Publications

The Johns Hopkins Center for Health Security developed this document in response to Representative Mariannette Miller-Meeks’ Request for Information (RFI) on how Congress can help to reform and strengthen the Centers for Disease Control and Prevention (CDC). The Johns Hopkins Center for Health Security believes that an adequately funded, appropriately authorized, and nimble CDC with a target mission is crucial to ensuring the public’s health and maintaining community resilience.

Prior to 2020, most pandemic preparedness efforts centered on influenza. Some countries, such as Aotearoa (New Zealand)¹, were able to successfully adapt national pandemic influenza plans to the response to COVID-19, and global influenza surveillance systems were harnessed for SARS-CoV-2 (ref. ²). It is now critical that nations and the international community implement lessons learned from COVID-19 back into influenza preparedness³. This task is particularly urgent given both the emergence of a number of influenza spillover threats and exhausted and depleted public health systems globally.

On March 29, 2023, the Johns Hopkins Center for Health Security provided feedback and recommendations in response to a Request for Information (RFI) in preparation for the upcoming Pandemic and All-Hazards Preparedness Act (PAHPA) reauthorization due by September 30, 2023. Senate Health, Education, Labor, and Pensions Committee Chair Sen. Bernie Sanders (I-VT), Ranking Member Sen. Bill Cassidy (R-LA), and Sens. Robert P. Casey, Jr. (D-PA) and Mitt Romney (R-UT) issued the RFI earlier in March. This submission follows the Center’s response to a US House of Representatives RFI issued by Reps. Richard Hudson (R-NC) and Anna Eshoo (D-CA) on the same topic.

In response to a series of biosafety incidents in 2014, the White House directed two high-level expert committees to analyze biosafety and biosecurity in U.S. laboratories and make recommendations for work with select agents and toxins. Overall, they recommended 33 actions to address areas related to national biosafety, including promoting a culture of responsibility, oversight, outreach and education, applied biosafety research, incident reporting, material accountability, inspection processes, regulations and guidelines, and determining the necessary number of high-containment laboratories in the United States.

On March 13, 2023, the Johns Hopkins Center for Health Security provided feedback and recommendations in response to a Request for Information (RFI) in preparation for the upcoming Pandemic and All-Hazards Preparedness Act (PAHPA) reauthorization due by September 30, 2023. House Energy and Commerce Committee members Rep. Richard Hudson (R-NC) and Rep. Anna Eshoo (D-CA) released the RFI in February 2023.

PAHPA is a groundbreaking piece of legislation that was first signed into law in 2006. PAHPA was reauthorized in 2013 and 2019, and the next round of reauthorization is rapidly approaching. PAHPA is now widely considered a “must pass” bill that bolsters the nation’s medical and public health preparedness and response capabilities against deliberate, accidental, and natural emergencies. Previous iterations of PAHPA have authorized the Administration for Strategic Preparedness and Response (ASPR) and the Biomedical Advanced Research and Development Authority (BARDA) and provided new authorities for a variety of programs.

Objective
The aim of the study is to describe the impact of colocating COVID-19 vaccinations with local syringe service programs on vaccine completion among people who inject drugs.

Methods
Data were derived from 6 community-based clinics. People who inject drugs who received at least one COVID-19 vaccine from a colocated clinic partnering with a local syringe service program were included in the study. Vaccine completion was abstracted from electronic medical records; additional vaccinations were abstracted using health information exchanges embedded within the electronic medical records.

Results
Overall, 142 individuals with a mean age of 51 years, predominantly male (72%) and Black, non-Hispanic (79%) received COVID-19 vaccines. More than half elected to receive a 2-dose mRNA vaccine (51.4%). Eighty-five percent completed a primary series, and 71% of those who received a mRNA vaccine completed the 2-dose series. Booster uptake was 34% in those completing a primary series.

Conclusions
Colocated clinics are an effective means of reaching vulnerable populations. As the COVID-19 pandemic continues and need for annual booster vaccines arises, it is important to bolster public support and funding to continue low-barrier preventive clinics colocated with harm reduction services for this population.

