Pandora Report 1.20.2017

We’ve got lots of biodefense goodies for you this week, so grab your PPE and let’s get rolling!

Billion-Dollar Vaccine and Epidemic Preparedness Project 
The Coalition for Epidemic Preparedness Innovations (CEPI) launched this week at the World Economic Forum with an initial $460 million backing from Norway, Germany, Japan, the Welcome Trust, and the Bill & Melinda Gates Foundation. CEPI expects to raise the rest of the needed $1 billion by the end of the year. Their focus is on pre-emptively developing and stockpiling vaccines to better prevent and respond to outbreaks. CEPI marks the largest vaccine development initiative and their plan is to start with vaccines against Nipah virus, MERS-CoV, and Lassa fever. While this is wonderful news, it may just be one step closer to marginalizing the WHO, which has been struggling to stay both relevant and effective. The WHO response to Ebola started drawing more recent attention to the organization’s struggles which were only fueled by slow vaccine procurement/development. These issues culminated with their recommendations to dilute the yellow fever vaccines during last year’s outbreak in Africa due to poor planning. Vaccine development and stockpiling is truly vital to outbreak response. “The CEPI intends to support research at every stage, from basic lab work to vaccine discovery and clinical trials. It also made its first call for research proposals on 18 January, and teams have until 8 March to submit preliminary proposals for grants. ‘For too long, we have separated out the academic work from the next step of taking it into all that is actually required to make a vaccine,’ says Farrar. There is also no market for vaccines against ‘potential’ epidemic threats, he notes, which explains why there is no commercial incentive to take research leads out of the lab and into clinical development’.”

ABSA DURC Roundtable
Don’t miss the Dual Use Research of Concern (DURC) Roundtable Discussion offered by ABSA International on March 15th! This distance learning opportunity will be offered from 12-2pm (CDT), and will aid the user in finding resources and guidance on the U.S. government DURC policies, developing a network of biosafety professionals, and more! “One size does not fit all when it comes to solutions to comply with research policy. The goal of this webinar is to provide best practices, provide insight on how several different institutions are meeting the DURC policy requirements, and help participants troubleshoot issues surrounding DURC that they may have at their institutions. Participants will have the opportunity to submit questions regarding DURC prior to the start of the webinar as well as during the live webinar.”

GMU Trains First Responders Against Infectious Disease  firstrespondertraining3_davefarris
GMU’s Office of Safety, Emergency, and Enterprise Rise Management is now providing local and national first responders with infectious disease training so that they’re better able to protect themselves during outbreaks. The program was made available through a three-year grant from the National Institute of Environmental Health Sciences. “This training is a natural extension of a program Mason’s Biomedical Research Lab biosafety manager Diann Stedman has offered to regional emergency response personnel since the 2010 opening of the lab on the Science and Technology Campus. Stedman is leading the training with Julie Zobel, assistant vice president of safety, emergency and enterprise risk management, and David Farris, executive director of safety and emergency management. Collectively, the three have more than 30 years of experience in the health and safety field, much of it focused on biological safety.”

Completing the Development of Ebola Vaccines 
CIDRAP and Welcome Trust have just released their report – Completing the Development of Ebola Vaccines: Current Status, Remaining Challenges, and Recommendations. “This is the third major report from the Wellcome Trust–CIDRAP Ebola Vaccine Team B. The first report, Recommendations for Accelerating the Development of Ebola Vaccines: Report and Analysis, was released in February 2015, and the second, Plotting the Course of Ebola Vaccines: Challenges and Unanswered Questions, was released in March 2016. In this report, similar to our previous efforts, we have three primary objectives. The first is to track progress toward ensuring that safe, effective, and durable multivalent Ebola vaccines are readily available and can be rapidly deployed when the next outbreak occurs. The second is to identify challenges and barriers where additional efforts are needed, although some of the remaining issues are complex and will require substantial resources to resolve. Our third objective is to provide a set of high-level recommendations that we believe, if implemented, will facilitate the goal of having a robust Ebola virus disease (EVD) prevention program in place that allows prophylactic vaccination of high-risk frontline workers and provides well- maintained vaccine stockpiles to facilitate rapid control of Ebola outbreaks.” The report highlights current clinical evaluations of Ebola vaccine candidates, funding, and regulatory activities. Some of the recommendations include reassessing the leadership structure for Ebola vaccine preparedness, developing strategies for mitigating the financial uncertainties and risks for manufacturers, etc. This report has left many experts pointing to the reality that we’re just not ready for another Ebola outbreak. 

