Pandora Report 9.2.2016

Welcome to September! Let’s start the month off with a yellow fever timeline and the history of this misunderstood disease. If a gin and tonic is your go-to drink, you’ll be pleased to hear it was actually born to combat malaria. Many are questioning if Syria has retained a stockpile of chemical weapons, pointing to continued contradictions and discrepancies regarding inventories and more. While the topic of sanctions is being debated, findings from recent international reports determined that both the Syrian government and ISIS were responsible for chemical attacks in 2014 and 2015.  On Tuesday, the French ambassador to the UN pushed for unified action at the Security Council, emphasizing that within the report, the Assad regime and the Daesh terrorist group have been responsible for several attacks.

Next Gen Global Health Security Agenda (GHSA) Happy Hour
Please join the newly elected Coordinator, Jamechia Hoyle, for a happy hour and networking event. Come engage with a network of talented Global Health Security professionals. Share ideas, connect, and learn how to join the world of global health security! You can RSVP to nextgenghsa@gmail.com by September 5th – the event is Friday, September 9th, from 5-7pm, at District Commons DC, 2200 Pennsylvania Avenue Northwest, Washington, DC 20037.

Is Accessible Synthetic Biology Making DIY Bioweapons More Likely?
The biotech industrial revolution and advances with CRISPR-Cas9 have raised many red flags about the risk for do-it-yourself (DIY) bioweapons. Dr. Koblentz and several others discussed the role of gene-editing technologies in the UN Security Council meeting last week, with General-Secretary Ban noting that these advances have made the production and application of WMD’s easier. These advances have the potential to move the playing field away from solely state-sponsored or university-level programs, to lower levels of necessary tacit knowledge. The dilemma surrounding dual-use technologies of concern and biosafety failures compound these concerns – are we becoming more and more vulnerable to intentional or accidental events? Antibiotic resistance is also a growing dilemma, and not just what we’re facing now, but also the risk that synthetic biotechnology could make the development of a highly resistant organism possible for malicious persons. The tricky part is combating the risk for mis-use while not stifling innovation – any takers? The growing threat potential of synthetic biology has many commenting that “Zika is just the first front in the 21st century biowar”. We so easily think nuclear or cyber warfare when it comes to large-scale threats, but the truth is that biological threats have been looming in front of us for years. James Stavridis notes that there three key components to preparing for the biological revolution. “First, we need an international approach that seeks to limit the proliferation of highly dangerous technologies (much as we try to accomplish with nuclear weapons) and fosters cooperation in the case of contagion or a transnational biological threat.” Second, U.S. government interagency practices need to strengthen their capacity to address both scientific advances and security threats from the biological research sector. Lastly, there must be private-public cooperation. He points to the need for a stronger marriage between government and academia, but in such a manner that doesn’t deter innovation. In the end, there is a imperative need for more frequent and frank discussions about the impending realities of biological threats.

GMU Biodefense Graduate Program Open Houses! Screen Shot 2016-04-21 at 1.28.57 PM
If you enjoyed reading about Dr. Koblentz and his work in biodefense, consider joining GMU’s Biodefense graduate program as a MS or PhD student! We’ve got some great Open Houses coming up- there is a PhD Information Session next Wednesday, September 7th at 7pm at our Arlington Campus in Founders Hall in room 134. If you’re interested in a MS in Biodefense (we offer both online and in-person!), come to our next Open House on Thursday, September 15th, at 6:30pm in our Arlington Campus Founder’s Hall, Room 126. Dr. Koblentz will be leading the information sessions, which will give you both some insight into the program, but also the range of student research and careers.

