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Our Work

Publications

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

Showing 161 - 180 of 477 results

Lives and Costs Saved by Expanding and Expediting COVID-19 Vaccination

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The Journal of Infectious Diseases
Publication Type
Article

With multiple COVID-19 vaccines available, understanding the epidemiologic, clinical, and economic value of increasing coverage levels and expediting vaccination is important.

Authors
Sarah M. Bartsch
Patrick T. Wedlock
Kelly J. O’Shea
Sarah N. Cox
lrich Strych
Marie C. Ferguson
Maria Elena Bottazzi
Sheryl S. Siegmund
Peter J. Hotez
Bruce Y. Lee

Utility of Rapid Antigen Tests in Nursing Homes

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Annals of Internal Medicine
Publication Type
Editorial

Few populations have experienced greater harms during the COVID-19 pandemic than residents of nursing homes. Before the introduction of SARS-CoV-2 vaccines, nursing homes accounted for just over 5% of all U.S. COVID-19 cases but represented more than a third of all deaths1. Not all nursing home facilities have been equally affected; an analysis found that death rates were more than 3 times higher in facilities with the highest proportions of non-White residents than in facilities with the highest proportions of White residents2.

Risk and the Republican National Convention: Application of the Novel COVID-19 Operational Risk Assessment

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Disaster Medicine and Public Health Preparedness
Publication Type
Article

The United States Centers for Disease Control and Prevention and the World Health Organization broadly categorize mass gathering events as high risk for amplification of coronavirus disease 2019 (COVID-19) spread in a community due to the nature of respiratory diseases and the transmission dynamics. However, various measures and modifications can be put in place to limit or reduce the risk of further spread of COVID-19 for the mass gathering. During this pandemic, the Johns Hopkins University Center for Health Security produced a risk assessment and mitigation tool for decision-makers to assess SARS-CoV-2 transmission risks that may arise as organizations and businesses hold mass gatherings or increase business operations: The JHU Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19 (Toolkit). This article describes the deployment of a data-informed, risk-reduction strategy that protects local communities, preserves local health-care capacity, and supports democratic processes through the safe execution of the Republican National Convention in Charlotte, North Carolina. The successful use of the Toolkit and the lessons learned from this experience are applicable in a wide range of public health settings, including school reopening, expansion of public services, and even resumption of health-care delivery.

Authors
David Callaway
Jeff Runge
Lisa Rentz
Kevin Staley
Michael Stanford
Cover: National Priorities to Combat Misinformation and Disinformation for COVID-19 and Future Public Health Threats: A Call for a National Strategy

National Priorities to Combat Misinformation and Disinformation for COVID-19 and Future Public Health Threats: A Call for a National Strategy

Publication Type
Report

The COVID-19 pandemic has shown that health-related misinformation and disinformation can dangerously undermine the response to a public health crisis. Contradictory messaging and active subversion have reduced trust in public health responders, increased belief in false medical cures, and politicized public health measures aimed at curbing transmission of the disease. Setbacks in the COVID-19 response have highlighted that health-related misinformation or disinformation can lead to more infections, deaths, disruption, and disorganization of the effort. The public health response and communication environment in the United States have been disrupted by significant distrust in government, exacerbated by confusing and conflicting messages from leaders. As a result, information voids have developed, easily filled by false or misleading information and directly targeted by perpetrators of disinformation. Taken together, the spread and consequence of public health misinformation and disinformation can lead to a range of outcomes that have national security implications and require effective response.

Authors
Divya Hosangadi
Elizabeth Smith
Marc Trotochaud
Prarthana Vasudevan
Yonaira Rivera
Jeannette Sutton
Alex Ruiz

Anthropological foundations of public health; the case of COVID 19

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Preventive Medicine Reports
Publication Type
Article

The complex societal spread of COVID-19 in the U.S. indicates a need to recognize sociocultural forces to best understand and respond to the pandemic. This essay describes four principles of anthropology and sister disciplines that underlie the theory and practice of public health.

