Publications

A scoping literature review of learnings from the coronavirus disease 2019 (COVID-19) pandemic was commissioned by WHO to inform operational priorities for future respiratory pathogen pandemic preparedness. The learnings are grouped according to WHO’s subsystems for health emergency preparedness, response and resilience. Key takeaway messages include: 1) Preparedness works; 2) Health is everyone’s business; 3) No one is safe until everyone is safe; and 4) Response must be agile and adaptive. The review will support pandemic planners at all levels to develop and update preparedness and response plans.

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. 

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 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

The COVID-19 pandemic has revealed that a true, end-to-end research and development (R&D) and response ecosystem—meaning, one that develops, produces, and delivers needed vaccines to global populations in a rapid and equitable fashion—remains an elusive goal. Most low- and middle-income countries (LMICs) have been unable to acquire and administer a sufficient supply of COVID-19 vaccines, and the dearth of vaccines and limited capacity to deliver them are prolonging the pandemic and contributing to destabilizing economies and societies around the world. Multilateral initiatives, bilateral aid, and vaccine donations, though useful, have been slow to arrive and insufficient to provide adequate vaccine coverage for LMIC populations. The consequences of this deeply inequitable global response extend beyond the COVID-19 pandemic. Global initiatives to prepare for and respond to future pandemic threats cannot succeed if LMIC governments believe they will be the last to benefit from vaccines produced as a result of improvements in global disease surveillance, increased sample sharing, or expedited vaccine R&D.

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.

To understand operational challenges involved with responding to US measles outbreaks in 2017–19 and identify applicable lessons in order to inform preparedness and response operations for future outbreaks, particularly with respect to specific operational barriers and recommendations for outbreak responses among insular communities.

Mass vaccination is a crucial public health intervention during outbreaks or pandemics for which vaccines are available. The US government has sponsored the development of medical countermeasures, including vaccines, for public health emergencies; however, federally supported programs, including the Public Health and Emergency Preparedness program and Cities Readiness Initiative, have historically emphasized antibiotic pill dispensing over mass vaccination. While mass vaccination and pill dispensing programs share similarities, they also have fundamental differences that require dedicated preparedness efforts to address. To date, only a limited number of public assessments of local mass vaccination operational capabilities have been conducted. To fill this gap, we interviewed 37 public health and preparedness officials representing 33 jurisdictions across the United States. We aimed to characterize their existing mass vaccination operational capacities and identify challenges and lessons learned in order to support the efforts of other jurisdictions to improve mass vaccination preparedness. We found that most jurisdictions were not capable of or had not planned for rapidly vaccinating their populations within a short period of time (eg, 1 to 2 weeks). Many also noted that their focus on pill dispensing was driven largely by federal funding requirements and that preparedness efforts for mass vaccination were often self-motivated. Barriers to implementing rapid mass vaccination operations included insufficient personnel qualified to administer vaccinations, increased patient load compared to pill-dispensing modalities, logistical challenges to maintaining cold chain, and operational challenges addressing high-risk populations, including children, pregnant women, and non-English-speaking populations. Considering the expected availability of a severe acute respiratory syndrome coronavirus 2 vaccine for distribution and dispensing to the public, our findings highlight critical considerations for planning possible future mass vaccination events, including during the novel coronavirus disease 2019 pandemic.

The Global Forum on Scientific Advances Important to the Biological Weapons Convention facilitates engagement between scientists performing cutting-edge research and States Parties delegations to the Biological Weapons Convention (BWC). The Global Forum helps the delegates become familiar with some of the rapid advances in the biological and related sciences that affect the treaty and its implementation, and it demonstrates to scientists the role of the BWC in shaping the governance of these technologies. Our efforts to inform BWC delegations on emerging and future biology and biotechnology capabilities supplement an existing portfolio of programs—including the BWC Meetings of Experts and regional science and technology workshops hosted by the InterAcademy Partnership—that work collectively to help States Parties identify and evaluate potential biological threats and develop mechanisms to allow the BWC to remain adaptive to these new capabilities. Additionally, the Global Forum supports efforts, such as model codes of conduct, to foster a culture of responsibility among the scientific community that enables researchers to pursue advanced and revolutionary capabilities while simultaneously encouraging them to account for potential risks and mitigate those effects.

This year, the Global Forum was cosponsored by the Johns Hopkins Center for Health Security and the United Nations Office for Disarmament Affairs (UNODA). The formal involvement of UNODA and the BWC Implementation Support Unit highlights the importance of addressing emerging science and technology in the context of the BWC and the commitment to facilitating engagement between scientists and policymakers to identify and understand emerging biological capabilities and risks.

Serology (antibody) tests for the SARS-CoV-2 virus have the potential to inform good public health decision making during the pandemic. This report describes potential uses of the tests, areas of uncertainty where additional research is needed, and examples from other countries now beginning to make use of these tests. The priority for the United States now is to make validated, accurate tests available to: (1) public health authorities, to conduct surveillance and to estimate the numbers of people previously infected. Should antibody tests be determined to correlate with immunity to the disease, they should then be made available to: (2) essential workers, with priority for healthcare workers and those who interact with vulnerable populations (eg, nursing home residents); and (3) individuals who may use them to assess their personal risk of becoming infected with SARS-CoV-2 (COVID-19 disease). These tests will be in high demand, and manufacturing should be scaled appropriately, but the first steps will be to ensure accuracy, validity, and comparability of available tests.