Disease Detection and the Outbreak Hunters
Venturing through the caves of South Africa, virus hunting researchers take us through the journey that is zoonotic disease tracking. The CDC has ten global disease detection centers and programs, like PREDICT, are all working to study the early signs of outbreaks and how we can prevent them from happening. “We were tracking almost 300 infectious disease outbreaks of concern in 145 countries,” says Dr. Jordan Tappero, director of the Global Health Protection Center at CDC. This was during a 2-year period. “Only about 30% of countries even self-report [and] are able to prevent, detect, and respond to infectious disease outbreaks,” Tappero says. “We are working around the world to try and improve capacity so that we have partners everywhere to respond quickly.” Bats are one of the primary animals studied, as they tend to be a reservoir for many diseases. Much of the research looks to test animals to identify what diseases are circulating within them, which acts as an early warning system for potential outbreaks. Outbreaks like MERS-CoV and Ebola have taught us the importance of early warning systems within the germ world. Cheers to those brave researchers who are crawling through caves and bat guano – we applaud and thank you!

The Growing Vaccine Refusal in Pediatrics Usmap
After the measles outbreak in California and Arizona related to Disneyland in 2015, there was a surge of national attention to pediatric vaccination exemptions. While California is taking strides to reduce non-medically indicated exemptions, many doctors are still reporting that parents are refusing to vaccinate their children. A recent study was published using data from the American Academy of Pediatrics Periodic Surveys from 2006 and 2013, looking at parental noncompliance and the frequency of requests for vaccine delays and refusals. Researchers also looked at the impact on US pediatrician behavior as a result of parental refusal or requests to delay. The study found that the proportion of pediatricians reporting parental vaccine refusal increased from 74.5% in 2006 to 87.0% in 2013. “Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004).” Sadly, these findings indicate that pediatricians are reporting more vaccine-refusing parents and while they provide vaccine education, they’re dismissing patients at a higher rate.

Get the Scoop on Zika Virus
The FDA has announced that all U.S. blood banks will test blood, regardless of the presence of Zika in the state, for the virus. Here’s a guide to help pregnant women reduce their Zika risk. A new report found that Zika was linked to congenital hearing loss in infants with microcephaly. This week, CDC Director, Dr. Tom Frieden, commented that the agency is almost out of funds for Zika. “Basically, we are out of money and we need Congress to act,” Frieden told reporters. “The cupboard is bare.”  Florida may be the perfect place for Zika transmission, but where else should we consider within the U.S.? Singapore is quickly becoming a Zika hot spot, with it being the only Asian country to have active transmission. The growing volume of cases is signaling that Singapore could easily be a new epicenter for Zika, triggering surrounding countries to ramp up their preparedness efforts. Many are wondering if Zika is a sleeping giant in Haiti. The country has all the ingredients for rapid and sustained transmission but hasn’t seen many cases yet, leaving many to wonder if it’ll hit. The CDC has reported, as of August 31st, 2,722 cases of Zika virus in the U.S. Yesterday, the Florida Department of Agriculture and Consumer Services officially announced that, for the first time, mosquitoes trapped in the continental U.S. were positive for Zika virus.

Event: The Elimination of Weapons of Mass Destruction: Lessons Learned from the Recent Past 
Attend the Nonproliferation Review’s Monday, September 12th event to discuss nonproliferation! The event will be held at the James Martin Center for Nonproliferation Studies CNS Washington office at 1400 K Street, NW, Suite 1225, on Monday, 9/12,  from 1-3 pm. Speakers include Rebecca Hersman, director of the Project on Nuclear Issues at the Center for Strategic and International Studies; Robert Peters, senior research fellow at the Center for the Study of Weapons of Mass Destruction at National Defense University; and Dr. Philipp Bleek, assistant professor at the Middlebury Institute for International Studies at Monterey and a fellow at CNS. Dr. Chen Kane, director of CNS’s Middle East nonproliferation program, will chair the event, with NPR Editor Joshua H. Pollack providing welcoming remarks.