Center for Health Security Joins Johns Hopkins Bloomberg School 
The Center for Health Security has a new home in Johns Hopkins Bloomberg School of Public Health! Previously affiliated with the University of Pittsburgh Medical Center, the CHS will now have significant new opportunities for research and work in national and international public health policy. Originally founded in 1998 by the late D.A. Henderson at Johns Hopkins, the center has been affiliated with UPMC since 2003. “The mission of our center is a perfect fit with the Johns Hopkins Bloomberg School of Public Health because we share a commitment to improving global health and to protecting lives through large-scale change,” says Tom Inglesby, director and CEO of the Center for Health Security. “Moving to the Bloomberg School will expand the reach of the center and help us collaborate with and tap into the universe of great talent at Johns Hopkins. We look forward to joining our expertise on health security and preparedness policy to Johns Hopkins’ internationally recognized community of scientists and public health scholars.” We’re looking forward to seeing all the great work that will be done as the center returns to Johns Hopkins!

Zika Outbreak Updates
As the dust settles, some are looking to the WHO and public health infrastructure failures regarding the Zika outbreak as many are pointing out how the response failed millions. “But the positives were counterbalanced by many negatives, experts said. They harshly criticized the partisan bickering that delayed a Zika-funding bill in Congress for months, and they decried the failure of every city in the hemisphere — other than Miami — to control mosquitoes.” You can also read an opinion piece here, from a pregnant woman living in Miami who tested positive for the Zika. As of January 18th, the CDC has reported 4,900 cases of Zika in the U.S.

Stories You May Have Missed:

  • screen-shot-2017-01-19-at-12-31-34-pmCDC Director’s Departing Words- As CDC director, Dr. Tom Frieden, prepares to leave office after 8 years, he’s offering some words of wisdom. Dr. Frieden has been tested by major health events like Ebola, Zika, MERS, 2009’s H1N1, and a growing domestic overdose issue. “Fundamentally, Americans are healthier and safer because of the work CDC has done over the last eight years. Americans are safer because we have better capacities in place, better infrastructure in place in this country and around the world to find threats early, stop them quickly and prevent them wherever possible. We’ve done that through laboratory work that looks at microbial genomics so we can stop outbreaks sooner. We’ve done that by training the next generation of public health specialists — more than 1,000 of them, fresh out of college and graduate school — deployed out to state and local governments. These people will be protecting Americans for decades to come.”
  • Proposed Presidential Autism-Vaccine Panel Could Help Spread Disease– The potential panel is drawing increasing attention as Robert F. Kennedy Jr. is poised to be the leader. The environmental lawyer has been vocal in his vaccine skepticism, which has led many to worry in terms of federal support for vaccine programs. “Although the autism–vaccine claim has been studied and debunked, the president-elect has also suggested a connection. His team later hedged about the panel, saying that nothing had been decided. (Kennedy’s office declined an interview request.) Nevertheless, public health experts and autism advocates are deeply worried that an effort with presidential backing could undermine public confidence in vaccines and trigger epidemics of all-but-eradicated diseases.”
  • Assad Linked to Syrian Chemical Attacks – The Syrian President has officially been linked to a series of chlorine bomb attacks in 2014/2015. “International investigators have said for the first time that they suspect President Bashar al-Assad and his brother are responsible for the use of chemical weapons in the Syrian conflict, according to a document seen by Reuters. A joint inquiry for the United Nations and global watchdog the Organisation for the Prohibition of Chemical Weapons (OPCW) had previously identified only military units and did not name any commanders or officials.”

Pandora Report: 7.1.2016

Happy Friday from your favorite source for all things global health security – from Anthrax to Zika, we’ve got you covered…like germs on a kitchen sink! If you’re hoping to catch the Washington D.C. fireworks over the holiday, check out this article regarding the state of D.C.’s preparedness for anything from traffic issues to lone-wolf terrorism. You can also get some insight into the Strategic National Stockpile via an interview with the director of the program, Greg Burel. Ever wonder the economic impact of a pandemic influenza outbreak? A recent study analyzed the consequences of such a health emergency.