When SARS-CoV-2 first began to sweep the globe, so too did information about the virus, including accurate, false, and misleading information. Almost immediately, this deluge of information was recognized as a significant threat to public health, with WHO Director-General Tedros Adhanom Ghebreyesus announcing in February 2020 that “we’re not just fighting an epidemic, we’re fighting an infodemic.” Since then, the notion of an infodemic, which has been defined by WHO as “an over-abundance of information – some accurate and some not – that occurs during an epidemic” (WHO, 2020), has gained traction as a serious and ongoing public health concern, interfering with individuals’ ability to obtain and/or trust accurate information when they need it most (WHO, 2020).

The Johns Hopkins Center for Health Security hosted an in-person meeting of subject matter experts in Arlington, VA, on March 6–7, 2023, to discuss a draft blueprint of the “Model State Indoor Air Quality Act” (MSIAQA). Prior to the meeting, members of the Johns Hopkins Center for Health Security Indoor Air Quality (IAQ) Project Team drafted a blueprint for the forthcoming act, comprising 6 major articles and more than 50 potential provisions.

On January 10, 2023, the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health convened an in-person, not-for-attribution meeting of experts and practitioners from government, academia, and the private sector to discuss the US Biosafety & Biosecurity Innovation Initiative launched as part of a September 2022 Executive Order titled, “Advancing Biotechnology and Biomanufacturing Innovation for a Sustainable, Safe, and Secure American Bioeconomy.” The meeting focused on priority actions and efforts needed to enhance biosafety and biosecurity throughout the biotechnology research and development (R&D) and biomanufacturing lifecycles, while maximizing potential societal benefits, as well as safeguarding and boosting US national competitiveness. This report describes discussion on these topics undertaken by the experts who attended the meeting.
 

An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention.

Botulinum toxins pose a major threat as biological weapons because they are extremely potent and lethal; some of the toxins are relatively easy to produce and transport; and people with botulism require prolonged intensive hospital care.

After a biological incident—whether it is natural, deliberate, accidental, or undetermined—there is an imperative to investigate and identify the cause of the incident, and attribute who, if anyone, is responsible. The ability to attribute responsibility for a biological incident (bioattribution) helps to ensure that the deliberate use of biological weapons may be fully prosecuted and those responsible are held accountable. Bioattribution capabilities may also serve as a deterrent for use of biological weapons. Such a capability is the result of an attribution investigation that integrates multiple data sources, including information collected by law enforcement and public health officials, intelligence information, and technical information about the biological agent and other biological and environmental samples collected. The process is complicated; it relies on technical methodology and social systems (ie, the ability to get samples and to have a trusted process) to produce the technical information and sampling for attribution. It is important to routinely evaluate the state of the science available for bioattribution to ensure that investigations may leverage state-of-the-art technology and that efforts are being made to overcome technical challenges.

There are scant data on the impact of coronavirus disease 2019 (COVID-19) on hospital antibiotic consumption, and no data from outside epicenters. At our nonepicenter hospital, antibiotic days of therapy (DOT) and bed days of care (BDOC) were reduced by 151.5/month and 285/month, respectively, for March to June 2020 compared to 2018–2019 (P = 0.001 and P < 0.001). DOT per 1,000 BDOC was increased (8.1/month; P = 0.001). COVID-19 will impact antibiotic consumption, stewardship, and resistance in ways that will likely differ temporally and by region.

Misinformation and disinformation during infectious disease outbreaks can hinder public health responses. This analysis examines comments about masks and COVID-19 vaccines on Twitter during the first six months of the COVID-19 pandemic. We conducted a content analysis of 6,600 randomly selected English-language tweets, examining tweets for health, political, of societal frames; inclusion of true information, false information, partially true/misleading information, and/or opinion; political components; risk frames; and use of specific types of rumor. We found false and partially false information in 22% of tweets in which we were able to assess veracity. Tweets with misinformation were more likely to mention vaccines, be political in nature, and promote risk elevating messages (p<0.5). We also found false information about vaccines as early as January 2020, nearly a year before COVID-19 vaccines became widely available. These findings highlight a need for new policies and strategies aimed to counter harmful and misleading messaging.