Authors
Robert A. Hahn

United States–India Strategic Dialogue on Biosecurity - Report from the Seventh Dialogue Session, Focused on COVID-19 Responses in India and the United States: Lessons Learned and Path Forward

Publication Type
Meeting Report

On January 26 and 27, 2021, the Johns Hopkins Center for Health Security hosted a virtual dialogue discussion, focused on coronavirus disease 2019 (COVID-19) responses in India and the United States. The session explored lessons learned thus far and the path forward for both nations in responding to the pandemic. The meeting was held in collaboration with the Regional Centre for Biotechnology of the Department of Biotechnology in the Indian Ministry of Science and Technology.

Authors
Marc Trotochaud
Divya Hosangadi

Four Steps to Building the Public Health System Needed to Cope With the Next Pandemic

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Journal of Public Health Management and Practice
Publication Type
Commentary

COVID-19 has revealed what many public health practitioners have known for some time: our nation's disjointed and underfunded public health system lacks the ability to mount a coordinated response against novel epidemic threats. Our failure to invest in our nation's state and local governmental public health infrastructure, as well as key federal programs, risks a large loss of life from future infectious disease threats, and during crises, jeopardizes the economy and the normal functioning of society.

Authors
Brian Castrucci
Chrissie Juliano

Building the global vaccine manufacturing capacity needed to respond to pandemics

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Vaccine
Publication Type
Article

Among the most pressing issues in preparing for the global response to a pandemic are the design, development, manufacture, and dissemination of vaccines. In 2018 and 2019, we conducted 48 interviews with prominent leaders in public health, pandemic preparedness, vaccine design, and vaccine manufacturing about how they would respond to a sudden, urgent need to manufacture 2 billion or more doses of vaccine. Little did we know that this scenario would become a dire global challenge a few months later with the onset of COVID-19. The response to this pandemic has shown that when leading vaccine manufacturers are fully engaged in a global response, it might be possible for them to manufacture substantial doses of vaccine on timelines faster than previously envisioned. It is now hoped that hundreds of millions of doses of vaccine will start to be produced sometime in the end of 2020 or the start of 2021, and that billions of doses of vaccine could be produced in the months that follow. Whether these timelines can be met or not, it is crucial now, while the world is fully attuned to the terrible consequences of pandemics, to begin preparing the system of global manufacturing for future pandemics. The following insights and recommendations are taken from our interviews with leading experts and our own analysis.

Authors
Matthew Watson
Lauren Richardson
Nancy Connell

Improving Understanding of and Response to Infodemics During Public Health Emergencies

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Health Security
Publication Type
Article

Effective communication during epidemics and outbreaks is a critical component of a public health response. Even more than usual, people need accurate information so that they can adapt their behavior and protect themselves, their families, and their communities against infection, onward transmission, and death. However, during an epidemic or pandemic, the communication environment can be complicated by an “infodemic,” which is the rapid, large-scale spread of health information and misinformation through a variety of media and informational channels.1 This overabundance of information—some accurate and some not—makes it difficult for people to differentiate between false and true information, and has been particularly challenging to address during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Addressing infodemics is a new and centrally important challenge to responding to acute health events. Given its global scale and rapid spread, the current COVID-19 infodemic is an important opportunity to find and adapt new preparedness and response tools to manage the information ecosystem in which we live.

Authors
Divya Hosangadi
Marc Trotochaud
Tina D. Purnat
Tim Nguyen
Sylvie Briand
Report cover: Staying Ahead of the Variants: Policy Recommendations to Identify and Manage Current and Future Variants of Concern

Staying Ahead of the Variants: Policy Recommendations to Identify and Manage Current and Future Variants of Concern

Publication Type
Report

As of February 2021, 3 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern with worrisome characteristics have emerged, each on a different continent. The B.1.1.7 variant, first identified in the United Kingdom, is substantially more transmissible than previously circulating variants. The B.1.351 and P.1 variants, first identified in South Africa and Brazil, respectively, both exhibit some degree of immune escape. Each of these variants has precipitated resurgences in the communities where they have become dominant. All 3 have already been identified at low levels in the United States. If they gain a foothold, the same resurgences can be expected here.

