Publications

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.

The Johns Hopkins Center for Health Security developed this document in response to Representative Mariannette Miller-Meeks’ Request for Information (RFI) on how Congress can help to reform and strengthen the Centers for Disease Control and Prevention (CDC). The Johns Hopkins Center for Health Security believes that an adequately funded, appropriately authorized, and nimble CDC with a target mission is crucial to ensuring the public’s health and maintaining community resilience.

Prior to 2020, most pandemic preparedness efforts centered on influenza. Some countries, such as Aotearoa (New Zealand)¹, were able to successfully adapt national pandemic influenza plans to the response to COVID-19, and global influenza surveillance systems were harnessed for SARS-CoV-2 (ref. ²). It is now critical that nations and the international community implement lessons learned from COVID-19 back into influenza preparedness³. This task is particularly urgent given both the emergence of a number of influenza spillover threats and exhausted and depleted public health systems globally.

On March 29, 2023, the Johns Hopkins Center for Health Security provided feedback and recommendations in response to a Request for Information (RFI) in preparation for the upcoming Pandemic and All-Hazards Preparedness Act (PAHPA) reauthorization due by September 30, 2023. Senate Health, Education, Labor, and Pensions Committee Chair Sen. Bernie Sanders (I-VT), Ranking Member Sen. Bill Cassidy (R-LA), and Sens. Robert P. Casey, Jr. (D-PA) and Mitt Romney (R-UT) issued the RFI earlier in March. This submission follows the Center’s response to a US House of Representatives RFI issued by Reps. Richard Hudson (R-NC) and Anna Eshoo (D-CA) on the same topic.

In response to a series of biosafety incidents in 2014, the White House directed two high-level expert committees to analyze biosafety and biosecurity in U.S. laboratories and make recommendations for work with select agents and toxins. Overall, they recommended 33 actions to address areas related to national biosafety, including promoting a culture of responsibility, oversight, outreach and education, applied biosafety research, incident reporting, material accountability, inspection processes, regulations and guidelines, and determining the necessary number of high-containment laboratories in the United States.

On March 13, 2023, the Johns Hopkins Center for Health Security provided feedback and recommendations in response to a Request for Information (RFI) in preparation for the upcoming Pandemic and All-Hazards Preparedness Act (PAHPA) reauthorization due by September 30, 2023. House Energy and Commerce Committee members Rep. Richard Hudson (R-NC) and Rep. Anna Eshoo (D-CA) released the RFI in February 2023.

PAHPA is a groundbreaking piece of legislation that was first signed into law in 2006. PAHPA was reauthorized in 2013 and 2019, and the next round of reauthorization is rapidly approaching. PAHPA is now widely considered a “must pass” bill that bolsters the nation’s medical and public health preparedness and response capabilities against deliberate, accidental, and natural emergencies. Previous iterations of PAHPA have authorized the Administration for Strategic Preparedness and Response (ASPR) and the Biomedical Advanced Research and Development Authority (BARDA) and provided new authorities for a variety of programs.

Objective
The aim of the study is to describe the impact of colocating COVID-19 vaccinations with local syringe service programs on vaccine completion among people who inject drugs.

Methods
Data were derived from 6 community-based clinics. People who inject drugs who received at least one COVID-19 vaccine from a colocated clinic partnering with a local syringe service program were included in the study. Vaccine completion was abstracted from electronic medical records; additional vaccinations were abstracted using health information exchanges embedded within the electronic medical records.

Results
Overall, 142 individuals with a mean age of 51 years, predominantly male (72%) and Black, non-Hispanic (79%) received COVID-19 vaccines. More than half elected to receive a 2-dose mRNA vaccine (51.4%). Eighty-five percent completed a primary series, and 71% of those who received a mRNA vaccine completed the 2-dose series. Booster uptake was 34% in those completing a primary series.

Conclusions
Colocated clinics are an effective means of reaching vulnerable populations. As the COVID-19 pandemic continues and need for annual booster vaccines arises, it is important to bolster public support and funding to continue low-barrier preventive clinics colocated with harm reduction services for this population.

When SARS-CoV-2 first began to sweep the globe, so too did information about the virus, including accurate, false, and misleading information. Almost immediately, this deluge of information was recognized as a significant threat to public health, with WHO Director-General Tedros Adhanom Ghebreyesus announcing in February 2020 that “we’re not just fighting an epidemic, we’re fighting an infodemic.” Since then, the notion of an infodemic, which has been defined by WHO as “an over-abundance of information – some accurate and some not – that occurs during an epidemic” (WHO, 2020), has gained traction as a serious and ongoing public health concern, interfering with individuals’ ability to obtain and/or trust accurate information when they need it most (WHO, 2020).

The Johns Hopkins Center for Health Security hosted an in-person meeting of subject matter experts in Arlington, VA, on March 6–7, 2023, to discuss a draft blueprint of the “Model State Indoor Air Quality Act” (MSIAQA). Prior to the meeting, members of the Johns Hopkins Center for Health Security Indoor Air Quality (IAQ) Project Team drafted a blueprint for the forthcoming act, comprising 6 major articles and more than 50 potential provisions.