Publications

The COVID-19 pandemic, while unfortunately notable for immense strain and death throughout the world, has also shown great promise in the development of medical countermeasures. As the global scientific community shifted almost entirely towards vaccines, diagnostics and therapeutics, new trial designs most significantly adaptive platform trials, began to be used with greater speed and broader reach. These designs allowed for deploying and investigating new therapeutics, repurposing currently existing therapeutics and flexibly removing or adding additional medications as data appeared in real-time. Moreover, public–private sector partnering occurred at a level not seen before, contributing greatly to the rapid development and deployment of vaccines.

Humans in the 21st century live in an unprecedentedly connected and dense world.¹ Modern air travel infrastructure allows people and animals to traverse the globe in a manner of hours. Climate change has put tremendous pressure on ecosystems; as such, humans are encountering new animals and environments with increased frequency. These changes to human living and travel have considerably increased the risk of infectious disease spillover and global pandemics.² Never before has the ability to rapidly detect and characterize any pathogen, be it known or novel, been so important to protecting global health. Pathogen agnostic tools, such as next-generation sequencing (NGS), enhance global biological defense and public health by addressing this exact need, but they must be deployed in a proactive manner to reach their full benefit. Using pathogen agnostic tools only during an outbreak is too retroactive and does not allow time for containment, particularly of a novel pathogen. In this commentary, we propose the development of national guidelines for a proactive, pathogen agnostic wastewater surveillance system in the United States with a focus on localities identified for risk of zoonoses and international ports of entry.

Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative.

Breathing should not make people sick. The air inside buildings (where people spend 90% of their lives) is often unfiltered, improperly ventilated, and unhealthy. Poor indoor air quality (IAQ) poses heightened risks of airborne infections and preventable exposures to harmful pollutants. US residents have little control over unhealthy built environments such as in workplaces, schools, shops, theaters, and restaurants. Absent their use of a personal air quality monitoring device, most people do not even realize the health risks. The Model State Indoor Air Quality Act (MSIAQA)¹ developed in collaboration with national advisors adopts science-based regulatory standards, such as testing, enhanced air filtration, system maintenance, and ventilation, to advance the public’s health and increase occupant productivity—ensuring that public indoor environments provide healthy air to breathe.

In late December 2019, novel human pneumonia cases were detected in Wuhan City, China. By February 2020, the disease was officially named coronavirus 19 (COVID-19),¹ and on March 11, 2020, the World Health Organization declared COVID-19 a pandemic.² As of March 30, 2022, the total number of deaths in the United States had reached 976,229 with nearly 80 million reported cases.

The COVID-19 pandemic may serve as a prime example of a 21st century public health emergency, an event accelerated and amplified by global interconnectedness, systemic fragility, and public misinformation. However, the United States continues to address this and other threats with distinctly 20th century information tools. This must change. Health emergency preparedness for modern threats requires rapid situational awareness, achieved only through common data elements, enforced information standards, investment in innovation, expert data analysis, and private sector engagement. To protect the health and safety of Americans, we must confront these challenges now and change the narrative of our future responses.

The proliferation of false and misleading health claims poses a major threat to public health. This ongoing “infodemic” has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal.

The COVID-19 pandemic illuminated the lack of resources available to US state and local public health agencies to respond to large-scale health events. Two response activities that were notably underresourced are case investigation and contact tracing (CI/CT), which health agencies routinely employ to control and prevent the transmission of infectious diseases. However, the scale of contact tracing required during the COVID-19 pandemic exceeded available resources, even in high-capacity public health agencies

Improving indoor air quality (IAQ) will diminish routine exposure to airborne diseases,^1,2 limit outbreaks or epidemics,³ and lower risks of noninfectious respiratory conditions like asthma that affect the health of millions each year.⁴ Improving IAQ is also cost-effective. Proper ventilation and filtration in crowded public indoor settings can significantly reduce the costs of illness at a benefit-cost ratio ranging from 3:1 to 100:1,⁵ exceeding similar ratios for most other public health interventions.⁶

On May 24 and 25, 2023, the Johns Hopkins Center for Health Security (“the Center”) co-hosted a dialogue (“the dialogue”) with the Regional Centre for Biotechnology of the Department of Biotechnology in the Indian Ministry of Science and Technology, in Washington, DC, to discuss biosecurity issues of importance to both India and the United States. The dialogue aimed to increase knowledge of prevention and response efforts for natural, deliberate, and accidental biological threats in India and the US; share best practices and innovations; examine opportunities for partnership and collaboration; develop and deepen relationships among dialogue participants; and identify issues that should be elevated to the attention of Indian or US government officials.

The COVID-19 pandemic has caused approximately 20 million deaths worldwide (0.25% of the world's population) and brought health systems in many places to the brink of collapse. As tragic and consequential as this has been, future pandemics could be worse.