Behind the Scenes at Porton Down
BBC will be airing a new documentary on the work that takes place within the secretive site of Porton Down. Located in Wiltshire, England, this government military science park falls under the Defense Science and Technology Laboratory (also known as Dstl). Dstl is an Executive Agency within the Ministry of Defense. Dstl’s website states that it “ensures that innovative science and technology contribute to the defense and security of the UK” however the facility has a long and controversial history. Considered to be one of the sites for research regarding biological and chemical weapons, the work within the 7,000 acres is extremely sensitive and secretive. “Inside Porton Down will also take viewers inside some of the site’s most secure biological research labs, where scientists have been tasked to find out how Ebola – potentially one of the biggest public threats facing us today – has the power to spread.”

Why We Need to Start Worrying About Yellow Fever Screen Shot 2016-06-30 at 6.26.37 AM
It’s been a few months since we started reporting on the yellow fever outbreak in Angola and as much as we’d like to reveal that this outbreak was quickly put out….a more sinister accelerant was added to the epidemic – a vaccine shortage. The outbreak has spilled over into surrounding countries, with 1,000 suspected cases in the DRC. There are only four major manufacturers of the yellow fever vaccine…that’s right, four. These four manufacturers don’t have the capacity to make vaccine at the rate it would take should the outbreak jump to Asia, which is the growing concern as Chinese workers visit the affected areas. The WHO maintains a stockpile of 6 million doses however, this outbreak is already burning through them and the factories that can make the vaccines are only capable of 2.4 million doses per month. Simply put, the vaccine manufacturing capacity will not be effective if this outbreak spreads much further. This particular detail is why we should be worrying about yellow fever. While it may not be as deadly as Ebola or as contagious as influenza, it’s preventable through vaccination….and yet we’re running out of vaccines. Even scarier is the presence of fake vaccination certificates. Coupled with globalization, yellow fever could easily make its way back to the U.S. and remind us of a history we’d rather not relive. “A yellow fever epidemic might seem anachronistic to people in the United States and Europe, where the disease no longer poses a threat. But some of the most devastating urban outbreaks of yellow fever have occurred in America. In the 18th century, the disease was called the ‘American plague.'”

Who Isn’t Equipped For A Pandemic or Bioterror Attack?
Annie Sparrow of the Bulletin of the Atomic Scientists asks this question and points to the sad reality that the WHO is the front runner for this unfortunate title. Pointing to the origins of the WHO in the days of the early cholera epidemics, Sparrow notes that despite WHO claiming they were a catalyst for multilateral cooperation, the reality is much less prestigious. “But in fact, the first six International Sanitary Conferences were entirely unproductive due to conflicting interests: government fears about losing profits from trans-Atlantic trade took priority over the need to reduce the international death toll. Consensus was achieved only at the seventh conference in 1892, after the opening of the Suez Canal for use by all countries made standardized quarantine regulations necessary.” The slow WHO responses to Ebola and then Zika brought attention to the discrepancies between the WHO’s role as a front-line defense for pandemics (and bioterrorism) and what was actually happening. Many have called for a reform of the WHO and the necessity to address systemic and deep-rooted problems within the organization. Sparrow hits on several key obstacles the WHO needs to overcome if it’s going to truly serve its purpose – “increase its financial resources, eliminate the undue influence of donors and member states, and redress its subservient relationship with governments who are themselves responsible for health crises.” The WHO must also address its practices when dealing with health issues in conflict zones or transitioning states. Lastly, Sparrow highlights the suggestions that transferring global health programs to the UN would not be beneficial, but rather there needs to be a push for rehabbing the WHO. In the end, the world aspect of the WHO needs to provide some muscle behind this work, especially in times of political assertion of sovereignty.

The Up-Hill Battle of Antibiotic Resistance in the World of Infection Prevention
The recent findings of a Pennsylvanian woman with colistin-resistant E. coli in her urine sent title waves throughout the health community. It was the exact moment an organism that was so resistant we have no effective antibiotics to treat it, had reached U.S. soil. In truth, the presence of multi-drug resistant organisms (MDRO’s) isn’t new…they just aren’t as flashy as bugs like Zika or Ebola. In this article, I talk about the framing of MDRO’s and the infection preventionist perspective. “Public framing and hysteria brought Ebola to the forefront. But where is this sense of urgency for organisms so resistant that we have no means of treating them? The case in Pennsylvania received fleeting public attention but it has long been the concern and fear of those working in healthcare and biology. IPs have been working for years on MDRO surveillance and isolation. ”

WHO Appoints Emergency Unit Leader 
While we’re on the subject of WHO emergency response, it was recently announced that Peter Salama was appointed as the leader for the health emergencies unit. The Australian epidemiologist is currently with UNICEF in the Middle East and North Africa, but will lead the new team that was established following criticism of the WHO’s response during the West African Ebola outbreak. The new unit was set into place to provide rapid (not rabid…but there’s some infectious disease humor for you), support to a country or community experiencing a “health emergency arising from disease, natural or man-made disasters or conflict”. The WHO website has more information here, regarding the Health Emergencies Programme.

