News highlights on health security threats and countermeasures curated by Global Biodefense
This week’s selections include dual-use research awareness and education shortfalls; challenges ahead for ARPA-H; a new DARPA policy on risk screening in researchers’ foreign affiliations; IAEA statement on the situation in Ukraine; and ACIP expansion of Ebola vaccination recommendations to additional populations.
POLICY + INITIATIVES
Biodefense Experts to Congress: The United States is Still Unprepared for Pandemic and Bioweapons Threats
Asha M. George testified at a Senate hearing Thursday, along with other biodefense experts, about shortcomings in federal preparedness for disease outbreaks and other biological threats. Those shortcomings involve the 2003 program designed to detect biothreats in dozens of US cities and the tangle of government programs and agencies that are supposed to protect the country from biological threats. Bulletin of the Atomic Scientists, HS Today
Lawmakers, Scientists Wrestle with Launch of ARPA-H
Does the country need an entirely new governmental agency to drive innovation in health research and bring about new cures? During a hearing this week of the House Energy & Commerce Subcommittee, some charged the proposed Advanced Research Projects Agency for Health (ARPA-H) lacked a “clear scientific mission” or any “measurable goals” and appeared to duplicate the aim of current programs. Others argued that attempting to house ARPA-H within NIH would be a mistake. “We need ARPA-H because the NIH cannot maintain a culture of radical innovation, disciplined execution, specific accountability and streamlined processes that are essential for ARPA-H. The NIH is outstanding at what it does, but it will never be DARPA or ARPA-H.” MedPage Today
Three Urgent Priorities for the National Security Council to Strengthen Global Health Security and Biodefense
The NSC’s incoming senior director for global health security and biodefense should tie Covid-19 investments to local health systems that include incentives for domestic financing for adaptable health services (while disincentivizing user fees), supporting regional pooled procurement mechanisms to expand access to medicines and supplies, and directing unrestricted funding toward multilateral organizations like the WHO that can advance cross-cutting sustainable development goals. STAT
The C.D.C. Isn’t Publishing Large Portions of the Covid Data It Collects
The agency has withheld critical data on boosters, hospitalizations and, until recently, wastewater analyses. Kristen Nordlund, a spokeswoman for the C.D.C., said the agency has been slow to release the different streams of data “because basically, at the end of the day, it’s not yet ready for prime time.” She said the agency’s “priority when gathering any data is to ensure that it’s accurate and actionable.” Another reason is fear that the information might be misinterpreted, Ms. Nordlund said. NY Times
NIH Issues a Seismic Mandate: Share Data Publicly
In January 2023, the US National Institutes of Health (NIH) will begin requiring most of the 300,000 researchers and 2,500 institutions it funds annually to include a data-management plan in their grant applications — and to eventually make their data publicly available. The data-sharing policy could set a global standard and help tackle the reproducibility crisis in scientific research, but questions remain about logistics and equity. Nature
How the World Health Organization Might Face Future Pandemics
Negotiations on new rules for dealing with pandemics will begin at the World Health Organization on Thursday, with a target date of May 2024 for a treaty to be adopted by the U.N. health agency’s 194 member countries. Reuters
One Health as a Catalyst for Sustainable Development
SARS-CoV-2 probably originated, like most emerging viruses, through contact between animals and people in a shared environment. The interdependencies in ecological systems are now acknowledged at the highest levels in political debate. Key challenges outlined in this article need to be tackled for One Health approaches to be successful in their own right, and in the wider context of sustainable development. Nature
UK Government Writes Off £10bn on Unusable, Overpriced, or Undelivered PPE
The government has faced much criticism for the way it has handled procurement during the pandemic, including its establishment of a high priority “VIP lane” through which potential PPE suppliers referred by MPs, ministers, or civil servants could gain quicker access to contracts, a process that was later ruled unlawful by a High Court judge. The BMJ
