows represented 19 countries on 6 continents and professions in the public and private sectors, the nonprofit space, and academia. The fellowship program was sponsored by the Open Philanthropy Project, hosted by Endy, and coordinated by the Center, BioBricks Foundation, and SynBioBeta. Center staffers Crystal Watson, DrPH, MPH, senior associate, and Matt Watson, senior analyst, organized the fellowship discussions and events and joined the fellows in Singapore for the 4-day experience. Gigi Kwik Gronvall, PhD, a senior associate at the Center and author of Synthetic Biology: Safety, Security, and Promise, spoke at SB7.0 and helped lead the fellowship’s panel discussions along with Watson and Watson.” Don’t miss out on GMU Biodefense PhD student Yong-Bee Lim’s reflection on page 39. Lim comments on the unique insight that comes from researchers with a non-technical background who still focus on the biosecurity, biosafety, and governance of emerging biotechnologies. “However, the enthusiasm of the technical conference attendees and fellows that I met about the advancements in synthetic biology was infectious. Whether Christina Smolke was talking about leveraging yeast to produce opioids to address medical access inequities, Kate Adamala was discussing synthetic cells as an alternative for research purposes, or Dorothee Krafft explained how her lab was seeking to synthesize a simple cell with alternate building blocks, their passion for their work came through. This allowed me the rare opportunity to enjoy the possibilities of these new avenues of innovation.” Don’t miss out on his tales of confiscated beef jerky and how there’s often a disparage between the science and security communities.

Building Airborne Isolation Units During Emergent Times  & Why the CDC Quarantined Potentially Defective Equipment
GMU biodefense PhD student Saskia Popescu is taking a deep-dive into faulty PPE and hospital preparedness efforts that might just save us during an airborne outbreak. Popescu first looks at the recent CDC actions to pull defective PPE from the SNS. “The special focused on personal protective equipment (PPE) that was being stockpiled by the CDC for use against future outbreaks or public health emergencies, such as treating an influx of Ebola patients during an outbreak. The 60 Minutes investigative team filed a Freedom of Information Act request to obtain documents regarding MicroCool gowns that are part of the US Strategic National Stockpile (SNS). The filing of the Freedom of Information Act request is especially prudent as a group of hospitals were recently awarded $454 million in damages from PPE manufacturers Kimberly-Clark and Halyard Health (formerly a division of Kimberly-Clark) after a jury found they were liable for fraud and defects within the MicroCool gowns.” While these gowns were advertised as meeting standards for the highest level of impermeability, their efficacy is clearly in question. Many are concerned about the existing stockpiles hospitals have been holding onto since the Ebola outbreak in 2014 and if such PPE is still effective. Popescu also takes a look into a recent study that evaluated the potential for hospitals to readily and cheaply convert entire wings into negative-pressure, airborne isolation units. Such a measure would be necessary if there was an influx of infectious patients with SARS, MERS, or another disease that requires airborne isolation, as most hospitals have limited amounts of negative-pressure rooms. “Following their analysis, the team found that they were able to maintain negative pressure that was actually higher than the CDC recommendations for airborne isolation and there was no pressure reversal during the entering and exiting of the ward by medical staff. They did find that ‘pressures within the ward changed, with some rooms becoming neutrally or slightly positively pressured’, which means that healthcare staff would need to wear proper personal protective equipment (PPE) at all times in the unit and not just while in the patient rooms.” While this isn’t a permanent response measure, it does show proof of concept that would allow safer hospitalization for infectious patients during an airborne outbreak.

Stem Cells, Smallpox Vaccines, and FDA Crackdowns 
Earlier this week, the FDA announced it was taking action to shut down clinics that were advertising and performing unproven stem cell therapies. Clinics in California and Florida have received warning letters and the StemImmune Inc, clinic in San Diego, CA, received a visit from U.S. Marshals, who seized five vials of smallpox vaccine. “The FDA says it learned that StemImmune was using the vaccines as well as stem cells from body fat to create an unapproved stem cell therapy. On its website, StemImmune says ‘The patient’s own (autologous, adult) stem cells, armed with potent anti-cancer payloads, function like a ‘Trojan Horse,’ homing to tumors and cancer cells, undetected by the immune system’.” These clinics have been using stem cell treatments for patients suffering from Parkinson’s, ALS, COPD, heart disease, and pulmonary fibrosis. “Action by the FDA on clinics promoting unproven stem cell therapies is ‘a long time coming,’ says Sean Morrison, former president of the International Society for Stem Cell Research (ISSCR) and d irector of the Children’s Research Institute at UT Southwestern.”

Hurricane Harvey – Harbinger of Infectious Disease?
As hospitals are forced to evacuate patients and medical centers become overwhelmed, the George R. Brown Convention Center has become the city’s largest emergency shelter. It’s always challenging though, meeting the medical demands of so many people in an emergent environment. As providers work to meet basic medical needs there is another concern that bubbles up with an influx of people into a small environment…disease. Floodwater injuries are of course a concern, but we also worry about infectious diseases associated with overrun sewage systems, lack of potable water and safe food, and the existence of mega-shelters that are ripe for transmission of respiratory and diarrheal illness. That’s not even considering the potential for nasty resistant infections like MRSA, VRE, etc. Did I mention mosquitoes? “Based on experience following Hurricane Katrina, there will be several competing effects on the population of mosquitoes and the prevalence of arboviruses, such as Zika, dengue and West Nile, that they transmit. Mosquitoes need stagnant water to lay eggs. Winds and floods will wash away containers that would have been breeding pools, said Hayden, who studies weather and vector-borne disease. In the immediate future, both Hayden and Hotez anticipate that local mosquito populations will decline. But once the floodwaters recede, mosquitoes will recover. In 2006, a year after Katrina, Tulane University public-health experts reported that cases of West Nile infection increased more than twofold in communities that had been in that hurricane’s path. The study authors suggested that increased exposure was the culprit. Fleeing partially submerged buildings, people spent days outside waiting for rescue.” Sadly, it will take years to recover and rebuilding Houston after Harvey, and there are lessons we can apply from not only Harvey, but also Hurricane Sandy, towards future preparedness and response efforts. Matt Watson and Eric Toner from the Center for Health Security are drawing attention to the need for Congress to start gearing up for the health impacts following Harvey.  “Stepping back from the operational response, it’s important to recognize that Congress has a vital role to play in both preparing for and enabling recovery following large scale disasters. On the recovery front, it will be important for lawmakers to pass an emergency appropriation that provides emergency funding. It is critical that Congress reverse that trend and continue to support annual appropriations for hospital and public health preparedness so that the nation is able to respond to increasingly frequent natural disasters and other large-scale emergencies.”

Stories You May Have Missed:

  • Distinguishing Virulent from Harmless Bacteria to Improve Biosurveillance- “Researchers at Los Alamos National Laboratory are working to eliminate false positives in detection of Francisella bacteria, a few species of which include highly virulent human and animal pathogens. The effort contributes to more efficient and effective biological surveillance, such as that conducted by the US Department of Homeland Security and the Department of Defense, which provides early warning of infectious disease outbreaks, hazardous environmental exposures, or possible bioterrorist attacks by spotting trends of public health importance.”
  • Deadly Strain of Klebsiella pneumoniae Found In China– Chinese researchers are reporting a highly virulent, resistant, and deadly strain of the bacteria in five patients at a hospital in Hangzhou, China. “All five patients—who were admitted to the ICU between late February and April of 2016—had undergone surgery for multiple trauma followed by ventilation and subsequently developed carbapenem-resistant K pneumoniae infections and severe pneumonia that responded poorly to all available antibiotics. All five patients died of severe lung infection, multi-organ failure, or septic shock.”

 

Pandora Report 7.14.2017

Welcome to your weekly dose of all things biodefense! We’ve got a lot of global health security goodies for you this week, so grab a coffee and let’s get our biodefense on!

Canadian Researchers Reconstitute Horsepox With Online DNA Order
Friday was an exciting day in the world of dual-use research of concern (DURC) and biosecurity efforts. News of a Canadian research team and their successful experiment in reconstituting horsepox, brought to light several concerns and gaps within DURC oversight. Led by virologist David Evans, the team was able to synthesize horsepox, a relative of smallpox, which is no longer found in nature. What is really concerning so many about this experiment is that Evans and his team were able to do this with little specialized knowledge, $100,000, and using mail-order DNA fragments. While the study hasn’t been published, it is drawing a lot of attention, not only for the potential that such a process could be applied to smallpox, but also that it failed to trigger more reviews at an institutional level for DURC risks. While the U.S. DURC oversight only applies to federally funded research with fifteen select agents, the Canadian processes cover such research that could disseminate knowledge, regardless of what organism is being used. GMU’s Dr. Gregory Koblentz spoke to Science and discussed DURC oversight, noting, “That should have captured the horsepox synthesis,”. “But as far as I understand, they did not engage in a systematic review of the broader dual-use implications of synthesizing an orthopox virus,” says Koblentz. “I don’t think this experiment should have been done.” Researchers and biosecurity experts around the world are weighing in on this study, especially since its publication is immiment. Tom Inglesby of the Center for Health Security pointed to three serious questions and concerns that this work raises – whether experimental work should be performed for the purpose of demonstrating that a dangerous or destructive  outcome could be created by using biology, how much new detail will be provided in the forthcoming publication regarding the processes for constructing an orthopox virus, and the international biosecurity and biosafety implications regarding the approval process for such experimental work. Perhaps one of the most startling aspects of all the commentary and reports on the horsepox experiment has been Evans own opinion on it all – “Have I increased the risk by showing how to do this? I don’t know,” he says. “Maybe yes. But the reality is that the risk was always there.” Where ever you might stand on the topic of dual-use research, bioethicist Nicholas Evans of the University of Massachusetts (of no relation to David Evans), said it best regarding this debated experiment – “an important milestone, a proof of concept of what can be done with viral synthesis. Aside from the oversight and life science research questions that this experiment brings to light, it also stirs the embers of the fiery debate regarding the destruction of the remaining smallpox stockpiles. The most recent blue ribbon panel review regarding the 2014 NIH variola incident sheds some light on the biosecurity and biosafety challenges of maintaining the stockpiles. You can check out the report of the Blue Ribbon Panel to Review the 2014 Smallpox Virus Incident on the NIH Campus  here. The report goes through the event itself, as well as their findings on the incident, response to the incident, and policy changes. Some of the contributing factors they identified included lack of responsibility for infectious materials in shared space, failure to find all variola samples in the 1980s, lack of complete and regular inventory of potentially hazardous biological materials, lack of policy for abandoned materials, history of NIH lapses following implementation of the Select Agent Regulations, etc.