Brexit and Public Health
Unless you’ve been vacationing in a remote part of the globe, the Brexit referendum has been taking over the news. The British vote to leave the European Union (EU) has set into motion a global wave of economic uncertainty. While many are discussing the financial, trade, and labor force implications of the Brexit, there are also far-reaching public health outcomes. Just prior to the vote, an article was published in the Journal of Public Health regarding the impact of the EU laws on public health. Aside from environmental issues ranging from water quality to emissions, the EU has also focussed on tobacco cessation. The EU has developed strong skills for information exchange to better support a healthy public. “The EU has provided continued bold and effective action on public health policy and designed an excellent funding framework for collaborative health research. The loss of the UK’s strong participation and policy voice in the EU would, as Lord Hague, the former Conservative Foreign Secretary, recently quipped ‘not be a very clever day’s work’.” While globalization makes the spread of disease easier, it would make the new British isolation extremely impacting. The isolation via Brexit could create issues regarding cross-border information sharing, which becomes especially vital during outbreaks or in cases of public health emergencies.

The Scoop on Zika
I was recently gifted (as a joke) this amazing device to fend off the Zika-carrying mosquitos…what could possibly go wrong with an electric zapping racket? University of Michigan researchers performed an analysis looking at the political response to Ebola and how that may bubble over to Zika management. Reviewing the U.S. response to Ebola they looked at the “fragmented system with no clear leadership and considerable ‘strategic politicization’ due to the outbreak’s arrival during a midterm election year.” Scott Greer of the U-M School of Public Health noted that “Republicans are going to continue not to give Obama the federal dollars he seeks to combat Zika. They don’t trust him. But when the virus starts to affect people anywhere south of Indianapolis there will be an elaborate game of blaming the administration for not doing it right.” Good news- Cuba recently announced that they have had no Zika transmission since March and Dengue is all but eliminated due to their wide-spread, military supported fumigation efforts. New studies are looking to the efficacy of Zika transmission via urine and saliva as a research team from Brazil’s Fiocruz Institute isolated live virus from such samples. U.S. Zika funding is still in limbo as Senate Democrats derailed the $1.1 billion bill on Tuesday over “objections to attached measures such as birth control restrictions.” Florida health officials reported microcephaly in a baby born to a woman from Haiti. Researchers are also finding that microcephaly may be just the tip of the iceberg, as findings suggest other developmental delays in babies born without microcephaly. There is also concern for the impact of the Zika on fetal brain tissue, causing cell death.  Despite the hold-up on Zika funding, the U.S. National Institute of Allergy and Infectious Diseases has started work on a research study regarding the mechanisms that allow Zika to be sexually transmitted.  As of June 29, 2016, the CDC has reported 935 Zika cases within the U.S.

Stories You May Have Missed:

  • Stopping Lab-Created Global Disasters One Scientist at a Time – Biotechnologist Kevin Esvelt talks about the shaky future of genetic engineering technologies like CRISPR. Esvelt notes, “We are walking forwards blind. We are opening boxes without thinking about consequences. We are going to fall off the tightrope and lose the trust of public. Lots of people are going to die.” Since he and his colleagues first suggested, two years ago, that CRISPR could create gene drive, he has been working hard to warn how dangerous the technology is.
  • One Health and the Politics of Antibiotic Resistance– Check out this webinar on July 7, 2016 from 11am-noon EDT. Dr. Laura Kahn will discuss the rise of certain MDRO’s, the different policy approaches in Europe and the U.S., and the history behind low-dose antibiotic use in agriculture.
  • Healthcare Worker Gloves and Disease Transmission– Researchers recently revealed results from a study reviewing “cross-transmission rates between contained gloves of healthcare workers and hospital surfaces.” Not surprisingly, results showed that contaminated gloves increased the likelihood of transmission among healthcare workers and in the environment.