The Johns Hopkins Center for Health Security co-convened government officials and other stakeholders for a Southeast Asia Strategic Multilateral Biosecurity Dialogue meeting from April 26-28 in Cebu, Philippines. It was the first in-person meeting of this series since SARS-CoV-2 emerged in 2019. This is the meeting Report from the 2023 Dialogue Session. 

Early detection of novel pathogens can prevent or substantially mitigate biological incidents, including pandemics. Metagenomic next-generation sequencing (mNGS) of symptomatic clinical samples may enable detection early enough to contain outbreaks, limit international spread, and expedite countermeasure development. In this article, we propose a clinical mNGS architecture we call “Threat Net,” which focuses on the hospital emergency department as a high-yield surveillance location. We develop a susceptible-exposed-infected-removed (SEIR) simulation model to estimate the effectiveness of Threat Net in detecting novel respiratory pathogen outbreaks. Our analysis serves to quantify the value of routine clinical mNGS for respiratory pandemic detection by estimating the cost and epidemiological effectiveness at differing degrees of hospital coverage across the United States. We estimate that a biological threat detection network such as Threat Net could be deployed across hospitals covering 30% of the population in the United States. Threat Net would cost between $400 million and $800 million annually and have a 95% chance of detecting a novel respiratory pathogen with traits of SARS-CoV-2 after 10 emergency department presentations and 79 infections across the United States. Our analyses suggest that implementing Threat Net could help prevent or substantially mitigate the spread of a respiratory pandemic pathogen in the United States.

Providing a definitive diagnostic test in a disease emergency is critical to limit pathogen spread, develop and deploy medical countermeasures, and mitigate the social and economic harms of a serious epidemic. While major accomplishments have accelerated test development, expanded laboratory testing capacity, and established widespread point-of-care testing, the United States does not have a plan to rapidly respond, to develop, manufacture, deploy, and sustain diagnostic testing at a national scale. To address this gap, we are proposing a National Diagnostics Action Plan that describes the steps that are urgently needed to prepare for future infectious disease emergencies, as well as the actions we must take at the first signs of such’ events.

When health emergencies arise, scientists seek to discover the cause — such as how a pathogen emerged and spread — because this knowledge can enhance our understanding of risks and strategies for prevention, preparedness, and mitigation. Yet well into the fourth year of the Covid-19 pandemic, intense political and scientific debates about its origins continue. The two major hypotheses are a natural zoonotic spillover, most likely occurring at the Huanan Seafood Wholesale Market, and a laboratory leak from the Wuhan Institute of Virology (WIV). It is worth examining the efforts to discover the origins of SARS-CoV-2, the political obstacles, and what the evidence tells us. This evidence can help clarify the virus’s evolutionary path. But regardless of the origins of the virus, there are steps the global community can take to reduce future pandemic threats.

Following the 2001 end to negotiations on a legally binding protocol, states parties to the 1972 Biological and Toxin Weapons Convention (BWC) developed entrenched positions about the necessity of treaty verification, hindering progress on treaty aims. The study described in this article was designed to facilitate dialogue on verification-related issues outside the context of those positions, using the term “assurance” to represent the degree of certainty that states parties are meeting their treaty obligations. From August 2020 to July 2021, the researchers conducted 36 interviews—16 with state-party delegations and 20 with independent experts, representing 20 countries. They performed mixed-methods analysis on the interviews, including quantitative metrics on qualitative interview content. Interviewees’ views on verification, compliance, and related concepts varied widely. Future efforts by states parties to achieve common understanding on these topics could facilitate concrete progress. While no single mechanism is sufficient to achieve verification or assess compliance, packages of mechanisms could increase assurance. Interviewees expressed general support for implementing assurance mechanisms, even in the absence of a comprehensive, legally binding protocol or verification regime, even among states parties for which that is the primary goal. Avenues to increase assurance among BWC stakeholders merit further discussion in the current intersessional program.

On July 23, 2022, the Director General of the World Health Organization declared a multicountry outbreak of mpox disease a Public Health Emergency of International Concern. Since this declaration, there have been thousands of cases detected in the United States. Although the outbreak has now waned, the virus is likely to continue transmitting at low levels across the United States among high-risk populations. Thus, it is critical for radiology nurses to be able to recognize mpox disease within the inpatient and outpatient settings, so that proper infection prevention and control precautions can be adhered to and so that patients can be referred for treatment.

In this article, we summarize findings from research conducted by the Johns Hopkins Center for Health Security and the Infectious Diseases Society of America to understand infectious disease (ID) workforce contributions to the coronavirus disease 2019 (COVID-19) response and their impacts. ID experts were found to have made diverse and unique contributions that went well beyond their usual responsibilities, with many spending several hours a week on these activities without additional compensation. These efforts were thought to not only build community resilience but also augment the ongoing public health response. Respondents also reported several hospital and clinical leadership roles taken on during the pandemic, such as developing protocols and leading clinical trials. We also make several policy recommendations, such as medical student debt relief and improved compensation, that will be needed to help fortify the ID workforce for future pandemics.