Summer Workshop – Last Chance to Register!
Our Summer Workshop on Pandemics, Bioterrorism, and Global Health Security starts on Monday, July 17th, which means you still have time to register! Don’t miss out on this wonderful opportunity to discuss everything from Ebola to the concerns surrounding the horsepox dual-use dilemma. This three-day workshop will feature experts across the field of biodefense and will provide participants with a wonderful opportunity for networking and brainstorming!

The Pentagon Weighs the Threat of Synthetic Bioweapons 
While the topic of synbio and DURC is still fresh in our minds, how is the Pentagon considering gene-editing as a potential threat? Sure, we prepare for natural outbreaks and acts of bioterrorism, but how does CRISPR come into the mix? “Pentagon planners are starting to wonder what happens if the next deadly flu bug or hemorrhagic fever doesn’t come from a mosquito-infested jungle or bat-crowded cave. With new gene editing tools like Crispr-Cas9, state enemies could, theoretically, create unique organisms by mixing-and-matching bits of genetic information.” In response to these questions and potential scenarios, deputy assistant secretary of defense for chemical and biological defense, Christian Hassell, is working to get some answers. Hassell and other Pentagon colleages funded a year-long review by the National Academies of Sciences to evaluate the health security threats of synbio. While the review is still going on, a preliminary report is undergoing “classified review” before it can be publicly released. This review will be vital to consider the future of gain-of-function research and other dual-use research of concern in the context of biodefense. “Scientists at the meeting expressed a range of ideas about how the military could best defend against biological threats. Sriram Kosuri runs a synthetic biology lab at UCLA that has developed libraries of DNA sequences that can be developed into new kinds of organisms. While he understands the possibility of a lab-engineered threat, he believes the Pentagon and federal health officials should focus on responding to emerging public health menaces rather than monitoring academic labs that use genetic manipulation tools. ‘There’s a legitimate threat of emerging viruses and we need to be prepared for those things,’ Kosuri said during a break in the meeting. ‘The tiny threat of engineered viruses is miniscule compared to that’.” The challenging part in all of this is that there’s no precedent – this is a new field of threat and risk analysis where historical examples are lacking. Hypothetical situations and response scenarios are the best we can offer, but some of the most valuable tools are the ones we already have, like surveillance or early-stage review processes.

Trump Appoints A Key Bioterrorism Position But Still Leaves Dozens Open
Biological threats aren’t just acts of bioterrorism, but also natural outbreaks or laboratory accidents. If the latest horsepox experiment hasn’t convinced you already, we live in a time of quite unique and diverse biothreats. The spectrum of threats requires an array of agencies and personnel with the skills and resources to prevent and respond to such an event. Unfortunately, we’re currently at a national disadvantage in terms of biodefense. If we look at just one small facet of biothreats (bioterrorism), the U.S. has twenty-six (now twenty-five with the nomination of Kadlec) major and vital roles that are vacant and have not been filled by the Trump administration. While some are awaiting confirmation, there are vacancies without even a nominee like the White House position of Director, Office of Science and Technology Policy. The Department of Health and Human Services is missing a surgeon general and assistant secretary for health (awaiting confirmation), while the U.S. Agency For International Development lacks a nominee for the assistant administrator for global health. There are just a few of the vital positions we rely upon for preventing and responding to acts of bioterrorism. In the wider context of all biological threats, it may not seem like much, but the truth is that these vacancies leave the U.S. in a dangerously vulnerable position. Fortunately, President Trump announced on Monday his plans to nominate Robert P. Kadlec of New York to be the Assistant Secretary of Health and Human Services for Preparedness and Response. “Currently, Dr. Kadlec is the Deputy Staff Director for the Senate Select Committee on Intelligence. Previously, he served as a Special Assistant to the President for Biodefense Policy for President George W. Bush. Dr. Kadlec holds a B.S. from the U.S. Air Force Academy; a M.D. from the Uniformed Services University of the Health Sciences, and a M.A. in National Security Studies, Georgetown University.” He was also the Director for the Biodefense Preparedness on the Homeland Security Council and aided in drafting the Pandemic and All-Hazard Preparedness Act, as well as conducting the biodefense end-to-end assessment (culminating in the National Biodefense Policy for the 21st Century). You can even watch Dr. Kadlec speak on C-SPAN at the Bipartisan Policy Center & Kansas State University forum on biodefense in October of 2016. Dr. Kadlec also directed the Blue Ribbon Study Panel on Biodefense during their efforts to establish guidance during critical biothreats.

Public Health Preparedness and Response National Snapshot 2017
The CDC just released their 2017 snapshot regarding U.S. public health preparedness and response, noting that “this year has shown us, once again, that we can’t predict the next disaster. But it has also shown us clearly how being prepared protects health and saves lives. Emergencies can devastate a single area, as we saw with Hurricane Matthew, or span the globe, like Zika virus. Disasters from 9/11 to Ebola have demonstrated that we absolutely must have people, strategies, and resources in place before an emergency happens.” Within the snapshot, there are four main sections- Prepare, Respond, Connect, and Looking Forward. Within these sections, you can look at Zika, laboratories as the front lines of America’s health, global training programs, delivering results through partnership, etc. I found the section on Health Security: How Is The U.S. Doing, quite interesting. They note that “as part of the Global Health Security Agenda, teams of international experts travel to countries to report on how well public health systems are working to prevent, detect, and respond to outbreaks. This process is known as the Joint External Evaluation.” The CDC and Office of the Assistant Secretary for Preparedness and Response (ASPR) work together to establish evaluators , etc. Thankfully, this position is in the process of being filled so that these efforts can move forward. While this snapshot captures the range of issues that must be covered in public health preparedness, it also draws attention to how vital the roles in each agency are, which makes the vacancies that much more impacting.

Summary of Key Recommendations – Meeting to Solicit Stakeholder Input on Forthcoming 2017 National Biodefense Strategy
The Johns Hopkins Center for Health Security, supported by the Open Philanthropy Project, recently held a meeting to discuss and consider the landscape of biological threats to the United States and what response measures, programs, and policies are in place, etc. Featuring members from across academia, industry, and government, these subject matter experts weighed in on this honest and frank discussion about U.S. biodefense strengths and weaknesses. There were several recommendations and topics that were discussed but some of the highlights include improving biosurveillance capabilities and laboratory network, performing risk assessments and characterizing threats, strengthening emergency response capabilities including decontamination efforts, prevention-related efforts, building global capacities for bio-threat preparedness and response, etc. They noted several components to improving U.S. biodefense – “internationally, laboratory and surveillance systems for early detection of new outbreaks will be most effective when they serve the needs of countries where they are housed. It will not work for the US to create systems to gather and export data that the US needs from countries if those countries do not get the information themselves and find it to be valuable.” In regards to healthcare system response and strengthening the workforce, the group pointed out that “national and international preparedness for biological threats requires a strong workforce, including public health experts and animal and plant disease scientists. To some degree, success at controlling infectious diseases in the US may have inadvertently resulted in workforce attrition in these fields. Federal support for developing the workforce in these fields is important”.

Strategies for Effective Biological Detection Systems: A Workshop
Don’t miss this workshop put on by the National Academies of Sciences on Monday, September 18th – Tuesday, September 19th. “The National Academies of Sciences, Engineering, and Medicine will host a two-day public workshop on strategies for effectively updating biological detection systems. The workshop will explore alternative effective systems that would meet requirements for the Department of Homeland Security’s BioWatch Program as a biological detection system for aerosolized agents. There will be a focus on systems or strategies that could be deployed by 2027, and enable indoor surveillance and dual-use with day-to-day environmental surveillance that would be of value to the public health and medical communities. There will also be a focus on the integration of improvements and new technologies into the existing biological detection architecture.”

MRSA Screening – Healthcare Prevention Methods for Resistant Germs & Swabbing Our Way To A Solution for Antibiotic Resistance
Antibiotic resistance is a growing global issue and one of the hotspots for transmission of resistant germs is in hospitals. Given that MRSA (Methicillin-resistant Staphylococcus aureus) is now a common bacteria in the community and healthcare world, hospitals are working to screen patients to ensure those with MRSA are isolated appropriately and they can stop the spread of infection. GMU biodefense PhD student and infection preventionist Saskia Popescu looks at MRSA screening practices within hospital intensive care units (ICUs) and the cost analysis that can make or break a program. Most hospitals utilize one of two approaches – preemptive universal precautions (isolate all ICU patients until microbiology labs can prove they are negative for MRSA) or targeted isolation (wait until labs come back and then isolate). Each tactic has benefits and weaknesses. Delays in isolation can translate to further spread of MRSA, while longer periods in isolation mean additional costs associated with isolation. A recent study evaluated these very two strategies and the “researchers found that the total cost of preemptive isolation ‘was minimized when a PCR screen was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time.’ For ICUs that used targeted isolation, the researchers found that costs would be lowest when chromogenic agar 24-testing was used and not PCR.” What this study highlights is that there is inherently no best practice and that depending on laboratory capability, hospitals may have to plan their MRSA screening and isolation protocols off their microbiology department and cost centers. While hospitals are working to screen patients as a means of responding to microbial resistance, researchers are working against the clock to find solutions. Dr. Adam Roberts is one such innovative microbiologist in the UK who is using an old-school approach to respond to a new problem. Popescu was able to interview him regarding his Swab and Send program, which utilizes citizen scientists from around the world to collect samples that may help produce new antimicrobials from the environment. Roberts is working to utilize environmental samples that hold microorganisms which produce compounds that can help build new antibiotics. “The initiative also helps create a microbial database. For £30, Dr. Roberts’ team will send anyone a handful of sample tubes, a mailing envelope, and directions for what to swab (for example: a nutritious area bacteria would likely grow, likely something unsanitary). After you send back your swabs, you can check out Swab and Send’s Facebook page and see what microbes grew from the samples.” Check out Dr. Roberts’ comments on trends he’s seeing and how even GMU biodefense students are getting in on the swabbing!

