Publications

Plague is an infectious disease that has haunted the human species for millennia. The Justinian Plague in the 6th century and the Black Death beginning in the 14th century were civilization-shattering events, the effects of which were felt long after plague had dissipated [3]. What conferred this capacity on plague was its virulence, its transmission characteristics, and a lack of effective countermeasures, which did not appear until the 20th century.

Plague, caused by the bacterium Yersinia pestis, continues to cause disruptive and deadly outbreaks, especially in resource-limited areas. Recent outbreaks in Madagascar and Uganda have triggered domestic turmoil, large-scale antimicrobial prophylaxis of case contacts and health-care workers, and concern for international spread [4, 5].

The COVID-19 (COVID) pandemic has led to unprecedented action and innovation in the US healthcare system; at the same time, it has presented extraordinary challenges and risks. Through dramatic augmentation of surge capacity, deferral of other services, and implementation of crisis standards of care, hospitals in many locations have been able to absorb the blow of the first peak of COVID cases and continue to provide lifesaving care to both COVID patients and others with life-threatening emergencies. But many communities are just beginning to experience the full force of the pandemic, and in every location, the healthcare response to COVID has come at a very dear price. Healthcare facilities have sustained huge financial losses, and healthcare workers’ health and well-being have been put at high risk. New standard operating procedures and work processes have been improvised, and many old lessons have had to be relearned.

The global reach of infectious disease pandemics typically necessitates a similarly ubiquitous public health intervention: mass vaccination. The development and large-scale deployment of a vaccine requires substantial investment and a coalition of stakeholders to undertake research and development (including phase I to III clinical trials), manufacturing, and widespread administration. Recent efforts by national and international funders and researchers to advance the state of vaccinology for pandemics and other infectious disease emergencies have focused largely on expediting the R&D phase1. There has been comparatively less attention paid to modernizing, optimizing, and therefore accelerating other aspects of the vaccine enterprise—namely, manufacturing, distribution, and administration. The current COVID-19 pandemic plainly underscores the need to vastly accelerate mass vaccination in every phase.

In late December 2019, a cluster of unexplained cases of viral pneumonia occurred in Wuhan, China.1 This initial cluster of patients with what soon became known as coronavirus disease 2019 (COVID-19) heralded the arrival of a new pandemic caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, close to 90 000 cases have occurred in more than 60 countries with approximately 3000 deaths. The World Health Organization (WHO) has declared these events a Public Health Emergency of International Concern.

Clade X was a day-long pandemic tabletop exercise conducted by the Johns Hopkins Center for Health Security on May 15, 2018, in Washington, DC. In this report, we briefly describe the exercise development process and focus principally on the findings and recommendations that arose from this project.

Clade X was a day-long pandemic tabletop exercise conducted by the Johns Hopkins Center for Health Security on May 15, 2018, in Washington, DC. Many details of the exercise are available online, including videos, background documents, and fact sheets.In this report, we briefly describe the exercise development process and focus principally on the findings and recommendations that arose from this project.

The Center for Health Security commends the issuance of the Executive Order on Modernizing Influenza Vaccines in the United States to Promote National Security and Public Health, on September 19, 2019, which has the potential to significantly improve the nation's capacities against influenza. As noted in the executive order, influenza is the preeminent pandemic threat the world faces. Unlike many pandemic threats, however, seasonal occurrences of the infection provide a yearly stress test of our influenza pandemic mechanism. Recent years have seen severe seasonal strains of the virus inundate hospitals, spark spot shortages of antivirals, and expose stark deficiencies in vaccine technology. These events have unfortunately demonstrated that, were a severe pandemic to occur today, the United States is not sufficiently prepared to withstand such an event without major societal disruption.

Vaccines are the cornerstone of the management of an infectious disease outbreak and are the surest means to defuse pandemic and epidemic risk. The faster a vaccine can be deployed, the faster an outbreak can be extinguished. To date, however, the pharmaceutical response to emerging infectious diseases and bioterrorism has been characterized by a “one bug, one drug” approach, in which specific medical countermeasures—effective vaccines and therapeutics—are developed, manufactured, and deployed. This is a process that is often measured in decades.

This volume focuses on Global Catastrophic Biological Risks (GCBRs), a special class of infectious disease outbreaks or pandemics in which the combined capacity of the world’s private and government resources becomes severely strained. These events, of which the 1918 influenza pandemic is emblematic, cause severe disruptions in the normal functioning of the world, exact heavy tolls in terms of morbidity and mortality, and lead to major economic losses.

The use of PrEP has revolutionized the response to HIV. If this success can be replicated for other STIs — which are on a major upswing — it would be a major win in the battle against these infections. Although the evidence base is not strong, there is an important positive signal that needs to be studied more systematically to demonstrate benefit and assess the risk of antimicrobial resistance with widespread use of antibiotic-based therapies. However, it may be a feasible strategy in high-risk populations if coupled to surveillance for resistance among targeted infections. STIs such as gonorrhea, chlamydia, and syphilis have slipped out of control and having an effective pharmaceutical preventive measure could significantly diminish the force of infection and reverse the worrying trend currently occurring.

