Publications

Every few years, a new pathogen emerges from the shadows to threaten global public health. And every few years, the global public health community struggles to mount a timely and effective response. The incremental advances that have defined public health in the last half century have been repeatedly outpaced by fast-moving epidemics. From HIV to Ebola, most innovations in preventing and containing outbreaks have come from medical countermeasures like vaccines, diagnostics, and therapeutics rather than advancements in epidemiological practice.

In February 2018, the Johns Hopkins Center for Health Security (“the Center”) hosted a Track II dialogue on biosecurity between experts from the United States and the Republic of India. The dialogue, which was held in New Delhi, India, was organized in collaboration with the DBT-UNESCO Regional Centre for Biotechnology, an autonomous institute of the Department of Biotechnology (part of the Ministry of Science and Technology, Government of India). This was the fourth meeting of the dialogue, following previous engagements in Washington, DC, in September 2016 and November 2017, as well as a meeting in New Delhi, India, in February 2017.1,2,3 This effort is supported by the Project on Advanced Systems and Concepts for Countering WMD (PASCC, which is sponsored by the Defense Threat Reduction Agency, DTRA) of the US Air Force Institute for National Security Studies.

In November 2017, the Johns Hopkins Center for Health Security (“the Center”) hosted a Track II dialogue (i.e. a non-governmental engagement) on biosecurity between experts from the United States and the Republic of India. The dialogue, which was held in Washington, DC, was organized in collaboration with the Department of Biotechnology (part of the Ministry of Science and Technology, Government of India). This was the third meeting of the dialogue; the first was held in Washington, DC in September 2016, and the second in New Delhi, India, in February 2017. The effort is supported by the Project on Advanced Systems and Concepts for Countering WMD (PASCC, which is sponsored by the Defense Threat Reduction Agency, DTRA) of the US Air Force Institute for National Security Studies.

The following narrative comprises a futuristic scenario that illustrates communication dilemmas concerning medical countermeasures (MCMs) that could plausibly emerge in the not-so-distant future. Its purpose is to prompt users, both individually and in discussion with others, to imagine the dynamic and oftentimes conflicted circumstances in which communication around emergency MCM development, distribution, and uptake takes place. While engaged with a rigorous simulated health emergency, scenario readers have the opportunity to mentally “rehearse” responses while also weighing the implications of their actions. At the same time, readers have a chance to consider what potential measures implemented in today’s environment might avert comparable communication dilemmas or classes of dilemmas in the future.

In February 2017, the Johns Hopkins Center for Health Security hosted a Track II (non- governmental) dialogue on biosecurity between experts in India and the US in New Delhi, India. The meeting was held in collaboration with the Department of Biotechnology within the Indian Ministry of Science and Technology. This was the second meeting of the biosecurity dialogue; the first was held in Washington, DC in September, 2016.* The effort is supported by the Project on Advanced Systems and Concepts for Countering WMD (PASCC; sponsored by the Defense Threat Reduction Agency, DTRA) of the US Air Force Institute for National Security Studies.

Although the healthcare system is undoubtedly better prepared for disasters than it was before the events of 9/11, it is not well prepared for a large-scale or catastrophic disaster. Just as important, other segments of society that support or interact with the healthcare system and that are needed for creating disaster-resilient communities are not sufficiently prepared for disasters. This report is the culmination of a 2-year project funded by the Robert Wood Johnson Foundation to examine US disaster healthcare with the purpose of identifying changes, innovations, and new efforts that could strengthen the country’s ability to provide medical care in major disasters. In the report, Johns Hopkins Center for Health Security researchers analyze a range of disasters that could confront the United States and consider their impacts on the healthcare system, including how medical care would be delivered in those scenarios, both to victims of the disaster and everyone else. We found that many of the current programs are quite valuable and should continue to be supported, and that several new initiatives should be pursued that would improve the disaster readiness and resilience of the US health sector.