Authors
Lane Warmbrod
Rachel West
Matthew Frieman
Dylan George

Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

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Infection Control & Hospital Epidemiology
Publication Type
Article

Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen.

Authors
Syra Madad
Priya Dhagat
Equity in Vaccination: A Plan to Work with Communities of Color Toward COVID-19 Recovery and Beyond

Equity in Vaccination: A Plan to Work with Communities of Color Toward COVID-19 Recovery and Beyond

Publication Type
Report

The coronavirus disease 2019 (COVID-19) pandemic has had tragic and disproportionate adverse effects on Black, Indigenous, and People of Color (BIPOC) communities across the United States. The number of cases, hospitalizations, and deaths related to this disease is significantly higher in these groups. Additionally, members of BIPOC communities are among those hit the hardest by the economic and social upheavals caused by the pandemic.

Authors
Emily Brunson
Divya Hosangadi
Rex Long
Madison Taylor
Marc Trotochaud
on behalf of the Working Group on Equity in COVID-19

Life-science research and biosecurity concerns in the Russian Federation

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The Nonproliferation Review
Publication Type
Article

This article examines the current state of the life sciences in the Russian Federation, which has potential health-security and biosecurity implications. Research involving advanced biotechnologies present opportunities for public-health advancement, but their dual-use capabilities raise biosecurity concerns that carry global economic and security implications. While experts have raised such concerns about possible Russian misuse of biotechnologies, Russia is not a top-tier nation for life sciences research, by many metrics. A better understanding of the current landscape of biotechnology and life-science research and investment in the Russian Federation will help to identify potential areas of concern and opportunities for international scientific engagement. This work builds on the substantial legacy of Raymond A. Zilinskas in his work to describe and analyze biodefense and biosecurity concerns in the Russian Federation and the Soviet Union.

Authors
Brittany Bland

Improving US-EU Effectiveness in Health and Health Security

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The Wilson Center
Publication Type
Article

The US/EU collaboration on health and health security issues has been steadily productive for years. Whether it was working together to support the World Health Organization, standing up the Global Health Security Agenda (GHSA) in 2014, or responding to the Ebola crisis in West Africa in 2014, health security problems have been in existence long before the COVID-19 pandemic, and fruitful cooperation between the US and EU has helped minimize threats and advance health. In the last four years, however, the US has stepped away from international cooperation on health security issues with the EU as well as other partners.

Authors

Genomic sequencing of SARS-CoV-2: a guide to implementation for maximum impact on public health

Publication Type
Report

Recent advances have allowed the genomes of the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) – the causative agent of COVID-19 – to be sequenced within hours or days of a case being identified. As a result, for the first time, genomic sequencing in real time has been able to inform the public health response to a pandemic. Metagenomic sequencing was fundamental to the detection and characterization of the novel pathogen. Early sharing of SARS-CoV-2 genome sequences allowed molecular diagnostic assays to be developed rapidly, which improved global preparedness, and contributed to the design of countermeasures. Rapid, large-scale virus genome sequencing is contributing to understanding the dynamics of viral epidemics and to evaluating the efficacy of control measures. Increased recognition that viral genome sequencing can contribute to improving public health is driving more laboratories to invest in this area. However, the cost and work involved in gene sequencing are substantial, and laboratories need to have a clear idea of the expected public health returns on this investment. This document provides guidance for laboratories on maximizing the impact of SARS-CoV-2 sequencing activities now and in the future.

Authors
Sarah C. Hil
Mark Perkins
Karin J. von Eije
Lane Warmbrod
et al.

