Publications

At the end of May, 194 member states of the World Health Organization (WHO) will meet for the World Health Assembly. Negotiations underway now will determine whether they vote then to adopt a pandemic agreement. For the past 2 years, discussions have focused on articulating essential components of a robust and equitable architecture for pandemic preparedness and response. Despite this, talks have failed to produce sufficient consensus on a detailed draft, prompting the intergovernmental negotiating body to propose a “streamlined” version.

Rasmussen et al. argue that “increasing oversight across virology or all microbe research would represent a misdirection of resources and would fail to provide a commensurate increase in safety or security” and “harm surveillance, antiviral discovery, monitoring for resistance to antivirals and vaccines, and other critical efforts.” On the contrary, a strengthened version of the recommendations of the National Science Advisory Board on Biosecurity (NSABB) is crucial for the success of microbiological science. Implementing these recommendations would reduce the risks of a deliberate or accidental pandemic, while using precious research resources efficiently, restoring trust in science, strengthening US leadership in biosecurity and biosafety, and safeguarding the biomedical research enterprise, as ASM itself has said.

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 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. 

The Tianjin Biosecurity Guidelines for Codes of Conduct for Scientists are a set of ten principles designed to promote responsible science and strengthen biosecurity governance. They should be broadly adopted, including being endorsed by the Biological Weapons Convention at its 9th Review Conference in November 2022.

This study examined the feasibility of creating a new nongovernmental health security research policy center in Asia, how such a center might benefit the advancement of policies promoting health security, and where such a center might be located. Health security policy encompasses numerous aspects of global health, including emerging infectious diseases, epidemics, medical and public health preparedness and response, deliberate and accidental biological threats, risk management related to advanced life science research and other biosecurity issues, and reduction of global catastrophic biological risks (GCBRs). GCBRs are 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.¹ If unchecked, GCBRs could lead to great suffering, loss of life, and sustained damage to national governments, international relationships, economies, societal stability, or global security.

On April 8, 2022, the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health convened a virtual, not-for-attribution meeting to solicit expert input on the US Department of Defense’s (DoD) first Biodefense Posture Review (BPR). US Secretary of Defense Lloyd J. Austin III called for a comprehensive BPR in a November 2021 memo concerning the DoD’s biodefense vision. In the memo, Secretary Austin points out the critical roles DoD played in the COVID-19 response, both within the Department and as part of the broader whole-of-government response. After-action reviews of these vital contributions highlighted areas for improvement in DoD’s preparedness and response. Therefore, Secretary Austin directed a whole-of-department review to efficiently and robustly assess the DoD’s capabilities and modernize its strategies for biodefense.

On February 8 and 9, 2022, the Johns Hopkins Center for Health Security co-hosted a virtual dialogue session with the Regional Centre for Biotechnology of the Department of Biotechnology in the Indian Ministry of Science and Technology. The meeting focused on successes, challenges, opportunities, and lessons learned in the COVID-19 responses in India and the United States, and how COVID-19 responses can continue while also preparing for future health security crises.

The dialogue focused on COVID-19 developments that occurred since the last meeting in January 2021. Discussions centered around national response efforts, mass vaccination, surveillance approaches, causes and biosecurity implications of COVID-19 misinformation and disinformation, synthetic biological risks, global biosecurity governance, and the need for future collaboration among countries and within the scientific community.

The meeting convened senior thought leaders, scientists, public health practitioners, and medical experts from the United States and India. In accordance with the dialogue format, participants offered insights based on personal expertise and did not represent the government of either country in an official capacity.

On December 14 and 16, 2021, the Johns Hopkins Center for Health Security held a second virtual meeting of the Southeast Asia Strategic Multilateral Biosecurity Dialogue. The ongoing impacts of the COVID-19 pandemic, including health risks as well as quarantine requirements and other travel restrictions, necessitated hosting the meeting virtually. Additionally, many of our dialogue participants play important roles in their country’s COVID-19 response, which makes it difficult for them to take time away from work for travel. In order to maintain the relationships that are so critical to the success of this dialogue and to share lessons from national-level COVID-19 response activities, we held a second virtual meeting, which built on the topics and challenges discussed in our previous meeting in February 2021.¹