On December 2-3, 2015, the UPMC Center for Health Security hosted the second meeting of Track II biosecurity dialogue between the United States, Singapore, Malaysia, and Indonesia. The meeting took place in Kuala Lumpur, Malaysia and was co-sponsored by the Malaysian Ministry of Health (MOH). The dialogue is supported by the Project on Advanced Systems and Concepts for Countering WMD (PASCC) of the Center on Contemporary Conflict, sponsored by the US Defense Threat Reduction Agency (DTRA).

The purpose of the second meeting of the dialogue – which is the focus of this report – was to engage participants in deeper conversations around the unique biosecurity landscapes of Singapore, Malaysia, Indonesia, and the US; examine ongoing national, regional, and global biosecurity threats; identify and critique current policies and approaches to biological threat mitigation; and exchange best practices in biorisk management to strengthen responses to emerging and evolving biological threats. The dialogue featured participants representing various levels of academia, and government, including experts in the life sciences, defense, public health, animal health, journalism, medicine, terrorism, and security.

This report is a compilation of the findings and recommendations discovered pursuing the Naval Postgraduate School Project on Advanced Systems and Concepts for Countering WMD (PASCC) Grant No. N00244-15-1-0028, for research entitled "Improving Security through International Biosafety Norms.” The focus of this project was the potential for a biological research laboratory accident to spark an epidemic, and become an international public health problem. We examined what norms and expectations nations should have of each other to maintain a biosafety infrastructure capable of preventing and mitigating consequences a catastrophic biocontainment failure.

This document summarizes the governmental policies and regulations for biosafety in research laboratories in the nations of Brazil, China, India, Israel, Pakistan, Kenya, Russia, Singapore, the United Kingdom, and the United States. In previous research, we found that there is a lack of international norms governing biosafety precautions for dangerous or especially contagious1; by describing a variety of biosafety governance approaches in these nations, we hoped to find areas of commonality which could be further developed into international norms.

Anthrax is a very serious bioterrorism threat. B. anthracis was developed by several countries as part of their biological weapons (BW) programs, and autonomous groups have also demonstrated the intent to use the bacterium in acts of terrorism.

Pulmonary agents (also known as “choking” agents) compose a class of chemical compounds that disrupt normal breathing.

Nerve agents are a class of chemicals grouped together based on their common mechanism of action, which is interruption of vital nerve transmissions to various organs.

Blister agents, also known as vesicants, are a class of chemical weapon first used in combat during World War I. The prototypical and most common blister agent is sulfur mustard (SM) (bis-(2-chloroethyl) sulfide), known as mustard gas.

Although never employed as a bioweapon to date, R. prowazekii was studied as a candidate for airborne dissemination by Japan during World War II and by the former Soviet Union during the 1970s because of its potential lethality and its ability to spread between humans via lice. Typhus has the potential to produce fatal disease and has been identified by the CDC as a Category B biological agent.

The CDC has classified ricin toxin as a Category B threat agent. Category B agents are the second highest priority agents because they can be disseminated with moderate ease, they cause moderate morbidity and low mortality, and they “require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.”

Y. pestis was developed as an aerosol weapon that, when deployed, can cause primary pneumonic plague, a highly lethal, and contagious form of plague.

Glanders is caused by infection with the bacterium Burkholderia mallei, and melioidosis is caused by Burkholderia pseudomallei. Both have the potential to produce fatal disease and have been identified by the CDC as Category B biological agents. HHS has identified these diseases as top priorities for development of medical countermeasures.

Some HFVs are considered to be a significant threat for use as biological weapons due to their potential for causing widespread illness and death.  Ebola, Marburg, Junin, Rift Valley fever, and yellow fever viruses have been deemed to pose a particularly serious threat, and in 1999 the HFVs were classified as category A bioweapons agents by the U.S. Centers for Disease Control and Prevention (CDC).

F. tularensis is considered to be a serious potential bioterrorist threat because it is one of the most infectious pathogenic bacteria known—inhalation of as few as 10 organisms can cause disease—and it has substantial capacity to cause serious illness and death. The bacterium was developed into an aerosol biological weapon by several countries in the past.

Smallpox was used as a biological weapon during the French and Indian Wars, (1754 to 1767) , and in the 1980s, was developed into an aerosol biological weapon by the Soviet Union.