Stories You May Have Missed:

  • ABSA Risk Group Database App! Biosecurity – there’s an app for it! The American Biological Safety Association has created an app for the ABSA Risk Group Database. You can find it in Apple or Android app stores under “Risk Group Database app” and it’ll allow you to access the database on your mobile devise. “The ABSA Risk Group Database consists of international risk group classifications for Bacteria, Viruses, Fungi, and Parasites. In many countries, including the United States, infectious agents are categorized in risk groups based on their relative risk. Depending on the country and/or organization, this classification system might take the following factors into consideration: pathogenicity of the organism; mode of transmission and host range; availability of effective preventive measures (e.g., vaccines); availability of effective treatment (e.g., antibiotics); and other factors.”
  • Possible Transmission of mcr-1–Harboring Escherichia coli between Companion Animals and Human– The growing reports of colistin-resistant E. coli findings have been raising the stakes in the fight against antibiotic resistance. A recent report found mcr-1 (the gene harboring the colistin-resistant mechanism) E. coli isolates in three separate patients admitting to a urology ward in China. One of the patients was found to work in a pet shop, so researchers collected fecal samples from 39 dogs and 14 cats where he worked. Six were positive for the mcr-1 gene by PCR (4 from dogs and 2 from cats). “These findings suggest that mcr-1–producing E. coli can colonize companion animals and be transferred between companion animals and humans. The findings also suggest that, in addition to food animals and humans, companion animals can serve as a reservoir of colistin-resistant E. coli, adding another layer of complexity to the rapidly evolving epidemiology of plasmid-mediated colistin resistance in the community.”
  • Frozen Strawberry & Hepatitis A Outbreak – Virginia is currently experiencing a Hepatitis A outbreak related to frozen strawberries used in Tropical Smoothie Cafe locations. There have been 40 reported cases, of which 55% have been hospitalized. “There are more than 500 of the smoothie franchises across the country, and Virginia is not the only state affected. All the potentially contaminated Egyptian-sourced berries were pulled from the 96 Tropical Smoothie Cafe locations in Virginia no later than Aug. 8 or Aug. 9.”
  • Foreign Policy Classroom – U.S. Efforts to Combat Zika – Catch the series featuring Gwen Tobert, Foreign Affairs Officer, Office of International Health and Biodefense. You must be a student enrolled in a U.S. academic institution or faculty to attend the September 8th (2-3pm) event at the U.S. Department of State.

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.

Biodefense Policy Seminar Wrap Up: Part 1

All Biodefense Policy Seminar events for Fall 2014 have concluded. Please enjoy a summary of the October 2014 event and join us for our Spring 2015 series. 

Carus and Caves

On Wednesday, October 22, Dr. W. Seth Carus and John P. Caves, both of the National Defense University, were speakers at the George Mason University Biodefense Policy Seminar on the topic of “The Future of Weapon of Mass Destruction in 2030.” Based on their 2014 paper of the same name, Carus and Caves investigate the possible nature and roles that WMD may play sixteen years from now.

In 2030, Carus and Caves argue, nuclear weapons may play an even larger role than they currently do. They anticipate that more states—for example, Japan and South Korea—could develop a nuclear arsenal in order to safeguard their own security. Proliferation isn’t the only threat that nuclear weapon pose, however. Carus and Caves also highlighted the potential for governments to lose physical control over existing weapons.

Furthermore, they said that the absence of current WMD terrorism is caused more by a lack of intent rather than lack of ability. Regarding chemical and biological weapons, Carus and Caves argue that these weapons could be more attractive in 2030 if the weapons have perceived military value, though they offer very little deterrent value.

In terms of U.S. policy, the speakers said that the United States should respond strongly to violations of WMD norms to deter proliferation. They also warned that if U.S. allies doubt the security guarantees of the United States, they may see developing their own weapons as the only surefire way to protect themselves in a multipolar world. Therefore, the United States needs to reinforce the strength of its security guarantees to prevent weapons proliferation among its allies.