MEDICAL COUNTERMEASURES
Sale of UK’s Vaccine Manufacturing and Innovation Centre
In a puzzling move, the UK government has put its Vaccine Manufacturing and Innovation Centre (VMIC) up for sale. Launched in 2018, the UK taxpayer spent over £200m on the centre, a joint venture between the University of Oxford, the London School of Hygiene and Tropical Medicine, Imperial College London, and industry partners. The non-profit facility was meant to help UK researchers and small and medium enterprises move promising vaccines to production and provide a bulwark against future pandemics, vaccine shortages, and price wars. Selling the VMIC without parallel improvements to strengthen the upstream innovation that led to much of the UK’s early Covid-19 vaccination successes makes little sense. The BMJ
Novavax Begins Delivery of Long-Delayed COVID-19 Vaccine in Europe
The first doses of the Nuvaxovid vaccine have departed a distribution site in The Netherlands, bound for Austria, France and Germany. Supplies to other countries in the European Union are soon to follow. Unlike the highly successful mRNA shots from Pfizer-BioNTech, Nuvaxovid is a protein-based jab, much like the traditional flu shots that have been around for decades. Fierce Pharma
Ivermectin and COVID-19: Legal Intervention in Clinical Practice Exposes Patients to Serious Harm
Efforts to influence clinical practice through lawsuits, including recent cases ordering hospitals to treat COVID-19 patients with ivermectin, could expose patients to serious harm and undermine the evaluation of COVID-19 treatments. To ensure patients receive evidence-based care and achieve optimal outcomes, it is critical to avoid inappropriate interference in the practice of medicine. Infectious Diseases Society of America
These Vaccines Have Been Embraced by the World. Why Not in China?
Beijing once said it had two mRNA shots within reach and ready for approval — one homemade and one produced by a foreign company. Today, neither is available. Two years into the pandemic, China’s 1.4 billion people still don’t have access to one of the most effective coronavirus vaccines the world has to offer. NY Times
ACIP Recommends Tickborne Encephalitis and Cholera Vaccine for Some
The vaccine advisory group to the CDC recommended that certain groups receive a recently approved vaccine against tickborne encephalitis (TBE) and that children traveling to cholera outbreak areas receive the cholera vaccine. CIDRAP
FDA Authorizes Revisions to Evusheld Dosing
Based on the most recent information and data available, Evusheld (tixagevimab co-packaged with cilgavimab) may be less active against certain Omicron subvariants. The dosing regimen was revised because available data indicate that a higher dose of Evusheld may be more likely to prevent infection by the COVID-19 Omicron subvariants BA.1 and BA.1.1 than the originally authorized Evusheld dose. Food and Drug Administration
Antibody Responses and Correlates of Protection in the General Population After Two Doses of the ChAdOx1 or BNT162b2 Vaccines
Anti-spike IgG antibody responses and correlates of protection after second doses of ChAdOx1 or BNT162b2 vaccines for SARS-CoV-2 in the United Kingdom general population. Older individuals and males had lower peak levels with BNT162b2 but not ChAdOx1, whereas declines were similar across ages and sexes with ChAdOX1 or BNT162b2. Prior infection significantly increased antibody peak level and half-life with both vaccines. Nature Medicine
BIOSECURITY + BIOPREPAREDNESS
Even as Omicron Infections Trend Down, Long COVID Remains a Threat to the Military
Given that the prevalence of long COVID could be up to 30 percent for adults who have had COVID-19, the Defense Department needs to consider that long COVID might cause a substantial impact on force readiness. Early studies show that vaccination may reduce the risks of developing long COVID. Still, considerable steps should be taken beyond the vaccine mandate to minimize possible COVID exposure to US military and civilian leaders when possible. Bulletin of the Atomic Scientists
The Next Wave of Biosecurity Experts: Young Scientists Need a Better Path into Global Diplomacy
Over the past decade, global biosecurity organizations have created programs that enable young scientists to explore science diplomacy and expand their professional networks in biosecurity. However, we see three major gaps: a lack of roadmaps for biosecurity diplomacy careers, few opportunities for international community-building, and a dearth of bridges into local policy communities. We identify a set of guiding principles for future programs that aim to grow the next generation of global biosecurity diplomats. Science & Diplomacy