Geoffrey Rose's Strategy of Prevention Applied to COVID-19

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Health Security
Publication Type
Commentary

While there is consensus for the use of personal protective equipment and other measures for the prevention of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in high-risk situations, such as aerosol-generating medical procedures, there is a divergence of opinion and enthusiasm for measures such as social distancing, cloth masks, and other recommendations in low-risk situations. The insights of epidemiologist Geoffrey Rose1 on sick and high-risk populations may be helpful. In its simplest form, his concept can be explained as follows: the high-risk subpopulation—such as elderly people with preexisting cardiac or pulmonary conditions—may contribute a lesser share to the outcome (eg, infection, death) than a low-risk subpopulation would. This is simply because of the sheer larger number of persons in the low-risk subpopulation. Consider, for example, a population of 1,000 persons, with 100 in a high-risk subpopulation and 900 in a low-risk subpopulation, and a rate of infection 4 times as high in the high-risk subpopulation as in the low-risk subpopulation; their rates of infection are 20% and 5%, respectively. In this hypothetical scenario, the high-risk subpopulation contributes 20 cases to the outcome compared to 45 cases from the low-risk subpopulation.

Authors
William Halperin
Nancy Connell

Crisis Standards of Care for the COVID-19 Pandemic

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National Academy of Medicine
Publication Type
Report

Hospitals across the United States must take immediate action to save lives and fairly allocate limited resources by implementing crisis standards of care (CSC).

Hospitals are experiencing large surges in COVID-19 patients, and intensive care units are already over capacity in many areas. In response, hospitals are canceling admissions and procedures, augmenting staffing, transferring patients, even establishing and operating alternate care sites. But these actions may not be enough. There will come a point in the crisis when these adaptations cannot compensate for the overwhelming caseload. At this point, hospitals must shift to crisis standards of care. This means making unprecedented and agonizing decisions under great uncertainty in order to do the most good possible with limited resources. The tools and publications on this page are intended to help health care providers and public officials plan for the implementation of CSC.

This document was authored by Dan Hanfling, John Hick, Rick Hunt, and Eric Toner, drawing on evidence-based reports from the Institute of Medicine (now National Academy of Medicine).

Authors
Dan Hanfling
John L. Hick
Rick Hunt

To Stop a Pandemic - A Better Approach to Global Health Security

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Foreign Affairs
Publication Type
Article

The COVID-19 pandemic, in the words of Tedros Adhanom Ghebreyesus, the director general of the World Health Organization (WHO), “is a once-in-a-century health crisis.” Indeed, the last public health emergency to wreak such havoc was the great influenza pandemic that began in 1918, which sickened about a third of the world’s population and killed at least 50 million people. But because global conditions are becoming increasingly hospitable to viral spread, the current pandemic is unlikely to be the last one the world faces this century. It may not even be the worst.

Authors

The biosecurity benefits of genetic engineering attribution

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Nature Communications
Publication Type
Article

Biology can be misused, and the risk of this causing widespread harm increases in step with the rapid march of technological progress. A key security challenge involves attribution: determining, in the wake of a human-caused biological event, who was responsible. Recent scientific developments have demonstrated a capability for detecting whether an organism involved in such an event has been genetically modified and, if modified, to infer from its genetic sequence its likely lab of origin. We believe this technique could be developed into powerful forensic tools to aid the attribution of outbreaks caused by genetically engineered pathogens, and thus protect against the potential misuse of synthetic biology.

Authors
Gregory Lewis
Jacob L. Jordan
David A. Relman
Gregory D. Koblentz
et al.

COVID-19 Antibody Tests: A Valuable Public Health Tool with Limited Relevance to Individuals

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Trends in Microbiology
Publication Type
Article

Antibody tests for detecting past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have many uses for public health decision making, but demand has largely come from individual consumers. This review focuses on the individual relevance of antibody tests: their accuracy in detecting prior infection, what past SARS-CoV-2 infection can currently infer about future immunity or possible medical sequelae, and the potential future importance of antibody tests for vaccine selection and medical screening. Given uncertainty about the antibody tests (quality, accuracy level, positive predictive value) and what those tests might indicate immunologically (durability of antibodies and necessity for protection from reinfection), seropositive test results should not be used to inform individual decision making, and antibody testing should remain a tool of public health at this time.

Authors
Rachel West
Nancy Connell