Predicting which pathogen will confer the highest global catastrophic biological risk (GCBR) of a pandemic is a difficult task. Many approaches are retrospective and premised on prior pandemics; however, such an approach may fail to appreciate novel threats that do not have exact historical precedent. In this paper, based on a study and project we undertook, a new paradigm for pandemic preparedness is presented. This paradigm seeks to root pandemic risk in actual attributes possessed by specific classes of microbial organisms and leads to specific recommendations to augment preparedness activities.

Testing of 14 patients with acute flaccid myelitis, or AFM, showed they had antibodies against enteroviruses, especially EV-D68, in their cerebrospinal fluid at a significantly higher rate than controls, supporting “the plausibility of a link” between enterovirus infection and AFM, researchers reported in mBio.

Infectious diseases (ID) physicians play a crucial role in public health in a variety of settings. Unfortunately, much of this work is undercompensated despite the proven efficacy of public health interventions such has hospital acquired infection (HAI) prevention, antimicrobial stewardship, disease surveillance, and outbreak response. The lack of compensation makes it difficult to attract the best and the brightest to the field of infectious diseases, threatening the future of the ID workforce. This paper examines compensation data for ID physicians compared to their value in population and public health settings and suggests policy recommendations to address the pay disparities between cognitive and procedural specialties which prevents more medical students and residents from entering the field. All ID physicians should take an active role in promoting the value of the subspecialty to policymakers and influencers as well as trainees.

Among the myriad infectious disease threats humans face from bacteria, prions, parasites, protozoa, fungi, ectoparasites, and viruses, it is viral infections that arguably constitute the biggest pandemic threat in the modern era. The replication rates and transmissibility of viruses are two major factors that underlie this threat. However, at least one additional factor plays an essential role: the lack of ‘broad-spectrum’ antiviral agents. Indeed, while bacteria can still cause substantial epidemics in parts of the world where access to clean water and/or antimicrobials is limited, the pandemic threats posed by bacteria, such as from the plague-causing Yersinia pestis, has been substantially diminished in the antibiotic era [1]. For viruses that pose epidemic risks, on the other hand, current therapeutic options are more limited.

A mass drug administration, or MDA, of azithromycin remained effective at reducing child mortality in the 3rd year of its implementation in Niger, according to a cluster-randomized trial published in The New England Journal of Medicine.

To date, the pharmaceutical response to emerging infectious diseases and bioterrorism has been characterized by a “one bug, one drug” approach, where specific medical countermeasures—effective vaccines and therapeutics—are developed, manufactured, and deployed. However, over the past several years, platform technologies have been developed that could make it possible for multiple vaccines to be more rapidly produced from a single system.

New clinical practice guidelines from the Infectious Diseases Society of America emphasize the need to test and promptly treat patients at high risk for seasonal influenza-related complications, including pregnant women, young children, patients who are extremely obese and those who have a weakened immune system.

Emergency physicians in every location in the world, in developed and developing countries alike, will undoubtedly be confronted with the possibility of an emerging infectious disease in their career. A subset of these physicians may be faced with a patient who has potentially been exposed to biological weapons. Of the myriad infectious disease emergencies an emergency physician contends with, these 2 possibilities are the gravest and most impactful. In such scenarios, the emergency department (ED) clinician can be the key in recognizing or containing an outbreak. The challenge inherent with emerging infectious diseases presenting in the ED is that such cases can be camouflaged, lurking amongst innumerable infectious disease clinical syndromes, from common colds to viral rashes. This article provides guidance to emergency physicians as to how to approach this challenging problem as well as familiarizing readers with specific microbial threats of high consequence.

The Johns Hopkins Center for Health Security conducted this study to elucidate the characteristics of naturally occurring microorganisms that constitute a global catastrophic biologic risk (GCBR).

GCBRs are defined as “those events in which biological agents—whether naturally emerging or reemerging, deliberately created and released, or laboratory engineered and escaped—could lead to sudden, extraordinary, widespread disaster beyond the collective capability of national and international governments and the private sector to control. If unchecked, GCBRs would lead to great suffering, loss of life, and sustained damage to national governments, international relationships, economies, societal stability, or global security.”

Biological threats, which range from naturally occurring outbreaks of infectious disease to intentional acts of bioterrorism, pose unique dangers to public health and national security in the United States. Medical countermeasures (MCMs)—drugs, vaccines, diagnostic tests, and other therapies and devices—rank among the most important assets in the nation's arsenal against dangerous pathogens, as well as chemical, radiological, and nuclear threats. Communities with access to vital MCMs are better equipped to detect both accidental and deliberately caused outbreaks quickly, immunize susceptible populations, and treat infected patients, thereby alleviating the consequences associated with infectious diseases: illness and death, economic losses, societal unrest, and strained public health and healthcare delivery systems.

The Johns Hopkins Center for Health Security is working to analyze and deepen scientific dialogue regarding potential global catastrophic biological risks (GCBRs), in a continuation of its mission to reduce the consequences of epidemics and disasters. Because GCBRs constitute an emerging policy concern and area of practice, we have developed a framework to guide our work. We invited experts from a variety of disciplines to engage with our underlying concepts and assumptions to refine collective thinking on GCBRs and thus advance protections against them.