Naval Research Lab Find High Prevalence of Antibiotic Resistance in Kenya
Microbial resistance has a way of popping up in even the most unexpected places and projects. The U.S. Navy Research Laboratory (NRL), U.S. Army Medical Research Directorate-Kenya (USAMRD-K), Kenya Medical Research Institute (KEMRI), and University of Washington, led a joint effort to evaluate intestinal tract bacteria and its resistance in patients across Kenya. The NRL-developed microarray they used is capable of detecting over 200 difference antimicrobial resistant genes. “These results suggest that there is selective pressure for the establishment and maintenance of resistant strains,” said Dr. Chris Taitt, research biologist, NRL Center for Bio/Molecular Science and Engineering. “This is potentially due to agriculture and prophylactic use of antibiotics and further suggests the need for more effective public health policies and infection control measures than those currently implemented.” “Specific to Kenya, widespread use of tetracycline in livestock production, use of trimethoprim/sulfamethoxazole (SXT) and chloramphenicol as first line therapeutics for typhoid, and prophylactic use of SXT in persons exposed to or infected with human immunodeficiency virus (HIV) might have contributed to the high prevalence of resistance.” Surveillance of antimicrobial resistance has been a struggle on an international level however, joint efforts like this are vital to not only establishing global standards and processes, but also highlighting the importance it has for military personnel abroad.

Stories You May Have Missed:

  • Agroterrorism Bill – a new bill was recently introduced by U.S. Rep. David Young (R-IA) and Sen. Pat Roberts (R-KS) regarding the preparedness of the U.S. agriculture, food, and veterinary systems. “The Securing Our Agriculture and Food Act requires the DHS Secretary, through the Assistant Secretary for Health Affairs, to ensure food, agriculture, animal, and human health sectors receive appropriate attention and are also integrated into the DHS’s domestic preparedness policy initiatives. The legislation specifically addresses issues seen after the 2015 avian influenza outbreak, which killed millions of turkeys, backyard flocks, and layer hens. It was the deadliest outbreak of avian influenza in Iowa’s history.”
  • What The G-20 Needs To Do To Fight The Next Ebola– The G-20 summit occurred last week in Hamburg and many were hoping for a renewed passion surrounding biological threats. While much attention was focused on climate change, there is also a call for efforts to prevent the next outbreak that will produce a pandemic. “Ultimately, strong health systems depend on communities, health workers, managers, researchers and other local stakeholders being empowered to respond to the inevitable, future waves of change we all face. At Health Systems Global, our members represent these multiple groups. Strengthening everyday resilience demands that we all — governments, donors, researchers, communities, health professionals — work with the resources that health systems already have — their people and relationships. This must be done as we take wider action to confront inequality at all levels. If we do not do that, then efforts to safeguard disease outbreaks will be meaningless.”

Pandora Report 5.26.2017

Summer is in full swing and that means the mosquitoes are out in force. Before you make those pesky bugs your biggest enemy, don’t forget about the threat of antibiotic resistance and the current MCR-1 Klebsiella outbreak in China!

Congrats GMU Biodefense Graduates 
Last week we saw several MS and PhD students graduate from GMU’s biodefense program and we couldn’t be more excited to show off their hard work! Earning their MS in biodefense, we’d like to celebrate Kathryn Ake, Rebecca Earnhardt, Nicholas Guerin, Andrew Joyce, Ryan Lockhart, Patrick Lucey, Alison Mann, Jonathon Marioneaux, Scott McAlister, Greg Mercer, Katheryn Payton, Dana Saft, Colleen Tangney, and Anupama Varma. Earning their PhD in biodefense, we’re celebrating Keith W. Ludwick (Dissertation title: The Legend of the Lone Wolf: Categorizing Singular and Small Group Terrorism), Nereyda Sevilla (Germs on a Plane: The Transmission and Risks of Airplane-Borne Diseases), and Craig Wiener (Penetrate, Exploit, Disrupt, Destroy: The Rise of Computer Network Operations as a Major Military Innovation). Congrats to our biodefense graduates – we can’t wait to see what wonderful things you’ll accomplish in global health security!

U.S. Investment in Global Health Security  – The Good and The Bad
Whether it be an intentional, accidental, or natural biological event, infectious diseases can devastate local economies and populations. “Catastrophic” is a term commonly used for such events. Disease knows no borders or boundaries, which means that our global health security is only as strong as the weakest link. To aid in the stability of global health security, the State Department funds projects around the world to help improve biosafety and biosecurity. The philosophy is that if we can train local trainers to establish expertise and biorisk programs, it would lay the foundation for biosecurity/biosafety for the future. “The State Department carefully evaluates and selects the most impactful projects for each region, pairing local needs with appropriate subject matter expertise. One source of such expertise is Sandia National Laboratories (SNL), which has received State Department funding to implement numerous health security projects. Just this April, Lora Grainger, working at the Labs’ International Biological and Chemical Threat Reduction (IBCTR), travelled to Algeria to train Algerian trainers on a project funded by the State Department. Participants included scientists working in Algeria’s national network of laboratories managed by the Ministry of Agriculture, the Institut National de Médecine Véterinaire (INMV).” This partnership is just one of many and involves education that is tailored to the skills and needs of those being trained. Global health security is bigger than any one country and it’s vital to not only strengthen our own practices, but also facilitate its development in countries that might not have all the resources needed. Speaking of U.S. health security efforts, don’t forget to catch the Operation Whitecoat documentary on the June 1st.                                                                                                                                                              

While these are great efforts the U.S. is putting forward, there is also an internal struggle to maintain public health during a hiring freeze. The freeze was imposed by President Trump’s executive order in late January, which covers currently open positions, blocks transfers, and prevents new positions from being created. It was recently reporting that nearly 700 positions within the CDC are vacant due to the ongoing hiring freeze. “Like HHS, the State Department and the Environmental Protection Agency have maintained the freeze as a way of reducing their workforces and reshaping organizational structures after a directive last month from the Office of Management and Budget that said all federal agencies must submit a plan by June 30 to shrink their civilian workforces. HHS, State and EPA also face significant cuts in the Trump administration’s budget proposal for the fiscal year starting Oct. 1. The administration, which unveiled a ‘skinny budget‘ for fiscal 2018 in March, is scheduled to release its full budget next week. A senior CDC official said unfilled positions include dozens of budget analysts and public health policy analysts, scientists and advisers who provide key administrative support.” A new CDC document notes that at least 125 job categories have been blocked from being filled, which includes positions in the Office of Public Health Preparedness and Response.

Ebola in the DRC – Updates
While we’re honoring researchers and workers for their efforts during the 2014/2015 West Africa outbreak, Ebola continues to rage through the DRC. You can find daily situation reports here from the WHO, as the numbers of reported cases are constantly changing. The WHO is reportedly optimistic that it can contain the outbreak and many are curious to see how the new director general will handle such challenges. The latest situation report from the WHO is pointing to six more cases of Ebola, bringing the total suspected cases to 43. 365 people are currently under monitoring in the DRC. Researchers have also made substantial progress towards understanding how Ebola disables the immune system so effectively. In response to this latest outbreak, the WHO is requesting funding to ensure adequate response to the DRC outbreak.

Pandemics, BT, & Global Health Security Workshop – Instructor Spotlight
We’re excited to announce that Kendall Hoyt is our instructor spotlight this week! Dr. Hoyt is an Assistant Professor at the Geisel School of Medicine at Dartmouth where she studies U.S. biodefense policy and biomedical R&D strategy. She is also a lecturer at the Thayer School of Engineering at Dartmouth College where she teaches a course on technology and biosecurity. She is the author of Long Shot: Vaccines for National Defense, Harvard University Press, 2012. She serves on the National Academy of Sciences Committee on the Department of Defense’s Programs to Counter Biological Threats and on the advisory board of the Vaccine and Immunotherapy Center at Massachusetts General Hospital. Kendall Hoyt received her Ph.D. in the History and Social Study of Science and Technology at the Massachusetts Institute of Technology in 2002 and was a Fellow in the International Security Program at the Belfer Center for Science and International Affairs at the Harvard Kennedy School of Government from 2002-2004. Prior to obtaining her degree, she worked in the International Security and International Affairs division of the White House Office of Science and Technology Policy, the Washington DC office of McKinsey and Company, and the Center for the Management of Innovation and Technology at the National University of Singapore. Did I mention that she’s also done work on Ebola and has written extensively about medical countermeasures for the disease? Dr. Hoyt is not only an expert on biosecurity and the impact of technology, but will take students through the journey of medical countermeasures and security.

The Finish Line in Ending Pandemics and The Future of the WHO
The recent election of a new WHO director-general highlights the current global shift in priorities, and yet the reality is that we’re still fighting an uphill battle against infectious disease and the threat of a pandemic. Recent decades have shown that outbreaks have been increasingly common, taking advantage of globalization, growing populations, and spillover. Avian influenza has been knocking at the door for a while…while bursts of Ebola and SARS have shaken global health security to its core. MERS has also triggered such events in hospitals, leaving no environment safe from emerging infectious diseases. The list of worrying viral diseases has also grown and taught us a rather painful truth – pandora’s box is already open and every time we think we’ve closed it…we realize the seal just isn’t that tight. “Dynamic, rapidly evolving viral threats emerge with increasing frequency, exploiting new pathways in endless pursuit of their biologic imperative. These viruses are the paradigm of adaptive learning. Pushing and probing at our defenses, they shift to new hosts, opportunistically hijack transmission routes, and acquire capacities to evade immune detection. They are subject to no rules of engagement, and their viral intelligence is anything but artificial”. Our new strategy is now to strengthen our detection efforts and to build up response processes. Many have highlighted that what we’ve seen is just a small percentage of what’s out there, but that doesn’t mean we have to keep our heads buried in the sand forever. The future of international disease response will change with the appointment of the new WHO director-general, especially for poor countries dependent upon resources. On Tuesday, it was announced that Ethiopia’s Dr. Tedros Adhanom Ghebreyesus was voted director-general. Dr. Ghebreyesus is the first ever African director-general and brings to the position a long history of health stewardship as a former health minister in Ethiopia. Not only is this election particularly significant as the future of the WHO will be heavily weighed against its failures in recent years, but recent accusations against the newly elected director-general have created further doubts as to the stability of the organization.