 

Pandora Report: 3.25.2016

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

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

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

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

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

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

Syria and the Future of the Chemical Weapons Taboo 

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

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

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

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

Stories You May Have Missed:

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

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Pandora Report 9.25.2015

You didn’t think a Papal visit would slow us down, did you? Even in the event of a zombie apocalypse, we GMU Biodefense folks would still find a way to get out the weekly report – perhaps pigeon carrier? Until that happens, don’t forget to check us out on Twitter! This week saw a lot of great focus on collaborations to fight public health threats like antimicrobial resistance and epidemics. Schools in Chicago were closed for concerns over Legionnaires’ disease, yours truly provided a piece on Ebola infection prevention, and we have a wonderful opportunity to contribute to World Medical & Health Policy regarding women’s health on a global stage.

Learned Lessons from Ebola in the US
Sylvia Burwell, Secretary of Health & Human Services, discusses the clinical complexity and reality that “our clinical approach to treating Ebola in a hospital setting posed different challenges.” Several key US health experts weighed in on the pivotal first patient, Thomas Duncan, to unknowingly bring Ebola to the US. The implications for healthcare and preparedness sent a tidal wave of response across US hospitals. Dr. Tom Frieden, director of the Centers for Diseases Control and Prevention (CDC), also highlights three main lessons from not only the cases in Dallas, but also the Ebola epidemic as a whole. He points to the necessity of a strong surveillance and response system, need for rapid international aid, and better infection control in hospitals….which segues beautifully into our next story.

The Infection Prevention Angle of the 2014 Ebola Crisis
Reports and analyses from a range of responders to the crisis have been trickling out for several months now, but there’s a constant in all of them – infection control. Given my background and experiences in this field, I wanted to take our readers down the rabbit hole of what exactly it was like to be an Infection Preventionist during this time. A hopeful start to a series of pieces on this subject, it will give you a taste of not only the daily struggles, but the brevity of what potential Ebola patients meant for US healthcare preparedness.

Partnerships to Support Antibiotic Development
564px-Penicillin_Past,_Present_and_Future-_the_Development_and_Production_of_Penicillin,_England,_1943_D16963The ASPR’s (Office of the Assistant Secretary for Preparedness and Response) Biomedical Advanced Research and Development Authority (BARDA) is part of a larger initiative to use Other Transaction Authority (OTA – flexible advanced research and development funding instruments) to start developing business relationships between government and private industry. The relationships are mutually beneficial, allowing both parties to invest and develop products for biodefense and the growing threat of antibiotic resistance. Given the slowing of new antibiotic development, this joint agreement comes at a pivotal time for antimicrobial resistance efforts.

Three Chicago-area Schools Close in Response to Legionnaires’ Disease Concerns
Three schools in the Illinois U-46 district were shut down on Wednesday and Thursday after cooling tower test results showed “higher than normal levels of Legionella bacteria”. The OSHA recommended threshold is no higher than 1,000 CFU/ml (colony-forming units per milliliter) and with the outbreak among residents of the Illinois Veteran’s Home, it’s not surprising to see many water towers being frequently tested, etc. The important thing to note is that Legionella pneumophila infections are a result of the intensity of the exposure and the immune status of the exposed person. Legionella can’t be totally eradicated from the water supply and a majority cooling towers will contain some amount of growth.

Call for Papers – Women’s Health in Global Perspective
Papers sought for a special issue and workshop of World Medical & Health Policy on “Women’s Health in Global Perspective,” to contribute to understanding and improve policy related to women’s health and wellbeing.  Forces ranging from the economic to the climactic have human repercussions whose genesis and solutions demand consideration of their global context.  A wealth of recent research and inquiry has considered the particular plight of women, who often suffer disproportionately from lack of education, compromised nutrition, poverty, violence and lack of job opportunities and personal freedom.  The Workshop on Women’s Health in Global Perspective will consider the broad ranging social determinants of health on a global scale that importantly influence health outcomes for women everywhere, which in turn has implications for economic, political and social development.
Abstract submission deadline (250 words): October 16, 2015 
Contact: Bonnie Stabile, Deputy Editor, bstabile@gmu.edu
Notification of selected abstracts: November 13, 2015
Workshop March 3rd, 2016
Completed papers due: March 11, 2016

Stories You May Have Missed:

