Publications

Providing a definitive diagnostic test in a disease emergency is critical to limit pathogen spread, develop and deploy medical countermeasures, and mitigate the social and economic harms of a serious epidemic. While major accomplishments have accelerated test development, expanded laboratory testing capacity, and established widespread point-of-care testing, the United States does not have a plan to rapidly respond, to develop, manufacture, deploy, and sustain diagnostic testing at a national scale. To address this gap, we are proposing a National Diagnostics Action Plan that describes the steps that are urgently needed to prepare for future infectious disease emergencies, as well as the actions we must take at the first signs of such’ events.

When health emergencies arise, scientists seek to discover the cause — such as how a pathogen emerged and spread — because this knowledge can enhance our understanding of risks and strategies for prevention, preparedness, and mitigation. Yet well into the fourth year of the Covid-19 pandemic, intense political and scientific debates about its origins continue. The two major hypotheses are a natural zoonotic spillover, most likely occurring at the Huanan Seafood Wholesale Market, and a laboratory leak from the Wuhan Institute of Virology (WIV). It is worth examining the efforts to discover the origins of SARS-CoV-2, the political obstacles, and what the evidence tells us. This evidence can help clarify the virus’s evolutionary path. But regardless of the origins of the virus, there are steps the global community can take to reduce future pandemic threats.

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.

The uniquely fragmented healthcare system of the United States is currently unable to adequately respond in a national emergency. Lessons From the COVID War: An Investigative Report documents how the US “met the 21st century COVID pandemic with structures mainly built for 19th century problems,” acknowledging that a new national health security enterprise is urgently needed. These findings are consistent with an earlier report, Integrating Primary Care and Public Health to Save Lives and Improve Practice During Public Health Crises: Lessons from COVID-19, in which the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health (CHS) detailed the challenges encountered during the pandemic and presented potential pathways for effectively addressing them. Experts and frontline workers interviewed for the report indicated that better integration of primary care (PC), public health (PH), and community-based organizations (CBOs) could have eased the burden on overstretched PH personnel and significantly leveraged PC’s trusted position and reach to amplify PH messaging, including information to support ill individuals and bolster testing and vaccination campaigns. If these coordinated activities had been effectively prepared for and implemented, they would have saved lives and reduced the pandemic’s health, economic, and societal impacts in the US.

View the report (PDF)

On July 23, 2022, the Director General of the World Health Organization declared a multicountry outbreak of mpox disease a Public Health Emergency of International Concern. Since this declaration, there have been thousands of cases detected in the United States. Although the outbreak has now waned, the virus is likely to continue transmitting at low levels across the United States among high-risk populations. Thus, it is critical for radiology nurses to be able to recognize mpox disease within the inpatient and outpatient settings, so that proper infection prevention and control precautions can be adhered to and so that patients can be referred for treatment.

In this article, we summarize findings from research conducted by the Johns Hopkins Center for Health Security and the Infectious Diseases Society of America to understand infectious disease (ID) workforce contributions to the coronavirus disease 2019 (COVID-19) response and their impacts. ID experts were found to have made diverse and unique contributions that went well beyond their usual responsibilities, with many spending several hours a week on these activities without additional compensation. These efforts were thought to not only build community resilience but also augment the ongoing public health response. Respondents also reported several hospital and clinical leadership roles taken on during the pandemic, such as developing protocols and leading clinical trials. We also make several policy recommendations, such as medical student debt relief and improved compensation, that will be needed to help fortify the ID workforce for future pandemics.

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.