As of September 2021, mortality in the United States due to the SARS-CoV-2 virus had exceeded the death toll from the 1918 influenza pandemic. COVID-19 was the ultimate test of healthcare and public health capacity and capability across the United States. From its acute onset and throughout its extended duration, the COVID-19 pandemic has overwhelmed hospitals, disrupted businesses, and caused lasting economic harm. It has also illuminated and exploited major vulnerabilities within the US healthcare and public health systems. The impact of the pandemic on hospitals, and to a lesser extent on public health departments, has been explored elsewhere, but relatively little has been written about the impact on primary care services. Operating largely in silos and chronically underfunded disciplines, primary care providers and public health practitioners in the United States have struggled to respond to the numerous waves of the pandemic, which have caused high levels of morbidity and mortality and jeopardized health systems in communities across the country, especially those that are most vulnerable. It is crucial that the lessons learned from the COVID-19 pandemic must be shared.

Masks and respirators have played an essential role in the response to the COVID-19 pandemic for both healthcare workers and the public. However, the masks and respirators that both healthcare workers and the public have needed to rely upon leave much to be desired. Despite drawbacks in terms of comfort and fit, the ubiquitous disposable masks and disposable N95 respirators used by the vast majority of healthcare workers have not appreciably improved since the mid-1990s. During the COVID-19 pandemic, the public has been advised to wear masks as well. Masks have long been known to be effective means of “source control” (ie, reducing transmission of respiratory droplets from the wearer to others). More recently evidence has accumulated that properly constructed and worn masks as well as respirators afford a limited but not inconsequential degree of protection to the wearer as well. Existing masks and respirators run the gamut in terms of effectiveness and wearability. In a future large-scale outbreak or pandemic, it is possible to increase the protection of healthcare workers and the public from infection through more efficient, well-fitting, and comfortable masks. The design and manufacture of better masks and respirators are possible by harnessing emerging technologies, the innovative research and development spirit evidenced since the early days of the COVID-19 pandemic, and the availability of resources to support technological innovation.

On February 10 and 11, 2021, the Johns Hopkins Center for Health Security hosted a virtual meeting of the Southeast Asia Strategic Multilateral Biosecurity Dialogue. Due to health risks stemming from the COVID-19 pandemic as well as associated restrictions and protective measures implemented around the world, the dialogue meeting originally scheduled to be held in Cebu, Philippines, during 2020 was postponed. To continue the productive dialogue between the participating countries, a virtual meeting was held to specifically address challenges and lessons from the countries’ experiences with COVID-19.

Memish and colleagues,¹in their response to our Comment,² perceive conflict between the current best-practice risk management advice on physical distancing and the scientific evaluation of cancelling or continuing mass gathering events during the coronavirus disease 2019 (COVID-19) pandemic. Although we have already acknowledged the need to balance these two considerations in order to maintain public understanding and trust, we do not accept that conflict is inevitable as our approach requires all mass gatherings to be considered in context, including the prevailing advice on physical distancing and movement restrictions. An open and transparent process to explicitly consider the risks of a mass gathering can, in fact, promote public confidence in the decision.

The COVID-19 pandemic has shown that health-related misinformation and disinformation can dangerously undermine the response to a public health crisis. Contradictory messaging and active subversion have reduced trust in public health responders, increased belief in false medical cures, and politicized public health measures aimed at curbing transmission of the disease. Setbacks in the COVID-19 response have highlighted that health-related misinformation or disinformation can lead to more infections, deaths, disruption, and disorganization of the effort. The public health response and communication environment in the United States have been disrupted by significant distrust in government, exacerbated by confusing and conflicting messages from leaders. As a result, information voids have developed, easily filled by false or misleading information and directly targeted by perpetrators of disinformation. Taken together, the spread and consequence of public health misinformation and disinformation can lead to a range of outcomes that have national security implications and require effective response.

On January 26 and 27, 2021, the Johns Hopkins Center for Health Security hosted a virtual dialogue discussion, focused on coronavirus disease 2019 (COVID-19) responses in India and the United States. The session explored lessons learned thus far and the path forward for both nations in responding to the pandemic. The meeting was held in collaboration with the Regional Centre for Biotechnology of the Department of Biotechnology in the Indian Ministry of Science and Technology.