Double-edged Sword Research
A new report from the Swiss Academies of Art & Sciences is drawing attention to the need for continued conversation and engagement about the potential for misuse in life sciences. As a result of the workshop, a report was developed highlighting “six issues that should be considered when designing, conducting, and communicating research projects. Each issue is illustrated with examples from actual research projects.” In fact, CRISPR inventor, Jennifer Doudna, is drawing attention to the promises and perils of the gene-editing technology. She points to the worries of creating designer embryos while contrasting the promises of reducing mosquito-transmitted diseases. In fact, recent work has shown some promise in using CRISPR to fight HIV. “Part of the problem is HIV’s ability to squirrel itself away inside a cell’s DNA – including the DNA of the immune cells that are supposed to be killing it. The same ability, though, could be HIV’s undoing. ast week, a group of biologists published research detailing how they hid an anti-HIV CRISPR system inside another type of virus capable of sneaking past a host’s immune system. What’s more, the virus replicated and snipped HIV from infected cells along the way.” While this work has only been done in mice and rats, the concept is promising. Overall, these advances bring about exciting future possibilities, but it’s important to remember that there are dangers too – whether it be tampering with human evolution, contaminated CRISPR kits, nefarious actors using them for terrorism, etc. The complexities of CRISPR and genetic engineering are only growing, which makes the 2018 arrival of the peer-reviewed publication, The CRISPR Journal, even more relevant.

Stories You May Have Missed:

  • Model Systems and the Need For Curiosity-Driven Science– GMU Biodefense PhD student, Saskia Popescu, is looking at the importance of model systems and picking the brain of a top researcher in the field, Dr. Julie Pfeiffer. “Poliovirus is great to use to create model systems because not only does it grow easily, but it is also relatively safe due to vaccination for lab workers, not to mention that we have a pretty solid understanding of the virus based off a century of working with it. ‘We know a lot about poliovirus and we have great tools in our toolbox. If you’re going to tackle a tough problem, it helps to have a great toolbox. For other fields, the ideal toolbox may be fruit flies, worms, or yeast. Collectively, these model systems have illuminated biology and have led to major advancements in human health.’ stated Dr. Pfeiffer in her recent PLOS Pathogens article on the importance of model systems.” “Firstly, I asked if she thought there were other eradicated or ‘almost’ eradicated diseases that could make decent models. She replied, ‘No. We use poliovirus as a model system because of its great tractability, safety, and ease of use (not because it’s nearly eradicated). [Other eradicated diseases such as] smallpox and rinderpest would not be good model systems because they have been completely eradicated from circulation, making biosafety and tractability major issues. [That being said,] if the poliovirus eradication campaign is successful, the idea is to stop vaccination. If this happens, poliovirus will likely become a BSL3/4 agent and I will no longer work with it’.”
  • Is Your Daycare Prepared For a Pandemic?– Daycare centers may not be your first thought when it comes to pandemic preparedness, however a recent survey found that fewer than one in ten U.S. centers have taken steps to prepare for a pandemic flu event. “Researchers surveyed directors of licensed childcare centers in 2008 and again in 2016, to assess flu prevention measures before and after the 2009 pandemic outbreak of a new strain of H1N1 influenza. Among other things, they looked at flu prevention activities like daily health checks for kids, infection control training for staff, communicating with parents about illness and immunization requirements for children and staff.” Children are great sources for disease transmission and when guardians are needed at work, childcare capacity will be extremely important if a pandemic flu occurs.

 

Pandora Report 4.21.2017

If you missed the Infectious Disease Mapping Challenge webinar last week, you can catch the recording here! Ongoing reports are highlighting that the Trump administration is unprepared for a global pandemic.

How Prepared Is The U.S. For Disease Threats?
Scientific American sat down with former CDC director Tom Frieden to discuss his experiences and what he worries may be on the horizon for public health threats. When asked about immediate health issues facing the current administration, Frieden highlights the ongoing Zika outbreak, antibiotic resistance, emerging infections, and the ever-present risk of influenza. In terms of CDC preparedness, Frieden says that, “It’s a big problem that when there is an emerging threat, we are not able to surge or work as rapidly as we should, as a result of a lack of additional funding and legislative authority. When there is an earthquake, the Federal Emergency Management Agency doesn’t have to go to Congress and say, ‘Will you give us money for this?’ But the CDC does. We have made a really good start working with 70 countries to strengthen lab systems, rapid-response and field-monitoring systems, but it is going to take a while before countries around the world are adequately prepared. A blind spot anywhere puts any of us at risk.”

Bill Gates Warns of Increased Bioterrorism Threat
The entrepreneur and philanthropist has been drawing increasing attention to the threat of infectious diseases, especially in regards to bioterrorism. Speaking at the Royal United Services Institute in London (RUSI), Gates stated that, “bioterrorism is a much larger risk than a pandemic.” “All these advances in biology have made it far easier for a terrorist to recreate smallpox, which is a highly fatal pathogen, where there is essentially no immunity remaining at this point.” He goes further to point out the unique aspects of infectious disease threats that make them more deadly than nuclear bombs. “When you are thinking about things that could cause in excess of 10 million deaths, even something tragic like a nuclear weapons incident wouldn’t get to that level. So the greatest risk is from a natural epidemic or an intentionally caused infection bioterrorism events. Whether the next epidemic is unleashed by a quirk of nature or the hand of terrorist, scientists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year. So the world does need to think about this.” Gates pointed to the insufficient public health response in countries that are likely to experience emerging infections and the importance of foreign aid. Moreover, he highlights two major advancements since the 1918 pandemic – globalization and genetic editing. The DIY biohacker and potential for a single infectious person to travel around the globe in a day are all making the threat of a pandemic that much more real. Lastly, Gates emphasizes that the stability of a country and that of its health systems are vital in that an outbreak is more likely to become an epidemic in a country where both qualities are poor.

Biopreparedness – Developing Vaccines For An Eradicated Disease
Speaking of smallpox and the risk of bioterrorism…Filippa Lentzos is pointing to the smallpox vial discovery at the NIH and that despite the eradication of the disease, a biotech company, Bavarian Nordic, is still working to develop a vaccine. She notes that “possible avenues for the re-emergence of smallpox, including the impact of developments in synthetic biology, and it gives an inside view on the biodefence industry and its unusual business model.” Lentzos is an expert in the field of biodefense and focuses her work on the governance of emerging technologies like synthetic biology.

A Scope, A Resistant Germ, and Missing Data Walk into a Bar
GMU Biodefense PhD student Saskia Popescu is looking into the rise of the resistant bug and how medical equipment can pose increased risks for such infections. In 2015 several outbreaks occurred in patients following a procedure with a type of duodenoscopes made by Olympus. These scopes are “flexible medical devices that look like thin tubes and are inserted through the mouth, throat, and stomach into the small intestine—are reusable $40,000 medical devices that contain many working parts, including a camera, and are used for more than half a million procedures a year. The successful dynamics of the device also make it challenging to clean and disinfect. Just over two years ago, cases of drug-resistant infections started popping up in patients who had recently had the procedure that commonly uses duodenoscopes (endoscopic retrograde cholangiopancreatography or ERCP).” Following an outbreak of the highly resistant carbapenem-resistant Enterobacteriaceae (CRE) at UCLA Medical Center, the scopes were recalled and interim cleaning guidance was provided by the CDC. Unfortunately, there is growing concern that the issues with the scope weren’t fully remedied. “In fact, Sen. Murray highlighted a recent outbreak in Europe (location not disclosed within the US Food and Drug Administration report) tied to the modified scopes. Although, modifications made by Olympus were done in response to the previous outbreaks and meant to reduce the risk of bacteria getting into the device’s channels and preventing proper cleaning and disinfection, Sen. Murray is now questioning Olympus regarding the devices and the role they played in this most recent outbreak. The senator is specifically asking for data proving that the repaired scopes could be properly disinfected between patient use.” As the threat of antibiotic resistance rises, the role of medical devices and manufacturer accountability will become increasingly relevant.

CRISPR Breakthrough Gives Hope for Disease Diagnostics 
CRISPR technology news often comes with a bit of controversy, but research recently published in Science is pointing to exciting new diagnostic capabilities. Feng Zhang and eighteen colleagues “turned this system into an inexpensive, reliable diagnostic tool for detecting nucleic acids — molecules present in an organism’s genetic code — from disease-causing pathogens. The new tool could be widely applied to detect not only viral and bacterial diseases but also potentially for finding cancer-causing mutations.” If you’re a fan of 221b Baker Street, you’ll be pleased to hear that the new tool is named SHERLOCK – Specific High Sensitivity Enzymatic Reporter UnLOCKing. The SHERLOCK tool utilizes the viral-recognition within CRISPR to detect genetic pathogen markers in some one’s urine, blood, saliva, or other body fluids. “They report that their technique is highly portable and could cost as little as 61 cents per test in the field. Such a process would be extremely useful in remote places without reliable electricity or easy access to a modern diagnostic laboratory.” This new finding has amazing potential for public health and rapid disease detection in rural areas to improve time to treatment, isolation, and prevention efforts.

National Science Advisory Board for Biosecurity May 2017 Meeting
Don’t miss this May 11th meeting (2-4:30pm EST)! Items include presentations and discussions regarding: (1) the Blue Ribbon Panel draft report on the 2014 variola virus incident on the NIH Bethesda campus; (2) stakeholder engagement on implementation of the U.S. Government Policy for Institutional Oversight of Life Sciences Dual Use Research of Concern (DURC); and (3) other business of the Board.  A detailed agenda and other meeting material will be posted on this website as they become available. This meeting will be a conference call only; there will be no in-person meeting. To join the call as a member of the public, please use the dial-in information below. The toll-free teleconference line will be open to the public at1:30 P.M. to allow time for operator-assisted check-in.  Members of the public planning to participate in the teleconference may also pre-register online via the link provided below or by calling Palladian Partners, Inc. (Contact: Carly Sullivan at 301-318-0841).  Pre-registration will close at 12:00 p.m. Eastern on May 8, 2017. Make sure to check the website for the public conference line and passcode.