This article describes implementation considerations for Ebola-related monitoring and movement restriction policies in the United States during the 2013–2016 West Africa Ebola epidemic.

Effective communication about medical countermeasures—including drugs, devices and biologics—is often critical in emergency situations. Such communication, however, does not just happen. It must be planned and prepared for. One mechanism to develop communication strategies is through the use of prospective scenarios, which allow readers the opportunity to rehearse responses while also weighing the implications of their actions. This article describes the development of such a scenario: The SPARS Pandemic 2025-2028. Steps in this process included deciding on a timeframe, identifying likely critical uncertainties, and then using this framework to construct a storyline covering both the response and recovery phases of a fictional emergency event. Lessons learned from the scenario development and how the scenario can be used to improve communication are also discussed.

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.

During the 2014-15 domestic Ebola response, US states developed monitoring and movement restriction policies for potentially exposed individuals. We describe decision-making processes and factors in the development of these policies. Results may help health officials anticipate potential concerns and policy influencers in future infectious disease responses. Thirty individuals with knowledge of state-level Ebola policy development participated in semi-structured interviews conducted from January to May 2017. Interviewees represented 18 jurisdictions from diverse census regions, state political affiliations, and public health governance structures as well as the US Centers for Disease Control and Prevention (CDC). Limited and/or changing guidance and unique state-level public health, legal, and operational environments resulted in variation in policy responses. Federal guidance developed by the CDC was an important information source influencing state-level policy responses, as was available scientific evidence; however, other external factors, such as local events, contributing experts, political environment, public concern, news media, and the influence of neighboring states, contributed to additional variation. Improvements in timing, consistency, and communication of federal guidance for monitoring and movement restrictions at the state level—along with balanced approaches to addressing ethical concerns, scientific evidence, and public concern at the state level—are considerations for policy development for future disease responses.

From April 29 to May 1, 2019, the Johns Hopkins Center for Health Security and the Thailand Ministry of Public Health’s Department of Disease Control co-hosted a meeting of the Southeast Asia Strategic Multilateral Biosecurity Dialogue in Phuket, Thailand. This dialogue began in 2014 as a bilateral Track II dialogue between Singapore and the United States and expanded the following year to include Indonesia and Malaysia. The Philippines and Thailand were added as observers in 2017, and they became full participants starting with this year’s meeting. The purpose of this dialogue is to examine biological risks facing the United States and the Southeast Asia region—including natural, accidental, and deliberate. This dialogue aims to facilitate cross-border and regional engagement and collaboration and identify novel solutions and share best practices in combatting priority threats.

We conducted semistructured interviews with individuals directly involved in the response to a mumps outbreak and analyzed outbreak response–associated cost data.

We conducted semistructured interviews with health officials from 9 city or county health departments to collect the firsthand experience of public health responders. We collected data from January to October 2018 via teleconference. Key informants, whom we purposefully sampled, were senior public health officials who were directly involved in outbreak response or in preparing for potential hepatitis A outbreaks in their communities.

A strategic multilateral dialogue related to biosecurity risks in Southeast Asia, established in 2014, now includes participants from Singapore, Malaysia, Indonesia, Thailand, Philippines, and the United States. This dialogue is conducted at the nonministerial level, enabling participants to engage without the constraints of operating in their official capacities. Participants reflect on mechanisms to detect, mitigate, and respond to biosecurity risks and highlight biosecurity issues for national leadership. Participants have also identified factors to improve regional and global biosecurity, including improved engagement and collaboration across relevant ministries and agencies, sustainable funding for biosecurity programs, enhanced information sharing for communicable diseases, and increased engagement in international biosecurity forums.

On December 3, 2018, the Johns Hopkins Center for Health Security convened the first annual Global Forum on Scientific Advances Important to the Biological and Toxin Weapons Convention, coinciding with the 2018 Meeting of States Parties to the Biological and Toxin Weapons Convention (BWC MSP) in Geneva, Switzerland. The forum had 2 purposes: (1) to inform States Parties’ delegations of cutting-edge biological capabilities, including the ability to engineer pathogens or more complex organisms, and (2) to build awareness of and support for international bioweapons nonproliferation norms among the scientific community. Advanced biology, engineered pathogens and other organisms, and accidental biological threats as sources of risk are of great concern to international biological nonproliferation regimes such as the BWC.

December 2018 marked the fifth anniversary of the start of the worst Ebola epidemic in recorded history. The epidemic spread rapidly from rural villages in Guinea to major cities across West Africa,¹ ultimately resulting in 28,652 cases and 11,325 deaths across 10 countries,² including the first known transmission of Ebola virus infection outside of Africa.³ Despite the declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) in August 2014,⁴ the international response lagged. The epidemic peaked in October 2014,⁵ but another 20 months passed before WHO issued its final declaration of the end of the epidemic in June 2016.⁶ Even before the official end of the epidemic, WHO announced major organizational and operational reforms in response to the challenges faced during the global epidemic response,^7,8 and public health and healthcare organizations around the world, including those that treated Ebola virus disease (EVD) patients, initiated efforts to increase preparedness for Ebola and other high-consequence infectious diseases (HCIDs).