Among the most pressing issues in preparing for the global response to a pandemic are the design, development, manufacture, and dissemination of vaccines. In 2018 and 2019, we conducted 48 interviews with prominent leaders in public health, pandemic preparedness, vaccine design, and vaccine manufacturing about how they would respond to a sudden, urgent need to manufacture 2 billion or more doses of vaccine. Little did we know that this scenario would become a dire global challenge a few months later with the onset of COVID-19. The response to this pandemic has shown that when leading vaccine manufacturers are fully engaged in a global response, it might be possible for them to manufacture substantial doses of vaccine on timelines faster than previously envisioned. It is now hoped that hundreds of millions of doses of vaccine will start to be produced sometime in the end of 2020 or the start of 2021, and that billions of doses of vaccine could be produced in the months that follow. Whether these timelines can be met or not, it is crucial now, while the world is fully attuned to the terrible consequences of pandemics, to begin preparing the system of global manufacturing for future pandemics. The following insights and recommendations are taken from our interviews with leading experts and our own analysis.

Since its recognition as a pandemic in early 2020, novel coronavirus disease 2019 (COVID-19) has touched nearly every corner of US society. However, some populations and environments have been affected far more severely than others. Vulnerable populations—especially those subject to structural racism, discrimination due to disability, and financial insecurity—tend also to be particularly susceptible to the economic consequences of and severe disease and death from COVID-19. In addition, the institutions, industries, and systems that are fundamentally important to our lives and our democracy have, in some cases, become places where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads readily if allowed to gain a foothold. In these places, it can be difficult to prevent the introduction of the virus or control the spread of SARS-CoV-2 once it is introduced.

The COVID-19 pandemic will continue for the foreseeable future, but widespread vaccination could hasten its end. At least 165 candidate vaccines for the SARS CoV-2 virus are in development around the world and there is hope that one or more of these candidates will soon be shown to be sufficiently safe and effective to achieve emergency use authorization in the United States. When a vaccine has been authorized for use, it will initially be in limited supply. During this period of scarcity, a plan is needed for how to allocate and distribute the limited supply—which groups should be prioritized to receive the vaccine first and which groups can wait until later. This difficult and potentially contentious topic is being actively discussed in the United States by the Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention (CDC) and the National Academy of Medicine (NAM), as well as globally at the World Health Organization (WHO) and elsewhere. The purpose of this report is to offer an additional ethics framework for use in making decisions about allocation of SARS-CoV-2 vaccine during this initial period of scarcity in the United States and make related suggestions about vaccine distribution. Our approach takes into account considerations of medical risk, public health, ethics and equity, economic impact, and logistics. We note where our approach aligns or differs from the 2018 CDC guidance for vaccine allocation in a severe influenza pandemic, which is the most recent pandemic vaccine guidance from the US government.

The impact of the COVID-19 pandemic in the United States has been profound. Despite initial declines in cases in May 2020 following implementation of stringent stay-at-home orders, cases are resurging in most states. The number of deaths has been rising in many states, with hospitalization rates for COVID-19 now again matching or exceeding numbers seen at the peak in New York City in March and April. Hospitals are under pressure or approaching a crisis in many places around the country. This resurgence is stressing many sectors of society, from businesses to education to health care. Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset.

This brief report describes concrete policy actions at the federal, state, and local levels that are needed to get control of the COVID-19 pandemic in the United States.

Before an infectious disease outbreak of any size can be addressed and before illness can be treated, it must be first be identified through the diagnosis of cases. Diagnostic testing is a mainstay of not only clinical medicine but also epidemiologic investigation. Limitations surrounding access to diagnostic testing have dominated much of the current response to COVID-19 and highlight the need to have more rapid, convenient, and equitable access to testing. Looking ahead, through the increasing diffusion of health technology to consumers and patients, it is becoming more feasible for diagnostic testing to be placed in the hands of the patient. Such tests when used to diagnose infectious disease, and coupled to information technology, could have a transformative benefit for future pandemic response.

The Johns Hopkins Center for Health Security conducted this study to develop an expert assessment of the promise and challenges posed by at home infectious diagnostic technologies. A major aim of this study is to inform pandemic preparedness activities that rely on diagnostic technologies and determine how at home approaches can integrate with and augment the existing diagnostic paradigm.