Synthetic Bioterrorism – US Developing Medical Response 
Preparedness efforts against biological threats are now expanding to include synthetic biological threats. “Dr. Arthur T. Hopkins, acting assistant secretary for Nuclear, Chemical, and Biological Defense Programs at the U.S. Department of Defense (DOD), testified that…’emerging infectious diseases, synthetic biology and engineered diseases…[is] an area where we are focusing and we have to continue to focus.’ To counter such current and emerging threats, DOD’s Chemical and Biological Defense Program is developing new strategies to more rapidly respond, especially in the area of medical countermeasures, Hopkins said.” He noted that the DoD has commissioned the National Academy of Science to lead a study on the potential for such an event and its impact on national security.

Chemical Reaction: North Korea’s Chemical Weapons Are A Big Threat- And China Needs to Help Deal With Them
GMU Biodefense PhD alum Daniel M. Gerstein is looking at the “role that China could play with respect to North Korea, in particular dissuading the use of chemical weapons. While tensions are high, the use of chemical weapons could be the “spark that could bring the region to war.” Gerstein notes that while the focus in Syria is internal, if Kim Jong Un used chemical weapons it would most likely be external- against South Korea or Japan (or even the U.S.). It is vital that there be a clear-cut response to the use of chemical weapons and action from China may just be the clear message that’s needed. “To prevent the unthinkable from occurring, the North Koreans must be dissuaded from using chemical weapons. They must be convinced that the use of chemical weapons is a red line that cannot be crossed. China should consider being the messenger for this message. China also should consider taking an active, forward-looking approach to prevent the use of chemical weapons by North Korea. When Syria deployed chemical weapons, there was speculation that Russia may have been complicit or at least aware of plans to conduct the attack.” Or perhaps some friendly games of volleyball are in order?

Wildlife Disease Biologists – An Unstoppable Force 
Neither rain nor sleet could keep APHIS wildlife disease biologists out of the field collecting samples. Animal diseases are a major source for infections coming down the pipeline for humans (i.e. spillover events) and these researchers are on the front lines trying to make sure we have a heads up. APHIS’ Wildlife Services (WS) program includes 36 wildlife disease biologists who work diligently to collect samples from wild birds for avian influenza testing (among other things). “‘By monitoring the avian influenza strains circulating in wild birds, WS and its partners are able to provide an early warning system to America’s poultry producers,’ states Dr. Tom DeLiberto, Assistant Director of WS’ National Wildlife Research Center. ‘Our experts focus their sampling on waterfowl species and locations where we are most likely to detect avian influenza. This ensures our efforts are as efficient and informative as possible’.” I think we can all appreciate the brave few who venture into frigid waters to help trap and test wild birds to help detect the spread of infectious diseases.

Stories You May Have Missed: 

  • Trends in Apocalyptic and Post-Apocalyptic Fiction – Writers frequently use an apocalyptic or post-apocalyptic backdrop for fictional stories. The Doomsday Clock is a visual representation of the general mood and often represents the fear and unease in the environment. Whether it be an environmental event or a killer virus, the end of humanity has been a frequent topic for many writers. “Often it is a fear of a naturally-evolving virus, as in Max Brooks’s World War Z: An Oral History of the Zombie War (2006) or Emily St. John Mandel’s Station Eleven (2014). Yet, with the advent of new biotechnologies, authors also considered the impact a malignant engineered virus would have on humanity, as seen in Margaret Atwood’s Maddadam trilogy (2003 onwards) and Justin Cronin’s The Passage trilogy (2010 onwards).”
  • Ebola Theme Issue – The Royal Society – Philosophical Transactions of the Royal Society B is focusing their latest biological sciences journal on the 2013-2016 Ebola outbreak in West Africa. In this edition, you can find opinion pieces discussing the contribution of engineering and social sciences, old lessons on new epidemics, and a wealth of information on outbreak evaluation and notes from the field.

Pandora Report 1.27.2017

The ghostbusters had proton packs and now researchers have DNA-analyzing smartphone attachments to help diagnose disease and fight antimicrobial resistance.

Doomsday Clock Moved 30 Seconds Closer to Midnight
The Bulletin of the Atomic Scientists announced that the clock setting was moved on Wednesday. This is the closest it has been to midnight since 1953 and now includes threats like climate change, cyberthreats, and biological weapons. The board has been critical of President Trump and noted that, “Over the course of 2016, the global security landscape darkened as the international community failed to come effectively to grips with humanity’s most pressing existential threats, nuclear weapons and climate change … This already-threatening world situation was the backdrop for a rise in strident nationalism worldwide in 2016, including in a U.S. presidential campaign during which the eventual victor, Donald Trump, made disturbing comments about the use and proliferation of nuclear weapons and expressed disbelief in the overwhelming scientific consensus on climate change.” You can get a better glimpse of the clock and its components here.

Possession, Use, and Transfer of Select Agents and Toxins; Biennial Review of the List of Select Agents and Toxins and Enhanced Biosafety Requirements- Final Rule
The CDC has released the final recommendations for select agent biosafety requirements in accordance with the 2002 Bioterrorism Response Act. The 2016 recommended changes included the removal of six biological agents, “add provisions to address the inactivation of select agents, add specific provisions to the section of the regulations addressing biosafety, and clarify regulatory language concerning security, training, incident response, and records.” However, as of January 19th, 2017,  HHS and USDA have published parallel amendments to the federal regulation for select agents and toxins. Following their review, HHS decided not to finalize the proposed changes to the list of select agents. They did however decide “to finalize provisions to address toxin permissible limits and the inactivation of select agents; to finalize specific provisions to the section of the regulations addressing biosafety; and to clarify regulatory language concerning security, training, incident response, and records”. The amendments are set to take effect 30 days from the date of publication.

Biodefense World Summit
Don’t miss out on the Biodefense World Summit in Alexandria, VA from June 27-28th! This will be the third summit in order to “bring together leaders from government, academia, and industry for compelling discussions and comprehensive coverage on pathogen detection, sample prep technologies, point-of-care, and biosurveillance. Across the four-track event, attendees can expect exceptional networking opportunities in the exhibit hall, across panel discussions, and shared case studies with members of the biodefense community from technology providers to policy makers.” Make sure you don’t miss out on GMU Biodefense PhD student, Mary Sproull’s presentation, “Recent Advances in Radiation Biodosimetry for Partial and Total Body Exposures” during the tools and technologies at the point-of-care session!

Missing Russian Smallpox Researcher  
This may sound like the plot of a horror movie (or Sum of All Fears), but the reality may be just as worrisome. Professor and Russian microbiologist, Ilya Drozdov has been put on Interpol’s wanted list. Having knowledge of Russia’s historical bioweapons program means that Dr. Drozdov’s disappearance has authorities worrying he may have gone abroad. Dr. Drozdov was head of Vector for five years, which means he has considerable knowledge in both the offensive program and the recent work regarding plague vaccines and HIV cures. “After quitting the institute, he returned to his native Saratov, but has now vanished. It is now confirmed that last month the 63 year old scientist – who needed top vetting clearance to lead Vector – was put on the Interpol wanted list, indicating fears he has gone abroad. He is accused by state investigators of misappropriating some 2 million roubles – then worth around $55,000, while his tenure also led to an outflow of staff unhappy at his management style. A criminal case was filed against him in 2014, and a Novosibirsk court has now approved his arrest in absentia, said Elena Chernyayeva, a regional deputy prosecutor. The microbiologist allegedly used the cash to purchase an apartment. There is no suggestion he has taken secrets abroad, but the Interpol alert indicates the Russian authorities have lost track of his whereabouts. There was criticism of him at Vector for the poor pay of its expert researchers, and ‘conflicts’.”

Bill Gates Talks Bioterrorism 
Last week we looked into the Coalition for Epidemic Preparedness Innovation (CEPI), which aims to head off worldwide outbreaks through the development and stockpiling of vaccines. CEPI has received massive financial support and one sponsor in particular is the Bill and Melinda Gates Foundation. Bill Gates recently warned, at the recent World Economic Forum, that there is a true gap in bioterrorism preparedness. “What preparedness will look like for intentionally caused things, that needs to be discussed,” he said. “It’s very hard to rate the probability of bioterrorism, but the potential damage is very, very huge. I think an epidemic, either naturally caused or intentionally caused, is the most likely thing to cause, say, 10,000 excess deaths,” Gates said. “He voiced the same concern in March during a Reddit Ask Me Anything session: ‘The problem of how we prevent a small group of terrorists using nuclear or biological means to kill millions is something I worry about,’ he wrote.” Other biotech gurus like Sam Altman noted that the 2011 H5N1 gain-of-function controversies have opened their eyes to synthetic viruses as a form of terrorism or bioerror.

Health Security Memos to the New Administration and Congress 
Despite a recent move, researchers at the Center for Health Security aren’t taking a break when it comes to global health security. They’ve recently written a series of commentaries for the new administration regarding facts and assessments that are critical for the world of health security. The memos range from healthcare preparedness to improving biosurveillance, partnering with communities to foster trust, communication of new disease threats, and much more.

FDA’s New Farm Antibiotics Policy – Is It Enough?
The new FDA Guidance for Industry (GFI) #213 is what some would consider a victory, while others are calling it a mediocre milestone at best. The new policy looks to reduce the usage of antibiotics in agriculture by requiring veterinary oversight. That’s right, prior to GFI #231, farmers could go to their local feed stores and buy penicillin and tetracycline over the counter to add to feed and water to promote growth. “Under GFI #213, which was first announced in 2013 and has taken 3 years to fully implement, pharmaceutical companies have been asked to voluntarily remove production purposes (such as growth promotion) from the labels of all medically important antibiotics used in food production. All affected companies have done so as of Jan 3, the FDA says. In addition, the guidelines require veterinary oversight for the continued use of these drugs for disease prevention and control in herds and flocks. From now on, all antibiotics used in water will require a prescription from a licensed veterinarian, and those used in feed will need a veterinary feed directive (VFD).” Sure, this is a move in the right direction, but are we ensuring the quality of veterinary oversight and truly changing the culture within farming to support responsible antibiotic usage?