The Dual-Use Education Gap: Awareness and Education of Life Science Researchers on Nonpathogen-Related Dual-Use Research
With the rise of synthetic biology, dual-use research risks are not confined to pathogen-related research. However, existing measures to mitigate the risks of dual-use research, such as export control, are still designed to hinder access to pathogens and do not address the risks of nonpathogen-related dual-use research. The current self-regulatory approach requires scientists to be aware of their responsibility and know how to assess risks and establish countermeasures. Health Security
DARPA Screening for ‘Risk’ in Researchers’ Foreign Affiliations
The Defense Advanced Research Projects Agency is implementing a “Countering Foreign Influence Program” that involves assessing risks posed by researchers’ affiliations with foreign institutions, even for unclassified projects in fundamental research. While other science agencies have likewise expanded their use of disclosure policies to identify problematic conflicts of interest and time commitment, DARPA’s policy goes further by tying the review process to specific categories of foreign entities of concern. Stakeholders are seeking more clarity on the kinds of affiliations DARPA and other science agencies might deem problematic. American Institute of Physics
SELECT AGENTS + PRIORITY PATHOGENS
Use of Ebola Vaccine: Expansion of Recommendations of the ACIP to Include Two Additional Populations
The Advisory Committee on Immunization Practices has expanded recommendations to include two additional populations at high risk for potential occupational exposure to Ebola virus: health care personnel at special pathogens treatment centers and laboratorians and support staff members at Laboratory Response Network (LRN) facilities. Morbidity and Mortality Weekly Report (MMWR)
Detailed Analysis of the Pathologic Hallmarks of Nipah Virus in African Green Monkeys
Results further substantiate the African green monkey as a model of human Nipah virus disease, by demonstrating both the respiratory and neurologic components of disease. Demonstrates the chronic phase of disease exists in this model, that may provide an important opportunity to study the enigmatic late onset and relapse encephalitis as it is described in human disease. PLOS ONE
USDA Confirms Highly Pathogenic Avian Influenza in a Non-Commercial Backyard Flock (Non-Poultry) in Michigan
The USDA Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic avian influenza (HPAI) in a non-commercial backyard flock (non-poultry) in Kalamazoo County, Michigan. As part of existing avian influenza response plans, Federal and State partners are working jointly on additional surveillance and testing in areas around the affected flock. APHIS
Virome Characterization of Game Animals in China Reveals a Spectrum of Emerging Pathogens
1,941 game animals from five mammalian orders were surveyed for viruses. 102 mammalian-infecting viruses were discovered, 21 posing a potential risk to humans. Civets carried a relatively higher number of potentially ‘high risk’ viruses. Human-infecting viruses were also identified in game animals. Of note, researchers identified avian Influenza A virus H9N2 in civets and Asian badgers, with the latter displaying respiratory symptoms, as well as cases of likely human-to-wildlife virus transmission. Cell
Avian Flu Spread in the U.S. Worries Poultry Industry
A highly contagious and deadly form of avian influenza has been barreling across the eastern half of the United States in recent weeks, killing both wild birds and farmed poultry and raising fears that an unchecked outbreak could prove calamitous for an industry that was devastated by a similar virus seven years ago. Although the danger to humans is low, scientists are keeping a close eye on the virus, the Eurasian H5N1. Experts suspect wild birds returning from winter feeding grounds are spreading the virus, most likely through contaminated droppings. With the peak springtime migration still weeks away, many fear the worst is yet to come. NY Times
Higher Viral Stability and Ethanol Resistance of Avian Influenza A(H5N1) Virus on Human Skin
