Publications

Approximately 6 years ago, then-President George W. Bush first signed the Pandemic and All-Hazards Preparedness Act (PAHPA) into law, reforming the nation's public health preparedness landscape. On March 14, 2013, President Barack Obama reauthorized the legislation, incorporating important lessons learned and setting the path for the next 5 years. When the law was originally passed by the 109th Congress, policymakers were acting in response to Hurricane Katrina and the threat of a possible influenza pandemic. Members of the 113th Congress have reauthorized PAHPA, seeking to enhance existing programs and authorities in light of recent public health emergencies. This article examines PAHPA, considers its impact on preparedness over the past 5 years, and describes the recently signed reauthorization legislation.

In this CFR working paper, author Gigi Kwik Gronvall examines the controversy surrounding the publication of two H5N1 flu–transmission and clarifies the arguments that arose for and against publication; offers lessons learned for future dual-use research to scientists, research directors, publishers, and policymakers; and promotes a reasonable consideration of the risks and benefits of dual-use research.
 

We celebrate the 35th year without smallpox, once the most serious pestilence known to mankind. The achievement was the product of a global eradication program that was launched in 1967 with a 10-year time target. The last case occurred in October 1977. The total cost of the program was estimated to be about $300 million, one-third of which constituted international contributions. The achievement has been lauded as one of the most important of the 20th century. However, the decision by the 1966 World Health Assembly to undertake this campaign had been controversial. At the time, a global malaria eradication program, then in its 12th year, was failing. Many argued that it was technically impossible to eradicate any disease and questioned the judgment of WHO and professional public health. The decision to proceed was decided by a margin of only two votes.

When letters containing anthrax spores were mailed to several US senators and media offices in September 2001, just one week after the 9/11 attacks, bioterrorism catapulted to the national stage. Political leaders and public health officials, desperate for guidance on this once-theoretical scenario, turned to experts including Tom Inglesby, then deputy director of the Johns Hopkins Center for Civilian Biodefense Strategies, a bioterrorism research and analysis think tank in Baltimore. In the years that followed, Inglesby and his colleagues ran exercises to simulate bioterror incidents, established a peer-reviewed journal on biodefense and advised government agencies on how to reduce the public health impact of biological threats.

Diagnostic tests are critical for diagnosing diseases in US troops, for domestic and in­ternational early disease detection and bio­surveillance, and for improving global health.¹ Advances in diagnostics could improve clinical management of a range of diseases in the US healthcare system. The ability to rapidly di­agnose infectious disease has been identified as a strategic priority by the White House,^2,3 the US Department of Health and Human Ser­vices (HHS),⁴ the National Institutes of Health (NIH),⁵ the US Centers for Disease Control and Prevention (CDC),⁶ and the US Department of Defense (DoD).⁷

Pulmonary agents (also known as “choking” agents) compose a class of chemical compounds that disrupt normal breathing.

It has been suggested that the true case fatality rate of human H5N1 influenza infection is appreciably less than the figure of approximately 60% that is based on official WHO confirmed case reports because asymptomatic cases may have been missed. A number of sero-epidemiological studies have been conducted in an attempt to identify such missed cases.

Nerve agents are a class of chemicals grouped together based on their common mechanism of action, which is interruption of vital nerve transmissions to various organs.

Blister agents, also known as vesicants, are a class of chemical weapon first used in combat during World War I. The prototypical and most common blister agent is sulfur mustard (SM) (bis-(2-chloroethyl) sulfide), known as mustard gas.

The vulnerability of the public’s health to cyber security threats has received insufficient attention in the research literature to date, and has yet to be well understood (Harries & Yellowlees, 2013). This paper is intended as a step toward analyzing cyber-related public health challenges in a systematic fashion. The research gaps on cyber security and public health are particularly striking in light of an April 2012 report by the Government Accountability Office, which noted not only the ever-increasing prevalence of cyber security threats (“cyber threats”), but the many intentional and unintentional sources from which such threats can originate, the numerous targets that malicious actors might exploit, and the varied tools at the disposal of those who would seek to launch cyber attacks (U.S. Government Accountability Office, 2012a). The adage noted by security expert Bruce Schneier in his 2012 Science piece rings truer with each passing day: “Everything gets hacked” (Schneier, 2012).”

Foodborne illness sickens or kills an extraordinary number of people each year. It also has great economic costs. Last year, an outbreak linked to contaminated cantaloupe in the United States sickened 146 and killed 30. In 2011, another outbreak in Germany that was eventually linked to contaminated sprouts, sickened more than 4,000 and caused at least 50 deaths. Foodborne disease outbreak response is a critical part of reducing the consequences of outbreaks that will occur in the future. If public health officials can more quickly recognize when a foodborne illness outbreak has occurred and identify the food causing the outbreak, lives can be saved and economic losses averted. The lessons learned from outbreak investigations can be used by industry and government to address the underlying causes of contamination that lead to illness, thus making food safer for everyone.

