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Our publications keep professionals informed on the most important developments and issues in health security and biosecurity.

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The Johns Hopkins Center for Health Security convened an in-person meeting of experts and practitioners to discuss the US Biosafety & Biosecurity Innovation Initiative

Building Strong Biosafety and Biosecurity into the Expanding US Bioeconomy

Publication Type
Meeting Report

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.

 

Authors
Aurelia Attal-Juncqua
Matthew E. Walsh

Measuring the Burden of Infodemics: Summary of the Methods and Results of the Fifth WHO Infodemic Management Conference

|
JMIR Infodemiology
Publication Type
Article

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.

Authors
Elisabeth Wilhelm
Isabella Ballalai
Marie-Eve Belanger
Peter Benjamin
Catherine Bertrand-Ferrandis
Supriya Bezbaruah
Sylvie Briand
Ian Brooks
et al.

Botulinum Toxin (Botulism)

Publication Type
Agent Fact Sheet

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.

Cover of the Discussion on the Future Science and  Technology of Biological Attribution; Summary of 6 December 2022 meeting organized by the Office of Science and Technology Policy

Discussion on the Future Science and Technology of Biological Attribution

Publication Type
Meeting Report

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.

Authors
Matthew E. Walsh

Antibiotic Consumption and Stewardship at a Hospital outside of an Early Coronavirus Disease 2019 Epicenter

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Antimicrobial Agents and Chemotherapy
Publication Type
Article

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.

Authors
Deanna J. Buehrle
Brooke K. Decker
Marilyn M. Wagener
Nina Singh
Mary C. McEllistrem
M. Hong Nguyen
Cornelius J. Clancy

Analyzing Social Media Messaging on Masks and Vaccines: A Case Study on Misinformation During the COVID-19 Pandemic

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Disaster Medicine and Public Health Preparedness
Publication Type
Article

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.

Authors
Marc Trotochaud
Elizabeth Smith

Exploring the value of a global gene drive project registry

|
Nature Biotechnology
Publication Type
Letter

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.

Authors
Riley I. Taitingfong
Cynthia Triplett
Váleri N. Vásquez
Ramya M. Rajagopalan
Robyn Raban
Aaron Roberts
Gerard Terradas
Bridget Baumgartner
Claudia Emerson
Fred Gould
Fredros Okumu
Cynthia E. Schairer
Hervé C. Bossin
Leah Buchman
Karl J. Campbell
Anna Clark
Jason Delborne
Kevin M. Esvelt
Joshua Fisher
Robert M. Friedman
et al.
PanREMEDY meeting report cover

Post-Pandemic Recovery: From What, For Whom, and How?

Publication Type
Meeting Report

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.

Authors
Rex Long
Emily Repasky
Britney Treviño
et al.

In-home healthcare worker COVID-19 vaccination awareness, access, and acceptability—An online focus group study

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Journal of the American Geriatrics Society
Publication Type
Letter

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.

Authors
Jennifer A. B. McKneely
cover of the CommuniHealth Maryland team report

Strengthening Health Promotion Through Sustained Hyperlocal Community Engagement

Publication Type
Report

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.

Authors
Stephen B. Thomas
Sandra Crouse Quinn
Meg Jordan
et al.
cover of the CommuniHealth California team report

Guide for Effective Partnerships Between Academic Institutions and Community Health Workers/Promotores

Publication Type
Report

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.

Authors
Diego Ceballos
Griselda Cervantes
Arrietta Chakos
et al.
Cover of the CommuniHealth Alabama team report

Building a Ground Game: How to Conduct a Community Needs Assessment and Launch a CHW Workforce Development Coalition

Publication Type
Report

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.

Authors
Stephanie McClure
Kathryn Oths
Carol Agomo
et al.
Cover of the CommuniHealth Playbook

The CommuniHealth Playbook: How to Spur on Your Local Community Health Sector

Publication Type
Report

The CommuniHealth Playbook compiles field-tested strategies and tactics for advancing the community health sector locally. The Playbook’s practical guidance is the culminating product of CommuniHealth, the successor to the CommuniVax Coalition. With the support of a national working group, teams in Alabama, California, and Maryland used direct experience, trial and error, and ground-level truth to develop practical ways of mobilizing local forces for vibrant and sustainably resourced community health systems. This introductory text provides context for the project, shares the CommuniHealth “Principles for Partnership with Communities,” and serves as a centralized index to the guidance contained in the 3 local team reports.

Authors
Emily Brunson
Madison Taylor
Marc Trotochaud
on behalf of the CommuniHealth Coalition

Cyanide

Publication Type
Agent Fact Sheet

Cyanide is a naturally occurring chemical, found in many plants, that has been used in conventional warfare and poisoning for 2 millennia. It is highly lethal, whether inhaled as a gas, ingested in solid form, or absorbed through topical exposure. Two notorious incidents in recent history—the Jonestown Massacre in 1978 and the Tylenol poisonings in 1982—highlight the lethality of this poison.