Outbreak Alert: Seoul Virus in Illinois and Wisconsin Rat-Breeding Facilities
While we’ve been busy with the inauguration and Zika virus, there’s been an emerging outbreak creeping up in Illinois and Wisconsin. Eight people have been infected with Seoul virus after working in several rat-breeding facilities across the two states. While not commonly found in the U.S., this is the first known outbreak associated with pet rats. “A home-based rodent breeder in Wisconsin was hospitalized in December 2016 with fever, headache, and other symptoms. CDC tested a blood specimen and confirmed that the infection was caused by Seoul virus, a member of the Hantavirus family of rodent-borne viruses. A close family member who also worked with rodents also tested positive for Seoul virus. Both people have recovered. A follow-up investigation at several rat breeders that supplied the initial patient’s rats revealed an additional six cases of Seoul virus at two Illinois rat breeding facilities.” While related to Hantavirus, Seoul virus presents with more mild symptoms.

Stories You May Have Missed:

  • Post-Ebola reforms: ample analysis and inadequate action–  Check out a new analysis on WHO response and global reaction to the Ebola outbreak. “Given the importance of improving our ability to battle current (Zika, yellow fever, etc) and future outbreaks of infectious disease, we examined seven major reports and identified areas of consensus on action. We then assessed what progress has been made and what can be done to address the gaps. The seven reports were selected on the following criteria: scope (tackling problems beyond a single organization, country, or sector); diverse authorship (defined by country of origin, organizational affiliation, area of expertise, and gender); and public availability (excluding internal reviews).”
  • Using the lessons of economics to stop global pandemics before they start -Larry Summers is looking to economics to calculate the likely future impact of pandemics on the global economy. By combining the mortality cost and losses in income, he and fellow researchers found that “it was on the same range as that of climate change-  although at the lower end of the possible scale. A moderately severe pandemic, of the kind that occurs every few decades, would knock 4-5% off global output. The “ultra scenario”—a pandemic similar in virulence to the flu of 1918—would raise that to 12%, reducing GNI in some developing countries by more than half.”
  • How Prepared is the U.S. for Avian Influenza?– Many are pointing to an impending avian influenza outbreak and questioning how well American response measures will work. “On Jan 9, the US Department of Agriculture (USDA) confirmed that a wild mallard duck in Montana had died from H5N2, a highly pathogenic avian flu strain that in 2015 affected farms in 15 states and led to the culling of more than 43 million poultry, with an estimated $3.3 billion in economic losses. ‘This confirmed H5N2 in a wild mallard duck in Montana keeps us on high alert,’ said Donna Karlsons, a public affairs specialist with the USDA’s Animal and Plant Health Inspection Service (APHIS). ‘We know the disease is out there and serves as a great reminder for constant biosecurity vigilance. There is never a good time to ease up on biosecurity, and it remains our greatest asset to protect against avian influenza’.”

 

Pandora Report 12.16.2016

Sick to your stomach? Make sure to tweet about it! Seriously – the UK Food Standards Agency is using social media to track stomach bugs like norovirus. Before we venture down the biodefense rabbit hole, have you ever wondered what would happen if college students tried to hack a gene drive?

GMU Biodefense PhD Writes ‘Groundbreaking’ Thesis on Cyber Warfare– GMU Biodefense PhD graduate, Craig Wiener, is talking about his PhD experience and the amazing work he did on his dissertation. Craig’s story is pretty unique – between the commute from his position at the Department of Energy’s National Nuclear Security Administration, to his background in biodefense and research in synthetic biology, he’s a prime example of the diverse and passionate students we see in the GMU biodefense program. “Wiener’s PhD dissertation, ‘Penetrate, Exploit, Disrupt, Destroy: The Rise of Computer Network Operations as a Major Military Innovation,’ is groundbreaking, said Gregory Koblentz, director of Mason’s biodefense graduate program, and it has nothing to do with biodefense. Wiener connected some rather complicated dots in determining the origins of computer network exploitation and computer network attacks in the U.S. intelligence community. ‘I’ve established that computer network operations are a major military innovation, and it was developed by the U.S. intelligence community…. It’s the first time the intelligence community has developed a weapon system,’ said Wiener.” A labor of love, his work will significantly contribute to the history of cyber warfare and is a prime example of what makes GMU such a wonderful university to study.

FDA Review of 2014 Variola NIH Incident

screen-shot-2016-12-14-at-7-57-52-amThe newly released report, “FDA Review of the 2014 Discovery of Vials Labeled ‘Variola’ and Other Vials Discovered in an FDA-Occupied Building on the NIH Campus”, details the findings and corrective actions following the FDA’s internal investigation of the 2014 incident. The compilation includes several interviews, findings from reports and site visits, and a timeline of events leading to the discovery of the 327 vials on July 1, 2014. Some of the findings include: “There was no single individual responsible for the entire contents and operation of the shared cold storage area. FDA did not follow the CDC Select Agent Guidelines for the packaging and transfer of samples to a high containment facility for securing the materials.” There were six findings in the report, which included corrective actions, future actions, and compliance mechanisms. The report also includes the table regarding the disposition of the 327 vials. “It was noted that an internal, inward-looking investigation by the FDA had not formally started at the time of the hearing because both the CDC and FBI were in the midst of their own investigations of the incident.  However, FDA informally started an internal review and audit of the incident to understand the failure points to implement best policies and practices to prevent such incidents from happening in the future.”

Global Virome Project – You may remember reading  this summer about finding the next patient zero via a speaking engagement from USAID Director for Global Health Security and Development Unit, Dr. Dennis Carroll. The truth is that outbreaks like Zika and Ebola have shown us that countermeasures are invariably weak and viruses like to hide out in nature. This formidable reality has led to the development of the Global Virome Project, which looks to catalogue viruses from all over the world as a means of identifying the threats before they can identify us. “The idea has been around for a while and is supported by individual scientists and organizations including the US Agency for International Development, the nonprofit EcoHealth Alliance, HealthMap, ProMED, and the epidemic risk firm Metabiota. Now support for a global push may be picking up momentum, as scientists and health organizations find themselves repeatedly called upon whenever new threats arise.” An extension of the vision that brought about the PREDICT project, the Global Virome Project looks to make the process more efficient and effective by utilizing new methodology. While knowing the existence of a disease does not equate to preparedness, the understanding of how it interacts with humans and where it hides can help us determine risk and vaccine development. “For instance, knowing that the risk of contracting viruses carried in a species of bats is highest when their offspring are young might push ecotourism operators to avoid caves at those times. And Carroll said filling in more of the picture of the viral world will simply help scientists understand its patterns and interactions better. Right now, predictions are based on the behaviors of a few hundred known viruses, he said.”

2017-2022 Health Care Preparedness and Response Capabilities – The Office of the Assistant Secretary for Preparedness and Response has released their report outlining “the high-level objectives that the nation’s health care delivery system, including HCCs [health care coalitions] and individual health care organizations, should undertake to prepare for, respond to, and recover from emergencies.” The report further breaks down the capabilities into four sections that will, when combined and fully followed, enable full readiness. The four sections are Foundation for Health Care and Medical Readiness, Health Care and Medical Response Coordination, Continuity of Health Care Service Delivery, and Medical Surge. The report is extremely detailed and includes a wide variety of methods for identifying and coordinating resource needs during an emergency, setting up a health care EOC, implementing out-of-hospital medical surge response, and much more.

Blue Ribbon Study Panel Report on Biodefense Indicators– I remember the excitement during the Blue Ribbon Study Panel presentation on their recommendations since the Ebola outbreak. The room was packed with so many contributors to biodefense and there was a sense of fervor regarding the possibilities that could come from their 87 recommendations. Sadly, it seems that enthusiasm isn’t enough to get the work completed. It seems that an overwhelming majority haven’t been completed, according to the latest report. In fact, Tom Ridge and Joseph Lieberman have taken to TIME magazine as a means to implore the incoming administration to help protect the U.S. from bioterrorism and infectious disease threats.

Nanotherapeutics Opens Plant Near Progress Park – Nanotherapeutics opened their new $138 million 183,000-square-foot plant near Progress Park in Alachua, which was built to fulfill a DoD grant that could be worth up to $359 million. “The purpose and the capability of this facility is really fundamentally to avoid a surprise and be better prepared,” said Chris Hassell, deputy assistant secretary of defense for chemical and biological defense. “Sixty years after Pearl Harbor we were surprised again with the anthrax mailings and other events of 9/11, so this whole issue of surprise is a common area of discussion, what can we do to avoid surprise, to defend it, to respond to it more effectively and to that end this facility is very important to our capability to do that.” The DoD maintains several contracts for vaccine and treatment manufacturing, however Nanotherapeutics has tackled several of the struggles with efficiency that have plagued several other efforts. Utilizing disposable bags within stainless steel equipment allows for less clean-up and quicker transitions to help make the process more efficient and successful. The new plant follows strict NIH and military guidelines regarding waste and handling of hazardous materials, not to mention a pretty hefty security system.

czqg73pwiaacplk-png-largeUNSC 1540 Resolution – The United Nations Security Council unanimously voted on Resolution 1540 this week, which is especially prudent given the devastation in Syria and use of chemical weapons. The overwhelming adoption of the 1540 review resolution furthered the fight to keep WMD’s out of non-state actor hands. Resolution 1540 was adopted in 2004 and extended periodically through 2012 as a means of imposing binding obligations on all states to adopt legislation to prevent the proliferation of nuclear, chemical, and biological weapons. The open debate, “Preventing Catastrophe: A Global Agenda for Stopping the Proliferation of Weapons of Mass Destruction to Non-State Actors” took place on December 15th, ending the second review of 1540 implementation. “The Council is expected to adopt a resolution endorsing the review and noting the findings and recommendations contained in its report, which was agreed by the 1540 Committee last Friday”. The comprehensive review process has been somewhat challenging lately due to differences in Council member priorities and ambitions. “Russia and China made clear that they did not see the need for radical changes in the functioning or mandate of the Committee, whereas Spain, as the chair of the Committee, and other Council members, such as the UK and the US, were pushing for more substantive measures and new approaches. As a result, the discussions in the 1540 Committee on the report of the review were quite contentious, in particular with regard to its conclusions and recommendations. It took more than two months of intense negotiations after the Committee considered the first draft of the report on 27 September to reach agreement on the final document. The whole review process has taken almost two years.” We’ll make sure to keep you posted as news is released!

