Publications

This article is the latest in an annual series analyzing federal funding for health security programs. We examine proposed funding in the President's Budget Request for FY2019, provide updated amounts for FY2018, and update actual funding amounts for FY2010 through FY2017. Building health security for the nation is the responsibility of multiple agencies in the US federal government, as well as that of state, tribal, territorial, and local governments and the private sector. This series of articles focuses on the federal government's role in health security by identifying health security–related programs in public health, health care, national security, and defense and reporting funding levels for that ongoing work.

This report highlights 15 technologies or categories of technologies that, with further scientific attention and investment, as well as attention to accompanying legal, regulatory, ethical, policy, and operational issues, could help make the world better prepared and equipped to prevent future infectious disease outbreaks from becoming catastrophic events.

News media plays a large role in the information the public receives during an infectious disease outbreak, and may influence public knowledge and perceptions of risk. This study analyzed and described the content of U.S. news media coverage of Zika virus and Zika response during 2016. A random selection of 800 Zika-related news stories from 25 print and television news sources was analyzed. The study examined 24 different messages that appeared in news media articles and characterized them using theories of risk perception as messages with characteristics that could increase perception of risk (risk-elevating messages; n = 14), messages that could decrease perception of risk (risk-minimizing messages; n = 8), or messages about travel or testing guidance (n = 2). Overall, 96% of news stories in the study sample contained at least one or more risk-elevating message(s) and 61% contained risk-minimizing message(s). The frequency of many messages changed after local transmission was confirmed in Florida, and differed between sources in locations with or without local transmission in 2016. Forty percent of news stories included messages about negative potential outcomes of Zika virus infection without mentioning ways to reduce risk. Findings from this study may help inform current federal, state, and local Zika responses by offering a detailed analysis of how news media are covering the outbreak and response activities as well as identifying specific messages appearing more or less frequently than intended. Findings identifying the types of messages that require greater emphasis may also assist public health communicators in responding more effectively to future outbreaks.

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.

Policy-makers and practitioners have a need to assess community resilience in disasters. Prior efforts conflated resilience with community functioning, combined resistance and recovery (the components of resilience), and relied on a static model for what is inherently a dynamic process. We sought to develop linked conceptual and computational models of community functioning and resilience after a disaster.

A scientific understanding of the threat posed by biological weapons is critical to determine biodefense priorities, set preparedness and response policies, and implement prevention and mitigation measures. The United States is committed to upholding the Biological and Toxin Weapons Convention (BWC)[1] and 18 U.S. Code 175,[2] which make it a crime to knowingly possess a biological agent, toxin, or delivery system for use as a weapon or if the material is not intended for peaceful purposes. For the purposes of defense, the U.S. government (USG) has deemed it necessary to conduct risk assessments and characterize the threat posed by biological weapons use to the U.S. homeland. Yet, the data required to develop risk assessments are largely insufficient; there are large gaps in our knowledge and understanding regarding biological weapons.[3] We often have limited data on the biology of many potential biological threat agents (e.g., their dose–response profile, behavior under different conditions, and environmental persistence), and rather limited understanding of the intentions of adversaries who possess or seek to possess biological weapons. This uncertainty about both the biology of a threat agent as well as its likelihood of use makes effective decision making about biodefense resource prioritization difficult.

Following the anthrax and 9/11 terrorist attacks of 2001, Presidents Bush and Obama both prioritized and supported investment in federal programs aimed at improving US defenses against health security threats, including major disasters; naturally occurring infectious disease epidemics; accidental releases of chemical, biological, or radiological materials; and chemical, biological, radiological, or nuclear (CBRN) terrorism.

There are a range of worrisome threats to US health and national security—worrisome because they have the potential to cause widespread disruption and damage to the public's health and to the US and global economies. These threats include major natural hazards like large earthquakes and hurricanes and infectious disease pandemics; accidental threats, including technological failures, such as nuclear power plant disasters like Three Mile Island and Fukushima; and intentional attacks by thinking adversaries, including terrorist use of biological, chemical, or nuclear/radiological weapons.