National Strategy for Improving Indoor Air Quality cover

National Strategy for Improving Indoor Air Quality

Publication Type
Meeting Report

The Johns Hopkins Center for Health Security hosted a meeting, “National Strategy for Improving Indoor Air Quality,” in Washington, DC, on September 8, 2022. The meeting featured a keynote speaker and four expert panels focused on the importance of indoor air quality (IAQ), challenges to providing healthy indoor air across the United States, international perspectives and strategies for healthy air improvements, and catalyzing needed science and technology innovation in the IAQ field. Dr. Ashish Jha, White House COVID-19 Response Coordinator, opened the meeting by reiterating the importance of IAQ to the Biden-Harris Administration. 

At-home infectious disease testing: An idea whose time has come

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Antimicrobial Stewardship &amp; Healthcare Epidemiology
Publication Type
Commentary

A hallmark of the coronavirus disease 2019 (COVID-19) pandemic in its current stage is the ubiquity of home diagnostic testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). These tests have been touted for their varied uses to facilitate navigating a world in which SARS-CoV-2 is an ever-present consideration. Apart from HIV at-home testing, COVID-19 is one of the only conditions that can be tested for at home with an almost immediate result. At-home infectious diseases testing has gained significant momentum during the COVID-19 pandemic given the myriad cascading positive benefits the technology offers. Currently, plans for home influenza and RSV tests are underway, as well as tests for sexually transmitted infections (STIs). These efforts began before the pandemic and have only accelerated as COVID-19 home tests have demonstrated their value. Here, I discuss how at-home infectious disease tests can be harnessed to optimize individual treatment outcomes and positively influence public health efforts. I have explored many of these themes in a prepandemic report,1 and the ensuing years have concretized many of the theoretic benefits.

Authors

The Biological Weapons Convention should endorse the Tianjin Biosecurity Guidelines for Codes of Conduct

|
Trends in Microbiology
Publication Type
Article

The Tianjin Biosecurity Guidelines for Codes of Conduct for Scientists are a set of ten principles designed to promote responsible science and strengthen biosecurity governance. They should be broadly adopted, including being endorsed by the Biological Weapons Convention at its 9th Review Conference in November 2022.

Authors
Leifan Wang
Peter F. McGrath
Yingjin Yuan
M. Iqbal Parker
Weiwen Zhang
Youhai Sun
Yang Xue
Junyan Zhang
Xi Zhang
Liang Yu
Jie Song
Marc Trotochaud

Analysis of trends in nurse practitioner billing for emergency medical services: 2015-2018

|
The American Journal of Emergency Medicine
Publication Type
Article

Despite projections of an oversupply of residency-trained emergency medicine physicians by 2030 and amidst intensifying national debate over Nurse Practitioner (NP) qualifications to practice independently and unsupervised, NPs are increasingly staffing Emergency Departments (EDs) as hospitals seek to contain costs while simultaneously expanding services. We sought to characterize NP practice in the ED by examining NP independent billing by level of severity of illness, and relationship to practice authority, State Medicaid expansion status, and rurality.

Authors
Roberta Proffitt Lavin
Sarah Schneider-Firestone

Infectious diseases experts: America's Link Back to Everyday Life

|
Infectious Diseases Society of America
Publication Type
Report

This report — a joint collaborative effort between the Infectious Diseases Society of America and the Johns Hopkins Center for Health Security — captures just how valuable infectious diseases professionals are to America’s health care system and society and sheds light on critical policies needed to ensure they are well positioned to help America for decades to come. We invite you to learn more.

Authors
Amanda Jezek

Patents as a Driver of the Unprecedented Biomedical Response to COVID-19

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INQUIRY: The Journal of Health Care Organization, Provision, and Financing
Publication Type
Article

The response by the biotech and pharmaceutical sectors to the COVID-19 pandemic has been historically unprecedented. Vaccines based in cutting-edge technologies, such as the mRNA platform, were invented, tested, and distributed to patients in less than a year. Yet politicians and activists argue that patents and other intellectual property (IP) have impeded the development and distribution of these vaccines. In explaining why this is profoundly mistaken, this essay first describes the medical and economic uncertainties inherent in the production of vaccines, especially those made in response to an emerging infectious disease like COVID-19. This makes clear the unprecedented achievement in the mass production and distribution of COVID-19 vaccines in less than 1 year after the start of the COVID-19 pandemic. It then describes the current manufacturing and licensing landscape, which was created on the basis of a market infrastructure built by reliable and effective patent rights. There is now a glut in the global supply of vaccine doses—and billions more doses are still being produced. The essay concludes by identifying the non-IP causes impeding global vaccine distribution, such as lack of infrastructure in the developing world, as well as regulatory restrictions and trade barriers. Those concerned with global vaccine equity should focus on policies to resolve these real-world problems.

Authors
Adam Mossoff