This is an eclectic overview of social-science theory and its interdisciplinary connections, with a practical objective: to clear the ground for constructing a large-scale historical data resource that ranges across social-science data with links to natural-science data in health and climate. The hope of finding empirical patterns at the global level—and of finding empirical linkages among various sorts of human experience over time—requires that analysts spell out theoretical linkages among social sciences. If we can’t link social sciences explicitly into a larger web of theory about human behavior, we are left with a positivistic segregation of economy from society and culture as the best we can do in analysis. Such an approach, which still survives in parts of the academy, runs counter to the widespread intuitive sense that we live in a highly connected and interactive society. Our limited ability to express this connectedness in theoretical terms means that, in describing a past that precedes our contemporary intuition, we have only the analytical tools of segregated disciplines. World historians have been writing narratives that suggest a global interweaving of complex historical dynamics, but they have made little progress in formalizing their interpretations.1 For lack of clear statements on past links among the domains of economics, society, and politics, we underestimate the degree of past connectedness in human affairs. As a result, our comparisons of past and present overestimate the rate of change in social interaction. In turn, such miscalculation of current rates of globalization exaggerates and misdirects our ability to intervene with policy to address current crises and to project future changes. Fortunately, there have been some advances in exploring interdisciplinary connections in the social sciences. These advances have been achieved particularly at macro levels, for instance in historical world-systems analysis and in studies of contemporary globalization. In addition, many more cross-disciplinary insights have doubtless been developed but remain below the radar for lack of a sufficiently robust overall discourse on unifying the social sciences.2

The Center for Biosecurity of UPMC conducted this study to provide leaders in the US Department of Defense (DOD) with an expert assessment of the technical feasibility and strategic implications of next-generation monoclonal antibodies (mAbs) as medical countermeasures (MCMs) for DOD personnel. Our assessment includes identification of potentially appropriate DOD investments in mAb technologies.

With the 2001 anthrax attacks, the threat of bioterrorism became real to the nation. Before that, biological weapons were a known threat to warfighters, but after, the vulnerability of US civilians was clear. It was also clear that the US government was not organized to address the national security and civilian threat of bioweapons. Only a handful of civilian experts were involved, and the Alfred P. Sloan Foundation was the only US philanthropy willing to commit resources to confront the challenges of preparing for bioterrorism. When Sloan got involved in 2000, the professional field of biosecurity did not exist. There was little science or scholarship. There were no guidelines or planning tools and few policies or officials to direct civilian preparedness, planning, and response. Over ten years, the Sloan Foundation awarded more than $44 million in biosecurity grants and was instrumental in establishing the field and many of its most prominent leaders. That was money well-invested. The nation is now vastly better prepared for bioterrorism and other catastrophic threats to the public's health and national security. Author Gigi Kwik Gronvall chronicles the foundation's leadership in the field and the innovations that followed to show how the Sloan Foundation help to build the foundation on which US civilian biosecurity now stands.

The 2009 influenza A H1N1 pandemic raised important, practical questions about how to vaccinate large numbers of people quickly, especially during an emergency, and how to reach vulnerable populations such as children. To accomplish both of these objectives, the New York City Department of Health and Mental Hygiene (DOHMH) conducted one of the nation’s largest efforts to deliver influenza A (H1N1) 2009 monovalent vaccine. This effort included an elementary school---located vaccination campaign for children enrolled at that school who were aged 4 years and older and a community-based, mass-vaccination, points-of-dispensing campaign that was initially targeted to people aged 4 to 24 years and pregnant women, then expanded to other priority groups, and finally opened up to anyone in the general population aged 4 years and older for the last weekend. In addition, vaccination was available through private providers, hospitals, community health centers, DOHMH clinics, and pharmacies.

Although never employed as a bioweapon to date, R. prowazekii was studied as a candidate for airborne dissemination by Japan during World War II and by the former Soviet Union during the 1970s because of its potential lethality and its ability to spread between humans via lice. Typhus has the potential to produce fatal disease and has been identified by the CDC as a Category B biological agent.

The CDC has classified ricin toxin as a Category B threat agent. Category B agents are the second highest priority agents because they can be disseminated with moderate ease, they cause moderate morbidity and low mortality, and they “require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.”

Y. pestis was developed as an aerosol weapon that, when deployed, can cause primary pneumonic plague, a highly lethal, and contagious form of plague.

Glanders is caused by infection with the bacterium Burkholderia mallei, and melioidosis is caused by Burkholderia pseudomallei. Both have the potential to produce fatal disease and have been identified by the CDC as Category B biological agents. HHS has identified these diseases as top priorities for development of medical countermeasures.

Some HFVs are considered to be a significant threat for use as biological weapons due to their potential for causing widespread illness and death.  Ebola, Marburg, Junin, Rift Valley fever, and yellow fever viruses have been deemed to pose a particularly serious threat, and in 1999 the HFVs were classified as category A bioweapons agents by the U.S. Centers for Disease Control and Prevention (CDC).