The survival time of the avian influenza A(H5N1) virus on plastic surfaces was ≈26 hours and on skin surfaces ≈4.5 hours, >2.5-fold longer than other subtypes. The effectiveness of a relatively low ethanol concentration (32%–36% wt/wt) against the H5N1 subtype was substantially reduced compared with other subtypes. Moreover, recombinant viruses with the neuraminidase gene of H5N1 survived longer on plastic and skin surfaces than other recombinant viruses and were resistant to ethanol. This data implies that the H5N1 subtype poses a higher contact transmission risk because of its higher stability and ethanol resistance, which might depend on the neuraminidase protein. Emerging Infectious Diseases
Malawi Finds Africa’s First Wild Polio Case in Five Years
Malawi has declared a wild polio outbreak after a case was identified in a three-year-old girl – the first of its kind in Africa for more than five years. The continent was declared free of all forms of wild polio in 2020. The Malawian authorities are now working to contain any possible spread including by boosting immunisation. Only one case has been reported, but paralysis occurs in less than one in 200 polio infections. The immediate goal will be to ensure Malawi does not suffer a large outbreak. BBC News
Enterovirus D68: Immunological Surveillance Test Case to Develop Tools to Mitigate the Pandemic Potential of Emerging Pathogens
There is a critical need for real-time immunology-based surveillance systems to provide specialized biological specimens, such as prospectively collected peripheral blood mononuclear cells, serum, and plasma, from children likely to have primary infection with contemporary circulating enterovirus D68 strains and other respiratory diseases. These types of specimens are a key component to rapid development of vaccine candidates, such as the highly successful SARS-CoV-2 vaccines. The need to further understand seroprevalence of enterovirus D68 in preparation of the next potential outbreak and the absence of current countermeasures for acute flaccid myelitis, creates an opportunity to use EVD68 as a test case to pilot the development of an immunological surveillance programme. The Lancet Microbe
SURVEILLANCE + DETECTION
Tracking COVID-19 Infections: Time for Change
One of the best ways the world has to get a clear view of COVID-19 is going underused. It’s time to exploit the power of random sampling. If a surge in cases slows, is transmission down, or is testing maxed out? Waiting to find out means that hospitals can’t prepare and policymakers are two to four weeks behind. Wastewater surveillance is an innovative part of the solution, but random sampling can help fill in important gaps on a broad scale. Testing fewer than 1,000 people can yield crucial information about 10 million, or even more. Nature
“Excess Deaths” is the Best Metric for Tracking the Pandemic
Multiple factors contribute to inaccuracies in documenting causes of death. Not everyone who dies from Covid-19 is tested, especially in resource poor settings; diagnostic tests for SARS-CoV-2 may fail to detect the virus (false negative) resulting in misclassification; and the definition of Covid-19 deaths has changed over time. All-cause mortality is not affected by these inaccuracies and captures both direct deaths from Covid-19 and deaths caused indirectly by the pandemic. The BMJ
Evaluation of Commercially Available High-Throughput SARS-CoV-2 Serologic Assays for Serosurveillance
Assays demonstrated a range of sensitivities (96%–63%), specificities (99%–96%), and precision (intraclass correlation coefficient 0.55–0.99). Durability of antibody detection was dependent on antigen and immunoglobulin targets; antispike and total Ig assays demonstrated more stable longitudinal reactivity than antinucleocapsid and IgG assays. Assay performance must be evaluated in context of intended use, particularly in the context of widespread vaccination and circulation of SARS-CoV-2 variants. Emerging Infectious Diseases
Simultaneous Detection of Zika, Chikungunya, Dengue, Yellow Fever, West Nile, and Japanese Encephalitis Viruses
Due to the concurrent prevalence and increasing risk of coinfection of the clinically important Arboviruses, timely and accurate differential diagnosis is important for clinical management and the epidemiological investigation. A two-tube The multiplex qRT-PCR assay for the simultaneous detection of Zika virus (ZIKV), chikungunya virus (CHIKV), dengue virus (DENV), yellow fever virus (YFV), West Nile virus (WNV), and Japanese encephalitis virus (JEV) was developed and optimized with high specificity and sensitivity – and was able to detect possible coinfections without competitive inhibition of target viral genomes. Journal of Medical Virology
CHEMICAL + RADIOLOGICAL THREATS