Avian Influenza and Global Trade Conditions– A series of avian influenza outbreaks are challenging the positive 2017 outlook for the global poultry industry. These events are especially distressing for the poultry industry as the global pork and beef production is rising. “The return of avian influenza is now shaking up global trade conditions and is especially affecting the outlook for Asia, Europe and Africa,” the report said. “It will also be a test for the U.S. industry after last year’s multiple AI outbreaks. As many European and Asian countries are exporters of meat and breeding stock, this will certainly impact the outlook for the industry and could shake up meat and breeder trade again.” The increasing protectionism and disease-related traded restrictions have caused some slowing within the poultry trade. This report comes at an auspicious time as the WHO warns of a H7N9 pandemic.

Zika Virus Updates- The most recent Florida Department of Health daily updates can be found here, which found six new travel-related cases on 12/14 and no new locally acquired cases. The CDC has issued a travel advisory for Brownsville, TX due to Zika virus. A new study has estimated the prevalence of Zika by the time a microcephaly case is detected. Saad-Roy, et al. (2016) explain, “this model gives us the probability distribution of time until detection of the first microcephaly case. Based on current field observations, our results also indicate that the percentage of infected pregnant women that results in fetal abnormalities is more likely to be on the smaller end of the 1% to 30% spectrum that is currently hypothesized. Our model predicts that for import regions with at least 250,000 people, on average 1,000 to 12,000 will have been infected by the time of the first detection of microcephaly, and on average 200 to 1,500 will be infectious at this time. Larger population sizes do not significantly change our predictions.” The CDC has reported, as of December 14th, 4,617 cases in the U.S.

Stories You May Have Missed: 

  • Biological Security Threats Situation Report – In this report from the Danish Centre for Biosecurity and Biopreparedness, you can find an assessment of current biological threats and risks. The authors note that “the overall likelihood of a major biological terrorist attack must be viewed as relatively low at the moment, but a successful attack could have grave consequences for societies.” Focusing on the capacity to respond to intentional attacks through biosecurity and biopreparedness is vital. The report looks at the risks from state, non-state terrorists, and criminals in its assessment.
  • DHS Backs Development of Livestock Disease Outbreak Readiness Program – America has a soft underbelly and it’s livestock and agriculture. The new funding for the National Agricultural Biosecurity Center (NABC) project to develop the readiness program is just over $330,000 and “will provide a clearinghouse for planning, training and knowledge products to help state, local, tribal and territorial entities prepare for transboundary livestock disease outbreaks.he program also entails extensive collaboration of academia, private industry and state governments. Faculty and staff in the Beef Cattle Institute and the College of Veterinary Medicine will provide subject matter expertise and assistance building the website, and student workers will be employed to assist with the project.”
  • ABSA International  – Don’t miss the USDA and the Agricultural Research Service’s 4th International Biosafety and Biocontainment Symposium- Gobal Biorisk challenges: Agriculture and Beyond. This symposium will take place from February 6-9th at Baltimore Convention Center. Topics will range from biorisk management challenges in one health world, arthropod containment in plant research, and much more!

Pandora Report 8.26.2016

A new report by the Organization for the Prohibition of Chemical Weapons (OPCW) is pointing to a harsh reality that despite incomplete and inaccurate Syrian disclosures, there are traces of nerve agents in their laboratories. While they promised to destroy their entire arsenal, there is a growing concern that Damascus has not followed through on commitments to destroy all of its armaments.   Feel like a biodefense arts and crafts project?  You can learn to make a plague doctor’s mask here. Chem-Bio warfare suits may be getting a fashionable upgrade as companies like Lululemon and Under Armor are competing to revolutionize the protective equipment. 

UN Security Council – Calls for Eradicating WMD’s  689139
On Tuesday, GMU Biodefense Graduate Program Director and Professor, Dr. Gregory Koblentz, briefed the UN Security Council on how terrorists could exploit advances in science and technology to acquire weapons of mass destruction. He delivered the briefing as part of a Security Council open debate on WMD nonproliferation that is part of the comprehensive review currently being conducted of Resolution 1540. You can read the summary of the meeting here, but the focus was on the evolving threat of WMD’s falling into the hands of non-state terrorists and actors. Emphasizing the threat of biological weapons, Secretary-General Ban Ki-Moon “questioned the international community’s ability to prevent or respond to a biological attack.  He also suggested giving a closer look at the nexus between emerging technologies — such as information and communication technologies, artificial intelligence, 3-D printing and synthetic biology — and weapons of mass destruction.” Dr. Koblentz (27 minutes into the broadcast of the meeting here) pointed to the Fourth Industrial Revolution as a source for huge gains in both productivity and prosperity, but also a darker potential for mis-use by non-state actors. Within his talk, Dr. Koblentz noted the five advances in science and technology that “increase the risk of CBRN weapons proliferation to non-state actors”. The advances include unmanned aerial vehicles (UAVs), 3D printing, accessibility of illicit items on the Dark Web, malicious software and cyber attacks, and genetic engineering tools like CRISPR-Cas9. While these advances reveal the diverse technology, there are also seven deadly traits within these emerging technologies – dual-use, disruptive, diffusion, reliance on a digital component, decentralization, deskilling, and the DIY (do-it-yourself) movement. Simply put, these seven characteristics make emerging technologies that much more challenging to prevent mis-use. “The international community faces a continuous challenge of encouraging innovation and maximizing the benefits of such innovation with the need to mitigate the security risks posed by these new technologies. I hope the Security Council will take advantage of the Comprehensive Review of Resolution 1540, which this open debate is an important contribution to, to update the resolution to take into account the impact of scientific discoveries and technological breakthroughs on the proliferation of weapons of mass destruction to non-state actors.” There was substantial discussion regarding the strengthening of Resolution 1540, especially to consider the implications of a biological attack in light of recent outbreaks like Ebola, MERS, and SARS.  During her remarks, Ambassador Michele J. Sison, U.S. Deputy Representative to the United Nations, described Dr. Koblentz’s briefing as, “a very interesting, but also very sobering intervention.” Hopefully, with the focus on these evolving threats, the current review of Resolution 1540 can be further strengthened and focused to reduce the risk of terrorists acquiring WMD’s.

A Tribute to D.A. Henderson
There are few times in the history of public health that we can say we’ve eradicated a disease. D.A. Henderson, smallpox guru and disease detective, led such efforts within the WHO and his absence has been felt throughout the health community. A legend among public health and biodefense students, his dedication to the field inspired generations. As an epidemiologist, his work in both infectious diseases and bioterrorism gave me hope that such a career was not only possible, but also filled with the kind of adventure that many only dreamed about. Having just read Scourge (and I would highly encourage you to read it), the dedication to the smallpox eradication efforts is still an inspiration. After conquering what many considered impossible, Henderson worked as Dean of the Johns Hopkins School of Public Health, founding director of the Johns Hopkins Center for Civilian Biodefense Strategies (now UPMC Center for Health Security), and following 9/11, led the Office of Public Health Preparedness. Described as a “Sherman tank of a human being- he simply rolled over bureaucrats who got in his way”, Henderson’s death is truly felt throughout the international community. In the wake of his death, we take a moment to truly applaud and appreciate all he’s given and inspired within global health security.

How Far Will the U.S. Luck Run?
With the anticipation and preparations for Zika having started months before it reached U.S. soil, many are wondering if our luck with infectious disease is running out. We were lucky with Ebola- a handful of cases and once we hit the panic button, we were able to overcome the crisis. Despite insufficient funds and battling diseases we had little to no experience in handling, U.S. efforts have been fortunate in their successes. Zika may be a different kind of ball game though – mosquito control efforts are flawed at best and with a disease that is often asymptomatic, we may have finally hit a wall. Did we really learn from Ebola? Have we strengthened our surveillance and response practices? Dr. Johnathan Fielding notes that “HHS must play a greater role in coordinating the global public health response through implementation of the Global Health Security Agenda, a cooperative arrangement launched in 2014 by over 50 nations, nongovernmental organizations and other stakeholders; better coordination with other government agencies, and state, local and private sector partners; and clear delineation of roles and responsibilities within and among HHS offices.” We need both the monetary and personnel support to properly address the failures from Ebola, but also implement the recommendations that so many have made following the crisis. The contingency funding that has been pushed recently is an indication of our potentially faltering luck – have we reached such an impasse in which our politics will override our disease response capacity or capabilities?

A Lot of Zika Goes a Long Ways 
Palm Beach is seeing its second case of Zika virus, with active transmission continuing in Florida. Florida Governor, Rick Scott, has expressed frustration that the promised federal support of antibody tests and lab support has not been delivered. “In a teleconference on Wednesday, Scott made a plea for more support in fighting Zika, complaining that ‘Congress and the White House have not been good partners.’ Scott said he asked the U.S. Centers for Disease Control and Prevention for 5,000 Zika antibody tests last week, but so far had only received less than 1,200.” Johns Hopkins is opening the first multidisciplinary Zika center, the Johns Hopkins Wilmer Zika Center, which is dedicated to caring for affected patients. As of August 24, the CDC has reported 2,517 cases of Zika virus in the U.S. The CDC has also awarded $6.8 million to partners to help support Zika response. “This funding will help enhance surge capacity for Zika case identification and mosquito surveillance. It will also help improve communications to key populations, by developing focused educational materials, sharing mosquito control guidance, and refining community public awareness campaigns.”