So, should we be worried? Carus and Caves said that there will be a greater scope for WMD terrorism in 2030 thanks to new dual-use technologies that could make it easier to assemble, acquire, and deploy chemical or biological weapons. Moreover, the definition of WMD could change by 2030, beyond the traditional CBRN group, to include nanotechnology or cyber warfare. Overall, the speakers said that WMD in 2030 is likely to present a high consequence, low probability threat, but the danger of wider proliferation and increased use is still very real.

Pandora Report 8.31.14

Fall classes at George Mason have already started and this Labor Day weekend marks the official end of summer. This week, we have stories covering a wide range of topics—an Ebola update (of course), a fascinating article on vaccinia infections acquired through shaving, Haj precautions, and the ISIS “laptop of doom.”

Best wishes for a safe and enjoyable holiday!

Ebola Virus Outbreak Could Hit 20,000 Within Nine Months, Warns WHO

There were many stories this week covering the continuing Ebola outbreak in West Africa. Senegal saw its first (imported) case of the virus this week and has banned flights to and from the affected countries while shutting its land border with Guinea and Nigeria saw its first death outside of the capital city of Lagos. In the Democratic Republic of Congo, where Ebola first emerged in 1976, there have been reported cases of a hemorrhagic gastroenteritis similar to Ebola. I read conflicting accounts this week of the “patient zero” for the Ebola outbreak—a young boy or an older traditional healer. There were reports of some U.S. universities screening students from West Africa for Ebola. There was coverage of a Toronto medical isolation unit ready for patients and information about GlaxoSmithKline’s experimental ebola vaccine which would be tested on humans in the next few weeks.

All of this news came among World Health Organization estimates that this West African outbreak could affect 20,000 people over the next nine months and that half a billion dollars would be needed to stop the spread of the disease.

The Wall Street Journal—“The WHO program will likely cost around $490 million and require contributions from national governments, some U.N. and non-governmental agencies, as well as humanitarian organizations, it said.”

First Reported Spread of Vaccinia Virus Through Shaving After Contact Transmission

This week, reports in the August issue of Medical Surveillance Monthly Report from the Armed Forces Health Surveillance Center covered vaccinia virus infection—the virus used for smallpox vaccinations—within the U.S. Air Force. The infections in the report occurred in June 2014, and affected four individuals.

Infection Control Today—“Over the past decade, most cases of contact vaccinia (i.e., spread of the virus from a vaccinated person to an unvaccinated person) have been traced to U.S. service members, who comprise the largest segment of the population vaccinated against smallpox. Most involve women or children who live in the same household and/or share a bed with a vaccinee or with a vaccinee’s contact. Of adult female cases, most are described as spouses or intimate partners of vaccinees or secondary contacts. Of adult male cases, most involve some type of recreational activity with physical contact, such as wrestling, grappling, sparring, football, or basketball. Household interactions (e.g., sharing towels or clothing) and “unspecified contact” are also implicated.”

Government to Keep Haj Infection-Free 

This week, the Saudi Arabian Ministry of Health announced mandatory measures for Haj and Umrah pilgrims coming from countries with active outbreaks or high rates of infectious diseases. The Health Ministry sent information to embassies outlining health requirements for those seeking pilgrim visas.

Arab News—“‘Although we do not issue Haj visas for pilgrims coming from endemic countries, we will still be monitoring pilgrims coming from other African countries for Ebola symptoms,’ said [Sami] Badawood [Jeddah Health Affairs director.]

He said the ministry would also focus on diseases such as yellow fever, meningitis, seasonal influenza, polio and food poisoning.”

Is the ISIS Laptop of Doom an Operational Threat?

Discovery of a laptop, which has been linked to ISIS, raises new questions about the organization’s plans relating to use of WMD—specifically chemical or biological weapons. Over 35,000 files on the laptop are being examined and has offered new insight into ISIS and their WMD aspirations.

Foreign Policy—“Most troubling is a document that discusses how to weaponize bubonic plague. But turning that knowledge into a working weapon requires particular expertise, and it’s not clear that the Islamic State has it.”

 

Image Credit: Wikimedia Commons