Strengthening Controls on the Family of Novichok Agents and Precursors
Novichok agents were not originally featured in the schedules of the Chemical Weapons Convention (CWC), which are intended to support the treaty’s verification regime and declaration requirements. However, following Skripal incident in 2018, the CWC schedules were amended to include Novichok agents. Precursors for their synthesis were added to the Australia Group’s (AG) list of chemical-weapons precursors. Both lists need further refinement to adequately address novichoks. The Nonproliferation Review
IAEA Director General Statement on the Situation in Ukraine
Regarding the situation at the Chornobyl Nuclear Power Plant, Ukraine has informed the IAEA that ”unidentified armed forces” have taken control of all facilities of the State Specialized Enterprise Chornobyl NPP, located within the Exclusion Zone. The counterpart added that there had been no casualties nor destruction at the industrial site. International Atomic Energy Agency
The Most Immediate Nuclear Danger in Ukraine Isn’t Chernobyl
There is a disquieting nuclear dimension to the unfolding humanitarian catastrophe of Russia’s illegal and unprovoked invasion of Ukraine. The most immediate nuclear danger comes from Ukraine’s four active nuclear power plants, which contain fifteen separate reactors and generate over half of the country’s electricity. Much of the fuel in these other reactors is substantially more radioactive than the fuel at Chernobyl. To put it simply, nuclear power plants are not designed for war zones. It seems exceedingly unlikely that Moscow would authorize deliberate attacks on these facilities, but they could nonetheless become targets in a war that will, in any case, disrupt their operations. For Ukrainian nuclear power plant staff, merely traveling to work may be a dangerous act—making it potentially challenging to ensure the reactor can be operated safely. In the event of an accident, backup personnel, such as firefighters, may not be able to reach the plant—not least because they could be involved in civilian relief efforts. Carnegie Endowment for International Peace
A Counter-Terrorism Medicine Analysis of Drone Attacks
The use of UAVs to carry out terrorist attacks is on the rise. Seventy-six terrorist attacks using this novel method were recorded since 2016, killing 50 and injuring 132 people. While the use of UAV-related explosives appears less lethal than traditional explosive attacks, advancing technologies and swarming capabilities, increasing ability to carry larger payloads, and the possibility of UAVs to disperse chemical, biological, radiological, and nuclear (CBRN) weapons will likely increase UAV lethality in the future. Prehospital and Disaster Medicine
Lessons from the COVID-19 Pandemic for Preparing for and Responding to a Domestic Radiation Emergency
The COVID-19 pandemic has raised important questions about resiliency and preparedness for other catastrophic disasters, including nuclear and radiological emergencies. Based on expert interviews with dozens of response practitioners, this paper assesses potential gaps in preparedness for nuclear and radiological emergencies, including challenges pertaining to coordination, training, equipment shortages, expertise deficits, and crisis communication with the public. NTI
SPECIAL INTEREST
Emerging Leaders in Biosecurity Fellowship
Launched in 2012, ELBI is a part-time program that provides an opportunity for talented graduate students and professionals to deepen their expertise, expand their network, and build their leadership skills through a series of events coordinated by the Johns Hopkins Center for Health Security. Apply by 31 March. Center for Health Security
IN MEMORIAM
Remembering Dr. Paul Farmer
Dr. Farmer and his colleagues pioneered novel, community-based treatment strategies that demonstrate the delivery of high-quality health care in resource-poor settings. He wrote extensively on health, human rights, and the consequences of social inequality. Dr. Farmer was a member of the American Academy of Arts and Sciences and the Institute of Medicine of the National Academy of Sciences, from which he was the recipient of the 2018 Public Welfare Medal. He authored multiple books, including: In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, Reimagining Global Health: An Introduction, and To Repair the World: Paul Farmer Speaks to the Next Generation. His most recent book was released in November 2020: Fevers, Feuds, and Diamonds: Ebola and the Ravages of History. Partners In Health