Recent calls to establish a global project registry before releasing any gene-drive-modified organisms (GDOs) have suggested a registry could be valuable to coordinate research, collect data to monitor and evaluate potential ecological impacts, and facilitate transparent communication with community stakeholders and the general public. Here, we report the results of a multidisciplinary expert workshop on GDO registries convened on 8–9 December 2020 involving 70 participants from 14 countries. Participants had expertise in gene drive design, conservation and population modeling, social science, stakeholder engagement, governance and regulation, international policy, and vector control; they represented 45 organizations, spanning national and local governmental agencies, international organizations, nonprofit organizations, universities, and district offices overseeing local vector control. The workshop aimed to gather perspectives on a central question: “In what ways could a gene-drive project registry both contribute to and detract from the fair development, testing and use of GDOs?” We specifically queried the perceived purpose of a registry, the information that would need to be included, and the perceived value of a registry. Three primary findings emerged from the discussion: first, many participants agreed a registry could serve a coordinating function for multidisciplinary and multisector work activities; second, doing so may require different design elements, depending on the target end-user group and intended purpose for that group; and third, these different information requirements lead to concerns about information sharing via a registry, suggesting potential obstacles to achieving transparency through such a mechanism. We conclude that any development of a gene-drive project registry requires careful and inclusive deliberation, including with potential end-users, to ensure that registry design is optimal.

On October 4 and 6, 2022, the Johns Hopkins Center for Health Security, in collaboration with the Center for Health and Economic Resilience Research at Texas State University, convened a virtual symposium to consider how to operationalize the process of holistic recovery from the COVID-19 pandemic. The purpose of the event was to advise leaders in local and state government on what strategies they might adopt and/or support to facilitate recovery of the whole person from COVID-19, reverse the societal determinants of uneven impacts, and develop resilience to future public health emergencies.

Participant discussions produced a set of strategic actions that government authorities and partners can implement now and moving forward to effect necessary repair and change when the impulse to forget and move on is strong. Speakers represented a broad range of stakeholders, including local elected officials, recovery/resilience officers, planners, public health practitioners, disaster managers, financial investors, mental health professionals, healthcare administrators, religious leaders, housing advocates, community health providers, rural health experts, food security providers, social service administrators, academic researchers, restorative justice experts, equity strategists, artists, writers, and journalists.

The home healthcare worker is a unique, under-represented subgroup in healthcare research. Based on labor statistics, 87% are female and 39% lack affordable housing. Just over 50% receive some kind of public assistance and most do not have a college degree. Home healthcare workers are racially diverse and earn relatively low wages.¹ This population has high levels of vaccine hesitancy, yet close interaction with potentially at-risk individuals.^{2, 3}

A constellation of factors related to confidence, complacency, and convenience affect vaccine hesitancy.⁴ Innovative countermeasures that engage, educate, and empower diverse populations with varied beliefs, life circumstances, and means of engaging with media are needed.⁵ Personalized persuasion has proven to be effective means of motivating behavioral change,⁶ but requires a thorough understanding of sub-populations. Political discord and social divides heighten the need for highly tailored communications.⁷

We aimed to understand underlying motivations and/or behavioral inhibitions of the home healthcare population to support proactive public health outreach campaigns, and aid responses in future health crises. This study was conducted in accordance with Johns Hopkins University's Institutional Review Board.

The University of Maryland team has codified and communicated lessons learned from its successful track record of implementing hyperlocal approaches to community engagement and health promotion, epitomized by a network of barbers and hairstylists championing the health of their host neighborhoods. Community health champions from elsewhere are welcome to adapt/apply the Maryland team’s the practical guidance on fostering partnerships and communicating successes.

Based on their own experiences, the CommuniHealth San Diego State University team developed these training materials to support other community-oriented universities that wish to leverage their neutral brokering position and access to resources to strengthen academic-community partnerships that integrate community health workers/promotores.

In this report, the University of Alabama team recounts how they conducted a communitywide needs assessment of community health infrastructure in the state’s Black Belt counties as the first step in mobilizing a community health coalition well suited to serving rural populations, which are often overlooked. Other jurisdictions wanting to establish a baseline of their community health sector are invited to adapt and apply the CommuniHealth Alabama team’s tools and templates.