Human Mobility and Epidemics
Tracking infectious disease cases is never an easy task – whether it be an asymptomatic patient, mosquito-spread disease, or global travel, epidemiology and case tracking is not for the faint of heart. An increasingly mobile population is only adding to this difficulty. The first few days of an infection with Dengue or Zika are often so mild that many don’t even seek medical care. How many times have you had a fever and it didn’t stop you from traveling or going about your day? Disease ecologists are now looking at the impact of a fever on human mobility and the shock this may have during an outbreak of a vector-borne disease. “We’ve found that people with a fever visit 30 percent fewer locations on average than those who do not have a fever, and that they spend more time closer to home. It may sound like stating the obvious, but such data have practical applications to understand how human behavior shapes epidemics,” says Gonzalo Vazquez-Prokopec, an assistant professor in Emory University’s Department of Environmental Sciences, and senior author of the study. “No one had previously quantified how a symptom such as fever changes mobility patterns, individually and across a population, in a tropical urban setting like Iquitos.” Not surprisingly, human mobility is a huge driver for spreading these diseases in urban settings. With the ongoing spread of Zika, researchers are continuing to learn about the impact of human behavior and mobility on the spread of these mosquito-spread diseases.

Stories You May Have Missed: 

  • Global Reaches of Antibiotic Resistance – Check out my latest comments on the global implications of antibiotic resistance for first responders and security personnel. It’s a topic we’ve so frequently cited as an international health emergency, and yet it gets so little attention. In this article, I point to the obvious implications, but also the worries that dual-use technologies of concern and genetic modification could allow for increased resistance for a more sinister reason.
  • South Sudan Crisis Calls for Additional WHO Surveillance  – the continued chaos and violence in South Sudan has translated into the WHO ramping up disease surveillance efforts. More than 1.6 million internally displaced persons (IDP) have been caught in the conflict, leaving the region more susceptible to malaria and diarrheal illnesses. “The conflict has exacerbated existing challenges with the health system and disease surveillance,” Dr Usman says. “With so many health workers and partners moving to safety, data is more difficult to collect and challenges have emerged as humanitarian access remains limited.” The WHO is coordinating with the Ministry of Health to strengthen surveillance efforts to help detect and respond to outbreaks.
  • FBI WMD Directorate Marks 10 Years – A program we’d rather have and not need than need and not have, the WMD Directorate within the FBI has been imagining worst-case scenarios for over a decade to better prepare and protect the U.S. “The Directorate has three sections: countermeasures, investigations and operations, and intelligence. In its first five years, the Directorate established itself as a central hub for WMD subject-matter expertise.” Assistant Director, John Perren, notes that while they’re intelligence driven, the things that keep him up at night aren’t what he knows, but what he doesn’t know.

Pandora Report 8.5.2016

August is here and so are the Zika cases…it does seems rather ominous that the Rio Olympics are starting a week after the confirmation of locally-acquired U.S. cases of Zika virus. Despite the outbreak and the concerns over water safety, the games must go on?

Syria Chemical Weapons Attack
Two chemical attacks were reported earlier this week in northern Syria. The first attack occurred in the city of Saraqeb, where chlorine gas-filled cylinders were dropped in a residential area. Russia has already begun denying any role in the attack and while officials haven’t formally called the Saraqeb incident a “chemical attack”, the evidence is mounting. “Evidence points to the Assad regime because the attack came from the sky and the opposition doesn’t have any aircraft, the source added. In the second alleged incident, the Syrian government claimed that ‘terrorist groups’ carried out a gas attack that killed five people in the old town of the besieged city of Aleppo on Tuesday afternoon, according to the state-run news agency SANA.” The second attack caused the death of five individuals and is considered a counteroffensive from Syrian regime forces and Russian allies. A physician tending to victims injured in Saraqeb noted that their symptoms are consistent with those of chlorine poisoning. On Wednesday, the Russian military informed the U.S. that “rebel forces were responsible” for the attacks.

Russia’s Frozen Anthrax Problem
Over ninety people are currently under healthcare observation and surveillance in the Yamalo-Nenets region of Siberia, related to an outbreak of anthrax. Eight cases have been confirmed and a young boy died on Monday from the outbreak that is believed to be associated with an infected reindeer carcass. While anthrax is a  naturally occurring bacteria in the soil and can be endemic in certain regions, the heatwave in Siberia is believed to have caused a decades-old reindeer carcass to become exposed. As a result of the exposure, thousands of reindeer have also been infected and officials are investigating the release of the anthrax spores into the environment from the carcass that was found in the 75-year-old permafrost. Siberia’s Governor, Dmitry Kobylkin, has declared a state of emergency and specialists from the Russian Chemical, Radioactive, and Biological Protection Corps have been called into assist with outbreak control and disposal of infected animals. A mass veterinary vaccination program is also underway to protect animals in northern Russia.

Spillover Special & Human Economic Activity
Wednesday night saw the premiere of the PBS documentary, Spillover, which focused on the impact and rise of zoonotic diseases. Given the recent Ebola outbreak and news of locally-acquired Zika virus cases, this documentary comes at an precarious time. Aside from a few dramatic moments, the documentary was both informative and visually captivating. It was refreshing to see the One Health approach to outbreaks within a documentary. The filmmakers appeared to have taken great care to present the complexity of the spillover process and the importance of global surveillance and the shock humans have on the environment. Between the documentary and Sonia Shah’s new article, the impact of human activity on microbes is becoming a much more prevalent and unavoidable topic. Shah points to an increasingly globalized economy and the glaring reality that sick people do in fact get on airplanes and spread their germs, These are the obvious points in the transmission chain though and she notes that we tend to forget the role of foreclosed homes, imported tires, and decorative bamboo as factors in disease transmission. “Today, abandoned properties and deteriorating infrastructure, brought on by housing crises and climate change, similarly threaten us with epidemics of mosquito-borne pathogens such as Zika.” Shah also points to the need to assess the public health implications of our “built environment the way we assess the environmental impact- before construction begins.” While we consider our carbon footprint, are we considering our epidemic one too?

UK’s HIV Gamechange with PrEP
A recent high court ruling that NHS England can pay for PrEP (pre-exposure prophylaxis) is being marked as a victory for HIV/AIDS campaigners in the UK. PrEP is a medication that can be taken daily to help people, who are at a very high risk of contracting HIV, lower their chances of infection. According to the CDC, “A combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada, is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who’s positive. Studies have shown that PrEP is highly effective for preventing HIV if it is used as prescribed. PrEP is much less effective when it is not taken consistently.” The court ruling is especially important as it will not only put pressure on pharmaceutical companies to lower the cost of the drug, but will now be available through the National Health Services (NHS), meaning that it will be widely available and accessible to a far wider range of people. “Condoms are cheap, but among some high-risk populations they are not used consistently. About 4,000 more people acquire HIV in the UK every year. The average cost of a lifetime of treating each one is put at about £360,000. The National Aids Trust brought the high court case following anger and consternation among campaigners after NHS England said it would not fund PrEP because it did not have the power to do so. It argued that it was the role of local authorities, which have been given control of public health measures including reducing smoking and family planning, as well as HIV prevention. Local authorities said they did not have the money to pay.” Accessible HIV prophylaxis is a huge step in prevention and despite the plans of NHS to appeal the decision, they are still putting aside funds for the cost of the medication.

Biodefense in Gaming Courtesy of Pandemic Inc game
Since we’re still reeling from the loss of prime-time contagion drama, nuclear systems engineer and aspiring biodefense wonk, Greg Witt, is helping us through this dark time via the enjoyable but inaccurate world of biodefense in gaming. Greg’s review of several popular video and board games will give you some great options for your next gaming adventure. “With pathogens like Zika, Ebola, and West Nile now household names, biodefense has rarely been more culturally relevant. Depictions of biodefense topics in popular culture are not limited to traditional media, though; numerous video games and board games have been released in the past few years in which biodefense plays an important role.” Discussing video games like Tom Clancy’s The Division and its underlying premise that is almost identical to Operation Dark Winter, to two of my personal favorites – Plague Inc. and Pandemic, Greg gives a tour through the minefield of biodefense gaming. Rest assured though, he points to the scientific failures and epidemiological snafus that plague these games, but do not ultimately deter our enjoyment while bringing biodefense to the general public.

Zika Updates 
Following last week’s news regarding a growing number of locally acquired cases in Florida, it was also reported that 41 U.S. military members have contracted Zika. “All cases were transmitted while abroad and one of the military service members is a pregnant female. Under Pentagon health policies, female service members are permitted to move out of countries where Zika exists.” Here’s a helpful little field guide for identifying the mosquitoes that are known to transmit Zika. A new model used by researchers from Northeastern University is pointing to a vastly underestimated amount of Zika in the U.S. They note that there is probably “way more Zika in the U.S. than has been counted”. Case counts are especially challenging in a disease that leaves many asymptomatic and unlikely to be tested. In response to the growing number of locally-acquired cases (currently at 14 cases) in Miami-Dade County, there will be aerial spraying for mosquito control.  The CDC has reported 1,825 total Zika infections in the U.S. as of August 3rd and has issued a travel warning for the Miami area. President Obama also pleaded with Congress to “do its job” and approve funding to fight the growing outbreak. Donald Trump was also recently asked about how he would handle the outbreak, noting that Florida Governor, Rick Scott, “seems to have it under control”. 

Stories You May Have Missed:

  • In Memoriam of Dr. Roger Gerrard Breeze– Dr. Breeze, a preeminent veterinary research scientist and biosecurity expert passed away in late June in Washington, D.C. We are grateful to have had Dr. Breeze as a professor for GMU’s agroterrorism courses and his contribution to the field of genetic engineering and molecular biology. “Dr. Breeze was a Member of the UK Royal College of Veterinary Surgeons and a member of the U.S. National Academies – Institute of Medicine’s Forum on Microbial Threats and National Academies – Committee on Biodefense Analysis and Countermeasures. For the past decade, Roger served as an advisor on biosecurity and biological/chemical weapons nonproliferation issues to the Defense Threat Reduction Agency (DTRA) and the Lawrence Livermore National Laboratory.”
  • GMU Biodefense PhD Awarded FAA Graduate Research Grant– Biodefense PhD student, Nereyda Sevilla, was recently awarded a grant from the FAA for her dissertation; Germs on a Plane: The Transmission and Risks of Airplane-Borne Diseases. The Graduate Research Award Program on Public-Sector Aviation Issues is a joint sponsorship from the Federal Aviation Administration of the U.S. Department of Transportation and administered by the Airport Cooperative Research Program (ACRP) of the Transportation Research Board/National Academies. You can read more about Nereyda’s work with the surveillance tool, Spatiotemporal Epidemiological Modeler (STEM), here.