  • Personal Microbial Cloud – researchers found that a person’s microbiome form a cloud around them, allowing scientists to identify a specific person just by sampling their microbial cloud. Food for thought: would this be our microbial cloud version of a fingerprint?
  • C. Difficile Drug Success – Researchers at Stanford University School of Medicine were successful in their ability to get rid of the deadly gastrointestinal toxin via a drug that didn’t focus on the organism, Clostridium difficile, but rather the toxin itself. C. difficile is responsible for 250,000 hospitalizations and 15,000 deaths per year while costing the US more than $4 billion in healthcare expenses. Yay for successful treatments!
  • EC, EU, and WHO Work To Better Share Private Drug Data – The European Commission, European Medicines Agency, and World Health Organization are working to “step up coordination” on EU medicines regarding safety, quality, and efficacy of new drug candidates. The first step in solving a problem is recognizing you have one, right? The new focus on global public health threats is one we can all appreciate!
  • WHO Makes Changes to Southern Hemisphere Flu Vaccine – The WHO committee recommended changes for two of the three trivalent influenza vaccines for the Southern Hemisphere next year due to changes in the circulating viral strains. They suggested using H1N1, H3N2 an A/Hong Hong/4801/2014-like virus, and for influenza B, the Brisbane/60/2008-like virus. In the quadrivalent vaccine, they recommended adding the influenza B Yamagata lineage component, with the A/H1N1 strain staying.

Airborne Bird Flu Transmission: Balancing Scientific Recourse and National Security

By Chris Healey

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

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

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


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

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

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

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

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

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

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

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

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

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

 

Image Credit: James Jin/Flickr

The Pandora Report 10.4.13

Highlights include our shutdown soapbox, more rumors of Syrian BW, the WHO’s pandemic influenza preparedness plans, Boston’s BSL-4 lab, and a real-life zombie apocalypse. Happy Friday!

CDC Director: ‘Microbes Didn’t Shut Down’

As we wrap up our first week of the shutdown, we thought we’d take a second to assess the damage. Many critical biomedical experiments are hemorrhaging money. Health and Human Services has furloughed 52% of its employees. DHS has furloughed over 31,000 employees. The number that concerns us most, however, involves the CDC. We tweeted earlier this week that the CDC has had to furlough 8, 754 people, or 68% of its staff. This means that flu season is starting, and no one is watching. If we’re hit with a novel strain, a mutated strain, a particularly virulent strain,  we’d have no idea. This giant blind-spot isn’t limited to the US – CDC employees are some of the world’s top epidemiologists, often helping with investigations at outbreak hotspots globally. What are we currently very worried about in the Middle East? MERS. Hajj is around the corner, which means an influx of millions of people from around the world to the virus’ epicenter. Is it inconceivable that a pilgrim travels from New York to Mecca, picks up the virus and brings it back? Absolutely not. What’s inconceivable is that because of the shutdown, we might not know.

Wall Street Journal – “The CDC won’t be able to conduct routine inspections of high security labs around the nation that work with ‘select agent’ pathogens that pose severe threats to human and animal health such as Marburg virus or hemorrhagic fevers, said spokeswoman Barbara Reynolds. Most of the CDC’s own lab work has been stopped. The agency is not conducting surveillance for flu outbreaks. Only one CDC staffer is tracking reports of dangerous foodborne pathogens rather than the usual six staff – not a lot given that 48 million Americans develop foodborne illnesses every year.”

The World Hasn’t Tackled Syria’s Real WMD Nightmare

Foreign Policy has a piece out discussing Syria’s alleged biological weapons program. “Forget the nerve gas,” the byline states, “It’s Assad’s bioweapons program that should keep you up at night.” We disagree. For the many, clearly elucidated reasons why, please see Dr. Ben Ouagrham-Gormley’s excellent piece, “On Not Falling Prey to Biological Weapons Alarmism in Syria” here.

Foreign Policy – “A recent U.N. report on chemical weapons use in Syria has strengthened claims that the regime killed more than a thousand innocent Syrians, including hundreds of children, with the nerve agent sarin. Video images after the Aug. 21 attacks showed victims frothing at the mouth, convulsing, and suffering tortured deaths. But the effects of a chemical attack, horrible as they are, can be minuscule compared with a worst-case assault with a biological weapon.”

