Publications

The domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014-2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events.

This article describes the use of “red teaming” to analyze and forecast biological threats to U.S. national security. Red teaming is a method whereby participants adopt an adversarial perspective, and is used to stimulate critical and creative thinking without some of the flaws of other types of threat assessments, including mirror-imaging. Red team analysis is prevalent in the military, security, and commercial realms. There have been widespread calls from government and private organizations to analyze biological threats with a red teaming approach, in order to prioritize resources and to counter a wide array of biological agents. This paper includes a timeline of historical examples of both biological red team simulations and vulnerability probes, and discusses the challenges of conducting realistic, cost-effective modeling of biological agents. Finally, we propose additional analytical tools to the UK Ministry of Defense’s red team framework for the future development of structured, biological red team exercises, and discuss other existing future-oriented threat assessments in this realm.

The Johns Hopkins Center for Health Security conducted this study to elucidate the characteristics of naturally occurring microorganisms that constitute a global catastrophic biologic risk (GCBR).

GCBRs are defined as “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. If unchecked, GCBRs would lead to great suffering, loss of life, and sustained damage to national governments, international relationships, economies, societal stability, or global security.”

In chapter 3, “Ensuring Biosafety and Security,” Gigi Kwik Gronvall analyzes the trends driving the development of advanced biotechnologies, and notes that biology is becoming more industrialized and economically powerful, as important industries increasingly rely on biological manufacturing processes. She recommends that the United States and South Korea should expand their security cooperation in the areas of global health, gene synthesis, and medical and pharmaceutical research, as well as provide global leadership on safety standards.

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.

The re-creation of horsepox virus, an extinct orthopoxvirus with similarity to smallpox virus, has caused concerns in the biosecurity and biodefense communities that the technical capabilities achieved could advance the re-creation of smallpox virus by nefarious actors. The work is now published. While the authors went through due biosecurity diligence at their research institution and with the proper Canadian federal authorities, now that the experiments have been published, there is an opportunity to discuss the dual use risks and benefits of the research itself, as well as those associated with publication of such research—all of which challenge current policies. Here, an analytical framework is used to assess the risks and benefits of such dual use research, and relevant components of biosecurity policy and the biodefense enterprise (including the acquisition of medical countermeasures) in the United States are discussed. The authors emphasize the need to use such risk/benefit assessments at the onset of research and throughout its development, followed by an assessment for its responsible communication.

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.

Local health departments (LHDs) help rally communitywide efforts to manage disasters with health impacts. This responsibility emerged as a centerpiece of the nation’s response to the 2001 terror attacks, including federal public health emergency preparedness (PHEP) grants to local and state health agencies. Encouraged PHEP capabilities include risk communication, building coalitions that integrate businesses and community- and faith-based organizations (CFBOs), opening emergency planning to public input, and mobilizing volunteers. National standards for local public health preparedness also feature community preparedness, including multisector partnerships, vulnerable population initiatives, and 2-way exchanges (eg, town hall meetings, public strategy sessions).

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.

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.

In 2014, the United States launched the Global Health Security Agenda (GHSA) as a 5-year initiative to increase progress toward “a world safe and secure from infectious disease threats.”1 The initial financial commitment was $1 billion. In the years since, important progress has been made. The GHSA has helped to bring political attention to the need to strengthen public health capacities across the globe and has created a mechanism for countries to work collaboratively and make financial commitments to do so.

Biological threats, which range from naturally occurring outbreaks of infectious disease to intentional acts of bioterrorism, pose unique dangers to public health and national security in the United States. Medical countermeasures (MCMs)—drugs, vaccines, diagnostic tests, and other therapies and devices—rank among the most important assets in the nation's arsenal against dangerous pathogens, as well as chemical, radiological, and nuclear threats. Communities with access to vital MCMs are better equipped to detect both accidental and deliberately caused outbreaks quickly, immunize susceptible populations, and treat infected patients, thereby alleviating the consequences associated with infectious diseases: illness and death, economic losses, societal unrest, and strained public health and healthcare delivery systems.

This article examines the biosecurity and biodefense implications resulting from the recent creation of horsepox virus, a noncirculating (extinct) species of orthopoxvirus. Here we examine the technical aspects of the horsepox virus synthesis and conclude that orthopox synthesis experiments currently remain technically challenging—and will continue to be so, even once this work is published in the scientific literature. This limits potential misuse by some types of nefarious actors. We also examine the implications of one stated purpose for the recreation of horsepox virus: the development of a smallpox vaccine. If the development is successful, it could take advantage of US government incentives for the priority FDA review of medical countermeasures (MCMs) against biosecurity threats. However, if this case leads to the determination that this incentive is counterproductive for security, the newly created priority review voucher program should be more clearly defined or limited based on need. Limiting the program could have costs that require further consideration, however, as general incentives for biodefense medical countermeasure development are required for MCMs to be available. Finally, while the recreation of horsepox virus was not technically trivial, nor was it cell-free, this experiment was a de facto demonstration of already assumed scientific capabilities.

Almost a century ago, a new and deadly strain of influenza spread around the world, shutting down schools and businesses and filling hospitals well beyond their capacity. In the end, the 1918 flu pandemic claimed the lives of approximately 50 to 100 million people, and it infected about one-third of the global population. Since then, medical care has vastly improved, and science has made major gains in vaccines and medicines. Yet the potential remains for a lethal strain of influenza or other contagious pathogen to overwhelm global health care systems by spreading at a rate that outpaces our ability to respond. In such a calamitous scenario, neither the United States nor other countries would be well enough equipped to contain it, increasing the potential for a true national or global catastrophe.

Last week, Houston-area hospitals displayed great resiliency as they faced catastrophic flooding from Hurricane Harvey's relentless rains over several days. However, some vital hospital services—understandably—experienced significant disruptions. Health systems nationwide can learn vital lessons from Texas' planning and response to further strengthen their own preparedness and "harden" their facilities to all hazards.

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.