Mosquito-borne infectious diseases such as dengue, chikungunya, and now Zika, pose a public health threat to the US, particularly Florida, the Gulf Coast states, and Hawaii. Recent autochthonous transmission of dengue and chikungunya in Florida, the recent dengue outbreak in Hawaii, and the potential for future local spread of Zika in the US, has led to the consideration of novel approaches to mosquito management. One such novel approach, the release of sterile genetically modified mosquitoes, has been proposed as a possible intervention, and a trial release of GM mosquitoes is being considered in one Florida community. However, this proposal has been controversial. The objective of this research was to increase understanding of community knowledge, attitudes, and beliefs regarding mosquito control and GM mosquitoes.

The U.S. government (USG) has taken steps intended to diminish the likelihood of misuse of research—in one recent action, declaring a funding moratorium on gain-of-function studies on influenza until a risk-benefit analysis can be conducted (1). The analysis is expected to examine biosafety concerns, the potential for such research to produce a biological weapons agent, and the possibility that publication may lower barriers to bioweapons development (1). To analyze the security risks of biological research, however, it is first necessary to determine the likelihood that bioweapons will threaten national security and to what degree legitimate research is at risk of misuse. This type of assessment is fraught with uncertainty.

This article assesses US government funding in 5 domains critical to strengthening health security: biodefense programs, radiological and nuclear programs, chemical programs, pandemic influenza and emerging infectious disease programs, and multiple-hazard and preparedness programs. This year's article also highlights the emergency funding appropriated in FY2015 to enable the international and domestic response to the Ebola outbreak in West Africa.

The US government has made sustained biodefense-related investments in basic and applied R&D aimed at producing anti-Ebola MCMs for more than a decade. Investments made by the National Institute of Allergy and Infectious Diseases (NIAID), through Biodefense and Emerging Infectious Diseases Program funding, and by the Department of Defense (DoD) Defense Threat Reduction Agency (DTRA), through the Chemical and Biological Defense Program (CBDP), have led to the development of a majority of the countermeasures in the pipeline. In addition, biodefense investments in building advanced development capabilities at the Biomedical Advanced Research and Development Authority (BARDA) and in building mechanisms for emergency clinical testing and emergency regulatory approval at the Food and Drug Administration (FDA) are now proving critical to current efforts to rapidly confirm safety and efficacy and ramp up production of countermeasures.

Contemporary cost estimates of dengue fever are difficult to attain in many countries in which the disease is endemic. By applying publicly available health care costs and wage data to recently available country-level estimates of dengue incidence, we estimate the total cost of dengue to be nearly 40 billion dollars in 2011.

Previous articles in this series have provided funding information for federal civilian biodefense programs and programs focused on radiological and nuclear preparedness and consequence management. This year the authors have expanded the focus of the analysis to US federal funding for health security. This article provides proposed funding amounts for FY2015, estimated amounts for FY2014, and actual amounts for FY2010 through FY2013 in 5 domains critical to health security: biodefense programs, radiological and nuclear programs, chemical programs, pandemic influenza and emerging infectious disease programs, and multiple-hazard and preparedness programs.

Approximately 6 years ago, then-President George W. Bush first signed the Pandemic and All-Hazards Preparedness Act (PAHPA) into law, reforming the nation's public health preparedness landscape. On March 14, 2013, President Barack Obama reauthorized the legislation, incorporating important lessons learned and setting the path for the next 5 years. When the law was originally passed by the 109th Congress, policymakers were acting in response to Hurricane Katrina and the threat of a possible influenza pandemic. Members of the 113th Congress have reauthorized PAHPA, seeking to enhance existing programs and authorities in light of recent public health emergencies. This article examines PAHPA, considers its impact on preparedness over the past 5 years, and describes the recently signed reauthorization legislation.