WHO Group To Discuss Plan For Industry Use Of Pandemic Flu Viruses

A group of WHO experts is meeting next week to work on a plan, Pandemic Influenza Preparedness, for companies to pay for use of flu virus strains in development of patented treatments.  The meetings will include members of a special WHO Advisory Group, as well as key industry stakeholders. The funds gathered would then be used primarily for pandemic preparendess (70%), with the remaining funds used for global response efforts.

Intellectual Property Watch – “The focus of the three-day meeting will be to discuss the draft implementation plan for the use of Partnership Contribution funds through the end of 2016, a WHO source said. WHO is aiming for final completion of the process by year’s end. The second day of the meeting will be dedicated to consultations with industry and other stakeholders, the source said. Other issues to be discussed include the status of SMTA-2 negotiations (Standard Material Transfer Agreement), and ‘technical matters’ in the PIP Framework, the source said.”

Federal judge OKs Boston U disease research lab

Boston University’s proposed BSL-4 lab has cleared another hurdle to construction, with a federal judge dismissing the case against the lab’s construction. Residents of Boston’s South End have obstructed the lab’s construction for years, citing fears of exposure to pathogens like Ebola. While we can sympathize with any and all fears of Ebola exposure, in this case we think the judge was right. The research conducted in BSL-4 labs are critical to helping us detect, prevent, and treat some of the world’s most dangerous pathogens.

Seattle PI – “A Boston University laboratory built to study some of the world’s most dangerous diseases is one step closer to opening following a federal judge’s decision issued this week that it poses little risk to the public…The lab now only needs a final review from the Boston Public Health Commission. Some portions of the 192,000-square foot building have already opened to study less dangerous germs. The court’s decision “affirms our view that this type of research can be done safely in Boston,” BU spokesman Steve Burgay told The Boston Globe.”

Our Puff Piece of the Week: Scientists Discuss The Reality Of A Zombie Apocalypse

RedOrbit reached out to a bunch of microbiologists and asked them to imagine what a “real” zombie virus might look like. We approve.

In case you missed it:

Dr. Paul Walker, October Biodefense Seminar Speaker, Wins Prestigious Rights Livelihood Award
– Chemical Weapons Team Arrive in Syria: Blair on Why the End in Not Nigh
DTRA’s New, Highly Sensitive Bio-agent Detector
– Using an Army of Fish to Fight Dengue

(image: Rich Renomeron/Flickr)

WHO: MERS Not a Public Health Emergency (yet)

Following their second meeting,  the World Health Organization’s (WHO) Emergency Committee on MERS has decided the outbreak in Saudi Arabia does not yet constitute a “Public Health Emergency of International Concern”. As such, the committee is refraining from issuing any travel restrictions at this time.

The committee met via teleconference yesterday, with members from all eight states with cases of MERS participating. While the MERS outbreak is not a PHEIC yet, the Committee nonetheless stressed that the outbreak is “serious and of great concern”. The Committee members will continue to monitor the virus’ spread, and will reconvene formally again in September.

MERS, or the Middle Eastern Respiratory Syndrome, is a recently emerged virus which causes flu like symptoms and in 60% of cases, death. The virus’ vector and reservoir remain unknown.

For the full WHO press release, see here.

(Image depicts an SEM of MERS, courtesy of the CDC & Cynthia Goldsmith/Maureen Metcalfe/Azaibi Tamin)

WHO to Convene Emergency MERS Committee

For those of you (like us) caught up in the fourth festivities, the World Health Organization (WHO) laid out plans late last week to convene an emergency committee  to address the growing threat of  Middle Eastern Respiratory Syndrome (MERS). The committee will pull together experts from across the public health fields for a telephone meeting tomorrow. The primary purpose of the committee at this point is as an information exchange. Key details of the virus’ mechanism of action, including the primary host, remain unknown. Once established, the committee would have the power to provide recommended travel restrictions and take other preparatory actions to prevent the virus’ spread.

Although the person-to-person spread of the virus remains limited, it is critical than a strategy for containment is established before Hajj, the annual Islamic pilgrimage which will bring millions to Saudi Arabia this October. Discussing  the WHO’s concerns over the upcoming influx of international travelers, WHO Assistant Director-General for Health Security and Environment Dr. Keiji Fukuda stated,  “we’re always worried in a globalized world that infection can travel quickly from one country to another,” but that given the sporadic pattern of infection, restricting travel is not yet recommended.

For the full transcript of the Friday press conference, see here.

(image courtesy of WHO)